What is this thing called “health”? An ontology for person-centred care

Abstract

In this article person-centredness is understood as a method, and ontology is presented as one of its building tools. Ontology is at work in clinicians and patients in the form of underlying conceptions about the mode of existence of realities pertinent to healthcare, such as: disease, health, body, or person. These unrecognized assumptions affect the communication of diagnosis, the design of treatment, the therapeutic relation, patient self-care, or patient positioning towards treatment. The ontology “instinctively” at work in both clinicians and patients is identified, discussed, and shown to have ancient roots (referred to as the “Platonic split”), to conflict with what can count as person-centred care today, and be unlikely to work well in long-term treatment. The clinical complications it generates are illustrated with possible cases of “substantialization” of disease; differences between this metaphysical concept, denoting a specific form of understanding and living with disease and various psychological terms (viz., externalization, somatisation, denial) are explained. The article, then, introduces an alternative ontology, called “transgressive” and considered more likely to facilitate health-with-disease in the long-term. It clarifies what distinguishes it from other approaches in the health-within-illness literature, and analyses two real-life cases of two very different chronic conditions that illustrate the “transgressive ontology” and its health-producing effects. Adopting this health-generating ontology is yet one other way to provide what I call “metaphysical care” or self-care.