The body's dignity in integrative understanding of health in IBD – A hermeneutic approach to holistic care

Current medical science has made great progress in the treatment of Inflammatory Bowel Disease (IBD) with antibiotics, pain, and fever inhibitive, anti-inflammatory, and biological medicines, all of which aid in bringing the patient out of an acute illness situation. Nevertheless, we now see that more chronic symptoms persist, and masking of acute relapse is established. We run the risk of controlling illness with external agents rather than establishing health as a balance between the body's inner and outer environment [1,2]. A change in course entails listening to important experience expressed by the patient group themselves and actively keeping these experiences in mind when choosing future treatment options. Attending gastroenterologists, IBD nurses, nutritionists, physical therapists and general practitioners are the healthcare professionals closest to the patient and who are responsible for providing worthy care for the patient.

The theoretical frame of reference is linked with dignity, the body, health as a whole and integrative healthcare treatment. A person's dignity, comprising both absolute and relative dignity, is caring science's most basic value. Absolute dignity is a matter of inviolability and respect for the people's opportunity to shape their own lives and being [3,4]. Relative dignity reflects the absolute dignity and is more connected to the psychical and bodily dimension [5]. Relative dignity is shaped by culture and society and the norms and rules that prevail within the culture. An inner freedom to make one's own choices and the right to protect oneself against external harm are aspects of dignity. Persons living with IBD are often experiencing an ongoing loss of personal dignity, and experiencing bodily decline can be a threat towards self-respect and the sense of dignity. Dignity of identity is concerned with the integrity of the subject's body and mind, and the universal human dignity pertains to all human beings. The universal dignity cannot be taken away from any person [3,5].

The goal of the future should be to ensure a development that respects the value of personal dignity, vulnerability and ecological sustainability [6,7]. By ensuring that healthcare personnel meet the patient with confirmatory communication and an attitude of appreciation, the patient will perceive dignity and respect. It takes time to be able to cope with one's suffering. In recent thinking, dignity is associated with pride, self-esteem and self-worth [8]. The health personnel's task is to realize the patient's potential and safeguard the patient's dignity [9,10].

French phenomenologist and existential philosopher Maurice Merleau-Ponty [11,12] claims that we experience the world and other people through our bodies. Hence, the body is an existential basic prerequisite, i.e. common to all humans. Our body can be neither selected nor rejected, and the living body is a basic prerequisite for experience to occur. Through body language, people can express themselves and speak to others around them. The lived body is understood as a coherent whole and a place of inner freedom [11,12]. The body is in constant interaction with nature and our surrounding environment. A holistic understanding of health is based on Gadamer's philosophy as found in his book The Enigma of Health [1]. Gadamer developed a conception of what lies at the core of health and what basic prerequisites or processes are at work and lead to understanding, coping and perception of the connection with recovery. Every person has experienced expectations. When living with a daily focus on illness, all patients wish to escape this and recover. With an understanding of how health is created, recovery can be enabled through knowledge of one's own limits of tolerance and the establishment of bodily knowledge [13]. Life force, a concept often used synonymously with vitality, is understood as being at the core of human health [14]. The goal is to alleviate suffering, regain health and again feel one's own vitality.

In nursing and in medical science, a nascent view of the patient as a whole and a systemic perspective on life in general is beginning to be adopted [6,15]. The systemic perspective on life entails an acknowledgement that health is a subjective experience that occurs over time. Health is a state of well-being that emerges when the organism functions optimally [4,6,16]. This means a state of well-being that is due to a balance which includes the physical and mental aspects of the organism, as well as interaction with the natural and social environment. Both “integrative nursing” and “integrative medicine” have been established as new scientific disciplines, entailing a desire on the part of both organizations and individuals to change the existing medical health system [17,18]. At the same time, we are now witnessing a renaissance of interest in sustainable development in agriculture and local communities, and a connection between healthy soil, healthy individuals, and healthy communities [6].

Integrative health care is a common concept for established health services, in which research includes complementary and alternative medicine (CAM), and patients share their experience in terms of the help they have received [19,20]. Integrative health care, in this article, encompasses caregiving, nursing and treatment as fundamental elements of recovery. These include the use of nutrition, physical activity up to the limits of tolerance, the use of Western medicine (allopathy), and the use of natural medicine. It includes herbal medicine, homeopathy, deriving from German medical tradition and acupuncture from Chinese medical tradition. Health science has shed light on the use of complementary methods and helped to develop concepts and research in the field [17,[21], [22], [23], [24]].

The purpose of this article is to shed light on the relationship between dignity, integrative health care and the whole-and-part perspective, and to shed light on the complementary interaction in the further development of health services. This research is a contribution seeking new valid understanding to a knowledge gap we have seen through empirical individual studies in caring for patients with IBD. This article will introduce abstraction of the language, which provides the opportunity for more long-term recovery. This abstraction is done with the help of reinterpretation of research through a circular hermeneutic understanding process.

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