Quality of life: A patient-centered outcome

Abstract

V ICTOR FRANKL, psychiatrist, concentration camp survivor, and author of Man's Search for Meaning, often quoted Nietzsche: Those who have a 'WHY' to live will put up with almost any 'HOW'. Frankl came to this conclusion after listening to the answer to the question he asked many of his fellow inmates, who, like himself, had endured privations, indignities, and horrors: Why is it that you do not commit suicide? One had a daughter with a future that could be bright; another had a manuscript to publish; yet another had a loving family to whom to return. When another camp was liberated, the following astonishing prayer was found, written in a child's handwriting: Oh Lord, when our captors come to judgment, consider not only the evil they have done, but also the good we have found in our imprisonment--the courage, the patience, the friendship, the appreciation of simple acts of kindness, the generosity of spirit, the love-and let those things be their forgiveness, If these persons could find hope for the future, or could even find meaning in lives that had little hope of a future, is it so surprising that patients with disabilities can find quality of life in the midst of their limitations, not only in spite of their limitations but, dare I say it, sometimes even because of their limitations? What is quality of life? This question has been addressed systematically for at least three decades and asked and answered by lovers of wisdom for millennia. It is related to health, wholeness, holiness, and harmony with all people. As the psalmist says (Psalm 133): How good it is for brethren to dwell together in harmony! Like oil upon the head-l ike much fine oil running down Aaron's beard! It is like the dew of Mount Hermon in the Land of Zion! The ancient Greeks and Romans sought health and harmony of body and mind. Their motto, Mens sana in corpore sano (a sound mind in a sound body), was not so much a statement of fact as a goal to be attained. The 16th century author, Andrew Boorde, inscribed the following motto on his Breviary of Healthe (1546): Myrrh is One of the Chiefest Things in Physicke. Not unduly constrained by the rigors of the Carthusian monastery to which he belonged, be went on to say: There is nothing that doth comfort the heart so much, beside God, as honest mirth and good company. merry heart and mind, the which is in rest and quietness, without adversity and too much worldly business, canseth a man to live long, and to look youngly, although he be aged. Care and sorrow bringeth in age and death, wherefore let every man be merry; and, if he can not, let him resort to merry company to break of his perplexities. In a 1978 report titled, A Research Approach to Improving