Vulnerability as a strength: Why, when, and how?

Abstract

The purpose of this issue of the journal is to explore preconditions for transforming demanding experiences from life and sickness into personal health resources, shifting the attention of healthcare providers from risk and weakness to strength and resources. Turning vulnerability into potential assets, the contributors aim for knowledge about the strengths of people who suffer from chronic illness or belong to marginalized groups. Knowledge about people’s personal resources may encourage doctors towards empowering strategies in health promotion, diagnosis and treatment of disease, and rehabilitation suited to accommodate the diversity of members of different marginalized groups. Chronic illness and life conditions that create experiences of oppression give rise to challenges for medical epistemology and practice [1]. The biomedical tradition appreciates objective findings, while subjective symptoms have less clout. Patients with medically unexplained disorders complain that they do not feel taken seriously by the doctor for this reason. Yet, there is evidence for the impressive and independent predictive power of people’s selfassessed health regarding future disease, death, and reduced functional capacity [2]. Patients’ perspectives are underestimated resources to understand more about health and illness, especially when these are different from the doctor’s assessments or assumptions. Salutogenetic perspectives underpin the importance of acknowledging the patient as a person and mobilizing his or her strengths [3], so that the patient’s resistance resources are given the best possible conditions in the fight against illness, suffering and oppression [4]. The concept ‘‘recovery’’, as it has been developed within psychiatric rehabilitation, means to reflect on oneself in a broad sense – creating meaning and functionality, while still recognizing the realities of disability and suffering [5]. Deegan says that the aim is to be the unique human being every person is, based on his or her assets [6]. The placebo effect demonstrates that the belief that something works – hope – can mediate a medical effect. Biomedical research describes neuroimmunological mechanisms functioning as molecular messengers [7]. Healing and recovery may also be mediated through such mechanisms. Modern culture values conformity, effectiveness, independence, and health. People who are dependent on others, or who deviate from what is considered ‘‘normal’’, run the risk of social marginalization. In the time of modernity, a widespread belief is that suffering, disability, and deviance can and should be eliminated or normalized by medical intervention. The patterns of disease in Western society have changed from infections diseases towards chronic conditions such as musculoskeletal disorders, mental illness, dementia, and consequences of accidents or social stigma. When cure is not optional (chronic disease) [8] or desirable (diversity) [9], the tasks of healthcare providers are changed from ‘‘repairing the failure’’ towards commitment, care, or support. Yet, doctors may also function as agents of modernity, mediating