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When Will We Agree on the Origin and Meaning of ‘Wellbeing’? Lewis S Blevins1

and Robert Knutzen2

1. Clinical Professor of Neurological Surgery and Medicine and Medical Director, California Center for Pituitary Disorders, University of San Francisco; 2. President and CEO, Pituitary Network Association


Quality of life is a nebulous term that is applied in medicine to assess the impact of disease states on the overall health of affected patients. It is difficult to measure, subject to interpretation based on the relative experiences of those assessing and reporting it, and there are no assessments or tools available to describe or determine the relative contributions of particular disease states and the affected person’s constitution and pre-morbid state or personality to their quality of life.

Keywords Quality of life, hormonal disorders, pituitary gland, acromegaly, Cushing’s disease

Disclosure: The authors have no conflicts of interest to declare. Received: 2 December 2011 Accepted: 23 January 2012 Citation: European Endocrinology, 2012;8(1):10–1 Correspondence: Lewis S Blevins, California Center for Pituitary Disorders at UCSF, 400 Parnassus Avenue Room A-808, San Francisco, CA 94143-0350, US. E:

‘Quality of life’, we believe, is becoming a more esoteric and often confusing term than first intended when it was originated. At one time just being alive constituted a primitive form of ‘quality of life’.

As early as 1913, Dr Harvey Cushing, a premier neurosurgeon who was well ahead of his time, uttered the immortal words, “The psychopathology of everyday life most often hinges upon the discharge of the ‘ductless’ gland upon the nervous system”.1


comments referred to substances, which we now recognise to be hormones that control other glands, produced by the anterior pituitary gland. More importantly, however, he recognised the association between disease states and what we now recognise to be a component of the gestalt of ‘quality of life’. Advances in knowledge in the medical community since that time, and especially the development of ‘instruments’ to measure quality of life for various disease states, gave rise to both confusion and denial in regard to the relevance and importance of such information, most often adversely affecting the patient(s) in question.

In 1999, the National Institute of Mental Health, US Department of Health and Human Services, issued the report Mental Health: A Report of the Surgeon General.2

In the report, the then Secretary of Health

and Human Services, Donna E Shalala, noted, “The United States leads the world in understanding the importance of overall health and wellbeing to the strength of a Nation and its people. What we are coming to realize is that mental health is absolutely essential to achieving prosperity”.2

Subsequently, she related, “This Surgeon

General’s Report on Mental Health takes the next step in advancing the important notion that mental health is fundamental health”.2


report also points out the following: “Nearly two thirds of all people with diagnosable mental disorders do not seek treatment (Regier et al., 1993; Kessler et al., 1996). Stigma surrounding the receipt of mental health treatment is among the many barriers that discourage


people from seeking treatment (Sussman et al., 1987; Cooper-Patrick et al., 1997)”.3

In many ways, linking wellbeing to mental health was a setback, as the vast majority of patients who are ill, for one reason or another, do not have mental illness but rather psychological consequences of their underlying disorders. Further, the report explains that “the mental health field was adversely affected when underlying causes and treatments for particular disorders were identified. These advances resulted in patients with certain conditions, which adversely affect sense of wellbeing and mental health, being transferred for care from the mental health field to another medical specialty (Grob, 1991)”.4

For instance, dominion over syphilis was moved to dermatology, internal medicine and neurology upon advances in aetiology and treatment. Dominion over hormone-related disorders was moved into the realm of endocrinology. Was the field of endocrinology prepared and trained to deal with this new and largely unexplored and untested field of medicine? Was the field of endocrinology sufficiently aware of its responsibilities for the doubled task of assisting patients through both the physiological and emotional ‘minefields’ of what we now recognise as the total care of the patient? Some would argue that, regardless of speciality, too little attention is paid to the psychological consequences of diseases. A disease is nothing but a pathologic entity that affects an organ, or organ system, and thereby has consequences regarding the physiological health of the individual. We recognise illness as the complete manifestation of the disorder, encompassing physiological and psychological manifestations within the affected patient, and secondary psychological effects on family members, friends, co-workers, etc. Wellbeing, then, is more related to the illness than it is to the underlying disease process. Because of the complexities and the far-reaching effects of the illness, a sense of wellbeing is rather difficult to quantify, much less treat.


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