Self-care E-Book

Fernanda Cabral Schveitzer

• Herausgeber: Epígrafe
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 322

Veröffentlichungsjahr: 2022

Beschreibung

Nesta obra, você encontrará referenciais para aprofundar o co­nhe­cimento em saúde e cuidado, passando pelas abordagens da saú­de ocidental, das práticas integrativas e complementares e da saúde consciencial, ampliando a compreensão dos elementos que com­põem essa dinâmica e favorecendo a autopesquisa e a auto­cons­ciência.

Leseprobe

Fernanda Cabral Schveitzer

Mariana Cabral Schveitzer

Self-care

A dynamic approach to integral health

Electronic Edition

Foz do Iguaçu – Paraná – Brazil

2022

Copyright © 2022 – Epígrafe Editorial and Graphic Ltd

1st English Edition [Electronic Edition].

The opinions expressed in this book are the responsibility of the authors and do not necessarily represent the position of the above.

Editorial production: Ernani Brito.

Illustrations (cover and core): Jéssica Zanovelo Fogaça.

Translation: Fernanda Lise and Flávia Lise Garcia.

Revision: Jaclyn Cowen, Victoria Chbane and Daniel Hiram Zengotita.

ISBN: 978-65-87816-22-7

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Dedication

To those consciousnesses committed to care and self-care.

Acknowledgments

To our parents, Fátima and Tarcísio, we express our gratitude for the practical lessons of care and for the adventures of life we shared with you. We discovered the world together and learned a great deal in living with the Cabral-Schveitzer Family. We love you very much.

On this journey we expanded our family: Fernanda and Cesar, Mariana and Victor Hugo. We thank you for the support and love that has guided our journey together. Thanks also to the family that grew up with you, who are now our fathers- and mothers-in-law, brothers- and sisters-in-law, cousins, nephews and nieces, which multiplied the affection.

To Laura, our youngest sister, our gratitude for showing us the importance of love and forgiveness.

We would also like to thank Dr. Waldo Vieira (in memoriam), for the conscientiological teachings, the extraphysical helpers for the opportunities of interassistance and the AIEC, ECTOLAB, IIPC, Intercons, Interparadigmas and UNICIN teams for the opportunities of growth through volunteering.

To the dedicated professionals of the Epigrafe Publishing House Gisele Salles, Rosemary Salles and Ernani Brito and portuguese edition reviewers Giséle Razera and Cesar Cordioli, our gratitude for their efforts in reviewing and publishing this work.

Thank you to Professor Maria Julia! Her loving and encouraging words filled the Portuguese language preface and our hearts.

Our gratitude to caregivers, to the therapists and health professionals who, through their personal example, assisted and taught us different ways of caring.

Mariana would also like to thank the following people: the Knecht Family who welcomed me to Iowa City, USA, with open arms, Professor Margarete Sandelowski for her research guidance at Chapel Hill, USA, and the dear graduate advisors: Professors Vânia Backes, Elma Zoboli and Marta Melleiro. To Marcelo Fabian Oliva who guided me down the path of traditional Chinese medicine in Brazil, China and Cuba. To the health professionals who opened the doors for my work with complementary therapies, especially, Maria Tereza Andreola and Desireé Souza. To my colleagues from the CUIDAR [CARE] Research Group, and from the Preventive Medicine Department at the Paulista Medical School of Unifesp, for their reception and the experience of doing projects together. Together we go further.

Fernanda would like to express gratitude to her colleagues and professors throughout this health journey: I would especially like to thank Professor Mário Steindel, for introducing me to this path of research. To Itaipu’s health team, from before and now, for their dedication and for showing me that the practice of care has many styles and ways. Experience is the best teacher.

The authors would also like to thank translators Fernanda Lise and Flávia Lise Garcia, reviewers Victoria Chbane, Daniel Zengotita and Jaclyn Cowen, for their meticulous work of translating this book into the English language, enabling us to expand the scope of the developed research.

Finally, we especially thank our patients, because, in the search to better care for them, we developed the knowledge we present in this book.

Gratitude: Reversed generosity.

Waldo Vieira (1932–2015)1:509.

Contents

Preface to the English Language Edition

Preface to the Portuguese Language Edition

Introduction

PART I ­– Development of Health Knowledge

Chapter 1 – Conceptions of Health and Care

Humanization of Care

Chapter 2 –Integrative Health

Integrative and Complementary Practices

Chapter 3 – Consciential Health

Conscientiology

Principles of Consciential Health

Chapter 4 – Research in Health

Research in Integrative Health

Science from the Fleck Perspective

Chapter 5 – Relations between Health and Consciousness

Consciousness Research in Science

Consciousness Research in Conscientiology

PART II – Development of Care Practices

Chapter 6 – Integrative Health Care

Health Technologies

Consciential Health Practice

Chapter 7 – Co-development of Care

The Case of Pain

Multidimensional Care

Chapter 8 – Self-care

Self-Care Triad

FEMA Method for Self-Care

The Case of Anastasius

Chapter 9 – Self-awareness and Self-research

Conscientiological Self-research

References

Audiovisual Sources

List of acronyms

Glossary

Index

The authors

The translators

The reviewers

Preface to the English Language Edition

Welcome to the self-care journey. Self-care is the experienced interaction of self-knowledge, understanding of health models, and the good use of available therapeutic resources and practices. It is a practice of self-connection and of reinventing yourself by expanding your understanding of the world and yourself, your interests and purpose in life.

The objective of translating this work into English is to meet three demands: the first, to present the construction of the self-care triad and the FEMA method to an international audience; the second, to promote health care practices that are carried out in Brazil, especially in the Unified Health System (Sistema Único de Saúde – SUS); and the third, to publicize the consciential paradigm and consciential health.

The authors of this book are sisters who grew up in southern Brazil, immersed in a syncretic culture, with a predominance of modern Western health, yet surrounded by a variety of experiences of other health models, whether in the care provided to them and their families, in the early stages of life; during the health training they chose to follow; or even in the health practices they chose to use in search of personal harmony.

Dr. Fernanda Schveitzer is a physician (Federal University of Santa Catarina – UFSC), who specializes in occupational medicine (Brazilian Medical Association/National Association of Occupational Medicine – AMB/ANAMT) and works in occupational health management. At the moment, she is the occupational medicine manager at Itaipu Binacional. Along with her medical studies, she has dedicated herself to experimenting with and offering alternative health approaches and therapeutic practices, for her own self-care and that of her family, friends and patients. She is also a volunteer and researcher of conscientiology, focusing on the subject areas of consciential health and the evolution of consciousness.

Dr. Mariana Schveitzer is a nurse (UFSC), holds a Post-Doctorate (School of Nursing at the University of São Paulo – EEUSP), PhD in Science (EEUSP-Catholic University of Portugal – UCP), Master of Nursing (UFSC), is specialized in Public Health (UFSC) and Acupuncture (Faculty of Health Technology – CIEPH-Shandong University), and has completed significant additional training in complementary therapies. She worked as an acupuncture and holistic therapist, and currently holds the role of Assistant Professor at the Preventive Medicine Department at the Paulista Medical School at the Federal University of São Paulo (UNIFESP), in addition to conducting research related to human aspects of care, scientific methodology and complementary therapies. She is a volunteer and researcher of conscientiology, with an emphasis on the subject areas of embracement and instruments of conscientiological research.

Together, the authors have built an integrative health care approach, supported by the multiple health models and therapeutic offers available, capable of adapting to the context and perspectives of the world experienced by each person, while supported by the self-care triad.

The self-care triad consists of 1) the knowledge of oneself and one’s health reference (self-knowledge), 2) an understanding of the production of knowledge and health technologies (cosmovision), and 3) the good use of techniques and practices in health (resources). These three factors are related to and mutually influence the production of personal well-being and can be applied in practice through the use of the FEMA method, with the tools being available in the book and at www.autocuidado.org for free download.

The FEMA method was developed by the authors, based on more than ten years of research and clinical practice. Its four stages were initially conceived in the English language from the words: 1) Find: needs or discomfort; 2) Embrace: feelings and thoughts; 3) Move: to a new benchmark of well-being and 4) Again: restart the self-care cycle whenever necessary.

The authors’ proposal is not to define the best path, but in fact to modify the logic of the construction of care, with an appreciation of technologies of different rationales and understandings in health, in constant interaction, to learn how to take care of oneself and others, in an integrative way.

The concept of self-care presented in this book is the result of a unique context of experiences that coexist in Brazilian culture, which provide a dialogue of different types of knowledge and paradigms of health. Understanding this work and its contribution to personal and collective health and well-being involves understanding the context in which it was produced:

A. The blending of ethnic groups, races, creeds and health understandings of a population distributed throughout its continental territory. Its strong popular wisdom in using traditional therapies, passed down by tradition in families and social circles, until the present time, derived from indigenous native cultures and immigrants, which include the use of herbs, teas, compresses, bottles, massages, blessings, among others.

B. A health system that proposes to provide universal and free access to the whole population and which coexists with the provision of private health, whose access is restricted only to those who can afford it, demonstrating the great challenge that is present in the promotion of health and disease prevention nowadays.

The Brazilian Unified Health System (SUS) spans across the entire national territory, serving a public of more than 150 million people (base year 2019), and since 2006, SUS has been incorporating humanizing practices and Integrative and Complementary Practices in Health (Práticas Integrativas e Complementares em Saúde – PICS).

Humanizing practices recover the respect and ethics in the relationships between professionals and patients, thereby increasing the quality and satisfaction of care. They include bonding, extended listening, embracing, integrality and protagonism. These practices can be related to the Patient-Centered Care proposal, in the sense that they value different types of knowledge and recover the individuality of the human being and their autonomy in the care process.

PICS include rationales, health practices and complementary therapies of Traditional, Complementary and Integrative Medicines (TCIM), such as: traditional Chinese medicine, acupuncture, ayurveda medicine, yoga, and meditation. The World Health Organization (WHO) uses the term TCIM and, in Brazil, we use the term PICS to talk about the inclusion of these practices in SUS. In this book we will use the term complementary therapies as a correspondent of PICS. Currently, there are 29 practices included in the National Policy of Integrative and Complementary Practices in Health. In SUS, complementary therapies are mostly offered in Primary Health Care, the patient’s gateway to the Health Care Services Network. In the private market, the number of complementary therapies offered in the national territory is even greater and continues to grow.

Since 2018, the Virtual Health Library on Traditional, Complementary and Integrative medicines (VHL TCIM) has been presenting research results and demonstrating the effects of these practices through interactive maps. This project is the result of a partnership between the Brazilian Ministry of Health, the Brazilian Academic Consortium of Integrative Health and the Latin American and Caribbean Center on Health Sciences Information, also known by its original name, Regional Library of Medicine (Biblioteca Regional de Medicina – BIREME), of the Pan American Health Organization/World Health Organization (PAHO/WHO). The TCIM Evidence Maps project was born from the need to identify evidence among the more than 1 million scientific studies available in the VHL TCIM and other databases.

C. The emergence in Brazil of the science of conscientiology, proposed by the Brazilian physician and researcher Waldo Vieira (1932–2015), which is dedicated to the investigation of the integral consciousness. Among the assumptions of this neoscience are the holosoma (different bodies with which the consciousness manifests itself), multidimensionality (multiple dimensions of manifestation), multiexistentiality (the set of successive human existences) and the thosene (the indissociable expression of thought, sentiment and energy). The approach to health from a conscientiological perspective, its principles and practical applications in everyday life, also make up the content of this work.

The confluence of this knowledge and experiences motivated the authors to recover the meaning of care, in order to help understand what should be considered to achieve self-care and integral health, whether for ourselves, for the people around us, or for those we assist professionally.

It should be noted that this book does not aim to replace the services and treatments provided by health professionals, therapists and caregivers. The information contained here is intended to complement the assistance and broaden one’s view on the construction of self-care.

Throughout the chapters you will find notes to contextualize definitions and practices in health, in addition to the glossary that will help the reader to understand the conscientiological neo-concepts presented in the book.

We wish you a pleasant reading!

The authors.

Preface to the Portuguese Language Edition

“What was the dog’s name?”

Have you ever imagined an anamnesis (medical history) starting with this question? Indeed, what does it have to do with a medical history? If you, dear reader, started to smile when reading this sentence, maybe you have understood and share the author’s opinion that the provision of care is much more than what has been practiced in many institutions, by many professionals, and by many people! Throughout the book we will provide a context to this question: “what was the dog’s name?”

This book you have in your hands will help you to reflect on the best way to take care of your health: yours, mine, ours. To this end, the book exposes the myths of current science, questions its neutrality and independence, and provides tips for identifying opportunities to expand your self-knowledge, self-awareness and self-scientificity. This is no small task, but Fernanda and Mariana have the ability to present their ideas in a clear, didactic manner, with the use of poetry, philosophy, suggested films, books and... many questions.

We know that the brain likes questions, so reading this book flows. They refer to Michel Foucault in Chapter 5: “There are times in life when the question of knowing if one can think differently than one thinks, and perceivedifferently than one sees, is absolutely necessary if one is to go on looking and reflecting at all.”

I confess that the invitation to write this Preface, in addition to being a great honor, surprised me; but, being a nurse, I spent much of my life reflecting, learning, experiencing the meaning of care, which models and practices to adopt in the face of so many options, to serve as an instrument in the therapeutic process and to qualify my own life, in its multiple dimensions and roles. It is to have attention, intention, and awareness regarding the physical, emotional, mental, energetic, and spiritual aspects. To integrate what can be integrated; whether it has a western or eastern origin. To combine ancient healing systems with modern Western medicine.

There is a central aspect of the book that makes us, the readers, feel very valued: the importance of our own experiences! Self-research to achieve self-healing. The authors used the reference of consciential health! We know that the consciousness is a current scientific challenge and conscientiological research urges readers/researchers to develop critical thinking about what is subjective and indissociable, by proposing a way of doing science by yourself and about yourself, for the benefit of all and the Universe itself. Do you want a more thought-provoking question than that?

Reflecting on our experiences as patients of health services, we understand the importance of keeping our permanent attention on models and practices that impact quality, which broadens the gaze to the human being that…. the person is much more than their disease! Labeling someone with a disease is to reduce them, to deny all of their (our) potential for creativity and life.

During our time of “experientially” living a pandemic and while reading this book, I remembered a current educator that I love very much: Edgar Morin. According to him, “by sacrificing the essential for the urgent, one ends up forgetting the urgency of the essential”. The essential requires discipline, commitment, involvement and will. Reading this book can help us remember the essentials, for life goes on.

Thank you, Fernanda! Thank you, Mariana! For broadening our gaze, for stimulating us to analyze how much we take ownership of our own self-care and, therefore, our own life. Always take care with love; it is the way.

By the way, the name of my puppy was Fluffy. She lived for 17 physical years in our family. Today she lives in my heart, in a place called gratitude.

“...the truth is not in the setting out nor in the arriving: it comes to us in the middle of the journey.”

(The Devil to Pay in the Backlands. J. Guimarães Rosa)

Pleasant reading, dear readers!

Have fun with questions and life.

Maria Júlia Paes da Silva

Retired full Prof. of University of São Paulo School of Nursing - EEUSP; Vipassana Meditator; practitioner of Tai Chi Chuan; author of the book: O amor é o caminho: maneiras de cuidar [Love is the way: Ways to care], Ed. Loyola, among others.

Introduction

Health care is a practice as old as humanity. It already existed long before dictionaries defined its meaning, science conceived its paradigms, universities taught their craft, services standardized clinical protocols, or laboratories researched diagnoses and cures. The evolution of health care has accompanied history, transforming itself together with societies.

Different paradigms and worldviews interfere in health practices and research that are carried out to categorize, identify and treat the most diverse diseases. Much more than theoretical discussions, different health visions integrate the bases of what professionals are able to offer and what patients learn to expect. However, the encounter of these different types of knowledge does not guarantee meeting the person’s needs in an integral context, nor the satisfaction of the professionals involved in the care.

Recovering the meaning of care is the purpose of this book, in order to help in understanding what needs to be considered to achieve self-care and integral health, whether for ourselves, for the people around us, or for those we assist professionally. It is a work dedicated to patients, family members, professionals, therapists, caregivers, and everyone interested in better understanding and improving their health and care practice.

This book is an invitation to reflect on the following questions, among others distributed throughout the chapters:

1. What is the best way to take care of my health?

2. Which models and practices of health care should I adopt, among many others available?

3. What challenges and opportunities does my health condition bring me?

4. How can I research myself and develop a strategy to optimize my own self-care and the people I assist?

5. How can I obtain more self-knowledge and self-awareness through self-research? And how can I support other people in this construction?

To achieve these goals, we recover the development of health knowledge and health care practices, present integrative and complementary therapies (traditional Chinese medicine, yoga, meditation, among others), humanizing practices (embracing, listening, amplified clinic, among others), consciential health and self-research, to diversify and qualify the assistance.

The proposal is not to define the best path, but, in fact, to modify the logic behind the construction of health care, with an appreciation of technologies from different rationales and understandings of health, to learn how to take care of yourself and others, in an integrative manner. In this process, it is important to recover the objectives of care, the roles played by patients and professionals, and to expand the tools used to improve health care and stimulate autonomy, self-knowledge, and self-awareness.

However, it should be noted that this book does not aim to replace the services and treatments provided by health professionals, therapists and caregivers, but rather to complement the assistance and broaden your understanding of self-care.

To amplify your reading experience, we suggest you adopt five postures:

1. Pay attention to the initial and final questions of each chapter, looking to answer them as the concepts are presented. Reflections are an integral part of the process.

2. Direct your reading from the summary words or expressions of each paragraph, highlighted in bold to help fix your attention and facilitate understanding.

3. Deepen your knowledge of the topics through the indicated references of videos, books and articles, which can broaden your insights.

4. Consider the cases presented, which are real, although the identities are safeguarded by fictitious names.

5. Consult the glossary for any questions concerning the neologisms presented in this book.

This work is organized into two parts: The first is dedicated to the development of knowledge about health, divided into five chapters; and the second addresses the development of care practices, divided into four chapters.

The first part presents a historical review of health and care concepts, the main paradigms, integrative health and consciential health, besides the development of science and research about health and the consciousness, in order to provoke a critical posture regarding scientific discoveries.

In the first chapter, we address the development of health conceptions and the movements that established the predominant health models in Western health. In the second, we differentiate between traditional, complementary and alternative health practices, highlighting the continued expansion of these movements in search of new forms of health and care. In the third chapter, we characterize health from the consciential paradigm, introducing the neoscience conscientiology, which studies the consciousness from an integral perspective, and we list the principles of consciential health.

Chapter Four shows how health knowledge is produced through different paradigms, and how the research developed modifies the care and assistance provided. It explains the challenge that science faces in innovating itself, due to the way it is structured, and it reinforces the importance of including subjectivity in health research. It elucidates the renovating potential of qualitative and mixed research designs, and research into alternative and complementary practices, by enabling the integration of subjectivity into care.

Chapter Five presents the indissociable connections between health and the consciousness that are expressed through their personal traits, temperament and essence. It emphasizes the impact of these relationships on the provision of health and on the construction of care, and the complexity of researching the consciousness, in the sciences in general and from the perspective of conscientiology.

The second part examines the care offered by health professionals and services and the expectations of patients and society. It invites the reader to recognize and reflect on their actions and practices of health and care through the FEMA method, developed from the experience of these authors, which promotes self-research.

Chapter Six discusses how the models to control and eliminate diseases have become limited, especially when they distance the patient from the care process. Moreover, it proposes integrative health care with the use of light technologies, such as embracing, listening, empathy and interprofessional collaboration, as well as the means and actions to promote consciential health.

In chapter Seven, we present the challenge of health practices to incorporate autonomy and integrality. We highlight the role of the patients in the therapeutic project, to recover their motivation for self-care, using the amplified clinic, the anti-protocol, the singular therapeutic project and multidimensional care. And we exemplify the complexity of incorporating these values through the case of pain.

In chapter Eight, we elucidate the factors that influence the development of self-conviviality and the elements that make up the self-care triad. By combining health knowledge with our personal and professional experience, we create the FEMA method as a tool to facilitate the promotion of self-care in the search for integral health. The FEMA method, or the dynamic and continuous self-care cycle, is organized in four stages: Find-Embrace-Move-Again. Each step is described in detail in this chapter and we offer tools that favor its application by the person or with professional support, as well as demonstrate a real case of using the method.

The last chapter invites the reader to reflect and research themselves. It proposes self-research as a tool to broaden your self-knowledge and self-awareness, so as to qualify your self-care, and experience daily life with more lucidity and applied scientificity.

The book demonstrates the process of growth and self-care experienced by the authors, from the conception of new ideas related to new paradigms to their practical application with yourself and others. Through this dynamic approach, self-experimentation and self-research provide personal recycling and the ability to reach new ways of living, which in turn, constitutes the ascending cyclical process of self-evolution.

We seek to develop an inter-paradigmatic approach between Western, integrative and consciential health in this book, however, without the desire of exhausting the subject. The purpose is to reflect on the role of professionals and each person in the promotion of health, care and self-research, based on different paradigms, in constant interaction. The authors await the weighted contributions from other researchers in the continuous exercise of integral health. We wish you all good reading!

“the publication of a work always brings the award of invaluable and free heterocriticism.”

Waldo Vieira (1932–2015)1:422[Translation].

PART I ­– Development of Health Knowledge

Chapter 1 – Conceptions of Health and Care

“Everything, for us, is in our concept of the world. To modify our concept of the world is to modify the world for us, or simply to modify the world, since it will never be, for us, anything but what it is for us.” [Translation]

Fernando Pessoa (1888–1935)

When you think about health, what first comes to mind? And when you think about care? The purpose of this chapter is to broaden one’s understanding of these concepts through a brief historical review.

Our language is modulated by the concepts and conceptions that we absorb from the world, and what we use to communicate, interact and build knowledge. To recover the meaning of health and care that we adopt today requires reflecting on how each person thinks about such concepts, until they begin to compose their own personal conceptions.

For starters, what is a concept? A concept is a term, used to describe concrete or abstract phenomena, experiences or realities, through words. The construction of a concept is based on the prevailing philosophical, theoretical and political conceptions at a given time, and it is therefore not possible to approach a concept without reflecting on its history2.

A conception is what we conceive in our mind from concepts, ideas and opinions3. It’s a way to see or feel something. Health conceptions reflect the social, economic, political and cultural situation of different people and are therefore dependent on the time period, place, social class, individual values, and scientific, religious and philosophical currents4. With this, we can understand that there is a wide variety of conceptions about health and care, which interfere both in the way care is practiced and in public health policies. This variety justifies the fact that some concepts are valid for certain periods and then criticized and even replaced.

The provision of care is one of the oldest practices in history. For thousands of years, the practice of care did not depend on a health system, much less belong to a profession. It concerned anyone who helped others to continue their lives in relation to the group, being guided by two situations: ensuring life and holding back death5.

However, care practices have evolved over time from changes in multiple contexts. In the social sphere, for example, an attempt was made to define who should have the role of caregiver: whether it should be men, women, young people, the elderly, of what social class and with what background and profession. In economics, it means to quantify how much it costs: how to value the spent time, dedication and structure. In the cultural context, to define how care is recognized: what financial and social values are attributed to it. In technology, what is the best way to do it: with what methods, techniques and equipment. And as such, care was divided and spread out into different tasks and professions.

The way a person receiving care is seen has also undergone profound changes. If it once focused on the integrality of the individual, the person was gradually isolated, parceled, split and separated from the social and collective dimensions that composed them, especially in the West. The practice of care, over time, became treating the disease5. In this process, general care to maintain life, such as eating, sleeping, exercising and relating to others, that was developed from popular wisdom, was gradually replaced by scientifically proven knowledge in many cultures.

The historical transformation that has occurred by the act of care can be perceived, for example, at different moments in the development of the medical profession in the West, as organized by Professor Nelson Filice de Barros6:

1. Empirical medicine: notions of care and prevention are acquired from routine observations, with an individual resolution of health problems.

2. Magical-religious medicine: there is recognition of the individual caregiver and the role of the healer, who explains the illness process and promotes healing.

3. Hippocratic medicine: medical care incorporates the theoretical matrix of hippocratic medicine, encompassing semiology, prognosis and therapy.

4. Medicine in the Middle Ages: the patient is recognized as a person in the purification process, carried out through pain, suffering and illness.

5. Medicine in modernity: establishes the division between scientific knowledge and common sense; health is compartmentalized into specialties, systems and organs, that increasingly rely on the use of measuring instruments.

Patients and health professionals can adopt different conceptions of health and care influenced by these moments. A patient who perceives their illness as a punishment approaches care from the Medieval perspective and still presents this perspective today. When attending to this patient, a professional can take the opportunity to broaden the patient’s understanding and the way in which they relate to their health, or they can choose to disregard this information. When addressing the patient’s conception of health, they may even disqualify the patient, incorporate it into an as it is therapeutic proposal, or interact with it so that the patient can revisit it and gain new meaning from it. Thus, on a daily basis, professionals act as multipliers of health knowledge and models, both for patients and their colleagues.

Such conceptions and models integrate an even greater set of established assumptions, theories, methods and procedures that characterize a science. Known as aparadigm, this concept expresses the matrix or model that structures and governs a specific scientific field at a given place and time in history. In practice, paradigms define the lenses we use to observe the reality around us, conduct research, value knowledge and endorse what is recognized as scientific.

Emerging from modernity, the health sciences developed fundamental characteristics, such as unicausality, mechanicism and objectivity which stimulated what became known as the paradigmof modern medicinea, also calleda biomedical model.

The discovery of several disease-causing microorganisms and the development of bacteriology and antibiotics have helped to consolidate the notion of the unicausality of diseases in the dominant medical practice6.

By interpreting diseases and cures as mechanical occurrences, that result from a physical-chemical interaction, medicine absorbs the mechanicism from physics and biology. This reduction excludes the interference of the patient’s subjectivity, their history and context of life, from the general understanding of what health is. For the social scientist Marcos Queiroz7, this was how medicine emerged as a modern science. The therapeutic act is explained by the chemical or physical intervention in different parts and structures of the organism, with the aim of eliminating the disease. The concentration of the scientific gaze to increasingly smaller parts of the biological body, eventually led to the loss of the patient being approached as an integrated human being.

Thus, there is a separation between the disease’s objectiveness and the patient’s subjectiveness and also a split between medical theory and practice, because, while the former becomes precise and objective, the latter remains uncertain and fallible8. Such reductionism in modern medicine resulted in limitations to the biomedical model6, in which three aspects regarding its practical application stand out:

1. A low ability to share its knowledge with the population and to act in conjunction with other forms of care.

2. An unequal relationship with the physician presenting a style of domination in relation to the patient, justified by the autonomy and technical competence of the professional.

3. The passive and subordinate participation of the patient, by excluding his knowledge, representation, uses and popular customs in relation to the health-disease process.

The appreciation of objectivity in biomedical science, as opposed to the subjectivity of being, led to a crisis in modern medicine, not just in relation to knowledge itself, but in relation to the ethical, political, pedagogical and social dimensions inherent in the health care context8,9.

Concomitant to this process,the provision of care also transforms with social changes and the emergence of science. The history and evolution of care can be organized in three different moments in the West as proposed by the French historian and nurse Marie-Françoise Collière5:

1. Practices of women who provide care, from the earliest times in human history to the Middle Ages.

2. Care practices of women recognized as caregivers, from prostitutes to nuns, from the Middle Ages to the end of the 19th century.

3. Female nursing, as a profession with a defined moral and technical role, from the beginning of the 20th century to the end of the 60’s.

The practice of care has differentiated between women and men throughout human history5. Women were predominantly involved in care practices to ensure the maintenance of life, especially those concerning childbirth and the sick person. Men repaired the injured body, which often required physical strength to dominate people in a state of agitation, delirium or madness.

This distinction explains how women became nurses and men became physicians, surgeons and nurses in prisons, leper colonies and asylums. The division of labor between genders was not so much a result of scientific advances, but of the very structuring of society, which attributes some forms of care and types of knowledge to one gender, to the detriment of the other5.

During the Middle Ages, the woman caregiver needed to review her relationship to the body. Before this period, women cultivated a relationship of naturality and belonging, in which the body was a form of expression. From the rise of Christianity and the witch-hunt movement, the woman had to move ever further away from her body and closer to the soul through religion and charity5.

With the creation of the first nursing schools at the end of the 19th century, care practices were fed by scientific knowledge, but they refused to deny the value of the body, for both the patient and the caregiver. The founder of modern nursing, FlorenceNightingale, stated that, in order to care for others, nurses had to be able to first take care of themselves5,10 so that they could approach the patient in an integrative way.

The concepts of health and care were developed from this moment on by nursing theories, considering the bio-psycho-social-spiritual context, integrality, interpersonal relationships, self-care and meeting health needs11–13.

However, the social perspective of nursing regarding care has also suffered from a predominance of the biomedical model, leading to care that is focused on the physical and biological aspects, thus reducing the individuality of the patient and their social and community environment.

Fortunately, the systemic view of health has also prospered and influenced the development of social medicine and public health. Since 1700, the Italian Bernardino Ramazzini had already been associating working conditions with diseases, and in 1779, German Johan Peter Frank argued for the necessity of the State to take care of people’s health14,15. This view was exacerbated by diseases arising from industrialization and the expansion of urban growth at different moments of public health16, as characterized below:

1. Empirical sanitation (1840–1890): appreciated the cleanliness of air, water, and urban agglomerations.

2. Bacteriological era (until the first decade of the 20th century): based on the scientific application of bacteriology and the control of infectious diseases.

3. Health education (from the second decade of the 20th century): begins with the implementation of health centers that propose to take care of the community, in order to reach the individual through the collective.

The “normal” functioning of the body, which was equated to the proper functioning of a machine and recognized as synonymous with health, was expanded by the World Health Organization (WHO), who defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”17. However, this same concept is questioned for being abstract and idealized2, after all, we live with multiple expressions of illness and sickness that generate different perceptions of discomfort and suffering.

Some illnesses that are characterized as diseases are incorporated into our daily life, and do not always disqualify our perception of health. For example, if you have myopia, astigmatism or hyperopia, you have probably already adapted and incorporated the use of glasses or lenses into your routine, without compromising your well-being.

At the same time, natural changes throughout life, whether they are growth, aging, menstrual cycles, or physiological changes in pregnancy and menopause, make it difficult to maintain a complete state of well-being. The challenges, stresses and frustrations of everyday life also interfere with this utopian reference of completeness. The adoption of an idealized and unattainable condition is incompatible with practice and, by itself, can lead to illness by bringing the idea of health closer to perfection and moving it further away from the singularity with which it is expressed in our lives.

WHO, 40 years later, has broadened its vision of health by proposing a definition ofhealth promotion in the Ottawa Charter18:

“Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well-being”.

The promotion of health thus seeks to integrate technical and popular knowledge, based on an expanded conception of the health-disease process and its determinants that are related to the social and historical spheres of life and work, such as sanitation, housing, education, leisure, living habits, and economic, cultural and environmental conditions. According to this view, it invites professionals and patients to work together to address different health problems and needs19.

Another effect of expanding the concept of health is to expand the choices of the individual, by encouraging autonomy, which calls for reflection and decision-making, so that the individual can exercise greater independence over their health20.

From the second half of the 19th century on, different movements began to propose changes to the biomedical model. The collective health