Play for Health Across the Lifespan

Stories from the Seven Ages of Play

Julia Whitaker, Alison Tonkin

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000389531
• Edition: 1
• Topic: Medicine
• Subtopic: Pedriatic Nursing

Play for Health Across the Lifespan uses case studies to explore the impact of play and creativity on health and wellbeing throughout the lifecycle. While play at the start of life influences future development, the authors show play also has a role in improving prospects for health and wellbeing in adulthood and later life.

A relational approach to health and wellbeing emphasizes the dynamic, mutually influential relationship between individual development and the changing contexts of our lives. Our personal play history is one feature of this dynamic process, and this book explores how the experience of play throughout the life course sculpts and resculpts the shape of our lives: our physical health, our mental wellbeing, and our relationship to the people and the world around us. Storytelling has been used since the beginning of time to communicate important life lessons in an engaging way. Taking inspiration from Shakespeare's 'Seven Ages of Man', the book uses a case-story approach to differentiate the stages of development and to present evidence for how play and playful experiences impact on health and wellbeing from birth to the end of life in the context of temporal and situational change. Each chapter in Play for Health Across the Lifespan introduces relevant evidence-based research on play and health, before presenting several narrative 'case stories', which illustrate the application of play theory and the neuroscience of play as they relate to each life stage.

With contributions from specialists in health and education, community organizations and the creative and performing arts, this book will appeal to academics, students, and practitioners who are interested in exploring the role of play in addressing contemporary challenges to our physical, mental, and social health.

1
Play for health

A journey for life

Once upon a time there were just two certainties in life: that we are born and that we will die. Now, when we think about what happens on the journey between these two landmarks, we can confidently make two further assumptions. The first is that personal experiences at the start of life will have an influence on every aspect of our subsequent development (Cozolino 2006; Narvaez 2018); the second, that our subsequent development follows an indeterminate course and that there is always the potential for change and for growth (Doidge 2008, 2015).

A relational approach to health and wellbeing (Lerner 1998) emphasizes the dynamic, interactive relationship between individual development and the impact of the changing contexts of our lives (Santrock 2007). Our personal play history is one feature of this dynamic process and, in this book, we explore how the experience of play throughout the life course, sculpts and resculpts the shape of our lives: our physical health, our mental wellbeing, and our connections to the people around us and to the world in which we live. The idea of play as integral to health and development is now well supported by evidence from play theory (Pellegrini 2009), from neuroscience (Kestley 2014), and from the stories of real people playing in the real world (Leichter-Saxby 2014).

In his book, Finite and Infinite Games, Carse (1987: 37) asserts, ‘only that which can change can continue’. The story of our playing, throughout the changing contexts of our lives, contains important clues to our lifelong health and wellbeing and therefore merits attention equal to that given to biological, social, economic, and environmental variables. A relational approach to play invites consideration of the impact of temporal and contextual change on how and what we play and of the relationship between play and our health and development. Huizinga (1955) famously proposed that play interrelates with culture – indeed that play is culture – finding expression in all aspects of our living. There is now a wealth of empirical evidence that play, located in its cultural context, interrelates with all six aspects of health – physical, mental, social, emotional, spiritual, and societal (Scriven 2017) – finding expression and meaning throughout the ‘Seven Ages’ of life (Shakespeare 2006).

What is health?

‘Hope you’re well’ is a phrase which eases the way into most verbal and written exchanges, and some claim it to be so clichéd a refrain as to have become redundant (Ough 2016). Yet, this everyday greeting originates in a genuine human interest and concern about the other (Keltner et al. 2010) – albeit about more than merely their physical condition.

The idea that health is more than a matter of biology is nothing new; it’s origins can be found in Ancient Greece (Tountas 2009), and it is an idea which persisted until developments in science during the eighteenth century prompted the adoption of the biomedical model of health and disease on which modern healthcare is founded.

A philosophical approach to health is important because it shapes our attitudes and behaviors toward one another, and the interchange between philosophy and medicine has played a fundamental role in conceptualizing health, particularly in the Western world (Adamson 2011). In the fourth and third century BCE, a group of physicians known as the Hippocratics were the first to theorize that illness was a consequence of natural, rather than supernatural, forces (Lagay 2002). They identified four bodily fluids – blood, phlegm, yellow bile, and black bile – known as humors, to which they attributed the causes of illness. Humoral medicine defined health as a state of humoral equilibrium and disease as a consequence of an imbalance of the humors due to ‘overindulgence in food or drink, too much or too little physical exertion, or changes in the so-called naturals, i.e. the uncontrollable environment and climate’ (ibid.). This early identification of many contemporary health concerns linked complex interactions between the physical body, lifestyle, habits, and the environment, a perception which persisted for over 2000 years, until the rise of empirical science in the mid-nineteenth century (ibid.).

Until the mid-eighteenth century, the prevailing orthodox Christian view of the mind–body relationship was monistic: people were perceived as spiritual beings and the body and soul as a single substantial entity. This perspective prevented scientific exploration of the human body which was prohibited on religious grounds (Mehta 2011). The proposition by Rene Descartes, in 1749, that mind and body were in fact separate entities, ‘demythologized’ the physical body and legitimized the study of anatomy and physiology as part of medical science (ibid.). Mind–body dualism laid the basis for logical medical practice that was ‘based upon empirical i.e. unbiased, impersonal and unsympathetic observation and measurement’ (ibid.: 203). At the same time, the significance of the mind for an individual’s experience of health was negated and ‘the field of medicine, by adhering rigidly to scientific method, mislaid its subject matter and gave up its moral responsibility toward the real health concerns of human beings’ (ibid.: 203).

In the 1940s, the French physician Georges Canguilhem (1991) rejected the prevailing distinction between ‘normal’ and ‘abnormal’ states of health, between the notions of ‘well’ and ‘unwell’. He recognized health to be a variable concept, different for each individual and determined by their own unique set of circumstances. For Canguilhem, health was a subjective experience defined by the individual themselves according to their functional needs. He saw health in terms of the person’s ability to adapt to their environment and defined the role of the doctor as a facilitator in this process of adaptation, thus anticipating the modern concept of ‘personalized medicine’. An editorial review of Canguilhem’s book, published in The Lancet in 2009, proclaims:

The beauty of Canguilhem’s definition of health – of normality – is that it includes the animate and inanimate environment, as well as the physical, mental, and social dimensions of human life. It puts the individual patient, not the [professional], in a position of self-determining authority to define his or her health needs. The [professional] becomes a partner in delivering those needs.

(The Lancet 2009)

Canguilhem’s thesis finds muted resonance in the World Health Organization’s original 1948 definition of health as a ‘state of complete physical, mental, and social well being, … not merely the absence of disease or infirmity’ – a definition which remains part of the WHO constitution today (World Health Organization 2019). Although widely criticized for being both vague and unrealistic, this definition of health acknowledges the inherent relationship between what Callahan (1973: 77) calls ‘the good of the body and the good of the self’ and endorses Canguilhem’s view of health as a subjective construct. It has been argued that cultural factors are so fundamental to the promotion and nurture of health that to ignore them is to deny the potential for novel and creative efforts to change things for the better (Napier et al. 2014).

A growing acknowledgment of the scale of health inequalities in recent decades has revived awareness of the social and cultural factors influencing public health and wellbeing (Marmot 2010) and resulted in a global commitment to a ‘social determinants approach’ to public health. In an article published in the British Medical Journal, Huber et al. (2011) propose changing the emphasis toward health as the ability to adapt and self-manage in the face of social, physical, and emotional challenge – reflecting the essence of Canguilhem’s treatise. A focus on adaptation, rather than the pursuit of an ideal state, opens the way for a more creative approach to health and development which recognizes the possibilities offered by a greater appreciation of the cultural context of people’s lives – including how and why people play.

What is wellbeing?

The National Health Service in the UK defines wellbeing as ‘feeling good and functioning well’ (Department of Health [DoH] 2014). It refers to both an individual’s experience of their life (subjective wellbeing) and the comparison of personal life circumstances with social norms and values (objective wellbeing). Put simply, ‘wellbeing … is about “how we are doing” as individuals, communities and as a nation and how sustainable this is for the future’ (What Works Centre for Wellbeing 2019). Wellbeing matters because it affects health and longevity (DoH 2014), and maintaining optimal levels of wellbeing is considered crucial for achieving an optimal quality of life (University of California Davis Campus n.d.).

The related concept of ‘wellness’ describes the ‘active process through which people become aware of, and make choices toward, a more successful existence’ (National Wellness Institute n.d.).

Wellbeing and ‘being-well’ are fluctuating constructs which reflect both individual and cultural priorities across temporal and cultural dimensions. The experience of pain or of sadness, for example, is different for every individual and dependent on a range of biological, social, and cultural variables (Peacock and Patel 2008). The consequences of this complex interplay between our emotions and the circumstances of our lives are vividly depicted in the Pixar Animation Studios film Inside Out (Pixar 2019). Taking us inside the mind of a young person, the film caricatures five of Ekman’s (2007) seven universal emotions, offering an insight into the emotional turbulence of growing up and the restorative qualities of play. Inside Out won numerous awards (including Best Movie for Grown Ups who Refuse to Grow Up) and has been widely acclaimed for pointing the lens at wellbeing and for raising awareness of emotional resilience as crucial to the successful negotiation of life’s transitions (Zeedyk 2015). It provides a powerful and accessible commentary on how we function emotionally and the significance of multifactorial influences, at both individual and societal levels, for optimizing our wellbeing and consequently our physical health (What Works Centre for Wellbeing 2019).

Improving wellbeing is an indicator of social progress and a key measure of both personal and societal success, which can be achieved through ‘good government and charitable activity’ (What Works Centre for Wellbeing 2019) and therefore registers high on the international public health agenda. The Measuring National Wellbeing Program at the UK Office for National Statistics [ONS] is responsible for collating and distributing statistical data on subjective wellbeing. The program measures wellbeing across ten broad dimensions: ‘the natural environment, personal well-being, our relationships, health, what we do, where we live, personal finance, the economy, education and skills and governance’ (ibid.). Highlighting personal wellbeing, the Five Ways to Wellbeing are advocated as a long-term strategy for maximizing individual wellbeing through personal connection, being active, taking notice, keeping learning, and giving of yourself (What Works Centre for Wellbeing 2017). These five ways to wellbeing are ‘integral to many activities that we care about and enjoy’ (ibid.), many of which have playful endeavors at their heart. This direct link between play and wellbeing is captured in many of the case-stories which form the main body of this book.

The meaning of play

From the infant’s mirroring of the mother’s gaze, to stories at bedtime; from playground games of make-believe to the risky ventures of the teenage years; the pranks of the office clown and family banter round the dinner table; solitary gardening and social singing. From the start of life to its close, humans are motivated to pursue experiences simply because they afford them pleasure and satisfaction. These experiences we have come to call ‘play’. Perry (2019) puts it simply: ‘Play takes many forms, but the heart of play is pleasure’.

Walz (2010: 11) writes that ‘playing is a special type of human activity – an anthropological constant’, yet most attempts to determine its meaning are characterized by ambiguity and a universal acceptance that there can...