Changing Views of Health and Illness

		Mind and Body

		A central tenet of views critical of "scientific medicine" has been the overriding importance of the interconnectedness of mind and body. Scientific medicine's roots in the dualism of Descartes has precluded it from viewing the human being as an organic whole. This has led to the neglect, minimizing, and denial of the mind's ability to produce and remove symptoms, if not create and cure illness. The opposing "holistic" view starts with the assumption that an organism (the whole) is more than the sum of its parts. According to this perspective, the nature of the parts is determined by the whole with each part understandable only as an interdependent part of the whole. While the dominant views in medical education and practice since Flexner have given short shrift to holism, developments in psychology, laboratory science, epidemiology, physics, and many other fields did not.

		The development of psychology as a field of inquiry and clinical practice exemplifies this gap with medicine. The work of many notable psychologists from John Dewey to Freud and the gestalt psychologists such as Wolfgang Kohler and Kurt Koffka, as well as the "human potential" psychologists such as Abraham Maslow, all viewed the human being as an indivisible unit of mind and body. The essence of living, and in particular the potential or overall goal-directed nature of the organism, could not be understood unless one comprehended this unity. While each of their perspectives influenced the development of American psychology, their work extended beyond the academic and clinical realms. This has been especially true of Maslow's theories, which directly led to the development of the "human potential movement" by Carl Rogers and others. The human potential movement was instrumental in carrying the message of holism to the fields of education, management, and organizational development, as well as to the worlds of art and music during the 1960s. Thus, psychology has been influential in contributing to holistic ideas about the interpenetration of mind and body and establishing them among the public, especially among the most educated and accomplished. The growing recognition and understanding of the "placebo effect" has contradicted views that proclaim the mind and body as fundamentally separate. The placebo effect occurs when substances lacking intrinsic actions produce cures, distinguishing them from the results of "real" treatments. Although many mainstream clinicians had long recognized that part of their power to heal people derived from the symbolism and expectations both patients and practitioners brought to the therapeutic encounter, the formal recognition of that fact by medical educators and organized medicine was consistently downplayed. Remission of symptoms and cures lacking a "scientific" rationale could be dismissed as being "only the placebo effect." Mainstream practitioners have often trivialized the placebo effect, not because a suffering patient would reject being cured on that basis, but because it undermines the rational scientific approach of Western medicine. As Linnie Price put it, ''The implications of the placebo effect for medicine, then, is that it relocates healing in the realm of the irrational. . . . If the pharmaceutical industry were able to produce a drug which was as reliable, of such wide-ranging applicability, and with a record of efficacy as impressive as that of the placebo effect, it would no doubt be proclaimed as a miracle panacea and attributed to the wonders of science." Despite scientific medicine's ideological discomfort with the placebo effect, it has been the subject of much cross-cultural research as well as a topic of interest to a small number of physicians, who have described its omnipresence in every sort of medical encounter from psychotherapy to surgery. Placebos have been shown to effectively treat a wide variety of conditions, including mood changes, angina pectoris, headache, seasickness, anxiety, hypertension, depression, and the common cold. Placebos can work for years, reducing symptoms as long as the patient believes them to be "real." Additionally, placebos have been shown to mimic the effect of active pharmacological agents and to be capable of producing many of the formal traits of drug dependency. Moreover, several studies have chronicled negative side effects in patients being treated with placebos and indicated that "just as a belief that a placebo is a 'real' drug produced a 'real' effect, belief that a real drug is a placebo produces a lack of effect." These studies provide evidence that the placebo effect remains as powerful as ever in the age of "scientific medicine." Ironically, it was the cumulative efforts of medical researchers, most of whom wished to demonstrate the efficacy of a new drug or technique, that provided the strongest testimony of the prominence and prevalence of the placebo effect. According to the standards of Western scientific medicine, "proof" of the efficacy of a new drug or technique requires the use of socalled "double blind" randomized controlled trails. By using random assignment to determine whether study participants will receive either a treatment drug or a placebo, and keeping both the participant and the clinician ignorant of which subjects have received which treatments, this type of study design is considered the most rigorous means of ascertaining the "true" effect of the drug being evaluated. This approach to medical research explicitly minimized the usefulness of clinical reports of success. The entire methodology was based upon the premise that if either the doctor or the patient (no less both) knew which treatment was "supposed to'' work, it would indeed succeed. The working assumption in medical research was that the placebo effect was an overriding presence, in constant need of being excluded if any sense was to be made of proposed innovations. Yet despite this omnipresent acknowledgment of the placebo effect's ubiquity and power, little attention was given to how its impact might be enhanced for the benefit of patients, much less what it implied about the underlying assumptions concerning the relation of body and mind. In like fashion, the critique of classical physics arising from the development of "the new physics" has raised questions about the adequacy of the current scientific biomedical model. The new physics refers to the theories of quantum mechanics, based on Max Planck's theory of quanta in 1900, and relativity, which began with Albert Einstein's special theory of relativity in 1905. According to the new physics, a complete understanding of reality lies beyond the capabilities of rational thought, and, at best, physics can merely describe the statistical behavior of systems and predict probabilities. That is to say, the new physics contravenes positivism, disputing the possibility of a detached and objective science in pursuit of "absolute truth." Indeed, Bell's Theorem, a keystone of the new physics, posits that ''underneath" ordinary space-time phenomena, there lies a deep nonlocal reality in which none of the "laws" of classical physics apply. Moreover, the new physics insists that it is not possible to observe reality without changing it; there is no objective reality apart from our experience. Therefore, our experience of the event occurs at the moment we observe the event. This implies that our experience of reality is determined by our own consciousness. Thus, these developments in physics question the validity of the assumptions upon which conventional scientific medicine is based. Additionally, they transcend traditional views which hold that mental and physical phenomena are functionally different.