Holism

Holism

		Holism is the belief that entities are greater than the sum of their parts. The belief that individuals must be seen in the totality of their lives permeates alternative medicine. Signs or symptoms are not isolated phenomena to be treated. Rather, the entire physical, emotional, spiritual, and social makeup of the person must be considered. The centrality of this belief to most modes of alternative practice is so pronounced that many people prefer to use the term "holistic medicine." Because holism directly contradicts the beliefs in dualism and reductionism that are central to biomedicine, it is holism, most fundamentally, that separates alternative medicine from the premises of the conventional biomedical model. Holism has two fundamental implications for a system of healing. The first, and most frequently described, is the belief in the interpenetration of mind, body, spirit, and the larger environment. Because this tenet is so crucial, it is discussed at length below. However, holism has an even more fundamental implication as well: the uniqueness of the individual. Holism rejects any separation of the mental and physical realms of life and requires that each individual be seen in terms of his or her uniqueness. In this regard alternative medicine is distinguished from mainstream practice by a matter of degree. Holism is a theme in conventional medical practice, but a relatively minor one. Most mainstream practitioners would concur that individuals are each one of a kind, defined by their own genetic inheritance, personal history, and social position. Nevertheless, in most situations, acknowledging this individuality would have relatively little to do with which specific therapy was offered for a particular set of symptoms, or with the basic understanding of the pathologic processes behind a particular disease. For alternative practitioners, treatment and pathology are often as unique as the person seeking assistance. As Gordon has written, "Each person will require a different approach—different forms of exercise, a different diet, a different pharmacological treatment, and different kinds of psychotherapeutic interventions. One asthmatic adolescent may best be treated in a group that runs several miles a day. Another may be seen in the context of a systems-oriented family therapy. The first may work out her anger and improve her vital capacity through daily running. The second may diminish her anxieties and increase self-confidence through biofeedback techniques." In practice, this emphasis on the uniqueness of the individual permeates alternative medicine, and for many clients is a source of great comfort. For example, homeopathy, a system of treating symptoms with minute doses of substances ("remedies") that in greater amounts would bring on the symptom, offers an extensive and highly personalized diagnostic encounter with the homeopath. According to homeopath Harris Coulter, "Homeopathy holds that the key to the 'wholeness' of the patient, and of the remedy, is found in their peculiarities or idiosyncrasies—in other words in the factors that distinguish this patient and this remedy from other patients and other reme dies that are similar but not the same as this one." In its essence, this view calls the entire biomedical classification of disease into question. Homeopaths and other alternative healers emphasize the immense diversity in symptoms reported by individuals suffering from the same condition or disease: arthritis, gastrointestinal distress, PMS, asthma, etc. They ask why the malady is taking the specific form it has in a particular individual. The biomedical model accepts symptomatic variation (and indeed even documents it) but justifies the clumping together of symptoms on the basis of an underlying physiopathology. Increasingly, alternative modes of care accept this view but raise questions about what it means. Homeopathy is not opposed to acknowledging that arthritis is usually initiated by a chemically induced inflammation. It asks, Why were these chemicals released? Biomedicine answers by citing a problem in the immune system. But, what caused the immune system to malfunction? Homeopathy says the answer will be different for each individual, as it will for the root cause of high blood pressure or any other condition. Linda Johnston, a well-known homeopath, writes, "Modern medicine doesn't bother speculating about the unknown initiating cause of symptoms. . . . Doctors usually want to know just enough to enable them to eliminate the symptoms. . . . These efforts seem beneficial to the patient, however, the disease causing the symptoms has not been cured, it has only been blocked . . . similar to putting a dam across a river." Each of the major systems within alternative medicine holds beliefs that are almost identical to those of homeopathy about the importance of individuality in assessing and treating illness. Ayurvedic medicine is a traditional Indian system of healing that uses diet, exercise, meditation, massage, herbs, light, and breathing techniques to treat illness by restoring inner harmony of body, mind and spirit. The best known practitioner of Ayurveda in the United States is Deepak Chopra, who states that "an Ayurvedic physician is more interested in the patient he sees before him than in his disease. He recognizes that what makes up the person is experience—sorrows, joys, fleeting seconds of trauma, long hours of nothing special at all. The minutes of life silently accumulate, and like grains of sand deposited by a river, the minutes can eventually pile up into a hidden formation that crops above the surface as disease." Traditional Chinese Medicine (TCM) is a three thousand-year-old system that combines acupuncture, diet, massage, herbs, and other treatments to enhance and restore health. The techniques that comprise TCM all explicitly reject treating specific symptoms. Rather, they view problems as reflecting the character of the individual, as expressed through combinations of "yin" and "yang," complementary interpenetrating forces that are reflected in bodily functions and organs and exert their energy through twelve bodily meridians. Naturopathy is a healing system that emerged from the European tradition of herbalism and spa cures, as shaped by the American experience of the Kellogg brothers and their Battle Creek-based sanitarium and health food business. Today its practitioners, licensed in a number of states, utilize a melange of techniques including herbal medicine, hydrotherapy, physical manipulation, homeopathy, and many others. Despite its eclectic nature and the absence of an overarching theoretical system, there is explicit consensus about the necessity of focusing on the person, not on symptoms or disease. This conceptualization is essentially identical to that of TCM. Holism is the most commonly held premise among all alternative medical systems. It is also a view that resonates strongly with fundamental values in American culture regarding the importance and uniqueness of the individual. In this affinity with a core American value, holism offers a connection to the nation's history and collective psyche. This linkage gives alternative medicine the opportunity to present itself as the embodiment of the most legitimate of the culture's goals: allowing individuals to freely assert their individuality

The Core of Alternative Medicine: Age-Old Wisdom Made New

The Core of Alternative Medicine:
Age-Old Wisdom Made New

Attending an alternative medicine conference, scanning the titles shelved under the heading of alternative medicine in a "megastore," or "surfing the net" for sites related to alternative medicine can be both an overwhelming and a puzzling experience. The sheer volume of what is readily available, no less its vague boundaries and overlapping categories, are, at best, confusing. Beyond the rhetorical tides of some of the most popular works (Total Health; Everyday Miracles; Ageless Body, Timeless Mind), the wide range of approaches, techniques, and philosophies encompassed is striking. There are specific healing techniques such as aromatherapy, flower remedies, massage, guided imagery, and acupuncture. Then there are entire systems of medicine: Traditional Chinese Medicine (TCM), Ayurvedic medicine, naturopathy, homeopathy, and mindbody medicine, among others. And there are other things that would seem to be more than a specific technique but less than a fully developed system of medicine, such as qigong, yoga, and herbal medicine. Finally, there are the so-called "New Age" phenomena like crystal healing and psychic healing, which defy simple classification.

		What, if anything, do these have in common? One thing they have in common is that they have typically not been taught about in American medical schools, not been utilized by most physicians and hospitals, and not reimbursed for by most in surance plans. A definition of alternative medicine based upon what it is not is therefore both accurate and convenient. It avoids the need to become embroiled in conceptual questions about the assumptions that underlie words like "health," "illness," and "healing." Not surprisingly, it is this straightforward empirical approach to defining alternative medicine that is used by the federal government and mainstream medicine. The Office of Alternative Medicine at the National Institutes of Health defines alternative medicine as ''an unrelated group of nonorthodox therapeutic practices, often with explanatory systems that do not follow conventional biomedical explanations." In the study conducted by Daniel Eisenberg and his colleagues that appeared in the prestigious New England Journal of Medicine and is the most frequently cited academic report on the subject, alternative medicine was defined as "medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals." Historically, there has been no alternative medicine, but rather many alternative medicines, each separate in its own mind. Practitioners of these alternative modes of care have often viewed each other competitively and acted accordingly, practicing in isolation from one another. Until recently, the various forms of alternative medicine had only been linked negatively by more conventional groups as health fraud or quackery. Organizations like the American Medical Association have been quite willing to describe the approaches now called "alternative medicine" as united by their ignorance, foolishness, and irrationality. But to define alternative medicine only by what it is not avoids important questions about its fundamental nature as well as that of mainstream medicine. The power, prestige, and authority, not to mention financial rewards, accrued by mainstream medicine have typically been justified by its practitioners as emerging from the application of scientific rationality to medical practice. Whatever is taught in medical school, or prac ticed on patients, is assumed by the general public to have some scientific basis. If a specific technique can become "mainstream" simply by its inclusion in a mainstream institution such as a medical school, what role does that leave for scientific rationality as an arbiter? Accepting an exclusively residual definition of alternative medicine may be pragmatically useful, but it is not very helpful in understanding the larger questions about the differences between mainstream and alternative medicine. More importantly, for our purposes, accepting a residual definition alone makes it difficult to understand the growing power and popularity of those techniques and approaches that comprise alternative medicine. If there are underlying themes within this cacophony of concepts, approaches, and techniques, then starting with the assumption that they do not exist will make them harder to find. There is no shortage of alternative medical practitioners who emphatically state that there are underlying commonalities to the wide range of alternative techniques. A number of earlier academic observers have been able to extract a coherent set of common themes from their studies of the topic. However, to specify a conceptually cohesive set of common elements does not necessarily indicate that they are apparent in the everyday practice of alternative medicine. Thus, in laying out the essential core beliefs within alternative medicine (and they are not radically different from those set out by others), my goal will be to show how they pervade the diverse range of alternative techniques and approaches. In order to assess whether or not a cohesive set of core beliefs underlies alternative medicine, we should keep in mind a sense of perspective about the real world. A core set of beliefs in the practice of alternative medicine will likely be no more sharply defined and operational than are core beliefs in the practice of mainstream medicine. In the latter we find brain surgery, psychopharmacology, medical genetics, and psychoanalysis coexisting along with scores of other specialties. Such variety doesn't preclude a common set of beliefs in biomedicine. Rather, it indicates that not every practitioner or specialty relates to these beliefs in the same way, or to the same degree. This is likely to be true in alternative medicine as well. Some observers of alternative medicine have seen only a hodgepodge of practices and points of view, and scoff at the notion that the phrases "alternative medicine" or "holistic medicine" characterize a uniform set of beliefs. As one such researcher commented, "No uniform set of holistic therapies can be identified . . . so much diversity exists among the proponents of holism that it can scarcely be considered a single movement." But, a far larger group of commentators, both favorably and unfavorably inclined toward alternative medicine, have discerned an underlying set of core beliefs or assumptions. Although most observers agree on the existence of a core set of assumptions, there is little consensus on what they are or how many there are. For example, James Gordon, a sympathetic physician writing in 1980, described seventeen distinct elements of what he called "the paradigm of holistic medicine." Almost a decade later, two social scientists, Kristine Alster and June Lowenberg, independently specified twelve core elements operating as "statements and slogans" and "parameters of the new model of holistic medicine" but agreed with the items on each other's list only half the time. More recently, Robert Buckman and Karl Sabbagh found eight "philosophical attractions" common to the work and beliefs of alternative healers, and Bonnie Blair O'Connor found nine "concepts common to many vernacular health belief systems'' in her study of alternative medicine. Yet again, however, the lists are in agreement on few of the terms. This initial appearance of inconsistency is somewhat misleading. A closer reading of these works, and many others, soon reveals that they use a wide array of dissimilar phrases and terms to express a relatively small number of commonly held ideas. A few central themes appear over and over, sometimes with vary ing emphasis, with elements combined in some schema while distinct in others. Those who have studied this phenomenon do not differ over whether a core set of beliefs exists, or even what these beliefs are. Rather, their differences of opinion revolve around to what extent these core beliefs are actually manifest in alternative medicine as it is practiced in the real world. The relationship between theory and practice is what needs to be ascertained. In my view, there are six significant points that distinguish alternative medicine from the medical mainstream: a belief in holism; an emphasis on the integration of body, mind, and spirit; a view of health as a positive state on a continuum with illness; a belief that the body is suffused by the flow of energy; a belief in vitalism; and a distinctive view of the healing process.

The Synergy of Complaint: Birth of a Grievance

The Synergy of Complaint:
Birth of a Grievance

A time like our own, when intensive criticism of medicine has become widespread, offers the potential for even more fundamental critiques and proposals for change. It has not been lost on observers or practitioners that the longstanding critiques of Western medicine as mechanistic, reductionist, and technologically biased can be joined with the recent criticisms of high cost, limited access, inefficiency, and therapeutic ineffectiveness. Taken together, the impact of both sets of criticisms is more than the sum of the parts. If medicine is not only too costly, inaccessible, and ineffective but also fundamentally wrong in its most basic assumptions about the nature of illness and healing, significant improvement can only come through a major change in how we think about health and healing. The problems are so great that a solution will require the emergence of what some have termed a new "paradigm."

		The relatively common use of the terms "paradigm" and "paradigm shift" is traceable to Thomas Kuhn's The Structure of Scientific Revolutions. Kuhn used examples from physics to rebut the idea that scientific change came about through the consistent and gradual accretion of knowledge among experts. Rather, Kuhn asserted, change was generated in bursts—as the accumulation of facts or insights that disproved existing doctrines took hold among researchers who were outside the scientific mainstream. These outsiders focused their thoughts and theories on the inevitable gaps or lapses in what the dominant perspective could explain. A new paradigm was "revolutionary" in Kuhn's view because it aggressively pointed out the deficiencies of the old ways of seeing, and because it offered a new way of understanding in place of the old. The extent to which the new paradigm helped people understand something heretofore incomprehensible would determine its success. Kuhn himself was surprised, and eventually somewhat aghast, at the way his descriptions of changes in physics became used to describe changes (or proposed changes) in many arenas of intellectual and social life. It was far from clear to Kuhn that something as vast as "medicine" was very much like the small world of theoretical physics. Still, both advocates and observers of alternative medicine use Kuhn's terminology in describing the "paradigm shift" to a new "medical model." For example, Deepak Chopra writes, "Each assumption of the old paradigm can be replaced with a more complete and expanded version of the truth." In his call for ''a new medical model," Kenneth Pelletier asserts: Medicine, based upon Newtonian physics, has adhered for some time to one mode of scientific inquiry with inherent assets and often-unacknowledged limitations. . . . Holistic approaches to health parallel the insights of quantum physics in that both supplant the Newtonian reductionist view of the world with the quantum perspective of a dynamic universe. From this new paradigm derive the philosophical and scientific roots for the practice of holistic medicine. In using this language, these and many other alternative practitioners "suggest that a holistic approach to health care is so original that it qualifies as a paradigm shift, that is, an entirely new way of characterizing and approaching the problems of a given discipline." Whether or not alternative medicine does offer a truly new paradigm is open to question. In part the answer lies in specifying whether those who advocate an "alternative medicine" hold a common set of conceptual understandings. This is the subject of the next chapter. But, the answer depends as well on the ability of the new paradigm to successfully respond to the gaps or failures of the dominant biomedical paradigm. An "alternative" paradigm requires something to which it is an alternative. In this respect it differs from a paradigm that claims to be "holistic," "complementary," or "integrative." It is the very ability to point out, emphasize, and respond to the vari ous failures of something else that energizes and gives a raison d'etre to anything that is self-consciously "alternative." Alternative medicine does represent a new paradigm in that it provides a new framing of ideas about illness and the health care system. Situations and circumstances that were previously seen as uncomfortable or unfortunate now are conceptualized as being wrong or unjust. For example, the standard biomedical approaches for treatment of chronic illness and suffering arc not just perceived as inadequate but as grievously and unacceptably limited. Alternative medicine offers the sense that the current situation is riddled with contradictions and that something else, something better, is possible. The future of alternative medicine hinges on its ability to prove that such an approach to health and illness does exist. But, the opportunity for alternative medicine to make its case at this point in history derives from the extent, depth, and acceptance of the notion that existing forms of conventional medicine have come to place an unreasonable burden upon society and hinder our ability to respond to illness. The phenomena described in the following pages are called by many names: holistic medicine, mind-body medicine, East-West medicine, complementary medicine, integrative medicine, and more. The advocates of each term are cogent in offering reasons for why their particular choice best encapsulates the underlying principles of the techniques they use. Often, these advocates disdain the term "alternative medicine" because of its residual character. Alternative medicine is what conventional medicine is not. From a purely clinical perspective this reasoning may be sound, if not persuasive. But the phrase "alternative medicine" best captures the role and meaning of these techniques and approaches to healing in relation to the larger society.