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.