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HOLISTIC MEDICINE: A NEW PARADIGM FOR THE 21st CENTURY
A Philip Walton
(Certificate in Studies in Complementary Medicine, Alternative Therapies Explained, Warwick Uni.)
When Thomas Kuhn wrote "The Structure of Scientific Revolutions" in 1962 he coined the phrase "Paradigm Shift" to describe the ways in which scientific theories change to accommodate new empirical findings. Derived from the Greek, for ‘pattern’ a paradigm can best be defined as "a basic theory or conceptual framework, within which (scientific) theories are constructed". It is a network of basic factual and methodological assumptions which are accepted and defined without question. A paradigm defines the limits of valid practice and also applies to other areas of culture and thinking e.g. religion, politics etc.
Modern orthodox medicine owes its origin in no small part to the influence of 17th Century philosopher, Rene Descartes (1596 –1650). It was Descartes whose Mathematical background led him to postulate a reductionist approach to the workings of the human body and who first separated the body (rex extensa) from the mind (rex cogitans). He concluded that in respect of human understanding, only thoughts mattered, (Cogito, ergo sum – I think, therefore I am.)
Taking this concept forward, successive medical philosophers and practitioners, including Isaac Newton and John Locke, have developed what is recognisably the modern medical paradigm of a subset of physiologically separated disciplines dealing with component parts of the human body, e.g. haematology – dealing with blood, cardiology- dealing with the heart, obstetrics – dealing with pregnancy and the reproductive female processes, with research undertaken in all of these disciplines to contribute to a greater awareness of how the body functions and based upon loosely the mechanical principles of interactivity that predominated at the time i.e. horology and clockworkings.
The successes of his logical reductionism have borne fruit in science ever since and modern civilisation owes its vast development to the Cartesian ethic.
Human beings however, are not machines, a point not lost on the Great Victorian thinkers and scientists such as Faraday and Darwin among others. The developing realisation that people could not be so simply reduced was highlighted by increasing empirical research evidence discovering how biological evolutionary processes influenced human activity and which were not embraceable by the old paradigm. It was Einstein and the early 20th century empiricists who concluded that in the physical world matter exists only relative to time and space and – crucially- energy, that has precipitated the greatest contemporary challenge to established science ever seen. Measurable observations of distortions in the fabric of space resultant from gravitational forces have thrown the old paradigm into disrespect. A new paradigm incorporating new findings is now evolving and necessarily includes a holistic integrationist approach to understanding the workings of the healthy and ill human body.
This is particularly relevant to the original Cartesian dichotomy of body and mind. In 1968 Thomas Szasz wrote "The Myth of Mental Illness" in which he argued powerfully against the idea that there was such an organ as the ‘Mind’ which could be ‘Ill’ Of course, since Freud and the early 20th century psychologists, the presumption predicated on Descartes’ philosophy had prevailed. Now the challenge that what we were really witnessing was the organic functioning processes of the Brain were becoming increasingly recognised. To what extent this reflected the integrated function of all the other component parts of this holist body and its interaction with the world still remains to be agreed.
What then is the contemporary evidential position? And what is meant by "holism"?
Holism refers to the concept of the whole person being the interactor with his/her environment. The accent is on wellness as opposed to illness and presumes an equilibrium of forces maintaining a stasis of functionality. An imbalance in the individual’s equilibrium results in observable symptomology which is therefore amenable to a restoration process.
Traditional medical approaches emanating from non-European sources reflect the Holistic ethic. In Chinese medicine, the central concept of the "Dao" underpins the philosophy of health. Dao is a way of life in which one is constantly monitoring one’s own energies. The quest for balance of energies is pivotal in gaining a deeper understanding of oneself. From the Dao devolves the twin notions of "Yin" and "Yang" as well as the "Five Element Theory". Essential to Chinese medical philosophy is the concept of Qi or Chi. This is the Life-Force or Energy which is affected by variables including weather, seasons, food, heritability etc.
Treatment is based on the diagnosis by careful pulse assessment (where the meridians converge) and sometimes protracted observation of the tongue, voice, manner; by history taking and lifestyle analysis to identify imbalances in the systems in the body. By stimulating points on the body - which are understood to be joined by twelve energetic meridians - either Acupuncture (using needles) or Shiatsu (use of finger pressure) can bring about beneficial changes.
Attention is paid particularly to the five elements, Fire; Earth; Metal; Water and Wood. Each of us is assumed to have varying proportions of these in our make-up. Shortfalls or excesses of any elements indicate the need for treatment aimed at restoring balance. Certain elements are considered Yang and others, Yin. Descriptive aspects relating to Yang are: light, active, energetic, expansive, hot and masculine. Aspects of Yin are: dark, restful, earthy, substantial, contracting, water, cool and feminine. So for example, a person with an impoverished fire element, characterised physically by pale or yellow skin tones and possible cardiac or intestinal and digestive disorders may present lonely and despondent exhibiting a greater propensity for depressive illnesses and associated problems. Treatment would target these deficiencies by increasing heat in for instance spicy foods and vivid activities. In Traditional Chinese Medicine, herbal remedies would also be made up for patient use.
By contrast, but also incorporating Five Element concepts Indian or Ayurvedic medicine, while recognising the idiosyncrasies of the individual identifies three ‘body types’. This can be defined as one’s individual world, or personal reality, including physical, mental and emotional states and their variations in different external situations. Ayurveda (which derives from "Ayur" =life and "Veda" = knowledge) assumes that mental and emotional events leave a marker on our physiology and shapes the body as they ‘talk’ to it. It further defines three ‘ Doshas’ – meeting places between mind and body, where thoughts turn to matter. Each dosha is related to a physical location in the body which is typically affected by our thought processes. Perfect co-ordination between mind and body therefore leads to balanced doshas and therefore health. Poor co-ordination and therefore imbalance leads to illness. The three Doshas are Vata, Pitta and Kapha.
Vata represents movement, e.g. breath, circulation, digestion, nerves. Pitta represents metabolism, processing of food, water. Kapha represents structure, holding cells together, muscle, fat. We contain elements of all three types, but often one will predominate and lead to problems if it is out of balance. The Ayurvedic practitioner will identify body and dosha type thereby advising how to restore balance. They may suggest Marma Therapy an ancient form of neuro-muscular stimulation of marmas – interfaces between body and mind.
Another example of Holistic medicine – and perhaps the most widely known- - is Homoeopathy. This system of medicine relies on powerfully stimulating the body’s Vital Force to bring about a cure for illness. In 1810, Samuel Hahneman, a German physician, published his "Organon of the Art of Healing". Disgusted by the errors and uncertainties of orthodox medical practices at the time, he conceived of an entirely new system of medicine, namely Homoeopathy, deriving from the Greek: Omeos – similar, and Pathos – suffering. Its radical central view was that the treatment of illness should be with something that produces an effect similar to the suffering, wholly contrary to the established medical position that treatment should suppress symptoms. Through a series of experiments on himself and colleagues which he termed, ‘ provings’, Hahneman discovered the Law of Similars which was, ‘Like cures Like’. He postulated that this bore out earlier medical writers’ findings, those of Hippocrates and Boulduc. By diluting his remedies to levels of seeming non- existence 1 : 100,000 Hahneman showed they were in fact more potent in alleviating illness. He suggested that this was because the influence of the substance had become energetic which in turn positively adjusted the Vital Force by its action. Indeed, the Homoeopathic view of illness was that there had been a derangement of Vital Force by the dynamic influence of a ‘morbific’ agent – either a micro-organic invader or some intrinsic susceptibility, a ‘miasm’.
Treatment, as with all holistic approaches, is shared by the practitioner and patient. Often a new lifestyle is recommended doing away with old patterns of behaviour and introducing new ways of living. The process can often also be time consuming, but the results can be dramatic, especially where orthodox methods had given up hope.
Many of the remedies used in homoeopathy are derived from plants. This in turn derived from the earlier widespread application of Herbalism or use of plants and their extracts in healing. This process has been documented worldwide and throughout history. Indeed, many of the key players who have contributed to the pre-Cartesian understanding of medicine have been herbalists. Hippocrates (460 –377 BC), Dioscorides (100AD) who wrote De Materia Medica – the standard reference text for nearly 1 and 1/2 millennia, Galen (131 – 201 AD) and perhaps most renowned, Thomas Culpeper who published his famous work in 1652. Latterly, Aromatherapy has emerged as a direct descendant of the applied herbalists and is currently enjoying great popular support.
The traditional use of herbs and plants in proprietary remedies owes its origins to the efforts and observations of generations of monks who propagated ‘Physic’ gardens and applied their findings to injured and wounded soldiers of many conflicts. The early anti-septic properties of Marjoram and Thyme developed here. Today the Chelsea Physic Garden remains as a flourishing tribute. It was started in 1673 by The Worshipful Society of Apothecaries. Modern drugs e.g. Valium, Digoxin and Quinine have developed from their plant origins, valerian, foxglove and cinchona.
Variants – together with more powerful efficacy and regrettably, side-effects, have been chemically mutated to become the current pharmacopoeia of modern medicine.
That there is widespread disillusionment with orthodox medical methods of the post-Cartesian period gives rise to the belief that perhaps the ‘technical experts’ capable of mechanically fixing bodies while not meddling with personal issues are no longer perceived as doing a proper job of healing. Not enough time or attention is being devoted to the very essentially personal interaction necessary between healer and patient for the effect to take place. In fact, patients are voting with their feet. In the developed economies, e.g. the USA up to 40% of the population have chosen to consult complementary therapists.
In the end, however, what may demolish the old paradigm and consolidate and advance the position of Holistic Therapies is for holistic practitioners to use a scientific strategy and adopt an attacking style. For a long time, practitioners of orthodox medicine have been ‘attacking’ complementary therapists with one of their staunchest weapons, arguing that, unlike modern medicine which is based on scientific evidence, complementary medicine cannot be relied on because claims of its effectiveness remain untested. However, the strength of argument is now weakening and practitioners of complementary medicine feel less intimidated by such attempts to undermine their practice. There are two reasons for this: firstly there is a growing realisation within healthcare that the practice of orthodox medicine is just as lacking in evidence-based information as the practice of complementary therapy. (Maynard 1994). This is not a counter-attack by complementary therapists. In fact, this admission is voiced from within the ranks of medical practitioners. A publication by the British Medical Journal pointed out the scarcity of research information to show that intervention is likely to lead to benefit is well known (Delamothe 1994). Calman (1994) added that, " in the absence of such research evidence, clinical decision-making about intervention tends to be based on judgement and peer opinion." In the same publication, Mulley (1994) pointed out that, even when evidence of trials is available, this often applies only to a narrow range of patients. This highlights a known but rarely admitted problem in health care, that of widely untested practice which is based on judgement rather than scientific evidence leading to wide variations in treatment. Indeed Maynard (1994) claims that many, if not the majority of procedures to which patients are exposed by health care practitioners have little, if any, scientific basis while others have argued that the use of research and / or its influence on health policy, has been minimal, " as rare as to be negligible" (Hunter and Polit 1992). Similarly, Blumenthal (1994) reveals that many patients receive different treatment(s) even when suffering the same clinical condition. There are striking variations in surgical interventions for prostatectomy, hysterectomy, tonsillectomy and carotid endarterectomy in their population-based rates between neighbouring small areas and between countries.(McPherson 1994) If orthodox medicine is practised on the basis of scientific evidence as is claimed by its practitioners, such variations defy explanation. In view of such admissions, it seems incredible that medical practitioners have been trying to undermine the practice of holistic complementary medicine because of its lack of an appropriate evidence base. In any case, a false rationale does not , of necessity, preclude clinical effectiveness. (Ernst 1994).
Secondly, as complementary medicine becomes more established, there begins to emerge a growing body of evidence, based on different research approaches including, ‘Randomised Controlled Trials’ (RCT) – the gold standard insisted on as the criteria for good evidence by medical practitioners ( Long & Harrison 1996) to demonstrate the effectiveness of complementary therapies. The following are a few examples: An RCT revealed that Aromatherapy and massage can be effective in reducing physiological and psychological stress after cardiac surgery. (Jackson 1995); similarly, both Homoeopathy and Acupuncture are effective treatments for psoriasis (Jackson 1996; Liao and Liao, 1992); massage effectively reduces anxiety and tension (Wilkinson 1996) while Reflexology is useful in managing pre-menstrual symptoms (Oleson and Flocco 1993). Aromatherapy has been found to be effective in reducing stress and improving sleep pattern (Cannard 1996). Such trials clearly demonstrate the value of at least some methods of complementary therapy.
In conclusion, there is little doubt that the popularity of holistic therapies will continue to grow. However, such growth need not be viewed as a threat to modern medicine but as a complement to it. Health care professionals, irrespective of their different contributions to individual patient care, and developments in treatment in general have a common aim: the well-being of their patient. Modern and Complementary medicine can best achieve this by working in tandem rather than against each other. By this process, ultimately can the paradigm shift to Holism in the 21st Century be painlessly effected.
20th April 2000
Maynard A. (1994) – Nursing Management 1 (4) , 9
Delamothe T. (1994) – Outcomes in Clinical Practice BMJ pp ix
Calman K. (1994) - ibid pp 1 – 12
Mulley A. (1994) - ibid pp 13 – 27
Hunter and Polit (1992) Journal of Public Health Medicine 14 163 – 8
Blumenthal D. (1994) New England Journal of Medicine 531, 1017 – 18
Williams M. (1994) in T. Delamothe above pp 56 – 69
McPherson K. (1994) ibid pp 80 – 84
Ernst E. (1997) Circulation 906 (3) 1031 – 33
Long A. and Harrison S. The Balance of Evidence London, Macmillan.
Jackson A (1995) Nursing Times 91 (36) 44
Jackson A. (1996) Nursing Times 92 (5) 44
Liao S. And Liao T.A. (1992) Acupuncture and Electrotherapy Research 17, (3) 195 – 208
Wilkinson S. (1996) Nursing Times 92 (34) 61 – 64
Oleson T. and Flocco W. (1993) Obstetrics and Gynaecology 82 (6) 906 – 911
Cannard G. (1996) Complementary Therapies in Nursing and Midwifery 2, 38 – 40