Conventional medicine as a reductionist system

It might be easy to comment that conventional medicine is a purely reductionist health system, and this is often suggested in pejorative tones by proponents of complementary health disciplines. It is true that many of the ideas of modern medicine have sprung from the reductionist view of the world that dominated scientific thought in the 18th to 20th centuries. The ‘Linnaean’ approach to classification of illness, which modern doctors use to define disease according to body system, is one good example. The tendency of doctors to specialise so that their focus is directed at single body systems or subsystems is also evidence of this approach. Medical training largely focuses on the diseases of body parts and diseases of the mind, and categorises them as distinct entities that merit defined and agreed treatment approaches.

However, an ever-deepening scientific understanding of the workings of the body and the mind over the latter part of the 20th century has begun to erode the more simplistic reductionist approach to disease. Increasingly, conventional practitioners recognise that the different body parts and the workings of the brain are inextricably interrelated and interdependent. Moreover, factors such as social class and standing, education, ability to deal with stress, and general happiness are now recognised to have very powerful effects on health and well-being. The healthy human being is no longer seen as a well-oiled machine that responds to a regular service of all parts. Instead it is seen as a complex entity, the health of which depends on delicate physiological internal relationships and on relationships that exist within the context of the community in which the individual is placed.

This more holistic perspective of health is expressed clearly in the 1948 constitution of the World Health Organization, where health is defined as ‘a state of physical, mental and social well-being and not merely the absence of disease or infirmity’. The medical model can now more accurately be described as a biopsychosocial model in which biological, psychological and social determinants are readily accepted as contributing to the development of disease. It is also now accepted that treatment focused on a body symptom in isolation may not deal fully with the real root of the problem.

However, there remain important differences, and these can lead to misunderstandings between practitioners of conventional medicine and practitioners of those complementary health disciplines that hold to a more holistic perspective. One author and alternative medicine practitioner has summarised the differences between ‘alternative medicine’ and conventional medicine as shown in Table 1.3a-I.

Table 1.3a-I A comparison between alternative and conventional medicine according to Gascoigne (2000)

This rather stark comparison perhaps unfairly places conventional medicine firmly in the reductionist camp. However, the comparison does illustrate some key differences between the conventional medical view of health and healing and those of medical disciplines such as Chinese medicine, Ayurvedic medicine, homeopathy and craniosacral therapy. All these disciplines adhere to concepts of a vitalistic principle and the interrelationship of the physical with spiritual as well as emotional and mental levels of health.

The major difference here is that modern medicine does not hold to the idea of a unifying vitalistic principle and a spiritual level of health. While modern medicine understands that the mind can affect the body, and vice versa, it attempts to explain this in terms of neural and endocrine connections rather than by means of a non-measurable energetic principle. In conventional medicine the two domains of mind and body are in practice not seen as totally enmeshed and interdependent, as the levels of health are understood to be from the more holistic medicine viewpoint.

A discipline such as Chinese medicine, for example, recognises that when the Heart is imbalanced, then symptoms will always manifest in the physical, emotional, mental and spiritual realms. A conventional practitioner will be less ready to make this claim. A conventional doctor may be very ready to accept that heart disease can lead to low mood and troubled thoughts, but the conceptual link made between the two will be less immediate. For the conventional medical doctor, the low mood of a patient with heart disease will be more a result of having to deal with the pain and disability that accompany heart disease and of carrying the weight of a poor prognosis. This contrasts with the holistic practitioner’s expectations that a disease of the heart will manifest naturally in the realms of emotions, mind and spirit because these are part of what defines the function of the Heart.

However, while the stereotypical conventional and alternative practitioner may practise within very different conceptual frameworks, this does not necessarily mean that either has a more accurate grasp of an absolute truth. This book has been written from the perspective that conventional and complementary practitioners are working with different aspects of the same essential truth.

A helpful analogy is that of a concert violinist and a sound engineer who are both listening to a performance of a violin concerto. The concert violinist may be attentive to the sensitivity of the interpretation of the music, and may be deeply moved as he listens. The sound engineer may recognise the physical characteristics of the harmonics she hears and can comment on the acoustics of the concert hall. No one can deny that they have both been listening to the same piece of music, but their ‘philosophies’ for interpreting the music mean that their individual perceptions, what they actually ‘hear’, will differ markedly.

This is the case when a complementary and a conventional practitioner consider health and disease in an individual. Both can offer valid insights about what is happening for that individual, although it is not always the case that either comprehends or can appreciate the view of the other (see Q1.3a-3).

It is important to recognise, however, that no practitioner, nor indeed medical practice, is wholly reductionist or holistic in focus, although the conventional/reductionist, complementary/holistic labels are frequently misused in this way. Many conventional practitioners adhere strongly to the holistic management of their patients, and many complementary medicine practitioners practise in a way that relies on a reductionist conceptual framework as its foundation (see Q1.3a-4).

For the patient seeking appropriate healthcare, it is important to recognise that the philosophical framework of any medical practitioner will have both strengths and weaknesses. Just as the violinist and the sound engineer both have a great deal to contribute to the production of a beautiful musical performance, so practitioners with different medical and philosophical frameworks can have truly complementary insights and skills to offer in promoting healing. Clarity about where these strengths and weaknesses lie will enable a patient to make an informed choice of medical treatment appropriate to their specific needs at any particular time.

Tables 1.3a-II and 1.3a-III summarise some of the potential advantages and disadvantages of seeking treatment from complementary and conventional medical practices. These lists have been drawn up from a patient’s perspective. Not all patients want to be actively involved in their treatment, nor wish to have their world view challenged, and both these things may occur in some complementary therapies. This explains why a statement such as ‘Requires the patient to be active in changing lifestyle to enable healing’ is listed as a possible disadvantage of complementary therapy, and ‘Treatment is not expected to challenge the patient at a deep level’ as a possible advantage of conventional medical treatment.

Table 1.3a-II Complementary medical treatment: advantages and disadvantages

Table 1.3a-III Conventional medical treatment: advantages and disadvantages

Being clear about the distinctions between the philosophical foundations of conventional and complementary thought is essential when practitioners of different medical disciplines seek to develop a meaningful dialogue. It is important to be both clear and respectful about essential differences, and avoid the tendency to overgeneralise. This clarity becomes perhaps most useful in building up relationships with patients who have complex health needs, many of whom are likely to benefit by receiving the best aspects of treatment from contrasting medical perspectives.

Suppression of symptoms

The concept of suppression of symptoms in homeopathic theory refers to the idea that the disappearance of symptoms or signs of a disease may not necessarily mean ‘cure’, but instead may be a consequence of the disease moving to a deeper, less immediately manifest level. This concept has a parallel with the Chinese medicine idea of disease having a manifestation (Biao) and a root (Ben). According to Chinese medicine theory, treatment that is targeted at the level of the manifestation, and which does not simultaneously attend to the root causes, may actually lead to a worsening of the root imbalance.

The Chinese medicine description of treating the manifestation is analogous to the homeopathic idea of suppression. In both there is a suggestion that, although treatment may cause an alleviation of symptoms, there may be a worsening of disease at a deeper level. In Chinese medicine, however, this is most often seen as not attending to the factors that cause the root imbalance, as a consequence of which it will become more pronounced and may generate further symptoms. Homeopaths take this a stage further, and argue that the symptom may actually serve a useful purpose by providing some sort of release for the deeper root imbalance. When it is prevented from serving this purpose, it may directly cause the root imbalance to deepen and be expressed in a different and potentially more damaging form. In both cases the unattended root imbalance is believed to create more serious problems.

Figure 1.3b-I illustrates the complementary medicine concept of suppression. The bathtub with a running tap has a problem; it is leading to a dripping overflow pipe, and thus causing damp to the exterior wall. This ideally would be treated by turning off the taps, the root of the problem. However, someone outside the house might be tempted to deal with the manifestation of the problem. They could stop the dripping overflow and allow the wall to dry out by blocking the overflow pipe with a cork. This treatment would indeed solve the problem of the dripping pipe, but of course would result in a more catastrophic problem inside the house as the bath then proceeds to overflow onto the bathroom floor.

Figure 1.3b-I • An illustration of the concept of suppression.

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