1.3 Comparisons with alternative medical viewpoints
Estimated time for chapter: 90 minutes.
This chapter is intended to promote the recognition that different health systems are built upon unique philosophical perspectives of the physiology of the body and pathology of disease. The approaches can be broadly categorised as ‘reductionist’ and ‘holistic’. There are crucial differences between these two approaches, and without asserting that either has greater or lesser value, these differences need to be clarified before the work of trying to compare one discipline with another can begin.
The term ‘reductionist’ refers to the principle of analysing complex things by considering them in terms of a collection of parts. Simply speaking, a reductionist view of the body will tend to examine and describe the workings of individual parts, without necessarily having to draw upon an understanding of the working of the body as an integrated whole. From a mechanistic perspective, this is similar to the approach of the engineer who, by identifying and replacing a faulty part, such as a distributor or fuel pump, can transform a faltering vehicle into an adequately working model. The process involves testing clearly defined systems within the malfunctioning vehicle and then identifying and making good the faulty part.
From a reductionist perspective, the body may be viewed as akin to a wonderfully intricate machine. In this model, illness or disease in one part of the body will not necessarily be manifest in or experienced by other parts. The faulty part will, however, like the vehicle, trigger warnings in the form of signs and symptoms, and the diagnosis of disease is then made by a thorough examination of all body parts and systems. The whole assembly is just a collection of individual parts, no more and no less.
By contrast, the term ‘holistic’ is used to refer to a view that sees each part of a complex system as being inextricably linked with all the other parts of the system, and the whole system being more than just the sum of the parts. A problem in one part will resonate widely throughout the system. Furthermore, this immediately brings the non-material aspects of life into the equation, the thoughts and emotions that form a part of the ‘whole person’. Some medical systems that might be described as holistic according to this definition are underpinned by the idea that the individual parts are linked and vivified by an underlying non-measurable energetic state. This energetic state is made manifest in the material body, but is more than just the physical body. This understanding of an underlying state has been described as the ‘vitalistic principle’. Terms such as ‘life force’, ‘Qi’, ‘Ki’ and ‘Prana’ are used to describe this energetic state in different health disciplines (see Q1.3a-1).
With a holistic model of health, the body, the emotions, the mind and the spirit are seen as interdependent and intercommunicating. An illness of the body will impact on the function of the emotions, the mind and the spirit, and, conversely, a sickness of the spirit or mind will have repercussions that become manifest in the physical body.
This belief is the basis for diagnostic systems that focus on just one body part such as the pulse, tongue, iris, sole of the foot or abdomen (hara). The interconnections within the body, mind and spirit will mean that every illness is reflected throughout all parts of the system. By following diagnostic systems such as these, the focus of a skilled practitioner on a single body part is understood to reveal information not just about the health of the body but also about the state of the mind and spirit (see Q1.3a-2).
One important corollary of this ‘holistic’ view of health is that symptoms of a disease may become manifest in a different body part, or indeed at a different level, from that in which a disease first developed. For example, the grief following a bereavement, which might be expected to be experienced at an emotional or spiritual level, may instead manifest in the body in the form of an asthma attack or skin rash. These emotional or spiritual correlates of physical disease are of great interest to many holistic practitioners. Some go as far as to suggest that all physical diseases have emotional or spiritual roots, and that some diseases consistently reflect specific emotional or spiritual ‘blocks’. A pain in the shoulders, for example, may be considered to represent a difficulty in shouldering the burdens imposed by a busy and complicated lifestyle.
The idea that symptoms are expressions of imbalances throughout all levels of the body, emotions, mind and spirit has implications when symptoms are treated medically. From a holistic perspective, if symptoms are not treated at their root origin then any other treatment of them may be described as suppressive. If the root imbalance persists, then it makes sense to a holistic practitioner that it will find an outlet at another body site or within another level of the body. This idea, that symptoms suppressed in this way might re-emerge in a different form at a different body site or level, is a concept that is not tenable within a purely reductionist health 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.
|Alternative medicine||Conventional medicine|
|Patient centred||Disease centred|
|Symptoms are useful pointers||Symptoms are to be removed|
|Disease is a group of symptoms (a syndrome)||Disease is a fixed entity|
|Cure is a move towards balance||Cure is removal of symptoms|
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.
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.
Self-test 1.3a Contrasting philosophies of health
2. Alice is a gardener and has a lot of work to do. She is finding that hay fever is really reducing the effectiveness of her work. The antihistamine tablets prescribed by her doctor do not seem to touch the problem. She turns to acupuncture as she has heard it has good results in hay fever.
2. It is likely that Alice has a conventional view of health, as her first choice for treatment was the conventional drug, an antihistamine. She may well be hoping that acupuncture can likewise suppress her uncomfortable symptoms and let her get on with her life. This could have the following consequences:
Estimated time for chapter: 120 minutes.
Chapter 1.2c introduced a method of categorising drugs by mode of therapeutic action and the concept of iatrogenic disease (illness as a result of medical treatment). This chapter presents some complementary perspectives on the beneficial and adverse effects of drugs in the body. It also describes some principles of mapping Chinese medicine concepts to western medical theory. These are explored in some detail under the heading ‘The Rationale and Method Used for the Mapping of Western Medical Diagnoses to Chinese Medicine Theory’ in the Note to the Reader contained in the preliminary pages of this book.
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.