The Basic Concepts of Alternative Medicine and their Impact on our Views of Health
Dr. Stephen Fulder
Conventional medicine can be said to have been the dominant medical system in the post-industrial world for not much more than 150 years. Prior to that, although differential diagnosis was the main diagnostic method used, physicians had to compete with traditional practitioners and bonesetters, and apothecaries with Galenicists. Traditional and ancient medical concepts such as the four humours, the elements, the vix medicatrix naturae, and crasis/dyscrasis (i.e. that health is based on inner and outer balance) only went out of fashion during the early part of the last century.(1) In its short history, modern medicine has proved to be so apparently effective, and so well adapted to the industrial world view that it gave the impression that indigenous, ancient or traditional medicine had no validity, and was well-nigh extinct. In fact, this was not so. It clearly existed in the East and the Third World, and in hiding in western culture, where it took a defensive cultic posture in the face of modern medicine's self-confidence.
However in the last 20 years there has been a radical renewal of interest in, and use of, traditional or alternative medicine. So much so, that we are re-entering a period in which scientific medicine and its services share and compete for customers with alternative medicine, within a pluralistic national medicine.(2) Indeed the British Medical Association's new report acknowledges that alternative medical systems are full systems, that they are here to stay, that doctors must learn about them even at undergraduate level, and if a doctor wishes to study them, he or she must undertake a full course of instruction.(3) Alternative medicine is becoming available on the National Health Service throughout the UK.(4) The scale of the current use of alternative medicine is not always appreciated. Surveys have shown that in Europe roughly a third of the population have used alternative medicine.(5) and roughly the same proportion in the USA.(6) Polls of doctors have shown that 3/4 of British General Practitioner trainees and nearly half of those in practice want to learn one or more alternative medical techniques,(7) that virtually all doctors in primary care want alternative medicine to become fully part of national medicine.(8) In addition, where doctors work with complementary practitioners, complementary medicine is highly popular.(9) Demand outstrips supply. (10) These developments may have profound implications on the concepts of health, which will be examined below. The implications arise from a growing familiarity within society of alternative explanatory systems concerning health and disease.
Common Features of Nonconventional Medicine.
Nonconventional medicine is an aggregate term for a variety of ancient or traditional medical systems in their modern forms. They include the specialities in Fig.1 which are grouped according to broad similarity.
Fig. 1. Therapeutic Modalities of Complementary Medicine
Some of the above modalities are complete medical systems with their own diagnostic and therapeutic methods based on a unique, global and self-consistent theory of health and disease (e.g. acupuncture, herbalism, homeopathy and naturopathy). Others, (such as the physical and manual therapies) are subsidiary techniques. Practitioners of these subsidiary methods do not consider themselves to be first-call primary care practitioners. Compatibility of alternative theories with conventional medical theory also varies.The physical therapies such as chiropractic, medical herbalism and to some extent naturopathy utilise essentially conventional diagnosis together with concepts of disease which are different from, but understandable by, conventional science. For example chiropractic is based on conventional anatomy and physiology, but extends knoledge of the pathogenesis and treatment of musculoskeletal problems (such as "adhesions" and "subluxations") into subtle areas that are regarded as invisible and unproven by conventional medicine. Herbal medicine recognises and uses conventional descriptions of disease such as eczema. However it chooses medicines that affect the supposed deeper imbalances (e.g. that allergies originate in part from inadequacies in the liver house keeping functions) as well as treatments that attempt to restore proper local tissue function. On the other hand homeopathy, naturopathy and Oriental medicine employ different concepts of disease, based on an alternative world-view which is not easily translatable or compatible with scientific medicine. It has been difficult or impossible to map these systems onto conventional medicine or vice versa. Even in China, where strenuous efforts have been made, there is still no agreement on whether acupuncture meridians or Oriental viscera such as "kidney" correspond to any known anatomical structures.(11)
Characteristics of Alternative Medicine Relevant to Descriptions of Health
There are certain basic features of the practice of alternative medicine that involve a view of health radically different from that implicit within modern medicine and modern life. I would like to review some of these features here and then discuss their implications for our perspectives on health.(12). Not all therapists will employ these concepts. However they represent the foundation of authentic alternative medicine, are laid out in the texts and taught in the colleges, even if the therapy has compromised towards the biomedical model during the current struggles between various competing systems. For example many acupuncturists find themselves called upon to focus on symptoms more directly at the expense of the slower restoration of energetic balance, because of the expectations of patients who are conditioned by modern medicine to expect a fast restoration of comfort.
1. Self-Healing is Paramount. The in-built natural healing process is respected and recruited during treatment, although it is not necessarily understood. Resistance is improved by preventive measures. Particularly in Oriental and Ayurvedic medicine, a considerable proportion of traditional practice is devoted to the restoration of vital force and self-healing energy. For example in Western herbal medicine there is very frequent use of a category of herbs called 'alteratives' or 'blood purifiers'. These are herbs such as echinacea (Echinacea purpurea), cleavers (Gallium aparine), burdock (Arctium lappa), sage (Salvia spp) and myrrh (Commiphora mol-mol). They are used during the treatment of most acute and chronic infections and inflammations, along with fasting or special diets and nutrients, and other herbs to promote circulation of lymph and body fluids, all of which is intended to awaken a more powerful immune response and encourage long term immune function. Other natural remedies such as garlic or thyme may be used as natural antimicrobials, but they are not the primary tools. This is also a fundamental position of naturopathy and homeopathy.
2. Working With, not Against, Symptoms. Symptoms are a guide in the journey to a cure. They are managed, not suppressed. For example the daily ebb and flow of a symptom such as headache may be used by an acupuncturist or homeopath as a guide to the course of treatment of deeper problems with organ function. For example a migraine-type headache could be seen by an acupuncturist as arising from overactive liver metabolism (liver 'fire' or 'yang'). Real treatment involves an adjustment to the propensity of the liver to create inflammation, not merely relief of symptoms by analgesia. The type and location of the headaches (frequency, severity, vertigo, sharpness, one-sidedness, etc.) is constantly monitored throughout the treatment as a guide to the effectiveness of the draining of the liver's excess. Accompanying symptoms, such as nausea, may be an indication of the energetic state of other organ systems such as the spleen.
3. Individuality Each person's condition is different, has arisen from different reasons, against a different constitutional background, and requires a different path for treatment. Decisions are personal and individualistic, not statistical. One of the indications of the richness of the medical system is the development of a typology with which individual differences in health, disease and response to the environment can be understood. For example the constitutional picture in Ayurvedic medicine is a highly detailed art, which integrates thousands of characteristics of body, skin, personality, habits, etc. are defined in terms of Vata ('airiness'), Pitta ('fieriness') and Kapha ('wateriness') integrated. This establishes an individual's susceptibilities, strengths and weaknesses, and guides both prevention and treatment. Western (Thompsonian) herbalism by contrast does not make extensive use of constitutional differences, and modern medicine ignores it completely unless there are inherited pathologies.
4. Integration of Human Facets. Individuals are regarded 'holistically' in diagnosis and treatment. There is less a priori division between Mind-Body-Spirit or Environment-Society-Individual. 'Holism' is just one of the approaches that may or may not be incorporated within a therapeutic modality. It is not a medical system in itself, although the term 'holistic medicine' is sometimes loosely used. Alternative medicine is essentially more holistic. In homeopathy and Oriental medicine, for example, emotional, psychological and behavioural signs are always included in diagnosis. This is rather less so in naturopathy, herbalism and the manual therapies, but even here holism is often applied as an approach of an individual practitioner. For example naturopaths may encourage relaxation and imagery along with diet and herbs to treat high blood pressure. Or osteopaths and chiropractors occasionally explore the psychosocial stresses that may give rise to a repeated musculoskeletal problem in a certain patient.
5. No Fixed Beginning or Ending There is no defined or determined state of illness where treatment must begin and wellness where treatment must end. Such points are defined contextually. One patient may require assistance to reach a state of well-being and accommodation to his cancer. Treatment will finish when this is achieved, although in conventional terms he is still seriously ill. Conversely, another client may be treated so as to improve his energetic balance and condition or vitality. He may seek treatment with Oriental medicine to cope with an addiction, an energetic dullness, convalescence or even to improve Shen, i.e. to bring light to his eyes. Treatment in this case, in conventional terms, is of a healthy person.
6. Conformity to Universal Principles. Remedies are discovered and employed in conformity to patterns of relationships (such as yin/yang) between all living creatures and their environment. These patterns are often subtle and involve energetic rather than material phenomena. For example Ch'i in Chinese medicine is a tangible but invisible vital force which operates continually as the basis of all function. In Oriental medicine it is sensed and utilised in much the same way that modern man would sense and also utilise gravity. Despite the fact that Ch'i is so universal, it is enormously elaborated as an explanatory principle to describe detailed changes in function, e.g. constrained, stagnant, wild, deficient, excess, etc. of liver, spleen, kidney, etc. This is in contrast to conventional medicine, which derives from reductionist science. Therefore processes in the body are examined as discrete entities, unconnected to basic forces and elemental qualities. Consider again the use of Ch'i in the diagnosis of 'Excess Liver 'Ch'i' rising' for a migrainous headache, in contrast to the conventional medical view of 'overstimulation of local vascular serotonin receptors at the pain site'.
A Meta Model for Complementary Medicine
It is possible to summarise many of the features of complementary medicine in a descriptive, qualitative manner. The basic axioms or concepts have been given above. When put together a working model would look something like this. The human being moves through his personal time and space, which is mapped out by biological, psychological and biographical events. He is in constant dynamic relationship with his internal, familial, physical and social environment, requiring constant adjustment and adaptation. This is a learning process for both body and mind. Some health related behaviour is always required so as to harmonise this relationship, and if the disharmony increases beyond a subjectively determined limit, it becomes time to seek professional assistance, for example, if the seasons change and the person feels chronic pain in the joints. Alternative medicine functions: a) To monitor the extent of the disturbance or distortion in the psychobiological field. b) To understand the inner and outer constitutional picture of the person, and the special susceptibilities of the person to his environment. c) To evoke appropriate self-healing capacities. d) To provide remedies for both mind, body and even spirit so as to restore health in an individualistic and holistic manner, and to combine this with appropriate instruction so as to reduce susceptibility in the future. e) To halt and reverse disease processes and repair damage. If the distortion is too great, the damage too severe, the disease acute or highly infectious or life-threatening, the condition becomes more suitable for the stronger methods of conventional, allopathic medicine. In such cases the patient is usually referred by the complementary practitioner or self-referred to allopathic health care systems.
The Conventional Perspectives on Health
Within conventional medicine there are two separate kinds of health definition: the practical/medical and the utopian. The practical/medical is that found in medical texts and that which medical students learn in university. A healthy person is a symptom-free person. Symptoms are defined as abnormalities which are recognised by professionals. They are not necessarily connected to the patient's subjective experiences of illness. For example a patient with non-specific discomfort, malaise, reduced function, withdrawal, insomnia and feeling off colour may not be recognised by the doctor as being ill, and may therefore remain untreated. Even if the doctor wishes to help he may find that extremely limited treatment options available within modern medicine for problems outside its definitions of sickness. However the patient may indeed feel subjectively very ill. A specific example of this is the so-called post viral syndrome (M.E. or Myalgic Encephalomyelitis). Patients were not recognised as having a legitimate disease until they mounted an international public campaign to have their disease named and recognised. Only then could it be taken seriously in treatment and research. There has been a long critique of this biomedical description of health, beginning with Illich(13). The main points of this critique are the lack of acknowledgement of the wider influences on health, including social forces, psychological disposition, stress, etc, and the pathological bias that sees in health a simple negative, an absence of disease, which is essentially a statement that there is no such thing as health.
There are those within modern medicine, especially paramedics such as art therapists, occupational therapists, speech therapists, physiotherapists, etc., who do recognise the need to go beyond this restrictive view of health, and who attempt to expand it in practice to include function and social relations. However with only a few minutes per patient, the conventional model dominates primary medical encounters, and it certainly is the conceptual basis for secondary (i.e. hospital) care. The utopian model goes beyond this. It is typified by the definition arrived at by the World Health Organisation in its 1977 conference at Alma Ata: "A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity". It is an ultimate definition of health, determining it as the fulfillment of the human potential. However it is of limited usefulness, because modern medicine does not have the tools nor the ability to serve the human potential. There are no well-being medicines in the pharmacopoeia. This definition is unrealistic even in western countries where there is a cultural awareness of human performance issues. However in Third World countries, where most of the World Health Organization's efforts are directed, their definition is even more inappropriate as a basis for action. Modern medicine is hard pressed to contain life-threatening diseases such as malaria, AIDS, tuberculosis, bilharzia, etc. In Third World countries, well-being is often identified as having enough to eat, and easy access to clean water. Thus there are obvious limitations with both the above definitions of health.
The Folk Depiction of Health
A further perspective is that based on common sense and life experience, and it is embedded in folk culture and ordinary language. Here health is one of those terms which run right across cultural and individual consciousness like 'goodness', 'life', or 'rightness'. Everyone will define it in a different way. For example someone who has chronic pain will define health as a pain-free period. In the modern fitness movement, health will be defined as physical performance. However in traditional village cultures, health is often defined as peaceful undisturbed existence. In rural France, the average lifespan of women is several years longer than those in the US or northern Europe. They smoke, drink wine, and eat meat, and view the essence of health as being close to the family, and being able to rest and do little. They regard the fitness obsessions in the Anglo Saxon countries as driven and therefore fundamentally unhealthy.(14) Folk views of health are set by role models and cultural norms. In some cultures fatness is a sign of health, in some thinness, and European culture has had both at various times in its history. Ancient Greece viewed health as perfect bodily proportions. The American Indians viewed it as endurance to physical strain. In China health is regarded as equivalent to longevity, by definition. In India health is regarded as the luster of the skin and the shine in the eyes. All of these perspectives are partial signs of health, none is all inclusive. Such common-sense views of health change all he time and are a reflection of present-time experience. Since they are changing, and they reflect human function and well-being rather than symptoms, the folk views are closer to those of alternative rather than conventional medicine.
Biopsychosocial Descriptions of Health
There has been a movement on the fringe of medical science to break previous disciplinary boundaries and introduce social, ecological and cultural/political issues into the considerations on health and disease.(15) The introduction of new fields such as medical sociology, social epidemiology, and community medicine, imply a wider theoretical basis to disease causation and the nature of health than that described above. It has become clear that most of the major advances in health during the last part of the last century and the early part of this century were the result of hygienic social measures and not of medicine or the biomedical model.(16) Today, at a time when the main causes of morbidity and loss of life are degenerative chronic diseases which are strongly influenced by the habits of the modern world, such as smoking and chemical pollution of the biosphere, the emphasis is returning once more to the social sphere. Many studies have demonstrated that diseases such as heart disease are much higher in groups such as poor urban blacks in the USA, which are under social pressure and stress.(17) There is a complex relationship between risk factors such as obesity or smoking and social pressures, such that it is quite clear that we cannot consider individual health behaviors in isolation from the social and cultural environment. Consideration of these aspects has led to a number of descriptions or definitions of health which are based on the way humans negotiate through the sea of environmental, social and informational influences.
These concepts are often based on systems theory, since they imply a complex hierarchy of relationships. Health is a process of alignment to norms of human function and well-being that are defined by society and by professionals. Illness implies deviancy from these norms. These norms will vary from time to time and social group to social group. Health is a process, not a fixed defined condition of the organism as in the biomedical model. The process is one of dynamic balance where the capacity of the organism to self-repair, self-support and renewal is not overwhelmed by the interactions with the world within and outside the organism. The organism, in this case, is not only the individual, but also the community, and the entire socioecological system, so that one can talk about the ill-health of a group as well as of a person. (18) Health is determined by two aspects, namely the degree of distortion or stress imposed by the environment, which can be described as the 'health balance' and the extent to which the organism is able to cope, that is the resources of the individual or group available for coping, which can be described as 'health potential'. This kind of systems thinking has been very useful in developing the field of health promotion. For example the improvement in health potential of a community will include promoting nutritional status, physical fitness, immunological capacity, healthy lifestyle and health knowledge. Improving the health balance will imply actions to reduce stress in the workplace, pollution from chemicals, radiation (such as from computer screens) and noise, and social integration. Perhaps the best known proponent of the biopsychosocial concept of health is Antonovsky. He had very little sympathy with the biomedical position, not because it is mechanistic, since Antonovsky's position was also mechanistic, but because it is concerned with the individual. According to Antonovsky, concepts of disease as an external influence ignore the ability of the individual or group to cope and adapt, and concern with individual behavior, i.e. risk factors for disease, is blaming the victim. The biomedical definitions are a kind of medical imperialism in which medicine defines health according to its interests, and for the sake of its continuing power.(20) Instead he proposed that there is a spectrum from ease (salutogenesis) to dis-ease (breakdown) according to the individual's ability to cope with stresses. The stresses are generally social, and include war, lack of food and clean water, family discord, unemployment, and discrimination. Salutogenic influences would include social stability, rewarding occupations, and social acceptance and integration. Antonovsky continued by considering that the way these influences act on the individual in his world is by information. Input that is conflicting and chaotic (e.g. anxiety, persecution) or excessive ( e.g. classical stress) or lacking (e.g. isolation, loneliness) will reduce the sense of coherence of the individual in his society and create conditions of stress and dis-ease.(21) This view is the other extreme from that in which the individual is responsible for his fate. Indeed Antonovsky has some harsh words for the well-being movement, described below, which "prevents understanding the social burdens that pressure people to behave in pathogenic fashion and that block them from behaving salutogenically. From a moral point of view the focus on the 'health within' is at the very least a passive and unconscious approval of the social status quo...........the world of technomedicine is not better. This comforts me not at all."(21) As we shall see, the social and systems approach to health is a step towards the more open descriptions implied by alternative medicine, because it stresses health as a balance, an ecological process, within and without the individual.
The Well-being and Autonomy Perspective
The well-being movement arose in the United States as a response to the extreme mechanistic and reductionist position of technical medicine. It defined health as feeling good, performing well, being fit and on top of the world. It expressed an interest in the psychosomatic origins of disease, but transcended it to embrace the psychosomatic origins of health. Health is a result of consciousness, of positive thinking, of affirmation. Health is achievable by mind-body techniques, such as meditation, relaxation, dance, massage, vitamins and having a good holistic physician at your disposal.(22) The perspective here is individualistic, stressing personal responsibility and freedom. The late Norman Cousins discussed this approach in his personal journey to health, and described health itself as such a personal odyssey, a process of fulfillment, of becoming what you truly are.(23) To which Antonovsky has commented that it is all very well if you can afford it. Such observations on the nature of health have arisen from considering those people who know themselves to be healthy, and indeed arrive at health by themselves even in the face of devastating illness or social conditions. Studies of cancer patients who cured themselves or lived far longer than expected found that they seemed to get better by individualistic health promoting attitudes and practices, rather than by therapy. Psychological treatments and psychotherapy which started with the question: "what is wrong with this person, and how did she or he get this way?" were less effective than asking: "what is right with this person, what are her or his unique strengths, enthusiasm, and zest for life?"(24) In addition, there is some research on those who cope well, who are healthy and appear to live long. The qualities which appear to be expressed by such people are those of activity, exercise and energy, involvement in life and commitment to some engaging life activity, a conviction that life has meaning, and good social connecions. (25) A summary of the characteristics of health based on such surveys of healthy people, and those overcoming major health problems has been collected by Rijke (25) and is listed below:
Will to Live
Experience of meaning and purpose in life
High quality of relationships
Consciousness of inner development
Individuality: the experience of being a unique part of a greater whole
These characteristics of health are not all expressed at the same time. Indeed they suggest a superhuman psychological disposition. However research on ordinary people, the neighbour next door, does suggest that these qualities are to some extent expressed in most naturally healthy people. These qualities reveal what in Jungian terms might be described as individuation - becoming a full person. According to Rijke, the discovery and development of autonomy is crucial, and is not an easy process. It involves a realisation of a deep will to be well, and a knowledge and affirmation of that wellness. It is a freedom from a life determined by unhealthy factors towards true choosing a wholesome and constructive life influenced by benign factors. In this sense it answers Antonovsky by the stating that a person need not be a mechanical subject of ineluctable social forces, but has the ability to swim upstream, to choose and negotiate her or his way through them.
It is interesting that the 'will to be well' is a quality that is agreed even by modern medical doctors to be important in recovery and the maintenance of health. Psychoneuroimmunology has shown that depression is one of the most prevalent and devastating threats to immunity, and is certainly a major cause of general ill-health and morbidity. However the process by which the 'will to be well' manifests in health is unclear. A behavioural perspective would argue that this results in healthy behaviors and positive lifestyle changes. However one could also argue that much of the operation of the will to be well is a subconscious affirmation, like a positive hypnotic suggestion or the placebo effect, which recruits the power of life in support of health and resistance. This is certainly a part of the perspective of alternative medicine described below, and is far from the biomedical model of health and disease.
The Alternative Perspective
Health within alternative medicine is drawn from a tradition which is far more ancient than that of conventional medicine. Because of that it does not need to formulate its perspectives on health with biomedicine in mind, either in accord with it or in opposition to it. Thus it would view the symptom-based definition of health of biomedicine, the function-based definition of the WHO, the fitness-based definition of the well-being movement, the autonomy-based definitions of the psychological movement, and the systems theories of the salutogenic movement as partial and limited. It would draw on all of these as needed, but transcends them all. It is much more vitalistic and life oriented, without the need to constrain itself into western mechanistic, reductionist models of how the human being functions. The definitions of health arise from the main themes of alternative medicine described earlier. Considering these themes will demonstrate the inclusive yet pragmatic definitions of health implied within them. For example, health in Oriental medicine involves a harmonious relationship with all the energies and influences within which man is immersed. These include but are not limited to material, natural, environmental and social influences. But it also implies having a good constitutional and genetic basis, termed 'inherited energy', and corresponding perhaps to the systems theory's 'health potential'. In addition, it is recognised that health is a mind-body-heart issue, without acknowledging any boundaries between them. Oriental medicine and the major alternative medical systems never passed a Cartesian phase, so there is no need to postulate or evoke concepts like psychosomatic, or even autonomy. These are qualities observed naturally within the mind-body-heart continuum, expressed as the total energetic body of man.
In alternative medicine both patient and practitioner share an alternative world view based on the themes described above. It is a more open, contextual definition. Health is viewed, in the clinic and in the home, as a process without a beginning and end. There is no absolutely healthy person, and no absolutely diseased person. There is, rather, a journey in which greater and greater health is achieved through a combination of life wisdom and health practices. For example, alternative medicine has a major role to play in the area between complete symptom-free well-being, and actual disease. This 'third state' or pre-disease state, is viewed as a lack of health needing attention. "Why dig a well after you are thirsty?" states the Oriental medical classic: Yellow Emperor's Book of Internal Medicine. Thus some of the work of alternative medicine may be with essentially symptom-free people. Alternative medicine deals not only with disease, but also with vulnerabilities, concerning which it has a huge knowledge and a large catalogue of remedies.(27) The skills of prevention and health maintenance rely on a concept of health in which all the many subtle levels of susceptibility and risk are regarded as states of health requiring assistance.
Since conventional medicine has drawn a line at the symptom boundary it has few tools for health maintenance (apart from public health). In consequence it also lacks an operational language to assess health itself. The various states of health are describable only in common language (e.g. 'well-adjusted', 'vital', 'energetic', 'glowing') even by doctors. Whereas in alternative medicine the practitioner is able to call on a rich language to describe subtle states of health, and to differentiate these different states of health by diagnostic signs. For example in Oriental medicine the practitioner determines the flow of energy and materials through organs and the functioning of the main organ systems. He may ascertain that an organ is too 'full' or 'empty', 'hot' or 'cool', etc. The quality of the 'chi' or vitality of the organ systems may be stuck or scattered, rising or falling, or balanced, spread in the right way around the body, full, resistant, etc. In other alternative systems this subtle health measurement is made using different conceptual frameworks and languages. Thus the balance between elements or fluids is tested in herbalism and naturopathy. Health is a dynamic state where these qualities are well-adjusted, and heat, moisture, etc. are balanced and in their right proportion and location relative to the constitution of the individual. In addition there are measures of the quality of organs (skin elasticity, brightness of eyes, clarity of skin, warmth, firmness of body, lack of waterlogging, etc.) which are similar to folk descriptions and to some signs used by good conventional doctors.
Although health is relativistic, alternative medicine does have some standards. Very often these standards are set by the therapist himself who is required and assumed to be healthy. In Oriental medicine the speed of pulse and breathing of the patient can be measured against that of the therapist himself. In therapy further measures of pulse are taken which reveal the individuality and characteristics of the patient, and build a constitutional picture which would then act as a reference point. For example a patient may naturally have a very deep and slow pulse. This is his state when healthy. The therapist will attempt to raise and lighten the pulse a little by means of acupuncture so as to adjust the patient towards even better health and reduce his natural vulnerability to cold diseases. If the patients pulse became too light, erratic or fast the therapist would know a disease was brewing and be able to take corrective action.
The definitions of health employed in alternative medicine have as their philosophical basis a view of nature different from that underpinning the modern world. There is more respect for what is 'natural', meaning unfabricated and less manipulated according to transient human intentions. There is a greater sense of co-ordination with global flows of energy. There is a strong vitalism. There is a lack of urgency to construct explanatory models - an empiricism incorporating a greater sense of the unknown and respect that goes with it. This leads directly to the lack of strong interventions that characterizes alternative medicine compared to conventional medicine, and the greater trust of self-healing capacities even if they cannot be understood.
Some Characteristics of Health Arising from the Vitalistic World View of Alternative Medicine
It is not easy to give one formula describing health within the various alternative medical systems. However some features of health that are common can be listed. They give the flavour of the definitions of health implicit within the alternative techniques and traditions:
1. Living a nontoxic life
2. Being sensitive to deep signs of function and dysfunction.
3. Understanding of your constitution and its patterns and needs.
4. Tending towards a state of harmony and balance between internal and external worlds, e.g. seasons, environment, social relations.
5. Respect for the unknown, indeterminacy, the wild side of life and change.
6. Knowing health as a journey, a process.
7. Discourse with therapeutic activities: knowing when to use what remedies or professional help.
8. Vitalistic, life-affirming attitude: the will to be well.
11. Subjective sense of well-being
12. Total accommodation to life - and death.
Consider, for example, the case of a young man of 40, Dennis, who had childhood diabetes. At the age of 25 he went blind as a result of diabetic pathology. Doctors noticed that his kidneys also began to fail as a result of his diabetes. Besides attempting to keep his keep his blood glucose levels as constant as possible, there was very little the doctors could do to protect his kidneys. His doctors could only helplessly record the deterioration towards an inevitable kidney transplantation. In this case, the definition of health of Dennis was exclusively that of his diabetic symptoms, and not at all of the total energetic functioning of all his organ systems and life processes. However one day he went to a traditional acupuncturist. The acupuncturist, using a different model of health, asked how each of the organ systems were functioning and adapting to the problem of erratic glucose supplies. The acupuncturist essentially worked with the processes of adaptation within the body to strengthen them and the coordination of all the organ functions and life processes. He began to feel psychologically better, less threatened and depressed about his future, and more fit and energetic. His general health indices, including the stability of his blood glucose, improved. Then his kidneys began to improve, something that is inconceivable within conventional medical explanations. Dennis's kidneys are now fine, and he is well through the use of acupuncture and herbal and dietary treatment, although he must also take insulin. Years later, Dennis was still in good health and leading a constructive life despite his blindness and diabetes. It seems that only the subtle methods of complementary medicine can help Dennis to adjust to his disturbed glands. Conventional medicine (insulin) is keeping him alive. Complementary medicine is helping him live.
Implications of Alternative Descriptions of Health on Health Care
We are not getting more healthy today despite a massive and crippling investment in health services. In the UK, in the last 20 years, there has been a 50% increase in the percentage of the Gross Domestic Product spent on health. Yet there has been a third increase, to 34% of the population, in those suffering from long term illness, and a 64% increase in incapacity, or days of certified sickness.(28) More than half a million Americans will die of cancer this year, and cancer death rates continue to rise steadily. The US President's Cancer Panel were told, in 1993, that the "decades of war against cancer have been an unqualified failure".(29) There has been a 43.5% increase in the incidence of cancer since the 1950's, (adjusted for age), and only a small improvement in the 5-year survival rate after treatment.(30). Though life expectancy has risen, largely because of the drop in infant mortality, US statistics show a steady rise in ill-health: from an average of 0.82 episodes of disabling illness a year in 1920 to 2.12 in 1988.(31)This is the age of "the vertically ill".
Evidently something has gone wrong. All of the many people who have offered critiques of the biomedical approach have provided partial answers to what is wrong, and there is no doubt that the biomedical model is in a slow crisis and in process of change towards a more holistic paradigm, in the Kuhnian sense. Here I propose that the limitations of the biomedical model are inherent in its definition of health. This definition, though largely implicit and unconscious, nevertheless informs everything that is carried on in the name of medicine. More than that, the definition of health produces the kind of results in the population that are inherent in that definition. Thus the definition of health as freedom from obvious symptoms has created a generation which are free of obvious symptoms, but are not fully well either. The clarity with which acute sickness can be defined as ill-health compared to chronic and early stage degenerative conditions has resulted in huge numbers of chronic cases, which, as the death certificates show, are largely untreated and untreatable.
Scientists and health professionals could learn a great deal from alternative medicine about defining and measuring health. Health care today would benefit from an awareness of more meaningful ways of describing and measuring health offered by alternative medicine, for example by including constitution and the quality of vitality. It could also provide a rich source of ideas and criteria for assessment to efforts at prevention, some of which (including lower fat, raised fibre, vegetables and food supplements to lower cancer risk, the health risks of food additives) have already been acknowled by modern medicine. That new criteria for assessment are urgently required is illustrated by the example of blood cholesterol. The question whether lowering it contributes to overall health has been tested using billions of dollars of research money and many years of investigation, yet the question is still not finally decided, and official advice on this question remains ambiguous. If more appropriate assessments of health were used it would be much easier to ascertain what is healthy and what is not, for each person, and design appropriate ways of assessment of therapeutic interventions. These are some of the principles about health which could impact deeply on conventional ways of thinking:
1. Depth. Alternative medicine could provide much deeper signs of the proper functioning of the human organism, for example the voice, spread of warmth, pulse etc. could be read and utilized.
2. Individuality. The acceptance of variability and individuality would make health definitions more valid and realistic. The nature of individual variation can be learnt from alternative medicine.
3. Constitution. This essential basis of all medicine has been lost in conventional medicine and needs to be relearned.
4. Process. Alternative medicine could provide knowhow on how to track more sensitively the change of health through time, for example an understanding of the various stages in the process of healing and recovery.
5. Respect. Alternative medicine can teach a way to have respect for the patient's own natural processes and experiences, including the natural processes of being born, being alive, and of dying. This is possible because such life and death processes come within the implicit broader definitions of health.
6. Expansion. Alternative medicine can contribute health practices and actions which begin before the disease state, and end after the point of so-called incurability, where conventional medicine runs out of options.
Alternative medicine is rapidly increasing in popularity. As its conceptual basis is prior to, and in many respects opposite to, conventional medicine, it provides a challenge to it which has not yet been accepted. Alternative medicine's concentration on healing the healthy as well as the sick, and its familiarity with the origins of disease on the ground of human life, give it special skills at understanding states of health. It sees health as a process which is intricately related to the way a constituion and personality develops through time within the matrix of all the influences and relationships that are experienced.
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