Wholistic Integrative Care
by Daniel J. Benor
- Complementary/ Alternative Medicine
- Integrative Care
- Wholistic Healing
There is a heightened interest in integrative care - the blending of complementary/ alternative medicine (CAM) with conventional medical practice. On the one hand this is motivated by patients' demands for services that complement conventional medical care, and on the other hand by health care providers' awareness of economic opportunities and to a lesser extent by their awareness of the benefits of complementary therapies.
Wholistic approaches empower patients to participate in their own health care. They enhance the integrity and the spirit of dignity in the healing encounter between patients and caregivers - who are increasingly under pressures of time and monetary constraints that are eroding their roles as carers. Complementary therapies introduce philosophies and methods of health care that promote whole-person care and acknowledge the place and needs of the caregiver in this process.
While a growing number of medical and nursing schools have courses on CAM, many presentations lack important elements of these approaches. For example, very few courses focus on wholistic approaches that consider the person who has the illness rather than upon the illness the person has. In addition, the courses often focus on complementary therapy methodologies (e.g. inserting acupuncture needles at certain points to control pain) without the associated CAM philosophies of health care.
CAM introduces five broad themes
1. CAM therapies are potent interventions that can enhance health and help to treat many illnesses that conventional medicine has limited means to treat. Illnesses that can be helped include allergies; arthritis; asthma; heart disease; backaches, headaches, and other pains; irritable bowel syndromes; menopausal problems, urinary tract dysfunctions; neurological disorders (including post- traumatic brain disorders, such as cerebral palsy and strokes); cancers; AIDS; chronic fatigue syndrome; and many more.
Members of the public are rapidly learning the benefits of complementary therapies and are voting for them with their dollars in a big way. Several surveys have shown that just about as many dollars are paid (out of pocket) for complementary therapies as are paid (mostly out of insurance) for conventional medical care. Public pressure has been a major driving force in accelerating the pace of development of integrative care.
2. Wholistic and CAM therapies offer ways to humanize
medical care. Both health care professionals and the public
often complain about the dehumanization of conventional medical
care. In the name of efficiency, and under the combined intense
pressures of information overload, departmentalization/ mechanization/
bureaucratization of medical care, and financial pressures, doctors
and nurses are being limited in the types of treatments they can
offer and in the units of time per patient allotted to provide them.
a. Patients are dehumanized by conventional medical care. Patients are stripped of their responsibility for their own care when they come for examination and treatment. They are expected to follow the routines, orders and prescriptions of institutions, of doctors and of nurses and hospital orderlies without question. Under this system, you are described as "the chronic backache in bed 7" rather than "the person with the backache in bed 7."
Members of the public are also choosing complementary therapists because they feel that doctors focus too much on their diseases and too little on themselves as people. CAM therapists spend 30-120 minutes per session with their clients, compared to 10-30 minutes for visits to doctors. Conventional medicine focuses on your symptom and disease management of your medical or surgical problems, while CAM therapies focus on you as the person who has the problems.
Some nurses and doctors who are sensitive to this aspect of medical care take wholistic approaches - which they might identify as good bedside manner. However, very little of wholistic philosophy is taught in medical schools. Under financial pressures nursing staff have been eliminated and the work load of the remaining few nurses has been increased and has been shifted towards more administration and less direct patient care. Nursing schools are more sensitive to this, but many nurses find that they are unable to apply these principles because their jobs have been pared down to focus increasingly on mechanized ministrations to patients' physical needs, with little time permitted in their schedules for attention to psychological and spiritual needs.
b. Health care professionals are dehumanized by conventional medical care. Medical and nursing students very frequently complain that their professional studies are stultifying and dehumanizing - discouraging and squelching their idealism and sensitivity to feelings in themselves and in their patients.
Excuses are given by medical educators that the enormous load of information that must be studied in medical and nursing school leaves no time for "inessentials" such as discussions of stresses and feelings. Nursing and medical students are expected to ignore their feelings about patients, such as anxieties about caring adequately for their patients, dealing with patients' grief, and dealing with fears about their own mortality -- again with the excuse of time constraints.
The same applies to doctors and nurses after graduation. The pressures of heavy workloads and clinical responsibilities are taken as excuses for not budgeting time for self-care. This is certainly a major reason why medicine as a profession has one of the highest rates of burnout, depression, alcohol and drug abuse, and suicide.
Wholistic healing emphasizes self-care of the caregiver as a preventiion to such problems. Self-care that includes wholistic integrative care introduces health care practitioners experientially to these approaches.
3. Wholistic, integrative care empowers you to assume greater responsibility for your self-care. Conventional medical care disempowers people from taking responsibility for their own health. Health care professionals are the diagnosticians and prescribers of treatments for problems.
Wholistic approaches provide whole-person care - addressing people rather than diseases, caring rather than curing, using all possible therapeutic modalities rather than a limited few, and empowering respants wherever possible to use self-care approaches and to be active participants in decisions regarding their health.
The very word patient suggests a passive person who patiently waits for treatment. Bernie Siegel proposes that we use the word respant, designating people with problems as responsible participants in their own care.
4. Wholistic integrative care awakens and nurtures intuitive
and spiritual awarenesses.
The western medical model is mechanistic and reductionistic. It assumes that physical causes will eventually be identified for all illnesses, just as they have been with infectious diseases, hormonal, and genetic disorders. It is a linear, either-or model.
Wholistic and integrative approaches are both-and models. While they acknowledge the contributions of conventional western medicine, they also include contributions of emotions, mind, relationships (with people and the environment), and spirit as vital factors in health and illness.
Wholistic care introduces concepts and practices that include the body-mind and person-spirit aspects of health and illness.
The importance of intuitive and spiritual awarenesses extend far beyond the therapeutic encounters of individuals. These awarenesses are vitally needed to address the ills of society and of Gaia, our planet.
5. The philosophies of wholistic integrative care
enrich the lives of health carergivers and respants. Wholistic
includes the cultural traditions and philosophies that accompany the complementary therapies. In many cases these suggest lifestyle changes - such as diet, meditation, yoga, and the like - that you may find pleasant and helpful.
Many clinics and hospitals now offer some CAM modalities. Growing numbers of medical schools are offering courses in complementary/ alternative therapies. For the most part, aspects of these therapies are transferred into the medical model and are presented as methodologies that address symptoms. For example, acupuncture, chiropractic, and osteopathy are used for pain; Chinese herbs for eczema; and so on. The rich theoretical and philosophical contributions of these therapies are largely ignored, as well as the understanding of dis-ease that contributes to disease.
Knowing that there is an alternative to the Western medical model, particularly as it is practiced under managed care, may alert you to new, productive, more satisfying options through integrative care. There are many such models and practices.
Guiding philosophy for Wholistic Integrative Care
Terminology informs, guides, and shapes the actions of therapists and public. Particular attention to terminology will be given to clarifying new ways of conceptualizing and approaching health care.
Integrative Care: Allopathic Medicine combining with CAM Therapies.
Allopathic Medicine: Conventional, Western medical care as provided in the average hospital, medical clinic, and private doctors\' offices.
Complementary Therapies: Term for therapies such as acupuncture, chiropractic, homeopathy, massage, osteopathy, yoga and many more approaches. I prefer this term over the more frequently used Alternative Therapies. Complementary promotes collaboration of colleagues using allopathic and complementary therapy approaches, working as equals for the benefit of people needing help. This term is the essence of a both/ and approach to health care.
Alternative Therapies: Term most commonly used for what we are calling Complementary Therapies. Alternative suggests that people have to choose between types of therapies on an either/ or basis. I feel this term is divisive and promotes competition rather than collaboration. The term is also used to denote methodologies transferred from the various complementary therapies and applied for symptom management within allopathic medical frameworks.
Complementary/ Alternative Medicine (CAM): Synonym for Complementary and Alternative Therapies.
Wholistic Healing Approaches and Therapies: Approaches that seek to bring people to a state of wholeness in body, emotions, mind, relationships (with other people and the environment), and spirit. The "w" is inserted to distinguish these approaches from another usage for holistic therapy -- the application of methodologies taken out of context from their rich philosophical and cultural frameworks and applied piecemeal as techniques for symptom management, without acknowledging or applying the guiding theories and philosophies that properly should accompany them.
Body-mind Therapies: Approaches that assume that the mind, emotions, and body are an integral unit in health and illness.
Spirit: That part in each of us that is known (and can only be known) intuitively, with an inner knowing that is immanent and transcends logic, that connects with the vast worlds of material nature and of noetic (beyond words), transpersonal/ Divine realities. The spiritual is invariably distorted when it is translated into words.
Soul: Term used by some to indicate an enduring aspect of life that survives physical death and incorporates the lessons the spirit learned into an enduring consciousness. (Others may reverse the meanings of spirit and soul as defined here.)
Bodyspirit Therapies: Approaches which assume that the soul and spirit incarnate for lessons in the school of physical life, and that illnesses, emotional difficulties, and relational challenges are such lessons.
· Addressing the person rather than merely treating
her or his problems
· Including body, emotions, mind, relationships,
· Dis-ease is addressed along with disease
· Health awareness and prevention of illness
· Caring and curing are emphasized equally
· The person who is the therapist is as important
as the therapeutic modality used
· The recipients of care are full participants in their
own care and treatment
Wholistic care addresses the person who has the disease rather than the disease the person has.
Western medical practice has tended to specialize in treating various parts of people. Several factors have contributed to this trend:
First, the overload of medical information makes it impossible for any one practitioner to master all aspects of medical care. Specialists can master certain parts of medical knowledge and develop treatment skills to much greater degrees than generalists.
Second, greater technical skills and efficiency are developed when teams of health care professionals specialize in narrower aspects of medical and surgical care.
Third are the personal preferences of practitioners. Health carers may find greater interest in medical, surgical, psychotherapeutic, social, or spiritual aspects of their patients.
Fourth, medical training focuses heavily on physical causes of disease and often does not prepare health care professional to deal with psychological causes and concomitants of acute, chronic, and terminal illnesses.
While the sub-specialization of medical practice may suit the treatment preferences of practitioners and may promote efficiency in medical management, many patients complain, "There is no one who addresses me as a whole person. I am a person with an illness, not just an illness. And I have all sorts of problems around the illness that are a part of the illness and need addressing just as much as the physical part of the illness does."
This is one of the main reasons why people are paying billions of dollars annually out of their own pockets for complementary therapy treatments.
Wholistic medicine addresses the whole person - body, emotions, mind, relationships (with other people and with the environment), and spirit, assuming that each component may need attention individually but that each is intimately related with all of the others. Emotional or relational problems may bring about stress reactions in the body. Physical conditions may influence psychological states and alter relationships. Spiritual upliftment may make difficult emotional and physical problems more tolerable. We tacitly acknowledge this in our language, as the origins of the word heal are in the Germanic and Old English roots of haelen, "to make whole."
Many complementary therapists practice within wholistic frames of reference. For instance, acupuncture assumes that proper balances in subtle energies within the body and diet are vital to health. Homeopathic clinical histories may require two hours of explorations concerning a person\'s personality, stresses, lifestyle, family history, and relationships, in addition to very detailed explorations of symptoms, history of illnesses, immunizations, and more. A broad range of hands-on therapies views the body and psychological states as a unity, sometimes referring to this as the body-mind. These include many types of massage, reflexology, Applied Kinesiology, Healing Touch, Therapeutic Touch, Reiki healing, and more. Some practitioners of these therapies also focus upon spiritual awareness in their interventions.
Clients of many complementary therapists are often as pleased with the fact that someone has taken the time to listen to them as with any of the specific therapeutic interventions they receive.
However, not all complementary therapists have a wholistic approach. Some apply various methodologies in a mechanistic manner, focusing primarily upon symptoms and not on the whole person.
Self-care is strongly emphasized in wholistic treatment. Diet, abstention from harmful substances, exercise, relaxations, meditation and imagery exercises may be prescribed as essential aspects of treatment.
The role of the wholistic health care professional is often that of a model, a counselor and a companion in the journey of life -- as much as that of a therapist and advisor.
When you bring a problem to a wholistic therapist, one of the first questions you may be asked is, "What do you think this symptom or illness is saying?" This often leads to a discussion of stress factors, dietary and lifestyle considerations, and support systems that you may be able to alter in order to improve your condition. "Who is the pain in your neck?" or "What do you think your stomach is grumbling about?" may bring into focus some of the ways in which people somatize their stresses or unhealthy lifestyles.
De-stressing is a major focus of wholistic care, both as a treatment and as a preventive health measure. Learning to deal with illness is another focus.
Caring is emphasized more than curing. Although complementary therapies may add many options for treating illnesses, the wholistic approach emphasizes caring for the person as the highest priority. The caring and counseling skills of the therapist are often as important as their knowledge and skills in their particular therapeutic modality.
Death is accepted as a natural part of the life process. People are helped to understand and anticipate the process of dying, to make living wills in which they specify the measures they wish to have applied to themselves when their physical and mental health may be severely impaired.
The physical and psychological wellbeing of health carers is of great importance in wholistic care because the carers are themselves instruments for enhancing the wellbeing of patients. Wholistic carers believe that one of the most important ways of introducing holistic approaches is to model for their patients that which they wish to teach.
Wholistic carers often follow many of the self-care practices that they advocate, such as diet, exercise, and various ways of de-stressing.
Wholistic care encourages carers to find peer support and supervision that enables them to de-stress from the burdens of clinicalcaring. De-stressing enables carers to be more available for their respants, to deal with the responsibilities and stresses of clinical care, to empathize with patients\' emotional distress, and to model for respants how to deal with problems.
Wholistic care is much more a set of attitudes and ways of being than a set of methodologies. Those carers who have adopted wholistic approaches usually find that their lives are substantially enriched and their ways of coping with stress are markedly enhanced. However, this approach may not appeal to every health care professional.
Copyright © Daniel J. Benor, M.D. 1999
P.O. Box 76 Bellmawr, NJ 08099
Reprinted with permission of the author.