1.9 Models of health care delivery: alternative or holistic models
Many CAM modalities have grown from a wide range of concepts of the body and health and healing that differ from the models discussed so far. As Fulder notes:
The body, in Chinese medicine, is energetic. In yoga and healing, the body is spiritual. In modern (conventional) medicine, the body is physicochemical. In homeopathy, it is phenomenological. In naturopathy it is vital, etc. All of these conceptions do not necessarily overlap with each other.
(Fulder, 2002, p. 395)
These examples demonstrate some of the diversity of concepts within and between CAMs and suggest that finding a model to encompass this diversity is difficult.
CAM embraces nearly 200 different forms of healing modalities. This suggests a considerable diversity of theories, philosophies and therapies (Furnham and Vincent, 2000). Fulder identifies the following common beliefs underpinning CAM.
Self-healing is paramount
Working with, not against, symptoms
Integration of human facets
No fixed beginning or ending but a continuum of wellness/illness
Conformity to universal principles, whereby remedies are used in conformity to patterns of relations between all living creatures and their environment.
(Fulder, 1998, pp. 148–50)
However, Fulder also points out that not all CAM therapists use all of these concepts. Even if they underpin traditional forms of treatment, there may be reasons why practitioners do not practise them, including: people present symptomatically; therapy has made concessions to secure political advantage – for example, osteopathy has become progressively less distinct from allopathic medicine (Johnson and Kurtz, 2002); or practitioners hold different health beliefs from others in their particular therapeutic group.
CAM has replaced much of what was previously considered ‘folk medicine’. Folk medicine provides mechanisms for coping with ill health as part of the wider context of dealing with misfortune and anxiety. In doing so, it overlaps significantly with cultural and religious beliefs held by the society in which it operates. Arguably, these phenomena are now incorporated into, and form part of, CAM's attraction.
[C]ontributing to the recent reconsideration of alternative medicine is a societal acknowledgement of cultural, religious, and ethnic diversity. This dissolving of a single modernist medical narrative has formed an increased awareness of medical pluralism. The old cultural war of a dominant culture versus heretical rebellion in politics and religion as well as medicine has begun to transform into a recognition of postmodern multiple narratives. Also, alternative medicine may provide a vehicle for establishment medicine to become more consumer-savvy and to ‘placate’ public dissatisfaction with such perceived mainstream health care problems as the impersonality of medical technology or the absence of robust patient–physician relationships. In addition, emerging economic and legal forces undoubtedly play a huge role in the recent rapprochement. Perhaps because it is beleaguered from battles on other fronts, orthodox medicine has simply abandoned its crusade against alternative medicine.
(Kaptchuk and Eisenberg, 2001, p. 193)
By rejecting the either/or thinking characterising the biomedical model in favour of multiple realities or ‘ways of knowing’, CAM allows for a wide variety of belief systems and cosmologies. These approaches may offer a congruent way of meeting the full range of health needs of people whose cultural beliefs about health are overlooked in the biomedical approach.
Traditional health care systems represent philosophical approaches to managing health and disease that differ substantially from those of Western biomedicine. The question of what is common to these traditional systems has been largely overlooked, but spirituality is an integral part of each. As this trait is often directly related to the dominant religion or philosophical system of the originating culture, it is taken for granted within the context of health care. For example, the ancient Chinese health care system was influenced by several spiritual schools, in particular Taoism. Ayurveda, a traditional medical system of India, reflects the traditional Hindu world view. Similarly, Tibetan physicians practice Buddhist meditation as an integral part of their medical training.
(Eskinazi, 1998, p. 1621)
CAM therapies originating from a different culture do not have the same potency, value and efficacy when practised in a culture dominated by biomedicine. Joan Engebretson points out:
As these techniques have been taken out of the cultural context of their historical and geographical or ethnic setting, the techniques are often used without a full understanding of cultural or philosophical underpinnings, beliefs and values.
(Engebretson, 2002, p. 178)
CAM is not homogeneous. Not all practitioners subscribe to every underlying principle. Some therapies claim to be more holistic than others (just as many general practitioners try to practise holistically). Watts (1992) maintains that, while virtually all orthodox medicine is underpinned by the same theoretical foundations, complementary medicine is the product of either many philosophies or none. A bewildering variety of sometimes contradictory ideas coexist, ‘their various exponents apparently untroubled by what, to the outsider, seems hopelessly chaotic’ (Watts, 1992, p. 106). There is also a dearth of research on the views and beliefs held by CAM practitioners. Individual practitioners may have personal views and philosophies that are at odds with mainstream thought in their particular therapy. The wide variation in practitioners’ health beliefs is described in the next section.