2.4.2 Holism and ideas about the body
Reductionist medical approaches have been criticised for providing a fixed, mechanistic view of the body, which fails to capture the patient's experience. The power associated with biomedical diagnoses and expertise means that patients’ explanations for their illnesses are often overlooked or dismissed. Does holism, which seeks to treat the mind, body and spirit, fare any better in giving patients a sense of control or ownership of what their illness means? This question is often reframed in terms of patient-centredness:
All healthcare practitioners, conventional or complementary, aim to tailor their interventions to the needs of individual patients. However, conventional practitioners generally direct treatment at the underlying disease processes, whereas many complementary practitioners base treatment more on the way patients experience and manifest their disease, including their psychology and response to illness. Treatment is ‘individualised’ in both cases, but patients’ personalities and emotions may be more influential in the latter approach.
(Zollman and Vickers, 1999, pp. 1486–7)
However, claiming that a treatment is holistic and user-centred may not make the user feel more in control, as the following hypothetical example shows.
Control and CAM treatment
A 30-year-old man visits a chiropractor, having had numerous experiences of care in the NHS, some of them upsetting and, he feels, humiliating. The first visit to the chiropractor includes an hour-long, extensive initial interview and he leaves feeling very satisfied and that, at last, someone is listening. However, on subsequent visits the appointment is much shorter (15 minutes), he undresses, receives a back treatment and leaves. This happens on several occasions and, although there is improvement, he believes the chiropractor is now more interested in treating his back and not in treating him as a person. He leaves and goes to another chiropractor who seems to spend time each session assessing how he is doing overall health-wise.
None the less, CAM does offer various ideas or explanatory models about what the body is and how it becomes ill, some of them opposing traditional biomedical notions of anatomy and physiology:
Teresa … had sought acupuncture treatment … to help with back pain which was thought to be associated with secondary cancer in her liver … she expected to have needles inserted in her back … where she had experienced pain, [but] she also had needles inserted on her calves and feet, areas considered unrelated to back pain in Western anatomy and physiology … her acupuncturist … explained that these were points on a liver meridian.
(Busby, 1996, p. 141)
Teresa's practitioner offered a view of the body according to traditional Chinese acupuncture (TCA) that she had not encountered before. In particular, the idea of energies moving around the body through meridian lines provided a different form of treatment and, doubtless, a different way of thinking about her illness. Busby (1996) goes on to discuss the way in which the notion of the body as ‘energy’ fits with some of Teresa's ideas about her own body. That is, some of the concepts of TCA were congruent with how Teresa experienced her body and thought about illness. Other therapies that explain health states by relating to energies in transit around the body include shiatsu, reiki healing, vortex healing and all healing systems that use the notion of chakras (energy centres positioned at various points on the body). With energy-based therapies, some people gain much from seeing themselves through the framework provided by the practitioner – that is, as having an energy imbalance which led to illness – rather than through the frameworks provided by GPs or orthodox medical specialists.
Other CAM therapies also provide different frameworks for understanding and thinking about bodies and disease or illness, which include the following.
Mechanical view of pain and dysfunction in the body – for instance, some osteopathic and chiropractic approaches.
Illness or disease as the product of imbalance in their systems – homoeopathy and many traditional healing systems, such as ayurvedic medicine.
Illness or disease as the product of stress, negative thinking or no longer useful subconscious processes – hypnotherapy and guided imagery therapies.
Emotions and shocks are held in the body and require healing – some osteopathic approaches, homoeopathy, massage and probably all the energy-healing modalities.
This list of different ways of conceptualising the body and illness or disease is not exhaustive, but it demonstrates the way in which CAM appears to offer a variety of ways for individuals to think about health, the body, the mind and the causes of disease. Patients can be empowered through having a sense of congruence and control in CAM therapy that they perhaps do not have in orthodox forms of medical care.
Activity 8: Who benefits from different views of the body?
Note down some reasons why health care users might gain from a different view of their bodies. Are there any ways in which a different view of their body may be damaging or distressing for a user?
Some users' health problems may not ‘fit’ orthodox care services, or their conditions may not be treated easily by orthodox means. Complementary therapy may be a chance to develop a therapeutic relationship with someone who does not even use the illness categories of orthodox care and is prepared to help with difficult symptoms when orthodoxy has perhaps ‘given up’. For instance, people diagnosed with the rheumatic illness fibromyalgia, which can lead to debilitating muscle pain in various parts of the body, often find that orthodox services have little to offer them and that some orthodox practitioners even doubt the authenticity of their symptoms. CAM may therefore give a sense of practitioner acceptance and support after what is a journey through orthodox care that is sometimes confusing, harmful or less than supportive.
So far in this extract the discussion has been about how CAM approaches to the body offer alternatives to the traditional biomedical approaches that have been criticised for making people feel out of control. From a positive perspective, new ways of seeing the body can enable users to choose those most congruent to their own personal ideas. A holistic view of the body and more equal relationships between practitioner and user could lead to a more empowering experience for the user.
However, is this experience of empowerment and congruence a feature of all CAM therapeutic relationships? Arguably, users can feel as out of control in a CAM encounter as in a conventional encounter. Numerous critics of CAM point to the way in which some CAM modalities leave little room for users' own views and can create their own sense of ‘loss of ownership’ of the body. Individuals have varying experiences of the CAM therapeutic relationship and what some people experience as empowering can for others be overbearing, bizarre or at odds with their own views of the world.
The issue of congruence and blame is very important. Some therapies are founded on the idea that different parts of the body relate to how the person feels inside. For example, the New Age ‘guru’ Louise Hay sees the body and its ailments as reflecting more general problems in a person's life and thinking (Hay, 1984). She believes the nature of illness yields clues about the person's problems. For instance, illness involving the eyes may indicate that the patient does not like what they see in their own life. Likewise, skin problems may indicate difficulties with anxiety, fear or being threatened. These views of illness or bodily malfunctions are open to a wide range of interpretations by individuals who are exposed to them. Some people use these pronouncements metaphorically, to help them see their condition in a new light and take active steps to ‘heal their life’. However, for others such an approach is at odds with how they feel and Hay's theory may seem intimidating or threatening. Some may also consider this approach to be ‘victim blaming’ in that it somehow suggests that people exhibit illness precisely because of their approach to themselves and their lives. The individualisation of illness that is helpful to some people may also demonstrate a gap between CAM practitioners’ views on health or illness and how the person receiving ‘therapy’ or advice feels.