Holistic medicine is “human” medicine

Advancements in medicine and technology over the past 300 years have given us an insight into the intricate cellular and mechanical complexities of the human body. Science has seemingly explained a world far apart from ancient systems of thought where magic, religion, emotion, and medicine were undifferentiated.

The material and mechanistic view of the human body that developed led to the separation of the spiritual and emotional dimensions from the physical body. The human body became treated as some kind of frozen anatomical structure, a “biochemical machine” that somehow learnt to think, and the epiphenomenon we call consciousness was thought to be produced through the “dance of atoms”— thought was believed to be the byproduct of matter.¹ Such a materialistic view has been controversially expressed by the evolutionary biologist Richard Dawkins: “What are all of us but self-reproducing robots? We have been put together by our genes and what we do is roam the world looking for a way to sustain ourselves and ultimately produce another robot child.”

The reductionist model

The social scientist and historian Michel Foucault noticed that as developments in science and medicine progressed, a parallel transformation took place in the way that the body was organised in medical thinking. As disease mechanisms became better understood, the doctor’s role became that of inquisitor, searching out the vast multitudes of signs and symptoms. Thus the patient became an object of medical study, and the body as a medical object became an entity separate from the body as a person. Foucault called this phenomenon the medical or clinical gaze.²

Objectifying the human body with the “medical gaze” made possible the empirical study of disease. This approach was undoubtedly beneficial as it aided in the development of therapeutic and management strategies to combat illness. However, one could argue that adopting such a materialistic model of the human body has led to medical strategies aimed at developing “magic bullets” to cure illnesses of an assumed materialistic nature. For example, people who have an infection are prescribed antibiotics; those with insomnia are given sleeping pills; cancer patients are offered chemotherapy, radiotherapy, or surgery; patients with chest pain may be given glyceryl trinitrate (GTN). However all these interventions are simply dealing with symptoms and at best interfere with the mechanisms of disease and not their origin.¹

An increasingly medicalised society has its negative effects. Bacteria often develop antibiotic resistance. In the 30 years from 1975 to 2004, the overall age standardised incidence of cancer has increased in Great Britain by 25%.³ This increase may be exaggerated because of improved screening and detection programmes, but cancer is still on the rise, despite ongoing research and improvements in treatment. In 1994 it was estimated that iatrogenic morbidity—disease occurring as a direct result of seeing a doctor—affected 2.2 million people in the United States. Most of these cases resulted from medically prescribed drugs. Of these patients 106 000 had fatal reactions, making iatrogenic disease the fifth most common cause of death in America.⁴

This is not to say that science does not have a crucial role in medicine. Scientific competency is a fundamental quality of being a doctor. But by limiting yourself to a “disease centred” or “biomedical” model of illness, you run the risk of neglecting both the body’s potential for self healing and a holistic approach to the patient’s wellbeing. In the 4th century BC, Socrates warned against treating only one part of the body “for the part can never be well unless the whole is well.”

It is unscientific to separate treatment, the patient’s physiology, and the patient’s feelings and inner experience. The emergence of relatively new fields like behavioural medicine and psychoneuroimmunology offers insights into how the mind, internal dialogue, and feelings are intimately wired into our bodies and affect our susceptibility to illness and recovery.⁴

Psychoneuroimmunology

In a 1984 study, blood samples were taken from medical students on the first day of their final exams and compared with samples from the pre-exam period. Natural killer cell activity was significantly lower in the second sample, providing direct evidence of immunosuppression in a young, stressed, and otherwise healthy population. Natural killer cells are vitally important in preventing the development and spread of tumours, so the changes in these cell levels may indicate a pathway by which stress could increase the risk of malignant disease.⁵

Other studies have shown that when people expect to receive a stimulant drug but are given placebo, their heart rate and blood pressure change as if they had received the stimulant. Changes in immune activity have also been documented. Placebos have been found to induce or alleviate inflammatory reactions of the skin.⁶

The hormonal system also shows the intricate relationship between mind and body. In the 1920s, Walter Cannon’s work revealed the direct relation between stress and neuroendocrine responses in animals; he coined the phrase “fight or flight.” Stress activates the hypothalamus-pituitary-adrenal (HPA) axis, leading to the secretion of various hormones. Circulating immune cells have receptors for these hormones, which when activated can alter their number, function, and distribution.⁷

One of the ideas that psychoneuroimmunology has shed light on is that our immune cells are “thinking cells”—when the brain thinks, it speaks in the language of neurotransmitters or neuropeptides. Immune cells such as B cells, T cells, and macrophages not only have receptors for these communication molecules but also secrete them.⁷ The immune system can be thought of as a circulating nervous system, further emphasising the inseparability of mind and body.

Psychoneuroimmunology has shown that the communication between mind and body is complex and multidirectional. The reductionistic approaches that isolate bodily systems or their components in an attempt to understand the variables that cause disease will thus continually fall short in helping us understand how a complex system operates in its natural context.⁶ In a sense, psychoneuroimmunology reasserts early ideas about the fundamental unity of the organism and accentuates that health rests on proper balance, paving the way for a more holistic approach.

Shifting to a holistic model

Despite ever increasing medical technology, every year about 40% more patients in the West are seeking complementary or alternative medicine (CAM).⁴ In America in 2003, almost 1 in 5 adults reported using one or more mind-body therapies.⁸ Why is this? I informally interviewed several patients about their experience with doctors and found recurrent views. For example, a 40 year old woman who had a prolapsed intervertebral disc in November 2005 has had several operations and been prescribed a multitude of drugs for pain relief, for problems sleeping, and even for constipation resulting from all the other medications. When I asked her what she thought about her doctors she responded,“I feel as though the doctors are only interested in operating on my back and getting me out of hospital as quickly as possible. They ignore me as a person.”

She has been unable to work for almost two years and currently has depression caused, she feels, by a lack of quality of life. Although she respects that “the doctors know best,” she believes her feelings and factors affecting her quality of life are unimportant to the medical establishment.

Implications for medical students

Medical students are taught basic investigative techniques, practical procedures, and how to diagnose various forms of signs and symptoms, but how often are we taught the basic skills of human interaction: empathy, communication, observation, and humanity? Perhaps as medical students we must take the responsibility to continually develop these skills, but courses in holistic medicine could have more prominence in medical curriculums. Such courses should be aimed at making students more aware of the body’s capacity for natural healing and approaches to patients as a whole, not at a cellular biochemical level.

Over the past few years there has been an increase in courses familiarising students with complementary and alternative medicine by giving students options in special study modules. At the University of Southampton, modules in complementary and alternative medicine are used as an opportunity to revisit basic assumptions about attitudes and values in medicine through a reflective learning process.⁹ The British Medical Association has published reports that six of the 26 medical school deans in the UK now offer complementary therapy training. This trend is even more prominent in the United States, where almost two thirds of medical schools offer complementary therapy teaching, with a third of these providing it as part of the core curriculum.⁵

Practising holistic medicine does not necessarily equate to using CAM. Most clinicians and researchers do not consider psychological interventions to be CAM. For example, psychoneuroimmunology, with the potential for psychological intervention, does not come under the umbrella term of CAM.

Conclusion

It seems that CAM may be driven largely by medicine’s major omission, the failure of holism. Given the insights derived from psychoneuroimmunology, health care must fundamentally be a holistic endeavour. This has helped the biomedical reductionist model of medicine adapt towards a more holistic approach, wherein the use of emotional, psychological, and behavioural interventions have proved useful.¹⁰

A holistic approach to medicine is gaining acceptance worldwide, even at the grass roots level. Some medical schools have begun to include lectures on holistic teaching to help the practitioner of tomorrow understand what may be involved and what patients with different beliefs and attitudes might expect in terms of treatment. In a society that is becoming increasingly multicultural and diverse, with different values, beliefs, and perceptions towards medicine, this approach to educate on the basis of holistic medicine is a welcome change.

As future doctors, it is our duty to relieve suffering, even in situations when a cure is not possible or treatment is limited. This can be achieved by using some of the insights derived from psychoneuroimmunology. Each patient is unique and has their own set of cultural beliefs and ideas about his or her situation which must be addressed in the therapeutic effort. It is our responsibility to form partnerships with patients based on trust and to display human values, moving from the old biomedical model to a more “human” model—for what could be more rewarding than practising the art of “human medicine”?

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

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