Integrative or Integral Medicine?

What do these terms mean?

To answer that, I feel it is necessary to examine the origins of Western allopathic medicine, to examine what its strengths and weaknesses are.

There is a wonderful story on the origins of Western medicine, involving Galen and the early Church. The story is probably apocryphal, but it makes the point: When the early physicians wanted to learn about the human body, they went to the only place they could go, to get cadavers to dissect – the Church, to get those poor unwanted, unclaimed or unknown bodies that turned up from time to time. But the Church said “there's a problem!” and a compromise was needed – the physicians could have the body, but the Church would keep the soul! And so, from those beginnings, we get a sense of separation of the human, into physical and spiritual.

In many ways this illustrates the origins of our discipline. Formal Western medicine clearly separates body from soul, and schools largely teach healing from this purely physical perspective. The elements of emotion, belief systems, personality, spirituality are just not addressed in the aetiology and treatment of disease. We are encouraged to focus more and more on the microcosmos, looking ever deeper into this ever-smaller world, looking for the origin of disease, looking for technological answers to relieving a person of their illness or disease.

Almost by definition, this model has no place for the acknowledgement of the rest of the person. We are all emotional, intellectual, physical, psychological and spiritual beings. In my view, the body is the final common pathway through which problems in any area can present. A problem in any area can then be manifest in the physical – and this may explain a lot of what we see, that can't be explained in a physical cause-and-effect manner.

Medical training in Western countries has focused on this approach, and one of its hallmarks is that, to master this approach, one has to learn to be in one's mind, to intellectualise everything, to accumulate masses of data. Arising from this, is the notion that one has to remain quite distant from one's patient, not to be emotionally involved with them, because this would rob you of your objectiveness, of your ability to stay in your head where all this data is. Only by going through a Holmsian deductive process, can one hope to arrive at a conclusion or diagnosis, and offer evidence-based (whatever that means) and rational therapeutic treatment.

There is another aspect of this approach – for the physician, it is easier. It is easier to remain distant from the patient, to not “feel” their pain, to not allow one's feelings to be part of the interaction between doctor and patient, because that takes energy, and that requires the doctor to have this energy to give. In the modern system, with the constraints of politics, time, other activities that take up one's focus, there is a relatively limited amount of energy for one's work. That doesn't even include the resources one has to keep in reserve for one's family and friends, and how often have we seen the very busy and “successful” doctor neglect even this part of his or her life, and see it all fall apart. It's all too hard!

The impact this approach has on patients is enormous, and disturbing. They want and need that compassion, that connection with their doctor, to feel that they will be looked after, that they are safe. I remember well, as a registrar in a teaching hospital, where a particular consultant was devoid of all ability to connect with patients. I would do three ward rounds each day – the first one by myself, a second with the consultant, and a third to go around and repair all the damage, and explain to patients what was happening, and of course to speak with their families. Another doctor I know of, took a slightly different approach, in that he would stay behind after the consultant, and speak to the patient. When he caught up with the main round, he was told that this was unacceptable behaviour , that this wasn't how the system ran, and he was eventually dismissed from that job.

The stresses and strains that this approach brings, is so evident that we now have “sick doctor” associations, physicians who look after physicians. The medical and lay press is full of stories of how disaffected physicians are these days, but no real solutions have been offered. One doctor described trying to fix the current system as being like “rearranging the deck chairs on the Titanic”. Many physicians feel now that we are close to the limits of where we can look into the microcosmos. Where we need to look now after all these years, is at the macrocosmos - the whole world – of the patient and of the physician, to enable true healing to take place. We can't neglect the technology – it has enormous strengths and benefits, but we can incorporate into our healing practices those modalities that look after the heart and spirit. To hold and support, whilst the patient gets truly better.

Healing and curing are not the same thing. A “cure” is where the patient gives responsibility of their well-being to an outside agent – whether that be surgery, drugs, homeopathics, acupuncture, whatever. The patient takes no part in this process, except to merely comply. “Healing” is where the patient takes responsibility for his or her own well-being. It is where they participate in this process, and involves inclusion of all dimensions of their being – mind, body, feelings, spirit. This participation invariably, or has the potential to, turn the person's world upside down, to revolutionise their world. Healing comes out of chaos! I have found that, for example, when counselling about behavioural change, the patient has to be made to feel uncomfortable (with their permission). No one will change their position from a position of comfort. Behavioural change is an emotional issue – that's why the current messages on cigarette packets don't work, by the way. We would be better off asking questions, like “why don't you like yourself?” or “how much control of your life/health/money have you given to this cigarette?”

This form of healing also has the great potential to empower that person, with the benefits of an enhanced sense of self-worth and self-esteem. That, by the way, is one of THE reasons for existence. None of us are born with self-esteem. We learn it and earn it as we grow. It is that which enables us to then manifest who we truly are, and also of course, helps us to help others.

So, in summary, Western allopathic medicine is very good at technology; its weakness is that it doesn't provide the physician with a means to address those other aspects of their patients' being, namely the emotional, psychological and spiritual dimensions. How then do we approach this issue?

What does “Integrative” medicine mean? What I have seen up to now, is more a model along the lines of complementary and/or alternative therapies, for any illness. On one hand that is valid. In other words, do other healing traditions have something to offer in the way of intervention that is more effective that that offered by Western medicine? There are numerous disciplines out there, offering alternative approaches for relief of illness. Ayurvedic medicine, traditional indigenous healing – whether it be Aborigine, North American, Inuit, Chinese or African, naturopathy, homeopathy, chiropractic, kinesiology, acupuncture, and so on. The point is, they can't all be wrong – there must be value in all of them. The challenge is to find out which discipline can produce the best results for any given condition, and in any given individual. There is a need to have an evidence-based system whereby physicians can pick out from all these approaches that which will work best in any given situation. Perhaps what is also needed, is a concerted approach from the medical profession to the other disciplines – “we want to use you, but please supply us with the evidence, so that we can.” I have met “alternative” practitioners who have said that “frankly, they couldn't be bothered. They know their field, what works and what doesn't, and that's good enough”. There is prejudice on both sides, and I believe that, as physicians, we have the strength, power and common sense, and goodwill, to overcome all of this.

“Complementary medicine” is more all-embracing. In other words, in any given circumstance, a patient could choose a number of treatment modalities, from different traditions. It is then up to the patient to do their own research, and involve themselves in something that has meaning for them. On the one hand, this goes some way towards that definition of “healing”, in that the patient is taking responsibility for their own well-being, but it also exposes them to a potential rag bag of therapists, all of whom may promise the desired relief, based more on their own belief systems or anecdotal evidence, rather than true research and study. This, even with thousands of years of tradition.

In fact, this is now already happening. In America, around a third of all consults for healing take place outside the Western model, and 75% of these people will not tell their doctor what they are doing – on the assumption that they will either not be interested, or they will be critical or dismissive, thus “disempowering” the patient. In Australia, this figure is estimated to be more like half of all healing consults that go outside the profession. It is a multi-billion dollar industry.

The term “Integral” medicine has evolved, which means that the patient is able to have the best of everything:

• Integral medicine does not just refer to the science of diagnosing, treating or preventing disease, but to a medicine that heals. It is a dynamic, holistic, life-long process that widens and deepens your relationship with self, culture and nature.
• It is about the transformation and growth of the individual and the restoration of wholeness.
• It is the ability to develop systems that allow you to function, heal and grow in the face of challenges, changes in yourselves, in relationships and the world.
• It is acknowledgement of the interaction between mind, body, emotion and spirit in shaping you as an individual, and your potential as a human being.
• That there is one model, which encompasses all knowledge, where the patient is treated as a whole, involving all dimensions of their being. That they have access to physical, emotional, spiritual and psychological help and guidance.

This would seem to be an impossible ask in our present system. What of the Hippocratic dictum: “Primum non nocere” – “First, do no harm”. No physician has the training to do all this … and yet, somehow, it is possible, it is possible to get close, without being any less of a physician. A doctor can be trained in ways or fields, which will enable him or her to incorporate much of what has been mentioned above, into their own medical practice.

We are at the very early stages of research into this integral field. The disciplines for example, of psychoneuroimmunology, sociopsychoimmnuology are just two of these complex fields wherein research has been done over the past 30 years or so, with remarkable results. We now know that there is a dynamic interchange of information to and from the immune system to the complete nervous system. That the “brain” of the cell is not the nucleus, but the cell membrane. And this does not include the field of quantum physics, from where we understand that the physician brings their own energy into the equation in any relationship.

The first place we need to go, in my opinion, is to stop the practice of distancing oneself from the patient. To teach the physician how they can acknowledge their feelings about any person or situation, allow them, and express them appropriately within the context of a (healthy) doctor-patient relationship. To allow the feeling of compassion to exist between doctor and patient, to have a sense of acknowledgement of one human being by another. Of allowing that Divine element to enter the relationship, which has its own powerful ability to heal. It has been said, in all manner of ways, by practitioners of the art of healing, from all ages, that the healing comes through the physician, that they are a conduit through which the process takes place. It isn't what's in the doctor's bag that counts, but the holder of the bag.

The physicians who do this, are those who enjoy what they do, are at ease with themselves, who are happy, who feel that they are working in a field where they acknowledge something “bigger than themselves”, and have a sense of humility – not that they minimise their efforts, but know that no matter how successful they may be, with their givens, they know enough to keep an open mind regarding whether they are doing the best they can. It seems however that these people are the fortunate ones. That by serendipity, they have achieved this state of Grace.

It is possible to incorporate this ability to empathise with patients into the training of doctors. To be able to acknowledge the patients' hurts and fears – fears of pain, suffering, and especially dying, and still retain the ability to focus on the job at hand. All it takes, is the ability to “look outside the box”, to think laterally, and see where these skills are to be found, and incorporate them into traditional training. From personal experience I can vouch that this does work, and that the work satisfaction to be thus had is beyond description.

For example, learning from the Life Coaching fields, such as how to take the drama out of life situations, and enable the patient to see where the cause of their distress really lies. To be able to take a moment to “clear the space”, so that one is fully present to whatever needs doing at that moment, without other agendas interfering with one's “presence”. To learn about the power of words; to listen to the language that people use, to understand quickly how they disempower themselves, and how easy and quick it can be to point this out. To learn how to simply listen, in stillness.

Most importantly however, I believe what is needed is to help the physician to learn about themselves. To be able to heal and grow themselves, as human beings. I had the great experience and privilege of joining a group of like-minded primary care physicians many years ago, to discuss “difficult cases”. This seemed to be an opportunity too good to miss. Within six months of weekly meetings, however, it became obvious to me, that members of the group kept bringing the same issue to be discussed. My initial reaction was “How come? Aren't these people learning anything! Why are we wasting our time here?” And then of course, the inevitable realisation: “perhaps I'm bringing the same stuff myself, all the time”. And of course I was. By twelve months, it was obvious that we weren't bringing difficult cases, but we were bringing difficulties that we had within ourselves, issues that we hadn't resolved. If patients presented with similar issues, they pressed our “hot buttons”, we lost objectivity, and were not then able to help the other deal with that issue. This is the Balint experience. It inevitably leads to dong work on oneself, with flow-on effects to all relationships – both personal and professional.

In my current practice, I have incorporated a cross psychotherapy-relaxation-meditation technique to treat patients at a non-physical level. It helps them to free themselves of a lot of buried energy, and this in turn has very beneficial results on the way they function, and therefore on their health.