Holistic Health: A Valuable Approach to Medical Care MARC LAPPE, PhD CONFUSION OVER THE ORIGINS, validity and usefulness of holistic health abounds. Medical practitioners, long used to offsetting the irrational approaches of health fads, neuropathic treatments and home cancer remedies are understandably cautious about embracing what appears to be the newest fad of the counterculture. Such a response would be unfortunate because the approach of holistic health itself and many of its specific therapeutic regimens are rooted in traditional medicine. More to the point, I am convinced that the philosophy of holistic health carries a very important message to practitioners facing contemporary medical problems ranging from antibiotic resistance to refractory psoriasis: namely, that new directions in medicine and health care are likely to be holistic because the problems they must address demand it.' The deepest roots of the holistic health movement can be traced to Eastern cultures, most notably the Chinese.2 Common to both historic and current approaches is the belief that most disease processes involve multiple organ systems, and that health and treatment of illness generally depend on viewing a person in relation to his surroundings. This means admitting that most health problems entail a multidisciplinary approach that acknowledges the force of external factors-including social, political, cultural and physical environments-on health and its maintenance. In the holistic view, disease processes should be understood in a broader context than linear causation; that is, as resulting from the interactions of multiple factors. Lest this seem too sweeping and vague, let me offer a few concrete examples. Major arthritic conditions, particularly those associated with relatively aggressive autoimmune reactions, form one Refer to: Lappe M: Holistic health: A valuable approach to medical care, In Orthodox medicine, humanistic medicine and holistic health care-A forum. West J Med 131: 475-478, Dec 1979 Dr. Lappe is Acting Director, Hazard Alert System, California Department of Health Services, Berkeley. Reprint requests to: Marc Lappe, PhD, Hazard Alert System, Department of Health Services, 2151 Berkeley Way, Berkeley, CA 94704.
of the most common categories of disorders requiring multiple office visits. Long thought to be precipitated by a bacterial infection, family history or just plain old age, diseases like rheumatoid arthritis were (and still are) treated symptomatically, with little or no attention to possible underlying causes. Advances in immunochemistry and genetics in recent years have brought about a recognition that a multiplicity of factors apparently interact to initiate the disease process, no one of which alone being the causative agent. These advances have also provided evidence of the immense storehouse of genetic variation among persons. Holistic medicine has long stressed what orthodox practitioners have only recently come to recognize as a fundamental theorem of modern medical practice: human beings vary significantly in their basic biochemical makeup. This variability now rests on a solid genetic base: Each person's biochemical makeup is qualitatively different from another's (with the exception of identical twins) because of the existence of genetic heterogeneity. About 30 percent of all the genes in the human species come in different allelic forms. This means that it is possible to be heterozygous at a minimum of 15 percent of the 70,000 to 100,000 genetic loci that we carry.2 Moreover, recombination and gametic choice vastly increase the chances for variation made possible by the multiple forms (polymorphisms) of so many of our genes. The relevance of this reservoir of genetic variability lies in the fact that each person individually adapts or reacts to environmental stress and circumstances; and that what constitutes health will vary according to these idiosyncrasies. The HLA locus is typical of these polymorphisms. It is a cluster of at least four related genetic loci on the sixth chromosome. An allele at one of these loci, known as HLA-B27, is strongly associated with the appearance of ankylosing spondylitis.4 More than 95 percent of all young males in whom this often debilitating syndrome develops have the antigen. Apparently, the THE WESTERN JOURNAL OF MEDICINE
475
antigen alone is insufficient for precipitating the disease, because less than 2 percent of all B27positive persons develop the syndrome. A second tier of evidence implicates several bacterial species, most notably Klebsiella, Brucella and Yersinia, as having a precipitating role in this illness because it often follows closely on the heels of a reported infectious episode. A third factor involved in the genesis of ankylosing spondylitis appears to be stress. A history of back strain, long hours of sitting and direct physical injury to the back have been associated with the development of the disease. Psychogenic stress, with or without an overlay of symptoms of psoriasis, is yet a fourth factor. And finally, there are the patients with uncomplicated ankylosing spondylitis, for whom none of the above conditions apply. Clearly, this is a multifactorial and complex disease entity. The association of at least 40 more disease processes with the HLA system clearly indicates that many diseases previously thought to be caused solely by outside agents actually result from a combination of internal and external factors.5 Holistic approaches acknowledge this complex causation as one of their starting points. While such a belief appears almost too simple, it is one of the first points any second-year medical student hears in a pathology lecture. It is the emphasis on seeking multiple causes-and treatments-of pathological processes that is new. Holistic medicine stresses the interdependence of organ systems in disease processes, much the way endocrinology research first linked the major glandular systems. And although many of these associations lack an empirical base at present, others, such as the interrelationship in the adrenal, lymphatic and neurohumoral axis, appear well-grounded in biological fact. A growing acceptance of the role of the immune system in the production of tumors implicates additional organ systems in the pathogenesis of cancer. Like it or not, the fact that stress and psychogenic factors can influence immune reactivity provides a rational hypothesis for the mutual interactions of mind and body, a claim which holistic practitioners have made for years. A second example of how holistic approaches work may be seen in the incompletely understood problem of toxicity associated with the use of dioxin-contaminated phenoxyherbicides. The presumption that chlorinated small-molecule hydrocarbons would be relatively innocuous to humans was based on the faulty premise that human 476
DECEMBER 1979 * 131
* 6
metabolic systems would be unaffected by novel molecules, except for nonspecific detoxification reactions generated by the microsomal system of the liver. Consequently, the dioxin contaminant went unrecognized as a major health hazard. We are learning quickly that dioxin contamination has reverberations throughout the ecosystem, and that its effects on humans may be more subtle and long-lasting than the simple toxic reaction known as chloracne as first reported. Differential susceptibility and dependence on serum levels of iron for toxicity,6 extraordinarily persistent effects of enzyme disturbances,7 and possible involvement in the development of birth defects suggest that the network of potentially harmful effects of dioxins should receive the broadest investigation possible.6 One of many interactions which could well be studied using a holistic approach is the production of elevated triglycerides by halogenated aromatics like dioxin (2,3,7,8-tetrachlorodibenzoparadioxin) which may be particularly harmful in those workers who have raised levels of lipids due to the relatively common genetic defect responsible for type II hyperbetalipoproteinemia. Because these and other enzymatic changes go on for years, dietary factors and life-style adjustments should be reviewed by conscientious doctors who wish to avoid the composite problems of heart disease and atherosclerosis in dioxin-exposed patients.
Specific Areas of Application At their best, holistic approaches complement and reinforce several major areas of medical practice.8 Practitioners may recognize forms of treatment and ideas that they have already incorporated into practice which are embodied in the holistic philosophy. Knowing that one's ideas coincide with a holistic approach does not necessarily validate them, but it does provide a basis for further broadening one's perspective towards new or alternative approaches to practicing medicine. Humanistic Medicine The concept that health care should fully consider human needs while embracing humane attitudes, ethics and behavior has recently regained popularity. Many practitioners, in fact, see such an approach as a necessary standard for our medical system. Minimizing the use of therapeutic interventions and choosing the least restrictive or damaging options when they are needed, as well as reducing patients' reliance on drugs have re-
cently been reemphasized. Not coincidentally, these practices are integral to the holistic movement. Holistic Medicine The term holistic medicine has been misused to cover a spectrum of new or unconventional approaches to medical practice, from embracing orthomolecular medicine and psychiatry to treating asthma and allergy. Many of these approaches, such as orthomolecular medicine, are relatively untested; others, such as allergen treatments by sequential elimination of offending substances, have received widespread acceptance. For example, the fact that migraine headaches often respond to the elimination of major foodstuffs with allergenic properties (beef, peas, wheat, and so on) has been reported recently in a prominent medical journal as a major advance. Adoption of optimal health practices, an essential component of holistic medicine, has received increasing recognition within the medical community as part of an overall approach to teach persons to take control of their own health-related behavior. Holistic medicine also bridges the barrier which has traditionally divided Western medicine into two separate domains-one treating diseases of the mind and the other diseases of the body. The most radical extension of this approach is to identify all health events as part of a continuum of systems extending from the molecular to the ecological.9 Alternative Health Care Holistic health actively encourages the proliferation of systems and approaches to health care which use nontraditional methods to treat disease as alternatives to orthodox regimens. Therefore, holistic health practitioners include among their successes the introduction of acupuncture, biofeedback and autogenic techniques in the control of pain; vasodilation, and physiologic effects of several other autonomic systems. A second area of advance centers on the introduction of Eastern approaches to medicine which rely extensively on philosophies that stress balance and integration of the mind and body-such as massage, Tai Chi and meditation. These approaches, while generally unquantified, nevertheless produce detectable changes in the activation level of the reticular system and in the alpha activity of the brain. The application of techniques not usually asso-
ciated with therapy, such as dance, visual arts, music and sensory awareness, represents still another area at the threshold of medical practice. Finally, many holistic practitioners promote the incorporation of entire systems of qualitatively different health approaches, such as those embodied by chiropractic, homeopathy and acupuncture as the basis of their practices. Taken as a whole, these approaches evoke understandable skepticism among more traditional practitioners. Nevertheless, holistic medicine has proved extremely valuable in at least one area: the experimental. Discoveries of the role of gating phenomena in the brain, and, indirectly, the identification of endorphins can be attributed in part to investigations triggered by the importation of acupuncture. Biofeedback research has also proved beneficial in treating migraines and hypertension. Enhanced Patient-Provider Relations Holistic health encourages a transition away from the patient dependency fostered by traditional medical practices towards self-reliance and responsibility-and where appropriate, self-care. This belief has been held in high regard by a variety of health planners from Marc Lalonde to the late John Knowles because it decreases the financial and medical dependency of patients on the system. It would be a mistake, however, to presume that this approach characterizes the holistic movement itself. A basic precept of the philosophical systems which undergird holistic health, holds that health can be maintained only when the major deleterious effects of environmental and other disturbances have been taken into consideration and where
appropriate, neutralized. Comment Traditional practitioners should, therefore, not see the intention of the holistic health movement as trying to supplant established patterns of preventive health practices. Indeed, both groups would probably insist that before persons be held fully responsible for their own health, known environmental hazards like lead and pesticides be controlled. Holistic and orthodox practitioners are increasingly aware of the weight which such external forces place on the adaptive abilities of persons, and together these groups can encourage their elimination so that personal health practices can be effective. Moreover, orthodox practitioners may wish to THE WESTERN JOURNAL OF MEDICINE
477
incorporate the most valuable techniques that holistic practitioners use into their own. Allergen testing, for instance, in the treatment of migraine headaches or sprue (gluten sensitization) now appears to be a bona fide concomitant of office practice. Whether a similar desensitization can be used for other brain allergies identified by holistic practitioners remains to be proved. Similarly, use of herbal preparations which previously have been neglected as old fashioned or simply too faddish might well be reconsidered. For instance, it may make good sense to use the calming and soporific properties of camomile tea for a sick child, rather than the recently proved potentially carcinogenic antihistaminic sleep preparations or cough syrups. Finally, seeing a health provider's role as helper and information giver rather than as cryptic, medicine dispenser reflects the American ethos of independence, autonomy and self-determination. We would all wish to discourage health approaches that encourage dependence, helplessness and lack of personal responsibility. Perhaps, like the inhabitants of Thomas Mann's Magic Mountain, patients of both holistic and orthodox practitioners may gain the most by learning to see serious illness as a special life experience.
Although a radical idea, dying is increasingly being recognized as an important, albeit final, opportunity for growth and transformation. And in less extreme circumstances, a practitioner might improve a patient's well-being by helping him or her to understand, learn from and integrate the experience of healing. Holistic health has this and probably much more to offer any open-minded physician, nurse or paraprofessional whose perspective on medical practice includes a concern for the integrity of the whole person. REFERENCES 1. Carlson RJ: Planners and the end of medicine. Am J Health Planning 1:32-37, Jul 1976 2. Huang-Ti Nei Ching: The Yellow Emperor's Canon of Medicine. China 249-221 BC (See Tsuei JJ: Eastern and Western approaches to medicine. West J Med 128:551-557, Jun 1978 for further review of Nei Ching and basic Chinese medical concepts) 3. Scriver CR, Laberge C, Clow CL, et al: Genetics and Medicine: An evolving relationship. In Abelson PH (Ed): Health Care: Regulation, Economics, Ethics, Practice. Washington, DC, AAAS: 145-150, 1978 4. Terasaki PI: High association of an HL-A Antigen, W27, with Ankylosing Spondylitis. New Engl J Med 288:704-707, 1973 5. Anonymous: HLA disease susceptibility: A primer. N Engl J Med 297:1060-1063, 1977 6. Sweeny GD, et al: Iron deficiency prevents liver toxicity of 2,3,7,8-Tetrachlorodibenzo-p-dioxin. Science 204:332-335, Apr 20, 1979 7. Crow KD: Lipid profiles in dioxin-exposed workers. Lancet 1:982, May 5, 1979 8. Fink DL: Holistic health: Implications for health planning. Am J Health Planning 1:23-31, Jul 1976 9. Blum HL: From a concept of health to a national health policy. Am J Health Planning 1:3-22, Jul 1976
On Healing the Whole Person: A Perspective RICHARD H. SVIHUS, MD, DrPH THE TERM holistic health has in a few short years, become nearly a household word. Holistic health centers have appeared like mushrooms, offering various alternative diagnostic and therapeutic modalities. For want of a better description of the nature of their practices, it appears that many alternative practitioners have jumped on a passing bandwagon and have adopted this new, Refer to: Svihus RH: On healing the whole person: A perspective, In Orthodox medicine, humanistic medicine and holistic health care-A forum. West J Med 131:478-481, Dec 1979 Dr. Svihus is Director, Department of Public Health, Butte County, Oroville, California. Reprint requests to: Richard H. Svihus, MD, DrPH, Director of Public Health Butte County, 18-B County Center Dr., Oroville CA
95965.
478
DECEMBER 1979 * 131
* 6
ill-defined term to mean whatever their practices happen to be. Because few people appear to know the origin or meaning of the word holistic and because the terms holistic health and whole person are so often misused, this commentary points out the source and original meaning of the concept. The word holism refers to the concept that any entity is greater in its wholeness than in the sum of its parts. Holistic refers to the state of integration of a person, as a body and a soul, with the spiritual self, making him or her whole.'12 Because these terms and concepts derive from biblical Greek, it is necessary to look to the Bible to
of the most common categories of disorders requiring multiple office visits. Long thought to be precipitated by a bacterial infection, family history or just plain old age, diseases like rheumatoid arthritis were (and still are) treated symptomatically, with little or no attention to possible underlying causes. Advances in immunochemistry and genetics in recent years have brought about a recognition that a multiplicity of factors apparently interact to initiate the disease process, no one of which alone being the causative agent. These advances have also provided evidence of the immense storehouse of genetic variation among persons. Holistic medicine has long stressed what orthodox practitioners have only recently come to recognize as a fundamental theorem of modern medical practice: human beings vary significantly in their basic biochemical makeup. This variability now rests on a solid genetic base: Each person's biochemical makeup is qualitatively different from another's (with the exception of identical twins) because of the existence of genetic heterogeneity. About 30 percent of all the genes in the human species come in different allelic forms. This means that it is possible to be heterozygous at a minimum of 15 percent of the 70,000 to 100,000 genetic loci that we carry.2 Moreover, recombination and gametic choice vastly increase the chances for variation made possible by the multiple forms (polymorphisms) of so many of our genes. The relevance of this reservoir of genetic variability lies in the fact that each person individually adapts or reacts to environmental stress and circumstances; and that what constitutes health will vary according to these idiosyncrasies. The HLA locus is typical of these polymorphisms. It is a cluster of at least four related genetic loci on the sixth chromosome. An allele at one of these loci, known as HLA-B27, is strongly associated with the appearance of ankylosing spondylitis.4 More than 95 percent of all young males in whom this often debilitating syndrome develops have the antigen. Apparently, the THE WESTERN JOURNAL OF MEDICINE
475
antigen alone is insufficient for precipitating the disease, because less than 2 percent of all B27positive persons develop the syndrome. A second tier of evidence implicates several bacterial species, most notably Klebsiella, Brucella and Yersinia, as having a precipitating role in this illness because it often follows closely on the heels of a reported infectious episode. A third factor involved in the genesis of ankylosing spondylitis appears to be stress. A history of back strain, long hours of sitting and direct physical injury to the back have been associated with the development of the disease. Psychogenic stress, with or without an overlay of symptoms of psoriasis, is yet a fourth factor. And finally, there are the patients with uncomplicated ankylosing spondylitis, for whom none of the above conditions apply. Clearly, this is a multifactorial and complex disease entity. The association of at least 40 more disease processes with the HLA system clearly indicates that many diseases previously thought to be caused solely by outside agents actually result from a combination of internal and external factors.5 Holistic approaches acknowledge this complex causation as one of their starting points. While such a belief appears almost too simple, it is one of the first points any second-year medical student hears in a pathology lecture. It is the emphasis on seeking multiple causes-and treatments-of pathological processes that is new. Holistic medicine stresses the interdependence of organ systems in disease processes, much the way endocrinology research first linked the major glandular systems. And although many of these associations lack an empirical base at present, others, such as the interrelationship in the adrenal, lymphatic and neurohumoral axis, appear well-grounded in biological fact. A growing acceptance of the role of the immune system in the production of tumors implicates additional organ systems in the pathogenesis of cancer. Like it or not, the fact that stress and psychogenic factors can influence immune reactivity provides a rational hypothesis for the mutual interactions of mind and body, a claim which holistic practitioners have made for years. A second example of how holistic approaches work may be seen in the incompletely understood problem of toxicity associated with the use of dioxin-contaminated phenoxyherbicides. The presumption that chlorinated small-molecule hydrocarbons would be relatively innocuous to humans was based on the faulty premise that human 476
DECEMBER 1979 * 131
* 6
metabolic systems would be unaffected by novel molecules, except for nonspecific detoxification reactions generated by the microsomal system of the liver. Consequently, the dioxin contaminant went unrecognized as a major health hazard. We are learning quickly that dioxin contamination has reverberations throughout the ecosystem, and that its effects on humans may be more subtle and long-lasting than the simple toxic reaction known as chloracne as first reported. Differential susceptibility and dependence on serum levels of iron for toxicity,6 extraordinarily persistent effects of enzyme disturbances,7 and possible involvement in the development of birth defects suggest that the network of potentially harmful effects of dioxins should receive the broadest investigation possible.6 One of many interactions which could well be studied using a holistic approach is the production of elevated triglycerides by halogenated aromatics like dioxin (2,3,7,8-tetrachlorodibenzoparadioxin) which may be particularly harmful in those workers who have raised levels of lipids due to the relatively common genetic defect responsible for type II hyperbetalipoproteinemia. Because these and other enzymatic changes go on for years, dietary factors and life-style adjustments should be reviewed by conscientious doctors who wish to avoid the composite problems of heart disease and atherosclerosis in dioxin-exposed patients.
Specific Areas of Application At their best, holistic approaches complement and reinforce several major areas of medical practice.8 Practitioners may recognize forms of treatment and ideas that they have already incorporated into practice which are embodied in the holistic philosophy. Knowing that one's ideas coincide with a holistic approach does not necessarily validate them, but it does provide a basis for further broadening one's perspective towards new or alternative approaches to practicing medicine. Humanistic Medicine The concept that health care should fully consider human needs while embracing humane attitudes, ethics and behavior has recently regained popularity. Many practitioners, in fact, see such an approach as a necessary standard for our medical system. Minimizing the use of therapeutic interventions and choosing the least restrictive or damaging options when they are needed, as well as reducing patients' reliance on drugs have re-
cently been reemphasized. Not coincidentally, these practices are integral to the holistic movement. Holistic Medicine The term holistic medicine has been misused to cover a spectrum of new or unconventional approaches to medical practice, from embracing orthomolecular medicine and psychiatry to treating asthma and allergy. Many of these approaches, such as orthomolecular medicine, are relatively untested; others, such as allergen treatments by sequential elimination of offending substances, have received widespread acceptance. For example, the fact that migraine headaches often respond to the elimination of major foodstuffs with allergenic properties (beef, peas, wheat, and so on) has been reported recently in a prominent medical journal as a major advance. Adoption of optimal health practices, an essential component of holistic medicine, has received increasing recognition within the medical community as part of an overall approach to teach persons to take control of their own health-related behavior. Holistic medicine also bridges the barrier which has traditionally divided Western medicine into two separate domains-one treating diseases of the mind and the other diseases of the body. The most radical extension of this approach is to identify all health events as part of a continuum of systems extending from the molecular to the ecological.9 Alternative Health Care Holistic health actively encourages the proliferation of systems and approaches to health care which use nontraditional methods to treat disease as alternatives to orthodox regimens. Therefore, holistic health practitioners include among their successes the introduction of acupuncture, biofeedback and autogenic techniques in the control of pain; vasodilation, and physiologic effects of several other autonomic systems. A second area of advance centers on the introduction of Eastern approaches to medicine which rely extensively on philosophies that stress balance and integration of the mind and body-such as massage, Tai Chi and meditation. These approaches, while generally unquantified, nevertheless produce detectable changes in the activation level of the reticular system and in the alpha activity of the brain. The application of techniques not usually asso-
ciated with therapy, such as dance, visual arts, music and sensory awareness, represents still another area at the threshold of medical practice. Finally, many holistic practitioners promote the incorporation of entire systems of qualitatively different health approaches, such as those embodied by chiropractic, homeopathy and acupuncture as the basis of their practices. Taken as a whole, these approaches evoke understandable skepticism among more traditional practitioners. Nevertheless, holistic medicine has proved extremely valuable in at least one area: the experimental. Discoveries of the role of gating phenomena in the brain, and, indirectly, the identification of endorphins can be attributed in part to investigations triggered by the importation of acupuncture. Biofeedback research has also proved beneficial in treating migraines and hypertension. Enhanced Patient-Provider Relations Holistic health encourages a transition away from the patient dependency fostered by traditional medical practices towards self-reliance and responsibility-and where appropriate, self-care. This belief has been held in high regard by a variety of health planners from Marc Lalonde to the late John Knowles because it decreases the financial and medical dependency of patients on the system. It would be a mistake, however, to presume that this approach characterizes the holistic movement itself. A basic precept of the philosophical systems which undergird holistic health, holds that health can be maintained only when the major deleterious effects of environmental and other disturbances have been taken into consideration and where
appropriate, neutralized. Comment Traditional practitioners should, therefore, not see the intention of the holistic health movement as trying to supplant established patterns of preventive health practices. Indeed, both groups would probably insist that before persons be held fully responsible for their own health, known environmental hazards like lead and pesticides be controlled. Holistic and orthodox practitioners are increasingly aware of the weight which such external forces place on the adaptive abilities of persons, and together these groups can encourage their elimination so that personal health practices can be effective. Moreover, orthodox practitioners may wish to THE WESTERN JOURNAL OF MEDICINE
477
incorporate the most valuable techniques that holistic practitioners use into their own. Allergen testing, for instance, in the treatment of migraine headaches or sprue (gluten sensitization) now appears to be a bona fide concomitant of office practice. Whether a similar desensitization can be used for other brain allergies identified by holistic practitioners remains to be proved. Similarly, use of herbal preparations which previously have been neglected as old fashioned or simply too faddish might well be reconsidered. For instance, it may make good sense to use the calming and soporific properties of camomile tea for a sick child, rather than the recently proved potentially carcinogenic antihistaminic sleep preparations or cough syrups. Finally, seeing a health provider's role as helper and information giver rather than as cryptic, medicine dispenser reflects the American ethos of independence, autonomy and self-determination. We would all wish to discourage health approaches that encourage dependence, helplessness and lack of personal responsibility. Perhaps, like the inhabitants of Thomas Mann's Magic Mountain, patients of both holistic and orthodox practitioners may gain the most by learning to see serious illness as a special life experience.
Although a radical idea, dying is increasingly being recognized as an important, albeit final, opportunity for growth and transformation. And in less extreme circumstances, a practitioner might improve a patient's well-being by helping him or her to understand, learn from and integrate the experience of healing. Holistic health has this and probably much more to offer any open-minded physician, nurse or paraprofessional whose perspective on medical practice includes a concern for the integrity of the whole person. REFERENCES 1. Carlson RJ: Planners and the end of medicine. Am J Health Planning 1:32-37, Jul 1976 2. Huang-Ti Nei Ching: The Yellow Emperor's Canon of Medicine. China 249-221 BC (See Tsuei JJ: Eastern and Western approaches to medicine. West J Med 128:551-557, Jun 1978 for further review of Nei Ching and basic Chinese medical concepts) 3. Scriver CR, Laberge C, Clow CL, et al: Genetics and Medicine: An evolving relationship. In Abelson PH (Ed): Health Care: Regulation, Economics, Ethics, Practice. Washington, DC, AAAS: 145-150, 1978 4. Terasaki PI: High association of an HL-A Antigen, W27, with Ankylosing Spondylitis. New Engl J Med 288:704-707, 1973 5. Anonymous: HLA disease susceptibility: A primer. N Engl J Med 297:1060-1063, 1977 6. Sweeny GD, et al: Iron deficiency prevents liver toxicity of 2,3,7,8-Tetrachlorodibenzo-p-dioxin. Science 204:332-335, Apr 20, 1979 7. Crow KD: Lipid profiles in dioxin-exposed workers. Lancet 1:982, May 5, 1979 8. Fink DL: Holistic health: Implications for health planning. Am J Health Planning 1:23-31, Jul 1976 9. Blum HL: From a concept of health to a national health policy. Am J Health Planning 1:3-22, Jul 1976
On Healing the Whole Person: A Perspective RICHARD H. SVIHUS, MD, DrPH THE TERM holistic health has in a few short years, become nearly a household word. Holistic health centers have appeared like mushrooms, offering various alternative diagnostic and therapeutic modalities. For want of a better description of the nature of their practices, it appears that many alternative practitioners have jumped on a passing bandwagon and have adopted this new, Refer to: Svihus RH: On healing the whole person: A perspective, In Orthodox medicine, humanistic medicine and holistic health care-A forum. West J Med 131:478-481, Dec 1979 Dr. Svihus is Director, Department of Public Health, Butte County, Oroville, California. Reprint requests to: Richard H. Svihus, MD, DrPH, Director of Public Health Butte County, 18-B County Center Dr., Oroville CA
95965.
478
DECEMBER 1979 * 131
* 6
ill-defined term to mean whatever their practices happen to be. Because few people appear to know the origin or meaning of the word holistic and because the terms holistic health and whole person are so often misused, this commentary points out the source and original meaning of the concept. The word holism refers to the concept that any entity is greater in its wholeness than in the sum of its parts. Holistic refers to the state of integration of a person, as a body and a soul, with the spiritual self, making him or her whole.'12 Because these terms and concepts derive from biblical Greek, it is necessary to look to the Bible to
