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A Challenge LEONARDJ. DUHL, MD A TREMENDOUS AMOUNT of discussion is taking place about holistic health and, as one listens carefully to the variety of dialogues, one hears many messages. At one end of the spectrum is the view that modern medicine is completely inadequate and must be replaced by another system; at the other end is the view that a variety of techniques exist that could supplement modern medicine. Within this range there are issues more directly related to the problems of healing the sick that must be faced every day by those in the medical community. Some physicians complain about the complexity and confusion surrounding these problems. Others speak of Medicine's fragmentation and inability to deal with issues in a comprehensive and thorough manner because of lack of time and money. I believe that we are being faced with problems that extend far beyond the fields of medicine and health care. Many of these have been laid on the doorstep of Medicine as if, by dealing with the medical-health problems, all else will fall into place. In some ways, hospitals and the medical establishment have replaced cathedrals and the Church as the focal points of attention in a society that at one time hoped and dreamed that the Church could provide answers to questions regarding the totality of existence. The medieval church, as strong as it was, proved unable to do this and we as physicians are-or should be-too wise to claim that we are capable of dealing with such broad issues. The words health, medicine, health care and medical care are used much too loosely. Medicine is related to the ill; health to a sense of wellbeing and not just the absence of illness. And what is called health includes a concern with the good Refer to: Duhl LJ: Holistic health and medicine: A challenge, In Orthodox medicine, humanistic medicine and holistic health care-A forum. West J Med 131:473-474, Dec 1979 Dr. Duhl is Professor of Public Health and Urban Social Policy, University of California, Berkeley, California. Reprint requests to: Leonard J. Duhl, MD, Professor of Public Health and Urban Social Policy, School of Public Health, University of California, Berkeley, CA 94720.
life and the totality of our existence. Yet if we have failed to come to grips with that totality of existence, it is not because of a lack of medical care but because we have neither reached an adequate comprehension of nor developed the social mechanisms needed to deal with the vast complexity and interrelatedness of the organism called Earth. Furthermore, as physicians or others concerned with human behavior, we must be humble in realizing that there is much we still do not know about the organism known as a human being. Nevertheless, physicians have been faced with the dilemma of how to deal with human beings in their pain and illness. And because the problems surrounding both the human organism and the organism Earth press upon us with such intensity we are forced to look continuously at alternative methods of perception and intervention. As in the field of medicine, those intervening in our society have tried hard through scientific means to understand fully both the human and social organisms and how they work. Many have tried techniques which have been called rational and scientific to tease out the complexities. Through models, Cartesian in nature, attempts have been made to control or intervene in the behavior of human beings to make them healthy. The same attempts are being made to understand and control our earth. We are endlessly faced with not knowing. We have searched for answers in biological, psychological and sociological areas. Though at times we have found a separation between psycho and soma, increasingly we are encountering difficulty with this division. We have become more aware that in human beings, we cannot separate the psyche and the soma, or the social context in which the two exist. I believe that behind most holistic dialogues is an awareness that we cannot separate internal from external environments. We cannot disregard problems that we have called internal homeostasis from questions of the homeostatic balance of the THE WESTERN JOURNAL OF MEDICINE
473
external world. Thus, health becomes a synthesis of the internal and external environments, and holistic means the integration of all parts of the whole. Does this mean that physicians have to deal with the problem of the holistic totality and interrelatedness of the organisms, Earth and human being? Again, my answer is that this is neither our wish, nor our capability. And yet we must place our actions as physicians within the context of holism. What has resulted is physicians becoming members of more complex teams of specialists and integrators who assist in the process of trying to make human beings whole within a larger social context-earth. The so-called holistic health explosion has forced us to face the fact that there may be alternative ways to view the human organism. Energy and Chi models, previously foreign to American medicine, are being incorporated into our work. In addition, there are persons who are endeavoring to show us that there is more to medicine than a rational, scientific approach, both in our ability to understand medical problems and in our intervention to solve them. These persons are forcing us to look at Eastern philosophiesTao and Buddhism, for example-as well as extensions of scientific medicine such as biofeedback, all of which contribute alternate ways of understanding that may prove helpful. If we respond by looking further, we show respect for other cultures and beliefs that have worked well in helping some people, and an openness to the possibility that there are other ways to cope with problems and issues that primarily have been called medical. Indeed, as we become more open, we find additional scientific, rational answers to questions and techniques we heretofore considered irrational or, at best, nonrational. We need to ask whether modern medicine, magnificent as it is, can cope with all the issues concerning either human beings or the contextual Earth. If we cannot cope, we need to develop new relationships with persons who are concerned with these issues and who may help by offering different conceptual models.1 This is a difficult path, for we may not know
474
DECEMBER 1979 * 131
* 6
how best to synthesize such a diversity of viewpoints, concepts and issues. Though we have toyed with the integration of religion and medicine, concepts of the soul and of physiologic medicine have been difficult to integrate with science. The path is frightening because it means giving up or letting go of the notion that weand we alone-have the truth. There may be other truths. If health is primarily a concern with human growth and development, and with a variety of forms offered by genetic and other heritages, we have a task that is more simple. In this process all aspects of society are involved in what I call societal education. In this context, physicians contribute but do not have prime responsibility. It involves all of the organism Earth. As the normal developmental process of the human organism is unbalanced by pressure and crisis in moments of tension, the possibility of dis-ease occurs.2 Dis-ease comes in many forms, one being medical illness. It is here that physicians play a primary role; and it is here that we must work closely with others to show that there is a possibility of jointly contributing to the treatment of illness. Our work does not end here, for although some people remain chronically ill (and must receive appropriate assistance, too), others must be helped in the healing process.4 It is here that we as physicians must again engage in joint relationships with others, with a focus on healing that may involve social networks, a sense of community and much more.5 All of this is holistic medicine. We as physicians own a monopoly only in our particular expertise, and unless we work with others with different views, we will never have holistic medicine for human beings nor holistic health for the organism Earth. REFERENCES 1. Knowles JH: The responsibility of the individual. Daedalus, Winter 1977, pp 57-80 2. Williamson GS, Pearse IH: Science, Synthesis, and Sanity. London, Collins, 1965 3. Health of the Individual, of the Family, of Society. Pioneer Health Center, Rotherfied, Sussex, Engand, 1971 4. Pearse IH, Crocker LH: The Peckham Experiment: A Study of the Living Structure of Society. London, George Allen & Unwin, Ltd., 1947 5. Duhl LJ, Den Boer J: Making Whole: Health for a New Epoch. New York, Pergamon Press, Inc. 1980 (In press)
.1..Iu
nin. § I tt. .t
A Challenge LEONARDJ. DUHL, MD A TREMENDOUS AMOUNT of discussion is taking place about holistic health and, as one listens carefully to the variety of dialogues, one hears many messages. At one end of the spectrum is the view that modern medicine is completely inadequate and must be replaced by another system; at the other end is the view that a variety of techniques exist that could supplement modern medicine. Within this range there are issues more directly related to the problems of healing the sick that must be faced every day by those in the medical community. Some physicians complain about the complexity and confusion surrounding these problems. Others speak of Medicine's fragmentation and inability to deal with issues in a comprehensive and thorough manner because of lack of time and money. I believe that we are being faced with problems that extend far beyond the fields of medicine and health care. Many of these have been laid on the doorstep of Medicine as if, by dealing with the medical-health problems, all else will fall into place. In some ways, hospitals and the medical establishment have replaced cathedrals and the Church as the focal points of attention in a society that at one time hoped and dreamed that the Church could provide answers to questions regarding the totality of existence. The medieval church, as strong as it was, proved unable to do this and we as physicians are-or should be-too wise to claim that we are capable of dealing with such broad issues. The words health, medicine, health care and medical care are used much too loosely. Medicine is related to the ill; health to a sense of wellbeing and not just the absence of illness. And what is called health includes a concern with the good Refer to: Duhl LJ: Holistic health and medicine: A challenge, In Orthodox medicine, humanistic medicine and holistic health care-A forum. West J Med 131:473-474, Dec 1979 Dr. Duhl is Professor of Public Health and Urban Social Policy, University of California, Berkeley, California. Reprint requests to: Leonard J. Duhl, MD, Professor of Public Health and Urban Social Policy, School of Public Health, University of California, Berkeley, CA 94720.
life and the totality of our existence. Yet if we have failed to come to grips with that totality of existence, it is not because of a lack of medical care but because we have neither reached an adequate comprehension of nor developed the social mechanisms needed to deal with the vast complexity and interrelatedness of the organism called Earth. Furthermore, as physicians or others concerned with human behavior, we must be humble in realizing that there is much we still do not know about the organism known as a human being. Nevertheless, physicians have been faced with the dilemma of how to deal with human beings in their pain and illness. And because the problems surrounding both the human organism and the organism Earth press upon us with such intensity we are forced to look continuously at alternative methods of perception and intervention. As in the field of medicine, those intervening in our society have tried hard through scientific means to understand fully both the human and social organisms and how they work. Many have tried techniques which have been called rational and scientific to tease out the complexities. Through models, Cartesian in nature, attempts have been made to control or intervene in the behavior of human beings to make them healthy. The same attempts are being made to understand and control our earth. We are endlessly faced with not knowing. We have searched for answers in biological, psychological and sociological areas. Though at times we have found a separation between psycho and soma, increasingly we are encountering difficulty with this division. We have become more aware that in human beings, we cannot separate the psyche and the soma, or the social context in which the two exist. I believe that behind most holistic dialogues is an awareness that we cannot separate internal from external environments. We cannot disregard problems that we have called internal homeostasis from questions of the homeostatic balance of the THE WESTERN JOURNAL OF MEDICINE
473
external world. Thus, health becomes a synthesis of the internal and external environments, and holistic means the integration of all parts of the whole. Does this mean that physicians have to deal with the problem of the holistic totality and interrelatedness of the organisms, Earth and human being? Again, my answer is that this is neither our wish, nor our capability. And yet we must place our actions as physicians within the context of holism. What has resulted is physicians becoming members of more complex teams of specialists and integrators who assist in the process of trying to make human beings whole within a larger social context-earth. The so-called holistic health explosion has forced us to face the fact that there may be alternative ways to view the human organism. Energy and Chi models, previously foreign to American medicine, are being incorporated into our work. In addition, there are persons who are endeavoring to show us that there is more to medicine than a rational, scientific approach, both in our ability to understand medical problems and in our intervention to solve them. These persons are forcing us to look at Eastern philosophiesTao and Buddhism, for example-as well as extensions of scientific medicine such as biofeedback, all of which contribute alternate ways of understanding that may prove helpful. If we respond by looking further, we show respect for other cultures and beliefs that have worked well in helping some people, and an openness to the possibility that there are other ways to cope with problems and issues that primarily have been called medical. Indeed, as we become more open, we find additional scientific, rational answers to questions and techniques we heretofore considered irrational or, at best, nonrational. We need to ask whether modern medicine, magnificent as it is, can cope with all the issues concerning either human beings or the contextual Earth. If we cannot cope, we need to develop new relationships with persons who are concerned with these issues and who may help by offering different conceptual models.1 This is a difficult path, for we may not know
474
DECEMBER 1979 * 131
* 6
how best to synthesize such a diversity of viewpoints, concepts and issues. Though we have toyed with the integration of religion and medicine, concepts of the soul and of physiologic medicine have been difficult to integrate with science. The path is frightening because it means giving up or letting go of the notion that weand we alone-have the truth. There may be other truths. If health is primarily a concern with human growth and development, and with a variety of forms offered by genetic and other heritages, we have a task that is more simple. In this process all aspects of society are involved in what I call societal education. In this context, physicians contribute but do not have prime responsibility. It involves all of the organism Earth. As the normal developmental process of the human organism is unbalanced by pressure and crisis in moments of tension, the possibility of dis-ease occurs.2 Dis-ease comes in many forms, one being medical illness. It is here that physicians play a primary role; and it is here that we must work closely with others to show that there is a possibility of jointly contributing to the treatment of illness. Our work does not end here, for although some people remain chronically ill (and must receive appropriate assistance, too), others must be helped in the healing process.4 It is here that we as physicians must again engage in joint relationships with others, with a focus on healing that may involve social networks, a sense of community and much more.5 All of this is holistic medicine. We as physicians own a monopoly only in our particular expertise, and unless we work with others with different views, we will never have holistic medicine for human beings nor holistic health for the organism Earth. REFERENCES 1. Knowles JH: The responsibility of the individual. Daedalus, Winter 1977, pp 57-80 2. Williamson GS, Pearse IH: Science, Synthesis, and Sanity. London, Collins, 1965 3. Health of the Individual, of the Family, of Society. Pioneer Health Center, Rotherfied, Sussex, Engand, 1971 4. Pearse IH, Crocker LH: The Peckham Experiment: A Study of the Living Structure of Society. London, George Allen & Unwin, Ltd., 1947 5. Duhl LJ, Den Boer J: Making Whole: Health for a New Epoch. New York, Pergamon Press, Inc. 1980 (In press)
