Patient health care in today’s world is subjected to the biases of the care provider, yet many biomedical doctors have foregone traditional medicine in favor of what are termed Complementary Alternative and Integrative Medicine (CAIM) modalities.
In this Article:
- Western medicine’s focus on reductionism leads to dissatisfaction in biomedical ideals, which in turn leads practitioners to move towards alternative, holistic modalities.
- Holism does not seek to drive out reductionism; it simply seeks to complement it.
- Patient health care in today’s world is subjected to the biases of the care provider, yet many biomedical doctors have foregone traditional medicine in favor of what are termed Complementary Alternative and Integrative Medicine (CAIM) modalities.
- What drives doctors, the individuals who have studied the system in the most depth, to make the switch? To answer this question, this article examines how two Los Angeles-area practitioners view the mind and body.
Comparing the Fundamentals of Conventional and Alternative Medicinal Modalities
Alternative medicine has long been defined as holistic, yet this word is not commonly used in traditional western medicine. This sparks a question: in what terms do CAIM practitioners see their fields: holistic or reductionist? And how is this reflected in their practices? From a series of interviews with Dr. James Ralph* and Dr. Henry Sing* at the Venice Family Clinic, an integrative medicine clinic in Santa Monica, CA, it is hypothesized that western medicine’s focus on reductionism leads to dissatisfaction in biomedical ideals. This in turn leads to practitioners moving towards alternative modalities and becoming more holistic in their work. The focus for this article is to provide a background on holistic and reductionist methods and perspectives, and to explore the current healthcare system and its general public dissatisfaction.
In an article defining holism, Joshua Freeman notes that one definition is, “the ability to use a biopsychosocial model taking into account cultural and existential dimensions—that everything affects health”1(155). Reductionism, however, can be viewed as the opposite of holism, and is currently the most commonly applied methodology in biomedicine. Andrew C. Ahn et al. explain in their article titled The Limits of Reductionism in Medicine that, “Reductionism pervades the medical sciences and affects the way we diagnose, treat, and prevent diseases… there are limits to reductionism, and an alternative explanation must be sought to complement it”2(709).
At the Venice Family Clinic, the first question asked of Dr. Sing and Dr. Ralph was how they saw holism and reductionism. Dr. Sing is an acupuncturist and doctor of Chinese medicine, and Dr. Ralph is a medical doctor with a Master's in Public Health. It was interesting to find out that each saw holism as a positive, guiding light of their profession, and reductionism as an evil word. For example, Dr. Ralph uses holism to guide how he evaluates his patients’ health:
- “I see holism as…what is going on for that patient not just physically, but emotionally…you know so it’s body, mind, spirit…the big thing for me is how are they sleeping, how are they in terms of support from around them, how are they eating…and that all acts, the symptoms are telling me that.”
He looks at day-to-day lifestyle choices and emotional support systems and how these can have positive or negative effects on health. Thus, the mind is connected to the physical well-being of the body. This is a practice highlighted in Joshua Freeman’s definition of holism as using a “biopsychosocial” approach1(155). From a patients’ standpoint, this is a much deeper, involved method than simply prescribing a remedy. Reductionism, on the other hand, is a simple treat-the-symptom process. As explained by Dr. Sing, “You see color, different color, learning one-by-one, piece-by-piece. You don’t see whole true spectrum of color all in one. You cannot separate, it’s all just one from each other.” Breaking this analogy down, reductionism is seeing simple color blocks (singular symptoms), as opposed to holism, which is the entire spectrum of colors (mind and body connected). Reductionist thinking can treat one symptom, but perhaps not the bigger picture. This ties in with the analogy by Andrew C. Ahn et al. that, “Much like a mechanic who repairs a broken car by locating the defective part, physicians typically treat disease by identifying [only] that isolatable abnormality”2(709).
Both Dr. Sing and Dr. Ralph started their careers in biomedicine. Dr. Sing finished his undergraduate schooling as a pre-medical student, but when he finished his undergraduate he reflected, “if you were to give me the doctor title at the moment right away, I won’t be happy for the rest of my life to do the job.” Though he had applied to medical school, he felt dissatisfied with the way that biomedicine treated patients, and so went back to his TCM roots and became a doctor of Chinese Medicine. He is one of many people who have studied enough of western medicine to realize that there are better alternatives that fit their personal medical morals. Similarly, Dr. James Ralph attended medical school and earned his MD, and because of similar feelings of unease with western medicine, he went on to do a two-year fellowship as an integrative physician. He explains his choice of integrative medicine as, “Feeling frustrated on how many people I couldn’t [help] with the tools I got in standard western medicine; literally like half the people I had no idea how to treat.” These frustrations with conventional medicine are perfect examples of the industry’s growing distrust of using biomedicine alone. There needs to be a more expanded approach, and the push for more integrative doctors is increasing.
While some may see reductionism and holism as opposites, there is a degree of overlap between the two, and there is room for each in the world of medicine. Holism does not seek to drive out reductionism; it simply seeks to complement it. Both Dr. Sing and Dr. Ralph agreed that reductionist methodology can be used if the patient is in good health aside from the complaint they have come in for. In such cases, healing the pain that the patient is feeling comes first, and there is no need to go into the cause. As Dr. Ralph said, there is no need to “get fancy” if the patient has a simple, treatable ailment. This may put critics to rest who argue that integrative medicine is a waste of time in cases where something as simple as antibiotics or a cast is needed.
However, even though the CAIM practitioners use reductionism at times, they still make sure that everything else is in order before letting the patient leave. Dr. Sing explains that he treats without using a mind-body approach “only in the most simple case… Energetically, you feel the spiritual level is good, the mind is good, the body is actually very healthy, so I don’t have to communicate.” This system still uses a holistic approach, yet simply eliminates any causes except for the one that the patient describes. For example, tripping and spraining your ankle needs no other explanation than just that. Though reductionism is used in times of simple diagnoses, there is nonetheless a much more holistic mindset behind CAIM.
Finding and treating the cause, not the symptom, is a basic tenet of alternative medicine philosophies. Dr. Sing explains that the fundamental task of his work as an acupuncturist is to, “find out [the] causing factor, instead of treating [the] chief complaint.” This is the stark opposite approach to western medicine; he goes straight to the source of the pain and cures it, rather than doling out medication to numb it temporarily. However, Dr. Sing gives credit where credit is due and does not deny that the emergency room and western doctors are necessary for life-threatening events.That being said, he amends that thought, imploring, “you want to prevent it before it happens.” Unfortunately, even though using holism as a guideline may seem the ideal way of looking at medicine, not all people see it in the same light as Dr. Ralph and Dr. Sing.
Medical schools on the whole do not even teach the word holism in conjunction with biomedicine. Dr. Ralph reported that when he went to medical school he did not hear the word holism used, “except in a derogatory manner.” He expanded, saying that they did not even model the idea of a mind-body connection in a positive way. “In fact it was the opposite,” he says, “we called things ‘supertentorial’...[that] it’s all in their head.” This illustrates the very basic and reductionist western medicine approach of compartmentalizing each section of the physical body and denying the fact that there is a connection between the body and mind. It was, in fact, this very shallow way of thinking that led Dr. Ralph, as well as Dr. Sing, into the arms of alternative medicine. This is just the sort of dissatisfaction commonly referred to in describing the current health care system.
As told by Victoria Maizes et al., “Dissatisfaction with the U.S. health care system is increasing despite impressive technologic advances. This dissatisfaction is one factor that has… led medical schools to start teaching CAM”3(851). The University of Arizona, where she has implemented a curriculum in CAM, is one of only a handful of institutions that have yet done the same. The Venice Family Clinic is another. Victor S. Sierpina et al. have done research on this facility and offer their summary:
- The Venice Family Clinic… now offers the nation’s first health, wellness, and integrative medicine services at a free clinic. These services focus on optimizing wellness for the whole person and the whole family.”4(535)
General practitioner Philip White is yet another western doctor who expresses dissatisfaction with his own practice, and urges others in his profession to take a step back and see why so many of their patients turn to alternative medicine. In an article in British Journal of General Practice, he states, “General practitioners must always strive to provide holistic and patient centred care… We should be aware of what evidence exists for the efficacy of such therapies and thus know which complementary therapies would best suit our patients”5(822). This quote brings confidence to the fact that there are some general practitioners who know their mistakes in reductionism and are moving towards creating a better general guideline alongside holistic medicine. It remains the case, however, that in today’s changing world, most mainstream healthcare modalities have nevertheless remained ignorantly stagnant.
According to Ralph Snyderman et al., authors of Integrative Medicine: Bringing Medicine Back to Its Roots, it is ironic that, “just when decades of biomedical research are beginning to pay miraculous dividends, public confidence in the medical establishment is eroding.” They describe the “rapidly widening gap…between what many conventional health care providers deliver and what the public wants and needs”6(395). Essentially, a public need for holism in medicine is clashing with the industry’s most fundamental, reductionist ways. Dr. Snyderman et al. highlight the need for the conventionalization of integrative medicine, saying that the field “calls for restoration of the focus of medicine on health and healings and emphasizes the centrality of the patient-physician relationship”6(396).
Integrating alternative modalities into hospitals and doctor’s offices offers a more holistic life for everyone. Dr. Ralph elaborates on expanding integrative medicine: “It’s all about patient-centered care, recognizing everything that goes into these people’s health. Recognizing health in a very broad way. That’s what integrative medicine is all about… The next evolution of holistic practice, I think.” Integrative medicine is the best of both worlds, and hopefully some day there will be an integrative physician in every practice. This would eliminate both public distrust of western medicine as “too chemical” and of alternative medicine as “too herbal.” Integrative and CAIM practices can help bring the medical world together to become more holistic. While holism and reductionism can be boiled down to very strict definitions, these do not necessarily encompass the ideals of the institutions behind each. Reductionism has pushed doctors away, and holism has drawn skeptics as well. Each field has its own biases and the only viable solution is melding them together. Integrative medicine is the next horizon on the onward march of health care. Though not currently the most well-known medicine, it is increasingly gaining momentum, and with more research and support it can become the new mainstream.
*Names have been changed to protect privacy.
by Hayley A. Lawrence
NOTE: This article was written originally as a paper for the UCLA upper division anthropology course Perspectives on Complementary/Alternative & Integrative Medicine, taught by Dr. Sonya Pritzker. More information on the course can be found here.
- Freeman, Joshua. Towards a Definition of Holism. British. Journal of General Practice. 2005; 55(511):154-155.
- Ahn, Andrew C.; Tewari, Muneesh; Poon, Chi-Sang; Phillips, Russell S. 2006. The Limits of Reductionism in Medicine: Could Systems Biology Offer an Alternative? PLoS Medicine. 2006; 3(6):709-713.
- Maizes, Victoria; Schneider, Craig; Bell, Iris; Weil, Andrew. Integrative Medical Education: Development and Implementation of a Comprehensive Curriculum at the University of Arizona. Academic Medicine. 2002; 77(9):851-860.
- Sierpina, Victor S. and Kreitzer, Mary Jo with Stanley, Jacqueline; Hardy, Mary L.; Spar, Myles D. and Arias, Mia. Poverty and Health: Blind Massage Therapists and a Free Integrative Pain Clinic. Innovations in Integrative Health Care Education. 2007; 3(5):535-538.
- White, Philip. What Can General Practice Learn From Complementary Medicine? British Journal of General Practice. 2000; 50(459):821-823.
- Snyderman, Ralph and Weil, Andrew T. Integrative Medicine: Bringing Medicine Back to Its Roots. Archives of Internal Medicine. 2002. 62(4):395-397.