Daniel J. Benor MDComplementary/ Alternative/ Integrative
Alternative medicine is the term most commonly used for therapies that have been outside the spectrum of conventional medical care. These include therapist-administered treatments such as acupuncture and massage, as well as the self-healing techniques of relaxation, meditation and imagery (the latter three have been combined as psychoneuroimmunology). When expertise is required in learning the methods or in choosing remedies, as in aromatherapy, flower essences and homeopathy, the approaches and therapist/ respant relationship can be fairly similar to those found in conventional care. The self-healing approaches are often practiced under the guidance of trained practitioners.
Holistic/ Wholistic
Holistic has been in use for several decades, used generally to indicate a focus in treatment that extends beyond physical problems as addressed by conventional medicine. In some instances holistic includes what I term wholistic, but in most instances it refers to the addition of some aspects of CAM therapies to medical care. Often this sort of holism includes bits and pieces of therapies, such as needling particular acupuncture points for pain relief, or providing massage for relaxation and post-injury rehabilitation.
Holistic may overlap with psychosomatic, including psychological aspects of illness, as reflected in emotional responses to the physical problems, in mental aberrations that occur as the result of disorders of the body (e.g. psychosis that may result for hormonal abnormalities), and psychological influences on the body. Minimal mention is made of the psychological contributors to disease and psychosomatic medicine has been grossly neglected in medical training at most medical schools.
Wholistic refers to whole person care, including body, emotions, mind, relationships and spirit. Where CAM therapies are modalities for wholistic care, wholistic healing acknowledges the broader philosophies of these approaches. For instance, acupuncture includes a complete system of biological energy diagnosis and treatment. This is fundamentally different from Western medicine, addressing the biological energies of the body as avenues for diagnosis and treatment. Western medicine tends to discount and discredit acupuncture (and the theoretical and philosophical cosmologies of other CAM modalities), ignoring that many of these have served the larger portion of our world’s populace, and continue to do so.
Many varieties of bioenergy therapies are available within the wholistic healing spectrum (Benor unpublished)
Integrative care
Integrative care – in its highest form – seeks to blend the best of conventional and CAM modalities, respecting the approaches of each modality. However, this term, too, may be used to cover token selected CAM interventions that are lifted out of their original contexts into Western settings.
Congruence of caregivers with their teachings
Within all of the variations on the theme of caregiver, we often tend to focus on the content of their ministrations. The family doctor prescribes medicines, the surgeon cuts and sews, the herbalist prescribes plants, and so on. We should not overlook the importance of caregivers as healing agents, in and of themselves. Within wholistic frameworks, caregivers are an essential part of the healing.
Caregivers are far more effective when they model what they are teaching than when they are simply purveyors of information. A quiet voice, a heart connection, and suggestions based on personal experience enhance the impact of any therapeutic intervention. In the deepest sense, this is when the therapist is keeping his or her word.
Biofeedback is an excellent example of the importance of therapist congruence with the therapy. Biofeedback introduces instruments or other methods for becoming aware of bodily processes that are usually outside of conscious awareness. For instance, a very sensitive thermometer or electrodes that measure electrical skin resistance may be taped to your hand. Your challenge is to discover ways to raise the temperature of your hand or to alter the electrical resistance of your skin, using the feedback provided by that thermometer or resistance meter. There are no precise instructions that can be given in how to do this. Each person must explore what works best for them. Biofeedback therapists who have mastered these techniques themselves are more effective in teaching them to be respants (Green and Green 1977; 1986).
Abbreviations
Internet users often use abbreviations in their quest for ever more time-efficient communications.
BTW – By the way
RUOK – Are you OK?
OIC – Oh, I see
KWIM – Know what I mean
Signing off with
BCNU – Be seeing you or
BFN – Bye for now
Medical charts are full of such abbreviations, as doctors maximize their use of pen on patients’ charts in the interests of saving time. For instance:
COPD – Chronic obstructive pulmonary disease
CVA – Cerebrovascular accident (technicalese for having a stroke)
EEG – Electroencephalogram
EKG or ECG – Electrocardiogram
We have to be careful with potentials for misunderstanding with some of these, such as SOB – Shortness of Breath.
As hospitals move into more wholistic care, some of these become a liability. The Planetree hospital group is humanizing hospital care in a big way. Some Planetree facilities are in custom-built structures that may include healing architectural features, such as an atrium extending from ground to top floors, facilities for relatives to cook home-style meals, and places for family to bed down near their relatives who are being treated in the hospital. Music may be played in the ground floor, audible through much of the hospital. Respants are invited to read their own medical charts and enter their own notes in the charts. When a doctor reads, “Dr. Smith was in a bad mood yesterday. He only peeked in and said, “Hello” but didn’t give me a chance to ask about my lab tests!” there is likely to be more doctor-respant communication.
Doctors have learned to not use certain abbreviations where respants might review their charts.
ASVD – arteriosclerotic vascular disease (may raise anxieties that the lab tests showed venereal disease)
BS – bowel sounds
PET – poor exercise tolerance
PIG – pertussis immune globulin
PIGI – pregnancy induced glucose intolerance
PROM – premature rupture of (amniotic) membranes
ROT – remedial occupational therapy
SOB – short of breath (may be taken as a disparaging term)
Unspoken words
Unexpressed emotions that fester
We may hesitate to say something that could lead to hurt or anger, often when we are experiencing these same feelings ourselves. If my boss is asking me to stay late when I have family obligations, my emphatic response of outrage might be better off toned down, lest I lose my job. If I am feeling such emotions, it is likely that others I interact with are too. When words go unspoken and underlying negative emotions simmer, they often leave residues of unresolved feelings on both sides of the communications. Unexpressed feelings tend to fester, generating defensive, irritable, and angry interactions.
Unexpressed feelings may produce physical tensions that cause or contribute to headaches, backaches, migraines, irritable bowel syndromes, chronic fatigue syndrome, allergic diseases (asthma,
Respants may feel unhappy or upset with doctors’ interventions. For instance, respants often complain that doctors take too little time to listen to respants’ explanations of their problems, don’t actually listen to hear what might lie behind the problems, and prescribe treatments without adequate explanations. This is often experienced as an expression of uncaring on the part of the doctor. Respants may reject medical advice and ignore recommendations for treatment. It is estimated that half of medical prescription written go unfilled – a reflection of these sorts of problems.
Many people who come to doctors are not looking for treatment. They want to share their anxieties and learn whether a pain or other symptom is serious. As often as not, if they are simply asked, “What is your body saying with these symptoms?” they will be able to identify the underlying stresses that are contributing to or actually producing physical symptoms. Joe, who had severe migraines, responded, “My headaches come on towards the end of the weekend, as I start to think of going to work on Monday.” Frieda, who had been suffering excruciating stomach aches for years, with occasional bloody stools, was scheduled for surgery to remove part of her bowel. She was startled to be questioned about why her guts were in such an uproar. No one had ever asked her to consider the stressors in her life and how she was swallowing down her feelings. Psychotherapy, relaxation and imagery exercises, and careful attention to her diet relieved her pains and made surgery unnecessary.
When frustration and anger is stirred and not resolved between caregivers on a therapeutic team, treatment also suffers. At the physical level, adrenaline levels rise when we are upset. While this is helpful if a tiger is attacking, it has negative consequences in a therapeutic setting. Adrenaline makes us more alert to deal with attack, but at the same time makes us more distractible, so that we can focus on any shift in the attack. In an office, anger can lead to unhelpful distractibility. Where emotions are unexpressed, staff get distracted more easily. This is when phone messages and medical records go astray. Psychological mischief may also intrude, with unexpressed feelings leading to unconscious or conscious manifestations of anger that are expressed through irritating behaviors, ranging from brusque or negative verbal and non-verbal interactions between staff, through passive-aggressive behaviors that release angers indirectly, and displacement of anger towards other staff and respants.
In a film featuring Danny Kaye, The Inspector General, there is a classic portrayal of such interactions. In the first scene of the sequence, the wife of the police chief berates and belittles him and stalks angrily out of his office. He chews out the first sergeant, who reams out the corporal on duty, who shouts at the patrolman who is leaving his office. This unfortunate officer, having no one lower on the totem pole to vent his angers on, storms down the stairs of the police station. Danny Kaye, an innocent bypasser, happens to be walking in front of the station at just that moment. The patrolman bumps into him and angrily shoves him into the gutter. Kaye, angered at his mistreatment, kicks at a passing dog.
Words, wisely used, are avenues to healing
Denial of death
Western medicine tip-toes around mention of death. Avoiding naming what every person is going to face denies respants the opportunity to deal with their anxieties and fears. Most doctors are not trained to deal with end of life issues, and therefore avoid them. This is worsened by Western society’s general tendency to deny and avoid dealing with death, doing everything possible to prolong life at all costs.
References
Benor, Daniel J. Healing Research, Volume II: (Popular edition)
How Can I Heal What Hurts? Wholistic Healing and Bioenergies,
Medford, NJ: Wholistic Healing Publications 2005 0-9754248-3-1
Popular edition Explains self-healing, wholistic complementary/ alternative medicine (CAM) and bioenergies, and discusses ways in which you can heal yourself.
Benor, Daniel J. Healing Research, Volume II: (Professional edition)
Consciousness, Bioenergy and Healing, Medford, NJ: Wholistic Healing Publications 2004. ISBN 0-9754248-0-7
Thorough review of research validating the efficacy of self-healing, wholistic complementary/ alternative medicine (CAM), biological energies, and environmental interactions with bioenergies.
“Book of the Year” award – The Scientific and Medical Network http://www.datadiwan.de/SciMedNet/11.htm
Green, Elmer/Green, Alyce: Beyond Biofeedback. New York: Delta/Dell 1977.
Green, Elmer/Green, Alyce: Biofeedback and states of consciousness. In: Wolman, Benjamin B./Ullman, Montague (Eds): Handbook of States of Consciousness. New York: Van Nostrand Reinhold 1986.
*An expanded version of this article appears in Benor, DJ, In a Word, International J of Healing and Caring – On Line, www.ijhc.org January, 2001, 1-8.
Dr. Judith Orloff MD
Barry Bittman MD
Jim Strohecker