Summary: An exchange with two friends over a decision about a bike trip in Moab, Utah brought to mind a distinction author Kurt Vonnegut made in his 1963 book, Cat’s Cradle. Vonnegut describes as a “karass” a true community of people who are “often unknowingly, working together to do God’s will.” Against this he juxtaposes a “granfalloon,” or false community. The reference led to reflection on the nature “CAM” and of the so-called “integrative healthcare community” or “integrative practice community.” CAM may well be the definitive granfalloon. But is integrative healthcare karass or is it a granfalloon?
Basic science researcher and former NIH NCCAM adviser Joel Pickar
reached back to Kurt Vonnegut’s Cat’s Cradle. He posed a question to Bill Meeker, also a former NCCAM advisory council member, and me via e-mail: Are we karass or granfalloon?
Author Kurt Vonnegut
The issue was not one of science. The issue was of community. Pickar was
goading us to fulfill on a wine-induced plan to meet in Moab, Utah for a
mountain-biking adventure. Pickar pulled out all stops. He went to the
source. He cited Cat’s Cradle. perhaps the authoritative text on community. Pickar sent us these key definitions:
- karass – a group of people
who, often unknowingly, are working together to do God’s will, ie. a group of
people linked in a cosmically significant manner, even when superficial
linkages are not evident. The group can be thought of as the fingers that
support a Cat’s Cradle.
- granfalloon – a false karass;
i.e., a group of people who imagine they have a connection that does not really
exist. An example is “Hoosiers“; Hoosiers are people from Indiana, and
Hoosiers have no true spiritual destiny in common, so really share little more
than a name.
Pickar’s question induced the intended shame
from recollecting the commitment in our late night conversation. Then
it resonated more deeply.
Is there an “integrative practice community” working together to do God’s will (Vonnegut’s phrase)? Or is the idea of an “integrative practice community” little more than granfalloon?
“CAM” is classically “granfalloon”
Certainly “CAM” is classically “granfalloon.” The
diverse therapies and disciplines clustered in CAM categories is certainly as meaningless as “Hoosiers.” Or in this case, given that CAM as category
is framed by what it is not, “CAM” has all the internal magnetism of
“Non-Hoosiers.” No one likes the term. Lassoing chiropractors and Ayurvedic medicines and running them into a corral cohabited by Reiki practitioners, holistic nurses and flower essences does not a community make.
But how about the “integrative healthcare community”?
Ten years ago, I helped create a not-for-profit styled the Collaboration for Healthcare Renewal Foundation (CHRF). We invited committed souls pioneering integration initiatives. The common denominator was investment in a new, health and healing focused paradigm. They
came 100 strong from massage, integrative and holistic medicine,
hospitals and health systems, nursing, chiropractic medicine, insurance, acupuncture and Oriental medicine, managed care, naturopathic medicine, federal policy, employers and more.
In those early days of integrative medicine we seemed linked in a cosmically significant manner.
In our private moments, my co-founder Jery Whitworth
sometimes referred to this apparent community of diverse stakeholders
as a figment of our imaginations. Of mine, in particular. I left on a long-planned sabbatical in 2002. The group honored me with the gift of a gorgeous, foot-long, dark green, egg-shaped hunk of polished granite. The stone sits in my office, reminding me of Sisyphus. CHRF died.
Vonnegut’s drawing of a cat’s cradle
Vonnegut offers an easy standard for affirmation by a community that
believes in energy, consciousness, homeopathy and distant prayer. The holistic nurse and the chiropractor could never invite the other to table and still see
themselves as linked in a cosmic manner of presumed significance. That the integrative practice community is karass, as Vonnegut defines it, seems a no-brainer. Hey, look at this movement we’re part of!
Yet that loose description makes me think a group of Hoosier fans self-congratulating on a basketball victory.
Vonnegut may think this “superficial.” But the
currently lousy state of healthcare induces a desire for more practical
measures of karass. Here are some measures. Who is at your table? Do
integrative practitioners actively confer clinically with those from other
Here are measures for collective efforts. Are your
organizations extending themselves beyond guild boundaries? Has the integrative
practice community collaboratively identified and jointly engaged in policy
initiatives? Do the diverse stakeholders invest in meeting together? Are
leaders of the integrative medicine and “CAM” academic institutions
and continuing education programs consciously connecting to each other? Are
they expanding outside their silos? Are we paying into community chests to
advance shared initiatives? Are we collaborating, proactively to advance health
Connections are forming
Recent experience weighs in on the negative side of the
ledger. Extraordinary, legislatively significant (if not cosmically significant) federal policy opportunities to define the
meaning of “integrative healthcare” and “integrative
practitioner” received little input from any of these entities. Someone
else is making up definitions. Members of Congress have opened doors for the
integrative healthcare community. Few show up for the party.
As an intentional community, we find little significant
presence. (See Brief Report, here.)
Yet in the last decade of this work, connective tissues
are forming. Consortium of Academic Health Centers for Integrative Medicine.
Integrated Healthcare Policy Consortium. The recent iMosaic conference.
Bravewell Collaborative. Integrative Practitioner Online/Integrative Healthcare
Symposium. Academic Consortium for Complementary and Alternative Health Care.
The new Grantmakers in Health Complementary and Alternative Medicine Funders
Network. The Institute for Functional Medicine.
These suggest the emergence of significant community. One can
find the points of collaborative light and form a cat’s cradle. Stories
multiply of what the cradle holds. This is good.
Yet that stone of unfinished business sits on the office
floor, like the invite to Moab.