The Holistic Hodgepodge: A Critical Analysis of Holistic Medicine and Health in America Today

Harold Y. Vanderpool, PhD Galveston, Texas

Contrary to a rather common assumption, no single “ holistic health movement exists, and many of the theories and thera­ pies now called holistic are not new to American medicine. The holistic movement actually represents four different ap­ proaches to medicine and health, each with its own theoretical perspective, historical background, and set of therapeutic op­ tions. The term holistic confuses the differences among these approaches, fails to capture their merits and defects, and as an all-purpose term is confusing rather than useful.

For nearly a decade, holistic health care has that is expanding rapidly. Actually, few data exist been discussed in articles, books, talk shows, and on its growth, and many of the theories and thera­ conferences, and by patients and health profes­ pies that are now often called holistic are not new sionals. In spite of its popularity, the meanings and to American medicine.8 connotations of holistic care remain imprecise and This essay will critically analyze contemporary confusing. holistic medicine and health. It will show that the This “movement” is being advanced by per­ genera and species that are being called holistic sons who assume that they hold certain theories, have evolved from different origins, have taken on purposes, and practices in common.1'5 In spite of a different character traits, and inhabit different few general similarities, the proponents of this cultural niches in American society. Even though movement often do not agree with each other.5 No some species resemble one another, holism actual­ uniform set of holistic theories and therapies can ly involves a heterogeneous mixture of theories be identified, and no common institutions are and therapies. found among its advocates. In fact, so much diver­ This study has several practical ramifications: sity exists among the proponents of holism that it to identify various groups that use the term holistic can scarcely be considered a single movement. and to assess valuable and worrisome features in Furthermore, it is thought that holism is a new, each, to give background information for decisions reformist movement within American medicine7 regarding licensure or accreditation, to provide a helpful bibliography, and to determine the useful­ ness of the widely used term holistic. From the Institute for the Medical Humanities, Department of Preventive Medicine and Community Health, The Univer­ sity of Texas Medical Branch at Galveston, Galveston, Texas. Requests for reprints should be addressed to Dr. A Common Creed Masks Actual Diversity Harold Y. Vanderpool, Institute for the Medical Humanities, Department of Preventive Medicine and Community One of the reasons holistic health and healing Health, The University of Texas Medical Branch at Galves­ has been widely viewed as a uniform movement is ton, Galveston, TX 77550.

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because a standard rhetoric is shared. Because it is This use of the term holistic medicine is parallel standardized and used frequently, this rhetoric to what Rene Dubos called for in the development functions as a creed that disguises diversity. Those of an “organismic and environmental medi­ who espouse this holistic creed contend that cine.” 15 It is also parallel to the biopsychosocial holistic medicine represents a more complete un­ model of medical care called for by George L. derstanding of the causes of disease and the fac­ Engel16 (although Engel avoided using the term tors that sustain health than what is held by most holistic because of its association with unscien­ scientific medical practitioners,1'5 is concerned tific, occult, and dogmatic practices). Engel recom­ with the complete human being (hence the borrow­ mended that medical curing systematically utilize ing of the Greek term holos, meaning whole or data from the disciplines of psychology, sociology, complete5), and takes into account all aspects of and anthropology in diagnosing and treating sick human life that relate to sickness and health. The persons. He contrasted this biopsychosocial proponents of holistic medicine regard these fac­ model of disease and health with the dominant tors as integrated and interdependent, while they “ biomedical model” of the past, which he identi­ regard traditional scientific medicine as overly fied as the “dominant folk model of the Western specialized, reductionistic, impersonal, and ori­ w orld.” 16 ented toward curing disease rather than promoting health.15’7’9-12 Historical Perspective Although this creed contains attractive ideals, The biopsychosocial approach has developed as the creed’s imprecise and simplistic rhetoric dis­ a consequence of the dramatic changes in disease guises the real diversity and character of holistic etiology over the last 80 years. With the rise of medicine and health in America today. Holistic scientific bacteriology in the 19th century, germ means different things to the different persons and theory became the dominant explanation for dis­ groups who espouse it. On examination, four tra­ ease. In the 20th century, however, new data and ditions of thought and practice that utilize the term separate disciplines emerged (the science of nutri­ holistic can be identified. Each is described in tion in the 1930s, psychosomatic medicine in the terms of its theoretical point of view, its respective 1940s, genetics in the 1960s, and environmental advocates and social institutions, its probable medicine, including social and cultural influences, historical lineage, and its characteristic forms of in the 1970s) demonstrating that a variety of fac­ therapy. tors were responsible for disease and health.17 This overview indicates that a multicausal (or holistic) understanding of disease is hardly new to Biopsychosocial Diagnosis and Therapy W estern medicine. In his classic essay in 1927, for A number of persons—many of whom have re­ example, Francis Weld Peabody18 spoke about the ceived conventional medical training—use the necessity of understanding the psychological and term holistic to refer to an inclusive and integrated social aspects of human illness. Peabody also said approach to scientific diagnosis and therapy.13’14 that a humanistic concern for patients was needed In their view, holistic diagnosis and therapy are to effect better cures. Furthermore, in the 1940s, based upon all the factors that cause disease, as 1950s, and 1960s, a number of comprehensive care well as an appreciation of the interdependence of programs were set up to integrate biomedical data these factors. with an understanding of the patient’s psychologi­ This view of diagnosis and therapy is often con­ cal and social background.19 Many physicians as trasted with an overly specialized, reductionist well tried to relate biomedical data to psychologi­ approach to human disease.3’7,13'14 Contemporary cal and social causes. These physicians tried to medicine is criticized, not because it is too scien­ assess the interplay among these factors by a tifically oriented, but beacuse it is not scientific shrewd, intuitive reading of the patient’s words enough. Exclusively biomedical procedures are and actions and by expert interviewing techniques.20 said to be less scientific because they propose to Thus, the history of American medicine offers diagnose and treat illness without fully under­ two legacies: one of greater and greater speciali­ standing and factoring in social, psychological, zation, and one aimed toward a comprehensive and environmental causes. and integrated approach, as evident in family med-

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icine programs at the present time. It is false and presumptuous to claim that an inclusive and inte­ these added factors cannot be assessed accurately. In spite of important gains, the goal of achieving grated approach to disease arose in the last ten both specificity and comprehensiveness is yet to years with the advent of the “ holistic health be realized. movement." From a moral standpoint, biopsychosocial cur­ Critique ing leads to questions of influence and manipula­ tion that are often overlooked. For example, one In view of this older tradition of comprehensive proponent of inclusive and integrated record­ care, does contemporary biopsychosocial medi­ keeping has stated that medical records should list cine nevertheless introduce new features of diag­ patients memberships in secret societies and nosis and therapy? In several respects it does. oaths of allegiance.22 Others categorize patients' First, several writers are trying to develop more personalities because certain longitudinal studies systematic, nonintuitive methods to identify the indicate that correlations are likely to exist be­ causes of disease and to determine how they are tween personality profiles and hypertension, or interrelated. For example, some utilize systems even malignant neoplasms. The patient is then said theory to explore the dynamics of each system to have a pathogenic or premorbid personality. (cell, tissue, organ, and so on) and to ascertain This approach is presumably for the patient's how they are interconnected with other, more benefit.24 Such procedures can stereotype pa­ complex systems (the nervous system, the indi­ tients, produce new anxieties, and possibly create vidual person, the family group, and so on).21 self-fulfilling prophecies. Inclusive forms of medi­ Second, data-gathering and medical charting cal care thus give rise to ethical dilemmas, even as are being redesigned to be more comprehensive do highly specialized ones. and integrative.22 Third, team approaches in medical care are being given greater attention, so that a compre­ Whole-Person Medical Care hensive and interconnected picture of a patient's Holistic is invested with a different set of mean­ disease can be created. ings by others who may also subscribe to the Fourth, certain innovative therapies have been importance of biopsychosocial medical care, but developed to deal more effectively with psycho­ want to accent additional concerns. This diverse social factors. Biofeedback enables patients to ob­ group sometimes uses the term holistic25,2'5 and, serve and influence autonomic physiological func­ sometimes, prefers the spelling wholistic.27'29 tions, such as skin temperature and heart rate; and Holistic or wholistic are used, not as symbols for autogenic training and other relaxation or medita­ biopsychosocial medicine, but as a way to em­ tive techniques focus on the control of autonomic phasize that medical curing is neither maximally functions to alleviate undue stress and improve effective, nor morally responsible, without special physiological functioning.23 These newer therapies humanistic dimensions: interpersonal sharing, are designed to complement standard forms of moral respect, and an active caring for each pa­ care. They are useful in correcting stress-related tient as a person, that is, as a uniquely moral, self- problems which cannot be treated adequately with conscious, private, believing self.25,27,30 Patients drugs alone. Only time will tell whether these must be dealt with in terms of their complete therapies will create yet another group of special­ (holos, or whole) self-identity. They are to be ists, or whether they will be used effectively by known and related to, respected as moral agents, primary care physicians. and understood in terms of their inner feelings, Although these biopsychosocial approaches are perceptions, and beliefs. valuable, they are not devoid of problems. Are The phrase “whole-person medical care" cap­ they actually effective? Do their results merit the tures these themes. It overlaps with biopsycho­ amount of time they consume? Do they cost more social diagnosis and therapy that includes personal and humanistic dimensions of patient care.13 than they are worth? Furthermore, even though highly refined subspecialties are not scientific Nevertheless, there are important theoretical, in­ stitutional, and therapeutic distinctions between enough if they fail to consider psychological, so­ cial, and environmental factors, little is gained if these two orientations.

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Advocates of whole-person medical care criti­ century, several notable physicians demonstrated cize contemporary medicine, not because it is not their awareness of the emotional, moral, philo­ scientific enough (as with biopsychosocial advo­ sophical, and religious dimensions of human ill­ cates), but because it is not as personal and moral ness.18,34 Social workers and chaplains were as it should be. Some have established smaller, brought into university and municipal hospitals to more personalized institutions that are designed to supplement care by the physician.34 Hospitals redress certain problems in university and teach­ founded by denominations took the psychological, ing hospitals: interactions with patients that are religious, and social needs of patients to be impor­ too brief, too much reliance upon complex techno­ tant. The ancient Greek and Christian historical logical equipment and batteries of medical tests, roots for these concerns are found in the words and constantly rotated medical personnel.29,31 hugies (to restore or make whole) and sozo (to heal Medical curing is regarded as limited and or make sound), rather than the frequently men­ reductionistic if it does not steadfastly consider tioned word holos (all or entire).35,36 patients as persons who happen to have diseases By the middle decades of the 20th century, psy­ and impairments. chiatrists, theologians, and religious educators The connotations of the term person imply the were engaged in discussing the many dimensions dimensions of care and therapy considered neces­ of medical care. For example, the internist- sary by this type of holism. Biological dimensions psychiatrist Paul Tournier asserted in numerous are dealt with through scientific diagnosis and books and articles that patients must be known as therapy; psychological dimensions by knowledge persons by their medical attendants if they are to of the individual, as well as personalized attention, be completely cured.37 Tournier detailed many in­ empathetic relationships, and effective communi­ stances in which illness was caused or complicated cation; and the social or communal dimensions, by by unresolved or unexpressed guilt, or fear, or making the patient part of a new, caring commu­ a crisis involving religious faith. Westberg's nity. Moral dimensions are looked after by just Wholistic Health Care Centers represent the crys­ and respectful care that preserves the privacy and tallization of this point of view in local, community autonomy of each patient; and the philosophical settings. and theological dimensions, by considering each patient's beliefs, values, and hopes. These con­ cerns are taken seriously by both secular philoso­ C ritique phers32 and religious thinkers, who ground human The virtues of this diverse movement are worth in a person's relationship to God.27,28,30,33 quickly perceived. Care designed for patients, as A social profile of the individuals and institu­ whole persons, includes scientific competence, tions that advocate whole-person care includes personalized and empathetic communication, a re­ chaplains and pastoral-care training programs, spect for the autonomy of patients, and a consid­ a number of community programs and clinics, in­ eration of each patient's social needs and personal cluding hospices for terminally and chronically ill beliefs. For patients with religious backgrounds persons,31 and such institutions as the Wholistic and needs, pastoral counselors bring an added di­ Health Care Centers, founded under the inspiration mension. With special training and expertise in the of the Lutheran minister, Granger Westberg.27’29 interplay among physiological, emotional, and religious factors, pastoral counselors seek to en­ able patients to cope better with suffering, anx­ Historical Perspective iety, stress, and regression. Styles of pastoral Like biopsychosocial diagnosis and therapy, counseling have shifted from paternalistic styles of the emphasis on whole-person medical care did counseling, to listening to, and understanding not begin in the last decade. In fact, its ideals re­ patients in terms of their own faith traditions.38 flect a complex, diverse, and ongoing dialogue be­ To achieve these ends, institutions such as tween medical science and Western culture. Westberg's Wholistic Health Care Centers utilize After the hospital became the center of scien­ teams of professionals to bridge the distance tific medicine in the early decades of the 20th among physicians, nurses, social workers, and

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chaplains. Most hospices are designed to provide Finally, it is exceedingly important to remem­ personalized care for chronically or terminally ill ber that the concerns of whole-person care are patients, to enable them to talk about their experi­ longstanding and commonly shared (even if not ences, and to manifest their religious beliefs. put into practice), and have long been regarded From a pragmatic standpoint, the many-sided as significant. The new term holism seems to dimensions of whole-person care raise certain di­ trivialize these concerns, rather than to capture or lemmas. For one thing, such care calls for more highlight them. time-consuming, less cost-efficient interventions. For another, it obliges medical professionals to High-Level Healthiness develop interpersonal and counseling skills, to ac­ Holistic is used by other proponents as a sym­ quire an ability to work in interdisciplinary teams, bol for ideal levels of human health and well-being. and to sustain relationships with patients. All They focus on health rather than medicine, and these factors are difficult to achieve in academic use the term holistic to emphasize that human centers where personnel are routinely rotated health and well-being are dependent on an inte­ among a number of hospital services. gration of all physical, psychological, social, envi­ A further dilemma posed by whole-person care ronmental, and ideological factors.9,40-42 Of course, relates to a definition of the ideal morality of phy­ comprehensive preventive medicine and human sicians. Is the physician morally obligated to dis­ healthiness is emphasized by many institutions play a high degree of personal sharing and reli­ and persons, so this discussion will focus only on gious concern for each patient? If these qualities those programs and institutions that expressly use are an essential part of the healing role, physicians the term holistic to describe their approach to ought either to display these concerns, or to see comprehensive health. that they are provided. Unless psychological and These advocates of holistic health emphasize spiritual counseling are manifestly related to the high-level healthiness (often called, somewhat patient’s illness, however, such counseling may be awkwardly, "high-level wellness” ) in a conscious intrusive, coercive, or possibly harmful.39 Many effort to redefine the meaning of health as it is physicians feel they lack the expertise, or they most often defined—either as freedom from disease realize rightly that such counseling is peripheral to (a negative definition), or as a state in which the their area of specialization. Diagnostic and thera­ body is in balance with itself and nature. These peutic roles are oftentimes correctly separated traditional views of health are regarded as only from roles as counselors or spiritual advisors. Of average by advocates of high-level healthiness, course, clear lines of demarcation are difficult to who believe that almost everyone can go beyond draw. normal good health to levels of dynamic fulfill­ Personalized care also engenders the risk of ment, activity, and pleasure. paternalism—making decisions for patients with­ Many advocates of high-level healthiness out their consent. Personalized care can lead to appreciate contemporary scientific medicine, but paternalistic care, because usually the more one believe that its priorities are misplaced because it knows others as persons, the more one feels gives insufficient attention to the poor health capable of making decisions for them. As health habits of Americans. They view most medical in­ care professionals begin to know and understand stitutions as caretakers of disease that do little to their patients as persons, they may be tempted to promote high levels of functioning and well­ make decisions for these patients. A strong dis­ being.9,40,43 Through centers, organizations, and tinction must, therefore, be made between medical journals, they offer varied programs. Some accent personalism and medical paternalism, so that per­ growth and self-awareness and offer no traditional sonalized care will not undermine the individual medical services—such as the Meadowlark Center worth and privacy of patients. Institutions that in Helmet, California. Others combine traditional seek to combine medical care with religious coun­ medical care with programs in high-level healthi­ seling should be particularly sensitive to the pos­ ness. The Mandala Holistic Health Society con­ sibility of persuasive, or possibly coercive, ducts annual conferences and has produced sev­ proselytizing.39 eral volumes of the Journal of Holistic Health,

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which serves as the voice of nearly every person tionary change and transformation.47,48 Many or movement offering some version of holistic advocates of this school of holism seek to harmo­ medicine or health.41,44 nize evolutionary optimism with Eastern religious Both sensible and questionable therapies have traditions of enlightenment and meditation.5 been developed in order to enhance self-actualiza­ tion, a major emphasis among many health advo­ Critique cates, and a notion that bears almost as many Some self-actualization therapies are helpful; meanings as the term holistic. These therapies some are at least not harmful; and others de­ constitute a supermarket of growth programs and serve skeptical scrutiny. Transcendental medita­ treatment modalities: transcendental meditation tion (TM) is widely advocated and is the subject of (TM), transactional analysis (TA), primal therapy, controversy. According to its practitioners, TM bioenergetics, and arica are among a list of more enables people to achieve a new, dynamic level of than I00.5,1012 consciousness that transcends and puts into per­ Responsibility of the individual for his or her spective ordinary levels of rational thought, sleep­ own health is also a common emphasis and is ing, and dreaming. In trance-like states, those who viewed as underemphasized in traditional medi­ practice TM are to experience the true, eternal cine. This responsibility includes a matching of “ reality” that permeates and lies beyond ordinary one’s personal needs with some approach to self- experience. The self that is discoverable is not re­ fulfillment, which some say can be done without garded as seething with animal urges, as described the aid of physicians. One should simply do en­ by Freud, but as a form of consciousness that lightened shopping among available programs and fuses and resonates with the unchanging energy techniques.1012 Others recommend that judgments and perfection of the cosmos. This experience of of physicians and local psychological societies boundless awareness is regarded as a path toward be utilized—as long as they know about new ap­ greater personal autonomy, freedom, and inte­ proaches to psychological fulfillment.5 grated power.49 Historical Perspective Critics and skeptics of this process claim that it represents either regression, or illusion, or both: The roots of high-level health advocacy lie in regression, because this “oceanic experience” Greek notions of balance with nature and in 19th (Freud’s term) is said to be similar to intrauterine, century health reformism, but this advocacy is or early infancy experiences, when the self was especially indebted to scientific investigations re­ not formed; or illusion, because life’s problems are garding stress reduction, exercise, and nutrition, experienced as no problem at all when fantasies of to humanistic psychology, to evolutionary op­ union and reunion are stimulated.50 Defenders say timism, and to Eastern philosophy. Humanistic psy­ that its effects are extremely positive and well- chologists, such as Abraham Maslow, became documented and that (in any event) such experi­ convinced in the 1950s that an understanding of ences should not be written off until they are in­ psychotic and neurotic sickness could not account vestigated and understood.51 for the dynamics of mental healthiness. Maslow Primal therapy, as devised by Arthur Janov, is believed that psychological research proved the available in the offices of many practitioners. It existence of a universal, inner self that could purports to enable people to discover their true, be developed and actualized beyond traditional inner selves and, therefore, to achieve integration expectations.45 and authenticity. Thus, it is sometimes listed as an Drawing upon the work of Maslow and others, optional path toward high-level wellness.5 Primal Halbert L. Dunn coined the phrase “high-level therapists believe that human potential is curtailed wellness” in the late 1950s.9,46 He was also influ­ and neuroses are developed because the psychic enced by the brilliant Jesuit priest and paleontolo­ pains and traumas of childhood are dammed up to gist, Pierre Tielhard de Chardin, who believed that form a “primal pool” of anguish and hurt. a vibrant energy resonates through all living and Through several weeks of lengthy, intense, one- nonliving matter and that this energy expands self- on-one therapy, followed by several weeks of awareness and presses inexorably toward evolu­ group experience, patients are supposed to release

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this flood of memories by literally screaming, cry­ also share more fundamental features: an advo­ ing, and kicking out their repressions.52 cacy of some form of diagnosis or healing that is Undoubtedly, great emotional power is gener­ unconventional, or esoteric in comparison with ated by this treatment, but critics question the canons of Western medical science, and a be­ whether the process leads to greater health, or to lief that contemporary scientific medicine is in­ further neurosis, or even to psychosis. They pro­ complete in failing to recognize and utilize the pose, for example, that suggestible persons some­ method advocated. Each diagnosis or therapy advo­ times create their own painful childhood fantasies cated is said to be holistic because it completes or or generate a false sense of peace, unconnected complements existing forms of diagnosis and ther­ with their actual psychological problems. These apy. The identification of many of these groups problems may be rooted in complex social rela­ with holism, however, appears to be based pri­ tionships that are not dealt with extensively in this marily on a wish for greater social respectability. form of therapy.52,53 The diagnostic and healing modalities of these A critique of high-level healthiness also in­ groups vary greatly in sophistication and credibil­ cludes a number of philosophical and moral issues. ity. Examples include acupuncture, reflexology Among them are the ambiguities within this broad (healing by massaging reflex points in hands and spectrum of health advocacy. The thinking of each feet), iridology (diagnosis of diseases and disor­ advocate must be analyzed to determine what ders by analyzing the iris), rolfing (realignment of holistic, high level, and self-actualization mean. the body by vigorous massage), homeopathy and a Furthermore, much of the literature on this subject host of herbal remedies,55 and paraelectricity, is colored with perfectionism and utopianism. which is said to be verified by Kirlian photogra­ Bloomfield and Kory,5 for instance, regard high- phy, a holistic form of diagnosis.44 These and level wellness as including not only physical fit­ numerous other unconventional approaches are ness, healthy dieting, and self-actualization, but each advocated by identifiable social groups, jour­ also exceptional creativity, glossy hair, sparkling nals, books, and training centers; each has an his­ eyes, personal assertiveness, unpretentious hu­ torical lineage and theoretical point of view that mility, and an enjoyment of frequent peak experi­ will not be explored here.10'12 ences. Others see health-related programs as doing away with the need for much sophisticated Critique diagnostic equipment and most acute care facili­ ties,54 while still others view tragedy, evil, and suf­ For the sake of greater specificity, three of the diagnostic and healing modalities just mentioned fering as virtually nonexistent.' Finally, from an ethical viewpoint, highly posi­ will be analyzed. Acupuncture is a complex sys­ tive consequences will result from giving more at­ tem of medical therapy based upon traditional tention to human healthiness, from adopting better Chinese concepts of health and disease, which are health habits, and from becoming more responsi­ correlated with classical Chinese metaphysics. The vital energy of the universe was believed to ble for one’s own health, but utopian health- follow specific pathways, or meridians, upon promotion schemes can give rise to illusions and which the acupuncture points lie. Although used in naive wishes that are fertile ground for exploita­ China to treat a great variety of medical problems, tion by charlatans and faddists. acupuncture is used in America primarily for pain relief, especially for chronic pain. Neurophysio­ Unconventional and Esoteric Diagnosis logical research on the effectiveness of acupunc­ and Healing ture has increased in recent years with respect to its relationship to the immune system, to peripheral More analogous to a genus than a species, these nerve stimulation, and to psychosomatic factors.58,57 practices represent a miscellaneous gioup of diag Other unconventional therapies and approaches nostic and healing modalities that share ceitain to diagnosis have generated little research and common characteristics. On the surface they iden­ seem patently outlandish. Iridology purports to tify themselves with, and use the term holistic, and diagnose acute and chronic diseases and disorders they mingle with one another socially. They

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throughout the body by analyzing the color, tex­ that are either superfluous, or possibly more harm­ ture, and brightness of the iris. Problems of the ful than efficacious. vagina are supposedly discoverable on the outside Because it is identified with all of these tradi­ edge of the five o’clock position of the right eye; tions, the term holistic now carries a hodgepodge but if the iridologist confuses this with the six of meanings and connotations. In spite of its popu­ o’clock position, the vagina will be mistaken for a larity, the term is shallow, more confusing than foot. On the other hand, if the eight o’clock posi­ enlightening and useful. Ardent commitments to tion of the left eye is confused with the nine holistic medicine and health represent everything o’clock position, lower back problems will be mis­ from a desire to harvest the finest accomplish­ taken for those in the esophagus. All of this is ments of contemporary scientific medicine to an spelled out in splendid detail by iridology charts.58 honoring of certain fundamental humanistic values Rolfing is no more convincing as a therapeutic within medicine, to a comprehensive or idealistic modality than iridology is as a diagnostic tool. type of health promotion, to some untested sectar­ Founded by the late Ida R. Rolf, who worked for a ian treatment scheme, or to a combination of most decade as a biochemist for the Rockefeller Insti­ of the above. Furthermore, the term holistic tute, rolfing is predicated on the notion that the trivializes certain important and complex tradi­ energy that radiates through the body produces tions within medicine by making it appear that trauma and morbidity if the body is not aligned they have recently been discovered, while it cap­ vertically with the earth’s gravity. Spreading the tures little of the richness and complexity of these notion that “gravity is the therapist” and that traditions. “ vertically” is virtuous, the rolfer vigorously re­ It makes sense, therefore, that the term holistic models, or realigns, the poorly postured anatomies should be abandoned for several more descriptive of those who are sick or out of joint.59 Articles categories like those suggested here. Each cate­ such as “ Gravity is a Drag,” and pictures illustrating gory represents a more or less diverse tradition the heightened health of post-rolfed patients, fill vol­ of thought and practice that has been associated in umes of the Bulletin o f Structural Integration.80,61 this essay with identifiable advocates, bodies of Such therapies as these present a variety of literature, and institutions. problems. From a scientific standpoint, some Medicine in America today is endowed with merit serious exploration, but others seem more depth, resourcefulness, and diversity. Several of entertaining than enlightening. Upon conceptual the traditions discussed here can support better analysis, most are anything but holistic, if holism and more humane patient care, more responsible is taken to be comprehensive and integrative (as health promotion, and the development of new its root meaning requires), for they seek to explain diagnostic and treatment modalities. Others call disease and to effect cures from a reductionist, for an alertness to harmful and ineffective treat­ rather than an inclusive perspective. From a moral ments that continue, as have their counterparts standpoint, they are easily used to exploit the throughout history, to parade under the guises of unwary. The subtle body energies, identified by medicine and health. several, lend themselves to lengthy, costly, and far-from-subtle therapeutic regimens.

Conclusions The four varieties of holistic medicine and health just discussed clearly do not constitute a References new, progressive, and uniform movement. Rather, 1. Pelletier KR: Holistic Medicine: From Stress to Op­ tim um Health. New York, Delacorte Press, 1979 they represent several different approaches to 2. Yahn G: The impact of holistic medicine, medical medicine and health. Several of these approaches groups and health concepts. JAMA 1979; 242:2202-2205 3. Sobel DS: Ways of Health: Holistic Approaches to are informative and important for contemporary Ancient and Contemporary Medicine. New York, Harcourt, health professionals. Others, even if they are in­ Brace, Jovanovich, 1979 4. Goldwag EM: Inner Balance: The Power of Holistic triguing to think about, represent interventions Healing. Englewood Cliffs, NJ, Prentice-Hall, 1979

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