For my part I want to counter the view of CM practitioners as ignorant or worse, the idea that cartoons them as conniving, sandal-wearers with an anti-science agenda.

CM practitioners have been accused of delaying diagnosis. Whats more, it has been said, (and rather shrilly of late) that the popularity of CM has more to do with trickery than treatment; with raising false hopes in ill people, or on the other hand with pandering to and pampering the worried well.

Although it would be naïve to think these things never happen, or that CM never provokes adverse events, in reality these events are rare. And of course they are far less likely happen when CAM practitioners are properly trained and regulated., so that they understand the limitations of their therapeutics.

And I would stress too the importance of projects that explore how doctors and CM practitioners can work more safely and creatively together, potentially mitigating some problems of both approaches.

So to dispel some of the myths around education, and while I would agree that not all CM practitioners are trained sufficiently well to take on a primary care role, we should be reassured that most CM patients have already consulted a doctor, because they realise that CM does not replace doctoring.

And regarding CM education and regulation, you should know that in the prominent CM therapies, many of the UKs practitioners train in full time three year university courses. Thereafter they are subject to regulation by their professional bodies. The osteopathic and chiropractic professions (whose training entails 4 years full time university courses) have been the pathfinders, for they are regulated by statute of parliament. In fact their CDP and revalidation processes are at least as rigorous as those of the GMC.

Furthermore we should take into account that many doctors include elements of CM in their practice, and commonly do so within the NHS. I believe that 10% of physicians who replied to an RCP questionnaire admitted to this! Several thousand doctors – mainly GPs - have trained in homeopathy or acupuncture; physiotherapists use acupuncture widely; and many nurses have learned massage or reflexology. So it is not unusual for these approaches to be delivered in the NHS. Why should this be?

Professor Lewith has given us clues. CM he has shown us, is relatively harmless. And he provided some reasonable evidence suggesting it can be very useful in real world practice.

The corollary of course it that CM has its clinical strengths and weaknesses, and so we must choose carefully when we seek to integrate any of them into patient care; to say that CM does or does not work would be a facile as saying that pharmaceuticals do or don’t work: which pharmaceutical you might ask; and for which diseases!

Well, Professor Lewith has alluded to medicine’s effectiveness-gaps; gaps that are most obvious where patients’ difficulties are due to long-standing health problems, particularly if their problems include relapsing pain and disorders of function made worse by stress, low mood and poor coping; end of life care is a problem area too, as is prescribing in pregnancy and infancy; nor are mild to moderate disturbances of mental heath well handled biomedically.

So these are all health problems that GPs find very challenging, and they are (we might think ‘therefore’) the sorts of problem CM practitioners tend to treat. Not heart disease, or diabetes, or schizophrenia. CM practitioners are not out there claiming to cure cancer. And though an increasing number - anywhere between 20-50% (Downer 1994, Begbie 1996, Gansler, and Burstein 2008) - of patients living with cancer do see CM practitioners, it is almost always in conjunction with standard approaches to cancer treatment.

And it isn’t because they expect to be cured but rather because they experience that CM improves their wellbeing and helps them cope better.

So let us allow the possibility that the public are not mugs, and that they seek out complementary therapies because they find them particularly helpful for stress-related health problems, persistent pain and the emotional aspects of illness. These are aspects of patient care that many of us doctors don’t always feel comfortable around, nor skilled at dealing with, nor may even have the time to delve into. But if we don’t meet this need then who should?

My colleague and I would propose that CM does good, and that it therefore has a place in mainstream care. Yet we have heard that it said that CM is culturally dangerous; that the very existence of CM –- undermines rational thought (this from people whose argument is that CM cant work so it doesn’t) that it subverts a proper acceptance of Scientific Medicine, and that - by rendering the masses gullible and irrational - it could even shake the foundations of liberal democracy. These are grandiose and evidence-free allegations. On the other hand the evidence that mainstream medicine is in crisis is now undeniable.

Indeed our health systems are in a critical condition
Healthcare now faces three interconnected crises of cost, cure and care. Costs are soaring as chronic disease and longevity outstrip both the development of cures and our natural resources. Struggling to cope with this onslaught, medicine has industrialised. But this has tended to erode timeless principles, particularly the central role of caring and compassion.

In the last two decades NHS costs have climbed from below 5% to more than 8% of GDP. In England, life expectancy for men increased by about five years, but healthy life expectancy by less than three. This means that more people are old and sick – mainly due to chronic mental and physical illness. One in four people in England is affected by obesity, rates are rising rapidly, and it already costs £3.7 billion every year 2. In England where one person in six experiences mental health problems, it costs the country £76 billion a year in health and social care services and lost economic output. Pharmaceutical solutions alone are not getting to the root of these problems.

Mainstream medical thought and practice necessarily mirror the culture of unlimited growth and progress that created them. The growth of the consumer culture and the hectic pursuit of magic bullets to treat its consequences has had cultural side-effects. One of them is the illusion that we can live personally, communally and ecologically unsustainable lives, because cocktails of pharmaceuticals will keep us alive into old (albeit impaired) age. The 2004 Wanless Report warned that without a major change in direction the NHS will become unsustainable by 2023, by which time its costs would absorb more than 12% of the GDP.

Caring and commitment
Doctors’ traditional role of caring for suffering people is morphing into the pursuit of centrally driven targets, guidelines and QOFs. There is a growing sense of professional malaise as levels of doctor drop-out and impairment rise, and the humble crafts of caring lose ground. Lord Darzi mentions the need for a more compassionate NHS in his Review, and the Government is seeking ways of measuring and delivering compassion in the NHS. (So watch out for the new compassion targets!!). But the notion that we, and our patients, are just biochemical machines hardly encourages compassion.

Medicine is in trouble and at the same time, CM is ever more popular despite anti-CM media campaigns. Surely then CM is telling us something about users’ dissatisfaction with what medicine has become. Should we shoot the messenger and ban CM? Surely no-one truly concerned for better medicine would want to foreclose on the possibility that there might be important insights within CM. Indeed it is because CM draws on knowledge from times and place very distant from our narrow medical culture that we must build up an academic field of CM studies and research. However, this is not the point I wish to make. Big ideas move in cycles, and medicine is bound to change. It cannot be otherwise because science pushes it forward. But not science alone: crucial forms of service innovation – mainstream integration of counselling and hospice care are good examples – preceded experimental evidence for their effectiveness. These services developed because they addressed costly, poorly met needs. And so it is with chronic illness, stress-related and painful conditions, all of which are ‘effectiveness gaps’ for conventional medicine, but for which people regularly choose CM and generally declare themselves satisfied with the outcome.

Warren Salmon’s research in the 1970s highlighted three reasons why people were becoming increasingly wary of biomedicine. They felt it fragmented them; that it was about parts rather than persons. They experienced that doctors too often discouraged power-sharing, and that as patients they feared medical treatments put them at risk. Perhaps many of them thought it did more harm than good

CM obviously is not in itself free from these drawbacks, nor does it have easy solutions to Biomedicine’s crises. Nor do I for a minute think that CM is the destination for 21st century medicine. But it could be a signpost. Consider how different CM is from what medicine has become: CM is
• Personal and small-scale
• It finds the patient’s social and emotional context important
• Its narratives provide meaning and significance
• It aims to encourage self-healing processes. Perhaps this is the most crucial point: Biomedicine, that so effectively wages war on disease, is ill-prepared for making peace in the body and mind. CM models on the other hand aim to muster the organisms own defences and to re-establish self-regulation
• Whereas biomedicine excels when patients are acutely ill and can be passive recipients, it is less than triumphant in longterm conditions where engagement and self-care must come to the fore.
• CM in contrast tends to be participative
• To seek mind – body connections
• And through the substances it uses, it might claim connection with the natural world

Many of these valued characteristic can be incorporated into mainstream medicine. Yet of course as a brand CM is unlike mainstream medicine because it is by definition
• low-tech
• low-risk
• non-corporate
• and counter-cultural

These are highly valued qualities which an industrialised biotechnical health service cannot easily provide. Nonetheless George Engel observing the shortcomings of Biomedicine thirty years ago, wrote that “nothing will change unless or until those who control resources have the wisdom to venture off the beaten path of exclusive reliance on Biomedicine as the only approach to health care”.

Can I therefore invite us temporarily to suspend our absolute faith in Biomedicine and any conviction that it has all the answers or one day surely will? Can we go even further and be open to the possibility that CM may fill some of medicine’s ‘effectiveness gaps”? Might we even toy with the idea that the resurgence of the biopsychosocial model 14 enriched by behavioural medicine and the wisdom of traditional CM systems could make healthcare not only more effective, and sustainable, but also more creative and professionally satisfying?

Finally ladies and gentlemen can I in opposing the motion ask us to be open to the possibility that far from doing more harm than good, the judicious integration of CM could help us doctors address poorly-met needs. And that by encouraging creative engagement, informed choice and self-care, CM ideas and techniques could help us find sustainable solutions to medicine’s unfolding crisis.

Pre-modern European medicine believed the emotions came from the body; Traditional Chinese Medicine still speaks of the angry liver, the melancholy spleen, the anxious kidney. Though ideas from distant times and far- off cultures carry deep wisdom, it would be a mistake to swallow them whole. Holists need to make post-modern sense of the mind-body; we need a mind-full holistic physiology for our time, and a holistic psychology that is less disembodied. Can science lend a hand here? Our brain-centred culture likens the brain to a computer, but the brain does not work digitally; it uses analogy to relate thoughts, feelings and impulses to one another. Inevitably, emotions are coloured by unconscious memories, for our earliest experiences are beyond recall: bodily experiences of the pressures of being born, infantile sensations from mouth, gut, skin, genitals; and at times, overwhelming feelings of pain, rage, fear. Stephen Porges’ polyvagal theory explains how these intense bodily currents of tranquility or agitation move through the autonomic nervous system stirring or calming the heart, and that the heart responds by sending intense waves of information to the brain via the vagus nerve. How well we learned to tolerate and make sense of emotions may depend on ‘a good enough mother’ , who could bear to hold these torrents and tides of feeling, and so allow a deeply embodied memory bank of calmness, bliss and attachment to form. Allan N Schore explains the neurophysiology of this ‘affect regulation’ process in his important new map of embodied mind and emotional development.

It seems science has begun to make sense of feelings and their bodily origins in heart and brain. In this issue (August 2006), Tony Yardley-Jones introduces the new field of neurocardiology which views the heart as a potentially powerful source of positive feelings. Max Fravell speculates on the heart’s intelligence and how its hormonal, nervous, rhythmic and electromagnetic outputs may regulate cognition and feeling. The heart, he tells us, is a sensory organ and the rhythmic, regulatory core of our being, rather than just a pump. Harvey Zarren, a cardiologist who shares these views, writes about the importance of exploring physical, mental, emotional, spiritual and tribal needs and discomforts when healing the heart. Mary Brice describes just such an approach in her development of holistic cardiac community nursing.

Joanna Macy and John Seed’s deep ecological invocation of the elements is a reminder of our connectedness with planetary processes. The same flows of love and physicality are powerfullly conveyed in Alex Grey’s evocative painting. Chris Drury’s landscape Heart of Reedsand Philip Kilner’s description of his flowform sculptures and high-tech investigations of intricate cardiac blood flow continue the theme. These metaphors of heart and flow are extended in the Triodos Bank’s appeal for a more heartfelt approach to finance.

The last section of this issue reports on new research into the impact of body-oriented meditation on students’ wellbeing. This is yet another piece of evidence in favour of mind-body interventions (MBI), an area overviewed with a particular focus on cardiovascular disease by one of the field’s pioneers – Ken Pelletier. Though he sees MBI as the heart of the matter, William Bloom introduces a note of caution, because ‘a change of heart’ will mean overcoming psychological resistance when introducing self-managed mind-body healthcare.

The ways we have been thinking about and doing healthcare aren’t working; a holistic transformation is needed. In his article, Michael Dixon predicts how creative use of the new commissioning system and a primary care-led NHS will drive a resurgence in the art of healthcare. We pray he is right. It will call for vision, group creativity and humanity. That is why the arts are so crucial right now, and why this issue looks at the potential role of the arts in several different ways. Because as holists our concern is not just with art as a ‘treatment’; art also has the power to evoke empathy, cohesiveness and solidarity; to inspire creativity and innovation.

Holism means recognising our interdependence, and re-owning the task of healing and being healed, individually and communally – something the playwright Nell Dunn tells about in her interview with William House. These are tasks the arts can help us reframe, see in a new light and address in unforeseen ways. As the artist Mateo Willis describes in this issue, ‘the creation of art is a holistic practice, a process that necessitates a perspective of the “whole”’. Yes, says the left brain, but can you provide me with evidence that it’s good for patients? Harry Caton, the patients’ czar, maintains that it is, and he wants those who work with the arts in healthcare to collaborate with researchers and prove their worth. Angela Clow’s small study of how visiting an art gallery changes immune function could be a piece of the jigsaw.

Art can do more than this: as John Salinski reminds us, it can be yeast in the lifeless dough of left brain- dominated education, practice and self-care. He reports on using literature and film with GP Registrars. In the same vein, Phil Hammond – doctor, writer and comedian – looks at doctoring as a performing art; Tim O’Leary, in the CD enclosed with this issue, shares the photographs and poems he made to help him digest the experience of a serious illness; Larry Butler brings us examples of poetry from his workshops at Maggie’s Cancer Centres in Scotland; Hazel Adams describes using painting as therapy in the NHS; Alan Kellas, an NHS psychiatrist, reflects on how movement therapy has helped him work more effectively with people who have learning disabilities.

This issue of the JHH (May 2006) illustrates how the arts can humanise ‘the system’, make us better practitioners and more effective self-healers. So let’s celebrate the ways art makes us human, and the fact that humans make art because it wakes us up; that it energises us because the act of creation is life-affirming, joyful, cathartic: for the NHS is in dire need of these gifts. Art can help make sense of experience or express what we can’t find words for: how crucial it is for medicine to harness its powers. Art’s messages about a larger reality inspire awe and connect us with eternal values: the renewal of 21st century healthcare will depend on them.

This issue is dedicated to the many practitioners who value their art and who work artfully. It was a pleasure to work with Dr William House, GP, playwright (and BHMA Trustee) who co-created this arts-themed issue.

An outsider might think it odd that many doctors are unhappy; the medical life ticks so many job satisfaction boxes. But the reality of doctors’ lives is less straightforward, and many are far from happy. Reports tell of declining medical morale worldwide; that doctors feel over-worked, under-supported and unable to meet the public’s unrealistic expectations of modern medicine.

Pressures and predicaments are something all professionals face, but doctors also face shocking events, and unrelenting strain often comes with the job. On top of this, their patients’ expectations are sky-high, and in striving to meet them hi-tech medicine must juggle ever more technologised investigations and treatments. If only that were all: doctors having trained to diagnose and prescribe scientifically, are now expected to manage people and finances, navigate legal and ethical minefields, and solve problems that don’t respond to drugs or surgery.

Against a backdrop of rapid and unpredictable change, these quandaries are even more stressful: small wonder that many UK doctors found the last 15 years’ sweeping health service re-organisations more than they could cope with. For though many patients consider healthcare workers – especially doctors and nurses – special, in reality they are of course only human. Doctors’ levels of stress-related diseases and mortality figures certainly suggest there’s a problem needing urgent attention: their mental health statistics are poorer, their likelihood of suicide greater, and their levels of alcoholism and drug abuse higher than any other profession’s.

Not all doctors are unhappy though, and some seem to thrive on pressure. A recent study has confirmed what common sense tells us, that personality affects how well they deal with professional pressures. Of course for those struggling to survive inside dysfunctional organisations or with impossible workloads, it’s the job that needs fixing, not the doctor. Still, if their training prepared them better all healthcare workers would bear the strain more gracefully. And since high levels of change and uncertainty are here to stay, promoting resilience will be crucial for high-risk groups like ours. Yet incredibly, even though doctors are dying for a lack of them, self-care skills seldom feature on the medical or nursing curriculum, even though there are ways of identifying high-risk people or groups.

In healthcare, the workplace itself or how we think about and practise healthcare will make or break resilience. It depends not simply on the body, or personal temperament and behaviour (influential though they are), but also on our values, community and environment. So this issue, which takes papers from the BHMA’s 2005 annual conference, looks at resilience not simply as a personal characteristic, but as a holistic phenomenon – a property of whole systems.

But is mental distress a brain-chemistry problem, or a personal challenge, a social indicator, a spiritual crisis? Whatever your position (all four?) there are serious downsides to a purely medical model. Not the least of them is how it can disempower individuals while prompting society to ignore the personal and social aspects of mental distress. Drug companies’ advertising and well-crafted research in medical journals aims to persuade doctors that psychological distress is biochemical, and that personal and social factors count far less. In parallel, the USA’s official classification of the psychologically abnormal – the DSM III – which defines the symptoms for each ‘diagnosis’, has been growing as new mental illnesses are discovered (or invented). The DSM III usually links drug treatment to these medical labels, but the labels themselves can present a second kind of problem: though valid some of the time, they get over-applied. No doubt ADHD exists, but do all five million children taking Ritalin in the USA truly need it? Yet, though well- spun research findings may drive this diagnostic zeal, they don’t explain why 10 million SSRI prescriptions are written annually in the UK for ‘mild depression’ despite there being no evidence that it helps. It was the myth of miracle cures that made Prozac a panacea for non-specific unhappiness, as was Valium in the 1970s. The hope of simple solutions to complex problems was behind the benzodiazepine epidemic, whose legacy included side-effects and dependency: the medical model’s third problem area.

As science advances it creates new stories: that depression boils down to serotonin deficiency is one of them. Swallowing the pills becomes easier (and perhaps more effective) once this idea is swallowed. And swallow it we have, with the result that the medical model has psychiatry – even more so than in the 1970s – by the throat. This fourth danger – of de-humanised mental health care, where psychiatry turns distress into disease and treatment into drug-taking – makes the nation’s shrinking ‘mental wealth’ a big issue for holists. Our response, when neuroscience delivers more effective drugs for mental distress, as it surely will, should be to complement them by addressing the roots of mental distress – be they biological, personal or social.

In this issue (November 2005) we focus on the impact of mental distress, alternatives to drugs, and ways of mobilising natural powers of recovery. Chris Manning explains why psychiatry’s model is worn out; its problems are pointed up in David Zigmond’s parable about our mental health services and Peter Linnett’s plea for a deeper understanding of mental distress; James Hawkins and Ivan Tyrell pose solutions that tap into human potential for self-healing; Ian Walton describes how one public sector centre is developing creative services, and Raja Selvam reports in from the frontiers of trauma therapy. Ritalin in the USA truly need it? Yet, though well- spun research findings may drive this diagnostic zeal, they don’t explain why 10 million SSRI prescriptions are written annually in the UK for ‘mild depression’ despite there being no evidence that it helps. It was the myth of miracle cures that made Prozac a panacea for non-specific unhappiness, as was Valium in the 1970s. The hope of simple solutions to complex problems was behind the benzodiazepine epidemic, whose legacy included side-effects and dependency: the medical model’s third problem area. As science advances it creates new stories: that depression boils down to serotonin deficiency is one of them. Swallowing the pills becomes easier (and perhaps more effective) once this idea is swallowed. And swallow it we have, with the result that the medical model has psychiatry – even more so than in the 1970s – by the throat. This fourth danger – of de-humanised mental health care, where psychiatry turns distress into disease and treatment into drug-taking – makes the nation’s shrinking ‘mental wealth’ a big issue for holists.

Lately certain facts of spiritual life have become grist for science’s mill: that humans have evolved the capacity to love and that they need love; that we have an interior world of consciousness which can appear to work independently of time and space; that attitudes and states of mind may kill or cure us; that healing relationships happen and that miraculous remissions do indeed occur. The scientific details are not yet available, but given the booming research efforts it may not be long before they are. So in anticipation that the spiritual paths and medical paths may be converging as we move towards a post-materialist worldview, this issue takes evidence from practitioners – nurses, doctors, social workers, priests, researchers who already weave this worldview into their practice.

Professor Steven Wright, formerly a thought leader in nursing practice and now an inter-faith minister, considers the importance of spirituality to wellbeing; the evidence that we are at a turning point in our culture, and how spirituality is increasingly seen as being at the heart of the healingprocess. Dr Chris Johns, a leading Macmillan clinical specialist and teacher, reflects on how being open to the everyday ‘here and now’ of clinical practice can make effective responses possible even when – as in palliative care – no easy answers are to be found. Reverend Alan Brown, a hospital chaplain, takes a look at how his field relates to health and its potential contribution to the holistic healthcare team. The Janki Foundation’s highly successful learning pack explores spirituality in healthcare. Heremembers of the team that developed it describe using a personal and team development approach to identifying practitioners’ core values, its sources of inspiration and underlying principals. Professor John Swinton explores the meaning of illness and how a sense of spirituality can enable a deeper understanding of how people live their health and illness. Consciousness and connectedness, caring and healing, values and intentions, meaning and lived experience: all examples of practical spirituality in healthcare. Because a fuller understanding of what used to be called ‘human nature’ is a matter of great consequence – not least economically and politically. It would change the way we think about our humanity, our relationship to the natural world, the tasks of healthcare, the nature of wellbeing and health creation, and how we should conduct ourselves as practitioners and humans. Professor Steven Wright, formerly a thought leader in nursing practice and now an inter-faith minister, considers the importance of spirituality to wellbeing; the evidence that we are at a turning point in our culture, and how spirituality is increasingly seen as being at the heart of the healingprocess. Dr Chris Johns, a leading Macmillan clinical specialist and teacher, reflects on how being open to the everyday ‘here and now’ of clinical practice can make effective responses possible even when – as in palliative care – no easy answers are to be found. Reverend Alan Brown, a hospital chaplain, takes a look at how his field relates to health and its potential contribution to the holistic healthcare team. The Janki Foundation’s highly successful learning pack explores spirituality in healthcare. Heremembers of the team that developed it describe using a personal and team development approach to identifying practitioners’ core values, its sources of inspiration and underlying principals. Professor John Swinton explores the meaning of illness and how a sense of spirituality can enable a deeper understanding of how people live their health and illness.

Consciousness and connectedness, caring and healing, values and intentions, meaning and lived experience: all examples of practical spirituality in healthcare. Because a fuller understanding of what used to be called ‘human nature’ is a matter of great consequence – not least economically and politically. It would change the way we think about our humanity, our relationship to the natural world, the tasks of healthcare, the nature of wellbeing and health creation, and how we should conduct ourselves as practitioners and humans.

Nevertheless, as Denise Rankin-Box reminds us, some practitioners – be they nurse or doctor – have a certain healing presence, which she associates with a capacity for engaging with people unconditionally, however distressed they are. Why then, since feelings come with the healthcare territory, have medical and nursing training ignored them and left us so ill-prepared for the powerful emotions our work sometimes stir up? This author compares holistic teamwork to a symphony. Highlighting the need for inter-disciplinary harmony, she implies that until we share a healing paradigm where treatment processes are more caring, and care is valued as something therapeutic, discord is likely to prevail.

Anne Cawthorn however rolls out a working model for collaboration: nursing-as-therapy attuned to the high-tech, high distress world of a regional NHS oncology unit. Here, nursing as therapy creates therapeutic space where patients can feel safe enough to deal with deep human predicaments; for who else but nurses, when it comes to the holistic symphony, will harmonise the darker tones of suffering in the NHS? Denise Tiran argues that midwives too must make clearings in the jungle of obstetric imperatives, for women to experience normal pregnancy, birth and early motherhood.

And, though a diagnosis and treatment programme (in obstetrics as elsewhere) can provide doctors with emotional distancing and control, they too need to hear patients’ stories, especially in long-term conditions; a point powerfully made in William House’s article about chronic pain. In which case it would be fruitful, as our authors suggest, for doctors to learn from good nursing practice: reflectiveness, mindfulness and compassion and the benefits of professional supervision. For there is a strong case that caring and communication improve outcomes; even that they improve practitioners’ own well-being. These are topics JHH will take up in a new section over- viewing the evidence base for holistic interventions, a regular feature which begins in this issue with the first of James Hawkins’ series on non- pharmaceutical options for psychological illness.

Whenever doctors and nurses discuss holistic practice, the cure-care polarity fuels the debate. Naturally, the same differences run through our nursing articles too: that caring matters, that not all problems can or should be medicalised; that doctors should listen more. These truths have even greater significance now medicine is so gripped by the New Reductionism,which is why holistic healthcare must square this circle, moving us beyond the cure or care polarity into a world where caring medicine works alongside therapeutic nursing. Would this hold back the flood of nurses leaving the profession; re-enthuse would-be recruits? Would it restore morale to a medical profession obsessed with outcomes? It might, but caring doesn’t happen by magic. Yes, it has to be nurtured individually, but also by organisations and by health policy that really (not just rhetorically) values service-users’ needs and experience, and cherishes the work-force that can provide practical holistic healthcare.

So we need new ways of thinking about health and healthcare; ways like mind-body medicine, and holistic healthcare that put health and pathology into their human context. Rather than just confronting disease, medicine will have to catch up with a broader 21st century scientific view that incorporates mind-body holism, co-evolution, a deeper understanding of self-regulation and self-healing processes. The world’s healing traditions have always sought to trigger self-healing, using touch, words, movement, art, ceremony, natural substances, food, exercise, harmonious living. But medicine in the West, having focussed in on ways of waging war on disease, has forgotten about self-healing and now has no model for building up the body-mind’s natural defences. Clearly the mainstream needs its own framework for understanding health creation, and science really should be more curious about this. The living body maintains stable chemical and physical conditions so that life can be sustained: too hot or cold, too acid or alkaline, excessive waste products or too few nutrients, and we die. The body continually breaks down and rebuilds itself, and most of the time the process works faultlessly. When it doesn’t, illness and disease follow. Yet just how organisms control the myriad chemical reactions involved is barely understood. Nor do we know much about the body’s ability to turn over its substance yet maintain reliable internal architecture and outer form, to move through space and constantly re-shape itself. And the sense of self is another mystery; seemingly stable, though it emerges out of a torrent of sense impressions and memories, it lets us sense, respond and reflect. confronting disease, medicine will have to catch up with a broader 21st century scientific view that incorporates mind-body holism, co-evolution, a deeper understanding of self-regulation and self- healing processes. The world’s healing traditions have always sought to trigger self-healing, using touch, words, movement, art, ceremony, natural substances, food, exercise, harmonious living. But medicine in the West, having focussed in on ways of waging war on disease, has forgotten about self-healing and now has no model for building up the body-mind’s natural defences. Clearly the mainstream needs its own framework for understanding health creation, and science really should be more curious about this. The living body maintains stable chemical and physical conditions so that life can be sustained: too hot or cold, too acid or alkaline, excessive waste products or too few nutrients, and we die. The body continually breaks down and rebuilds itself, and most of the time the process works faultlessly. When it doesn’t, illness and disease follow. Yet just how organisms control the myriad chemical reactions involved is barely understood. Nor do we know much about the body’s ability to turn over its substance yet maintain reliable internal architecture and outer form, to move through space and constantly re-shape itself. And the sense of self is another mystery; seemingly stable, though it emerges out of a torrent of sense impressions and memories, it lets us sense, respond and reflect.

Stability in the midst of flux is the theme here; stability at different levels of organisation: bio- chemical, structural, personal. Science promotes DNA as its explanation; traditional healing systems talk about vital forces and elemental qualities. Their timeless models might well provide us with useful imaginal hooks on which to hang ideas about health, but they are a world away from the style of science that builds explanations up from parts, since holistic healing works down from an understanding of the whole. The two perspectives ought to be complementary, but until lately traditional medicine’s holism and vitalism were anathema to science; those who took the healing path usually abandoned the scientific way, or at least learned to live with two apparently irreconcilable concepts of health. Or is this no longer true? Might there be a convergence between traditional healing systems’ views and science’s growing interest in whole system behaviour? Science now supports some of traditional healing’s key principles: that body and mind are effectively inseparable; that the body-mind has untapped in-built healing responses; that complex systems are self-sustaining because a flow of information organises them. Health professionals’ growing interest in complementary therapies, bodywork and new approaches to psycho-therapy all reflect a desire to put these ideas into practice.

Science moves on

Medical science has had spectacular success by pursuing the analytic approach. It learned a lot about taking the body apart, next to nothing about what keeps it together. Now science is realising its limitations. Information science provides one example of this. When parts function in a whole system, properties emerge which cannot be inferred by studying them in isolation for the whole changes the parts. Developments in psycho-immunology and neuro-biology are fuelling interest in pattern and process, whole systems and information flow. In parallel, sensitive new technologies now allow us to witness how thoughts affect blood flow in the brain, how an emotion affects the cardiac electrical energy spectrum, how molecules of emotion bathe the brain in information drawn from every cell in the body. Take a look, for instance, at the superb images coming out of University of Wisconsin-Madison’s Centre for the Neuro-biology of Emotion. These functional MRI scans demonstrate the living brain’s response to emotions and mindfulness meditation, and how they affect immune, circulatory and endocrine systems. Wisconsin’s findings already affirm a seamless mind-body wholeness.

The intelligent body

Michael Hyland’s ‘intelligent body’ hypothesis (Hyland, 2002) builds a conceptual bridge between information theory and vitalistic ideas. Hyland – Professor of Health Psychology at Peninsular University – explains how complexity theory (Cilliers, 1998) predicts that complex systems will function in quite different ways from simple ones, and that complex networks of highly interconnected nodes have properties we associate with intelligence. Hyland’s contention is that our stereotypical western scientific views (the brain is intelligent and the body stupid; the brain sits on top of spine controlling the body) are thoroughly outdated, because the body’s interacting organ systems form an intensively connected network of interactive nodes. Therefore characteristics of intelligence are distributed throughout the body, and the brain is no longer master over the slave- body, since the intelligent body has its own kind of pattern- recognition, problem-solving and memory. information drawn from every cell in the body. Take a look, for instance, at the superb images coming out of University of Wisconsin-Madison’s Centre for the Neuro-biology of Emotion. These functional MRI scans demonstrate the living brain’s response to emotions and mindfulness meditation, and how they affect immune, circulatory and endocrine systems. Wisconsin’s findings already affirm a seamless mind-body wholeness. The intelligent body Michael Hyland’s ‘intelligent body’ hypothesis (Hyland, 2002) builds a conceptual bridge between information theory and vitalistic ideas. Hyland – Professor of Health Psychology at Peninsular University – explains how complexity theory (Cilliers, 1998) predicts that complex systems will function in quite different ways from simple ones, and thaThis image shows that specific mid-brain areas are activated in response to negative images, relative to a baseline of viewing neutral images.

Hyland offers a new way of thinking about health and information flow in the body: for instance that disease begins as an information error and that two kinds of error are possible in the body–mind. Conventional western medicine deals with the first type – ‘serial’ error – a cause and effect chain of events where the body behaves as a biological machine. This approach works well when it can identify an organic disease (the ‘broken part’) – diabetes, cancer, ischaemic heart disease or arthritis. It then fixes or removes it, replacing the missing hormone, killing bacteria with antibiotics, reducing blood pressure with a drug, suppressing inflammation with steroids, replacing a blocked artery with an artificial graft, or cutting away a tumour. But the other type of error affects information processing in the whole network. In ‘network’ error no single organ or biochemical system can be pinpointed and repaired, because the information needed to produce health and healing processes is spread over the entire network. To correct this kind of error, successful treatments have to exchange information with the network itself. Hyland suggests that complementary therapies may be an effective way of doing so, providing they actually trigger the intelligent body’s self-healing responses.

Networks can take in many different kinds of information, and Hyland suggests that errors in the information network body respond to diverse kinds of ‘natural’ input – diet, botanical medicines, movement and touch; to more refined information as well – art, communication with a therapist, perhaps even some kind of subtle information conveyed by a homeopathic medicine or by the effect of an acupuncture needle. And the entire information body could be influenced by lifestyle packages impacting on the combined biochemical, structural and mental information systems.

We can imagine the whole system of information flow – the body’s intelligence – as an orchestra of countless players. Their tunes need no score or conductor, for the parts play themselves and each one responds to the entire chorale – more or less harmoniously. The songs are played on three kinds of instrument: biochemical codes and electrical impulses, structural pressure waves and rhythms, language and symbols from the conscious and unconscious mind. Hyland’s intelligent body can be conceived as a fourth level of information emerging from these three and meta-organising them; perhaps rather like a conductor, directing but at the same time moved by the musical totality. This is complexity in action, where information flow emerges from the interweaving of biochemical, structural and mental information systems, but at the same time it forms and shapes them all.

Science,information flow and holism

In the 1970s George Engel presented his biopsycho- social model, explaining that bio-medicine was harming itself and its users by failing to recognises human beings’ complexity and connectedness. His systems approach was based on the understanding that inputs at any level in the system would spread upwards and downwards. Reductionism maintained a focus on the lower levels, and that, said Engels, is bio-medicine’s fundamental flaw. Engels’ flaw as far as reductionist science was concerned was the lack of a physiological vehicle for such a seamless information flow. He was, after all, at least 10 years ahead of psycho-neuro-immunology’s first glimmer. Thirty years after Engel, it is easier to see that diverse forms of information flow are involved in mind-body integrity: the nervous system digitises the information as electrical impulses; molecular messages flow in the blood and cellular fluid creating waves of two-way biochemical conversation; heart, gut and muscle cells encode a flow of pulsations and vibrations that spreads through the connective tissue and down via individual cells’ cytoskeletons into every nucleus in the body. Hyland points out that just as mobile phones and landline phones connect seamlessly into a single phone system, these different forms of communication are no barrier to seamless connection between the different organ systems of the body.

These elements are lining up into a scientific model of the organism as a living matrix integrated and shaped by an incalculable traffic of regulatory information. This flow of organising information has similarities with what the traditional systems called ‘vital energy’; except – as James Oschmann points out (2000) – rather than involving some single, paranormal or ‘subtle’ life force, this information is modulated by forces that science already knows about: the organism’s electro- magnetic flux, its clouds of neuro-receptor traffic, its rhythmic impulses of sound, heat, gravity, elasticity and pressure. If this information flow is what the traditional healers call ‘life force’, then what Hyland terms the intelligent body could correspond to complementary medicine’s ‘energy body’; though perhaps it would be would be more accurate to call it the ‘information body’. Science is now in a position to explore how such flows are encoded in the living matrix, how they mal-function and how treatments might engage with errors in the information body.

Faced as we are now with a new reductionism born of genome projects and smart drugs, holists are faced with a challenge: to depict living organisms as form-building fields that support a self-sustaining flow of materials, energy and information. A combined biopsychosocial-intelligent body model is one way of imagining how these flows of information link all the way from gene to biosphere and back again. And in this model, consciousness is not some electrical secretion of the cerebral cortex, but an emergent property of our entire organism – blood, gut and sinew as well as nerve and brain. And this is why medicine must comprehend the entire lived body, for its reptilian and mammalian origins formed the triune brain. Our thoughts and feelings, though culture-shaped, also arise from a body moulded by this phylo-genetic past; just as our embodied responses – for instance to stress and trauma – are a psycho-physiological inheritance from our plains-dwelling hunter-gatherer forebears.

Science as myth-maker

Co-evolution spins a new creation story; a story about the beginning of time and space, and the evolution of stars and planets, some with biospheres. In this story, complexity – parts forming greater wholes – is the rule up and down the scale from particles to galaxies. Connectedness is another universal rule, since fields are a property of space-time. The emergence of new properties when parts form wholes makes the universe creative: just as matter itself evolved after the big bang, so do organisms of every possible form and function emerge as life co-evolves in response to a changing world. Over eons, increasingly complex forms of sentient life have emerged, driven by the exchange and storage of unfathomable amounts of life-supporting information. This tapestry of information stretches back to the beginning of time, and most of it is shared by all living organisms. In fact each developing human foetus reiterates the evolutionary process as it transforms from reptile to fish to mammal. encoded in the living matrix, how they mal-function and how treatments might engage with errors in the information body. Faced as we are now with a new reductionism born of genome projects and smart drugs, holists are faced with a challenge: to depict living organisms as form-building fields that support a self-sustaining flow of materials, energy and information. A combined biopsychosocial-intelligent body model is one way of imagining how these flows of information link all the way from gene to biosphere and back again. And in this model, consciousness is not some electrical secretion of the cerebral cortex, but an emergent property of our entire organism – blood, gut and sinew as well as nerve and brain. And this is why medicine must comprehend the entire lived body, for its reptilian and mammalian origins formed the triune brain. Our thoughts and feelings, though culture-shaped, also arise from a body moulded by this phylo-genetic past; just as our embodied responses – for instance to stress and trauma – are a psycho-physiological inheritance from our plains-dwelling hunter-gatherer forebears. Science as myth-maker Co-evolution spins a new creation story; a story about the beginning of time and space, and the evolution of stars and planets, some with biospheres. In this story, complexity – parts forming greater wholes – is the rule up and down the scale from particles to galaxies. Connectedness is another universal rule, since fields are a property of space-time. The emergence of new properties when parts form wholes makes the universe creative: just as matter itself evolved after the big bang, so do organisms of every possible form and function emerge as life co-evolves in response to a changing world. Over eons, increasingly complex forms of sentient life have emerged, driven by the exchange and storage of unfathomable amounts of life-supporting information. This tapestry of information stretches back to the beginning of time, and most of it is shared by all living organisms. In fact each developing human foetus reiterates the evolutionary process as it transforms from reptile to fish to mammal.

Science tells us that in the last million years, a biped mammal evolved a brain with a novel capacity. In early life, gradually and traumatically, their power to think is moulded by a world of objects, and they learn to reflect on experience and emotion. These creatures use language and make up stories about themselves and the world; stories for instance like science, and the story I have just told, whose mythic resonance is nevertheless couched in science-speak. This is possible because so much of what science is now reaching for has mythic dimensions. Another example of this is the way systems theory views the biosphere rather in the way Michael Hyland sees the body as a complex system of interconnected causal nodes; so something intelligent self-sustains it, and it has been named Gaia.

Until recently, scientists ignored consciousness and left questions about the self to philosophers and psychoanalysts. Yet thoughts and feelings can make the body blush or shiver; conversion symptoms and voodoo-death are more dramatic examples. Psychologists and neuroscientists have accumulated a great deal of evidence on how states of mind affect the body and conversely how the body affects consciousness. They tell us that attitude influences health outcomes; that a person with a terminal disease can postpone their death until after a significant date; that placebos and hypnosis can reverse established pathology; even that the immune system can be classically conditioned (Clow, 2001). The clinical implications guarantee exponential growth in this area of research. On the positive side, there are reliable accounts of spontaneous remission from catastrophic disease, and much research illustrating how temperamental factors, social support or practices like mindfulness meditation can improve health outcomes.

Conclusion

Medicine stands at a threshold; the morbidity figures, theoretical, educational and organisational crises, and the failure of current practice to meet rapidly changing expectations, all make progress towards holism inevitable. Moreover, a less alienated medical model will help the medical profession heal itself. Given the current levels of distress and impairment among doctors and nurses, and the rate at which they are leaving the field, the challenge to develop a new model must be faced.

In the 80s information science and systems theory sparked off late 20th century holism. Now we have complexity theory, neurobiology and psychoneuroimmunology to support 21st century holism. Cognitive neuroscience and real-time imaging technology provide startling insights into the mind-body connection; PNI tells new stories about how words become fresh, and how happiness or anguish gets into cells. This century’s holism has a biological backbone we can hold on to and new knowledge at its fingertips: knowledge that connects. We must use it to create 21st century holistic healthcare.

References

Cilliers P. Complexity and postmodernism: under- standing complex systems.
London: Routledge, 1998.
Clow A. Behavioural conditioning of the immune system. In: D. Peters (Ed) Understanding the placebo effect in complementary medicine: theory, practice and research. London: Churchill Livingstone, 2001.
Hyland M. The intelligent body and its discontents. Journal of Health Psychology 2002; 7
Oschman JL. Energy medicine. London: Churchill Livingstone, 2000.

So how will 21st century healthcare find its way out of these binds? Crises of cure and cost are two sides of the same coin; health creation names one way of solving them both. But medicine is faced with even deeper crises. With its place in society changing rapidly, medicine is losing the authority and respect it once attracted; at the same time a mechanistic vision of healthcare is threatening its once unquestioned benevolent values. If these two trends are connected, then no amount of new magic bullets will address medicine’s crises of compassion and commitment. On the contrary, the arts of caring are losing ground precisely because they aren’t easily reduced to biochemical actives; the tacit assumption that people are separate biochemical machines robs them of significance. And this could be another reason (along with sheer overwork) why doctors and nurses say they are unhappy in healthcare; when compassion is devalued and meaningless we are in danger of losing our sense of commitment. These crises of cure and costs, compassion and commitment, are telling us we need a new way of looking at medicine and new ways of doing it. Ironically, science itself can turn these tides: for instance, far from side-lining the art of medicine, evidence-based healthcare shows that communication and kindness improve most healthcare outcomes. Which is why hi-tech approaches need the therapeutic relationship to balance them out; and why healthcare organisations should nurture their compassion-resources by looking after their staff. Those that do will be more productive, recruit better and be less litigated against.

Medicine’s crises are signs that we need holism more than ever. Fortunately, in a world of governance and guidelines there is science to support holistic approaches: for the therapeutic relationship, mind–body medicine, the mainstream potential of complementary medicine, for ways of mobilising self-healing. The BHMA’s December 2004 annual conference Examining 21st century expectations of healthcare explored new ways of delivering humane care and education in an increasingly impersonalising world. This issue of JHH (March 2005) presents some highlights from the meeting.

We have to prevent that version of the future. Yet with hyper-modern horizons in view, and the welfare state fast retreating in our rear view mirror, staying well could become a rational obsession. It has been said that in the early 21st century the UK is already a nation of individuals, each one compelled to manage the direction of his own life, advance her own abilities, while making preparations for an unpredictable future, and striving for ‘the good life’. Small wonder then, that people are increasingly interested in their personal wellbeing.

Healthy, ’productive’ old age – which is highly cost-effective, both medically and actuarially – would solve the state’s dual funding crises. Retiring can be bad for you; elders who are active members of society have better health (and vice versa of course). Some would say that individual lifestyle is the key and that we should all get on our exercise bikes. The strange case of Cuba, however, suggests there is more to health than jogging and high-fibre muesli. The article on Cuba in this issue implies that human lives are more than units of production and that holistic healthcare is at odds with a ‘healthier than thou’, ‘every man for himself’ culture. There is something the Cubans can teach us about sustainable healthcare based on low-tech alternatives and basic off-patent drugs, the massive use of complementary and traditional medicines and the mysterious effects of social cohesion.

Unhappiness, disempowerment and loneliness damage communities, impair lives, and eventually get into organs and cells, where they undermine the body’s self-regulation and prepare the ground for chronic disease. Mike Waldron and Frank Keating remind us that having choices and being valued are crucial health determinants. Only as a society can we tackle under-privilege and deprivation before they translate into personal illness; on the other hand it would revolutionise healthcare if practitioners could demonstrate such homeostatic upset and intervene with individuals before distress converts to disease. Angela Clow and David Beales are researching ways of doing this, and in this issue they offer short reports on their progress.

Holism demands individual as well as group developments. Ironically, in an era of growing individualism, medicine finds itself charging headlong into corporate governance, evidence-based medicine and mass technology. Can personal service survive in big picture medicine? This question is central to our annual conference on December 3rd (2004) where we will be asking just what 21st century healthcare might become. Because when the chips are down – and we are all bound to be patients one day – personal care is what we will want; public health and mind-body medicine can provide bedrock for better healthcare, but the human factor and self-healing will always be medicine’s supreme resources.