The Clinical Setting
At this juncture it is reasonable to ask "How can such a model be integrated into the contemporary health care setting, and more specifically, the biomedical model?" As a consequence of the introduction and expansion of managed care delivery systems, individuals have increasingly lost their capacity to directly access specialty care practitioners. As a result, the primary care practitioner has become the door of entry into the medical care system. Therefore, it is the primary care practitioner who will become the critical triage officer. This most important and highly trained individual must have the capacity and skill to triage problems according to the levels of care required and to train and supervise others to do the same. Although the primary care practitioner should coordinate and overview the various aspects of care, the individual components of the health care plan can be implemented by a variety of individuals trained in each of the specific healing modalities. This would require a reorientation of the clinical setting to allow for a variety of intervention formats in contrast to the exclusively biomedical approaches of our current system.
It is important to recognize that mind/body and spiritual healing approaches are largely educational in contrast to therapeutic. It is therefore preferable that practitioners can easily access educational programs, off-site or on-site, which provide these services in group formats. To a considerable degree the resources of mind/body and spiritual healing, which are not currently considered in clinical settings, are best provided for in educational, nonclinical environments, and the distinction between medical therapeutics and person-centered education slowly disappear as we shift toward the latter levels of healing.
Practitioners and Clients: Partners in a New Perspective
This proposed model has very definite implications for practitioners and their clients. If primary care practitioners are to perform the role of triage officers as proposed here, they must be provided with an integrated systems based education. Such a physician must be knowledgeable in the dynamics of each of the four healing systems, but the distinctive aspect of his or her education will be an understanding of the principles, concepts, and structural issues that underlie a comprehensive approach to healing. We are not seeking experts in specific domains. The level of data and information available makes that task impossible. Rather, we are seeking practitioners, conventional and "alternative," whose training is expanded to include an understanding of each of the essential aspects of healing complemented by a strong emphasis on integrative studies. The latter is not merely an emphasis on structure and organization, but contains a value system that emphasizes synthesis and wholeness, a perspective that is largely absent from current educational programs.
Similarly, our clients must also review their monotheistic and fragmented approach to health care. It will be increasingly necessary to view health as an artistic creative act, one that is engaged for the duration of the life cycle. The expansion of consciousness, self-knowledge, capacities, resources, and skills is the very process of health itself. In these terms health
becomes more a verb than a noun, an intentional and proactive orientation to life that values personal growth and development. Health is then viewed as a lifetime journey rather than as a response to illness. In this context, a consciously lived life cycle will engage an individual in exploring each of the healing systems and in this manner maximize their contributions toward enhancing the quality and duration of life while simultaneously compressing morbidity into the final years of life.
Thomas S. Kuhn, in his seminal work The Structure of Scientific Revolutions (Kuhn 1970), suggests that scientific paradigms that serve to tightly organize and structure the development of a particular field of study will in time progressively fail to account for anomalous findings. The tenaciousness of an entrenched paradigm will, through denial, discounting, or other attempts to sustain itself, invariably delay the crisis that will inevitably confront an increasingly inadequate model. Eventually, more comprehensive models will develop, and a competitive battle will ensue between old and new.
This is our current circumstance. The biomedical treatment model, as a direct result of its very successful reductive approach, cannot adequately incorporate the significance of psychological, psychosocial, and spiritual factors of health. It cannot make sense of and respond to the extensive literature that documents the effect of social support and socioeconomic influences on morbidity and mortality (Adler et al., 1993; Berkman and Syme 1979; House et al., 1982; Williams et al., 1992). It cannot easily acknowledge and integrate an exceedingly well documented lifestyle and psychosocial based program for the nonpharmacologic reversal of coronary atherosclerosis (Ornish 1990). There is no accommodation for the increasing research in the field of psychoneuroimmunology, which is demonstrating the relationship between mental attitudes and physiologic change, and no explanation for the well documented reversals of what are considered terminal diseases (O'Regan and Hirshberg, 1993). Finally, there is no consideration of the potential efficacy of "nonconventional" therapies or the emerging and growing public interest in health promotion.
Beyond these issues are the social and cultural consequences of the biomedical treatment model, which have become progressively detrimental to the human experience. The social roles assumed by practitioner and client, roles that are a direct consequence of the professionalism and authoritarianism of modern medical practices, and the "medicalization" of many aspects of human life (e.g., socially deviant behavior) have undermined the development of personal autonomy and responsibility, the very qualities that are essential for both human development and for access to the extended aspects of healing. Further, the cultural view of essential human concerns such as disease, health, pain, suffering, and death, are increasingly defined in medical and pathologic terms. For example, pain and suffering, which can be viewed as an existential issue to be lived through and grown from, have now become something adverse to fix and remove. They have shifted from personal concerns to technologic medical problems, from a source of knowledge and wisdom to an unwanted disruption in life.
In response to these concerns we have seen the development of various new models and approaches: the wellness model, the biopsychosocial model, and mind/body, holistic, and alternative practices. Each of these initiatives is a response to our current dilemma: the inability of the biomedical treatment model to fully respond to the needs of our time. The model I am proposing incorporates these ideas into a singular expanded vision of the future, one that is inclusive, comprehensive, accessible, and functional. This model can serve to responsibly integrate conventional practices with the emerging interest in mind/body and spiritual healing, alternative therapies, and health promotion initiatives, provide a theoretical basis for new system based research methodologies, assist with the development of an expanded curriculum for practitioners, and serve as the template for an innovative and flexible approach to healing that responds to
both individual and social needs as they have emerged in our time.
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