Each of these initiatives were honest attempts by sincere individuals and institutions to bring change to an entrenched health care system, one that no longer seemed effective in dealing with present day problems and sensibilities, and was at odds with the emerging post modern viewpoint. Let’s examine the results of each of these efforts.
The idea of wellness was rapidly integrated into our culture. But as it entered the mainstream of our cultural life, and particularly when it was integrated into existing health care institutions, wellness was reduced to four physically based issues: nutrition, smoking cessation, fitness, and stress management. Its fundamental emphasis on personal development, and its psychosocial framework and values were largely jettisoned, and with its assimilation into the larger culture it was reshaped until it more resembled traditional preventive approaches, packaged as generic commodities carrying the "wellness" label, than the dramatic shift in perspective envisioned by Travis.
The idea of holism suffered a similar fate. As a philosophy, holism evolved as a counterforce to atomistic and reductionistic perspectives. Sixty years after Smuts defined this concept, his vision was reduced to packaged commodities that could be bought and sold with labels such as holistic medicine, holistic dentistry, and so on. And further, it became a marketable credential that was self-applied by a diverse group of practitioners who confused humanism and an expanded repertoire of remedies and practices with holism. And even in the case of those practices that evolved from a more comprehensive framework, the "holistic" components rapidly receded in importance, or were completely discarded as they were secularized and reduced to disease-oriented treatments. As we are discovering, this is the cost of integrating into and accommodating to the institutional structures of mainstream health care whose perspectives are solidly embedded in the traditions of the modern world view. It is the price of cultural acceptability and third party reimbursement.
Alternative and complementary approaches to health and healing, however valuable in diversifying our treatment options, have similarly failed to significantly alter our existing world view. Conventional and alternative practitioners, irrespective of their rhetoric or intention, generally use their specific expertise to prescribe techniques, practices, drugs, or supplements for the purpose of repairing or fixing an abnormality. The professional defines the approach solely within the context of his or her professional domain, and the prescribed treatment is external rather than internal. The individual is a more or less passive recipient of the therapeutic process gaining little in the way of personal insight or additional self-healing capacities. Because all of us are conditioned to turn to authoritarian structures and external remedies at times of adversity, we often demand and easily accommodate to the treatment model. There are always individual practitioners whose practices reflect a substantial shift in perspective (both conventional and alternative healers can access holistic principles within their traditions), but this remains an individual prerogative in distinction to a cultural shift.
The answer to our second question is now apparent. With few exceptions these and similar efforts ultimately failed, usually in their implementation, to explicitly and consistently express the perspectives that characterize a post modern medicine, perspectives that most of us would agree with and ones that would take us in the direction of fundamental change? So why has this happened? The answer is clear. Old perspectives and parochial interests are powerful and enduring. They silently and effectively reshape our efforts to more or less conform to existing conventions, incorporating and reshaping them until they accommodate to the assumptions of the existing world view. Because each of these initiatives explored new approaches and perspectives, and in this way succeeded in expanding existing perspectives and stretching our imagination, they have been useful endeavors. But so far they have failed at fundamental change. As a result, these initiatives have ultimately fallen within the hegemony of the existing values, perspectives, and practices, falling far short of taking us in the direction of a post modern medicine. Wellness became prevention, holism became an empty word, and alternative approaches became alternative treatments. The powerful influence of the existing world view subtly but surely changes us before we can change it, and our efforts fall of short of animating the perspectives of the emerging post modern viewpoint. Overcoming ourselves and our deeply conditioned and often unconscious assumptions is a difficult task.
A Post-Modern Medicine
So how do we assure fundamental change? How do we align ourselves with the future? First, we must clearly articulate the perspectives that we choose to assert, then carefully design and embed them into innovative programs, and finally, measure the success of these programs by their demonstrated capacity to foster these perspectives. To accomplish this goal these perspectives must gain priority over our conditioned thoughts and actions, and our parochial professional interests. The changes that will result from such an effort will not be an accumulation of new ideas and practices that are subtly but assuredly reshaped to resemble the past, but rather a fundamental revision of our approach to health and healing.
Because the central perspectives of the post modern world view - multidimensional realism, intentionality, holism, and personal authenticity - are activated, animated, and validated through direct personal experience guided by an inquiring consciousness, the individual (in contrast to professionals and institutions) becomes the essential focus and primary healer of post modern medicine. Health and healing - its character, symbols, and metaphors - become personal issues, ones that are uniquely defined and orchestrated by each individual. In a sense, the individual is the healer, the healee, and the healing. Directly engaged in the historical process of actively integrating and living a new world view, the individual himself is transformed. This transformation is marked by a shift in authority from professionals and institutions to the individual, a shift that is accompanied by an expansion of personal consciousness and capacity.
It follows from this that initiatives that result in an expansion and extension of professionalism and its monopoly over knowledge, conventional or alternative, expropriates power and possibility from the individual and runs counter to the values of a post modern medicine. Practitioners and their therapies will remain an important component of a person-centered post modern medicine, but not a dominant one. They will be a valuable resource to individuals who are actively engaged in composing their lives, defining their personal visions of health, and learning from and responding to life’s adversities.
Because we are still living in the gap between world views, we can only catch glimpses of what the full flowering of post modern medicine will look like. Yet there is much to gain from these glimpses. Let’s consider two programs: the Dean Ornish Lifestyle Intervention Program and the Planetree Hospital Unit and Consumer Education Program. In examining each of these programs we can measure them against the perspectives that will characterize a post modern medicine.
In 1977 Dr. Dean Ornish began to explore an alternative, non-pharmacological approach to atherosclerotic heart disease. The central elements of his program included a low fat diet, meditation, yoga, exercise, and psychological counseling and support. When I visited this program in 1990 I had an opportunity to join an evening meeting and to speak in some detail with several of the participants. What most impressed me was the extent to which these individuals had become empowered in the pursuit of their own healing. They had developed a repertoire of new skills, resources, and capacities, gained insight into their lives and relationships, cultivated a more expansive understanding of health and disease, learned to make conscious and self-directed choices in a complex and pluralistic universe, and accomplished each of these goals within the context of a community. As a result of these experiences the participants extended the scope of their personal autonomy, expanded consciousness and self-knowledge, and created new options, each of these valued outcomes was built into the ongoing program. By transforming their approach to health and healing they had simultaneously transformed themselves.
The goal of Ornish’s program, as I view it, is to support the personal growth and development of the participants so they can assert their primary role in the healing process, recovering from illness and promoting vital and healthy lives. Ultimately, the professional fades into the background, and the individual and his or her experience becomes the central factor in health and healing. This is not a treatment program in the way we have previously conceptualized treatment. I’m not quite sure what to call it, but my sense is that it expresses the values we have discussed, and contributes to the creation of a fundamentally new and effective approach to health and healing, one that begins to engage the central elements of the post modern view.
Let’s look at another example, the Planetree model. In 1977 Angelica Thieriot, an Argentinian, was hospitalized during a visit to San Francisco. Although impressed by the technology she was appalled by her hospital care. As a result of this experience she approached the chief of medicine at the Pacific Presbyterian Medical Center in San Francisco with the idea of creating a model program, a program that would respond to the needs of the individual by supporting personal autonomy.
In 1981 the first Planetree Health Resource Center opened. This consumer library was designed to assist individuals in acquiring up-to-date medical information that would enable them to be active and informed participants in the healing process. The center maintained a library, subject files on conventional and alternative health care, access to the National Library of Medicine’s search service, selected bibliographies, and listings of national and local organizations and support groups.
In 1985 the first Planetree hospital unit was established. In each of the patient’s rooms the colors, lighting, carpeting, and other details were specifically designed so that the healing needs of individuals could be met. The patients had full access to their medical records, and were encouraged to add their observations, feelings, and responses to their files. The new unit provided kitchen facilities, flexible visiting hours, and a health educator. Alternative practitioners were permitted within the hospital setting, and patients had the option of wearing their own clothes, robes, and pajamas. In what is for most individuals a highly vulnerable circumstance the Planetree program focused on enhancing personal autonomy, expanding the individual’s knowledge and capacities, and allowing for a pluralistic approach to the healing process.
When I visited the Planetree hospital unit and consumer library the difference was clear. I did not feel I was visiting a treatment facility, but rather a healing center, one that was focused on the individual. Patients could leave the hospital more informed, aware, resourceful, empowered, and autonomous, a unique experience in health and healing. This project is another example of how postmodern perspectives when designed into the core of a program can support the emergence of a fundamentally new kind of medicine.
Each of these programs is a first step in the right direction, a movement away from the limitations of an exclusively reductionistic and professionally-centered treatment program. In each instance the advances of modern science are not discarded, in fact they are honored and then integrated into a larger, post modern world view. The result is the emergence of a post modern medicine.