There is great fervor in the health field. New ideas, innovative programs, and hope are everywhere, and today’s rapid changes seem to have a momentum of their own. States are providing licensure to new categories of health practitioners, medical schools are offering programs on holistic healing, the Office of Alternative Medicine is funding research on complementary therapies, insurance carriers are beginning to offer reimbursement for these therapies, the Internet is overflowing with information and informal dialogues, and the state of Washington has passed legislation mandating that "Every health plan after January 1, 1996 shall permit every category of provider (chiropractors, acupuncturists, naturopaths, etc.) to provide health services or care for conditions included in the basic health care services (offered by the health plan)..."
Confronted with the complexities of lifestyle and stress-related degenerative diseases, addictive disorders, anxiety, depression and their physical counterparts, dissatisfaction with the over use of pharmacological and interventionist therapies, a rising antipathy with professional arrogance and authority along with a growing demand for high level health conventional medicine has finally reached its limitations. There is now a broad based consensus that change is necessary and desirable.
But the current pace of change has allowed both practitioners and the general public little opportunity for reflection and evaluation. As a result there has been a lack of significant discourse in regard to the extent and the direction of change. Motivated by very real concerns yet conditioned by old patterns of thought, fired up with enthusiasm and hope yet compelled by complex professional and financial interests, and carried along by a seemingly unstoppable momentum, we simply assume that our current initiatives are taking us in a beneficial and innovative direction. As a result, we have failed to ask the critical questions whose answers can either reassure us about our current efforts, or cause us to reconsider them. Consider these two simple but basic questions:
• What perspectives do we wish to see expressed in a reconfigured
approach to health and healing?
• Do our current initiatives reflect and support the development of these perspectives?
Past and Future Gathered Together
The first question, one that deals with the articulation of a newly emerging world view, must be considered in the context of our unique historical moment. Today we find ourselves living in an extraordinary in-between time, a sort of gap in time that has been created by the decline of our previously unquestioned optimism and faith in the 500 year tenure of modernism, and the slow and as yet uncertain emergence of a new post modern viewpoint. As practitioners and individuals in search of a more meaningful approach to health and healing, we rarely concern ourselves with these larger cultural movements, issues we usually leave to historians, social scientists, and philosophers. Yet at times of great transformation we cannot afford to do so. Only to the extent that we can accurately comprehend the historical forces that are driving and shaping our times can we effectively embrace and empower these forces rather than oppose them with potentially misguided efforts. With this in mind it becomes incumbent on us to inform our efforts with an understanding of our extraordinary historical moment, an understanding the can enable us to best answer the two questions we have proposed.
As westerners our cultural history can largely be traced to Hellenistic Greece. This meeting of the ancient mythological world and the emerging world of rational inquiry gave rise to an extraordinary culture which sustained, for a brief period of time, a precarious yet highly creative balance between sensory and intuitive knowledge - the seemingly opposing perspectives of analysis and synthesis. Among this culture’s many achievements was the rise of Aesclepian medicine, an amalgam of the rudimentary elements of a scientific medicine, the practice of hygiene, and the active invocation of the imagination and spirit.
Several centuries later this union of rational and intuitive knowledge was sundered apart with the rise of the monotheistic Christian mythos. Faith and scripture replaced rational inquiry as the primary route to knowledge and truth, and faith, revelation, salvation, and healing became one. Independent intellectual exploration of the human experience and the natural world was surrendered to the absolute authority of the Church. But the rise of a monochromatic perspective in either personal psychology or history always empowers its counter-balancing force which in time forces the decline of the previously dominant perspective. It is in this manner that the dominance of the Christian era eventually declined, giving way to the Copernican revolution and the modern era, an extraordinary epoch which was to last for 500 years, and is only now beginning its decline.
Initiated by Copernicus and completed by Kepler, Galileo, and Descartes this paradigm shift engaged the western world in a compensatory, yet equally monotheistic world view, one that was sensory-based, factual, and mechanical. This powerfully pragmatic perspective has been highly successful in elucidating the mechanistic aspects of nature, but it has left us with a disenchanted and devitalized world, one that is devoid of meaning, spirit, and faith. We have deconstructed metaphysics, leaving ourselves with no encompassing vision of life, transcendent or immanent. We have deconstructed the individual, turning the immense experience of humanity into a mechanistic collection of biological parts. We have alienated ourselves from the natural world, preferring to control and manipulate it rather than to learn from and be nurtured by it. We have delegitimized the poetic, imaginative, and aesthetic realms. And as a result, we are losing our centuries old faith and hope that an objectified and technological understanding of life acquired through reason alone would provide us with a progressive and endless improvement in the quality of our lives.
The recognition of the limitations and dark side of the modern world view has placed us in a time of great uncertainty, one that is simultaneously filled with an unlikely mixture of personal and social nihilism and an unfettered optimism. The consequences of the former can be seen in social decay, personal despair, and the of loss meaning and hope, and the consequences of the later can be seen in a momentous surge of creativity, pluralistic thinking, and hopefulness. It is in this gap between world views that we live. And both our disillusionment with the existing medical model, and our efforts to revitalize and reconfigure our approaches to health and healing emerge from this pregnant historical moment. To understand this circumstance is to comprehend that the changes we must now envision are fundamental rather than cosmetic, and as much compelled as chosen.
Through the mist of the uncertainty of our times the elements of a post modern world view are slowly becoming evident. This new perspective, unlike those preceding it, will most assuredly be polychromatic, allowing for the inclusion of multiple perspectives while denying the dominance of any single perspective. And the individual, within the framework of community, will rediscover his or her unity with life while simultaneously maintaining an authentic sense of autonomy and transcending the alienation imposed by the modern world view. For the purpose of seeking guidance in our efforts to reconfigure our approach to health and healing within the context of the larger cultural movements of our times I would like to set forth four perspectives that now appear to be critical elements of the emerging post modern world view, perspectives that must be central structural supports for a post modern medicine.
The modern world view requires that reality be objectified, sensory-based, impersonal, measurable, quantifiable, opaque, and collectively experienced and validated. The post modern view of reality is far more complex. It rejects the view that reality is limited to the receptive capacities of our five senses, and validates the legitimacy of non-sensory, intuitive knowledge. Reality is extended, revitalized, and personalized. It is seen as a multidimensional amalgam of sensory and non-sensory knowledge. This amalgam denies the extremes of a purely sensory-based universe, and its antithesis a radical subjectivism.
The modern world view postulates that all phenomena are caused by unchanging universal laws that exist independently of human consciousness. In essence, causality is seen as physically based and upward in its direction. The post modern perspective validates and legitimizes the causal nature of consciousness which is individually willed and downward in direction.
The modern world view assumes the distinct separateness of subjective and objective, external and internal, material and immaterial, mind and body, reason and intuition, and man and nature. At its essence, irrespective of its extraordinary accomplishments, it is an alienating perspective. The post modern viewpoint accepts the value of an analytic methodology within a larger context that comprehends and honors the unbroken unity of all life.
The modern world view assigned great importance to the individual and his/her rights, an ideal that too often was degraded to a self-indulgent, egoistic, and aggressive quest for power and material gain accompanied by personal alienation. The post modern world view revitalizes and deepens the meaning of individualism by asserting the significance of the individual search for authenticity through self-knowledge, legitimizing the shift in authority from belief systems, institutions, and professionals to the individual (a shift in authority from external to internal), and recognizing that authentic individualism comes into being in the context of relationship.
These four perspectives underlie, inform, and drive our current process of cultural change. Together they constitute the historical imperative of our times, an elastic world view that unlike previous religious and empirical perspectives is both pluralistic and inclusive. These essential perspectives characterize the post-modern world, and as such they can most appropriately guide and define an approach to health and healing that is unique to the needs and character of our times - an approach that I have called post modern medicine.
A Shift in World View or More of the Same
With these new perspectives in mind, let’s consider our second question: Are our current efforts expressing and supporting these perspectives, the viewpoints that characterize fundamental change? Consider the following recent attempts to expand our ideas about health and healing.
• John Travis, M.D. opened the first wellness center in the late 1970s in Mill Valley, California. Influenced by Halbert Dunn’s book High Level Wellness, Travis’ concept of wellness sought to expand our ideas about health beyond the customary focus on preventing and curing disease to include a concern for the promotion of well-being. Health and healing were seen as a personal affair, a psychosocial process of education and lifestyle change.
• The idea of holism, first described by Jan Smuts in his 1920s book Holism and Evolution, was revived by individuals and practitioners seeking a broader vision of health and healing. As a concept, holism expressed the view that life at all levels is organized as a unity. Although reductionism had been successful in explaining the mechanistic workings of nature, it was increasingly seen as a limited and partial approach to knowledge, an approach which distracted us from a more comprehensive and ecological view of the human condition that offered a more meaningful, vital, and enchanted view of nature.
• In the 1980s alternative and complementary practices began to emerge as a further expression of the rapid changes in our ideas about health care. Naturopaths, chiropractors, acupuncturists and others sought and achieved state licensure, and began the initial steps towards full integration into the mainstream of institutionalized health care, a process aimed at achieving conventional acceptability and consensual validation. The Office of Alternative Medicine was established at the National Institutes of Health to examine the efficacy and appropriateness. of these diverse approaches to health and healing.