Integral Healthcare: The Benefits and Challenges of Integrating Complementary and Alternative Medicine with a Conventional Healthcare Practice PDF

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Integrative Medicine Insights Open Access Full open access to this and thousands of other papers at C o mm e n ta r y http://www.la-press.com. Integral Healthcare: The Benefits and Challenges of Integrating Complementary and Alternative Medicine with a Conventional Healthcare Practice Christina L. Ross PhD Candidate in Energy Medicine, Akamai University, Hilo, Hawaii. Email: [email protected] Abstract: Today’s medicine is in the midst of an undeniable crisis. Calls to reform healthcare are in the forefront of economic and political discussions worldwide. Economic pressures reduce the amount of time physicians can spend with patients contributing to burnout among medical staff and endangering the patient iatrogenically. Politicians are getting involved as the public is calling for more affordable healthcare. A new paradigm must be embraced in order to address all aspects of this dilemma. It is clear that science and technology have resulted in vastly improved understanding, diagnosis, and treatment of disease, but the emphasis on science and technology to the exclusion of other elements of healing has also served to limit the development of a model that humanizes healthcare. The healing of a patient must include more than the biology and chemistry of their physical body; by necessity, it must include the mental, emotional and spiritual aspects. Because of these challenges, the development of an integral healthcare system that is rooted in appropriate regulation and supported by rigorous scientific evidence is the direction that many models of integrative healthcare are moving towards in the 21st century. Keywords: complimentary medicine, alternative medicine, healthcare Integrative Medicine Insights 2009:4 13–20 This article is available from http://www.la-press.com. © the authors, licensee Libertas Academica Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://www.creativecommons.org/licenses/by/2.0) which permits unrestricted use, distribution and reproduction provided the original work is properly cited. Integrative Medicine Insights 2009:4 13 Ross What is Integral Medicine? that he will reach his destination. The most proficient Integral medicine recognizes that human beings way to move forward is with small steps. The transition possess emotional, mental and spiritual dimensions that from gas-powered automobiles to gas-free automobiles are essential in the diagnosis and treatment of disease must go through a hybrid stage in order for drivers to and the cultivation of wellness. Integral medicine is feel comfortable with the new system. The same can about being concerned with the whole person rather be said about transitioning from a pathophysiological than the disease; calling on the universal life force based medical system to an integral based system. (prana or chi) manifested mentally, physically and There are many biases towards complementary and spiritually. “Body, mind and spirit are operating in alternative practices that prevent total acceptance self; culture and nature, and thus health and healing in the current medical field. Biases towards viewing sickness and wholeness are all bound up in a multi- spirituality as organized religion and also biases as to dimensional tapestry that cannot be cut into without whether or not humans really have a conscious mind loss” (Schlitz,1 forward, p. xl). that is capable of healing the body on its own. According to philosopher Ken Wilber, there A lack of “qualified” research is also of major are four elements necessary for the progress of concern to many conventional medical practitioners. an Integral medicine paradigm: 1) An expanded A biological based medical practice steeped in treat- consciousness which includes inner thoughts, feelings ments proven through the “double-blind random- and spiritualism as well as outer behavioral indices ized controlled trial” (the gold standard of medical such as race, culture, religion, sexual orientation and research) will need to be reassessed as a research family influences. These stages of consciousness method for complementary and alternative treatments span a spectrum from sensory to mental to (which have been time tested and take into account spiritual. Potentials coming from the physical, the whole person) comes to fruition. emotional, mental and spiritual spectrums effectively resist reductionism. Since we all have physical, emotional, mental and spiritual dimensions of being What Model can be Used and awareness, attempting to reduce mind and for Integrating a Conventional spirit to matter can be considered folly; 2) Holism, Medical Practice? which includes oneness of experience. Instead of A model for integrating medicine and psychology an egocentric viewpoint or even an ethnocentric is already in existence can be expanded upon for an viewpoint, this paradigm embraces a worldcentric integral healthcare model. The Model for Integrating point of view; 3) Intentionality, which would integrate Medicine and Psychology (MI-MAP) was devel- mind/body systems, and 4) A larger self view of the oped over a ten year period of training physicians interconnectedness of all life. This view would create in both behavioral health and psychological factors, a larger consciousness, which in turn would manifest and training psychologists in physical health and a larger self and then generate larger medicine. pathophysiology.3 “An integral medical practice is a practice that makes MI-MAP attempts to combine the categorical and room for the entire panoply of effective treatments individual aspects of other models and create a more across all quadrants and dimensions of human health integrated depiction of factors to be assessed. It also and illness” (Wilber,2 forward p. xxx). organizes a sequential process by which the clinician can perform a comprehensive yet expedient inquiry regarding symptomatology relevant to the biopsycho- How do we Progress from a Patho- social model. This model serves as a guide to employ Physiological System to an Integral the concepts of the biopsychosocial model, and Healthcare System? apply these concepts consistently with the process of Integrating healthcare is somewhat like getting drivers clinical evaluation, treatment planning and clinical to switch from combustion engine automobiles to elec- intervention. The agenda for developing the MI-MAP trically powered motor cars. It is very difficult to “turn stemmed from several observations in the clinical off the gas” and have the driver feel safe and confident training setting. This model could be extended to 14 Integrative Medicine Insights 2009:4  Integral healthcare include spiritual imbalances as well as mental and instead of either ignoring or guessing at the causes emotional disorders. of psychological, emotional or spiritual imbalances. Physicians and nurses often struggle with the “The challenge with many alternative, complementary psychosocial components of a biopsychosocial or holistic practices is that for all their sincere efforts, practice. In the medical setting, patients present their their practices often create a grab bag of treatments physical symptoms and physicians often focus exclu- from which a conventional medical doctor would have sively on the diagnostics of the physical disease. The no idea which would work with her patient” (Wilber,2 MI-MAP grew from the need to make attention to forward p. xxx). psychosocial factors easier yet more comprehensive The transpersonal practitioner, however, knows for physicians, nurses, health psychologists, general when to refer out a patient, making room for new psychologists and social workers, starting from the techniques by becoming part of a medical group or patients’ presenting complaints of physical symptoms.3 center that specializes in integral treatments. The Incorporating spiritual counselors and alternative transpersonal practitioner refers to a human-to-human medicine practitioners will help with assessing all connection that goes beyond the personal, physical dimensions of the patient’s healthcare needs. ego self and connects with a deeper, more spiritual, A check list of red flags pointing to biological, transcendent, consciousness based practice. spiritual and mental health issues can be quickly Without primary care physicians having to become diagnosed and attended to by all types of health psychologists or spiritual counselors, there are ways practitioners. Here are ways to empower practitioners to alert all types of health practitioners to spot red flags as well as patients to remain alert for signs and in each others’ scope of practice. Physicians may not symptoms in all types of healthcare. This can also be adept at all healing aspects of the human being, but be advanced through a network of support groups they should at least be cognizant of psychological and for practicing primary care physicians, behavioral spiritual issues in their patients and should be aware health practitioners, complementary and alternative of the implications of ignoring these aspects when it practitioners and spiritual counselors. comes to health and healing. How do we Begin the Movement Why is a Spiritual Aspect of Healing Towards Change? Necessary? Starting with educating physicians, the need to integrate Today, spirituality is considered an important part complementary and alternative practices in medical of secular life. According to Norman Shealy, M.D., schools is of utmost importance. According to Ken PhD.,4 “Concomitant with the spiritual decay of Wilber,2 over two thirds of medical schools now have the Vietnam War, the redeeming influence of the courses in complementary and alternative medicine; humanistic psychology movement was born. It was however, the challenge is to educate by cross training followed by the transpersonal psychology movement, spiritual and behavioral healthcare practitioners as and then the holistic health and medicine movement.” well as medical practitioners. An integrally-informed Humanistic psychology emphasizes the importance medical practice educates the practitioner’s first so they of the individual, of feeling, of self-actualization. The can then decide which of the treatments—conventional, transpersonal psychology movement emphasizes a complementary, alternative, and/or holistic they wish connectedness with spirit, soul and God. The holistic to use. It is important to note that some integrative health movement emphasizes the importance of the practices will complement Western medicine and spiritual aspects of life in overall well-being.4 some will provide an alternative to Western medicine. A health challenge or healing crisis opens for An integrative system of complementary and alterna- many people the realm of the spiritual. When the gift tive medicine differs from a system which is considered of good health is interrupted, we have the opportunity integral. Integral medicine blends Western allopathic to realize that the well-being we tend to take for medicine with complementary and alternative medical granted is a gift. The loss of good health is very often choices. From these options the practitioner could experienced as a gift because it can be a doorway to then individually or collectively practice medicine a new understanding of self in relationship to others. Integrative Medicine Insights 2009:4 15 Ross A whole new sense of gratitude for life can change a Integrating medicine with a carve-out structure patient’s quality of life. of managed holistic healthcare would greatly benefit Spiritual counseling often involves a search for both the patient and the physician, especially if equal meaning in terminal illnesses, confronting suffering coverage is granted for all modalities. “Integral and exploring forgiveness and gratitude. Mind-body medicines goes one step further: it treats the illness, the medicine focuses on the potential for mental, emotional, patient and the physician” (Wilber,2 forward, p. xix). social, behavioral and spiritual processes that affect health and personal growth. Yoga, meditation, prayer So What is the Next Step Towards and expressive arts such as dance, art and music are Initiating an Integral Medicine often suggested in mind-body practice. Practice? If Western medicine could embrace a system where How can Conventional and Integrative physicians, social workers, spiritual counselors and Medicine Benefit from an Integral behavioral healthcare providers are able to collaborate Model? more freely by co-locating, they would readily see Of great concern are the growing number of uninsured how the quality of the care provided to their patients persons and the lack of reasonable mental, emotional improves. This structure may have the added benefit and spiritual healthcare coverage worldwide.5 of destigmatizing mental healthcare as patients The way insurance is relegated is perhaps one of the come to see mental health providers as part of the biggest underlying deterrents in using the integral medical team. healthcare model. Conceivably the answer lies in It would be quite simple to follow up a physical moving from a carve-out system to a carve-in structure health exam with a mental and spiritual health of managed behavioral healthcare. Insurance issues visit if medical doctors, psychologists and spiri- in the healthcare industry remain as big a problem tual counselors worked in the same location. Sup- as the reductionistic theory of matter in medicine. port groups could meet on site at the medical center. In most cases insurance benefits for a specific service The patient could book an appointment with their category are separated from other insurance benefits healthcare practitioners in the same office and feel and managed under a different contract. So even confident that all their needs are being met by the same if medical doctors decided to practice alongside medical team. Having to leave the office and find a psychologists, psychiatrists and spiritual counselors, psychologist or spiritual advisor who doesn’t know the insurance processing systems would be separate. the patient’s medical history can give pause to the This carve-out structure system increases the chances patient not following through with the recommended of over prescribing psychotropic medications by appointments. This model for integrating conventional primary care physicians who may not be trained in medicine with psychology and spirituality would such unless they are a psychiatrist.3 provide an expedient assessment sequence to assist There is also a lack of equality granted to psychologists and social workers in understanding mental health coverage as compared to conventional the stresses and coping demands of various physical medical coverage. According to Marilyn Schlitz,1 illnesses as well as to orient physicians and nurses 60 to 70 percent of all medical visits primarily have to the psychosocial factors that may interfere with a psychosocial basis and 25 percent of primary care important medical outcomes. patients have a diagnosable psychological disorder Barriers to an integral system of this type include with anxiety and depression being the most common. the fact that managed care has not provided financial Schlitz asserts that 50 percent of patients with mental incentives for adopting an integrated model of health problems are seen only in primary care, healthcare.6 There is a lack of integrated technologies and 70 percent of all psychotropic medications are making administrative integration difficult and most prescribed by non-psychiatric physicians. Less than medical facilities are not structurally designed to one third of adults with a diagnosable mental disorder accommodate behavioral health providers and are receive treatment each year, leaving the majority therefore prohibitive of co-location. The lack of without care. adequate reimbursement in insurance policies is 16 Integrative Medicine Insights 2009:4  Integral healthcare another problem and cost codes for mental health consciousness shapes our understanding of health and remain separate from the physical health system disease. Because of this misunderstanding, integral creating billing problems for the patient, doctor and medicine will require a reassessment of assump- insurance company. tions. Objectively it cannot exist—separate from our If a more integrated approach were taken in health consciousness. Today’s medicine must integrate and insurance and a managed care organization owned appreciate multiple social and cultural approaches to and operated its behavioral health organization as a healing. Its desire for health and healing is as impor- subsidiary and would retain the risk for the mental tant as scientific information and technology. health services, management could focus on the person as a whole as well as provide a combination of medical What are the Cultural Benefits and psychological services. This is important since of an Integral System Versus the World Health Organization7 ranks psychological a Conventional or Integrative System? disorders second only to cardiovascular disease as a Different cultures add other dimensions to the art leading cause of worldwide disability. and science of healing. According to David Bohm,9 Why Does Conventional Medicine complex linkages of the “implicate order” between Need Complementary and Alternative mental, physical, social, cosmic and spiritual realms provide the holistic phenomena that Navajo people Therapies? refer to as indigenous medicine. Bohm’s notion of It is important to understand that integrative medicine holistic order, in which any given element “contains cannot exist without both conventional and alterna- the totality of the cosmos enfolded within itself ”, per- tive therapies to draw from, which, in turn, supply the tains to both consciousness and the Navajo healing context for each other’s very existence. “We are all process; hence it is relevant to noetics, the scientific part of a health care hologram—shine a light through study of phenomena classified under such descriptors one of us, and you will see an image of the whole”.8 as “consciousness” and “mind”. Larry Dossey, MD suggests that the popularity of alternative therapies and therapists is largely due to the “Westerners often emphasize the transcendental side of sha- fact that they help people find meaning in their lives manism to the neglect of its practical aspects. In the Navajo when they need it most. Dossey writes, “No matter way of thinking, the causes of imbalance, (disease) and healing how technologically effective modern medicine may (restoration of balance) areintrinsically interrelated. Other physical be, if it does not honor the place of meaning in illness, symptoms may attach themselves to the original imbalance. One it may lose the allegiance of those it serves” (1982, becomes aware of a multiplicity of invisible interconnections page 154). Integrative medicine honors the body’s within the organic system. These complex alignments are visible own intelligence and transformative nature. and understandable to Navajo diagnosticians. However, they are “The net result of the problem between conven- most often invisible and discounted by Western allopathic phy- tional and alternative approaches is that physicians sicians who have been trained to deal with causality-factored and nurses are very unhappy with the present state diagnoses” (Maryboy,10 p. 408). of conventional medicine and yet they often distrust Following this same holistic paradigm, Tradi- the holistic alternatives” (Wilber,2 forward, p. xxxii). tional Chinese Medicine uses Chi, the “vital energy They know conventional medicine is limiting them of life”. Ancient people concluded that all things in personally and in the healing they offer the sick, yet the universe (with or without life) are made up by they may suspect that too many of the alternative and an ultimate, invisible, yet ever-existing Chi. Ancient holistic approaches have abandoned sound research, medical theory posits that the human body is formed scientific evidence and rigor in what amounts to a by Chi and that the body correlates with nature. The medical version of “popularity with the public”. first complete Traditional Chinese Medicine textbook, Misunderstandings with regard to integral medicine The Yellow Emperor’s Classic of Internal Medicine include the idea that it doesn’t just diagnose or originally published in China more than 2,000 years fix—it uses the body’s innate ability to heal itself. ago explains that diseases are believed to be caused Conventional medicine does not use the principle that by deficits and imbalances of Chi in the body. Integrative Medicine Insights 2009:4 17 Ross Different Traditional Chinese Medical treatments related Web resources. Organizations that specialize have the common objective of regulating Chi and in integrative resources include the National Cancer restoring balance. Institute (NCI), the National Institute of Arthritis and The ancient science of Tibetan medicine is rooted Musculoskeletal and Skin Diseases (NIAMS), the in the teachings of Buddha and the essence of these National Institute of Environmental Health Sciences teachings is the central importance of the mind. (NIEHS), the Office of Dietary Supplements (ODS) The Buddha says the mind is both the source of and the Agency for Healthcare Research and Quality happiness and the root of suffering. At the same time (AHRQ). it possesses an extraordinary capacity for healing; it One example of an Integral healthcare model is the also plays a part in making us ill. “Tibetan medicine Health and Healing Center of the Institute of Health is an integrated system of healthcare that has served and Healing at the California Pacific Medical Center. the Tibetan people well for many centuries; but the The center integrates self-care with expert care end result is that it doesn’t matter whether a patient and the best of conventional medicine with proven utilizes Western medical services or the ancient healing practices from around the world. The center’s healing methods; the most important thing is that the physicians and practitioners are experts in the world’s patient is an active participant in their own healing great healing traditions, including Western medicine, process” (Rinpoche,11 page 420). all backed by research. The center offers a person- alized approach to healthcare that combines conven- What Organizations are Moving tional and complementary approaches. The Institute Towards an Integral Model? of Health and Healing also offers classes to teach For an overall view of the integrative healthcare individuals and practitioners fundamental tools for process, reference the American Holistic Medical wellness. Association (AHMA) which serves as the leading Other treatment centers around the world have advocate for the use of holistic and integrative medi- taken up the challenge of integral healthcare. One in cine by all licensed healthcare providers. The AHMA particular is The Cancer Centers of America (see www. embraces integrative, complementary and alterna- cancercenter.com), which uses mind/body medicine, tive medicine techniques, while holding onto what is guided imagery, holistic patient centered approaches, helpful in allopathic medicine—understanding that naturopathic medicine and spiritual support along side healing includes the body, the mind, the emotions, chemotherapy, surgery and radiation treatments. This and the spirit. integrated approach has shown to be rewarding to not “The AHMA is committed to increasing awareness only the patient, but also the healthcare practitioners. and understanding of the natural healing tenets of The testimonials regarding improvements in health Holistic Medicine and to link together those who rates and hospital admission/release/re-admission rates wish to utilize and promote a holistic approach to and lowering of mortality rates is substantial as well as conventional and integrative medicine. Teaching showing an improved quality of life for the patient. the value of prevention and wellness instead of a The Maricopa Integrated Health System (http:// “quick fix” is best accomplished through correcting www.mihs.org), a burn center, is another integrated core imbalances and by addressing contributing clinic and the Roger C. Lipitz Center for Integrated factors”. Health Care, a foundation of Johns Hopkins Bloomberg Other organizations providing information for School of Public Health (www.jhsph.edu/LipitzCenter) integral healthcare include the National Center for has integrated conventional and alternative care as well. Complementary and Alternative Medicine (NCCAM) Ways an integral health care model would help and also the National Library of Medicine (NLM), patient/doctor interaction include instructions which have partnered to create CAM on PubMed, on patient care and self-management as well as a subset of NLM’s PubMed. PubMed provides access somatization (which includes underlying emotional to citations from the MEDLINE database and addi- causes for medical diagnosis such as chest pain, tional life science journals. It also includes links to fatigue, dizziness, headaches and constipation). many full-text articles at journal Web sites and other On average 85 percent of these illnesses were the 18 Integrative Medicine Insights 2009:4  Integral healthcare result of psycho-social issues and undiagnosed and At times, the sociopolitical and economic dimensions misdiagnosed mental illness.3 of healthcare can seem overwhelming. There are For the last several decades, behavioral scientists so many interests at stake, and so many complex have demonstrated improved clinical outcomes as well relationships between institutions and individuals. as cost savings resulting from targeted psychological In the integral model, there is a shift from a disease interventions that have been integrated within primary centered approach to one that seeks to build optimal and specialty medical care. Many chronic diseases, healing environments. What is being called for such as diabetes, pulmonary diseases, hepatitis and are organizations that align hospitals, physicians, asthma can be prevented or managed more effec- nurses, alternative practitioners, and communities to tively with behavioral interventions targeted at diet, optimize patient care. But the focus of a fully integral exercise, smoking, chronic pain, sexual practices and system also includes the workplace, the home, and adherence to medical regimens to improve medical the individual. It spans the distance from religion to treatment outcomes. Surveyed medical doctors also culture, social interaction to family interaction. The expressed an increased sense of confidence in their public is calling for something more, and many of ability to provide patients the medical care they the leaders in hospitals and government recognize the need when working together with behavioral care need for whole system change.1 practitioners.1 Katon12 and colleagues demonstrated superior Conclusion clinical outcomes for the treatment of depression in Unless and until medicine embraces the paradigm of an integrated primary care setting with co-located the patient as a mental, physical and spiritual being, mental health treatments provided along with primary the medical industry is destined to be stuck in an medical care. After being referred to a mental health infinite quandary. The paradigm shift from integrative provider, 44 percent of patients showed symptom to integral medicine requires more than an evolution reduction. This study further revealed that 80 percent from the basic model of “body, mind and spirit” into a of participating physicians expressed that the collabo- more inclusive social, political, economic, metaphys- ration with mental health providers greatly increased ical, ecological and worldwide dimension of health their satisfaction in healing depression. care. “The multiple dimensions of the patient with Whereas much of the writing on the integral health self and others require equal status with the physi- care model focuses on aspects that are not emphasized cal and objective foundations of science”.1 Although in our contemporary culture, it does incorporate an physicians may not be adept at healing all facets of evidence-based approach. Data from many scientific the human being, they should at least be cognizant studies support the overall value and efficacy of of cultural, social, spiritual and psychological issues various elements of integral health care. Research in their patients and should be aware of the implica- Professor Candace Pert, PhD13 explains how her tions of ignoring these aspects when it comes to health work has shown that the form of neuropeptides and and healing. Integral medicine is the next step up from their corresponding cellular receptors, which make integrative medicine because it incorporates not just up our biological systems, are literally flooded by our conventional and alternative medicine, but all dimen- cognitions and emotions. Neuropeptide receptors are sions of healing—from physical to psychological and not limited to the brain; they are present on cells in cultural to spiritual. tissues throughout the body. Emotions are therefore a bridge between mind and body. Disclosure James W. Pennebaker14 and his students are exploring The author reports no conflicts of interest. the links between traumatic experiences and physical and mental health. 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