Complementary and Alternative Medicine PDF

25 Complementary and Alternative Medicine Eeva Sointu Defining CAM The term complementary and alternative medicine (CAM) encompasses a diverse array of healing practices with diff...

25 Complementary and Alternative Medicine Eeva Sointu Defining CAM The term complementary and alternative medicine (CAM) encompasses a diverse array of healing practices with differing diagnostic approaches and understandings of illness. Complementary and alternative medicine is not a coherent or unified whole; forms of CAM can differ from one another in relation to their histories and geographical origins, their methods of diagnosis and treatment, but also their cultural appeal and acceptability. Furthermore, practices that may be considered complementary and alternative medicine in the West – such as Traditional Chinese Medicine, Tibetan Medicine or Ayurveda – possess long histories outside the West and can be central to systems of caring for health within the cultures from which they originate. What is often thought to unify the diverse range of CAM prac- tices is a lack of state supported legitimacy (Cant and Sharma 1999; Saks 2003). There are, however, differences between CAM practices in terms of their relation- ship with, and standing within, biomedical institutions. While forms of CAM are increasingly accepted and integrated into some biomedical settings (Alameida and Gabe 2016; Fitzsimmons et al. 2019), other CAM practices exist primarily outside the biomedical mainstream. The process of integration, and search for scientific legitimacy, is also shaping how complementary and alternative medicines are practiced (Doel and Sergott 2003; Givati 2015). There are differences between forms of CAM also in terms of professional organization. Some practices, such as acupuncture, homeopathy and herbal medicine, tend to have organized professional bodies. Others, however, lack a central professional body or are organized in a manner that is more dif- fuse and fragmented (Baer 2010; Givati 2015). CAM practices also vary in their The Wiley Blackwell Companion to Medical Sociology, First Edition. Edited by William C. Cockerham. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd.  Complementary and Alternative Medicine 517 diagnostic and therapeutic approaches. While some focus on the manipulation of the body, others revolve around meditation and breathing, and yet others contain more spiritual components, or entail the prescription of different kinds of non- biomedical remedies. In this chapter I posit that defining the diverse complementary and alternative medicines primarily through their exclusion from the dominant, state-supported, systems of healthcare (Cant and Sharma 1999; Saks 2003) risks sidestepping the manner in which many complementary and alternative medicines capture broad cultural values around health and illness, and the self and the body. Even when institutionally marginal, CAM practices and philosophies can be culturally resonant (Sointu 2012). Many complementary and alternative medicines embrace a holistic conceptualization of health and illness that underscores the interconnectedness of the mind, the body and, at times, the spirit. An active role allocated to the client also characterizes many CAM practices; the capacity for healing is often considered innate and available for a person in search of wellbeing. Many CAM approaches also stress self-responsibility as well as consider self-exploration and self-awareness as a means of attaining fuller well-being. Rather than physiological health only, the kind of well-being emphasized in the complemen- tary and alternative health arena frequently encompasses feelings of personal fulfil- ment and happiness (Sointu 2006a, 2012). The cultural resonance of forms of CAM, and of philosophies associated with CAM, is visible today not only in the continuing popularity of different CAM practices, but also in the rise of diverse products and practices aiming at well-being and wellness. Beliefs, products and practices located with the broad category of CAM – such as mindfulness, meditation, and natural remedies – entwine with diffuse practices seeking to enhance wellness, often through the consumption of varied wellness products. Situating CAM Historically To understand the idea of CAM it is important to look to the past. I will start from considering the significance of the separation of health from the domain of the sacred. Health and healing were central concerns in, for example, Medieval Chris- tianity and in popular religious movements throughout modernity. In this context, lay people were seen as capable of directly drawing on sacred power through rit- uals aimed at safeguarding people’s material needs, including their health (McGuire 2008: 32). Throughout early modernity, the reformation movements delineated the sacred as a sphere distinct from the profane, including the body. Locating sacred power in the hands of churches entailed efforts to discour- age folk religion and ritual. Furthermore, “[c]hurch leaders’ efforts to disabuse church members of their trust in the powers of religious and folk healers preceded, by several centuries, the development of modern, rational biomedicine” (McGuire 2008: 132). What might today constitute forms of CAM – folk remedies or even the idea of lay people having access to healing power – is shaped by historical developments relating to the separation of religion and medicine into two institutionally distinct 518 Eeva Sointu spheres. The moving of the body from the domain of the sacred to the domain of the profane also played a role in opening the body to the emerging scientific biomedical gaze (McGuire 2008). The idea of complementary and alternative medicine is also connected with the rise of what is considered “orthodox” or conventional biomedicine. The consolida- tion of regular medicine – and later biomedicine – is interwoven with institutional, scientific, and legal shifts that took place throughout the nineteenth and early twen- tieth centuries (Baer 2001; Dew 2004). In Britain, licensing laws such as the Apothe- caries Act of 1815 and the Medical Act of 1858, distinguished regular medicine from irregular healing practices. In the US, most states had enacted licensure laws favoring regular medicine by the 1890s (Baer 2001). State supported licensing laws allocated regular medicine, and medical education acquired through regular medical schools, with a degree of legitimacy unavailable to unlicensed practices. The founding of regular medical societies – such as the American Medical Association in 1847, the Association Générale des Médicines de France in 1858, and the Canadian Medical Association in 1867 – was also integral to the development of what today is considered complementary and alternative medicine. Regular med- ical societies were central in the unseating of irregular practitioners from licensing boards and, consequently, from the ranks of licensed medical practitioners (Baer 2001; Porter 1999). Regular medicine gaining the upper hand in questions of licens- ing, gradually throughout the nineteenth century, gave rise to a state-supported ­system of distinguishing what was alternative and what was not. Licensing laws un- derscored the legitimacy of regular medicine and, simultaneously, relegated practices and practitioners not adhering to the regular medical principles to the margins (Baer 2001; Porter 1999; Saks 2003). The shifts in licensing laws were, at least in part, driven by a desire to eradi- cate medical competition. After all, the nineteenth century landscapes of health and healing were characterized by medical plurality (Baer 2001). This medical plurality was partially grounded on the methods used by regular medical practitioners. The “heroic medicine” practiced by many regular doctors entailed procedures such as bleeding, cupping, leeching and blistering, or the prescription of poisons to induce vomiting. Many of the irregular healing practices – that are today considered CAM – were popular during the nineteenth century because the methods utilized by licensed medics were harmful as well as expensive (Baer 2001; Porter 1999). The efforts of regular medical societies to eclipse irregular practice and to acquire control of the medical marketplace were, however, also supported by scientific development. Germ theory and improvements in fields such as surgery contributed to the rising success and standing of regular medicine, particularly from the latter half of the nineteenth century onwards (Porter 1999). The ascent of what would later be termed biomedicine was also entwined with economic interests. The focus on individual pathology improved the health of the workforce while, simultaneously, facilitating the ignoring of social and environmental causes, such as pollution or poverty, that also underlie ill health. By the 1930s, medical systems across the West that had been characterized by plurality had become dominated by biomedicine (Baer 2001). State and corporate support, and the growing importance of scientific thinking, enabled regular med- icine to gain the upper hand in defining medical knowledge. In contrast with the  Complementary and Alternative Medicine 519 abundance of practitioners addressing ill health historically, ours is a world marked by biomedical dominance. The power of biomedicine is central to the manner in which complementary and alternative medicines are defined, perceived, and prac- ticed. The consolidation of institutionalized biomedicine was accompanied by the exclusion of practitioners and practices that either competed with regular medicine or did not adhere to scientific ideas of pathology. Complementary and alternative medicines were, as such, created through processes of exclusion (Baer 2001; Cant and Sharma 1999; Porter 1999; Saks 2003). CAM Today The position of biomedicine as the primary provider of health care has, however, been eroded over the past decades. Particularly since the late 1960s, non-biomedical practices have become increasingly popular. Although usage figures vary depending on whether CAM use refers to consulting a CAM practitioner, or making use of over-the counter remedies, special diets, forms of exercise or prayer (Kristoffersen et al. 2018: 2), the complementary and alternative health field has grown consider- ably. The use of complementary and alternative medicines in the US has been placed at 38.3% of the population (Barnes et al. 2008: 14; Nahin et al. 2016). The most popular forms of CAM are thought to be used by as many as 68.9% of Australians (Xue et al. 2007: 644), while in Britain, 44% of the population is estimated to utilize a form of CAM at least once in their lifetime (Hunt et al. 2010: 1498). Increasing popularity has also fostered growing professionalization, the estab- lishment of professional bodies, as well as the entry of forms of CAM into bio- medical institutions (Givati 2015; Saks 2003). Despite some forms of CAM being available through biomedical care settings, consultations with CAM practitioners are frequently paid for privately. Considerable amounts of money are spent on complementary and alternative medicines. For example, in the US in 2012, the out-of-pocket spending on complementary health approaches was estimated at $30.2 billion (Nahin et al. 2016). The growing utilization of complementary and alternative medicines has also made questions of efficacy and safety important. Many biomedical practitioners, as well as policy makers, are calling for the further study of CAM, especially through randomized controlled trials (RCT). Government initiatives around complementary and alternative medicines, such as the House of Lords 6th Select Committee Report on Complementary and Alternative Medicine in the UK in 2000, and the White House Commission on Complementary and Alternative Medicine Policy in the US in 2002, also underscored questions of effi- cacy, regulation and safety. Entry into Mainstream Medicine While biomedicine has been and continues to be a broad and diverse institution (Berg and Mol 1998; Lawrence and Weisz 1998), biomedical institutions and societies have, historically, held a negative view of complementary and alternative medicines. Up until the 1990s, medical associations actively sought to prevent 520 Eeva Sointu doctors from working with complementary and alternative health practitioners or utilizing non-biomedical techniques (Porter 1999; Ruggie 2004; ­ Winnick 2005). Some CAM practices have, nevertheless, gradually entered biomedical set- tings (Wiese et al. 2010). By 2001, nearly half of general practitioners in England provided some access to complementary and alternative medicine, with 27% making referrals to CAM practitioners (Thomas et al. 2003: 575; Thomas et al. 2001b). More than half of office-based physicians in the US recommended complementary health approaches (CHAs) to their patients in 2012 (Stussman et al. 2020). Biomedical institutions and practitioners are not, however, unified in their views towards complementary and alternative medicines (Wardle et al. 2018). For example, general practitioners, internists, and psychiatrists have been found to recommend complementary health approaches and mind-body therapies more than other specialists (Stussman et al. 2020). Further, forms of CAM such as Tai Chi, Yoga, Healing Touch, or Reiki are often partially integrated into biomedical cancer care settings (Fitzsimmons et al. 2019), while close to half of nurses in Aus- tralia utilise CAM techniques or draw on CAM philosophies in their clinical prac- tice (Shorofi and Arbon 2010: 232). The continuing marginality of CAM practices within integrated settings is embodied in the division of therapeutic labour and authority. Whereas areas such as diagnosis and referrals belong under the pur- view of biomedicine, CAM practitioners tend to work on combatting chronic complains and pain (Hollenberg 2006: 738; Mizrachi et al. 2005: 32), or focus on alleviating the side effects of biomedical treatments and on improving wellbeing (Fitzsimmons et al. 2020). Aspects of CAM are, simultaneously, being drawn on and appropriated by bio- medical practitioners (Hollenberg 2006; Hollenberg and Muzzin 2010; Sharp et al. 2018). Many biomedical practitioners favour “the selective incorporation of CM [complementary medicine] and co-optation of CM practices rather than an integra- tive CM and biomedical practice” (Wiese et al. 2010: 339; Wiese and Oster 2010). CAM practitioners who enter biomedical settings often need to navigate a terrain that remains critical of non-biomedical ways of understanding health (Hollenberg and Muzzin 2010; Shuval et al. 2012). The drive towards the integration of CAM treatments within biomedical settings has often been met with criticism on the part of CAM providers. This criticism underscores not only the appropriation of CAM treatments but also the loss of self-determination on the part of CAM practitioners wishing to enter the biomedical mainstream (Parusnikova 2002; Sharp et al. 2018; Wiese and Oster 2010; Wiese et al. 2010). Who Uses CAM? The use of complementary and alternative health practices appears to follow certain demographic trends. Chronic ill health has been found to characterize many users (Hunt et al. 2010; Ruggie 2004). Women are also more likely to turn to CAM than men (Clarke et al. 2018; Hunt et al. 2010; Keshet and Simchai 2014; Ong et al. 2002; Ruggie 2004; Thomas et al. 2001a; Xue et al. 2007). CAM use is, ­furthermore, thought to be more common among people with higher than average income and  Complementary and Alternative Medicine 521 levels of education (Conboy et al. 2005; Hunt et al. 2010; Nahin et al. 2016; Ong et al. 2002; Ruggie 2004; Thomas and Coleman 2004; Xue et al. 2007). While in the past practices that might today be considered CAM offered the poor and the disen- franchised access to medical care, today those with lesser economic means may be “priced out of certain CAM options” (Wasserman 2014: 3). Despite there being connections between CAM use and at least some affluence, CAM techniques are utilized across social classes. Studies indicate that CAM use is higher among white people than other racial groups (Conboy et al. 2005: 980; Hunt et al. 2010) and that there are racial differences in the type of CAM used (Johnson et al. 2018). The use of certain complementary and alternative medicines, such as traditional Chinese Medicine, Ayurveda or Tibetan medicine, can also entwine with the ethnic and cultural roots and traditions of particular communities. Why Do People Turn to CAM? Dissatisfaction with Conventional Medicine The rise of complementary and alternative medicines is often seen to relate to a sense of dissatisfaction with conventional medicine (Astin 1998; Kelner 2003; Rug- gie 2004; Salamonsen and Ahlzén 2018; Sharma 1992; Siahpush 1999). A focus on managing chronic ill health that biomedicine has failed to alleviate constitutes an important factor pulling people to CAM (O’Connor 2003; Ruggie 2004; Thomas et al. 2001b). Complementary and alternative medicine use has also been considered as a critique of the Parsonian “sick role;” rather than passive recipients of doctors’ expertise, CAM clients are thought to desire agency in their health care and to claim a more proactive and responsible role in the treatment and prevention of ill health (Cartwright and Torr 2005; Gale 2011; Hughes 2004; Kelner 2003; Ruggie 2004; Stacey 1997; Wiles and Rosenberg 2001). A critique of conventional medicine among CAM users may encompass addi- tional meaning among non-white CAM users. Continuing racial discrimination within health care settings (Feagin and Bennefield 2014; Phelan and Link 2015; Shippee et al. 2012), may constitute a factor in Black Americans turning to practices outside conventional medicine, including forms of CAM. As Shippee et al. (2012: 1161) argue, “seeking CAM represents agentic action – an effort to reassert control over health care choices for Black persons who feel marginalized by discrimination in various settings.” The Appeal of Holism Holism – treating the mind, the body and, at times, the spirit – appeals to many CAM users. In part, through connecting the mind with the body, CAM practices offer “deeper-level explanations of health and illness, linking psychological and physical dimensions of health” (Cartwright and Torr 2005: 564). The holism of complementary and alternative medicines also sets CAM apart from biomedicine. While what Anne Harrington (2008) refers to as the “physicalist” approach in bio- medicine “denies the r­ elevance of the kinds of questions people so often ask when 522 Eeva Sointu they become ill: Why me? Why now? What next?” (Harrington 2008: 17), CAM practices tend to ascribe illness meaning. Forms of CAM allow for, and even encour- age, personal interpretation of ill health and resonate with the lived experience of illness (Cartwright and Torr 2005; Harrington 2008; Sointu 2012). Complementary and alternative medicines also often stress the uniqueness of each client. Tailoring treatments to the needs and individual characteristics of clients is, furthermore, often seen to underlie the therapeutic efficacy of CAM practices. As a CAM practitioner explains, “[y]ou’ve got to know what you are to be able to treat it” (Sylvia – a prac- titioner, cited in Sointu 2012: 48–9).Through their emphasis on individual experi- ences and characteristics of clients, CAM practices can provide a counterpoint to standardization underlying biomedical knowledge. CAM can challenge “the extreme depersonalization and bureaucratization of regular medicine” (Porter 1999: 689). As such, the rise of CAM practices captures the growing significance of patients’ own experiences, perceptions and self-assessed health needs, as well as a desire for mak- ing sense of illness beyond biomedical frameworks. Pragmatic Mixing and Matching Clients consult CAM practices for physical unease ranging from common colds to musculoskeletal problems, and from chronic pain to medically unexplained symp- toms. However, people also turn to CAM for help in dealing with non-medical chal- lenges and losses in life. Differing motivations of CAM use can, furthermore, exist simultaneously (Baarts and Pedersen 2009; Sointu 2006a, 2012). Importantly, com- plementary and alternative medicines are rarely used as substitutes for conventional care. Rather than rejecting biomedical care, many CAM users are “purposeful and pragmatic” in choosing non-biomedical practices (Connor 2004: 1703). CAM users are involved in eclectic mixing and matching of health care options (Cartwright and Torr 2005; Grace et al. 2018; Mcgregor and Peay 1996; Sirois and Gick 2002). Importantly, much CAM use is directed at health maintenance and more general well-being (Sointu 2006a, 2012; Stussman et al. 2015; Thomas and Coleman 2004; Wiles and Rosenberg 2001). Well-being While CAM practices can provide solutions to chronic medical problems, consti- tute forms of health maintenance, as well as offer “treats” for the mind and the body (Bishop et al. 2008; Thomas et al. 2001a), understanding CAM as primarily focused on the production of biomedical health ignores the complex cultural factors underlying the rise of the complementary health arena. The stories of clients and practitioners reveal a complex story about CAM use often aiming at a broad sense of well-being (Johnson et al. 2018; Sointu 2006a, 2006b, 2006c, 2012, 2013; Sointu and Woodhead 2008). Many CAM clients and practitioners are involved in search- ing for and providing well-being, not merely biomedical health. Understanding how clients and practitioners define well-being provides a means of accessing and analys- ing the social and cultural values that underlie the popularity and meaningfulness of diverse CAM practices.  Complementary and Alternative Medicine 523 The well-being offered through CAM practices is defined in different ways (Soin- tu 2006a, 2012). Rather than physiological health only, well-being denotes feelings of fulfilment and happiness, as well as a capacity of responding to and navigat- ing challenges in life. Well-being entwines with feelings like optimism, and a sense of control over one’s life. Well-being is also understood as harmony and balance that saturate lives marked by well-being. This kind of well-being transcends bio- medical understandings of health and is, as such, difficult to measure scientifically. The notion of well-being also reconfigures medical authority and locates defin- ing ill health more firmly in the hands of non-biomedical experts and lay people (Sointu 2012). The well-being that many users and practitioners aspire to is frequently thought to rest on self-awareness. Being true to oneself is also often understood as the key to well-being. As a CAM client explains, well-being emerges from “being true to yourself rather than truer to the pack” (Helen – a client, cited in Sointu 2012: 49). Well-being is, furthermore, available through “reconnect- ing where I’ve been disconnected” (Ivy – a client, cited in Sointu 2012: 48). As such, listening to “wisdom within” is often seen as what facilitates access to person-specific well-being (Sointu 2006a, 2012; Sointu and Woodhead 2008). Many CAM practices emphasize and encourage clients to develop deeper aware- ness of their experiences and feelings. As a practitioner explains, “self-knowl- edge, self-awareness is crucial” (Sylvia – a practitioner, cited in Sointu 2012: 58). Conceptualizing well-being as connected with self-awareness normalizes, and encourages, self-exploration and reflexivity. The valuing of self-exploration that is captured in ideas of well-being is not new. Listening to wisdom seen to lie within has, rather, been important throughout his- tory (Taylor 1989, 1991, 1994). Today, being true to one’s unique self is readily seen as “something we have to attain if we are to be true and full human beings” (Taylor 1994: 28). The ideal of inner depth resonates through everyday language; expres- sions like “be true to yourself,” “listen to your heart,” “do what is right for you” capture the normalization of inner depth and the valuing of individual authenticity. Considering the appeal and popularity of CAM as connected not with biomedical health but, rather, with values such as inner depth and self-exploration, it is possible to start to see further commonalities uniting the diverse array of CAM practices. The importance of self-reflection in many CAM practices captures the hold of the ideal of inner depth over selfhood today. The Neoliberal Ethos and CAM Defining well-being as not only happiness but also agency and control embodies and reproduces important social values including individual uniqueness, self- fulfilment and self-responsibility. Through the focus on self-awareness, CAM practices also readily capture reflexivity characterizing selfhood in late moder- nity (Giddens 1991). The ideal of wellbeing also entwines with values such as self-responsibility and agency that are increasingly important in the context of “neoliberal reason” today (Brown 2015). The valuing of “the self-regulating, self- surveillant and autonomous self” (Peacock et al. 2014: 175) that characterizes neoliberal thinking saturates also the CAM domain and, more specifically, the 524 Eeva Sointu manner in which well-being is tied with self-responsibility and self-exploration. Simultaneously, the “narrative of responsibility” individualizes ill health and hides the social and economic causes underlying illness (Horrocks and Johnson 2014: 178; Peacock et al. 2014). The rise of complementary and alternative medicines also echoes the importance of consumer choice imbuing social and economic landscapes today. CAM practices allow, even invite, the shopping around for suitable treatments. As such, they fit neatly into the broader consumerist frame of Western modernity (Cartwright and Torr 2005). At the same time, CAM practices are often seen as less commercial than biomedicine and even understood as free from the profit motive driving “Big Pharma” (Attwell et al. 2018). Simultaneously, a sense of self-responsibility in the management of disease and in health behavior more generally, characterizes many users (Baarts and Pedersen 2009). Being self-directed and knowledgeable about treatments and the workings of medical bureaucracies now define the manner in which many patients engage with medical settings, including complementary and alternative medicines (Shim 2010). The empowered client who chooses to turn to CAM rather than to adhere to a more traditional biomedical patient role emerges in relation to broader neoliberal trends emphasizing self-responsibility and individual fulfillment. In a consumer soci- ety, a perpetual search for well-being is normalized and this further encourages the turn to practices like complementary and alternative medicines. The emphasis on consumer choice and personal responsibility, the availability of medical information, and the general medicalization of life (Conrad 2005) all contribute to the conditions that enable complementary and alternative medicines to flourish. Ideas of personal responsibility that resonate through the complementary and alternative health arena are also congruent with health policy developments that underscore individual responsibility for health and illness. CAM and Class At the same time as the notion of well-being captures and reproduces broad social values, the ideal of wellbeing also embodies possibilities and dispositions that are classed. Research shows that CAM use is more common among the more educated and affluent (Conboy et al. 2005; Hunt et al. 2010; Nahin et al. 2016; Ong et al. 2002; Ruggie 2004; Thomas and Coleman 2004; Xue et al. 2007). The dominance of the middle classes within the CAM arena connects with the cost associated with CAM treatments. Actively managing ill health through CAM can also be consid- ered a form of “cultural health capital” (Shim 2010) that is more readily available to the more privileged. There is also an alignment between values, such as reflex- ivity and self-exploration, emphasised in many CAM practices and more middle class dispositions. As Illouz (2008: 150) argues, “middle-class emotional culture… has been ­characterized by an intense introspectiveness and reflexivity.” Introspection and reflexivity are central also to the kind of wellbeing that many clients seek and that many practitioners offer (Sointu 2006a, 2012; Sointu and Woodhead 2008). Working on the self, however, requires resources, including time and money, that are more available to the more affluent (Skeggs 2004; Skeggs and Loveday 2012).  Complementary and Alternative Medicine 525 Gender and CAM While men and women both use and practice forms of CAM, the field is domi- nated by women (Clarke et al. 2018; Hunt et al. 2010; Keshet and Simchai 2014; Kristoffersen et al. 2014; Ong et al. 2002; Ruggie 2004; Taylor 2010; Thomas et al. 2001a; Xue et al. 2007). The prevalence of women users and practitioners can be seen to capture gendered patterns in health care utilization more generally. Women are, for example, thought to visit conventional doctors more and to engage in health- ier behaviours (Cockerham 2005; Courtenay 2000). Many complementary and alternative health practices also offer and emphasize values such as care, acceptance and empathy that have, traditionally in the West, been associated with femininity (Hochschild 2003; Keshet and Simchai 2014; Lupton 2012; Sointu 2012; Widding Isaksen 2002). As Stacey explains: “the cultures of alternative health are based upon philosophies more traditionally associated with the cultural competences of femi- ninity: communication, caring, gentleness and natural remedies” (Stacey 1997: 216). Femininity has, in the West, also long been associated with informal, familial care (Courtenay 2000; O’Grady 2005; Young 1990). The feminization of the CAM arena also pertains to historical developments around access to medical training and practice, and rests on the manner in which practices that are now considered CAM offered a route to medical practice to female medical practitioners. While women were generally excluded from regular medicine and med- ical education through the nineteenth century, irregular practices were more open to female practitioners (Baer 2001; Heggie 2015). For example, throughout the nineteenth century in the US, New York’s homeopathic Women’s Medical College, the American Hydropathic Institute, and Woman’s Medical College in Philadelphia offered hundreds of women training in irregular healing practices (Baer 2001; Bix 2004). Women, as well as the feminine qualities of intuition and empathy, were valued in many of the healing movements, such as the mind-cure movement, Spiritualism, and Christian Science that emerged in the late nineenth and early twentieth centuries (Baer 2001; Harrington 2008; McGuire 2008). This openness to female practitioners, and the valuing of qualities associated with femininity, contribute to the feminization of the CAM arena that continues today. However, cultural associations between CAM prac- tices and femininity extend also to the ways in which CAM is understood as not only “irrational” but also as a form of “pampering;” qualities and behaviors that remain more readily connected with femininity. The feminization of the CAM field is impor- tant for understanding the experiences of people navigating this diverse field. Good Practitioner The entwining of CAM with traditional ideas of femininity can be detected also in the manner in which CAM practitioners and users conceptualize a good practitioner. For example, a client describes a good practitioner as someone who “is genuinely and utterly there, giving you complete and utter undivided attention” (Ivy – a client, cited in Sointu 2012: 74). A good practitioner “genuinely gives me the impression that she cares” (Dave – a client cited in Sointu 2012: 74). According to another client, a good practitioner is “non-judgmental and I think with non-judgmental, accept- ing” (Angela – a client, cited in Sointu 2012: 74). The gentleness and care of good 526 Eeva Sointu CAM practitioners affirm the experiences of clients and can, furthermore, remedy the silencing and powerlessness experienced especially by female clients in encoun- ters with conventional medicine but also in patriarchal societies more broadly. Care and acceptance feature in the manner in which many CAM practitioners also understand their work. A practitioner, for example, aims to create “a holding environ- ment” which enables “people to find themselves, and to, you know, gain insight and awareness” (Frances – a practitioner, cited in Sointu 2012: 76) as an important part of their work. Another practitioner describes her role also in terms of facilitating aware- ness and empowerment: “I like to encourage people to, I suppose, find their own life and their own power, really” (June – a practitioner). The therapeutic work in many CAM practices centers on reflection and meaning-making, with good practitioners supporting clients uncovering, expressing and analyzing their experiences. The kind of care offered by good practitioners is accepting and compassionate. At the same time, a good practitioner must remain “very grounded themselves” and even “emotionally removed from it, from the operation” (Jan, a practitioner, cited in Sointu 2012: 74). The authenticity and empowerment that characterize the wellbeing that many clients seek shapes also how good practitioners are conceptualized. While a good practitioner “has a sort of, caring, loving approach” this care “isn’t overwhelming or threatening in any way” (Bella – a client, cited in Sointu 2012: 75). Good practitioners often offer guidance rather than definitive answers. In the CAM sphere, the ultimate authority to decide on treatments and explanations is more firmly located in the hands of the client. Accordingly, good CAM practitioners are valued for utilizing “affiliative speech” that involves “showing support, expressing agreement, and acknowledging the other’s con- tributions” (Leaper and Ayres 2007: 329). At the same time, many CAM practitioners and clients avoid “assertive speech” that entails disagreement and “directive state- ments” (Leaper and Ayres 2007: 329) that are more readily associated with biomedical expertise and a more traditional patient role (Sointu 2012). Even while ideas of the good CAM practitioner connect with more traditional ideas of caring femininity, CAM practices encompass potential for challenging traditional ascriptions of femininity, especially on the part of clients (Stacey 1997; Sointu 2011, 2012; Sointu and Woodhead 2008). This is because many CAM practices encourage focusing on one’s own wellbeing, rather than the wellbeing of others. While traditional ideas of femininity connect femininity with care for others (O’Grady 2005; Young 1990, many CAM practices emphasise care for the self (Sointu 2011, 2012; Sointu and Woodhead 2008). It is, as such, possible to see the CAM domain as a setting for women navigating “increasingly conflictual female roles” (McNay 1999: 110–1). The impor- tance placed on the self, and on individual lives, contrasts ‘the conventional expectation of “being there for others” that is associated with femininity’ (Adkins 2002: 45). Sociological Reflections on the Healing Produced through CAM Despite ongoing work to establish an evidence base for forms of complementary and alternative medicine, CAM practices rarely enjoy scientific legitimacy and the standing accorded to biomedical practices (Baarts and Pedersen 2010; Barry 2006; Paterson et al. 2009). Notwithstanding the lack of scientific legitimacy, people  Complementary and Alternative Medicine 527 continue turning to CAM and, what is more, find help for their concerns. As such, even without being scientifically efficacious, CAM treatments can make people feel better. Some of the therapeutic effect of CAM may relate to physiological efficacy that is yet be scientifically established. Experiences of healing may also emerge through the placebo response that can underlie the therapeutic effect of CAM prac- tices and biomedicine alike. While often understood in negative terms – as a sham or a sugar pill influencing susceptible patients, or as the inert control against which real pharmacological compounds are measured in clinical research (Bishop et al. 2012) – it is becoming evident that placebos can play a potent, albeit poorly understood, role in all experiences of healing (Harrington 2008; Kaptchuck 2002; Thompson et al. 2009). Improvement experienced through CAM use can include enhanced mobility, feel- ings of optimism and coping, and a lowered sense of anxiety (Cartwright 2007; Kelner and Wellman 1997; Sointu 2006a, 2006b, 2012; Wiles and Rosenberg 2001). CAM is thought to afford those utilizing these practices a stronger sense of control over health and health care than what may be available via conventional medicine alone (Baarts and Pedersen 2009; Cartwright and Torr 2005; Fitzsimmons et al. 2019; Johnson et al. 2019; Mcgregor and Peay 1996; Wiles and Rosenberg 2001). At the same time, CAM practitioners provide personalized services that are aligned with the individual needs of clients, and facilitate the development of personal illness narratives that transcend the “physicalist” orientation of biomedicine (Harrington 2008) and that accommodate the emotional aspects of illness experience (Cartwright and Torr 2005; Sointu 2006a, 2006b, 2012). Healing Bodies, Feeing Bodies While the body has, historically in the West, been understood as not only a hindrance to the operation of the mind, but also as something sinful (Grosz 1994), the body is important and positively regarded in many CAM practices (Baarts and Pedersen 2009; Gale 2011; O’Connor 2003; Sointu 2006c, 2012, 2013). The focus on the body in CAM is important for a number of reasons. First, while “our relationship to our bodies, in the normal course of events, remains largely unproblematic and taken- for-granted” (Williams and Bendelow 1998: 159), CAM can give rise to “bodily awareness” that is valued by clients (Baarts and Pedersen 2009). The awareness of the body that CAM can generate is poised to disrupt the ordinary invisibility of the body (Baarts and Pedersen 2009). Through CAM practices that focus on the body, tacit embodied experience can become a more explicit, and enduring, part of life (Baarts and Pedersen 2009: 274). The body that CAM practitioners work on is often seen as holistically connected with the mind and, at times, the spirit. As a CAM client explains, “my body, I see it very much as reflection, or intertwined with my attitudes – they’re not separate” (Kate – a client, cited in Sointu 2012: 154–4). The idea of holistic connectedness facilitates working on emotions through the body. As a practitioner puts it, “the body is a very powerful medium to reach a person, or to promote healing” (Beth – a practitioner, cited in Sointu 2012: 155). CAM practices often call on clients to recog- nize and attend to their bodies. As such, the holistic body tends to be conceptualized as possessing a voice as well as feelings. 528 Eeva Sointu At the same time, the care involved in forms of bodywork tends to be trivialized (Gimlin 2007; Twigg 2000; Twigg et al. 2011). What is more, “bodywork also bor- ders on the more ambivalent territory of sexuality” (Twigg 2000: 390). Practitioners and clients need to navigate meaning ascribed to bodies and touch within cultural contexts where “sex is symbolically fused with the body” (Oerton 2004; Oerton and Phoenix 2001: 406). As such, tacit maintenance of bodily boundaries is impor- tant in many forms of CAM that focus on the body. The blending of bodies and touch with sex (Oerton and Phoenix 2001) accentuates the importance of trust in CAM practitioners (Twigg 2000). Furthermore, according to Oerton and Phoenix (2001), the idea of holism itself offers a means of navigating complex associations between bodies and sexuality. Understanding the body as holistically connected with the mind and the spirit, locates the body treated in CAM practices outside sexual intimacy (Oerton and Phoenix 2001: 401). The holism of CAM practices, often considers bodies as “containers” for feeling. As a practitioner explains, “when you have unresolved emotional issues, which you don’t deal with, you know, you suppress, they become – they don’t disappear. They are in your body” (Anne – a practitioner, cited in Sointu 2010: 160). Bodywork makes it possible to “release some of the trauma” (Kim – a client) captured in the body. The idea of the body as a container for feeling is not new. The “body that speaks” constitutes a cultural motif rooted in Christian ideas of the healing poten- tial of the confession (Harrington 2008: 68–9). The “body that speaks” is embodied also in Freudian psychoanalysis and the idea of the unconscious making past trauma present through physical ailments (Harrington 2008: 93–4). Today, “the body that speaks” is especially visible in the CAM domain where healing is often seen to entail bringing the trauma contained in the body to the surface (Harrington 2008). The holism of many CAM practices, thus, implicitly ties healing with the willingness and the capacity to express and analyze feelings captured in the body. As such, the holism of CAM practices entwines with ideals of reflexivity and self-responsibility. Despite the positive emphasis on the body, this holism often subtly reproduces the primacy of the self-reflexive mind over the body (Sointu 2012). The idea of the holistic body can, however, also generate experiences of authorship. Holism that links the mind with the body can ascribe ailment meaning outside biomedical interpretations as well as biomedical expertise. The holism of CAM practices can, as such, facilitate experiences of both ownership and control. The holistic body in the CAM field is, simultaneously, deeply individualistic. CAM and Recognition Focusing on the relational dynamics within therapeutic encounters offers another means of making sense of some of the positive experiences of CAM users. As social beings whose lives are made meaningful through responses from others (Benjamin 1988, 1990; Sayer 2011), how others relate to us, and to our concerns and ailments, matters. Affirmation given by CAM practitioners can enable self-expression which, in turn, can grant a client a voice as well as authority in defining illness. Within the biomedical context, illness tends to be understood as “an intra-cor- poral lesion or abnormality” (Armstrong 2011: 802) that is “located within the anatomical frame” (Nettleton 2006: 1168). Further, it is primarily the biomedical  Complementary and Alternative Medicine 529 expert, rather than a patient, who possesses the specialist knowledge to define and treat illness. CAM practices, however, allow for and even call for reflexively mak- ing sense of one’s experiences and ailments. CAM can, as such, be experienced very differently compared with conventional medicine. As a client explains: “I’d been to the doctor. I didn’t feel I was getting anywhere… it felt um, that like somehow you had to prove something more for doctor whereas the homeopath was more likely to take what you were saying seriously” (Sue – a client, cited in Sointu 2012: 107). The “physicalist” way of conceptualizing disease tends not to allow for the personal meaning-making that can be important to the ill (Harrington 2008). A lack of alignment between biomedical diagnosis and the illness experience can, furthermore, challenge patients over “the validity of their own experiences” (McGuire 1996: 108). As another CAM client explains: “I used to come away ques- tioning my own mental health if ever I went to see a doctor because of the way they received me” (Ivy – a client, cited in Sointu 2012: 109). CAM practitioners and consultations can be experienced differently to biomedicine. According to a CAM client, “when I’m with [the practitioner]… something inside me feels touched by that warmth, love, care. And it makes me feel valued in a way, somehow kind of affirms me as a person” (Kim – a client, cited in Sointu 2012: 100). Clients see good CAM practitioners as not only non-judgmental, but also skilled in hearing and addressing the individual concerns that clients bring to them (Sointu 2006a, 2012). As such, in addition to, for example, musculoskeletal manipulation or non-biomedical remedies, good CAM practitioners offer recognition. Theories of recognition posit that “the establishment of one’s self-understanding (one’s idea of ‘self’ or ‘subjective self-certainty’) is inextricably dependent on recogni- tion or affirmation on the part of the others” (Yar 2001: 59). Recognition, as Jessica Benjamin (1988: 12) explains, constitutes “that response from the other which makes meaningful the feelings, intensions, and actions of the self.” Not only do experiences of recognition underlie the development of subjectivity and agency, experiences of rec- ognition connect with feelings of esteem and worth (Honneth 2001; M ­ cQueen 2015). CAM practitioners who listen to and affirm their clients can – beyond any positive physiological effect that a practice may generate – give their clients experiences of recognition that, in turn validate what the client is experiencing. The recognition that CAM practitioners give clients rests on the importance that the CAM arena ascribes to self-awareness and self-expression. Experiences of recognition, and the positive effect of being recognized, are made possible through the emphasis placed on the views and the voice of the client. The social values around selfhood – the emphasis on the expe- riences and interpretations of the client – that saturate the CAM domain can thus also be seen as meaningful in the production of experiences of healing. Concluding Thoughts: CAM as Culturally Resonant, Even while Institutionally Marginal In order to understand the popularity and even the effect of forms of CAM, it is necessary to look beyond biomedical health. Cultural rather than solely medi- cal factors underlie the rise, but also the appeal of many CAM practices. Social and cultural ideals pertaining to normal and desirable selfhood – ideals such as 530 Eeva Sointu individualism, self-responsibility and self-fulfillment – echo through much of the complementary and alternative health sphere making CAM practices acceptable and appealing to today’s health consumers. 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