An editorial by Daniel Redwood, DC ~ Our thanks to Health Insights Today
Through the 1970s and 1980s, those of us seeking to advance alternatives to conventional medicine that would be far less reliant on drugs and surgery, far more friendly to hands-on forms of healing and the use of natural substances, and cognizant that illness and pain usually have more than one cause and potential cure, identified ourselves as proponents of holism, holistic health care or holistic medicine. The words were chosen to convey the importance of seeing ourselves and our patients as whole persons—body, mind and spirit.
But phrases fall out of fashion. By the early 1990s, holistic had become alternative, then complementary and alternative (CAM), and finally (for now) integrative. We all understand that the map is not the territory, but changes in language signal changes in outlook and emphasis. Subtly and gradually, we have lost something in the process. When we raise the banner of holism, we assert the value of a whole systems paradigm. Endorsing alternative, complementary, or integrative medicine lacks this engaged focus on principles and thus affirms far less.
Personally, I have a positive response to each of these terms. At one time or another, I’ve identified myself and my profession with all of them. But none of the others has the deep resonance of holism, which best conveys the essence of who we are and the beliefs we hold dear.
Holism and Chiropractic
How can chiropractors best embody the tenets of holism? A key first step, ably articulated in this issue by Cleveland Chiropractic College–Los Angeles Director of Research James Brantingham, DC, PhD, is to be vigilant in reminding ourselves that the physical body functions as an integrated whole. Each part of that structure affects every other part, directly or indirectly. Thus, while maintaining and deepening chiropractic’s traditional focus on the structure, function, balance, and mobility of the spine, we must never view it in isolation.
To give just one example, the weight-bearing structures of the lower extremity, particularly the foot and ankle, form the foundation for all that rests upon them, including the spine. Research by Dr. Brantingham’s team at CCCLA is expanding our understanding of the critical role of the extremities in maintaining the body’s structural integrity. What he calls “full kinetic chain adjusting” incorporates a holistic view of the body’s overall musculoskeletal structure.
Structure and Beyond
Building such structural holism into the core of our health worldview is necessary but not sufficient. A comprehensive holism must also account for the widespread functional interactions between musculoskeletal structures and visceral organs via the nervous system and other pathways, as well as the connections between all of these physical structures and our mental, emotional, social and spiritual aspects.
This should come as no surprise to contemporary chiropractors. From D.D. Palmer’s late 19th century recognition of the multi-factorial causation of illness in his pithy “3 Ts” model—trauma, toxins and thoughts—through a variety of iterations culminating in the World Federation of Chiropractic’s 21st century endorsement of the biopsychosocial model of health and illness, chiropractors have always endorsed holism in theory.
From Theory to Practice
But endorsing something in theory does not guarantee its implementation in practice. Consider your own practice and those of other chiropractors you have observed over the years. Think about the treatments given and the content of the doctor-patient conversations. Does our targeted focus on the motion or alignment of spinal joints and other musculoskeletal structures sometimes lead us to lose sight of other key components of health, particularly nonphysical components?
In other words, are we holistic in our words but reductionist in our actions? Honest introspection is needed and we should not expect this self-examination to lead to an all-or-nothing answer. All of us are mixtures. But where do we stand, as individual practitioners or students, on the spectrum of holism and reductionism? Are our actions consistent with our professed beliefs? Inquiring minds want to know.
Can Specialists Practice Holism?
Professions (including chiropractic) that require us to study large quantities of scientific information and then apply a finely-honed focus to specialized physical treatment methods, pose challenges to developing a holistic practice. To frame the key question precisely: Is it possible to be an accomplished specialist (e.g., in neuromusculoskeletal diagnosis and manual adjustment/manipulation) while also maintaining a holistic worldview and applying it consistently in interactions with patients?
Chiropractors are by no means alone in confronting this issue, but our current position at the intersection of conventional and CAM healthcare puts boldface type on the question. Like all challenges that arise from a clash of opposites at a time of changing paradigms, grappling with this question presents us a choice between reaching for a higher synthesis and retreating into old familiar patterns.
What would a higher synthesis look like? Conceptually, it would include: (1) high-level expertise in our hands-on, physically-focused, musculoskeletally-oriented specialty; (2) awareness that musculoskeletal patterns and symptoms comprise part, not all, of a patient’s physical health status; (3) recognition that nonphysical factors play a key role in the causation of illness and that mind-body interactions are present in all of us at all times; and (4) emphasis on prevention and health promotion throughout the course of treatment, with lifestyle changes monitored by the practitioner.
The Value and Limits of Specialization
In our quest for holism, we must acknowledge at the outset that we cannot be all things to all people. Cramming more and more jewels onto a crown does not enhance its beauty. Instead, choosing a smaller number with care, and attention to the ways they complement one another, is the mark of the artist. We would do well to see ourselves as healing artists with a vision steeped in holism.
It is no sign of failure for us, as individuals or as a profession, to admit that no one can attain specialist-level expertise in many areas simultaneously. All chiropractors are trained to specialist-level knowledge in neuromusculoskeletal diagnosis and manual adjusting methods, and some also attain wide-ranging expertise through postgraduate training in radiology, sports medicine, acupuncture, rehabilitation and other areas. Whichever areas of specialization we do or do not pursue, we need to also nurture within ourselves a generalist’s holistic perspective that incorporates awareness of a broad range of healthcare approaches, both inside and outside the chiropractic scope of practice. Then we need to share it with our patients whenever it is relevant to their healing.
We chiropractors have a responsibility to educate ourselves about other healing methods and traditions—both conventional and alternative—in order to deepen our understanding of other health practices and paradigms, to know when to refer patients to practitioners of these healing arts, and in some cases to incorporate into our own practices aspects of this knowledge compatible with our role as chiropractors. Calling on other qualified practitioners for assistance is sometimes precisely what the best interest of the patient requires. Developing a network of practitioners in your community, who bring a variety of skills to the table, is essential.
Every one of us can choose to think and practice more holistically. Let us all view health in wide-ranging terms that include but are not limited to the physical and the visible, apply our specialized skills to the best of our ability, and seek out collaborative relationships with others who share our desire to help our patients achieve optimum health.
Daniel Redwood, DC, is Associate Professor at Cleveland Chiropractic College–Kansas City and Editor-in-Chief of Health Insights Today and The Daily HIT.