Editor’s note: This article was first published in the magazine Complementary Therapies in Nursing & Midwifery Volume 6 Number 1 February 2000

Healing as a primary function of life touches all aspects of an individual as well as of the collective, be that a community or our society as a whole. Living for the last 11 years in an intentional community, the Findhorn Community in north-east Scotland, the author has the privilege to explore the relevance of healthcare for individuals and as a community service. Healthcare is much more than medical care. Mostly it is a basic aspect of daily life and relies on self-responsibility, self-care and appropriate resources/opportunities. Should medical care become necessary a wide choice of treatment approaches offered to the patient facilitates patient empowerment and involvement. The author, therefore, advocates the integration of orthodox and complementary medicine. © 2000 Harcourt Publishers Ltd

THE FINDHORN COMMUNITY

In 1962 three adults and three children moved to a caravan park on the Moray Firth in north-east Scotland. They did not intend to start a community, but were brought together as part of their individual commitment to follow God’s will. At first they developed an organic garden in cooperation with nature spirits/devas. The results of this drew worldwide attention and the truth behind the often quoted ‘40 lb cabbages’ is still one of the most intriguing questions for many visitors. As more people came to learn about the gardens and the principles behind them the community slowly grew. In the last three decades an intentional community has evolved where a diversity of people show by example a new way of living in the world: in alignment with spiritual principles, in cooperation with each other and in service to the earth. Now approximately 450 people live in and around Findhorn with thousands of friends and supporters throughout the world.

One of the founders, Eileen Caddy, still lives within the community and has recently drawn up a model for the community which puts healing at the very centre. Healing within individuals, healing of relationships (between people, groups and nations), and healing of our wounded earth are the prerequisites for the survival of humanity. Healing creates unity, trust, love and acceptance which allow the expression of a higher beneficial power (this can be called God, Christ energy or Spirit) to become tangible.

INTEGRATED HEALTHCARE

Fig2 A model for the Findhorn Community by Eileen Caddy

When I came to the Findhorn Community in 1988 I had just reached the stage in my career where I could have accepted a partnership in a general practice in Germany. However, I decided to move to Scotland to experience something I hadn’t found in my searches so far, an environment where the spiritual aspects of life were openly integrated. I enjoyed the unfragmented lifestyle where I could live and work with people in a close-knit community. In this environment the different aspects of my personal potential were called for and encouraged to unfold. I deeply appreciated the prospects of working and living in an environment of a ‘social experiment’ in line with my values of a humane and caring society where these values would find practical applications in many aspects of life.

I always had an interest in alternative approaches to medicine. But I felt that I wasn’t able to do the different disciplines, like homeopathy or acupuncture, justice if I had them just as an addendum to my orthodox medical training. At Findhorn many different practitioners from a wide variety of disciplines crossed my path and taught me much about the complexity and diversity in complementary medicine. The spirit of cooperation which is engendered in the culture of the community also influenced my own work with healthcare in the community and in my medical practice. I began to formulate ideas for a cooperative healthcare which integrates the many choices available to patients in a way that empowers the individual to take an active part in their own healthcare. In experimenting in such cooperation I found the joy of cross-professional fertilization and the tremendous enrichment and support that gave me for my own practice.

Over the years I hosted several conferences under the theme of ‘Medical Marriage – The New Partnership Between Orthodox and Complementary Medicine’. With the attending colleagues we developed a model for integrated healthcare that gives comprehensive practical suggestions for multi-professional cooperation.

We found ourselves in very good company with our ideas. It was no longer only patients who clearly chose to use complementary medicine in their care (Eisenberg 1993), but also an increasing number of professional groups and committees discussed the wider applications of healthcare and the integration of complementary disciplines (Foundation for Integrated Medicine 1997, BMA 1993).

In this model of healthcare the person is a ‘patient’ in a hopefully temporary role. All the aspects of their life which contribute to their wellbeing and quality of life are validated for their healing potential. It is an integral part of the role of the healthcare professional to facilitate the ‘patient’ to move out of a disempowering dependency on experts to ‘fix’ their lives. They can only do this if they always realize that they are working with a person who is capable (to some degree or other) to live their own life as they choose. This serves the health and wellness of the individual as it gives them the right to be an active and responsible partner as they chose the elements of their own care. This self-empowerment is an essential element in healing as it restores the sense of integrity and self-directedness which is often destroyed through the experience of ill-health.

The integration of complementary therapies into healthcare not only offers ‘patients’ the choice of care, it also exposes healthcare professionals to a paradigm which differs dramatically from that of orthodox medicine.

The following statements are presented to highlight the difference and are more a caricature rather than the ’truth’. Orthodox medicine is set out to attend to worst-case-scenarios. Therefore, it is most suitable for accidents, acute life-threatening crisis and for diagnosis. The latter becomes necessary when health deteriorates and any sinister causes for this situation have to be either found or excluded. The worst-case- scenario mind-set results in heroic interventions (which have saved many a life) and in therapeutic or preventative actions which may per se be harmful (chemotherapy, vaccinations, prophylactic drug treatment).

The paradigm behind complementary therapies addresses the person in their totality and can focus more on their health (what works well in their lives) or their healing capacity rather than on the presenting symptoms. Complementary therapies can be used for a treat, for stress management, or for improved life quality in a chronic debilitating illness. A practitioner working with that framework may well not have the technology to cure but in most cases they can significantly contribute to an increased sense of wellbeing.

Working in cooperation between the two paradigms offers much benefit to all involved. The patients are offered the choice which many of them obviously want (Eisenberg 1993). The doctors and other orthodox professions can learn to see the person who is suffering from a disease rather than the disease, the infamous ‘ulcer in room 5′. The increased focus on health and patient involvement in care relieves the professional of the often crushing responsibility for others’ lives. For complementary therapists the cooperation brings validation for their work. They can find themselves attending to patients in the context of the concerted effort of a team whom they otherwise would not have seen.

Health centred care is dependent on many factors and most of them are out with the sphere of direct influence of the healthcare professional. However, it is good for the health carer to bear those aspects in mind and use their influence with the patient to improve their quality of life through validation of the patient’s efforts, through support and education as well as encouragement for self-empowerment.

Health is more than health care and is not just about medicine. Health also depends on other social and economic factors such as social deprivation, social justice, housing, education and nutrition.

Health Care is more than the care of individual patients; doctors have a responsibility to the community. The continuing spectrum between health and illness requires the skills of all doctors from acute specialists through general practitioners to public health doctors. Medicine is a public service and doctors should provide a service in partnership with society….Doctors
are agents of social change (BMA. GMC 1994).

Of course this statement does not only apply to doctors but to all healthcare professionals.

MULTIDISCIPLINARY COOPERATION

Fig3 The model of integrated healthcare

The integration of complementary therapies and the cooperation with practitioners of those disciplines is not only relevant for medical care as represented by the smaller circle in the diagram (Fig. 3). Besides medical care health-centred care includes health enhancement, health maintenance, and disease prevention. Many aspects of the latter three are well provided for by complementary therapies.

Cross-professional cooperation is not easy. The different professions have often very different paradigms, languages and cultures. However, the effort is well worth it to find ways to facilitate cooperation and provide concerted action for patient care. The Medical Marriage model suggests that professional healthcare is provided by a team of healthcare professionals in basically two functions:

The gatekeeper/care coordinator

In this role a medically trained professional (probably a new type of GP) with a broad background in orthodox and complementary medicine acts as an advisor to the patient on what is available. They provide information and support for the patient to make their choices in their care. They also receive reports (in form of letters as well as through case conferences) from all specialists involved in the patient’s care. The patient reviews with them their care at regular intervals to assess that the appropriate therapies are applied.

In times of good health the GP would offer an annual review of the present state of health on all different levels, to confirm what works well and to introduce new goals of health enhancement. A possible format for such a ‘health overhaul’ is for the patient to fill in an extensive questionnaire covering all medical information, family history, social background, lifestyle, and the functioning of their different physical organs or systems. Before any future overhaul they will reflect on any changes which have occurred, and use a shorter questionnaire to assess their present situation. In the consultation, apart from the physical examination and some laboratory tests, the GP and patient will reflect together on the following areas: diet; exercise; emotional, social, spiritual and work life; and creativity, as well as family and intimate relationships. Future goals are discussed and concrete, manageable steps towards achieving them agreed. They may include:

• Taking up a hobby which provides physical activity and social interaction
• Attending a yoga class
• Learning a new style of cooking
•  Expanding the range of healthy options when shopping for food
•  Entering an evening class for intellectual stimulation or expanding career options
•  Having regular bodywork sessions to deal with stress-related physical tensions
• Exploring new ways of expressing creativity
• Engaging in counselling to release old patterns of limiting interaction and improve communication skills with partners or children.

The GP would offer to provide support, monitoring and ongoing encouragement to implement these changes. This coaching is a crucial element for a successful programme for change and development.

Specialist practitioners

This role is filled by many different healthcare professionals: orthodox doctor specialists, such as gynaecologist, ophthalmologist, or orthopaedic surgeon and medical and non-medical practitioners of complementary disciplines. The specialists would provide the diagnostics and therapeutic interventions of their discipline reporting back to the care coordinator in regular intervals and possibly participate in multidisciplinary case conferences if more than one treatment modality is being used in the patient’s care.

In this group would be the many other medical and paramedical professions which use their own unique know-how for the care of patients. Nurses have always had a central role in care, be that in a hospital setting or in the community. Their particular perspective can not be valued enough and is already often included in multi-disciplinary case conferences when they occur. An increasing number of nurses expand the traditional nursing skills and knowledge with training in complementary therapies. Thus, they create a powerful synthesis between the two paradigms in daily practice and can often be a catalyst for cross-professional cooperation.

INTEGRATING COMPLEMENTARY THERAPIES

Massage therapy session in ‘Meridian’

The number of complementary disciplines available to patients today could be over 100 as the offers in the complementary field are very varied and range from the well known and acceptable therapies (aromatherapy, reflexology, homoeopathy, osteopathy/chiropractic) to new developed modalities or far-out practices which stretch the imagination. There are of course many questions of regulation, safety and efficiency to be asked, as well as the discussion to be had about what could be provided within the National Health Service and what has to be paid for privately. The latter also raises the issue of integrating NHS and private care with all the ethical and social justice considerations which ensue.

In principle. I feel that it has to be the patient’s choice as to what they want to include in their care. As long as there is an open communication and willingness to cooperate within the larger context of care, not denying the patient any other choices of treatment, any approach should be welcomed if the patient so wishes. This may not be a scientific approach but it is pragmatic and respectful of the patient. I have known of cases of terminal cancer where a patient has improved dramatically when drinking a certain herbal tea, or going to a psychic surgeon who ‘removed’ some tissue from their abdomen with their bare hands. Whilst this challenges my rational mind and is beyond my ability to comprehend, who am I to deny a patient’s experience? And in any case, restricting the options only will mean that at one point the patient may see such a practitioner and opt for non-coordinated care which in my eyes is a health hazard. Fragmented care where no-one holds the overview as to what is happening in a patient’s care may in some cases lead to physical harm but in most cases it certainly leads to psychological stress, feelings ol isolation, lack of support and insecurity.

SUMMARY

Healthcare is much more than medical care. An individual is much more than a ’patient’ suffering from a disease. By focusing on health the interaction between healthcare professional and patient can significantly contribute to affirmation, support, education, and self-empowerment. These are in themselves crucial aspects of healing.

The offer of a wide range of different therapies (both orthodox and complementary) provides the patient with choice and involvement. It gives the healthcare professional options in care beyond the limitations of their own discipline.

Cooperation between a wide range of health-care professions facilitates integrated healthcare. Thus, unfragmented care and concerted action in patient care can be achieved.

REFERENCES
Eisenberg D M et al. 1993 Unconventional medicine in the United States: prevalence, costs and patterns of use. New England Journal of Medicine 32S: 246-252

British Medical Association 1993 Complementary medicine – new approaches to good practice

British Medical Association. General Medical Council. Joint Consultants Committee. Committee of Postgrad. Deans. Council of Deans of UK Med. Schools and Faculties, Conference of Medical Royal Colleges and their Faculties in the UK 1994 Core values tor the medical profession in the 21st century p 10

Foundation for Integrated Medicine (on behalf of the Steering Committee for the Prince of Wales’ initiative on Integrated Medicine) 1997 Integrated healthcare: a way forward for the next 5 years

Cornelia Featherstone

Originally German, I came to Findhorn in the search of ‘It’. I found ‘It’ in our way of sharing our spirituality in our daily lives, privileged to work with my focus on Healing in the widest sense.