First Do No Harm

In disease care the least harmful intervention has to be provided first. Only if that fails to solve the problem are more invasive treatments justified. This means, in many cases, that complementary modalities should be applied first with the technology of orthodox medicine being used as a back-up when needed.

There will always be conditions which need to be treated with orthodox interventions in the first instance, e.g. insulin dependent diabetes, severe asthma, epilepsy and severe infections to name a few. As efficacy must be the other deciding factor in choice of treatment, there are cases where orthodox intervention has to be given preference. For example, while complementary medical intervention for Hodgkin’s disease may be far less harmful than chemotherapy, the cure rate of chemotherapy is high if provided early, thereby justifying its use.

The shift in health care towards an integration of complementary therapies with modern medicine will take place over a period of time. It has to be based on sound scientific evidence to be acceptable and applied in a broad medical context.

The paramount objective of health care is the provision of the best treatment for the patient in any given situation. Knowledge of and an open mind towards the whole spectrum of interventions including complementary approaches are essential for optimal patient care.

Arguments for Complementary Therapies as Treatment of Preference

Side Effects

The vast majority of complaints brought to a GP are minor ailments and chronic diseases. In both cases the armamentarium of contemporary Western medicine may not be very suitable. Many interventions produce side effects and do not address the underlying cause of the presenting problem, therefore not offering long-term solutions. These conditions, however, fall in the domain of complementary therapies which empirically have helped many people and for which demand is increasing dramatically. Complementary therapies have fewer (if any) side effects and should therefore be offered to the patient as the first option for treatment if suitable. Modern medicine then becomes the back-up option, to be used if less interventionist approaches fail to address the problem.

At the moment this is reversed, with complementary therapies being used often as a last resort after everything else has failed. It is the growing vision of many patients, as well as health care practitioners, to turn this situation around.

Patient Empowerment

Patients who are helped by complementary medicine experience an enhanced sense of self-empowerment, receive education and learn skills which they can use in future to improve their general health as well as deal with the presenting problem.

Economics

Apart from serving the patient, this strategy also has the advantage of reducing the use of orthodox medicine, with benefits all around. The increase in the cost of health care currently puts an ever greater burden on society and is confronting those in authority with uncomfortable questions as to what to spend the money on.

For example, what should £50,000 be spent on?

2000 people can be counselled to help them stop smoking;
200 babies can be vaccinated, who currently miss out;
60 people can be removed from the waiting list for hernia operations;
40 people who are dying can be nursed at home;
15 hip replacements can be performed;
3 elderly people can be cared for in a nursing home for one year; or
2 liver transplants can be given to patients who otherwise would die.[1]

Somebody somewhere has to make impossible choices which will cost lives.

The integration of complementary therapies in health care could potentially form the basis for a financially sustainable future. There is presently a debate as to whether using complementary therapies, particularly in primary care, may be more cost- effective. However, evidence to support this argument has yet to be forthcoming. Besides comparing the cost-effectiveness of both orthodox and complementary forms of treatment, the necessary long-term prospective studies will have to take into consideration the educational impact of complementary therapies, such as health-conscious lifestyle, self-care and personal responsibility, which may well reduce demand on expert services.

Pressures on Medical Staff

The staff providing medical care benefit from the strategy of using complementary therapies as the first line of treatment, for two primary reasons. Offering medication with potentially dangerous side effects is a great responsibility, leading to personal stress which contributes to the high rate of suicides, addictions and depression amongst doctors.[2] Having available a variety of less invasive treatments lightens their burden. The second benefit is that they are under less demand and therefore can give more quality time and attention to those patients who actually need their expertise. They can spend more time attending to severe acute situations, emergencies, crises and conditions where medical or surgical interventions are required.

The Role of Disease

Another reason for complementary therapies to be employed as a new strategy for disease care is that, being based on holistic principles, they virtually all embrace the concept that, within the process of health, disease has an important role to play in the evolution of the individual and, indeed, of humanity as a whole.

Physical symptoms indicate dis-ease within the human organism. It is not just the body; the person may be emotionally imbalanced, mentally confused, socially isolated or spiritually disconnected and undernourished. The physical symptom is a messenger for any of these underlying causative factors.

The way a person responds to life’s challenges determines their health. If people are assisted or educated to be able to integrate challenges in a way that increases their capabilities, responsibility, autonomy, spontaneity and joy, they are more likely to grow into self-confident, flexible and loving individuals with ever increasing emotional, mental and social skills as well as a strong spiritual connection.

If, however, people lack assistance and education, they may develop sub-optimal coping mechanisms in relation to challenges, reacting with depression, rigidity of mind, addictions, and/or withdrawing either socially or from their source of spiritual nourishment. This can lead to somatisation, that is physical symptoms.

Considering the illness process in this way, it is obvious how ‘our biography becomes our biology’’.[3] People start to identify with their traumas or illnesses rather than seeing themselves as a person with a large array of qualities and levels of being, who happens to have an illness or to have experienced a trauma in the past. If individuals reduce themselves to a small segment of their being in this way, they debilitate and disempower themselves further, which can contribute to and exacerbate the disease process, leading to a career of ill-health and unhappiness.

The widely held holistic principle that everything happens for a purpose and is an opportunity for growth and expansion of consciousness can restore individuals to a position of power in their own lives. The challenge of disease can then become a turning point in their development and can facilitate health.

In some circumstances disease is actually a positive process of evolution. Childhood illnesses are postulated to provide the immune system with challenges which trigger its maturation and ability to contend with the demands of a stimulating environment.[4] To illustrate this, the following case from Cornelia’s practice is of a small child who made a leap in his emotional development through a measles infection.

John was two and a half years old when he contracted measles. He was a socially outgoing, alert little boy with a quick mind. His parents had consciously decided not to vaccinate him against measles or any other childhood illness and were therefore prepared to nurse him through this challenge.  As he was their first child, they understandably had anxieties and insecurities. I was in the fortunate position to visit them almost every day throughout the illness and give them support and reassurance. For most of a week they had sleepless nights with a crying and fretful toddler who was very withdrawn, yet demanding at the same time. When his temperature was too high they lowered it with compresses and by sponging him down, encouraged his intake of fluids and gave him what little food be wanted. The atmosphere in the house was subdued. The curtains were drawn, the parents were tired and exhausted yet willing to persevere.

Then on the fifth morning I came into their home and everything had changed. The curtains were open, the mother received me with a big smile and the father reported that the fever had broken in the early hours of the morning and they had all slept well after that. When they woke up, John had clear eyes and a smile, went over to his father and said ‘I love you, Daddy’- a concept which up to then had not been part of his awareness. The parents enthusiastically agreed ‘that this made it all worth it’. John is now almost six years old. He has had most childhood illnesses in an easy and uncomplicated way. He is very healthy and the parents can trust his strong constitution even in times of greater challenge such as prolonged periods of travelling to the other side of the world.

‘Love your disease – it’s keeping you healthy.’[5] This aphorism encapsulates the concept that disease plays further positive roles such as those of balancing and harmonising a person’s system on all levels and also of education and personal growth. Examples from the authors’ own lives illustrate this:

Cornelia has suffered for many years from regular migraines which have served as her teacher, leading her into the exploration of many different therapies in an attempt to free herself from them. This has been a journey of health enhancement and self-empowerment. It has taught her about the nature of pain which has made her more understanding and empathetic with her patients. While the pains and the underlying reasons have shifted as she learned the lessons and integrated the messages into her life, the migraines still persist and she now sees their role as creating the balancing factor in her busy life as they force her to retreat into quiet and relaxation every so often. In time she hopes that she will learn to balance her energy in a way that does not require this painful symptom to recur.

Seen in this way it is possible to say that symptoms are a sign of health, of the ability of the organism to balance itself, an expression of the innate integrity and wisdom of the physical body.

One of Lori’s symptoms has been interpersonal rather than physical. She found herself sharing a house with a woman friend who seemed to be her polar opposite. This led them to intense conflict and Lori found herself taking up ever more extreme positions in the polarity to a degree that denied a large part of her own personal expression and creativity. In the polarity she was the hard, fiery, ambitious, active one while her friend was the soft, Earthmother type, who found fulfilment in the routine tasks of a housewife. Overtime they both recognised the classic archetypes of feminine and masculine, or yin/yang, roles with which they were identifying and saw how each was balancing out the other’s need- however painful their partnership. To internalise this balance, they consciously embraced the opposite mode of being within themselves. Lori rediscovered her love of knitting and householding while her friend moved to a town and got a job. This allowed them to disentangle from their relationship distortions and be more whole in themselves.

Health care professionals faced with patients in situations like this would find their role to be one of education, assistance, and facilitation – enabling patients to undergo their process of growth with minimum pain and anguish. The professionals have to read the message being delivered by the symptom or the behaviour and help individual patients to understand for themselves and integrate, in their own time and in their own way, the aspects which the dis-ease is carrying for them. The symptom or disease is not the enemy to be vanquished but a process to be worked through as individuals unfold their potential.

There is also the spiritual perspective which considers the person’s life as a soul’s journey through incarnation. From this point of view disease cannot be judged as good or bad but only be observed as an expression of evolution. One very moving and impressive example is the transformational nature of the life-threatening disease of AIDS.[6] Many sufferers have expressed their gratitude to the disease as it had led them to search for meaning in their lives and to come to a place of spiritual connection and serenity unknown to them before.

This understanding brings humility to health care as the carer learns to accept and respect the individual’s journey and personal expression of their evolution.

The same humility applies when working with people in the dying process. When trusting in the innate wisdom of a person’s transition, death no longer has to be feared or prevented but facilitated and witnessed. Death need not be the enemy which has to be fought at all cost.

The Practitioner’s Evolution

Practitioners’ personal life paths allows them to reach this state of humility as they tackle each challenge in ways that increases their capability, spontaneity, autonomy, responsibility and joy. In expanding their own health they apply the learning inherent in integrating illness to their work with patients, becoming more authentic, compassionate and empathetic. As they become less fearful of illness and death, they experience less need to take action – for the sake of taking action – in their patients’ care. They can educate and assist their patients in integrating and maximising the benefits of a difficult situation, as illness and death are part of the learning process from which they themselves have benefited.

Some of the lessons the authors have learned from their own personal experiences of illness are:

  • there are no easy answers – following a particularly healthy lifestyle does not guarantee freedom from illness at all times. Health is not the reward for good behaviour;
  • illness is not ‘bad’, wellness is not ‘good’ – the state of a person’s physical body is not the measure of a person’s value or indication of their spiritual alignment;
  •  illness is the great equaliser – no one, no matter how rich, educated or enlightened is immune to illness;
  •  to respect deeply the suffering that people have to endure in life and to honour their resilience and fortitude. Human beings are extraordinary survivors;
  • to be grateful for the privilege of witnessing so many people’s life paths and to learn vicariously through their lessons;
  •  to trust in a greater purpose behind all suffering – experiencing that positive outcomes emerge from seemingly unbearable situations.

What Kind of Help Really Helps

The most powerful way of helping a person in a state of illness is to be fully present for them, not to judge their state and not to impose theories and assumptions on their process. Following a patient’s inner process and unfoldment as they gain insight into the context, cause and purpose of their situation, offering them support, providing validation as well as information and suggesting positive choices is the best a practitioner can do. Any approach which provokes separation between patient and practitioner will compound the patient’s loneliness and isolation: do not ask, ‘What did you do to draw this to yourself?’ with the implied judgement that they did something wrong but ask, ‘How are you using this condition?’ or ‘What are you learning from it?’, which will facilitate connection.[7]

References:

  1. Source of this list: Shropshire Health Authority, (HC 288-1, Ev p 356).
  2. R P Chaplan, Stress, Anxiety, and depression in hospital consultants, general practitioners, and senior health service
    managers, BMJ, Vol 309, 12 Nov 1994, p 1261-63.
  3. Caroline Myss, Why People Don’t Heal, Sounds True Audio, 1994.
  4. Michaela Glfickler, Wolfgang Goebel, A Guide to Child Health, Anthroposophic Press, 1990.
  5. John Harrison, Love Your Disease Its Keeping You Healthy, Angus & Robertson, 1984.
    Thorwald Dethlefsen, Rüldiger Dahlke, The Healing Power of Illness- The Meaning of Symptoms and How to Interpret Them, Element, Shaftsbury, 1990.
  6. Norm Shealy, Caroline Myss, AIDS: Passageway to Transformation, Stillpoint, 1987.
    Oscar Moore, A Matter of Life and Sex, Penguin, 1996.
  7. Ken Wilber, Grace and Grit – Spirituality and healing in the life and death of Treya Killam Wilber, 1993; p251-5.

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This post was previously published as a chapter in the book Medical Marriage, the New Partnership Between Orthodox and Complementary Medicine, Dr Cornelia Featherstone and Lori Forsyth, published by Findhorn Press, 1997.