CAM, medicine and an Integral View
CAM, medicine and an Integral View
But that would be to take a stand the same as hers, rather than to offer something that is more useful in reply.
One of the difficulties with Margaret's approach is that it lacks a number of useful perspectives all of which would result in a better more complete health service for all.
I applaud Joe Beecham for starting to see this light when stating "If we are looking for explanations as to why CAM is experiencing a resurgence, perhaps the nature of the CAM consultation itself would be a good place to start"
For a number of years I have been looking for a more Integral Operating Sytem, one that allows a better integration of conventional and non-conventional approaches. In this I have found the AQAL (All Quadrant, All Level) approach developed by Ken Wilber. kenwilber.com
This Integral system starts with the maxim that nothing can be 100% wrong, therefore what about it works, what is dogma and belief and needs discarding? What are the commonalities that can be found across all domains in this area?
From this Ken was able to construct a map that can be used to observe where something is arising in just about any context you want to put it in. It has successfully been applied to politics, economics, art, literature, education, relationships and a number of health interventions. More on this in this post Health is a 4 Quadrant Affair
One of the most useful aspects of Ken's work is how he has divided the basics of any occasion in to one of 4 quadrants which then relate to internal and external, individual and collective aspects. For example our mind and mental experience is an internal individual or Upper Left quadrant (internal becuase it can't be seen externally), the body, its organs, tissues, cells etc is an External Individual or Upper Right quadrant (because we can see them); relationships, cultural worldviews etc are Internal Collective or Lower Left quadrant and our environment, cities, farms etc are External Collective or Lower Right.
But what does this have to do with effective health care, please bear with me, a little ground needs laying for the picture to be seen.
Each one of these quadrants has 2 zones in it, an inside and an outside, the inside can only be experienced (never observed in anything other than a 3rd person manner), the outside can be observed, but only to a degree in the Left Hand or Internal Quadrants.
Each zone also comes with its own methodology, based strongly in the scientific method and its own metric for measuring that. In that there is an injunction or method (do this = get this) and way to record and a way to review. Each of these methodologies have been widely accepted as providing accurate representation for the area they study. For each zone they are
2. Structuralism (both upper left internal individual)
4. Social Anthropology (both lower left internal collective)
6. Empiricism (both upper right external individual)
7. Social Autopoiesis
8. Systems Theory (both lower right external collective)
With integral theory the important thing to remember is that a methodology can only make claims for the area for which it represents. For example Empiricism can only disclose phenomena about the external individual. If it tries to make claims about any other area then it is engaging in quadrant absolutism, stating that it can explain the areas that are outside of its field of reference.
And this is where our problem lies.
The gold standard that medicine is using can only accurately represent 1/8th of the experience of any individual. Although its view is a complete and robust one it is only partial.
And this is something that we must accept, each view has its truths, each view is a representation but it is only partial to the whole picture.
What we really need to make a successful health system is a more complete view.
But the doors are closed from the inside here. Medicine believes it has a complete view, but won't recognise the partiality of it and is therefore reluctant to recognise that anyone else may have information of value.
Coming back to Joe Beecham's idea, what is it that CAM has that makes it so popular, so trusted and used by so many patients today? In all honesty, we don't know, partly because the support isn't there to find out, partly because the phenomena it discloses cannot be seen by a purely zone 6 viewpoint.
An example of this can be seen in meditation, you cannot reduce meditation down to what happens in the brain when you meditate, that is purely a zone 6 understanding, useful, but partial. We need to look at zone 1, the persons actual experience, which is then affected by their cultural interpretation (zones 3 and 4) and how that is affected by their environment (zones 7 and 8).
All those perspectives have something to say on what meditation is and they are all right, partially.
To understand what patients gain from CAM it needs experiencing and contextualising, this cannot be done from a purely empirical viewpoint, although that information is also useful, it isn't everything. The experience of CAM cannot be measured from an empirical viewpoint and to put it all down to placebo is a narrow minded and closed process, again the doors closed from the inside of medicine. There are 7 other methodological ways of looking at this with their own metrics for doing it. How does the saying go, if you measure the intelligence of a fish from its ability to climb trees it will spend its life thinking it is stupid.
The future of medicine and health care in this country will come from finding an Integral approach that comes from a broader perspective where we can let go of the Dogma and false belief (on both sides) and focussing on the commonalities, the parts that do work and expanding those.
I will concede that false claims made by either camp do nothing to help their situations, but when you are shut out from the majority of the resources and tools that would allow you to further understand what you have, it makes it a much slower and more difficult process. And if the evolution of science has shown us one thing, ideas and theories made now will be revised, disproved and changed later, in every field.
If we make a move to look at what works in CAM and try to understand why from the broad scientific approach laid out in integral theory, then we have a much better chance of between us creating a more adequate, more complete, more accurate model for health.
I know that most CAM practitioners would love to extend the experience of GP's and other health professionals and an increasing number are looking at this. But without the doors being opened so we can find what the true benefits are, if we keep on behaving like children and closing off our circles while mud slinging then we won't find the integration of what works best in medicine and what works best in CAM. Both fields have things that they do better than the other, but neither wants to work together because they both want to hold the ultimate 'I'm right'. All viewpoints can only ever be partial, because at some point something will come to transcend and include that which has gone before into something new.
I hope this has been useful and would be happy to engage in any discussion on finding that integration and improving our health service to be something even greater.