By Dr. Mike Olson
In the recent decade, there has been a renewed interest in all things “mind-body.” Mind-body is, in reality, a concept that has existed for thousands of years among various world groups and cultures. The idea that our minds, bodies, and spirits are separate components of our health and wellness is a function of recent philosophies and ideologies, rather than what has been believed and practiced for centuries. For most of us, the thought that our minds, bodies, and spirits are connected is intuitive and logical.
In ancient cultures, the relief of suffering included the care of the whole person, including the treatment of body, mind, and spirit. The first recorded instances of medical care being provided to others were in Egyptian and Greek temples. “Holism”(from the Greek, holos, meaning all, whole, entire, total), is the idea that systems (physical, biological, chemical, social, mental) should be viewed in their entirety, rather than as acollection of individual parts. Prior to our modern era of medicine, those providing relief to the suffering of others have understood this important concept.
Reductionism can be thought of asthe opposite of Holism, specifically that the whole is best explained by reducing it down to its individual parts. Science has relentlessly pursued this goal of trying to break down matter into smaller and smaller bits to better understand things. Rene Descartes, the 17th-century French philosopher, among others that pre-dated him, has proposed ideas that maintain a rigid distinction between the mind and body.
This fragmented approach has beentermed “Cartesian dualism” or the “mind-body split.”Around the time of Descartes, patients began to be treated as individual parts, rather than as an integrated whole. Physicians became focused on the physical body (tangible, measurable, etc.). The spiritual life and suffering of patients became the domain of spiritual leaders (priests, Rabbis, etc.). The beginning of psychiatry (medical specialization) can be dated to the middle of the nineteenth century. With advances of psychiatric theory and classification extending through the 20th century with figures like Sigmund Freud, the care of the psyche and mental/emotional illness became the focus and domain of mental health providers. Thus, the idea of wellness, health, and balance was broken down into its component parts, each becoming the focus of specialized branches of the scientific and the sacred.
There is a common parable that has crossed many religious traditions and is part of Jain, Buddhist, Sufi, and Hindu lore that illustrates the problems of reductionism and mind-body dualism. It is a tale of a group of blind men (or men in the dark) who touch an elephant to learn what it is like. Each man feels a different part, but only one part. They then compare notes and learn they are in complete disagreement. Each believes entirely what his own experience has taught him and is unable to see
what others “see.” None are able to see the whole and understand the integration of each man’s perspective to understand what the actual creature really is.
This ideological myopia persists to a large extent today but is being challenged by visionaries from fields of medicine, religion, and mental health. It has been difficult, espcially in Western culture and medicine, to bring back the original view of patients/individuals as an integrated whole, with mind-body-and spirit at the center of efforts to provide care and relief of suffering.
Given the rapid advances in medical science and technology over the past century, the care of patients has become increasingly specialized. However, with clinical and research efforts of leading figures in medicine, mental health, and religion, and with mounting empirical science/evidence, the winds of change are blowing. Finally, we are finding movement in the healthcare system that promotes whole person care. A recent development in catalyzing this change has been a move toward what is called the “patient-centered medical home (PCMH),” anapproach that brings holism back into the center of care with teams of providers (mental health, physicians, nursing, etc.) working side-by-side for patients. For the first time, government, insurance, non-profit groups, patient advocacy groups, and corporations have come together to revision the way we provide care to patients in this country.
This column will provide more detailed information related to the patient-centered medical home along with a more in-depth look at some of the treatments/therapies that bring the patient back to the center of care.