A presentation for:NZPsS Annual Conference, 17-20 July 2010

by Helen Madden and Kerry ChamberlainMassey University

Holism, empowerment and subjectivity:Practitioners’ and patients’ accounts of

integrative medicine

Overview

The social context of healthcare What is integrative medicine? The notion of holism – a key concept Methodology of the study Findings: from interviews with practitioners

from interviews with patients Conclusions

The shifting landscape of healthcare

Processes of medicalisation, consumerism, etc, have: - turned health into a commodity - healthcare into a product - healthcare delivery into a commercial service

Healthcare highly individualised and new forms sought

Hybridised forms of healthcare are emerging, e.g. integrative medicine

What is integrative medicine?

A combination of allopathic and alternative medicines

A transformative sphere reshaping both patient and practitioner

A clash of paradigms: Biomedicine v holism A site of political and ideological struggle

(Fries, 2008)

Holism

A belief system serving the patient

or

A rhetorical strategy for gaining dominance over a contested healthcare site

(Keshet, 2009)

Methodology

Semi-structured interviews: - with integrative medicine practitioners and patients

- about their understandings of the treatment, the practitioner-patient relationship, the body, health and illness

- about responsibility for health and where it lies in the healthcare they experience?

A discursive analysis of the interview transcripts

Findings: Practitioners’ talk

Integrative medicine practitioners describe their practice as holistic

James: “I mean I call it holistic medicine I guess. So holistic means mind, body, soul”

Jenny: “the model that I work in is a Chinese medical model which is a holistic model and which is very different to a western medicine model. So I’m interested in the jigsaw in people’s lives. I’m interested in ALL of their lives, from before they were born until now and that’s the physical, the physiological, the personal and the spiritual”.

Practitioners’ talk on holism, health and healthcare

Holism drawn on to construct the body as having a natural movement towards healing and wholeness

Movement towards healing not just about alleviating symptoms:

Carole: “my approach would be not just getting rid of the illness or the symptoms but what’s this about? What’s the sort of gems in this? Or the learnings from it?”

Healthcare is not merely about eradicating illness or symptoms but about the learning patients gain from their ill-health

Illness becomes understood as: multi-layered a deeper malaise that conventional

medicine cannot treat or understand a manifestation of multiple causes which

combine to create a malady whose whole is greater than the sum of the parts

A transformative process

Practitioners’ talk on holism and illness

Patients’ talk on holism

Patients understand holism in a similar way to practitioners:

Jill: “Well, a more holistic practice I suppose. Although I don’t really know what that word means. But I guess just, yeah looking at the whole person, looking at the whole picture, looking at you on all your different levels, not just your physical level, but your emotional level as well”

Patients’ talk on illness

Sarah “I see illness if you like as coming about through a toppling over of those systems, you know you’ve got emotional, physical, psychological and when the stresses build up to a critical mass, either in one, or, I mean it’s never just one you know, there’s a mix, at some point you topple. And I think if you want to reverse that topple you’re gonna have to get involved with all of those things…. For me, it all comes together. What am I strong enough to do emotionally? What time of day do I have to do it according to my psychological health and according to physical health you know, fatigue and things like that? It’s all working together to allow my body to get back through that bottleneck situation and get to the place where all the different physical symptoms can start to function better and support each other so the overall health level goes up”

Patients’ talk on healthcare

Patient’s responsibility for their own healthcare appears to be heightened:

Jan: “ So it’s a massive jigsaw puzzle of reading and talking to people and following up any little lead, anything that anyone can suggest and then doing, you know what

you can with it”

Conclusions

Holism reproduces the idea that patients need to make lifestyle changes

Illness becomes a transformative process and a route through which patients can understand something more about themselves and what they are doing ‘wrong’ in their lives; perpetuating a tendency towards self blame

The patient accrues a heightened degree of hyper-vigilance over mind, body, and spirit, but a sense of self-mastery, particularly in people with chronic illness, remains elusive

The medical gaze – understood as an objective view of the patient’s body by the practitioner, becomes internalised by the patient, penetrating ever deeper into the body