Key Ideas in Alternative MedicineA Georgian translation by Ana Mirilashvili is available
1. ALTERNATIVE MEDICINE IS NATURALThe idea that natural = good and desirable seems to be accepted without question by almost everyone today. It was not always so; in the eighteenth century such an idea would have seemed perverse. It was the Romantic movement that gave it currency; enthusiasm for mountain scenery is one of the best- known manifestations of this new awareness. It stems from a nostalgic yearning to return to Nature, to our Source. In its extreme form, this is a quest for what Marghanita Laski called the Adamic state -- the condition of humanity before the Fall. The designers of travel advertisements and brochures draw on this longing when they try to seduce us with their specious images of blue skies, empty beaches, and laughing figures redolent of eternal youth.
But is Nature always benevolent?Darwin and his associates saw conflict as the driving force of evolution -- "nature red in tooth and claw". Even at that time, however, many people found this too stark a message and preferred a softer image of the natural world. This attitude has become if anything more widely accepted today. We hear so much about ecology that, for us, the natural world has become a cooperative effort rather than a battlefield.
We know, of course, that animals eat one another and members of the same species fight one another for territory or mates, but we like to think that they do so only within certain limits. Predator and prey are not deadly enemies; the lion wants to eat the individual antelope but it doesn't want to destroy the whole herd -- if it did it would have nothing left to eat. Predator and prey, we are told, depend on each other in a delicate symbiosis, so that their relationship is more like a partnership than a struggle for survival. As for battles between members of the same species, these seldom lead to death for the defeated individuals, and in any case the conflict results in greater health and fitness for the species as a whole.
A sentimental view of NatureThis is the sentimental view of nature that Helen Cronin has called "greater goodism". According to this idea, nature forms a vast ecosystem which would persist indefinitely in harmony with itself were it not for us. We are the wild card, the unnatural joker in the pack, who has invaded the ecosystem and disturbed it, perhaps irreversibly. The evidence of our meddling is continually brought home to us in television programmes, books, and newspaper articles. We are made to feel guilty because we are destroying our planet by pollution, by upsetting its temperature control mechanism with carbon dioxide, by deforestation.
Alternative medicine seems to fit rather well into this view of nature. From this point of view, orthodox medicine, which is of course technological, is part of the problem. Alternative medicine sees our orthodox medical treatments as one aspect of the ecological catastrophe we are in the process of bringing about. Our medicine, it could be said, is flawed in the same way as our management of the planet is flawed, and for the same reason: because we have moved too far from our roots in nature.
Just as we insensitively try to 'conquer nature' on the outer level, so too on the inner, physiological, level we try to bulldoze our way to health. Antibiotics, corticosteroids, antidepressants, and the rest of the conventional therapeutic armamentarium may 'work' in a sense, the alternative purists usually concede, but they are 'against nature' and so can only lead in the end to worse catastrophes than those they are designed to cure.
The Noble SavageThe lure of the primitive, the natural, is always there. 'Primitive' peoples who live or lived close to nature -- the Australian aborigines, the North American Indians, the forest dwellers of the Amazon -- are said to preserve valuable information about the uses of plants and to possess sophisticated rituals of healing and psychotherapy that we have arrogantly spurned or even tried to suppress. Our own pharmacology, in contrast, is seen as crude, dangerous, and, inevitably, 'unnatural'.
Is homeopathy 'natural'?Some forms of alternative medicine make less claim to be natural than others. Patients who ask for homoeopathy often explicitly say that they want it because it is natural, but naturalness was not a selling point for homoeopathy originally -- the quality was not so highly prized in the early nineteenth century -- and even today more emphasis is placed on the safety and effectiveness of homoeopathy, and its 'holistic' character, than on its naturalness.
However, homoeopathy is supposed to stimulate the natural healing properties of the body, instead of suppressing them as orthodox treatment is held to do, and the starting point of practically all the traditional homoeopathic medicines is a natural vegetable, mineral, or animal extract; often the plant or animal is used whole. In this respect homoeopathy is rather similar to herbalism, in which the medicines are typically prepared from the whole plant.
This is said to be natural, in contrast to the products of the modern pharmaceutical industry, which are isolates of the 'active principle'. Using the whole plant is said to prevent adverse effects, because the various components balance one another instead of acting unopposed, as in 'allopathy'.
Are 'natural' medicines always safe?Even within orthodox medicine, the use of whole plant extracts died out only quite recently. As late as the 1960s, when I was a medical student, some of the older physicians were still using digitalis (foxglove) leaf tablets to treat heart failure, in preference to the active principle, digoxin, as contained in the "newfangled" tablets produced by the drug companies.
In alternative medicine there is a deep-seated belief that herbal medicines -- and by extension, 'natural' methods of treatment in general -- are safe and somehow intrinsically virtuous, whereas 'drugs' are nasty and even vaguely immoral; a belief that slides rather easily into sentimentality. The natural world abounds with toxins -- the deathcap mushroom, snake venom, puffer fish toxin; and of course bacteria and viruses, are all natural too.
The idea that nature is inevitably benevolent is extraordinarily sentimental. Mother Nature is not only Mother Divine, taking care of her children; she is also Kali, dancing naked on the bodies of her victims and wearing a necklace of human skulls.
The delusion that everything natural is, by the same token, health-giving inevitably suggests the corollary: artificial = bad. I think it is this notion that underlies the belief, taken seriously by some people, that the AIDS virus was manufactured deliberately by bacteriological warfare laboratories in the USA or the USSR (take your pick according to your political attitude) and then either escaped or was disseminated deliberately. The psychological basis for this belief seems to be the feeling that a benign nature would not have produced such a terrible plague; it must have been due to human malevolence.
The concept of nature that is so characteristic of alternative medicine is sentimental and moralistic. This emerges in the kinds of things patients say. They announce: "I eat all the right [i.e. natural] things," with the unspoken implication that they deserve praise for this. And if, in spite of eating all the right foods, doing all the right things, and thinking all the right thoughts they nevertheless become ill, they feel aggrieved. It wasn't fair, they complain. This is of course absurd. "Fairness" is a concept that has no place in nature. Indeed, "unfairness" is built into the system.
It would hardly be going too far to say that the whole idea of the "natural" as applied to medicine is a mistake. Medicine, of whatever kind, is a product of culture; this is as true of the medicine of the Amazonian Indians as it is of our own. Taking medicine is essentially an unnatural procedure, wherever and by whomever it is done. The idea of "natural medicine" will thus hardly stand up to serious examination.
2. ALTERNATIVE MEDICINE IS TRADITIONALSome forms of alternative medicine are explicitly based on ancient knowledge. It is not every alternative therapy that can claim an antiquity as impressive as that of acupuncture or Ayurvedic medicine. Even so, practically all the therapies make at least some claim to have roots in tradition; certainly it is very difficult to think of any system that makes a virtue of being completely new and original.
Those therapies that are not obviously ancient, such as osteopathy and chiropractic, homoeopathy, Anthroposophical medicine, and the Alexander technique, do the best they can by pointing to a Founding Father (or sometimes Founding Mother).
Gurus in altermative medicineThis may seem like a trivial comment, since it is clear that if a system did not originate in the mists of antiquity or even prehistory, as did acupuncture, for example, there must have been someone who invented or discovered it in the first place (and even acupuncture is traditionally ascribed to the mythical Yellow Emperor); but the important thing is that this person almost invariably becomes invested by practitioners of the system with an aura of near-infallibility.
As Jung (who is himself an illustration of the process) would say, this is an activation (or 'constellation') of the archetype of the Wise Old Man.
Even if a therapy is relatively recent, there is often a tendency for its advocates to try to trace the underlying concepts as far back as possible, as if proving their antiquity would somehow validate them. Claims are often made that the treatment in question was anticipated by Hippocrates, always a favourite ultimate progenitor. This is true of homoeopathy, which seems to be exceptionally richly endowed with authority figures, starting, of course, with Hahnemann himself and continuing down to our own day.
Modern authority figures also exist. There is a considerable tendency for systems of alternative medicine to acquire charismatic authority figures. These are practitioners (some medically qualified, some not) who give lectures, hold seminars, publish articles and books, and sometimes even found institutes and other organizations to disseminate their views. They accumulate students and followers and can become remarkably influential within their own field.
This phenomenon is certainly not unknown in orthodox medicine and in science generally, but at least in mainstream science an authority figure is expected to produce evidence for his or her claims and is open to challenge; this seldom happens in alternative medicine. The subjective nature of much alternative medicine makes it easy for such people to build up their own versions of these things, and provided this is done with enough assurance few critics appear.
A good deal of what is said by such people is not substantiated in any way, the principle they use being apparently that of the Bellman in The Hunting of the Snark: "'I have said it three times,' said the Bellman / And what I say three times is true.'"
Relying on tradigtion means things don't changeThe penalty that all alternative medical systems pay for their historical basis is that they are static. Homoeopathy has changed little since the late nineteenth century. In acupuncture there have been apparently new ideas, for example ear acupuncture (auriculotherapy), but even here the departure from tradition is not radical, and in fact the Chinese themselves have claimed that there are ancient texts describing the use of the ear for needling.
In the West, doctors who have taken up acupuncture have indeed practised it without reference to the ancient ideas and have interpreted it in terms of modern anatomy and physiology; but adherents of the traditional version (often Western enthusiasts rather than the Chinese themselves) usually decry this as a betrayal.
The ancient books are the language of Chinese medicine, and while the vocabulary can be expanded and enriched, the grammar and syntax are fixed. Complete and self-contained, traditional Chinese medicine is incapable of assimilating anything that challenges its fundamental assumptions. New ideas and substances can be identified and even incorporated, but they can never expand or transform the fundamental matrix. So vitamin B12 is very Yang, penicillin is very Yin, but there is nothing beyond Yin and Yang." [Kaptchuk 261]
Similar remarks apply to pretty well all the major forms of alternative medicine.
3. ALTERNATIVE MEDICINE IS HOLISTICThis is probably the most widely used, and abused, word in the whole of alternative medicine. People seem to use it simply as a term of recommendation; no form of alternative medicine is complete without it. It is supposed to signify "treating the patient as a whole", and it is axiomatic in alternative medicine that orthodox medicine doesn't do this. Conventional doctors are supposed to have an exclusively disease-based, technological, approach to their patients; they regard the patient, not as a whole human being, but as a vehicle for a disease. And if no disease can be diagnosed -- so the argument goes -- the doctor will simply label the patient as neurotic or a hypochondriac and dismiss him or her.
Orthodox doctors sometimes get rather annoyed by this accusation. They protest that the practice of good medicine does require the doctor to take an interest in all aspects of the patient's problems, and there are many general practitioners who would insist, with justification, that this is exactly what they do. It is nevertheless true that it doesn't always happen. Partly the problem is simply one of time. If you are a doctor who has to get through a busy surgery under NHS conditions it is almost inevitable that you will not be able to give much time to most of the patients. Alternative practitioners, in contrast, are almost all in private practice, where time is not much of a constraint.
That isn't the whole story, of course. There is no doubt that specialists often suffered from blinkered vision and find it difficult to look outside their own area of interest. Richard Asher tells the delightful story of the ophthalmologist who, having examined a patient who was referred to him, wrote in his reply: "Any evidence of polydactyly?" As an eye specialist, he evidently didn't consider it part of his job to count a patient's fingers.
But alternative practitioners may be narrow-minded tooBut a similar criticism of narrow-mindedness could be made of quite a few alternative practitioners. Most therapists in the alternative field practise just one or two methods, and they tend to be rather suspicious of anyone who offers a wider range.
The result is that if you go to a herbalist you will be given a herbal preparation, if you go to an acupuncturist you will have needles inserted in you, or if you to a hypnotist you will be put to sleep. In other words, many therapists believe that their particular form of treatment has an answer for almost all the complaints that come their way.
But at least the patient is centre-stagePerhaps the central idea of the holistic approach is that if you go as a patient to a therapist who practises in this way, the symptoms you complain of will probably not be the main focus of attention. The therapist may not concentrate, at least initially, on your headaches, backache, or whatever, but instead may ask you a lot of questions about your circumstances, mood, diet, sleep patterns, and so on.
Many patients find this satisfying. It can indeed be beneficial, especially for patients who are not suffering from a readily identifiable illness but from the myriad non-specific symptoms that so many people seem to experience. In such cases what matters is not so much the advice that the therapist gives or the theories that she or he believes in, but simply the fact that someone is listening to the patient with undivided attention for half an hour or more and, above all, is taking them seriously.
Conventional medicine has largely lost sight of the idea that the doctor himself or herself is often the best medicine for the patient. The very success of modern technological medicine has blinded many orthodox doctors to this obvious fact. Alternative practitioners may not fully realize it either, but they do rely on it unconsciously.
Alternative medicine as psychotherapyThere are resemblances here between alternative medicine and psychotherapy; it has often been remarked that an important part of the reason why psychotherapy has become so widespread is that it allows patients to talk and be listened to.
Some years ago a doctor wrote a letter to one of the medical journals, saying that he had tried the experiment of getting the patients in his waiting room to talk to one another and discuss their problems; many of them apparently found this very helpful. Even a computer program can fulfil this need. It has been found that patients can happily interact with a computer that has been programmed to give suitable-seeming responses to a patient's statements and questions; patients find that the machine reflects their own thoughts and emotions and, perhaps, shows them in a new light by doing so. We are only a small step here away from the use of oracles such as the I Ching or the Tarot.
I think myself that the term "holistic", if not exactly meaningless, is so vague as to be almost useless. All alternative practitioners claim to be holistic, but, like Humpty Dumpty, they make the word mean whatever they want it to mean.
4. ALTERNATIVE MEDICINE HAS A SPIRITUAL BASISYou don't need to have much to do with alternative medicine before you realize that it is not all that far removed from the kinds of belief system we tend to call religious. This is in fact one of the defining features of much alternative medicine. Many or even most alternative practitioners have an anti-materialistic outlook, and claim, probably correctly, that in this they differ from many conventional doctors. A recent survey found that nearly half the holistic practitioners questioned said that religious and spiritual experiences were important in shaping their views of health, illness, and healing, compared with only 13 per cent of family doctors.
A particular view of the human constitution is usually assumed or stated openly. A tripartite arrangement - body, mind, and spirit - is often quoted in books on all kinds of alternative medicine, not just homoeopathy. It seems to appeal to many people because it seems to offer a compromise between a scientific and a mystical view of human nature, even though it is vague and woolly.
What are the respective functions of mind and spirit? How do they relate to each other and to the body? None of this is explained in any detail or even discussed very much; the terminology is simply used to create a warm feeling in the reader (and presumably in the writer too). It also opens a door to let in the doctrine of vitalism, and this too is important for alternative medicine, which is still based on vitalistic thinking. The notion of 'the vital force' is certainly still widely accepted in alternative medicine.
Much ado about 'energy'The "energy" that practitioners of alternative medicine often speak about is closely related to vitalism. Like the vital force, it doesn't have any identifiable source, it doesn't obey any kind of law, it can't be defined. It is simply postulated ad hoc, to explain whatever effects or alleged effects need explaining. It can't be pinned down or put to the question; its function is to provide the illusion of meaning without the substance.
It is a little like the ether which was postulated in earlier times to explain the transmission of light through space, or like phlogiston, which was used at one time to explain the phenomenon of heat (if you burn something, it usually gets lighter; this is because the phlogiston has disappeared in the flame - QED). However, phlogiston and the ether could be, and were, disproved by experiment, so at least they were open to disproof and so were scientific theories; "energy" in alternative medicine can't be disproved because it is too amorphous and vague a concept.