Change of self, change of system – journey into integrative medicine
Elizabeth Thompson, CEO and founder of the National Centre for Integrative Medicine
Published in JHH17.3 Beyond COVID
I trained at Oxford University and then Guy’s Hospital before embarking on training in oncology, radiotherapy and palliative medicine. When asked to write an article about integrative medicine (IM), I found myself writing both a personal and professional account of why I think IM is important in supporting a transformation of healthcare. The personal side of describing my own experience of burnout and how that helped me discover a new way of being has left me feeling somewhat vulnerable. However, I have stayed with describing my experience and have included a poem and some drawings that I did at the time of my illness. This time was also the point when I started to understand what IM meant at a very practical level and developed a vision of a new centre of IM in Bristol. I do not pretend to be either poet or artist but found these creative endeavours a key part of making sense of what was happening to me.
We are living through interesting times and as I write on a train visiting my recently bereaved mother, my father having died in lockdown from a sudden and unexpected widespread cancer, I am wearing a face mask, now mandatory in the time of Covid-19.
Covid-19 has highlighted many things and one is the question of how we define health. Thirty years ago, as a doctor training in medical homeopathy alongside palliative medicine, its philosophy offered me models of health I hadn’t been introduced to in medical school. Samuel Hahnemann, a German physician, disillusioned by the lack of science that underpinned medical practice and who developed homeopathic principles and practice, defined health in Aphorism 9 of The Organon thus:
In the healthy condition of man, the spiritual vital force (autocracy), the dynamis that animates the material body (organism), rules with unbounded sway, and retains all the parts of the organism in admirable, harmonious, vital operation, as regards both sensations and functions, so that our indwelling, reason-gifted mind can freely employ this living, healthy instrument for the higher purpose of our existence.
Hahnemann, 1810
We can see how in 1810 Hahnemann was defining the mind and body as a whole energetic system, striving for balance and harmony and equating health with freedom and finding meaning and fulfilment in our lives. Quite a tall order for any of us
An inclusive model
So why have I opened with homeopathy, having been invited to write an article about integrative medicine (IM)? Perhaps because IM, a term coined by Dr Andrew Weil from Arizona University, was brave enough to conceptualise an inclusive model that combines conventional, lifestyle and holistic approaches to support health and wellbeing (Maizes et al, 2015). It’s those pesky holistic approaches and their purported lack of science that bother the sceptics, and in October 2018 NHS England, under Simon Stephens’ leadership, recommended that no doctor be allowed to prescribe homeopathic or herbal products. Soon after, it was decided that some doctors would be asked to prescribe cannabis for their patients, creating confusion about whether herbalism should have a place in modern healthcare. It highlights the battle between what our patients find useful and what doctors find acceptable, described by Sophie Sabbage as being ‘caught in the crossfire’ (Sabbage, 2016).
Holistic approaches within the IM model offer something very important in the mix, but they do not come without tension. My experience of burnout a decade
ago, as a busy NHS consultant homeopathic physician, highlighted my personal need to combine conventional, lifestyle and holistic approaches to get well again. I couldn’t do without any of them. Before my illness, I realised I was holding a purist view, encouraged by the idealism of my homeopathic training and the war between allopathic and homeopathic medicines, that felt very real for Hahnemann and his followers. So it was hard for me to admit I needed help and consult my kindly GP. He offered a listening ear and reassurance and gave me a prescription of an antidepressant that gave me troubling side-effects. I was then left to piece together the breakdown of my autonomic nervous system which appeared poorly understood by the conventional teams.
I had always been a good girl with grade As, stepping straight into medicine at the age of 18, and apart from maternity leave with my three children there had been no let-up in the intensity of my working life. Understanding my unconscious drivers, like you are only worth something if you are producing something, was difficult but important to grasp. Societal pressures also played their part including my upbringing in the Catholic church. To discover a book of Sufi wisdom where the first chapter was called ‘The great no’ was a revelation to me. How could a spiritual text give me permission to say ‘no’ when the Christian tradition taught me about the worthiness of sacrifice and always saying yes?
Leaning into chaos
Mindfulness was key for me and rather than run away or deny what was happening, Pema Chodron encouraged me to lean into the fear and uncertainty (Chodron, 1996). Leaning in meant I had to grapple with my own story of trauma. Slowly the penny dropped that my brother’s diagnosis and difficult death from a very aggressive cancer had propelled me into wanting to help rescue others from the despair of these life-changing diagnoses. I realised that I had, with hundreds of my patients over the years, been offering the safe space I craved. A Jungian analysist helped me harness my vivid dreaming and tap its hidden meaning. In one dream a male and female angel were fighting it out under a large clock, the female angel driving the male angel to the ground. What did this all mean?
The concept of male and female forces was important for me to understand and in my dreams they appeared to be at war. The masculine brings structure, clarity, certainty and the strength to push through, to penetrate – encapsulated by the image of the sword and associated with the sympathetic nervous system and the accelerator. The feminine brings flow, uncertainty, nurture and holding. With the feminine comes the image of the chalice or womb and associated with the parasympathetic nervous system and the brakes that allow us to rest and restore. With help I realised I could no longer sustain my place in a world of masculine power structures and the army of doctor heroes intervening and never needing rest or showing vulnerability.
Therapies outside the box
Complementary and alternative medicine (CAM) therapists were crucial to me in this time of meaning making and healing. My craniosacral therapist worked with my body, unflinching as the connections I made got more and more curious. In one session, the pain in my shoulders connected me to an angel whose wing had
been ripped in a fall from grace. My loyal acupuncturist also worked away to balance the yin and yang energy with the feminine energy, the yin, barely recordable in my pulse. There was of course my homeopath walking alongside me and matching my inner state, which was creating such turmoil, to a homeopathic medicine that helped me find balance. Random events were also reassuring, like opening the door and finding a friend’s husband holding a box of Ginseng tea, something I had been recommended for my tired adrenals, strived to obtain but failed to find anywhere.
Falling into the abyss
The rather graphic drawing I found myself sketching now was an image of falling with layers or platforms. The falling went on for a long time. Eventually the abyss became populated with a baby’s head! This may sound strange, but this is where I had to trust the process I was in and realise I couldn’t go back – the only way was forward into this new way of being. And through this intensely personal time, I gradually had a sense of letting go of old ways, of being and embracing a new beginning. The internal process linked to something external, which was the vision of a centre for integrative medicine in Bristol. Somewhere where others could be supported with conventional, lifestyle and holistic approaches to create health and support healing.
Pupating the organisation
Change like this was difficult and tiring and as things took time to rebalance, surrendering to the process was important. I realised I needed time to rest, recover and restore and allow myself to do things differently. It was not easy for me to properly stop. I did return to work after just three months before I was fully well and not sure how this change of direction would manifest. A full recovery did take time. It was a couple of years after my return to work that I saw the opportunity to set up a social enterprise that would spin out of the NHS, taking with it the existing homeopathic services. It took some years but eventually the National Centre for Integrative Medicine (NCIM) was born. Important to me was the use of the words integrative medicine, and putting my flag with Andy Weil and the movement for change he had begun. Setting up the structure of the organisation was a challenge but with the help of a social enterprise fund and serendipity working its magic, the NCIM board and core team came into being. We took over existing homeopathic education and decided to set up a new Master’s level diploma in integrative medicine.
Critical analysis informs the learning throughout the diploma, with experts in research and evaluation helping learners understand how to assess the research that is out there and the available evidence base. Threads of self-care, planetary health and leadership and finding balance in our professional and personal lives, permeate the course. It is structured around six pillars of three, three-day intensives and regular face-to-face online tutorials and self-directed online learning with the NCIM learning management system which is a Moodle site.
Creating the diploma
Over the four years of working with a dedicated team of people to create the diploma, something emerged as we gathered nutrition, green care, the arts in healthcare, exercise and a range of holistic interventions. Whereas lifestyle could slip into the biomedical model, these holistic approaches, sometimes with ancient traditions like Ayurveda, traditional Chinese medicine, naturopathy and homeopathy, challenged the model of man as machine and crucially the meaning of symptoms.
These whole systems approaches valued balance and the belief that the body is a vital, energetic and expressive organism whose illness is communicating distress. As a palliative physician I was used to managing symptoms so difficult that they needed conventional measures, while at the same time having to understand how emotional, psychological, spiritual and social factors were playing a part in how symptoms are experienced. In homeopathic practice, symptoms are a gateway to a deeper understanding of vital disturbances and I have found that they can direct an individual to connect in unfamiliar ways with themselves. Homeopathy views materials – plant animal or mineral – as signature substances that may help the body restore harmony and flow: as if nature and human were indivisible. Some of these approaches have more evidence to support them than one might imagine. The diploma’s critical analysis module reinforces the need to understand, critique and communicate existing experimental evidence dispassionately, while also valuing the qualitative and quantitative research that provides a balance.
A community of like-minded colleagues
Integrative medicine is also about building a community of like-minded colleagues and our open clinical days, held three times a year as part of the face-to-face intensives, have been filled with doctors, nurses, CAM practitioners, medical students, researchers and the public. The feedback has been ‘it’s great to be in the same room!’. When we first set up the diploma, we had entry criteria about being a statutory registered healthcare professional and many irate CAM practitioners contacted to say ‘why can’t we join the diploma?’. This year we have opened it up to those with a diploma in their chosen CAM practice and two years’ clinical experience. We have had a record number of applications, the majority being statutory registered healthcare professionals plus a healthy mix of CAM practioners. We are embarking on this new academic year with excitement and the added challenge of holding community, while delivering all our teaching including the face-to-face intensives, online in this time of Covid.
The human factor
IM isn’t just about a diverse range of interventions. At its heart is holistic consulting and sensitive inquiry and we have also been building clinical services and the new holistic doctor service. The holistic doctor team at NCIM can worry about their lack of knowledge when anticipating their clinics, with questions like ‘What will I do?’ ‘What will I recommend?’. Our impulse to fix things is strong as doctors, but the consultation is that safe place where people, in putting their complexity on the table, sometimes find the pieces coming together so they find their own solutions. The hope for us as clinicians is that somewhere in a diverse model there will be something that can be done. And naturally we can also harness the ‘placebo’ – better called the self-healing response – and activate our client’s power of hope.
Realistic hope
If we are fortunate, the scientific evidence may help our decision-making, always in the light of patients’ preferences, the cost and any potential harms and benefit. Several times in my life’s work in integrative cancer care I have been able to help someone to decide not to spend their hard-come-by £10,000 to fly somewhere far away for a ‘cure’ for their cancer which had clearly spread too far through the body to ever be cured. However, the diversity and inclusivity of the IM model still allowed me to stay in connection with the person whatever their choices. This highlights the need for thorough record keeping and clear letters to colleagues, to make it clear that supporting someone’s choices in the light of frank discussion about their clinical condition and the evidence, does not mean
advocating treatments that are expensive and ineffective. As well as one-to-one consultations, we at the NCIM have also developed a range of courses: Mindfulness for Cancer, Food for Wellbeing, Food for a Healthy Heart and Voice and Creative Writing for Wellbeing. The team is building and maybe one day soon we will find a building for our home, a physical manifestation of the Centre for Integrative Medicine.
The Covid-19 pandemic
I find it curious that all Covid mainstream scientific messaging aligns exclusively with the biomedical interventionist model: ‘the only way out is a vaccine’. Pasteur’s cry to humanity to care for the soil or the terrain of the body is all but forgotten even though susceptibility to the virus is strongly correlated with underlying chronic persistent lifestyle-related health issues such as diabetes and obesity. Covid is revealing just how unhealthy we are in the UK. Many of us are measuring our waistlines and finally finding the impetus to lose weight and get active. For some people this could mean curing their diabetes through dietary change and exercise. Covid has impacted our mental health enormously, so it was really good to see an article about food and mood in the BMJ with an increasing focus on lifestyle change (Firth et al, 2020).
Looking ahead
Many of us who have been supporting a transformation of healthcare for decades, now see a lot of positive change, with an increasing number of IM centres and courses popping up all over the world. We have had more applications than ever before for the diploma so we feel the wave of change is building. As a small social enterprise hit as other organisations have been by Covid, we are trying to stay on the surfboard as the IM wave builds. We moved quickly to online learning and consultations, set up the NCIM Integrative Health and Scientific Network and delivered a series of Covid-19 live webinars around building personal, organisational and planetary resilience. We also set up our NCIM Friends free members page and the Holistic Doctor Webinar Series to get key messages about health and wellbeing out there to the public. We have also been teaching new IM courses to Bristol University medical undergraduates. They have enjoyed these courses and we have enjoyed supporting their natural leaning towards nutrition, green care and the healing arts.
As ever, I continue to be over-busy of course. But as we build the NCIM team I hope to step back and focus on my role as vision-holder and CEO. I am still striving for a work-life balance that takes me out of the precarious zone and into feeling resilient with a bit of doing nothing time available! I have a lot to be grateful for and very many people to thank in the co-creation of NCIM. Do get in touch with us if you would like to learn more about our courses. You can email education@ncim.org.uk for a prospectus and check out the NCIM Integrative Health and Scientific Network on our website www.ncim.org.uk – we would love to hear from you!
The Fall
I remember falling
Comrades scattering at the sight of Him
Dropping like stones
The flame I held dimming
And then darkness
For a few centuries I lay stunned,
Another couple, realising what I had been capable of
Shame and Blame resting with me
And then Despair at my side
Questioning why I drew breath
I remember falling
For an aeon, the sudden jolt on impact
Slicing the root of my wing
Pain like a mighty rose, thrust to my shoulder.
My finger edging the wound
Impossible to heal
Undaunted by my lament
Soft hands surprised me
Filled the wound with herbs
Prepared a fire
Cast it with Frankincense
Burning yellow blooms of Gorse
For meaning making, in this barren time
And again, I remember falling
Weapons first, then armour,
The heart-shaped encasement,
Rusting where it tumbled away
And there a glinting sword,
Reminiscent of the fire that burned
My armour spoke of glory and power
So, I shook away the rust
Heaved it over my head
And forced myself to fly
The wing root smarted with the effort
But soon the arch was following
Warm air sucking beneath me
Moments later, I was spent
The pain searing through
This unbearable feathered weight
That had carried me so high
Falling again
Loneliness swept through
And too many questions
Where could I fly, where I would not follow?
Everything I had dreamed of,
To take action when He looked on
To intervene where He watched over
To illuminate what had been left in darkness
Anger bloomed in me
The fire, left by formless friends, I rekindled
Dragged the burnished defence on to it
And waited for it to burn away
It leapt toward me copper flame,
Begging to break the mould
I drew it to me, still hot
Tended it and shaped it
Making a rounder thing of it
Spaces where light and air could move
Fashioning fur and feeling things
Silent helpers still gifting
Olive for the soul
Myrrh for surrender
Jade green jewels left at my feet, for new growth
I remember rising
Not the exact day, but I knew I could fly
My wings unfurling
Moving into the abyss which had so filled me with dread
Neither heaven above nor hell below
But something beyond both
To take my place anew
My once armoured heart, now a tender thing
My sword sharpened
In my cloak the precious chalice
And lifted off into the view
This poem reflects an image that emerged for me in various therapeutic settings and in my dreams. I realised that part of my struggle was to make sense of a God who had not intervened to save my brother who died aged 26 from a very aggressive cancer and many of my patients who also longed for life. Then came an understanding that I was trying to intervene in impossibly difficult clinical cases, and I found myself connecting to Lucifer, the light bearer, who had become angry with God and wanted to do things differently. As you know he has had a bad press, but I found myself exploring whether even he could find a new way of being, hence my poem The Fall.
References
- Chodron P (1997) When things fall apart: heart advice for difficult times. Shambala Publications.
- Firth J, Gangwisch J, Borisini A, Wootton R, Mayer E (2020) Food and mood: how do diet and nutrition affect mental wellbeing? BMJ, 369. Glouberman D (2002) The Joy of burnout. Skyros Books.
- Hahnemann S (1810) The Organon of Medicine.
- Maizes V, Horwitz R, Lebensohn P, McClafferty H, Dalen J, Weil A (2015) The evolution of integrative medical education: the influence of the University of Arizona Centre for Integrative Medicine. J Integr Med, 13(6) 356–62.
- Sabbage S (2016) The cancer whisperer. Coronet
