David Peters, Editor-in-chief, JHH

Published in JHH 19.1 – Integrative Medicine

Introduction

Our body and mind constantly adapt to change and challenge. We stay ‘healthy’ if they get what they need. Like a spinning toy gyroscope, if there’s not enough energy in the system and we are not pushed too far, balance is maintained. On the other hand, if something is lacking or the challenges are too great then illness follows. So what kinds of stabilising ‘energy’ does Life need in order to thrive in us? How do we get it and keep it? What helps maintain this complex harmony? If we are ‘out of tune’ how do we restore health and harmony? These questions are at the heart of integrative medicine: multilayered questions that biology alone cannot answer.

Modern scientific medicine is sometime called biomedicine. The 21st century challenge is for us to re-imagine medicine. The challenges healthcare faces go beyond biology. Can we keep what’s best in modern medicine but rediscover the art of medicine and refresh its soul and spirit? You might ask why we need to, for surely scientific medicine has triumphed in so many ways. Yes it has, but it is in crisis: the rocketing costs of long-term stress-, lifestyle- and environmentally-mediated chronic disease are forcing medical systems to deliver on an industrial scale. As techno-medicine gets ever more impersonal, there’s nostalgia for former times (did they really exist?) when doctors seemed as interested in who a person is as they did in what disease they had. And there’s concern about side-effects and about doctors’ overreliance on pharmacy and hi-tech; yet also disappointment when hopes for chemical fixes can’t be found, or when cures are bought at the expense of feeling understood and cared for ‘as a whole person’. There are widespread misgivings both within and outside the healthcare professions about over-testing, over-diagnosis and over-treatment.

Medicine in crisis

You might think that working to make people better would be a source of true job satisfaction. But many health professionals feel disenchanted by all this, as they struggle to meet their own high standards and stay fully human in under-resourced impersonal systems. In fact ever more doctors and nurses are burning out, giving up or retiring early. This loss of expert know-how is a cause of worldwide concern because medicine faces a twin crisis of cure and care. The technical tools doctors rely on to fix the biological facets of disease – drugs, operations and radiations – deliver many amazing fixes. But for tackling complex long-term mental and physical health problems, or as a basis for prevention or selfcare, they fall short. And in turn, biomedicine’s many technical imperatives leave those clinicians who have a calling to heal profoundly dissatisfied and disillusioned with their work.

Nearly a century ago Carl Jung warned that technology’s grip on society would before long hold the human soul hostage. He believed the mechanical (now electronic) world we have made seduces us to ignore our true needs. This, said Jung, was the source not only of much personal distress and illness, but ultimately why world wars are waged, and why our way of life despoils land, air and oceans. Ominously too, he predicted that if these inexorable trends persisted, humankind and even life itself might not survive. His remedy was for a renewal of the participative, respectful, dependant relationship which humankind once upon a time enjoyed with Mother Earth. This co-evolved, ancient bond has faded ever more from view as our species set itself above and apart from nature. Yet it still calls us home. It has been called biophilia.

How is this relevant to healthcare?

Ideas about health and illness change over time. But wherever and however people seek to explain the human condition and its discontents, their questions and their conclusions inevitably reflect the assumptions of their culture, with all its beliefs about ‘reality’. Inevitably modern biomedicine is a product of our technologised society, a society largely divorced from nature, and dominated by sceptical scientific views about soul, the inner self and life forces. But paradoxically the rising tide of long-term lifestyle-dependant, environmentally mediated and stress-related illness and disease – all of them entangled with and often caused by the ways we live, think, work and consume – are largely impervious to the technologies that biomedicine has to offer. Consequently, many people and their doctors are looking outside of the biomedical box.

Times are changing

They need to and fast, because doing what we have always done won’t steer us out of our planetary crisis. Scientific and medical thought and research proceed, in the main, along the furrows they know best. The world of academic research and clinical medicine are alike in that they function in specialist silos: most biologists don’t hang out with anthropologists; nephrologists seldom work alongside psychologists. Fortunately science is becoming more holistic, more transdisciplinary, largely because single discipline reductionist approaches, though they can solve simple linear problems, fail where complex whole-system phenomena are concerned. However, precisely because organisms, minds, climates and cultures are non-linear, chaotic and unpredictable, the most pressing challenges to health and to the environment are large-scale and complex: single track thinking just cannot comprehend them.

The solutions to our multi-stranded health crisis will (to paraphrase Einstein) be simple, but they must not to be too simple. Big Pharma, Big Ag, Big Food and Big Oil, all by applying powerful narrow science, have ploughed deep furrows across the field of human wellbeing. No doubt without them many folk would be sicker, hungrier and colder, but the ways of thinking that underpin these vast enterprises have themselves become a problem. If we are to make more joined-up sense of human health and planetary flourishing, healthcare (and you might say our way of life) must somehow clamber out of the furrows they have been running in.

If humans are so complicated, is medicine too simple?

If it’s to be worthy of being called integrative, integrative medicine should aim to consider how disorders in the body, or mind, or society, environment, and perhaps in the soul or spirit, lead to illness. If we understood how these realms overlap and synergise then, in the light of this much broader diagnosis, we could intervene more effectively, whether that be through body or mind, and probably through changes in society itself, to make healing possible.

Medicine would then become more integrative because people are complicated. We know this: that mind and emotion affect tissues and organs, but also that the opposite is true, for physiological disorders can impact on emotion – anxiety due to an overactive thyroid, a depression to hepatitis. The question of nature or nurture? It’s both: blue eyes can ‘run in the family’ but so can abuse and trauma, or a certain artistic and musical ability. Genetics? Several generations of rats can inherit the original mother’s anxiety. Is this nature (like blue eyes) or changes in nurture (like having piano lessons)? Or do epigenetics cross them over? Neurons that fire together will soon enough wire together: so what are the limits of such neuroplasticity? Can the unwell mind-body be re-wired? We know that having only a few adverse childhood experiences may have a massive impact on a person’s lifelong psychological, social and physical health outcomes. Should society therefore do more to make sure children have happier childhoods? We know that early infant attachment sets a person’s emotional thermostat for the rest of their life. A handbook on how to rear resilient babies might help a bit, but if we are serious about big picture integrative medicine, who’s job would it be to support families wanting to break their chain of ancestral trauma? Bereaved men die more often than widowed women because male grief paralyses killer T cells. Unhappiness gets into cells and loneliness is as big a health risk as a smoking habit. Prolonged stress is proinflammatory. Depressed people are more likely to get heart attacks. Poverty means a poor man’s life is likely to be 18 years shorter than his well-off neighbour. It’s clear that political policies impact hugely on well-being and health. Should the politicians’ central task be to increase human well-being? In which case at whose expense; ideally not the planet’s.

My point is that good medicine – integrative medicine – should not ignore the indivisibility of mind and body and that 21st century science is already breaking down the walls that kept these realms in their silos. Much food for thought and controversy here, so I hope readers will correspond to the editor.

Three kinds of mind body system

The body is incessantly in motion; even when immobile and asleep, circulation, heartbeat and breathing never cease. Every cell is constantly nourishing and renewing itself, as food is processed and oxygen pours in to fuel the biochemical furnaces that give us energy so that life’s physical and mental challenges can be met by emotional and physical adaptation. Yet the whole body mind organism self-regulates, as every living cells die and are replaced until, over the course of only a few years every molecule in the body will have been reinstated. The body itself is a community: every cell a symbiotic combination brought about billions of years ago when mitochondria first migrated into archaic organisms. Nor is the body only human: the microbiome constitutes more than half the body’s cells!

The human creature has three interdependent ‘bodies’: the biochemical or metabolic body, the structural and movement body and the psychosocial body (mind). So in healthcare we need always to be thinking about how the three bodies are interacting. In addition, there is a fourth M, to consider: M for the meta-management of the organism as a whole. This self-regulation is made possible by flows of information emergent form the other three Ms and encoded chemically, electrically, and in the body’s stretching, vibrations and pulsations.

The 4Ms of metabolism, movement, mind/mood and meta-management are a framework for thinking about how these entangled ‘bodies’ create health and illness. Of course the four are in reality inseparable – whatever impacts on one will affect the others to a degree – but they are a convenient fiction and – provided we don’t mistake the map as the territory – useful way of looking at the option for what we might integrate into prevention, diagnosis or treatment.

Integrative medicine aspires to encompass all three Ms. Obviously some therapies are more directed at a particular M: herbal medicines, nutritional supplements more at the biochemical metabolic category, physical therapy, chiropractic or massage work through movement and touch, psychological therapies through the mind and emotions. Homeostasis is usually thought of as primarily biochemical, with how in trillions of cells, billions upon billions of molecules interweave in an unending dance of intricate reaction pathways.

It’s true that second to second, life depends on the body having energy, and that metabolic wastes and toxins don’t build up and poison it. As oxygen and information pour through every cell, tissues don’t cool down too much or overheat. This truly mysterious ability of life depends on an as yet barely understood ability to ‘self-organise’. We can assume that these myriad chains are meta-managed by the information flows that emerging from the complex interplay of the three ‘bodies’ – through a dance of metabolism, movement and mind.

A simple example: ischemic heart disease is more likely for someone who has too much cholesterol (a metabolic imbalance), who doesn’t move enough or has high blood pressure (movement issues) and in addition if their response to stress is over-activated (mind and mood). Integrative prevention or treatment requires that all three Ms be addressed.

A fourth M: the intelligent body

We generally think about intelligence as something in the brain, and that the brain controls the body, like some all-powerful phone operator sending telegraph signals down into dumb tissues. Nowadays though its common knowledge that the traffic of electrical and chemical messages is two-way so that the whole body is an information network. Every cell entwines with a filigree of nerve endings, and every cell membrane is etched with receptors for the hormones and neurotransmitters that Candace Pert called ‘molecules of emotion’ (Pert, 2012). The psychologist Michael Hyland, comparing the brain and body to an extended computer network of parallel processors, proposed that this elaborate cloud of information is what enables ‘the intelligent body’ to maintain life. Every cell in the body has a voice in this impossibly complex choir, yet though it has neither a score nor a conductor, still in health their myriad voices work rhythmically together in harmony. Like fragments of a hologram – every cell contains the entire chorale, and so can respond in resonance with the whole.

Modern medicine performs brilliantly with many health problems: antibiotics for an infection, replacement therapies, chemotherapy to do battle with cancer cells, pain relief, anaesthetics, life support, joint replacement – the list is a long one: but when the information system itself is upset the body won’t function well, yet the usual blood tests and scans look completely normal. In computer terms there’s nothing wrong with the hardware so doctors call such problems ‘functional disorders’ and scratch their heads over the ‘medically unexplained symptoms’. They do what they can to reduce symptoms, whereas the integrative approach which views functional disorders – irritable bowel syndrome or migraine or restless legs syndrome, or pain syndromes – as software malfunctions, would aim to trigger whole mind-body healing responses. Fortunately the intelligent body information network can absorb many different kinds of quite non-specific input. This might be a combination of the three Ms: possibly metabolic, a change of diet or a well-chosen botanical medicine; maybe a movement- or touch-based therapy to reduce stress-arousal; a mind-mood intervention to encourage reappraisal or enable insights through art therapy, journaling, coaching or counselling.

Some clinicians have found a repository of healing resources in older traditional medical knowledge which, lacking western technologies and test instead have accumulated centuries of experience and observation of healing processes and natural ways of promoting them through for instance herbal medicines, acupuncture, touch and trance. Perhaps, as science gets a holistic grasp of emergence and complexity it will comprehend what traditional healers mean by ‘life force’ or ‘energy body’. Psycho neuroimmunology and neuroscience – still quite new inter-disciplinary fields – have already given us a better understanding of mind-body self-regulation. It remains to be seen whether science will in time reveal how a homeopathic medicine or the stimulus of an acupuncture needle could convey subtle information into the intelligent body information network. All this is speculation (we should keep an open mind but without our brains falling out) but I can imagine that informational meta-management medicine will one day be reality.

Resources

Hyland ME (2002) The intelligent body and its discontents. J Health Psychol, 7(1) 21–32. doi: 10.1177/1359105302007001649. PMID: 22114224.

Pert C (2012) Molecules of emotion. Why you feel the way you feel. Simon & Schuster UK.