Introduction

This discussion is written from the perspective of my professional experience as an Integrative therapy practitioner (more specifically, Essential Oil Therapist), lecturer and author of related books, and  generally describes my awareness of the issues involved.

Background

Integrative medicine is a broad term that umbrellas a spectrum of healing modalities, from complementary therapies to bio medical, ranging from the ethereal realms of Reiki and distant ‘healing’,  to the physical manipulation of chiropractic and osteopathy, acupuncture and the practical intervention of diet control and naturopathy, and aspects of biomedicine, psycho-therapy and emergency care.  Integrative medicine views clients or patients in holistic context as sovereign; autonomous interdependent individuals comprising body, mind, spirit, and soul.  Modalities in this spectrum focus on nurturing balance and equilibrium to restore and maintain health and healing; treatment and support focuses on restoring physical, psycho-emotional, and spiritual harmony.  Dis-ease and/or dysfunction is addressed within this holistic context, extending beyond the one-disease or dysfunction one-treatment approach of pharmaceutical-driven biomedicine.   Integrative medicine melds aspects of conventional (allopathic) healthcare with complementary medicine or therapy practices, thus, creating an overarching, eclectic approach to health care.

Integrative medicine modalities, therefore, are naturally underpinned by holism and are, and have always been, practiced as potentially interwoven specialities that may, if necessary, be overlaid at one and the same time. For example, an acupuncturist, depending on their underpinning premise, may use oral herbal remedies as well as stimulating (either using very fine needles or moxa) specific meridian points as a collective measure to achieve the rebalance of ch’I (the unencumbered flow of energy throughout the meridian system within the body).  Or, a client receiving allopathic treatment from their GP for, say, mild depression and/or anxiety, may be advised to also receive, say, essential oil therapy and/or attend mindfulness or yoga classes to aid their relaxation, and/or counselling sessions to assist in re-framing their psycho-emotional response or attitude. Or, an individual may elect to use, of their own volition, say, aromatherapy massage, to deal with their insomnia and/or headaches and/or eczema, synchronously with dietary intervention following an allergy/food intolerance test. Bach Flower Remedies apparently influence subtle physical, mental and emotional energetic resonance within the body and are applied to harmonise or rebalance mood and emotional attitude, and may safely be used by virtually anyone in isolation or concurrently with allopathic medication and/or other complementary therapies. And so on.  A person may select one modality or method according to their condition and/or personality, for example, homeopathy, acupuncture or chiropractic, to work on the underlying fundamental precursor, as well as the symptoms, of their condition or dis-ease.  I observe from my own practice that integrative medicine and/or therapies, for example, are also frequently utilised as a preventative measure, to support and maintain wellness, to ‘manage’ the effects of stress and to navigate challenging health and life events.

“Vibrational healing methods represent new ways of dealing with illness. Practitioners of subtle-energy medicine attempt to correct dysfunction in the human organism by manipulating invisible yet integral levels of human structure and function. Healing at the level of human subtle-energy anatomy is predicated upon New Physics understanding that all matter is, in fact, a manifestation of energy.”   Gerber (2001)

Acknowledgement and acceptance of subtle (as well as obvious) energetic resonance underpins many integrative medicine modalities (especially, for example, acupuncture, homeopathy, Bowen and healing). Unfortunately, it is the apparent vagueness, illusive, or non-tangible aspect of this energetic aspect that some allopathic practitioners appear to have difficulty accepting.  Separating the body into component parts, focusing on a single condition and applying a remedy for that condition may be useful, particularly in an emergency situation or as ‘first aid’ support, but this approach is incomplete, overlooks and is not reflective of the complexities and nuances of everyday life; the multiple overlying, interwoven dynamics and numerous variables, often difficult to disentangle, all of which interfaces to influence the whole ‘picture’.

Integrative medicine practices are increasingly popular in the West.  Indeed, over 70% of the world’s population, particularly in developing countries, where most people do not have access to bio-medicines, rely on traditional healing modalities and herbal remedies.  Explanation for this burgeoning phenomenon is explained as a reflection of public disenchantment with allopathic treatment and drugs, their toxicity and side effects, among other things.  Equally, this shift of public interest toward integrative approaches and practices may be explained as a consequence of spontaneous evolving enlightened perception and awareness, or consciousness, which, acting as a precursor, or catalyst, has naturally directed attraction towards modalities complementary to the remit of holism and acknowledgment or awareness of the seamless interconnection between body, mind, and soul and subtle vibrational energy resonances or fields, and spirituality (a sense of being more than the sum of our total parts).

However, some sceptics of integrative medicine modalities, (especially those that embrace subtle energetic principles), argue these pander to an individuals need for attention (affirmation and reassurance), and tend to attract those of a sensitive nature, especially ‘hypochondriacs’, the gullible and those desperate to find a ‘miraculous cure’ where conventional allopathic medicine has reached its limit. Indeed, the word ‘placebo’ is often cited in this context.  Some critics argue that emotive, romantic claims regarding the therapeutic value or processes of certain therapies are made without real substantiation, are often anecdotal accounts, and may skew or mislead important decisions about appropriate health care.  It is true that, embracing the ethereal, some of these modalities appear to be, and often are, entangled within the romantic notions of New Ageism (a media driven commercial opportunity exploited for all its material worth), obscured by the shroud of commercial hype and a leaning towards Mystic-Meg-type freakishness.

Observing my own practice, I notice that the majority of my clients are middle-class, mostly mature females, some males, who generally have access to a ‘disposable income’, therefore, are able to exercise a certain amount of freedom of choice regarding their health and wellbeing.  I am equally aware that most of my clients are generally sensible, intelligent professionals; many of my clients, for example, work (or are retired from) in health and social care, education, and management).  As a private, independent practitioner (sole trader), in order to cover costs, a minimal charge has to be applied, which consequently limits clientele to those who can afford to buy their treatments. This phenomenon is true for the majority of integrated medicine practitioners; not all integrative modalities are included in health insurance schemes.  Although some practitioners offer concessionary rates, potential clients in receipt of low or minimal incomes or state pensions or benefits, tend to have negligible disposable income; even reducing the cost of a treatment, it is still rendered an unaffordable luxury for many people.

Even so, while the above disparities and limitations do exist, people (from a range of socio-economic backgrounds) appear increasingly inclined to take personal responsibility for their own health and personal well being; evidenced, for example, through increasing awareness of and taking proactive responsibility for personal fitness, wellbeing and healthy lifestyles, the surge of interest in mindfulness, meditation, relaxation techniques, yoga, exercise, movement and mobility, diet and nutrition, and so on.  Indeed, self-help courses and advices abound – from crystal healing to yoga, meditation and mindfulness practice, to super food or exclusion diets, to name just a few.

Many integrated modalities are sanctioned (accepted or allowed) in palliative and ‘end of life’ care, where focus is on emotional support, comfort and management of pain relief; treatments, however, are mostly delivered on a voluntary basis, either ‘free of charge’ or for nominal token fees.  Funding for research and development is limited or non-existent for modalities that fall outside of the narrow realm of mainstream pharmaceutical or bio-tech parameters.

Questions

Reflection on the above indicates a number of reasons, and concerns, that support the need for high quality outcome measures and rigorous research to assess the value and viability of interventions and treatment modalities provided by integrative medicine modalities.  Fair, unbiased, carefully considered research will provide necessary validating (or not) evidence to placate scepticism, eradicate naive ignorance and encourage appropriate effective and honed application and integration within a universally accessible holistic health care system.

For example, research might be aimed broadly at:

1. Identification of limitations
2. Identification of strengths
3. Validation of efficacy measured against a holistic outcome
4. Identification of the ‘right fit’: which health issue best suits which modality?

However, reflecting on my own practice, I also appreciate that some compromise is necessary.  For example, it is not possible to completely overlay the principles and philosophy of one approach on top of the other as integral parts of a whole without acknowledgement or validity. Acceptance and integration of attitudes and methods as diverse as those represented by reductionism and holism requires a shift of boundaries and mutually, amicably agreed consensus in terms of the achievement and viability of treatments, goals and outcomes.  A universal overarching consensus must also include health and wellness maintenance and personal sense of wellbeing. Eliciting evidence embraced within the holistic philosophy of integrated and complementary medicine, which includes subtle energetic elements alongside more tangible elements (diet control, muscular-skeletal manipulation and so on) might prove challenging to a purist reductionist mindset, as much as a reductionist stance is often perceived as inadequate for integrative purist medicine mindsets.

Equally, as pointed out previously, users of integrative medicine modalities often engage various methods of treatment concurrently, rendering the outcome of a single treatment modality an unreliable indication of singular efficacy. Quantifiable data may be retrieved from consultation details, but many integrative medicine modalities tend to treat each client as an individual, with longer and more involved client-therapist interaction. Also, even if clients present with similar symptoms, methods of treatment are tailored and vary according to individual needs.  Many integrative medicine modalities also hold as valid client’s perceptions of their treatment, their personal sense of wellness, their attitude and their personal response to their dysfunction, illness or dis-ease, viewing such dynamics as integral aspects of the underlying cause and/or ability to manage their recovery and/or energetic rebalance. What may be accredited a successful outcome by one mode of thinking might be measured as a failure or a limited success by another.

For example, eliciting the quantifiable details from consultation records, I am able to determine the gender, age and socio economic status of my clients, their common underlying presenting conditions, general wellness status and identification of their reasons for coming for treatment. However, subsequent to consultation, each client has a treatment plan specifically orientated to their individual requirement, and consequently, each client is given a different blend of essential oils, which they participate in selecting on an acceptance/rejection basis. In terms of measurement of outcomes, the variables are endless in this type of scenario; success or failure tends to be judged subjectively. But does this invalidate the outcome? Clients usually come of their own volition, knowing what they expect, and are informed of the limitations before treatments commence, therefore, the rate of success is highly increased (in aromatherapy) as their expectations are already geared up for it. But does this preconception bias the successfulness of treatment? Is this not merely positive collaboration between therapist and client to achieve a desired outcome? Equally significant, clients often choose therapy as a preventative measure, for its potential emotional balancing and immune stimulating qualities. Consequently, there needs to be a system of measurement which embraces what some might regard as the placebo effect, but which others regard as an inevitable mechanistic result triggered by energetic manipulation, sometimes produced at a very subtle level, whether manifesting on a mental/emotional level, or a physical level, but which ultimately leads to health improvement or an ability to positively manage the effects and consequences of a chronic condition, illness, or recovery in general.

Summary

• Integrative medicine treatments may be applied singularly or applied (if appropriate) concurrently with allopathic treatments or other CAM methods.
• Integrative medicine treatments may be used as a preventative therapy.
• Integrative medicine treatments may be used to support wellness and a sense of wellbeing.
• The premise of most integrative medicine practices is underpinned by the acceptance of the principle that energy is an intrinsic part of all matter, and, therefore, may be influenced on subtle as well as gross, obvious, levels.
• Allopathic practitioners do not necessarily accept the ethereal element implicated in energetic medicine.
• The term placebo is often ascribed to many integrative medicine outcomes.
• Trivialising integrative medicine as a fad or hypochondriacal pursuit distracts attention from potential efficacy.
• New Ageism is entangled with some romantic notions and misperceptions that may serve to dangerously skew or misguide choice regarding appropriate health care.
• Reliable and appropriate research may placate ignorant and misguided misperceptions and identify and validate the role that integrative medicine modalities may play in health care, wellness and wellbeing.
• The reductionist view of allopathic medicine and the holistic, energetic views of integrative medicine may not completely fit into each other’s ideological framework, but evidence based research could widen the overlaying middle ground.
• Integrative medicine practices and philosophies presents many variables, and sometimes unquantifiable, results that do not necessarily negate the validity of an outcome.

Conclusion

As a practicing integrative therapist, it is difficult for me not to display bias. If legitimate integration within a universal health care system is to be achieved, then all possible views and angles must be explored and properly evaluated to enable effective and productive synthesise into a realistic, workable and universally accessible health care infrastructure, perhaps with equal emphasis on the validity of ‘wellness’ (and ‘feeling well’) and preventative measures of maintaining health and wellness as there is on ‘cure’ and pharmaceutical and/or biomedical intervention. Success of treatment, measured within a broader context and set against a holistic perspective, will provide realistic innovative insight and development.

Research Methods

Phenomenological

Methods

• Independent research
• Interviewed by researcher
• Client’s views of process and outcome
• Practitioner’s views of process and outcomes

Process outcome/bias

• Qualitative
• Some quantitative
• Single case studies
• Time consuming

Practitioner based

Method

• Researcher elicits information from clients and therapist regarding outcomes and procedures

Process outcome/bias

• Quantitative
• Qualitative
• Researchers interpretation
• Inference of questioning
• Time consuming

Practitioner as researcher

• Practitioner from single discipline
• Practitioners from various disciplines – Independent Researcher to collate collective outcomes

Process outcome/bias

• Quantitative
• Qualitative
• Case Studies
• Anecdotal
• Risk of bias

Independent researcher

• Both potential for non-bias and bias outcome depending on motivation of researcher(s) / funding body (Duerden, 2003; Jenkins et al, 1998; Clegg, 1997)

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