Viewpoint

Holism and Medicine

Professor David Richmond

The oldest concepts of the nature of the person were essentially theological. The Hebrew of the Old Testament used words for physical life, reaction and interaction via the mind, will and emotions and the inner spiritual or godlike quality interchangeably, indicating unity of personhood.

This concept was not shared by the later Greek philosophers. Plato and his followers taught a dualistic concept of the nature of the person in which the immortal spirit was imprisoned within the inferior body. At death, it was released to the spiritual realm where it could exert its full potential. This philosophy was carried over into Christendom and became official church dogma in the 10th century.

In the 17th century, the French mathematician René Descartes, a pivotal figure in the establishment of the scientific method, came to the conclusion that mind and matter were separate and fundamentally different. He advanced a concept of the person in mechanistic terms, and this idea was strengthened with the discoveries of science in the 18th and 19th centuries.

Charles Darwin's 19th-century theory of evolution set even the origins of life within a mechanistic world view requiring no supernatural explanations. The so-called Age of Enlightenment drew all these threads together in a reaction against the spiritual as having any great relevance to human affairs. Thus the body and its functioning became the main focus of scientific endeavour, to the neglect of psychological, social, spiritual and environmental aspects of illness.

Twentieth century medicine has been profoundly influenced by this legacy. The dominant scientific stream of thought has focused strongly on the physical aspects of life. The spiritual is at best irrelevant to health; at worst an aberration of the human imagination.

The scientific-secular world view, together with the development of the scientific method with its reductionist approach, have contributed to the specialisation of medicine. Specialisation has been vitally important in the advancement of medicinal knowledge, but it has contributed to a loss of the concept of the whole person. This has resulted in a detrimental approach which regards sick people as "cases". It has led to a suspicion about the validity of the functions of various professional groups including the chaplain, the psychiatrist, the psychologist and counsellor. It has contributed to the separation of groups of health professionals and has threatened communication by the development of specialist jargon. It has emphasised the importance of so-called "hard" data -- the results of laboratory tests -- over "soft" data, which includes enquiries into how patients perceive their illness and how that affects the disease. It has encouraged a low priority for health services for groups who are not particularly valued because they do not require high tech, scientifically interesting and financially rewarding interventions.

The winds of change are, however, stirring. Society has begun to realise that science does not hold the answer to every human ill. At the same time the very progress of research has begun to re-emphasise the unity of human physiological processes. For example, in the last 40 years the kidneys have been shown to possess complex endocrine functions, the heart to be a member of the "endocrine orchestra" and the appendix part of the immune system. As a result of such findings, the subspecialties have been forced to cross over into each others' domains.

Other gaps are closing with the discovery that there is an interdependence of the psyche and physical function. It is now understood that emotional distress modulates immunologic mechanisms of the body in such a way as to enhance the likelihood of cancer developing. Depression reduces the responsiveness of lymphocytes to stimulation and the number of T lymphocytes in the body. Physical disease and disability can cause psychological and psychiatric problems. Psychiatric illness may masquerade as physical disability.

All of this is bringing about a new ethos in medicine in which the interdependence of disciplines is recognised as a necessity.

This return towards a holistic view of the person is however not sufficient. The spiritual dimension, trivialised by 19th-century philosophy, must be recognised as a potent source of healing power. Is there any evidence to support this view? There is.

It comes from two sources: first, the experience of people with physical and psychological illnesses which are clearly based on disorders of the spiritual and moral life. These can be healed by the "spiritual therapies" of repentance, restoration for wrongs, forgiveness and a renewal of a Godward relationship.

Secondly, from the research literature. Although religious measures are largely neglected in scientific research, when they have been studied they have shown religious commitment to be of great benefit for physical and mental health.

My thesis is that until the conceptual gaps which remain between the physical, the psychosocial and the spiritual attributes of personhood are closed and personhood viewed once again as a unity by society and health professionals alike, then medicine will continue to be denied its full healing potential. Science without spirituality is as limited in its potential for healing as was spirituality without science in times past.

David Richmond is professor of geriatric medicine at North Shore Hospital in Auckland.