Critically examine whether complementary and alternative medicines offer a distinctive understanding of health and illness?

The old scientific discourse of biomedical medicine has encountered a threat to its hegemonic position; the new arising form of health care, the Complementary and Alternative Medicine, has given birth to a new pluralism in the medical system (Cant & Sharma, 1999). Complementary and Alternative Medicine can be generally described as a distinctive form of health care that is at odds with the conventional medicine which mainly subscribes to scientific scrutiny and proof (Yuill, Crinson & Duncan, 2010). However, this broad definition has been subjected to criticism because within the area of this complementary and alternative medicine there are significant differences in their practice and philosophy; for example the degree of holism (i.e. discussed in the main body of the essay) in one practice can be higher or lower than in another. This is also where the distinction between alternative and complementary takes place: alternative medicine totally refuses to recognize any similarity with biomedicine (i.e. conventional medicine), whereas complementary medicine is seen as an addition and not a challenge to the orthodox medicine. Nonetheless, this essay will refer to these practices in their totality as Complementary and Alternative Medicine (i.e. CAM) (Cant & Sharma, 1999; Heller et al., Yuill, Crinson & Duncan, 2010). This essay will analyze the claims of CAM and their actual impact on how health and illness are understood, treated and integrated in peoples life and how these differ from biomedical practice. Thus several different characteristics of the alternative approach are going to be proposed for this discussion and critically compared to the conventional health care system. The main CAM aspects such as its: holistic view, individualistic approach, consultation environment, relationship between patient and practitioner, naturalistic approach, and integrative

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or independent status. These main characteristics will be then considered, explained and expanded in the main body of this essay so as a better understanding of CAMs discourse shed light on its genuine or apparent distinctiveness from conventional medicine.

Firstly, we will explore the concept of holism and individualism in relation to CAM. The concept of health is seen here not just as the absence of disease, which is maintained by biomedicine, but as a relationship between body and other aspects in an individuals life such as spirituality. This philosophy can also be traced back in Western history with the Christian ideology of morality. The habit of eating meat was seen as a stimulant for weak morals and sexuality, the ascetic idea of vegetarianism was then promoted for the cleansing of both body and soul (OConnor, 1995). Thus, the reductionist attitude of conventional health care, which strictly deals with parts of the body, as if they were parts of a machine that have to be assembled again in order to function at their maximum capacity; is confronted by CAM. By rejecting the either/or thinking characterizing the biomedical model in favour of multiple realities or ways of knowing CAM allows for a wide variety of belief systems and cosmologies (Stone and Katz cited in Heller et al., 2005: 159). The main CAM healing treatments are, however, unique varying from one alternative practice to another. The more mechanistic way and similar to biomedicines way of dealing with pain is encountered in some osteopathic and chiropractic approaches, homeopathy and ayurvedic medicine (i.e. traditional Chinese healing practice) are more inclined to regard illness as an imbalance in the humans entire system, which does not only result from the physical components of an individual but from their entire way of living, their personal health history, how they react to pain and what meanings they attach to different things. Nonetheless, this can also lead to a clash between the practitioners and the patients

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beliefs and ideas of what illness is, which can then lead the patient to find another practitioner that is in accordance with hers or his life experiences and ideas. This also puts the patient in a position to shop for health care, and consume the best alternative for him/her (Cant & Sharma, 1999; Heller et al., 2005; The Open University, 2005). The alternative medicine proposes a way of living that maintains health and works with the imbalance or illness from the inside, leaving the body to heal itself; standing at odds with orthodox medicine that is external, which views the body as a battle field in which the illness needs to be exterminated in order to restore health. Dissatisfaction with orthodox medicine is being illustrated in many alternative literatures (Cant& Sharma, 2005; Lupton, 2003; Furnham, 2002), who point at its failure to cure chronic pain and the lack of disregard for the individuals personal history that might have an impact on her or his health situation. In another words CAM offers more meaning to the patients and allows them to link their illness to wider cultural, personal and social frameworks (Cant & Sharma, 1999: 4243). Stevenson et.al (2003) also point out that the iatrogentic fear (i.e. the complications that might appear after taking a specific biomedical treatment or intervention) is also a factor of why alternative medicine is increasingly sought, however, this will be discussed further on along with medicalization and the natural characteristics of CAM.

Going back to the holistic distinctiveness, the whole idea that: the body can heal itself, that it maintains a certain balance and harmony in order to function correctly or that it requires the natural flow of energy arises certain problems. Lupton (2003) points out that from an ethical point of view, alternative medicine does not eliminate the preaching attitude in teaching what is good or bad in order to function properly and be a healthy human being. He also acknowledges that using the metaphor of energy or the flow of energy that is being used in many CAM

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discourses may indicate a capitalistic-mechanic mode of production. This also implies that the individual as a whole (both with hers or his objective and subjective characteristics and not just the physical body) has to function to its full capacity so as it can be efficiently used in the production of hers or his life; it suggests efficiency, a metaphor of the body as productive, not wasteful or static, but in tune with its environment and expanding in productive possibilities (Coward cited in Lupton, 2003: 138). Moreover, even if the patient can better reflect and perceive his/hers own body and emotions, the empowerment of the individual to self-regulate its own body, takes much of the responsibility of restoring the health from the practitioner and bestows it to the patient. This is also being a biomedical critique regarding CAM, that in the end it is the individuals own fault if health/balance is not restored (Albrecht, Fitzpatrick & Scrimshaw, 2003; Siahpush, 2000).More so, blaming the individual and referring only to the immediate and psychological experience of the individual only distracts the attention from other underlying causes of illness, that is the social, structural and political impact that may affect the individuals quality of life. This has been also tied with the self-help movement which is criticized for being more or less a characteristic of the middle class and also blaming the agent rather than the structure (Lupton, 2003; Radley, 1999). From a Foulcauldian perspective, the self regulation of the individual and also in the self- helping groups (e.g. Alcoholics Anonymous through public confession) can also present themselves as a normalizing practice which replaces the physician scrutinizing gaze with the practice of personal surveillance, thus holism does not empower the individual, for it does not provide effective social and political analysis of the causes of ill health ( Cant and Sharma cited in Albrecht, Fitzpatrick & Scrimshaw, 2003: 429) (Albrecht, Fitzpatrick & Scrimshaw, 2003; Cant & Sharma, 1999; Lupton,2003; Radley, 1999).

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Another distinctive feature of the heterodox medicine in relation to conventional heath care are the conditions under which the consultation takes place. Jewson (2009) acknowledged that there has been a major shift regarding the relationship between patient and practitioner after the rise of modern medicine in the second part of the 18th century. What he described bedside medicine was a practice that resembles very much with the alternative care in contemporary western society; the whole patient was the centre of the attention and he/ she were the ones who discussed the terms in which they preferred to be treated. In other words, the patient was empowered, he/she had a say in the kind of treatment it was given and the nature of the disease was defined in terms of its external and subjective manifestations rather than its internal and hidden causes. In accordance with this principle diagnosis was founded upon extrapolation from the patients self report of the course of his illness (Jewson, 2009: 294). Cant & Sharma (1999) also argue that orthodox consultations are hierarchical and put the patient in a position where she/he is seen as a broken object that is studied in order to fix it. The consultations in most of the CAM practice can go up to 2 hours in which patients can develop a kind of relationship with the practitioner, which can also be seen as a therapeutic treatment and an enabling factor to the recovery of the patient. However, this lengthy time frame must not be generalized since as we shall see in the last part of the essay, the integration of CAM in the conventional health care system might not have the same benefits; for example some more mechanized therapies such as osteopathic and chiropractic consultations may last only 20 minutes. These qualities, such as the amount of time spent with one patient and the more equal relationship between patient and practitioner is perceived to be one of the main reasons for CAMs growing popularity. In this environment the body is no longer seen an object but an active participant in its healing. Astin (1998) argues in one of his study that users of CAM address more often feelings of not being Iulia Maria Coanda Page 5

well which can be explained by the fact that users are being affected by somatisation (i.e. somatisation is described as feelings of pain and poor health that are not attributed to physiological accounts) which can affect further studies in why people seek alternative care and how this might helps them in their recovery. Moreover, he attributes the new western attraction for alternative medicine to a new paradigmatic shift in cultural values and beliefs that are more open to ideas of holism and spirituality.

Cartwright & Torr (2005) and Siahpush (1999) argue that conventional medicine produces alienated and dissatisfied patients (Siahpush, 1999: 160) which is described as a Fordist health care system; the consultations are short and often practitioners can seem disrespectful with the patients. In contrast to this, because of the closeness that can develop between patient and practitioner in a CAM environment, it can offer a more psychological, almost religious need which can aid patients in making sense of their anxieties; as one homeopathic patient describes: I talk these things through... and just talking about them almost gets them out of my system Im sure, and then I feel better even without the remedy she is giving to me (Cartwright & Torr, 2005: 563). The trust of the patient is also gained because in this relationship there is no expert or ignorant patient but an egalitarian interaction, which makes the distinction between alienated and active patients. Nonetheless criticisms of this beneficial relationship argue that CAM is more or less just a placebo effect. That is, the healing of the patient does not depend on the treatment involved but in the mind of the patient; this means that the healing is perceived and not totally eradicated. Other shortcoming of the relationships between practitioner and patient is that the therapeutic side of the treatment might make the patients health worst. Secondly, it might result in a failure to communicate with the practitioner because of clashes in personal beliefs or that

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boundaries between patient-practitioner might be breached and might end up in the patients dismissal: I still go now that I am well and talk to him about any old thing. But he has suggested that I do not see him for a while (Cant & Sharma, 1999: 41) (Cant & Sharma, 1999; Frank, 2002; The Open University, 2005). With regards to the orthodox hegemonic medicine, analyzed from a Fouclaudian perspective is acting as a surveillance power for the purpose of normalizing the population through the practice of its scientific discourse; that is the moment one is born it is subjected to the watchful eye of biomedicine. However, alternative medicine is not so far away from this criticism. The abundant exchange of information that takes place in the consultation covers aspects that are not just physiologically important but also cover every other aspect in the individuals life, thus medical surveillance becomes totalizing [...] humane and holistic medicine is castigating as extending the web of medical power and surveillance ( Nettleton, 2008: 165). Therefore, so far the analysis has covered the more personal aspects of CAM; however, next we shall discuss the consumerism and biomedical integration of alternative therapies in the new postmodern society.

Moving forward, alternative medicine must be also considered in the contemporary societal landscape and not as an individual entity. As pointed earlier in this essay, the fear of iatrogenic consequences has pushed users to search for more natural remedies that do not involve conventional chemical treatments. However, this search for a purer consumption has made users of alternative medicine extremely concerned about their bodies and maintaining a healthy lifestyle. This has been called the body project whereby people increasingly see the body as an unfinished project to be shaped by lifestyle choices (Cant & Sharma, 1999: 27) (Cant & Sharma, 1999; Cartwright & Torr, 2005). Rayer & Easthope (2001) have argued that

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postmodernity (i.e. in economic terms, consumption has taken the place of Fordist mode of production in the present market system) has integrated CAM in the economic landscape as the new source for consumption. This mode of consumption he argues has shifted from a chemicalized, risky and polluted purchase of goods, such as alcohol, to a new self-medicalized ascetic cult, interested in organic food shops and herbal remedies. An estimation of CAM consumption by The Pharmaceutical Society of Great Britain is of about 240 million pounds for herbal products. The purchase of alternative medicine, as much as it is holistic it is also prone to inequalities. Lupton (2003) maintains that poor people are confronted with higher morbidity levels than people who are on a higher socio economic ladder and who do not received their health benefits from orthodox medicine but from the more costly alternative medicine: the barriers of the greater financial cost to the patient serves as an effective limitation of the services of alternative practitioners to the more wealthy (Lupton, 2003: 138). Moreover, criticising orthodox medicine for medicalizing people and praising CAM for the liberation of conventional therapies can be argued to be just a facade since alternative practices invite consumers to succumb to a healthy way of living, monitoring their emotions, thoughts and embracing spirituality. Nonetheless Rayer & Easthope (2001) write that not all studies relate a high social economic status to the consumption of alternative medicine, but rather to the choices and values that an individual possesses. The consumption of holistic medicine is mediatised from aromatherapy advertisements which invite the consumer to a more holistic life to the individual responsibility to protect ones health by having a more active life. Thus, consuming health products is not necessarily restricted to orthodox pharmaceutical products but also to CAM practices that involve the purchase of products which resemble natural and pure.

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The last issue of this essay is the professionalization of CAM. The integration of alternative medicine in biomedical settings by doctors and government was due to its popularity among consumers. However, some had more success than others in doing so. For example, osteopathy because of its more mechanized principles it was generally better accepted by the biomedical power. Nonetheless, alternative medicine was in general dismissed on the base that it had no empirical evidence to support it (Cant & Sharma, 1999). Stevenson (2003) indicates that because of this mismatch patients were reluctant in telling physicians about consulting a CAM practitioner and appeared inhibited from discussing it according to perceptions of the legitimacy of the remedy in question (Stevenson, 2003: 525). Mizrachi, Shuval & Gross (2005) name the integration of CAM in the conventional practices of medicine as reconciliation. They argue that even though a more holistic approach is sought, the ethos of biomedicine is still prevalent in physician institutions, such as the hospital. In their research, taking place in an Israelian hospital, they interview a physician trained in alternative medicine, who clearly expresses that the only way CAM would be fully be integrated in the biomedical system is through the validation of the benefits of CAM by subjecting them to scientific scrutiny. He also argues that in the hierarchical order of biomedicines environment alternative practitioners hold the lowest position and are fully assimilated by morphing the appearance and the attitudes physicians have toward patients, which are formal and cold. Hirschkorn & Bourgeault (2005) also noted that the bureaucratic duties in the orthodox clinic impede them to give the patients same holistic treatment and lengthy consultations that private practitioners have, also suggesting that the high costs of CAM consultation also restrain physicians to recommend such practices. Adding to this, Frank (2002) also finds that in his research involving the practices of homeopathic physicians, that the constrains of the biomedical system can hinder their alternative physicians practice; for

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physicians acting within the system of public health insurance it is the limited time- frame which causes most trouble. The economic pressure leads to shortened consultations and clashes with some patients expectations of extensive care (Frank, 2002: 1292). Thus, the integration and professionalization of CAM in the conventional system is not a smooth transition but restraining traditional practices and coercing them to mould according to the empiric medical practices.

In conclusion, we can map a generalized distinctiveness about alternative and complementary medicine, being that it has striking differences ,compared to biomedicine, in how illness, body and health are viewed: the discourse of alternative therapies seek to recast the imaginary of the body and disease by moving away from aggressive military metaphorical conceptualizations of the body, to depicting the body as natural, self regulating and part of wider ecological balance (Lupton, 2003: 138). Nonetheless, this holistic and individualist approach does not leave behind biomedicines shortcomings: it can be argued that it is a new form of surveillance, more thorough and self learnt than the more coerced by the orthodox medical power; or that even if CAM connect the physical wellbeing with the personal and psychological, it fails to recognize and acts as a veil for wider structural inequalities that are one of the main causes for poor health, by blaming the individual for emphasising a personal responsibility for a healthy lifestyle.

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