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HOLIST~1

HOLIST~1

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Published by: Hasty Wahyuni on Feb 15, 2013
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02/15/2013

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Faculty of Medicine Gadjah Mada University

Holistic Approach and The philosophy, mental, social, and spiritual impact of health care
Question: What is the concept of health care? What is the role of doctor as a profession in public health system?

WHAT IS HEALTH
HEALTH IS DEFINED BY THE W.H.O AS A STATE OF COMPLETE PHYSICAL, MENTAL, AND SOCIAL WELL BEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY HOWEVER, THE MENTAL COMPONENT OF HEALTH REMAINS AN AREA OF CONSIDERABLE NEGLECT IN MEDICAL PRACTICE

WHAT IS THE IMPACT OF DRUG ABUSE MORTALITY RATE 17.56% ORGANIC MENTAL DISORDER PSYCHOTIC DISORDER --.90% CANCER. HIV/AIDS TO DECREASE LIFE EXPECTANCY + 10 YEARS TO INCREASE CRIMINALITY ECONOMICAL IMPACT .10 % HEPATITIS 56.57 % HEPAR DISTURBANCES 55.PERSONALITY DIS.SUICIDE ANXIETY DISORDER RELAPS RATE 43.16 % RESPIRATORY DISTURBANCES 53. DEPRESSIVE DISORDER --.

THE DOCTOR MUST WEIGH THE RELATIVE CONTRIBUTIONS OF SOCIAL AND PSYCHOLOGICAL AS WELL AS OF BIOLOGICAL FACTORS IMPLICATED IN THE PATIENT’S DYSPHORIA AND DYSFUNCTION . THE DOCTOR’S TASK IS TO ACCOUNT FOR DYSPHORIA AND THE DYSFUNCTION WHICH LEAD INDIVIDUALS TO SEEK MEDICAL HELP. ADOPT THE SICK ROLE. AND ACCEPT THE STATUS OF PATIENTHOOD.HOW DO THE DOCTOR ASSIST PATIENTS A BIO-PSYCHO-SOCIAL-SPIRITUAL MODEL WOULD INCLUDE THE PATIENT AS WELL AS THE ILLNESS.

THIS GIVES STUDENTS THE FALSE IMPRESSION THAT PSYCHIATRY ONLY DEALS WITH THAT PSYCHOSIS COMMONLY TERMED MADNESS THE TEACHING OF PSYCHIATRY IN MANY MEDICAL SCHOOLS TENDS TO CONCENTRATE ON THE SEVEREST OF MENTAL ILLNESS IN EXEMPLIFYING MENTAL ILL HEALTH .WHAT IS THE REASON THAT PSYCHIATRY ONLY DEALS WITH THAT PSYCHOSIS PATIENTS THE REASON ARE COMPLEX BUT ONE OF THE MAIN REASONS IS THAT MOST PSYCHIATRIC WARDS WHERE PSYCHIATRY IS TAUGHT HAVE RESOURCES TO ADMIT ONLY THE MOST DISTURBED AND SEVERELY ILL PATIENTS.

STRESSES OF LIFE MANY OF THE DAILY STRESSES OF LIFE WE MUST ALL FACE BUT WITH WHICH SOME CANNOT COPE THE STRESSES OF LIFE DO NOT ALWAYS EVOKE PSYCHOSES OR DISTURBED BEHAVIOR THAT IS SO EASILY RECOGNISED PSYCHOSES THAT ARE EASILY IDENTIFIED ONLY ACCOUNT FOR 7 % OR SO OF ALL MENTAL ILLNESSES IN ANY GIVEN COMMUNITY .

CHRONIC TIREDNESS. THESE LESS SEVERE BUT MORE COMMON ILLNESSES ARE USUALLY SEEN IN GENERAL PRACTICE SETTINGS WHERE LESS THAN HALF ARE RECOGNISED AND ABOUT A THIRD RECEIVE DRUG TREATMENT. DEPRESSION. EVEN IF THESE CONDITIONS ARE RECOGNISED THERE IS NO GUARANTEE THAT THEY WILL BE PROPERLY UNDERSTOOD OR THAT PATIENTS WILL RECEIVE APPROPRIATE TREATMENT.WHAT ARE THE COMMON MENTAL PROBLEMS? THE MORE COMMON MENTAL PROBLEMS ARE LARGELY DUE TO ANXIETY. ALCOHOL OR SUBTANCE ABUSE AND UNEXPLAINED SOMATIC COMPLAINTS. . SLEEP DISORDERS.

MANY FEEL HELPLESS WHEN FACED WITH EMOTIONAL DISTRESS THE FIRST STEP IN HELPING THE PATIENTS WITH EMOTIONAL DISTRESS IS TO UNDERSTAND THE CAUSES AND THE PRESENTATIONS OF THESE ILLNESSES .HOW ABOUT PHYSICAL ILLNESS PHYSICAL ILLNESS OR DISTRESS IS APPROPRIATELY MANAGED BY MOST DOCTORS.

HOLISTIC APPROACH IN RECENT YEARS A BIO-PSYCHOSOCIAL AND SPIRITUAL APPROACH TO MEDICINE HAS CAPTURED PUBLIC INTEREST AND. WITHIN THE MEDICAL PROFESSION. THE ATTENTION OF PRIMARY CARE PRACTITIONERS AND PSYCHIATRIST YET MOST PHYSICIANS STILL VIEW BIOLOGY AS THE BASIC SCIENCE .

PSYCHOLOGICAL. WE HAVE A NUMBER OF SCIENCES RELATING TO THE PERSON. BUT NO SCIENCE OF THE PERSON. BIOLOGY. AND SOCIAL FUNCTIONS THE PERSON AS A WHOLE HAS ATTRIBUTES THAT CANNOT BE EXPLAINED BY THE ATTRIBUTES OF ITS CONSTITUENT PARTS . AND SOCIOLOGY DEAL WITH ARTIFICIALLY SEPARATED SINGLE SCIENCE THAT STUDIES THE HUMAN PERSON IN ITS TOTALITY. PSYCHOLOGY. FROM A HOLISTIC POINT OF VIEW THE HUMAN BEING IS MORE THAN A MERE AGGREGATION OF BIOLOGICAL.HOW DO THE APPLICATION OF THE HOLISTIC PRINCIPLE THE APPLICATION OF THE HOLISTIC PRINCIPLE TO THE STUDY OF HUMAN BEINGS HAS FAR-REACHING IMPLICATIONS.

She has been under the treatment of doctors in the internal medicine clinic for more than half a year with increasing symptoms. I am unhappy”. Gently. pallid. 28 year-old teacher at a local primary school in BTL. sensing a deep disquiet behind the tight lips and mask-like squint.SW if she feels depressed. weakness. I ask Mrs. tiredness. she has suffered from chronic headaches for the past three years and she is telling me about her symptoms: dizziness. For several minutes she continues sobbing. The brave mask dissolves into tears. the deep inhalations reverberate as a low wall. She quickly adds as a justification. with the diagnosis of neurasthenia. easy fatigue. At this point Mrs. Her thin lips tremble. After consumed mogadon for more than 4 years . They refered her to the psychiatrist.SW A thin woman. “Yes. though against her objection.CASE OF MRS. and a ringing sound in her ears. .SW looks away. she replies”. My life has been difficult. name is SW.

demanding.SW --. and a brother had become paralyzed in a car accident. to her great shame. and her mother. She and her brothers and sister were dispersed to different places. After a year she felt that she was starving. SW took the highly competitive entrance examinations for university education. irascible personalities. in five miserable years her only friend was a fellow middle school student with a similar background from a native city. who shared her complaints. She then learned that one of her sisters had committed suicide while being struggled by drug abused. and each time. Finally. SW do not know her husband well before their mar. She felt terribly lonely. SW explains that she is the daughter of intellectuals who died during the way to office some years ago. Mrs. in the mid seventies she returned to Btl. Three times Mrs. and afterward she discovered that both he and his mother had difficult.mune in the rural area to which she was sent. which whom they live. She could not adapt to the weather and the inadequate diet. she married a man in her work unit. and indeed had decreased in weight. Their marriage has been characterized by frequent arguments which end at times with her husband beating her. Both husband and mother-in-law hold her responsible for the stillbirth of a nearly full term male fetus one year before. was treated harshly by both the cadres and peasants in the impoverished com. Two years before anamnesis. SW then a teenager. The marriage was arranged by the unit leader.riage.Case Mrs. Mrs. Mrs.continue After regaining her composure (literally reforming her face).in-law. she failed to achieve a mark high enough to gain admission. . attacking her for being an ungrateful daughter-in-law and incompetent wife.

.continue Over the past two years. appetite. she admits to more symptoms --difficulty with sleep. as well as joylessness. and feelings that it would be better to be dead.Case Mrs. anxiety. When questioned by me.SW --. but she has put these suicidal ideas to the side and has made no plans to kill herself. She has an intense feeling of guilt about the stillbirth and also about not being able to be practically helpful to her paraplegic brother. During the past six months she has developed feelings of hopelessness and helplessness. and energy. She has fleeting feelings that it would be better for all if she took her life. Mrs. Mrs. SW’s physical symptoms have worsened and she has frequently sought help from physicians of both biomedicine and traditional medicine. SW regards her life as a failure. as well as self-abnegating thoughts.

The patient refuses and remarks if only she could be cured of her physical problem. . experience. expression. Illness refers to the patient’s perception. and diffuse bodily complaints believed to be caused by inadequate physical energy in the central nervous system. fatigue and feel would be better able to adapt to her all problems. dizziness.depressive disorder The internist did not agree also the patient Neurasthenia --. Official diagnostic--. headache. and pattern of coping with symptoms Disease refers to the way practitioners recast illness in terms of their theoretical models of pathology. weakness.Case (discussion) From the case the chief problem is mental disorder.a syndrome of exhaustion.

IS A BIO-PSYCHOSOCIAL-SPIRITUAL CREATURE WHO TIGHTLY INTEGRATES ALL HIS SUBSYSTEMS AND AT THE SAME TIME IS STRICTLY INTEGRATED IN HIS SUPRASYSTEMS. AS WE ARE AWARE OF. NOT HIS SICK BODY PARTS OR HIS DISEASE MAN. AT ALL LEVEL OF THE LIVING SYSTEM.THE HOLISTIC APPROACH WE ALL AGREE THAT MAN IS THE PRIMARY OBJECT OF MEDICINE. DISEASE IS A DISTURBANCE OF THE BALANCE BETWEEN MAN AND HIS ENVIRONMENT. .

AND TO HAVE THEM TREATED IF THEY DO ARISE THEY DO NOT KNOW WHERE. THEY CANNOT AFFORD TO PAY FOR THE SERVICES THEY NEED . THEIR USE OF SUBSTANCES SERVICES ARE PROVIDED IN A PLACE WHERE THEY COULD BE SEEN BY PEOPLE WHO KNOW THEM. MENTAL HEALTH SERVICES ARE PROVIDED THEY DO NOT WANT TO CALL ATTENTION TO THEMSELVES OR TO THEIR ACTIONS ( FOR EXAMPLE. WHICH WOULD COMPROMISE DISCRETION HEALTH WORKERS MAY ASK THEM DIFFICULT AND EMBARRASSING QUESTIONS. AND PUT THEM THROUGH UNPLEASANT AND PAINFUL PROCEDURES.BARRIERS TO THE UTILIZATION OF MENTAL HEALTH SERVICES TO COMMUNITY COMMUNITY MAY FAIL TO SEEK HELP BECAUSE        THEY DO NOT RECOGNIZE THEIR MENTAL ILLNESSES OR ARE NOT AWARE OF THE SERIOUS CONSEQUENCES OF THEIR MENTAL ILLNESSES THEY DO NOT KNOW THAT THEY COULD GET HELP TO PREVENT THESE MENTAL ILLNESSES. AND UNDER WHAT CONDITIONS.

WHY SHOULD HOLISTIC APPROACH TO OVERCOME THE DISTURBANCE WE SHOULD TAKE INTO ACCOUNT OR PAY ATTENTION TO ALL LINKAGES BETWEEN THOSE LEVELS IN THIS ENDEAVOUR WE SHOULD FOCUS OUR ATTENTION TO MAN AS A BIO-PSYCHO-SOCIALSPIRITUAL CREATURE. THE PATIENT IS TAKEN CARE OF AS A UNIQUE PERSON (MULTICOMPLEX CREATURE). MEDICAL SCIENCE AS WELL AS MEDICAL ART SHOULD BE UTILIZED. THE PHYSICIAN SHOWS HIMSELF AS A UNIQUE INDIVIDUAL OWING TO THE ART OF MEDICINE HE APPLIES WHICH IS UNIQUE AND PERSONAL . HIS BIOLOGICAL AS WELL AS HIS OTHER ASPECTS. THEREFORE. AND HENCE. INCLUDING MEDICAL TECHNOLOGY AND MEDICAL CRAFT. AND AT THE SAME TIME.

DISEASES ARE ALSO EVOLUTIONARY PRODUCTS. IN THERAPY WE OBSERVE THAT INTERVENTION AT ONE LEVEL/PART WILL SHOW EFFECT AT OTHER LEVELS/PARTS. A PRODUCT OF HIS BIOLOGIC SYSTEM INTERACTING WITH HIS ENVIRONMENT IN TIME AND SPACE. WE COULD OBSERVE THAT THE INSULT AT ONE LEVEL/PART OF THE LIVING STATE WILL INFLUENCE OTHER LEVELS/PARTS AS WELL. THE RESULTS OF INTERACTION BETWEEN MAN AND HIS ENVIRONMENT IN TIME AND SPACE. INCLUDING FOR EXAMPLE THE DISTRIBUTIVE JUSTICE IN HEALTH SERVICES AND THE BIRTH RIGHTS WHICH ARE SOMETIMES NOT CONSIDERED TO BE VERY IMPORTANT. HOLISM ALLOWS US TO REGARD MAN AS AN EVOLUTIONARY EPISODE. AS REGARD TO ETIOLOGY. DEPENDING ON THE NATURE OF THE INSULT. EITHER THE THERAPEUTIC AS WELL AS THE SIDE EFFECTS.HOW DO THE HOLISM AT THE POPULATION LEVELS HOLISM AT THE POPULATION LEVELS WILL NOT NEGLECT THE ETHICAL ASPECT OF MEDICINE. .

AND CONSEQUENTLY. MEDICINE CANNOT BE REGARDED JUST AS AN EXACT SCIENCE. BY EMPLOYING NATURAL AND BEHAVIOURAL SCIENCES. VARYING IN VERTICAL AND HORIZONTAL AXES. OR ON THE OTHER HAND. . OUR OUTLOOK OF MAN AND HIS DISEASE IS NECESSARILY WIDEANGLED. OR EVEN JUST BIOLOGY OR PHYSICAL CHEMISTRY. JUST AS A SOCIAL SCIENCE. AND HIS DISEASE IS THE DISTURBANCE IN BALANCE AND HARMONY HE EXPERIENCES. DISEASE IS NOT REGARDED AS MONOCAUSAL.THE CAUSA OF DISEASES MAN IS A MEMBER OF HIS ECOSYSTEM. MEDICINE SHOULD BE VIEWED AS A MEANS TO OVERCOME THE DISTURBANCE IN BALANCE AND HARMONY OF MAN AT VARIOUS LEVELS/PARTS OF THE LIVING SYSTEM IN THE BIO-PSYCHOSOCIAL-SPIRITUAL MATRIX. INTERVENTION AGAINST IT SHOULD TAKE THESE INTO CONSIDERATION. AND OCCURS ONLY AT ONE LEVEL/PART OF THE LIVING SYSTEM.

SUCH AS BETWEEN ACTIVITY AND REST.PREVENTION OF DISEASE AND PROMOTION OF HEALTH PREVENTION OF DISEASE AND PROMOTION OF HEALTH IN MEDICINE ARE CARRIED OUT BY MEANS OF MAINTAINING THE BALANCE AND HARMONY IN LIFE. MAN AND SUPERNATURAL POWER. SELF AND ENVIRONMENT. ETC. PLEASURE AND UNHAPPINESS. INDIVIDUAL AND SOCIETY. SLEEP AND WAKEFULNESS. COLD AND WARM. PHYSIQUE AND PSYCHE. MODERATION IN ATTITUDE AND BEHAVIOR . .

WE DID NOT SPLIT THE PERSON INTO SEPARATE PARTS --.BIO-PSYCHO--SOCIAL --. THAT IS.WE HAVE TO VIEW THE PERSON AS AWHOLE --. .SPIRITUAL THE WHOLE PERSON CANNOT BE UNDERSTOOD BY AN ANALYSIS OR DISSECTION OF HIS PARTS.HOLISTIC APPROACH WHAT IS CALLED A HOLISTIC VIEW OF THE PERSON.

.HOLISTIC APPROACH IF YOU ARE A PHYSICIAN  YOU WOULD LIKE TO HAVE AN OBJECTIVE PROCEDURE THAT WILL SHOW YOU HOW MUCH VARIOUS DRUGS AND THERAPY PROCEDURES YOU USE ARE HELPING YOUR PATIENTS.

HOLISTIC APPROACH IS THE BEST SOLUTION OBJECTIVE OF HOLISTIC APPROACH ANALYSIS  EVALUATION OF INTEGRITY OF HOMEOSTASIS  EVALUATION OF TREATMENT .IF YOU ARE PATIENT YOU WOULD BE INTERESTED TO SEE HOW MUCH THE TREATMENT ARE HELPING ACCORDING TO AN OBJECTIVE MEASURE? IN BOTH CASES.

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