INTRODUCTION

The science and art of “healing” as well as concepts of “illness” have always been significantly
influenced by the cultural context in which they developed. What most Western medical
practitioners conceive of as “health care” is actually quite in its infancy compared to many
practices aimed at curing or ameliorating illness that developed across the world for many
centuries past. Major advances in biomedical research and in the scientific method in general
over the last century have brought the discovery of revolutionary medical interventions that
have saved countless lives, most notably through the treatment of infectious illnesses. Yet,
many practitioners and patients alike sense that the biological and reductionist concepts of
illness and its treatment that have come to guide much of Western medical care often minimize
the role of psychosocial factors in health and wellness. Psychiatry itself, supposed champion
among medical fields in addressing psychosocial etiologies of illness, has also become
increasingly biological in its focus. Although this approach has undoubtedly benefited persons
with mental illness and has helped public appreciation that the brain is no less a physical organ
than the heart or kidney (susceptible to maladies at times at no fault of the person suffering
mental illness), some mental health practitioners worry that the “listening cure” in psychiatry
will be increasingly marginalized. After all, addressing psychosocial aspects of health is almost
always more time-consuming than biological interventions and thus, in a short-sighted vision
of health outcomes, often seems inefficient and expensive. Paralleling the biomedical,
reductionist approaches to health care of recent decades, Western countries have also
experienced a notable growth in the use of nontraditional health care practices, usually coined
“complementary and alternative medicine” (CAM). Many people have theorized that these
events are related, i.e., that patients more and more find traditional health care impersonal and
inadequate to address the aspects of their health and wellness that cannot be measured in blood
levels or visualized by radiological tests. Of course, this is speculative, and studies have sought
to determine empirically why people use CAM. Factors associated with an increased likelihood
of CAM use include higher educational level, poorer overall health, congruence with personal
values and philosophical orientations to health, and symptoms of pain, depression, or anxiety.
CAM users more often use such practices as complementary to traditional medicine than as an
alternative, indicating that CAM use does not equate with a shunning of traditional health care
nor with a lack of appreciation of the benefits of receiving scientifically scrutinized treatments
from thoroughly trained and credentialed practitioners. Other studies have confirmed that users
of CAM frequently have chronic illnesses, many of which are only partially relieved by
conventional medical treatments. Chronic pain, many psychiatric illnesses, certain forms of
cancer, and dementia are prime examples of conditions for which there is no metaphorical
“penicillin” and for which people often turn to CAM in hopes of gaining some additional relief.
Many of these chronic conditions are age-related, and worldwide population trends portending
exponential growth in the number of adults over age 65 indicate that many older adults over
the upcoming decades will be living with currently incurable, often debilitating illnesses.
Additionally, the generation of Americans that appears to use CAM most frequently is the
“Baby Boomers,” who will soon be a part on this surging population of older adults. Together,
these circumstances warrant a review of CAM and its use in geriatric psychiatry. Although
most readers likely know in general what CAM is, defining it can actually be a somewhat
elusive endeavor. Although the Western concept of CAM encompasses an incredibly diverse
range of practices, philosophies, and techniques, what they share in common is a general lack
of acceptance and/or use in conventional Western medical settings. Even still, as attitudes and
evidence bases change, what is one day CAM may later be mainstream practice. Although the
above description implies possible negative outcomes of an overly reductionistic approach to
health care, at the same time most conventional practitioners who are open to considering the
merits of certain CAM therapies still appreciate that there must be some means of objectively
evaluating the efficacy and safety of CAM. Acknowledgement of limits of conventional health
care and willingness to consider other cultural and unfamiliar philosophical approaches to
health and illness also require simultaneous awareness of charlatanism, conflicts of interest,
and possible unknown toxicities that exist in certain CAM practices.