There is great fervor in the health field. New ideas, innovative programs and hope are everywhere, and today’s rapid changes seem to have a momentum of their own. States are providing licensure to new categories of health practitioners, medical schools are offering programs on holistic healing, the Office of Alternative Medicine at the NIH is funding research on complementary therapies, insurance carriers are beginning to offer reimbursement for these therapies and the Internet is overflowing with information and informal dialogues.

Confronted with the complexities of lifestyle and stress-related degenerative diseases, addictive disorders, anxiety, depression and their physical counterparts, dissatisfaction with the over use of pharmacological and interventionist therapies, a rising antipathy with professional arrogance and authority along with a growing demand for high level health conventional medicine has finally reached its limitations. There is now a broad based consensus that change is both necessary and desirable.

But the current pace of change has allowed both practitioners and the general public little opportunity for reflection and evaluation. As a result there has been a lack of significant discourse in regard to the extent and the direction of change. Motivated by very real concerns yet conditioned by old patterns of thought, fired up with enthusiasm and hope yet compelled by complex professional and financial interests, and carried along by a seemingly unstoppable momentum we simply assume that our current initiatives are taking us in a beneficial and innovative direction. As a result, we have failed to ask the critical questions whose answers can either reassure us about our current efforts or cause us to reconsider them. Consider these two simple but basic questions:

• What will be the distinguishing elements that will characterize an expanded and revitalized approach to health and healing — a post-modern integral medicine?
• Do our current initiatives reflect and support the full development of these essential elements?
  

Past and Future Gathered Together

The first question, one that deals with the essential characteristics of a newly emerging worldview, must be considered in the context of our unique historical moment. Today we find ourselves living in an extraordinary in-between time, a sort of gap in time that has been created by the decline of our previously unquestioned optimism and faith in the 500 year tenure of modernism and the emergence of a new post-modern integral viewpoint. As practitioners and individuals in search of a more meaningful approach to health and healing we rarely concern ourselves with these larger cultural movements, issues we usually leave to historians, social scientists and philosophers. Yet at times of great transformation we cannot afford to do so. Only to the extent that we can accurately understand the historical forces that are driving and shaping our times can we effectively embrace and align ourselves with these forces rather than unknowingly undermine them with potentially misguided efforts.

As westerners our cultural history can largely be traced to Hellenistic Greece. This meeting of the ancient mythological world and the emerging world of rational inquiry gave rise to an extraordinary culture that for a brief period of time sustained a precarious yet highly creative balance between sensory-based and intuitive knowledge — the outer and inner ways of knowing. The outer way investigates the world and attains its knowledge through the sensory-based intellectual analysis of what is considered an “objective” pre-given world. In contrast, the inner way uses the first-person investigative tools of reflection and meditation to uncover an experiential knowledge of the “lived world,” the subjective experience. One of the most important achievements of Hellenistic Greece was the rise of Aesclepian medicine, an amalgam of the rudimentary elements of a scientific medicine interwoven with a knowledge of the inner healing capacities — a prototype for the reunion of the matured inner and outer aspects of healing that is the essential movement that is unfolding in our time.

Several centuries later this union of rational and intuitive knowledge was sundered apart with the rise of the monotheistic Christian mythos. Faith, scripture and external authority replaced rational inquiry and inner exploration as the primary route to knowledge, healing and health. But the rise of a monochromatic perspective in either personal psychology or cultural history always empowers its suppressed counter-balancing force that invariably re-emerges from the shadow, forcing the decline of the previously dominant perspective. It is in this manner that the dominance of the Christian era and its emphasis an external authority eventually declined giving way to the Copernican revolution and the modern era with its rational analytic exploration of the outer world, an extraordinary epoch which was to last for 500 years and is only now beginning its decline as a dominant perspective.

Initiated by Copernicus and completed by Kepler, Galileo and Descartes this paradigm shift engaged the western world in a compensatory yet equally monotheistic worldview, one that was sensory-based and “objective.” It assumed that humans are parachuted into a pre-given world whose intricacies could be accurately know through our natural senses and our extended senses- our sophisticated technology. This powerfully pragmatic worldview has been highly successful in elucidating the mechanistic aspects of nature but it has left us with a disenchanted and devitalized world, one that is devoid of meaning and purpose. We have denied and devalued all inner ways of knowing, leaving ourselves with no way to grasp or understand the groundless and mechanical world we have so brilliantly envisioned with our science. The result is the epidemic anxiety of our age — a lostness, an emptiness, an alienation from ourselves and our world that is reflected in our mind, body, spirit and social institutions. It has become increasingly apparent than an understanding of life acquired solely through a sensory-based outer knowledge cannot in itself provide us with a progressive and endless improvement in the quality of our health and our lives. For this we need something else. We need to expand our consciousness and re-gain a rich inner life. This leap in consciousness will provide us with the knowledge and capacities that are required for a larger healing and health. To understand this is to comprehend that the changes we must now envision are fundamental rather than cosmetic and as much historically compelled as chosen. We either grow larger in our consciousness or our science and medicine will remain much the same irrespective of our sincere efforts to change it through the addition of more therapies and remedies.

I would like to set forth the four elements that will characterize and distinguish a post-modern integral medicine, both serving to align us with the historical imperatives of our time and guiding us in our efforts to move beyond the limits of our current medical model.

An Expanded Consciousness
An expansion in consciousness is the foundation of a post-modern integral medicine. It is the key component that shifts our efforts and results from horizontal change that merely expands the range and scope of what is to vertical change that transforms the entire landscape, embracing all previous perspectives and approaches to health and healing while simultaneously transcending them in the creation of a fundamentally new vision. Through the exploration and full development of consciousness we will at first re-discover the profound and denied inner aspects of healing — wholeness, peace, love, joy and wisdom, and then seamlessly interweave the two traditional aspects of healing — outer and inner — into a new medicine.

Holism
The modern worldview assumes that outer reality is pre-given objectified, impersonal, measurable, quantifiable and ultimately knowable through our sensory perceptions. The post-modern view does not make this assumption. Objective and subjective, outer and inner, are seen as inseparable and seamless experiences with each shaping the other in an ongoing circularity of movement. This inter-connectedness of outer and inner is a middle way that denies the extremes of a purely sensory-based objective world and its antithesis a radical subjectivism. Holism asserts the ultimate oneness of experience, viewing the objective and subjective as two aspects of the same reality. To reach this understanding and to know it directly heals our alienation from self, others and the illusion of a pre-given world.

Intentionality
The modern worldview postulates that all phenomena are caused by unchanging universal laws that exist independently of human consciousness. In essence, causality is seen as physically based and upward in its direction. The post-modern perspective validates and legitimizes the causal nature of consciousness that is individually willed and downward in direction. In validating both downward and upward causation we affirm and expand our understanding of the mind/body unity and simultaneously affirm and expand our capacity for self-regulation. Here causality, “upward and downward,” is seen as a seamless interconnectedness of experience that lays the foundation for an integral medicine that reflects the complex and dynamic flow of forces, biological and intentional, that define the human experience and open the possibility of a larger life and health.

A Larger Self
The modern worldview has assigned great importance to individualism, an ideal that has too often been degraded into a self-indulgent, egoistic and aggressive quest for power and material gain. The post-modern worldview revitalizes and deepens the meaning of individualism by asserting the significance of the individual’s search for authenticity through self-knowledge and a deepening consciousness while simultaneously affirming the larger goal of self-development: the transcendence of the self-grasping sense of “I” and the discovery of a deeper and more authentic ground of being that knows and lives our interconnectedness with all of life. It is this deeper more expansive and impersonal self that is the only agent that can fully comprehend and integrate the inner and outer forces of healing into a seamless embodied whole. The formula for a post-modern integral medicine is: larger consciousness, larger self, larger medicine.A

Shift in World View or More of the Same

John Travis, M.D. opened the first wellness center in the late 1970s in Mill Valley, California. Influenced by Halbert Dunn’s book High Level Wellness, Travis’ concept of wellness sought to expand our ideas about health beyond the customary focus on preventing and curing disease to include a concern for the promotion of well-being. Health and healing were seen as a personal affair, a psychosocial process of education and lifestyle change.

The idea of holism, first described by Jan Smuts in his 1920s book Holism and Evolution, was revived by individuals and practitioners seeking a broader vision of health and healing. As a concept, holism expressed the view that life at all levels is organized as a unity. Although reductionism had been successful in explaining the mechanistic workings of nature, it was increasingly seen as a limited and partial approach to knowledge, an approach which distracted us from a more comprehensive and ecological view of the human condition that offered a more meaningful, vital, and enchanted view of nature.

In the 1980s alternative and complementary practices and mind/body strategies for self-regulation began to emerge as a further expression of the rapid changes in our ideas about health care. Naturopaths, chiropractors, acupuncturists and others sought and achieved state licensure, and began the initial steps towards full integration into the mainstream of institutionalized health care, a process aimed at achieving conventional acceptability and consensual validation. The Office of Alternative Medicine was established at the National Institutes of Health to examine the efficacy and appropriateness of these diverse approaches to health and healing.

Each of these initiatives were honest attempts by sincere individuals and institutions to bring change to an entrenched health care system, one that no longer seemed effective in dealing with present day problems and sensibilities, and was at odds with the emerging post-modern viewpoint. Let’s examine the results of each of these efforts.

The idea of wellness was rapidly integrated into our culture. But as it entered the mainstream of our cultural life, and particularly when it was integrated into existing health care institutions, wellness was reduced to four physically based issues: nutrition, smoking cessation, fitness, and stress management. Its fundamental emphasis on personal development and its psychosocial framework and values were largely jettisoned. And with its assimilation into the larger culture it was reshaped until it more resembled traditional preventive approaches, packaged as generic commodities carrying the "wellness" label, than the dramatic shift in perspective envisioned by Travis. The idea of holism suffered a similar fate. As a philosophy, holism evolved as a counterforce to atomistic and reductionistic perspectives. Sixty years after Smuts defined this concept, his vision was reduced to packaged commodities that could be bought and sold with labels such as holistic medicine, holistic dentistry, and so on. And further, it became a marketable credential that was self-applied by a diverse group of practitioners who confused humanism and an expanded repertoire of remedies and practices with holism. And even in the case of those practices that evolved from a more comprehensive framework, the "holistic" components rapidly receded in importance, or were completely discarded as they were secularized and reduced to disease-oriented treatments. As we are discovering, this is the cost of integrating into and accommodating to the institutional structures of mainstream health care whose perspectives are solidly embedded in the traditions of the modern world view. It is the price of cultural acceptability and third party reimbursement.

Alternative and complementary approaches to health and healing, however valuable in diversifying our treatment options, have similarly failed to significantly alter our existing worldview. Conventional and alternative practitioners too often use their specific expertise to prescribe techniques, practices, drugs, or supplements for the purpose of repairing or fixing an abnormality. The professional defines the approach solely within the context of his or her professional domain, and the prescribed treatment is external rather than internal. The individual is a more or less passive recipient of the therapeutic process gaining little in the way of personal insight or additional self-healing capacities. Because all of us are conditioned to turn to authoritarian structures and external remedies at times of adversity, we often demand and easily accommodate to the treatment model, conventional or alternative. There are always individual practitioners whose practices reflect a substantial shift in perspective (both conventional and alternative healers can access holistic principles within their traditions), but this remains an individual prerogative in distinction to a cultural shift.

The answer to our second question is now apparent. With few exceptions these and similar efforts have ultimately failed in their implementation to explicitly and consistently express the perspectives that characterize a post-modern integral medicine, perspectives that alone can take us in the direction of fundamental change? So why has this happened? The answer is clear. Old perspectives and parochial interests are powerful and enduring. They silently and effectively reshape our efforts to more or less conform to existing conventions, incorporating and reshaping them until they accommodate to the assumptions of the existing worldview. Without a defining leap in consciousness all we do is expand the range and scope of what is, deluding ourselves in thinking we are creating fundamental change.

Because each of these initiatives explored new approaches and perspectives they have been useful endeavors. But so far they have failed at fundamental change. As a result, these initiatives have largely fallen within the hegemony of the existing values, perspectives and practices, falling far short of taking us in the direction of a post-modern integral medicine. Wellness became prevention, holism became an empty word, alternative approaches became alternative treatments and mind/body strategies became relaxation techniques. The powerful influence of the existing world view subtly but surely changes us before we can change it, and our efforts fall short of embodying the perspectives of the emerging post-modern viewpoint. Overcoming ourselves and our deeply conditioned and often unconscious assumptions is a difficult task.

The central components of a post-modern integral medicine — an expanded consciousness, holism, intentionality and a larger self - arise dependent upon the first factor, a leap in consciousness that takes us beyond the limitations of the rational analytic mind. This is at first a personal quest. So it is the individual (in contrast to professionals and institutions) that becomes the agent of change that will take us towards a post-modern integral medicine. Directly engaged in the historical process of actively integrating and living a new worldview, we ourselves are transformed by our quest for a larger consciousness, life and health.

It follows from this that initiatives that result in an expansion and extension of professionalism and its monopoly over knowledge, conventional or alternative, expropriates power and possibility from the individual and runs counter to the values of a post-modern medicine. Practitioners and their therapies will remain an important component of a person-centered and consciousness-centered post-modern integral medicine, but not a dominant one. They will be a valuable resource to individuals who are actively engaged in composing their lives, defining their personal visions of health and using life’s adversities as a doorway to a larger consciousness and expanded inner healing capacities.

Because we are still living in the gap between worldviews, we can only catch glimpses of what the full flowering of what this new medicine will look like. Yet there is much to gain from these glimpses. Let’s consider two programs: the Dean Ornish Lifestyle Intervention Program and the Planetree Hospital Unit and Consumer Education Program. In examining each of these programs we can measure them against the perspectives that will characterize a post-modern medicine.

In 1977 Dr. Dean Ornish began to explore an alternative, non-pharmacological approach to atherosclerotic heart disease. The central elements of his program included a low fat diet, meditation, yoga, exercise, and psychological counseling and support. When I visited this program I had an opportunity to join an evening meeting and to speak in some detail with several of the participants. What most impressed me was the extent to which these individuals had become empowered in the pursuit of their own healing. They had developed a repertoire of new skills, resources, and capacities, gained insight into their lives and relationships, cultivated a more expansive understanding of health and disease, learned to make conscious and self-directed choices and accomplished each of these goals within the context of a supportive community. As a result of these experiences the participants extended the scope of their personal autonomy, expanded consciousness and self-knowledge, and created new options, each of these valued outcomes was built into the ongoing program. By transforming their approach to health and healing they had simultaneously transformed themselves.

The goal of Ornish’s program, as I view it, is to support the personal growth and development of the participants so they can assert their primary role in the healing process, recovering from illness and promoting vital and healthy lives. Ultimately the professional fades into the background and the individual and his or her experience becomes the central factor in health and healing. This is not a treatment program in the way we have previously conceptualized treatment. My sense is that it begins to express the elements of a new medicine.

Let’s look at another example, the Planetree model. In 1977 Angelica Thieriot, an Argentinian, was hospitalized during a visit to San Francisco. Although impressed by the technology she was appalled by her hospital care. As a result of this experience she approached the chief of medicine at the Pacific Presbyterian Medical Center in San Francisco with the idea of creating a model program, a program that would respond to the needs of the individual by supporting personal autonomy.

In 1981 the first Planetree Health Resource Center opened. This consumer library was designed to assist individuals in acquiring up-to-date medical information that would enable them to be active and informed participants in the healing process. The center maintained a library, subject files on conventional and alternative health care, access to the National Library of Medicine’s search service, selected bibliographies, and listings of national and local organizations and support groups.

In 1985 the first Planetree hospital unit was established. In each of the patient’s rooms the colors, lighting, carpeting, and other details were specifically designed so that the healing needs of individuals could be met. The patients had full access to their medical records, and were encouraged to add their observations, feelings, and responses to their files. The new unit provided kitchen facilities, flexible visiting hours, and a health educator. Alternative practitioners were permitted within the hospital setting, and patients had the option of wearing their own clothes, robes, and pajamas. In what is for most individuals a highly vulnerable circumstance the Planetree program focused on enhancing personal autonomy, expanding the individual’s knowledge and capacities, and allowing for a pluralistic approach to the healing process.

When I visited the Planetree hospital unit and consumer library the difference was clear. I did not feel I was visiting a treatment facility but rather a healing center, one that was focused on the individual. Patients could leave the hospital more informed, aware, resourceful, empowered, and autonomous, a unique experience in health and healing. This project is another example of how postmodern perspectives when designed into the core of a program can begin to support the emergence of a fundamentally new kind of medicine.

Yet each of these programs is only a first step in the right direction. In their early phase they are more a movement away from the limitations of an exclusively reductionistic and professional-centered treatment program than a full embodiment of the perspectives of an integral medicine. The complete unfolding of an integral medicine requires much more. It requires the full development of the inner aspects of healing which results from a leap in consciousness that is brought about through reflection, study, meditation and other related practices.

This personal transformation is then extended into the three other realms of the human experience – our physical body, our personal relationships and our social values and institutions. As we have already discussed the inter-connectedness of mind and body assures that a leap in consciousness will result in a corresponding shift in our physiology towards a more a natural state that significantly alters the modern epidemic of stress related dis-ease and distress. And as we transform ourselves we will simultaneously transform and heal our relationships through the infusion of empathic listening, kindness, patience and a more selfless love that are the qualities that emerge from an expanded consciousness. Finally, we will discover the collective social change comes about not by pressure exerted by the smaller self but rather by the infusion into our culture of the values exemplified by the transformation of our own life. So we can see that a fully developed post-modern integral medicine, driven by a personal leap in consciousness, extends into and heals all aspects of the inter-connected human experience.
It is difficult to be a midwife to a new vision. Each of us was born, socialized and educated to live within and to honor the existing viewpoint a set of perspectives whose basic assumptions are unstated and silent yet at the same time relentlessly compelling. The science, and particularly the medicine, associated with this viewpoint have taught us to seek the remedies for our problems outside of ourselves, to distrust our inherent healing capacities and to look towards the professional as the singular authority on issues of health and healing. An understanding of our historical moment would suggest that a post-modern integral medicine will be defined and directed by the individual. Its focus will be the development of consciousness and the inner healing dimensions as a prelude to the seamless integration of the outer and inner aspects of healing.

Thomas Kuhn, in his seminal book The Structure of Scientific Revolutions, said: "The transition from a paradigm in crisis to a new one .... is far from a cumulative process, one achieved by an articulation or extension of the old paradigm. Rather it is a reconstruction of the field from new fundamentals, a reconstruction that changes some of the field’s most elementary theoretical generalizations. .... When the transition is complete, the profession will have changed its view of the field, its methods, and its goals." It is time that we step back and begin to speak about fundamentals, about the perspectives that define our lives and our work. Such a conversation will surely assist us in creating and successfully implementing the fundamental changes that are now awaiting us. The result will be an uncommon life and health that will emerge from a post-modern integral medicine. Its foundation will be an expansion in consciousness. Its focus will be human flourishing rather than human survival.

© Elliott Dacher, M.D. (Revised and reprinted with permission from The Journal of Alternative and Complementary Medicine, Volume 2, Number 4, 1996, pp 531-537.)