Holism, reductionism and cultural relativity

It’s strange to think that the idea of everything being interconnected is considered by many scientific thinkers to be a novel, somewhat hypothetical, or even dubious idea. Science hobbles itself with it’s own scientific method, because it must isolate and separate whatever it studies from it’s environment in order to control the study process. And yet nothing in reality is ever separate from it’s environment.

A single cell is one of many, coordinating it’s activity and function within a tissue, and the collective structure and function of these cells is what creates the tissue they are part of. The tissue these cells are a part of, is one of many tissues which interlock and overlap to form an organ. The specific character of these tissues, and the way they interact, is what governs the structure and function of the organ they are a part of. And from here, it is the organisation of many organs, all structurally and functionally interconnected, that creates the human body as a whole.

The cells within one human body, however, are completely unique to that body. Each cell is an individual being in it’s own right, as are the tissues they form. We may, as humans, adhere to a general, uniform shape and function but each one of us is uniquely different from the other. Which is perhaps part of the reason why so many ancient cultures approach medicine in such a different manner to that of the more recently developed ‘bio-medicine’, a common term used for modern-day science-based medicine in the West. In Chinese medicine for example, each human is seen as unique, so even if three people present to the practitioner with the same symptoms, they won’t automatically treat all three people the same way, with the same medicine. They don’t assume that the underlying cause is the same across the board.

Nor do they treat the symptoms rather than the cause, or focus solely on the apparent dysfunction in a single organ and ignore the rest of the body. Blood pressure is a good example. Biomedicine has done a good job of recognising that high blood pressure isn’t just isolated to the cardiovascular system; it can be linked with the function of the kidneys, the endocrine system, and the nervous system. But tit struggles to grasp a broader full-body picture, and to apply the knowledge it does have in a way that address underlying causes. Biomedicine too often they relies solely on medication without exploring the underlying causes and encouraging lifestyle and behavioural change.

Admittedly, the system itself often fails these doctors because they are expected to do a lot in very little time. The industry the are a part of, and the clients they are servicing, tend to demand quick fixes. Many people don’t want to ask themselves difficult questions about their diet and lifestyle, their thinking patterns, sleeping habits, relationships, community, and emotional demeanour, for example. I certainly do think biomedicine plays an important role for people who simply aren’t that interested in health, self-awareness, personal growth and self-responsiblity. And I absolutely love that fact that we have it there as a back-up for more serious conditions. Where would we be without surgery or powerful drugs to ease our latter years as we succumb to the illnesses of ageing and approach death?

But too often biomedicine is touted as the be-all and end-all; the only viable, credible, valid option a level-headed person might turn to in times of need. My preferred view is of a broad range of different modalities interlinked in a cooperative and mutually respectful manner, servicing a community that is full of diverse needs, beliefs and values. Biomedical doctors and researchers could perhaps benefit from having some training in cultural relativity. Cultural relativity helps us cope with different models of reality so we can make sense of the different ways people have of explaining themselves and their worldview. Here are some lovely quotes from Claire Monod Cassidy, who wrote the fifth chapter of The Fundamentals of Complementary and Alternative Medicine by Marc S. Micozzi.

“That there are numerous cogent models of reality is often disturbing to people. In the West, battles have been fought and lives lost in defence of a singular reality (Ames, 1993). Earlier in our history the search for this reality was mainly expressed in religious terms, but for more than 150 years, many have believed that science provides that singular reality. By this logic, health care practises that are not considered scientific are not trust-worthy and the path to acceptance demands “scientific research….

But….everyone has beliefs, and all realities are constructed; the facts of science are as culturally contextualised as those of law, theology or social manners. Scientific fact is only as stable as the logic that preceded it and the systems that apply it. Thus, science also experiences paradigm shifts. Plasma physics operates differently from Newtonian physics; population biology is quite a different kettle of fish from Linneaen systematics; and an ecological or holistic approach to gathering scientific knowledge is very different from a reductionist one.

The curious thing about modular reality is that you are likely to find exactly what you expect. The observer is not separate from the observed.”

This last point makes the scientific method quite a tricky thing to pin down and apply accurately. There are so many variables you have to control for, and science does this by isolating what is studied from the context of the broader reality it exists within. Can the results then truly be an accurate reflection of reality? If you take my cells and study how they respond to a drug inside a petri dish, can you really be sure the drug will have the same impact when delivered to the complexity of the body as a whole?

You might then test that drug on whole human bodies, but unless you lock these bodies up in laboratories so you can control all the other variables that might be impacting and affecting that body, how you you really be sure what outcomes are caused by the drug itself? You can test on other non-human animals, but this actually isn’t very effective. For example, over 99% of all Alzheimer’s drugs that proved effective in non-human animal studies have proved useless in human studies. You can’t make assumptions across species.

So we’re back to human trials, but even then, you have to conduct double-blind placebo trials. Because if either the human being tested on or the experimenter supplying the drug know which drug is real and which drug is the ‘placebo’ (fake), the results are declared useless. What has always fascinated me is that science understands enough about the placebo effect that they have to go to extraordinary lengths to control for it, but they’ve never taken any interest in exploring the effect itself.

Placebo is essentially the power of belief, or expectation. If you think you are taking the real drug, you might think yourself into a cure, or even side-effects (nocebo), even if what you are actually taking is just sugar and water. For me, this phenomenon is a million times more interesting than any drug the biomedical pharmaceutical industry might come up with. If we could find ways to effectively tap into the placebo effect and use it in medicine and healing, it could be a game changer.

For me personally as a practitioner, the defining lines between the placebo effect, the power of suggestion and the art of self-hypnosis are blurry, because the three are interlinked. And while I happily and intentionally incorporate these tools into my practise (as many doctors do*), by no long stretch of the imagination do I consider my practise to be ‘placebo-only’. It baffles me when doctors dismiss herbal medicine as placebo when so many of their drugs are borrowed from the constituents of plants. And a lot of the intangible ‘medicine’ I dispense in my role as a counsellor listening to stresses and sad stories, coaching clients through behavioural and lifestyle change, or training clients in the development of mindfulness and stress-management skills, is exactly what is missing from modern biomedicine.

My grandmother was a doctor, but she was wise and ahead of her time in so many ways. She often said to me that she felt most of the healing happened when she listened with care to people’s problems. Grandma Anne was famous not only her bedside manner, but for her unparalleled ability to be non-judgemental.

As Claire Monod Cassidy says, it helps when practitioners can “remain in a fairly neutral, non-judgemental stance, knowing the values of people without adopting or rejecting them (Kaplan, 1984).” But like so many practitioners who work in cross-cultural environments, my grandmother had enough compassion, empathy and respect for other cultures that she didn’t dismiss their beliefs as being beneath her and unworthy of her respect.

My great uncle recently told me that when Grandma first arrived at work in the remote town of Alice Springs in Central Australia in the 1960’s, she asked when she would be making her rounds to the local Aboriginal communities.

“Oh no!”, they told her. “We don’t service the natives!” Heaven forfend! What a strange idea!

“Well you won’t be keeping me on here as a doctor then”, my Grandmother replied, and promptly got her way. This incredible woman worked tirelessly to improve health services for the Aboriginal people. Speaking to a Senate select committee about the plight of Aboriginal people, and establishing the first school classes for profoundly deaf children were just two of her many accomplishments, for which she was awarded a WHO fellowship for overseas post-graduate study and an OAM.

Mum tells me the locals called her “pick-a-pina” She doesn’t know the spelling, or the exact translation, but suspects it may have meant “ear-pain doctor”. Grandma specialised in ear, nose and throat conditions and the Aboriginal children she was working with were plagued by almost constant ear infections, many of which lead to deafness if not treated.

image“I can’t keep giving them antibiotics all the time!”, she lamented. I love the fact that this wasn’t an acceptable solution to her. Antibiotics are wonderful, but if we keep needing them, then surely there is an underlying issue that isn’t being addressed. Grandma thought so too. And having recently discovered that her own health problems improved dramatically when she removed cow’s milk form her diet, she made the courageous decision to try removing cow’s milk from the diets of these children…. and it worked!

I guess I couldn’t help but be a holistic thinker, raised by the family I was born to. I was constantly immersed in an eclectic mix of science, medicine, compassion, spirituality, love for nature and creativity. I thought this was a completely normal upbringing of course, but the adult world I’ve emerged into seems to have quite a bit of trouble pulling these various ideas together into one cohesive whole and seeing the connections between them. And at times, this hinders my own instinctive perceptions of reality. My ideas seem so different from the mainstream that I often assume my ideas are silly, rather than valuing and developing them.

Thank goodness for writing, my very first love! If it weren’t for the pen and the page, or the keyboard and the blank screen, my sense of self might wisp away into nothingness, because my spoken voice can be quite shy!

*”Most allopathic [my notes: another word for biomedical] physicians consider it unethical or even deceitful to actively encourage a placebo response. However, in a recent survey os 1200 practicing internists and rheumatologists in the United States that inquired about behaviours and attitudes regarding the use of placebo treatments, among those who responded (n=679), half reported prescribing placebo treatments on a regular basis in the form of saline, sugar pills, over-the-counter analgesics, and vitamins within the previous year. Most physicians describe these substances to their patients as potentially beneficial or as a treatment not typically used for the patient’s conniption, and most physicians believe this practise to be common and ethically allowable (de la Rochefordiere et al 1996).”

The Fundamentals of Complementary and Alternative Medicine by Marc S. Micozzi. From Chapter 8 (Titled ‘Neurohumoral Physiology and Psychoneuroimmunology. This chapter was written by Marc and Hakima Amri. Marc is an Adjunct Professor of the Dept of Pharmacology and Physology & Biophysics at Georgetown University School of Medicine. Hakima is the director of the CAM Master of Science Program in Physoligy, at the dept of Biochem and Physiology at Georgetown University Medical Centre)

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