What is vitalism and how does it relate to chiropractic? For some in the profession, vitalism consists of two foundations (and controversial) notions:
1) The body is a self-regulating system with the innate ability to heal itself
2) The central nervous system is the master control system that allows the body to self-regulate
Although not everyone views vitalism as an integral component of chiropractic, it may be time to re-evaluate its place in the profession. Why? Because as new research emerges and the health care system continues to change, we must consider the repercussions of these changes on the way we "view" health and the way we practice chiropractic. In this article, we examine the notion of vitalism or innate, assess whether we can reconsider it with more scientific rigour and then discuss its potential influence on the way we practice.
A Limited View?
Most professions have a common element -- they often become mired in old paradigms and outdated thinking. In chiropractic, have we restricted our focus to merely the safe and proven or alternatively, the dogmatic? The orthopaedic model, while a useful one, may be limiting. Is there room for change or growth beyond this model? And with respect to the more "philosophically driven" practice of chiropractic -- do alternative ways to practice exist besides "hands only, spine only" which empower innate? Can this be done while at the same time maintaining philosophic principles? It is crucial that we re-examine our paradigms and the way we see the world, from both an orthopaedic and philosophic point of view, or we risk stagnation. T.H. Huxley once said, "Sit down before fact like a little child, and be prepared to give up every pre-conceived notion, follow humbly wherever and to whatever abyss Nature leads, or you shall learn nothing." Practitioners who are unwilling to do so many find themselves left behind in the "new economy" of health care.
Vitalism Revisited -- The Neurology of Chiropractic
In chiropractic, an examination of vitalism and innate centres on the existence of the vertebral subluxation complex -- a subject of debate that seems to divide more than unify the profession. While this article is not intended to persuade those who do not accept the subluxation, more and more research is demonstrating the need for re-evaluation for the subluxation. And contrary to conventional chiropractic thought, it has very little to do with a bone out of place that impinges on a nerve (only in a very few rare instances is this the case). The basis and consequences of vertebral subluxations is neurological -- specifically, nociceptive irritation and the dorsal horn (a thorough examination of this is provided in MPI's Neurology seminar presented by David Seaman). Those reading this who embrace the bone out of place theory should not feel threatened by this somewhat more sophisticated description. If anything, it should empower the doctor of chiropractic to believe more strongly in the power of "eliminating subluxations." A deeper understanding of this literature allows one to articulate the importance of practising "subluxation-based" chiropractic without apology (though with some limitation). Conversely, for the "scientifically-oriented" chiropractor, there is no need to feel weak kneed at the "S" word. Before writing off subluxation and innate, give the literature a look. While there is still much study to be done to fully understand the mechanisms involved, the pathways are becoming clearer as technology improves.
Innate: A Lost Idea?
The crucial question here is do you believe the body has the ability for self-healing and self-regulation? The dilemma in chiropractic is that while we continue to bicker over the existence of the subluxation and the innate healing power of the body, other health care practitioners are becoming more interested in innate -- making it part of their language and practice.
Medicine & Innate
Looking outside of chiropractic and more broadly at vitalism reveals a growing body of both popular and scientific literature to support the notion that there is indeed an innate healing quality to the body. Familiar and even household names pervade this expanding field. Herbert Benson of Harvard Medical School, Jon Kabat-Zinn of the University of Massachusetts and Deepak Chopra (of no fixed address) are some of the main players. Their books and lectures are powerfully influencing North America about the power of innate. Falling under the banner of Mind/Body Medicine, increasing scientific evidence is catching up to own intuition that tells us our bodies are our own pharmacies, our own doctors.
What system are they attempting to influence? The nervous system of course -- the very neurological pathways chiropractors are attempting to influence. And they are doing it with great success. According to Kenneth Pelletier, PhD, "the discovery that individuals can learn to control autonomic functions is one of the most profound discoveries of contemporary medicine, with far-reaching implications for the future of holistic, preventative health care." When I was at Harvard's Mind Body Medical Institute, they were very excited about the body's innate ability to heal itself via self-regulation of the nervous system. They see it as the health care of the future. Sound bizarre to you? Well, it shouldn't -- after careful study, medicine is starting to come around to the idea of innate. The question is whether as a profession, have we lost it?
Chiropractic and Auto-suggestion
D.D. Palmer specified three main causes of subluxations: trauma, toxins, and auto-suggestion. At this point in the history of chiropractic we have done well in dealing with the first two. To the best of our knowledge, nutrition was not emphasized in the early training and clinical practice of chiropractors. Still, the profession has for the most part made it an integral part of the chiropractic paradigm. We've changed with the times -- we are now leading the way in primary care in nutrition and musculoskeletal health.
The final area chiropractic has been less effective in addressing is auto-suggestion or the mind body component -- particularly unfortunate since it's what is currently catching the attention of the public. Seldom does a day go by in the popular press when some new finding isn't being reported on the effect of emotions, thought, and the mind on our health. As the public becomes increasingly aware of this vital mind/body link and the body's innate abilities to help restore health, market share in the new economy of health care enters the equation. But just who will be the health care provider in this new and exciting area?
Mind/Body Medicine and Chiropractic
Are chiropractors appropriate providers to deliver this care? Absolutely -- unless mind/body interventions don't fit your paradigm of what constitutes health (is the nervous system part of your paradigm of health?).
As we have described in past articles, not only does mind/body medicine fit the chiropractic paradigm of health (from both a scientific and philosophical point of view) but patients love it, it's easy to implement into practice (without slowing you down as a practitioner), and it creates a more stimulating way to practice. Of course, the new areas of practice that open up (such as consulting with business and athletes) are not mere bonuses -- they invigorate any existing practice and become a great source for new patients.
The windows of opportunity in mind body interventions, however, will not remain open forever. At this point, mainstream medicine, and other disciplines have not yet fully integrated mind body medicine into their practice. As we are all aware once they decide to, they will do their best to monopolize it.
The Witch Doctor
Finally, we need to determine our role as chiropractors. Are we merely technicians limiting ourselves to adjusting the spine as the sole means to either reduce fixations orthopaedically or empowering innate? Are there other ways to do both and still maintain scientific and philosophical integrity? In the final analysis, aren't we all just attempting to empower the body toward health and away from disease using the most effective and non-invasive methods available to us?
Albert Schweitzer, MD, was once asked why the "witch doctor" in Africa succeeded in curing his or her patient. He explained it this way:
"The witch doctor succeeds for the same reason all the rest of us succeed. Each patient carries his own doctor inside him/her. They come to us not knowing that cure. We are at our best when we give the doctor who resides within each patient a chance to go to work."
J.P. Pawliw-Fry, DC
Guelph, Ontario, Canada
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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A central challenge in creating our identity is that chiropractic is a method of care, not a technique or procedure. This is an important concept for us to promote. Our patients are treated with lifestyle modification, exercise, nutritional supplements, diet and a whole-body approach to accelerate the natural healing process. We are not simply CMT providers.
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