Rather than addressing the whole system contributing to health and well-being, medical and chiropractic science often limit themselves to a uni-analysis of factors -- to the germ or the fixated segment -- viewed as the cause of dis-ease or ill health. These one-point analyses are essential elements but, they are just one component of what is required to fully understanding illness and health.
The approach to health care has been, and continues to be, largely based on this reductionistic disease model, which not only is limited in its utility, but also extremely costly. Even so, it has remained the standard paradigm of our approach to health and disease. David Sobel, MD, MPH, of the Kaiser Permanente Foundation, points out:
"Medical treatments, especially the drug and surgical treatments of sick individuals, have had relatively little to do with the better health that people enjoy[ed]. We are wedded to medical ideas that are incorrect."
Emerging Disease Trends
In the post-industrial societies, new demands and realities influence health and well-being. Infectious disease is no longer the threat it once was, resulting in major limitations of the germ theory. We are now faced with so-called problems of well-being and prosperity: chronic conditions such as cardiovascular disease, cancer, and pain syndromes.
In an address presented at a recent international symposium on the effectiveness of disease prevention and health promotion held by the Centre for Health Promotion (University of Toronto), Dr. Bo J. A. Hagland of the Karolinska Institute in Sweden, described another emerging disease trend in the area of "psycho-emotional social health." This trend is thought to escalate into the 21st century, largely caused by the stress of life in post-industrialized societies. According to Dr. Hagland, no longer are infectious diseases the major cause of ill-health, nor the so-called unhealthy lifestyle behaviours (smoking, alcohol use, sedentary lifestyles, etc.) be seen as so critical. Stress is now becoming the major challenge to optimal health of individuals and societies. The physical and social environments in which we work and live will be the major contributors to our health. Given this new emergence of psychosocial emotional disease, a modified approach is essential for ensuring a relevant response by the health care system. A New Strategy: Behavioural Medicine Mind/Body Medicine
Behavioural medicine or mind/body medicine (a subspecialty of behavioural medicine) is a newly developed area that responds to the psychosocial component of disease. In this field, mental and emotional factors, the ways in which we think and behave, are recognized for the significant role they play in our health. Such factors have a fundamental impact on our ability to withstand and recover from illness and injury. Mind/body medicine recognizes the strong interconnection of mind and body, believing it is only through a deeper understanding of this relationship that we can truly understand health and disease. The power that made the body can heal the body; in this way, it shares a strong similarity with chiropractic philosophy.
Through mind/body medicine, allopathic medicine is gradually developing a response to shifting disease trends. New clinics focusing on the "whole person" and the stresses they face in their lives are emerging as a consequence. Although the notion of stress interventions is certainly not new, there are growing successes in the range of illnesses found to be amenable to this type of treatment. There is very good research to suggest that interventions based on current stress reduction techniques are highly efficacious for such diverse conditions as:
So where does the chiropractic profession stand on this issue? As with the majority of other illnesses, joint and muscle disorders do not exist in a vacuum. Are we reductionistic like the traditional medical practitioners? Do we need to consider other components of the subluxation complex, not just the fixated segment? What is our philosophy of health? These are important questions when respected institutions such as Harvard's Mind Body Medical Institute states that 70-90 percent of all disease and illness is caused by stress.
The doctor of the future, whether in chiropractic or medicine, will have to consider all relevant components of the presenting patient, from the necessary one-point analyses to larger behavioural determinants. This combined form of treatment is not only clinically effective and cost-effective, but the emerging disease trend of the 21st century requires this approach. Already HMOs in the U.S. are covering these interventions. Furthermore, the National Institutes of Health in the U.S. recently published a consensus statement describing stress interventions as a treatment of choice for chronic pain syndromes.
Max Plank once said that a scientific truth does not triumph by convincing its opponents, rather its opponents die off and a new generation grows up aware of the new truth. The era of mind/body medicine is upon us. It possesses part of the best current explanation of what constitutes optimal health. Will chiropractic be part of the new paradigm or part of the old generation?
References
Ornstein, R, Sobel, D. The Healing Brain. New York. Simon & Schuster. 1987
Proceeding of: Symposium on the Effectiveness of Health Promotion: Canadian and International Perspectives. The Center for Health Promotion, University of Toronto. 1996. In Press.
Kabat-Zinn J et al. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry 1992; 149: 936-943.
Benson, H. The Mind/Body Effect. New York Simon & Shuster.
J.P. Pawlin-Fry BA, BPHE, DC
Elizabeth Pawlin-Fry BSc., M.HSc
About the authors: J.P. Pawlin-Fry BA, BPHE, DC, completed clinical training at Harvard Medical School's Mind Body Medical Institute and the internship program at the Stress Clinic, University of Massachusetts Medical Centre. Elizabeth Pawlin-Fry BSc., M.HSc is a research associate with the Centre for Health Promotion (a World Health Organization collaboration center) at the University of Toronto. The doctors are co-presenters of "Stress, the Mind, and the Body," a two-module MPI seminar.
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