Not What You Think It Means- Holistic

Join us on a journey through the intricate landscape of medical philosophy as we explore the dynamic interplay between reductionism and holism. In this thought-provoking podcast, we delve into the contrasting perspectives that shape modern healthcare and challenge traditional notions of disease and wellness.

At the heart of our discussion lies the age-old debate between reductionism and holism. While reductionism champions the idea that understanding the smallest components of a system unlocks the secrets of the whole, holism contends that the synergy of interconnected parts yields emergent properties beyond individual comprehension.

Through engaging narratives and insightful anecdotes, we unravel the complexities of these philosophical frameworks and their implications for medical practice. From the biomedical reductionism that underpins our understanding of disease to the holistic approaches revolutionizing patient care, we examine the strengths and limitations of each perspective.

So, whether you're a healthcare professional seeking to broaden your understanding of medical philosophy or a curious listener intrigued by the complexities of human health, tune in to our podcast as we navigate the intricate terrain of reductionism and holism in healthcare. Together, let's embark on a journey to embrace the richness and diversity of approaches that define modern medicine.

Pubmed "holistic" graph
Joshua Freeman: Towards a Definition of Holism
The history of reductionism versus holistic approaches to scientific research
"Touching Work" by Dr Carrie Ann Purcell
Whole Health
Total Pain
The UK's Holistic Massage

Chapters

• 1:01 Reductionism, the Evil Twin
• 3:44 What is Holism?
• 5:07 Pubmed "Holistic" Graph
• 5:52 Holistic Mindset
• 6:03 Joshua Freeman's Article
• 6:29 Holistic Research Evaluations
• 6:54 Holistic Therapy
• 7:25 Whole Health
• 7:44 Total Pain
• 8:20 Holistic Massage
• 8:25 "Touching Work" Disseration
• 9:44 Why is CAM Automatically Holistic?
• 11:29 Holistic Therapy?
• 13:00 You Don't Wan to Be a Pretzel
• 13:41 The Moral of the Story

Transcript

Corey Rivera: 0:43

Welcome to the Rub. I'm your host, corey Rivera, licensed massage therapist and information magpie. In today's episode, we're going to be talking about the word holism, because I don't think that word means what you think it means. In order to understand holism, I'm first going to talk about reductionism. It's evil twin. Separated at birth, holism and reductionism have become sworn enemies in the fight to dominate medicine. Just kidding, holism and reductionism do tend to be pitted against each other, though. Okay, reductionism is the idea that understanding the small parts of something will help you understand a big something. Also, understanding those small pieces might help you transfer what you know to something related. For example, can we understand how the brain works by understanding how neurons work? And if you take it a step further, can we understand how neurons work by understanding their pieces, like the nucleus and the mitochondria Mitochondria powerhouse of the cell. Reductionism is a broad idea that is applied to all kinds of sciences. In physics, reductionism has taken us from the movement of the planets all the way down to quantum physics, and quantum physics has given us very cool things like solar panels and GPS.

Corey Rivera: 2:08

Biomedical reductionism is the belief that all disease has a biological cause. Cells act up, bacteria gets out of control, we get sick. The idea of disease itself is central to biomedical reductionism and in that view, the role of medicine is to fix a disease. This leads to ideas about physicians sort of being like mechanics they diagnose and fix a problem. Biomedical reductionism also tends to focus on strictly biological explanations. For example, yes, you have a B12 deficiency, but is the lack of B12 because you aren't absorbing what you eat a biological reason, or is it because you can't afford groceries? Biomedical reductionism can be a great way to miss systemic problems. Despite that, biomedical reductionism has gotten us quite far. Our progress in understanding cancer treatments and why some work better than others is because of reductionism. Our knowledge of how cells work allows us to choose a better treatment for each individual person.

Corey Rivera: 3:06

Like all systems, at some point reductionism fails us. It turns out that people are not a basket of disease, they are people. Because reductionism is about taking things apart, we've also tried to take humans apart, like the idea that body and mind are separate things. So relatively recently, we in the West have turned to a different idea wholism. The idea of a hole being greater than the sum of its parts is a direct quote from Aristotle, but the word holism was created only about a hundred years ago A hundred years Like we had cars at that time.

Corey Rivera: 3:44

In 1926, a man named Jan Smuts, a South African general and philosopher, published a book called Holism and Evolution. He took the word from the Greek holos, meaning holes. Smuts actually had a few definitions for the word holism in his own book, but the one that really caught on is the tendency in nature to form holes that are greater than the sum of the parts through creative evolution. So holism is the idea that sometimes one plus one equals potato. When you combine small pieces, they make something new, often something you could never have guessed just by looking at those pieces. For example, sometimes when you combine things, they become Captain Planet, and while Captain Planet is pretty straightforward about fighting looters and polluters, most things that qualify as holistic get really complicated because there's so many parts to take into account. Because you're listening to this podcast and not one about accounting practices, I'm going to assume that you think of holism in a health-related way. But there is actually holistic accounting and linguistics and physics and education. Even though Jan Smuts coined the phrase in 1926, it didn't really start to gain traction in medicine until the 1960s. Okay, nerd moment.

Corey Rivera: 4:54

The research database, pubmed has a feature where you can search for a term and it will show you a graph of usage over time. It is very cool. You should totally check the link in the show notes. If you do, you will see that in 1950, there were three published academic articles that use the term holistic, and then 50 years later, in the year 2000, there were 507 articles published. And in 2023, last year, over 5,000 articles with the word holistic were published 5,000 in one year. The problem with 5,000 articles is that each author tends not to define their particular use of the word, which leads to a lot of mixed meanings.

Corey Rivera: 5:35

Like which whole are you talking about when you say holistic? Is it your general mindset? How wide a net are you casting with your holistic approach? Because what you consider holistic has everything to do with the level you work at. In this great article by a man named Joshua Friedman, link in the show notes, he says the largest scale that is relevant to you that you pay attention to is probably what you define as wholism. He means that your personal definition of wholism is all about your perspective.

Corey Rivera: 6:05

For a cell biologist, an organ is holistic the sum of its parts becoming a new thing For a social worker. It's about a person being part of a family and other social systems. Are you talking about your research evaluation methods being holistic? One of the common struggles of research is figuring out what to measure and how to measure it. Heelwell's massage therapy research in hospitals tends to be more concerned with the experience of pain as opposed to a pain score, and the term experience covers a lot of ground. It includes symptoms like tiredness and depression and well-being metrics like quality of life and outlook. Okay, what about the term holistic therapy? This one kind of bugs me, because it's easy to say you do holistic therapy and it looks really good in marketing and search engine optimization, but it's not very easy to define and, like all those academic articles, people don't even try, although it might not be possible for a solo practitioner to have a fully holistic practice. But we'll get there in a second.

Corey Rivera: 7:11

First, I want to talk about three examples of medical holism that are used right now. The first example is from the US Department of Veteran Affairs. They call their program whole health. Their model includes the pieces that make up a person's health, like body, mind, spirit, but it also identifies self-care, professional care and the community that the patient lives in as factors that affect well-being. The second example is called total pain. This is a concept that's used in palliative care. It was developed by Dame Cicely Saunders, who is a major leader in the modern hospice movement. Total pain says that pain is more than physical. Sometimes when patients talk about pain, they are talking about a combination of factors. It's their body, but it's also worry about their family or their fear of death. All the things causing them distress are included in the pain score that they then give to the nurse. That means that at some point opioids aren't the whole solution. The patient may need a social worker to help with their family or a hospital chaplain for spiritual support.

Corey Rivera: 8:15

My last example of medical holism is particular to the United Kingdom and specifically about massage therapy. I read this dissertation called Touching Work by Dr Kerry Ann Purcell. It's specifically about holistic massage and for 300-ish pages I was confused by what I felt was a marketing term and why it was on every page at least once. So I dug a little more and I found a massage therapist who defined the term. He said that he is a whole person and he expects his client to be a whole person. And having two whole people in a room means that each massage is different every time, because every day we are all different people. He takes all those differences into account in his approach and in the United Kingdom this is called holistic massage, and I thought, well, isn't that all massage? And then I reexamined my biases Because no, no, it's not. If someone thinks of massage as strictly biological therapy as opposed to the biopsychosocial therapy you and I know it to be, then it's not super holistic. I call this type of massage meat massage. If anyone in the room massage therapist or client could be replaced by a pile of meat and nothing would change, then it is not the United Kingdom definition of holistic massage. At Heal Well, this difference is defined by adjusting your language from working on to working with, and I have been gently corrected several times because language is both important and hard.

Corey Rivera: 9:42

Okay, you might be wondering, or I hope you're wondering, why complementary and alternative medicine are automatically considered holistic. Honestly, I think it's because we're really into binary thinking yes or no, either or this, not that. And in order to have a binary setup, you have to have two sides that disagree. So if biomedicine is reductionist, then the thing called alternative medicine must be the opposite, so we call it holistic. In the vast collection of therapies we've decided to call alternative or complementary, there are certainly ideas that biomedicine doesn't focus on.

Corey Rivera: 10:22

Alternative or complementary therapies tend toward the idea that factory default for a body is health and medicine's job is to return a person to health, not necessarily eradicate disease. It might seem like a fine line, but the decision to focus on creation or destruction has implications for the rest of your practice as a massage therapist. Are you destroying adhesions or are you creating a calm nervous system? It feels different, right? Also, side note, you shouldn't try to destroy adhesions, but that's a topic for a different episode. The other thing that alternative or complementary medicine often has in common is a focus on the individual as the vehicle of health. Instead of a physician making you well, you make yourself well. This is great for the concept of agency, but it also leads to blaming people for being sick.

Corey Rivera: 11:10

This kind of wholism can be a great way to miss systemic problems. Wait, didn't I say that earlier? I did, I did, but I said biomedical reductionism is a great way to miss systemic problems. Think about that. Okay, remember when I said that the idea of a holistic therapy kind of bugs me. Our friend Joshua Friedman, who talked about your personal definition of holism, says that the term holistic therapy is kind of an oxymoron. Saying your therapy or modality is the miracle answer to everything is essentially biomedical reductionism. It doesn't matter how many times you use the H word, it is no different than thinking medication is the answer to all problems.

Corey Rivera: 11:56

Here's an example of this I saw a rheumatologist a few years ago and they had a very cheerful resident with them. I was there because I'm hypermobile and I have a smattering of other weird symptoms, so I thought maybe there was enough for a diagnosis and treatment of some kind. No luck, by the way, but I digress. Anyway, I asked the rheumatologist about exercise when your ligaments don't hold so well. Choosing a form of exercise is hard and hiring a personal trainer or getting access to a swimming pool wasn't financially possible for me. The resident excitedly offered yoga and both the rheumatologist and I winced. Having bad ligaments means having a bad sense of proprioception, your sense of where you are in space. So unless my joints are fully flexed I don't get good sensory input, which is why I sit cross-legged pretty much anywhere. I think I can get away with, so doing yoga by myself when I can't tell where my hips are. Bad plan, unsupervised. Yoga is not for everyone, but the eager resident was so used to offering yoga as a solution for everything they didn't take time to consider if it was right for me.

Corey Rivera: 13:01

Please keep in mind that you cannot be medically holistic by yourself. You would go crazy. You'd have to be an expert in biology, psychology, sociology, communication, diagnosis, government policy. Your brain would explode. You would twist yourself so many ways you would turn into a pretzel. This is part of the reason. Professionals have a scope of practice and if you want to take care of a person in a holistic manner, find people that you can work with and refer to and I don't just mean refer, as in sending clients to someone else. I mean having a person you can ask questions to and run ideas by. Real holistic practice requires a team, because you don't want to be a pretzel.

Corey Rivera: 13:42

So what's the moral of all this? Super simple it's not reductionism or holism, it's both and, if possible, at the same time. Any word that ends in ism is a philosophy. It is a model used for thinking about the world and, like all models, it will fail at some point. So, instead of trying to decide which one is better. You need to look at what is useful in your current moment.

Corey Rivera: 14:06

Think of isms like lenses. You can take off your glasses and use a microscope or a telescope. You can try someone else's glasses. Think about what lens you were choosing and why you were choosing that one. When a client is standing in front of you telling you about how their back hurts and also that they're a caregiver for their sick parent, you might put on your holism lenses and think about the total pain concept. Maybe you do your treatment and then you also refer them to a talk therapist or a support group. Or maybe your client is telling you about how their back hurts and how yesterday they accidentally spent 19 hours cleaning out their flower beds. So you zoom in and focus on a more orthopedic approach. You and your practice don't have to pick a side, but I hope next time you're peering through your lenses you realize which ones you have on and that you chose them on purpose. Thank you for listening.