Heroes Not Zombies

How can a doctor practice holistically? Intention and attention are certainly fundamentals but there are concepts and mental frameworks which set up holistic care. Here are three key ways to make holistic care happen.

1. Looking for connections

If a human being is considered as a complex adaptive system, then symptoms and physical changes in individual are understood to be connected. Every part of a complex adaptive system can act on, and, in turn, be acted upon, by other parts. So what’s the connection between this symptom and another one? How are all the symptoms connected up? Looking to see what connections there are develops the focus from parts towards the whole.

Within a human being we can become aware of whole systems of interconnection. The fields of psychoneuroimmunology (the interaction between the mind, the nervous system and the immune system), psychoneuroendocrinology (the mind, the nervous system and the endocrine system), and in more recent times, interpersonal neurobiology (the links between the mind, the brain, and others), have all advanced our understanding of the interconnectedness within a human being, and between an individual and their environment.

2. Looking for context

Every living being is in constant active relationship with multiple environments, physical, social, cultural, temporal. A holistic approach entails seeing the individual within their particular environments and understanding how they are related. In other words, exploring the contexts of the person, their health and their illness.

A reductionist approach de-contextualises phenomena. Randomised, controlled trials, for example, claim to “control for” contextual factors and study individual phenomena without those influences and relationships. I have serious doubts if such approaches are ever really achievable, but even if they were, the findings would need to be re-contextualised to make sense of an individual life.

In a holistic approach, context is always important.

3. Stories and metaphors.

I’m particularly fascinated by individual stories. Every person I see tells me a new story, and its always a fascinating one. We make sense of our lives through story. We understand the present in the light of both the past, and of future hopes and fears. We gain a sense of Self through story. We understand each other through the shaking of our stories.

For me, narrative is the core of a holistic approach.

There is also one very intriguing element of an individual story which, when it manifests itself is like a nugget of gold, the embodied metaphor. For example, the person who presents with an eye problem whose core issue is that “my family don’t see things the way I see them”. The whole area of embodied metaphors is a fascinating one and if it appears in someone’s story, it can be the key to resolving the problem.