A Short History of Clinical Holistic Medicine
A Short History of Clinical Holistic Medicine
S?ren Ventegodt 0 1 2 3 4
Isack Kandel 5
Joav Merrick 6 7 8
0 Quality of Life Research Center , Teglga?rdstraede 4-8, DK-1452 Copenhagen K , Denmark
1 Research Clinic for Holistic Medicine
2 Nordic School of Holistic Medicine , Copenhagen , Denmark
3 Scandinavian Foundation for Holistic Medicine , Sandvika , Norway
4 Interuniversity College , Graz , Austria
5 Faculty of Social Sciences, Department of Behavioral Sciences, Ariel University Center , Samaria, Ariel , Israel
6 National Institute of Child Health and Human Development
7 Office of the Medical Director, Division for Mental Retardation, Ministry of Social Affairs , Jerusalem , Israel
8 Kentucky Children's Hospital, University of Kentucky , Lexington , United States
Clinical holistic medicine has its roots in the medicine and tradition of Hippocrates. Modern epidemiological research in quality of life, the emerging science of complementary and alternative medicine, the tradition of psychodynamic therapy, and the tradition of bodywork are merging into a new scientific way of treating patients. This approach seems able to help every second patient with physical, mental, existential or sexual health problem in 20 sessions over one year. The paper discusses the development of holistic medicine into scientific holistic medicine with discussion of future research efforts.
Holistic health and medicine; complementary and alternative medicine
Millennia ago, around 300 BCE, at the island of Cos in old Greece, the students of the famous physician
Hippocrates (460-377BCE) worked to help their patients to step into character, get direction in life,
and use their human talents for the benefit of their surrounding world. For all that we know this approach
was extremely efficient medicine that helped the patients to recover health, quality of life, and ability, and
Hippocrates gained great fame. For more than 2,000 years this was what medicine was about in most of
On other continents similar medical systems were developed. The medicine wheel of the native
Americans, the African Sangoma culture, the Samic Shamans of northern Europe, the healers of the
Australian Aboriginals, the ayurvedic doctors of India, the acupuncturists of China, and the herbal doctors
of Tibet all seems to be fundamentally character medicine[2,3,4,5,6,7,8]. All the theories and the medical
understanding from these pre-modern cultures are now being integrated in what is called integrative or
transcultural medicine. Many of the old medical systems are reappearing in modern time as alternative,
complementary and psychosocial medicine. This huge body of theory is now being offered as a European
Union Master of Science degree[2,3,4,5,6,7,8].
?2007 with author.
Interestingly, two huge movements of the last century have put this old knowledge into use:
psychoanalysis and psychodynamic therapy[10,11] (most importantly STPP[12,13]) going though the
mind on one hand, and bodywork (most importantly Reich, Lowen[
] and Rosen) and sexual
therapy (especially the tantric tradition) going through the body on the other. A third road, but much
less common path has been directly though the spiritual reconnection with the world[18,19].
Our international research collaboration got interested in existential healing from the data coming
from epidemiological research at the University Hospital of Copenhagen (Rigshospitalet) starting in
1958-61 at the Research Unit for Prospective Paediatrics and the Copenhagen Perinatal Birth Cohort
1959-61. Almost 20 years ago we were conducting epidemiological research on quality of life, closely
examining the connection between global quality of life and health for more than 11.000 people in a
series of huge surveys[see 20] using large and extensive questionnaires, some of them with over 3,000
questions. We found (quite surprisingly) from this huge data base that quality of life, mental and physical
health, and ability of social, sexual and working ability seemed to be caused primarily by the
consciousness and philosophy of life of the person in question, and only to a small extent by objective
factors, like being adopted, coming from a family with only one breadwinner, mother being mentally ill,
or one self being financially poor or poorly educated (which are obviously very much socially
This scientific finding was not expected and so contra-intuitive for us that we were forced to
investigate the subject going to the roots of western medicine, or the Hippocratic character of medicine.
This meant that we had to look at transcultural and integrative medicine, the emerging science of
alternative medicine (scientific CAM theory) and to the very much forgotten traditions of psychosomatic,
psychodynamic, and bodily oriented therapies. Around 1994 we received substantial fundings for our
research project trying to embrace this huge heritage of medical wisdom
philosophically[21,22,23,24,25,26,27,28], theoretically [29-49], epidemiologically/statistically [50-71].
We have since 1997 with a great effort tried to take this knowledge into clinical practice [72-113],
and with quite extraordinary results. Clinical holistic medicine has in our Research Clinic for Holistic
medicine in Copenhagen helped every second patient with physical, mental, existential or sexual health
issues or diseases over one year[114-119]. Finally we have been looking at what seems to be the common
denominator for all existential healing work in all cultures at all times: the sense of coherence, most
clearly expressed by Aaron Antonovsky (1923-1994), a sociologist from the Faculty of Health Sciences at
the Ben Gurion University of the Negev in Israel[18,19,120-125]. We have also been debating many
difficult issues related to modern day medical science, especially in the British Medical Journal [126-139]
and finally we are now collecting most of what we consider essential knowledge for the holistic physician
in a series of books on the ?Principles of holistic medicine?[140-142].
What we have learned from this long journey through the grand medical heritage from the different
cultures on this planet is that we need to work on body, mind and spirit at the same time (medicine men
has always combined talking, touching, and praying), and that being human and truly kind is what really
heals the other person. This is what Hippocrates called ?the Art?, not ?the art of medicine? or ?the art
of right living?, but simply ?the art? ? the way of the human heart, cultivating existence into sheer
compassionate behaviour and joyful being, which has always been the ultimate goal of all the great
healers in our history.
We are more than happy to see our research project in scientific holistic medicine (clinical holistic
medicine, CHM) developing. The most paradoxal aspect of this is that while we like to think we are
taking medicine forward, we are actually just taking medicine back to its roots.
The most important thing is that research and development in this field is made in a dialectic process
between qualitative and quantitative research.
QUALITATIVE AND QUANTITATIVE RESEARCH
There are basically two ways of documenting an effect of a holistic medical intervention, the quantitative
and the qualitative approach. Much effort has been given to developing valid methodology and measuring
tools, but the art of documentation has become a complex and expensive task. Due to lack of resources we
have been forced to seek simple, but still valid ways of documenting effect. In this communication we
will focus on the qualitative research method.
Fortunately the holistic approach makes it much simpler, because there are always three domains to
investigate: health, quality of life (QOL) and ability. These three domains can be subdivided in as many
detailed domains as one wishes, but often three are sufficient for most purposes.
There are two qualitative aspects of documenting effect in medicine, often called subjective (that is
from the perspective and experience of the patient) - and objective (that is from the perspective of the
therapist or researcher). To document effect of an intervention using both perspectives, the patient must
be interviewed before and after the intervention. Semi structured interviews with interviewer rating of the
state immediately before and after the intervention can be used to give the objective perspective on the
effect of the intervention. Interviewing the patient after the intervention can give the patient's subjective
experience of the effect.
Most importantly these perspectives often leads to two different results, but confronting the patient
with the observed improvement, after the patient has given his own experience of the effect, can be very
The consensus paradigm states that only to the degree that there is consensus between patient and
therapist/observer, the treatment has an effect. If the patient experience an effect that cannot be observed,
something else is likely to have happened, i.e. an upgrade of other dimensions than the three defined as
outcome. Instead of QOL, health and ability the patient has gained self-esteem, confidence, admiration
from others etc. As holistic medicine aims to improve life in these three domains, a pleasant experience
with the therapy is not the same as en effect of a treatment.
If the patient does not experience an observed effect, this effect is most likely to be happening only in
the observer?s mind. Very often a therapist is convinced that a cure or intervention gave a positive result,
but the fact that the patient did not experience that is then often neglected. In holistic medicine the
dimensions we want to improve are highly experiential, so if the patient did not experience any
improvement, such an improvement is most likely not to have happened.
Interestingly one single patient is enough to document effect with the consensus paradigm. If both the
physician and his patient, after careful investigation before and after the treatment, find that the treatment
has helped, this is most likely the case. The more precise the target group and the treatment are defined
the more valuable the documentation. We recommend for securing the validity that the presented method
is used with five highly comparable patients receiving five highly comparable treatments.
As always we recommend for the observer rating a five point symmetrical Likert scale with neutral
middle point and equidistance. A clinically significant improvement must be half a step on this scale
or more. The patient needs to express the gain as a "significant improvement". When both patient and
observer find improvement of QOL, health, and ability significant (according to the above), we call the
PERSPECTIVES FOR FUTURE RESEARCH AND DEVELOPMENT
There are lots of possible advantages with the scientific holistic medicine that must be closely examined
in future research:
How can it be make a affordable, efficient medicine for the future The possibility to prevent disease
The possibility to cure cancer and coronary heart disease
The possibility to seroconvert HIV-positive patients to HIV negative
The possibility to relief pain and discomfort
The possibility of rehabilitating working ability
The possibility of improving peoples competency as parents
The possibility of improving working efficiency though development of talent
The possibility of helping people to be happy in spite of difficult circumstances and
The possibility of people developing consciousness and becoming more responsible for local
and global environment
The Danish Quality of Life Survey and the Quality of Life Research Center was 1991-2004 supported by
grants from the 1991 Pharmacy Foundation, the Goodwill-fonden, the JL-Foundation, E. Danielsen and
Wife's Foundation, Emmerick Meyer's Trust, the Frimodt-Heineken Foundation, the Hede Nielsen Family
Foundation, Petrus Andersens Fond, Wholesaler C.P. Frederiksens Study Trust, Else & Mogens
WedellWedellsborg's Foundation and IMK Almene Fond. The research was approved by the Copenhagen
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