ABSTRACT
Modern healthcare is remarkable. Every day, dedicated, highly trained health professionals provide medical care and treatment and assist people to overcome the devastating effects of long-term illness. What is more, the biomedical model really delivers. There have been many remarkable achievements in the various fields of healthcare and the development of new and effective treatments continues apace, especially in pharmacotherapy. New medications offer relief to millions of people with long-term conditions ranging from chronic and enduring schizophrenia to HIV; new surgical interventions offer treatment with greater efficiency and in less time; and ever more specialist services are able to offer bespoke expert advice. As a result, medical interventions and treatments have increased survival rates, and overall life expectancy continues to rise. This may seem to be an odd starting point for a book on holism but, as is apparent, our approach to this book is not anti-medical. Nor is our stance in any way antiscience. Many of the authors of the chapters are clinicians who are not only embedded in clinical ‘reality’ but actively draw upon empirical research to inform their discussion. Without question, medical science has been enormously successful in treating illness and disease and there is much to celebrate. However, much of the success of medical care and treatment, of course, comes from advances in understanding the germ theory of diseases and from isolating, caring for and treating parts of the body. Such developments have been accompanied by (and have perhaps even been necessitated by) an emphasis on reductionism, rationality, scientific objectivity and a persistence of Cartesian separation of the mind and the body. It has become clear that the medical model has become limited in its ability to account for, and respond to, the totality of the lived experience of the individual, and as such is inadequate in improving the overall sense of health and well-being of people. For example, medical explanations of disease processes continue to be accounted for by
linear models and simplified unicausality at a time when the modern world has increased the complexity of lives. Traditional communities have been replaced by modern societies, and the erosion of family and social networks and a concomitant sense of isolation have become implicated in the development of psychological distress. With growing expertise in medical areas has come increasing and inevitable specialisms, which has tended to also bring with it a disparate set of assumptions and ideologies about health and illness among healthcare practitioners, demarcated along professional lines. Expert healthcare practitioners may often find themselves ‘living out their existence next door to each other but in altogether different subjective worlds’ (Kelly 1955/1991, 56). Individuals and carers, likewise, may feel excluded from this increasing technological world and as such are in danger of being mere passive bystanders in their own care, or the care of their loved ones. There is, therefore, an increasing awareness of gaps in the provision of modern medicine, and in the knowledge needed to participate in one’s own care. People with long-term mental health problems, for example, often have poor access to specialist health services where diagnostic overshadowing may lead to a misinterpretation of physical symptoms as psychiatric phenomena. Further, many patients feel that modern medical services lack responsiveness to the totality of their healthcarerelated needs, particularly mental health service users and those with functional health-related issues. Medical sociologists, such as Ivan Illich (1975), have argued that an exclusive interpretation of ill-health in purely medical terms attributes blame for an individual’s illness or disease to factors located within the lifestyle choices they have made, rather than as a consequence of social and environmental factors brought about by industrialised societies. Furthermore, there is increasing evidence that social, psychological, emotional and even psychiatric factors are implicated in the aetiology and trajectory of physical illnesses. There is also much evidence that well-delivered holistic care where people feel connected with and involved in their own treatment have better clinical outcomes (Hassed 2004).
