Not What You Think It Means- Holistic

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 . 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 . 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 . 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 . 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 . 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 . 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 . 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 . 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 . 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 . 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 . 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 . 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 . 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 . 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 . 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 .