PEER GYNT'S ONION by ANTHONY CAMPBELL
Posted to Wiretap 10/13/94.
(C) Copyright 1994 Anthony Campbell
This text is COPYRIGHTED, but freely distributable.
COPYRIGHT NOTICE
This book is copyright. I am distributing it electronically
as an experiment.
Permission is granted to make and distribute verbatim copies
of this book provided the copyright notice and this permission
notice are preserved on all copies.
Comments, questions etc. should be sent to the author at
[email protected].
Anthony Campbell
Consultant Physician, Royal London Homoeopathic Hospital,
London, UK.
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PEER GYNT'S ONION
An Alternative Alternative Medicine Book
Anthony Campbell
[Peer Gynt addresses the onion]
I'm going to peel you now, my good Peer!
You won't escape either by begging or howling.
[Takes an onion and pulls off layer after layer.]
...
What an enormous number of sheaths!
Isn't the kernel soon coming to light?
I'm blessed if it is! To the innermost centre,
It's nothing but sheaths - each smaller and smaller -
Nature is witty!
[Henrik Ibsen, PEER GYNT, Act V, Sc.5]
(C) Anthony Campbell 1992, 1994
For Marie-Christine
CONTENTS
________________
INTRODUCTION
1. THE CHANGING FACE OF MEDICINE
2. WHAT IS ALTERNATIVE MEDICINE?
3. COMPLEMENTARY OR ALTERNATIVE?
4. IDENTIFYING FEATURES
5. ALTERNATIVE CAUSES OF DISEASE
6. IS IT SAFE AND DOES IT WORK?
7. PLACEBOS AND PSYCHOTHERAPY
8. THE NEW AGE
9. TRYING TO MAKE SENSE OF IT ALL
INTRODUCTION
Like Peer Gynt's onion, alternative medicine has many
layers: practical, sociological, philosophical, even mystical.
In this book I have sought to peel my own version of it,
discovering in the process a variety of opinions both in
others and in myself. And if in the end I find, like Peer, no
centre to my onion, no one fixed viewpoint I can confidently
label as right to the exclusion of all the rest, perhaps that
is no bad thing; the world seems over-supplied just now with
people convinced of their own rightness.
I have been practising a combination of unorthodox and
orthodox medicine for nearly twenty years, and this seemed a
good time to put down the conclusions I have arrived at up to
now, although without claiming that they are final (the only
final conclusions should be those we hold when we die). Their
merit, such as it is, comes from the fact that I am not a
journalist or other armchair critic but a labourer at the coal
face. (Not that I have anything against journalists; indeed, I
was a medical journalist myself for a number of years.)
Patients quite often ask me how an orthodoxly trained
doctor like me came to practise homoeopathy and acupuncture. I
think they often expect to hear about a 'road to Damascus'
conversion experience, but really it wasn't at all like that.
It happened more or less by chance, as these things so often
do.
As a medical student in the late 1950s I learnt nothing
whatever about any form of alternative medicine. I can only
remember homoeopathy, for example, being mentioned on one
occasion, and I assumed, without thinking about it very much,
that homoeopathy had probably ceased to exist as a medical
system in the nineteenth century. As for acupuncture, I knew,
of course, that it was still practised in China, and at some
time in the 1960s I happened to read a letter in the British
Medical Journal from a doctor who described with amusement his
experience of being treated with acupuncture for a sprained
ankle in France. This was pretty much the total of my
knowledge of alternative medicine until the 1970s.
At that time I was working for a journal called ABSTRACTS
OF WORLD MEDICINE, which was published by the British Medical
Association. Sometimes as I walked about the streets in the
neighbourhood of BMA House I would chance to pass by a
building that bore the legend "Royal London Homoeopathic
Hospital". I used to wonder about this a little; I supposed
that the name was probably a quaint survival from the
nineteenth century, but it seemed unlikely that homoeopathy
was still practised there today.
I found out my error thanks to some friends who were
ardent homoeopathic patients. They told me that homoeopathy,
far from being extinct, was still alive and flourishing and
was practised by doctors as well as by people without a formal
medical training; the homoeopathic hospital I had noticed was
in fact the foremost institution for the study and practice of
medical homoeopathy in Britain and perhaps the world.
By this time I had for various reasons (including the
demise of the journal for which I worked) left medical
journalism and returned to clinical medicine. I had just
obtained the membership of the Royal College of Physicians,
which is the essential higher qualification needed by anyone
who wants to become a consultant in medicine in the National
Health Service, and I was looking for a new career direction.
Owing in part, perhaps, to a certain contrariness of
character, I was also interested in exploring unorthodox
medicine. What attracted me most was acupuncture, but I did
not know of any way to take this interest further, while
homoeopathy was evidently a practical possibility. I therefore
made enquiries at the hospital.
As it happened, British homoeopathy was in crisis at that
time. A short while previously a British Airways Trident had
crashed just after taking off from Heathrow, killing all
aboard. Among the passengers were several of the most
prominent homoeopathic doctors of the day, who had been on
their way to an international congress in Belgium. There was
accordingly an urgent need to find new recruits for
homoeopathy in Britain and to secure the future staffing of
the Royal London Homoeopathic Hospital, and I was one of the
doctors who eventually filled this gap.
The Hospital is within the National Health Service, and
sees a large number of patients annually (over 20,000
consultations in a year). It offers not only homoeopathy and
orthodox medicine (all the doctors who work there are qualifed
in both areas) but also a range of other complementary
therapies, including acupuncture, osteopathy, and autogenic
training. Some patients are admitted for more intensive
treatment or for investigation, but the majority are
outpatients. Most have long-term disease; we see few acute
problems, partly owing to the length of our waiting lists.
In the time that I have been at the hospital public
attitudes, and doctors' attitudes, have changed considerably.
I have noticed this in connection with the acupuncture courses
for doctors which I hold. Ten years or so ago I had to spend a
certain amount of time on courses answering questions from
doctors who were sceptical. Nowadays this very seldom happens;
they nearly all assume unquestioningly that acupuncture works
and simply want to get on with learning it.
As might be expected, however, the enormous outpouring
of popular interest in alternative medicine has not gone
unchallenged. There has been a reaction. Books and articles
criticizing various aspects of alternative medicine have begun
to appear, and the British Medical Association carried out an
investigation whose findings were largely unfavourable to
unorthodox treatments. However, the mistake of the 'anti'
lobby is usually to pick off the easy, obvious targets without
really going into the subject in any depth. Of course there is
a large element of nonsense in alternative medicine, and it is
tempting, and sometimes legitimate, to make fun of it. But
some of the treatment that is included under the rubric
'alternative' does actually work, and has been shown to do so
in proper scientific studies, so it is wrong to dismiss the
whole lot as mumbo-jumbo. Reading some of these books, I seem
to hear the despairing gurgles of some quite presentable
babies as they disappear down the plug hole.
Moreover, the critics of alternative medicine usually
fail to see that, even if a lot of what they attack so
vehemently is foolish and misguided, there must be a reason
why it has become so popular. There must be something wrong
with orthodox medicine, there must be a need that it is not
responding to.
It can be difficult and uncomfortable for people trained
in Western mainstream medicine to come to terms with
unorthodox practices. I have noticed, for example, that many
of the doctors who come on my acupuncture courses seem quite
happy to use the technique for treating painful disorders of
muscles and joints, but relatively few go on to apply it to
the treatment of other things like allergies, gynaecological
problems, or colitis, to mention just a few which often
respond well. Yet treating these disorders is no more
difficult than treating muscles and joints; in fact, in some
ways it is easier. What prevents them is probably a
psychological block; they can just about imagine that
acupuncture might work for a painful back, but they cannot see
any reason why it should work for, say, ulcerative colitis.
For that matter, nor can I; but it certainly appears to.
At the other extreme a few doctors switch allegiance
almost completely after they qualify and become, in effect,
alternative practitioners, using almost no conventional
treatment at all. However, these are very much the exception,
and the vast majority continue to use the two approaches
together. In so doing they attract the scorn of many non-
medical therapists, who regard them as dabblers. However, I am
quite unrepentant about mixing methods in this way.
I am thoroughly convinced of the value of sustaining
creative tensions within oneself. It is no doubt more
comfortable to be a whole-hearted believer or a whole-hearted
disbeliever in anything, but either of these attitudes tends
to cut one off from many possibilities. I am reluctant to do
this; I like to keep my options open. This book should be seen
as an exploration of the (I hope creative) tension that
results from trying to keep both the orthodox and the
alternative perspectives in view simultaneously.
1: THE CHANGING FACE OF MEDICINE
To begin with, a thought experiment, which will help you
to define your own attitude to the ideas I want to examine in
this book.
Suppose that an old friend whom you have not seen for
several years telephones you unexpectedly and says she would
like to talk to you. When you meet, she tells you that she is
seriously ill and has not long to live. She has no close
relatives, so she wants to leave her considerable fortune to a
medical charity of some kind. She has two ideas, and finds it
difficult to choose between them.
The first idea is to leave the money to buy a scanner
for her local hospital, where she has been well treated. She
knows that there is a need for such a machine in the district,
and it would undoubtedly benefit many patients.
The other idea is more unorthodox. She has received a
lot of help from a practitioner of alternative medicine, who
is keen to set up an institute for the study and practice of
various kinds of therapy. This person has plenty of enthusiasm
and many plans and your friend is convinced of the value of
what he is trying to do.
Although your friend is well off, her legacy would not
be enough to fund both of these projects fully. She wants your
advice about what she should do.
How do you advise her?
1. She should leave all her money to fund the scanner.
2. She should leave it all to fund the institute for
alternative medicine.
3. She should divide it between them in the hope that the
balance will be made up from elsewhere. If so, what proportion
would you suggest she ought to leave to each? (Give your
reasons.)
It is a fairly safe prediction that this imaginary
situation has at least made you pause for a moment to wonder
about your attitude to alternative medicine. Fifteen or twenty
years ago, unless you happened to belong to the then tiny band
of stalwart supporters of homoeopathy and other unconventional
forms of therapy, you probably would not have hesitated for a
moment in dismissing it all as quackery. As we know, things
are very different today.
Recently I was in the Casualty Department of my local
general hospital. The notice board contained advertisements
for local services of various kinds; nothing very remarkable
in that, except that included among them were a group of local
osteopaths and a hypnotherapist.
Only a very short time ago such a thing would have been
inconceivable. Indeed, it is not very long since an orthodox
doctor would have been liable to erasure from the Register if
he 'associated' with an alternative practitioner. Things are
certainly changing fast. Nowadays we hear more and more about
osteopathy, homoeopathy, acupuncture and other kinds of
unconventional treatment. Once they were a minority interest,
pursued by just a few cranks. Now they are constantly in the
news, on television, in articles in popular magazines.
But there is a correspondingly large amount of confusion
in the minds of both patients and doctors. What are these
things? Do some of them work? All of them? None of them? Is it
all a media hype?
And it is difficult to find definite answers to
questions such as these. There are so many different
alternative treatments available, and the number seems to grow
all the time. It is not even clear what we should call the
phenomenon. Once it was 'fringe medicine', then 'alternative
medicine', and now often 'complementary medicine'. (The
progressive change reflects the increasing respectability of
the thing in question.)
Nor can one easily define alternative medicine. At one
time it would have been safe to say that it was any kind of
treatment that is not taught to medical students or practised
in National Health Service Hospitals, but that definition is
no longer valid; many hospitals now use acupuncture, and other
forms of alternative treatment, such as osteopathy or
reflexology, can be found in some. So far no form of
alternative medicine is officially part of an orthodox medical
course in this country, but a number of medical schools have
included occasional lectures on homoeopathy or acupuncture,
and a University Chair of alternative medicine is now about to
be established. At a postgraduate level these subjects are
already well accepted; many doctors have attended courses in
them.
So why are these forms of 'rejected knowledge' suddenly
so acceptable? An important part of their appeal must surely
be that they provide answers to questions that orthodox
medicine fails to address or answers unsatisfactorily.
Sometimes these questions and answers are quite down-to-earth
and practical (What can I do to relieve my migraine? Take
feverfew), but sometimes they are psychological or spiritual
(Why have I got cancer? Because you failed to resolve your
deepest psychological and emotional problems). Philosophical
ideas are seldom far from the surface in alternative medicine.
Partly, too, it is simply a question of time and
attention. When patients visit their family doctor they
usually expect a prescription, certainly, but they also want
(but probably seldom really expect) something less tangible:
to be listened to, to be given sympathy and reassurance, and
especially to be allowed time to talk about themselves.
This tends not to happen in consultations under the
National Health Service, simply because there are too many
patients. But in any case doctors are not always well equipped
to provide this kind of service. Their education does not
necessarily prepare them to cope with the social and emotional
problems they encounter, especially in general practice. A
modern medical training is largely concerned with the
diagnosis and treatment of identifiable physical disease, and
even the psychiatry that a medical student learns is likely to
be based on physical models.
Orthodox medicine has fallen into difficulties that in
large part have been created by its own successes. The roots
of this lie in the late nineteenth century, when medical
scientists such as Pasteur, Koch, and Virchow were making
discoveries that, for the first time, gave doctors an insight
into the way the body works and what happens to it in disease.
This was a most exciting time for young medical men, as we can
see in George Eliot's portrait of Lydgate in Middlemarch.
And the excitement continued into the twentieth century,
with the discovery of insulin and other hormones, vitamins,
and the sulphonamides and penicillin. Later, effective
treatment was introduced for tuberculosis, and vaccination
against poliomyelitis more or less eliminated this disease
from the rich countries. Smallpox was finally eliminated
world-wide, the first (and so far the only) time that a major
infective disease has succumbed to the advance of science.
In Britain, the setting up of the National Health
Service made all these medical advances freely available to
the whole population. Aneurin Bevan, who introduced the
scheme, apparently believed that it would eventually result in
many fewer people going to their doctor. Possibly this thought
was suggested to him by his Socialist ideals; it sounds a
little like the withering away of the State which was supposed
to occur in Communism, and it proved as delusive. Instead of
diminishing, the numbers of patients coming for treatment
increased steadily, as people came to think of health as their
right.
Gradually, however, medical optimism began to receive
set-backs. Perhaps the first major disappointment was the
discovery that cortisone, which at first had been greeted
enthusiastically as the scientific answer to arthritis, proved
to have serious unwanted effects. Since then the same story,
with variations, has been repeated again and again, most
notably in the thalidomide disaster in 1962.
A certain degree of naive optimism about medicine does
still exist, especially in the popular press, which continues
to trumpet the arrival of new miracle cures for various
ailments, as it has done for many years; and we feel aggrieved
if we learn from our doctor that there is still no effective
treatment for many people suffering from quite common diseases
- asthma, for example, or migraine. A lot of these patients
can be helped to a greater or lesser extent, of course, but
they cannot be cured, and a sizable minority still cannot be
helped at all.
Along with our expectations of modern medicine, however,
many of us have also grown suspicious of it. There have been
too many cases in which people have been harmed or even killed
by treatment, and some of us therefore reject scientific
medicine - 'drugs' - partially or even wholly.
There is a paradox here - modern medicine is perceived
as both good and bad - and there is another paradox in the
way we think about doctors. The old paternalistic image of the
doctor as a benign bespectacled figure in a white coat
dispensing wisdom as well as medicines still persists in many
people's subconscious, but it is beginning to coexist uneasily
with another image, that of the coldly dispassionate
scientist, who is more interested in research or diagnosis
than in actually treating patients.
Nevertheless, surveys continue to show that people rate
doctors very highly in terms of trustworthiness. And the
persistence of the avuncular image leads us to bring to the
doctor many problems that in other times might have seemed
more appropriate for a clergyman to deal with - unhappiness,
loneliness, guilt. Many people become deeply emotionally
dependent on doctors because, in a secular age, they have no
one else to turn to.
Doctor-dependency is quite a new phenomenon, and so is
the degree of respect commonly accorded to doctors and
medicine today. In former times doctors were often considered
as little better than tradesmen. (Within living memory
physicians were excluded from the Turf Club at York because
they sent in bills.) As for surgeons, their original
associations were, we remember, not with the consulting room
or the operating theatre but with the barber's shop.
Nous avons chang� tout cela. But doctors today find it
difficult to live up to their reputation; most of them know
they do not have all the answers, and, increasingly, so do
their patients. A large part of the appeal of alternative
medicine stems from patients' rejection of the god that has
failed them. "Much of today's revolt against orthodox medicine
is not so much kicking the habit completely as seeking an
alternative guru, a drug that is more satisfying... Faced with
life's problems, more and more people become doctor-dependent
or medicine-dependent." (Roy Porter, Senior Lecturer in the
History of Medicine at the Wellcome Institute, writing in The
Listener in 1985).
But there is an additional reason for the rejection of
orthodox medicine by many people today. This has to do with
the popular image of the doctor as a scientist - a picture
of themselves which many doctors share.
Modern medicine, in keeping with the rest of our lives,
becomes ever more dominated by technology. This makes it more
expensive, but also widens the range of problems it can
tackle. In one way this is perceived as good, but it can also
appear soulless and impersonal.
And it is easy to understand this idea. There is
undoubtedly something intimidating - terrifying to some
people - about a large modern hospital; it is not hard to
imagine oneself being swallowed up in it for ever more, like a
Kafka protagonist (hero does not seem quite the word here), or
like Russell Hoban's Kleinzeit. (Not that there is much new
about this. The hospitals of former times were also perceived
as frightening, though for different reasons; admission to
hospital was often regarded as little better than a death
sentence, which in view of the lack of sterility,
anaesthetics, and effective treatment of almost any kind it
often was.)
Why is this image of the doctor as scientist so off-
putting for many of us? Partly because we fear - with some
justification - that care for the individual patient may
sometimes conflict with the demands of research, and it may
not always be the interests of the patient that come out
ahead. But it goes deeper than that.
When I was a boy in the 1940s I had a series of books
called the Wonder Books. There was, I remember, The Wonder
Book of Why and What, The Wonder Book of How and Why, and
various others whose titles I have forgotten. The general
theme (still based on pre-war euphoria) was the conquest of
the natural world by human science and technology. If I had
those books today they would seem impossibly dated, and not
only because the information they contained has long been
superseded by later discoveries. An even more significant
change has been the abandonment of our triumphalist
convictions about the very notion of 'conquering nature'. Our
self-praise is more muted than it used to be; we are a good
deal less sure of ourselves.
At the same time as we have begun seriously to question
the attitude to nature that almost everyone took for granted
in my youth (along with a pride in, and conviction of, the
durability of the British Empire), there has been a subtle but
important shift in the kind of thought and sensibility that
many of us value.
One way of representing this shift is to construct a
table containing opposed pairs of ideas, which could
conveniently be labelled 'head' and 'heart'. If you prefer a
more up-to-date way of saying the same thing, they could also
be called left-hemisphere and right-hemisphere thinking.
HEAD HEART
left brain right brain
reductionism holism
tough-minded tender-minded
rational intuitive
scientific artistic
materialistic spiritual
mechanism vitalism
astronomy astrology
chemistry alchemy
artificial natural
yang yin
male female
complementary alternative
The psychologist and philosopher William James identified a
quite similar polarity when he divided people up into two groups,
which he called tough-minded and tender-minded.
TOUGH-MINDED TENDER-MINDED
empiricist rationalistic
sensationalistic intellectualistic
materialistic idealistic
pessimistic optimistic
irreligious religious
fatalistic free-willist
pluralistic monistic
sceptical dogmatic
For the last several hundred years, Western thought has been
dominated by left-column attitudes, but now there seems to be a
movement towards the right column, at least at a popular level.
For many people - certainly for nearly all who are involved in
alternative medicine - the left-hand column represents BAD and
the right-hand column GOOD. I have arranged the columns in this
way because the right side of the brain, which controls mainly
the left side of the body, is supposed to be artistic, creative,
and so on, therefore 'good', while the left side of the brain,
controlling mainly the right side of the body, is analytical and
language-dominated, and therefore, if not actually 'bad', at
least not entirely approved of.
(It would be possible to tease this distinction out further.
For example, left-handedness, because of its association -
sometimes - with a dominant right hemisphere, has a certain
aura of virtue and value in alternative circles. Again, there are
political overtones in the idea of the right hemisphere as
somehow occupying the place of a repressed, non-vocal, minority
vis � vis the dominant left hemisphere.)
You may have noticed something odd about the first table. I
have listed 'alternative' and 'complementary' as polar opposites,
yet a little earlier I used these terms more or less
interchangeably. In fact, the difference between them is, in a
way, what this book is about.
'Complementary' implies a fairly amicable relationship
between orthodox and unorthodox medicine. The recently founded
Research Council for Complementary Medicine includes both
orthodox and unorthodox practitioners among its trustees.
'Alternative', on the other hand, implies a rejection of the
conventional approach and the substitution of something
different.
For the most part, my focus in this book is on the
philosophical and emotional rejection of conventional medicine,
which is why I have generally used the term 'alternative'. I
realize that many people practising various forms of
unconventional medicine would claim that their methods are
complementary, not alternative, and that they have no hostility
to orthodox medicine. I fully accept this, and in so far as
anyone does maintain this position, what I say about alternative
medicine may not be applicable to him or her. However, there are
undoubtedly many others who are hostile to conventional medicine
at least to some degree, and it is their attitude that I have in
mind in much of what follows.
Believers in alternative medicine tend to act in one of two
ways. Either they try to build bridges between the orthodox and
the unconventional methods as much as they can, or they think of
them as mutually antagonistic and not only do not build bridges
but often devote a good deal of energy to trying to blow up those
that may already exist.
When one listens to some of the more radical advocates of
alternative medicine one often gets the feeling that they are
saying medicine is too important to be left to the doctors. And
doctors who use alternative medicine themselves often seem to be
regarded as the worst of the lot; it is as if they have committed
a kind of trahison des clercs in reverse. Hahnemann spoke
contemptuously of 'half-homoeopaths', meaning doctors who used
orthodox medicine together with homoeopathy; nearly 200 years
later this practice attracts the same scorn from the ultra-
committed. Inglis and West, for example, are dismissive of most
doctors who claim to practise alternative medicine:
'Medical qualifications do not in themselves make
anybody a better therapist than somebody who has not
done the standard medical training. Rather the reverse,
in fact, as the standard training is only too likely to
condition medical students into accepting ideas and
attitudes inimical to the practice of natural medicine'
[295]
It is clear what they have in mind; in terms of the
table on p.000, the standard medical training is supposed to
condition you to think in the left-hand column (assuming, that
is, that you were not initially selected for medical school
precisely because you thought like that, which you probably
were).
What comments like that of Inglis and West tell us is
that there are important differences between the underlying
assumptions of nearly all non-medical alternative
practitioners on the one hand and most, though certainly not
all, medically qualified ones on the other. (But I must
emphasize once more that I am, inevitably, generalizing, and
exceptions on both sides can always be found.)
A remarkably clear statement of the alternative position
appeared quite recently in The Homoeopath [1990, 10, 110 -
113]. Its author, Dr Denis MacEoin, is an academic who is not
professionally involved in homoeopathy; however, he feels
strongly on the subject, as he indicated in his response to a
talk given by a senior homoeopathic doctor at a seminar on the
relations between medical and non-medical homoeopaths.
Most of the audience, one gathers, approved of the
sentiments expressed; not so Dr MacEoin. He is entirely
hostile to any attempt to integrate the two brands of
homoeopathy.
Orthodox doctors, and this often includes those with a
smattering of homoeopathic training, are not competent
to lay down the parameters for the management of a
homoeopathic case. It is axiomatic that homoeopathy
represents, in the broadest sense, a philosophical and
clinical contradiction of allopathy and a system of
medicine in its own right.
MacEoin correctly identifies the dilemma that has always
faced homoeopathy. Either it tries to go it alone, and risks
isolation, or it tries to integrate itself with orthodox
medicine, in which case it risks being taken over. MacEoin has
no doubt that independence is the right course, and he believes
that this will eventually lead to a situation in which
homoeopathy will become 'a distinctive, broadly-based medical
system capable in the fullness of time of usurping the current
role of allopathy...'. There must, he insists, be no compromise
on essentials: 'to seek for anything less than freedom to pursue
the goal of raising homoeopathy to the status of a primary
system of medical treatment to which surgery and drug treatment
will be complementary would be to betray the vision of
generations of homoeopaths and the hopes of thousands of
patients like myself.'
There is evidently an almost unbridgeable gulf between
alternative views of this kind and the more moderate
'complementary' version of unorthodox medicine. I shall look at
this in more detail in Chapter 3. First, however, we need to try
to establish what it is we are talking about.
2: WHAT IS ALTERNATIVE MEDICINE?
About the only way one can define alternative medicine is
negatively, by saying that it is all those forms of treatment
that are not taught in conventional medical schools. It would be
impossible to list all the different kinds of alternative
medicine, partly because new ones keep appearing, and partly
because in some cases it is a matter of opinion whether or not a
particular method is 'medical' at all. Homoeopathy and
osteopathy, for example, obviously do qualify as therapies, but
what about yoga, 'sacred Native American exercises', and
'techniques for releasing Karmic patterns that may be inhibiting
your growth and well-being', all of which were on offer at a
recent exhibition of alternative medicine and complementary
therapies in London? It is hard to classify these as treatments,
but they are certainly intended to be methods of improving your
physical and mental well-being.
But methods of treatment as such were on offer at the
exhibition too, of course. They included reflexology,
therapeutic massage, kinesiology, Feldenkrais, the Alexander
technique, Touch for Health, biofeedback. Aroma therapy,
shiatsu, and polarity therapy, as well as other methods, some of
which I had not heard of previously.
Prevention was not forgotten either: there were lectures
about the technological dangers that surround us. 'An academic
teacher and scientist' looked at 'how computers, microwave
ovens, electronic watches, and geopathic stress can make you ill
and what you can do about them,' and another lecturer gave a
timely warning about 'how the misuse of Kundalini energy can
cause mental, physical, and emotional problems.'
There was a good range of alternative treatments on offer
at this exhibition, but even so only a fairly small proportion
of those that exist were represented. A survey carried out in
New Zealand found that among 270 people advertising some kind of
alternative medicine a total of 94 distinct therapies were
mentioned and 81 practitioner qualifications were listed.
We need some kind of scheme to make sense of this plethora
of treatments, to fit them into categories of some kind. But it
is not easy. In their book THE ALTERNATIVE HEALTH GUIDE, Brian
Inglis and Ruth West use four main groups, with subdivisions.
Their main groups are Physical Therapies, Psychological
Therapies, Paranormal Therapies, and Paranormal Diagnosis. But,
as they point out, the boundaries between the various therapies
are tending to break down, which makes categorization difficult.
Even so, their scheme contains some curious illogicalities: it
is not obvious, for instance, why Iridology, which purports to
be a scientific method of diagnosing disease, should be classed
as paranormal, or why art therapy and music therapy should be
included as Physical Therapies instead of as Psychological
Therapies.
My task, fortunately, is easier than theirs, since I am
not trying to survey the whole field of alternative medicine but
only to pick out certain items to look at in more detail. For my
purpose it will be sufficient to use the following scheme.
A. Medical therapies: that is, therapies which use
pharmacopoeias of some kind (herbalism, homoeopathy).
Anti-allergy treatments such as dietary manipulation and
clinical ecology (Chapter 5) form a sub-group.
B. Physical therapies: osteopathy, chiropractic,
acupuncture; also polarity therapy, metamorphic
technique, and Rolfing, which have additional
psychotherapeutic aspects.
C. Psychological therapies: psychotherapy, hypnotherapy,
biofeedback, the humanistic psychotherapies, autogenic
training, meditation, Silva Mind Control,
psychosynthesis.
D. Miscellaneous, including so-called paranormal therapies
(spiritual healing, radionics and radiaesthesia,
'psychic surgery'.) I include this category for the sake
of completeness, but I don't want to say very much about
it.
E. Diagnostic methods (Kirlian photography, Iridology,
astrological medicine).
Many of the categories overlap to some extent. Although I
have included psychological therapies as one of the categories in
its own right, there is an element of psychology in all the
treatments, as of course there is in orthodox medicine too; but in
some of them it is much more prominent than in others. On the
other hand, there are some therapies that are mainly intended to
produce psychological effects but which use physical methods such
as massage and posture to do so.
There is another way of classifying alternative treatments
which is more contentious. This is to divide them into those that
are semi-respectable from the point of view of orthodox medicine
and those that are not. Obviously this cannot be a rigid
distinction, if only because the tolerance of individual doctors
for the unorthodox varies from doctor to doctor. However, it is
fair to say that homoeopathy, acupuncture, manipulative medicine
(a deliberately vague term to include both osteopathy and
chiropractic), and hypnotherapy are semi-respectable, in the sense
that there are appreciable numbers of orthodox doctors who have
studied these methods and use them at least part of the time,
whereas the remainder of the therapies are used hardly at all by
doctors, although even here there are a few exceptions (some
doctors, for example, use radionics and radiaesthesia).
A third classification has been used by some people. This
has three main categories: (1) well-established treatments
(acupuncture, osteopathy, homoeopathy, naturopathy, herbal
medicine, hypnotherapy); (2) 'core' treatments, used by a wide
range of alternative 'specialists' as an adjunct to their own
methods (advice, diet, vitamins, relaxation, stress management,
massage, exercise); (3) fringe treatments and diagnostic methods
(colour therapy, music therapy, radionics, aromatic oils, gem
therapy, biofeedback, iridology, Kirlian aura diagnosis, hair
analysis).
Although the vast majority of alternative practitioners lack
conventional medical qualifications, some alternative techniques
are used by doctors. In Britain there are very few legal
restrictions on the techniques that a doctor can use, even within
the National Health Service. Provided the doctor is either a
principle in general practice or a consultant, he is remarkably
free to do what he thinks best for his patient. If he wants to
attend a course in homoeopathy or acupuncture, for example, he can
do so, even if it is given by people without orthodox medical
qualifications, and he can use the techniques he learns to treat
his patients, provided they agree. Under the new provisions of the
National Health Service general practitioners can employ
alternative practitioners to work under their supervision in their
practices.
Non-medical practice is also very free in Britain. A few
diseases, such as venereal infections, may only be treated by
doctors, but otherwise anybody may call himself or herself a
therapist of any kind, with or without having received any kind of
training. The situation is different in many other countries,
where often it is only doctors who are allowed to treat patients.
One tends to think that interest in alternative therapy on
the part of doctors is quite new. But this is due to our
historical parochialism. The Scottish surgeon James Braid used
hypnosis in the 1840s to relieve pain during surgery. He coined
the term hypnosis to dissociate the phenomenon from Mesmerism and
he tried to get the method generally accepted, but shortly
afterwards anaesthetics were introduced and hypnotism was
abandoned. However, a French country doctor named A.A.Li�bault
took up hypnotism as a method of relieving symptoms by suggestion,
and later it was used in Paris at the Salpetri�re hospital by the
celebrated neurologist Charcot. Hypnotism is still used today by
some doctors in Britain and elsewhere, and it has now largely
completed the journey from quackery to orthodoxy. There has been a
Society of Medical and Dental Hypnosis in this country for many
years.
Acupuncture has likewise been known in the West for a
surprisingly long time; as early as the seventeenth century, in
fact, although it only became widely known in the nineteenth. At
that time it was practised quite extensively in France and in
England, where the Leeds Infirmary became a major acupuncture
centre in the 1840s. Shortly afterwards, however, it fell into
disuse, and only revived after President Nixon's visit to China in
1972. Today the British Medical Acupuncture Society has over 1200
members and the number is constantly rising.
The position of homoeopathy is more curious. For a variety
of reasons it has attracted more hostility from orthodox doctors
than either acupuncture or hypnotherapy, yet there has always been
a small but resolute body of medically qualified homoeopathic
doctors. When the National Health Service was set up after the war
the homoeopathic hospitals were included, perhaps because there
were influential people who habitually received homoeopathic
treatment, and later the Faculty of Homoeopathy, the official
teaching body for medical homoeopathy in Britain, was incorporated
by Act of Parliament. This gives homoeopathy a greater degree of
official recognition than it enjoys in any other country except,
perhaps, India, yet British medical students learn nothing
whatever about the subject and indeed are (or were until very
recently) not likely even to have heard of it except in the
dismissive phrase 'a homoeopathic dose', meaning an absurdly small
dose.
In the next chapter I return to some of these issues and
look at them in a little more detail.
3: COMPLEMENTARY OR ALTERNATIVE?
In her recent book on alternative medicine, Rosalind Coward
made an important point.
The alternative health movement has given voice to a
fundamental philosophical opposition to past ways of
viewing health... For many, the notion of being
alternative is considerably more than just doing it
differently from orthodox medicine. It is also a
symbolic activity. It is a profound expression of a
new consciousness which individuals have about health
and the body. [THE WHOLE TRUTH, 11]
This is exactly right. Another way of putting the same thing
would be to use William James's term "over-belief". For many
alternative medicine enthusiasts the over-beliefs are far from
being incidental additions to practical methods of treatment; one
could almost say that the practical therapies emerge from the
philosophical presuppositions than the other way round.
All the same, an important qualification is needed here.
There are certain "major" forms of alternative medicine -
acupuncture, homoeopathy, osteopathy and hypnotherapy - that are
practised by quite large numbers of doctors as well as non-
medical practitioners. The British Medical Acupuncture Society,
for example, has over a thousand members at present and the
number is rising all the time. A few doctors who take up
alternative medicine become "renegades" and abandon conventional
medicine altogether, but this is exceptional; most remain more or
less orthodox but modify their practice by adding one or more of
the alternative therapies, which they generally practise part-
time.
These "major" alternative therapies therefore tend to exist
in two forms. To use the terminology of politics and religion -
not wholly inappropriately - one could speak of moderates and
extremists. The problem here, however, is that opinions about
these things are not sharply polarized but lie along a spectrum;
it would be an over-simplification to represent all medical
practitioners of alternative medicine as moderates and all non-
medical practitioners as extremists.
In the case of osteopathy, in fact, the distinction is not
very relevant. The osteopaths have decided, for better or worse,
to cast their lot with "the medical establishment", and it seems
likely that within a few years osteopathy will be as "orthodox"
and uncontentious as, say, physiotherapy. But some of the early
osteopaths' theories and beliefs will have been jettisoned along
the way.
The distinction is however very relevant for acupuncture,
homoeopathy, and hypnotherapy, and I should like to bring this
out by looking briefly at the way these two forms of medicine
have developed.
ACUPUNCTURE
In traditional Chinese medicine acupuncture has an elaborate
theoretical basis. The most basic idea is yin-yang polarity,
which underlies every phenomenon in nature. There is also said to
be a universal subtle fluid or energy called chi which is
responsible for the processes of life. Chi flows through the body
in the blood vessels and also in special channels, usually
misleadingly called meridians in English. The so-called meridians
connect the various internal organs (liver, spleen, kidney and so
on). Disease is held to result from imbalances in the flow of chi
and hence in the proportions of yin and yang, and the task of the
acupuncturist is supposed to be to restore the balance by
judiciously adjusting the flow. This is essentially a hydraulic
concept, and the acupuncturist is pictured as a kind of engineer.
The theory of acupuncture is elaborate and complicated. It
is said to be very ancient and may indeed be so, although most of
the texts on which the modern practice is based are mediaeval. It
is certainly very complicated, and it employs concepts and
terminology that are exotic and strange for Westerners.
This seems to be a considerable part of its appeal for
Western enthusiasts, especially for those (the majority) who are
not medically qualified. To learn it, you must put aside your
Western concepts of pathology, physiology, and even anatomy; such
a willing suspension of disbelief is obviously easier if you have
not acquired them in the first place to any great extent.
Moreover, acupuncture is part of Eastern wisdom, hence profound,
and in studying it you distance yourself decisively from dull,
mechanistic, materialistic Western science.
In part the notion that acupuncture is vaguely mystical is
illusory, for the ancient Chinese were remarkably pragmatic and
mechanistic thinkers themselves, and there is nothing mystical
about their view of acupuncture. Many Western enthusiasts for
acupuncture, however, do think of it as an esoteric, mystical
branch of knowledge. This is merely one example of the difficulty
of making cross-cultural leaps of this kind.
But there is another view of acupuncture. In the last
fifteen year or so there has grown up a different version, which
might be called modern or non-traditional. This is based, not on
the ancient Chinese theory of chi, yin and yang, 'meridians' and
so on, but on modern Western concepts of anatomy and physiology.
It ignores the Chinese system of pulse diagnosis and assumes that
the effects of acupuncture - many of which, obviously, it
accepts as real - are produced via the nervous system as
generally understood by modern science. And it assumes that there
must be changes in blood flow in various organs, alterations in
hormone levels, and other physiological effects to account for
the effects.
I originally learned acupuncture from a Western doctor who
had written a number of books on the subject; these we were
required to read before attending the course, which lasted a
week, from Monday to Friday. When we arrived on the course we
were told by our tutor that he no longer accepted the Chinese
theories which his own books were about, though he still thought
it was important to have a grasp of the traditional ideas so as
to understand the subject. He said he had come to this
iconoclastic position as a result of his own experience, which
showed that you got the same kind of results even if you didn't
practise according to the classic Chinese principles. I admired
his honesty in reversing his thinking in this way.
Nearly all non-medical acupuncturists in the West base their
practice on the traditional system, though sometimes in a
somewhat modified form. (I think it is in fact questionable how
far it is possible for a Westerner to adopt traditional Chinese
ideas and make them thoroughly his own, at least without learning
to read Chinese and spending a considerable time in China.) In
China itself, it seems, things are changing.
According to Nathan Sivin, a sinologist who has studied the
question at first hand, modern Chinese doctors do not use or
understand the ancient system. They are unable to read the
classical literature, which has to be translated into modern
Chinese. Although acupuncture is still used, the diagnostic
methods are modern. Patients, likewise, are no longer familiar
with the yin - yang and five-element concepts. Sivin concludes
regretfully that there can be no return to traditional Chinese
medicine in its original form. (American Journal of Acupuncture
1990, vol. 18, 325, 341).
The majority of Western doctors who take up acupuncture use
the non-traditional version, although this is not universally
true; adherents of both views can be found in the British Medical
Acupuncture Society, whose members are all medically or dentally
qualified. For a Western doctor, the non-traditional version has
several advantages. There is no need to try to come to terms with
obscure medical concepts, which are likely to seem
incomprehensible or incredible, or both, to someone with a modern
scientific training. Moreover, since the 'new' version is based
on the orthodox medical ideas that the doctor is already familiar
with, he or she can absorb the basic skills in quite a short time
and start to practise them without a long delay.
The traditionalists, not surprisingly, look on all this with
horror. They say that doctors are looking on acupuncture simply
as a medical technique, and neglecting the real treasures that
the 'proper' version contains. They speak disparagingly of
doctors who attend one or two weekend courses in acupuncture and
then start to treat their patients. In reply, doctors point out
that all their conventional medical knowledge is relevant to
modern acupuncture and therefore they have in effect been
studying for years.
Who is right? There is no doubt that doctors can learn the
basics of practical acupuncture in a short time, and by applying
these principles in the light of their knowledge of medicine they
get good results in many disorders. Naturally it takes time and
experience to become thoroughly skilled in the techniques, but
the contention of the modernists is that techniques is what they
are; the ancient theory is irrelevant. And clearly if someone is
not convinced that the traditional Chinese ideas are valid, he or
she has little motive to spend years learning them.
The traditionalists, of course, claim that acupuncture done
according to the ancient theories gives better results. The
modernists claim the contrary, and moreover point out that the
Chinese themselves have in recent years been quite prepared to
update the traditional practice in various ways. In the absence
of any proper scientific studies of the question it is impossible
to say whether the classical or the modernistic approach gives
the better results, or whether there is no real difference
between them. The practical details of the treatment are in any
case often quite similar in the two versions, though there is a
tendency for the traditionalists to use more needles per patient
and to leave them in for longer. (For what it is worth, the
ancient texts seem to imply that the most skilled acupuncturists
use very few needles - ideally only one - so in this respect
the modernists seem to be the more 'traditional'!)
HOMOEOPATHY
In the case of homoeopathy we again find at least two views
of how it should be approached. There is a purist school of so-
called 'classical' homoeopathy, and there is also a more
pragmatic version which takes more notice of recent developments
in orthodox medicine and tries to relate homoeopathic practice to
these. Nearly all non-medically qualified homoeopaths are purists
in this sense, but the position of medical homoeopaths is more
complicated; there are wide variations from country to country
and changes are occurring all the time.
One important way in which homoeopathy differs from
acupuncture and indeed from most other forms of alternative
medicine is that it was invented or discovered by a doctor and at
first was practised almost exclusively by doctors. (There were in
fact some eminent early non-medical practitioners, such as
Hahnemann's widow Melanie and Von Boenninghausen, a lawyer; but
these were exceptions and they had to get special permission from
the authorities to practise.)
The story of homoeopathy begins with Samuel Christian
Hahnemann (1755 - 1843). He was an orthodoxly qualified German
doctor who became disillusioned, understandably, with the
medicine of his day, and therefore abandoned medical practice for
a number of years, working instead as a translator and chemist.
In 1790 he carried out an experiment on himself which planted the
seed of homoeopathy in his mind and ultimately was to change his
life. The idea was suggested to him by a book he was translating
from English, Cullen's Materia Medica. In this he found a
description of the Peruvian bark cinchona, from which quinine is
derived. He disagreed with Cullen's explanation of how cinchona
acted, and decided to take some himself to see what happened. He
experienced the symptoms of an attack of 'intermittent fever',
and this eventually gave him the central idea of homoeopathy: to
choose medicines on the basis of similarity between their effects
and the symptoms of the disease.
The medicines Hahnemann used at this time were almost all
taken from the ordinary pharmacopoeia of his day. Most were
herbal, although he also used a few minerals. Thus they can in a
sense be called 'natural', an important consideration for modern
homoeopaths although probably less so in Hahnemann's day.
In 1821 Hahnemann was forced to leave Leipzig owing to the
hostility of the apothecaries. He moved to Anhalt Kothen, a small
principality some 36 miles away where the Duke was an ardent
admirer of his system. Here he remained in virtual seclusion (for
travel in those days was very arduous), cut off both from his
followers and from contact with mainstream medicine. His patients
were now nearly all sufferers from chronic disease, and this,
together with his virtual isolation, led to changes in his ideas.
While in Kothen he published a controversial theory of
chronic disease, the miasm theory (see p. 000), together with a
series of new and unfamiliar medicines for treating such disease
according to his theory. And he propounded the 'dynamization'
idea, which was to grip the public imagination almost to the
exclusion of everything else.
'Dynamization' is the term Hahnemann applied to the process
of trituration (for solids) or hard shaking (for liquids) which
he used in preparing his medicines. As well as this, he also
diluted them in successive steps, to levels that seemed
improbable to his contemporary critics and even more so today,
when according to modern molecular theory there should be none of
the original substance left at all in many of the medicines and
very little indeed in the rest. He explained the claim that these
extraordinarily dilute substances nevertheless could be used as
medicines by saying that the process of dynamization made them
much more active than before.
During his lifetime Hahnemann was a very contentious
individual who managed to sow discord wherever he went, not least
among his followers. He was unwilling to accept any deviation
from his precepts, and as these changed quite considerably over
the years adherence to them was not always easy. He disapproved
violently of any attempt to compromise with orthodox medicine, an
attitude which resulted in the premature closure of a
homoeopathic hospital founded in Leipzig after his departure.
Fierce disputes continued to be a feature of homoeopathy
even after Hahnemann's death. To see why, we need to understand
that there were two distinct sides to Hahnemann's thought. In
some ways he was a scientist, carrying out pharmacological and
clinical research. In other ways, however, he was prone to build
speculative theories that were closer to metaphysics; in this he
resembles Anton Mesmer. Thus, in later editions of his main
theoretical work The Organon he included a considerable amount of
speculation about vitalism that some of his disciples, especially
in England, found unacceptable. He also became progressively more
extreme in his teaching about potency.
At Hahnemann's death his ideas had become widely diffused
throughout Europe. They had also crossed the Atlantic to both
Americas, and at some point they reached India, still the country
where homoeopathy is most widely practised.
In the late nineteenth century, however, it was the USA
rather than India which was most deeply committed to homoeopathy.
The new doctrine reached a peak of success in the decades 1865 -
85, when an astonishing number of homoeopathic hospitals and
colleges were constructed. In 1900 there were 22 colleges, and
before the First World War there were 56 purely homoeopathic
general hospitals, some with up to 1400 beds, 13 mental asylums
with up to 2000 beds, 9 children's hospitals, and 21 sanatoriums.
Soon after this homoeopathy went into decline in America.
The main reason for this was quarrelling among the homoeopaths
themselves. They were divided into two factions. The more
numerous was composed of doctors who did not distinguish sharply
between homoeopathy and orthodox medicine and were prepared to
compromise with orthodoxy. The other group, who regarded
themselves as strict Hahnemannian purists, distanced themselves
as much as possible from orthodox medicine and took Hahnemann's
later ideas even further than Hahnemann himself had done. In
particular they were extremists in the matter of potency, taking
the dilution method to extraordinary lengths. For this purpose
they invented various machines, since to make these ultra-high
dilutions by hand would have taken far too long.
This 'purist' group, the best known of whom was Constantine
Hering, were strongly influenced by the teachings of the Swedish
mystic Emanuel Swedenborg, which by this time had become
established in America. The Swedenborgians found in homoeopathy
just the medical system they were looking for, while the
homoeopaths thought that Swedenborg's ideas complemented
Hahnemann's perfectly and gave them a new philosophical
profundity. They were particularly attracted by the Swedenborgian
emphasis on the mental and spiritual characteristics of patients,
and also by the idea that chronic disease has deep roots in the
personality.
The last, and probably the most influential, of these
Swedenborgian homoeopaths was James Tyler Kent (1849 - 1916). He
compiled a Repertory - a kind of large index of symptoms and
medicines - which is very widely used today; he also wrote
extensively on methods of prescribing and on the medicines
themselves.
In England, meanwhile, homoeopathy was pursuing quite a
different course. The English homoeopaths, of whom the best known
today are Robert Dudgeon and Richard Hughes, were enthusiastic
about the new medical teaching but nevertheless were prepared to
be critical. They rejected some of Hahnemann's more extreme
ideas, and instead of ignoring orthodox medical knowledge they
did their best to build bridges between it and homoeopathy. For
example, they took account of the results of animal experiments,
and in choosing medicines they took note of the pathological
changes of disease as well as the symptoms. This could be called
Hughesian homoeopathy.
If the empirical school of British homoeopathy that existed
in the late nineteenth century had continued it is possible that
homoeopathy today would be much more accepted by orthodox
medicine than it actually is. But change was on the way.
In the early years of the twentieth century an English
homoeopathic doctor, Margaret Tyler, went to America to study
under Kent. She returned full of enthusiasm for Kent's ideas, and
began to proselytize for them with considerable success. Other
doctors took them up, notably Dr (later Sir) John Weir. Probably
Tyler did not convert many of the old guard, but as they retired
or died they were replaced by her sympathizers. As a result,
British homoeopathy changed its character radically in the first
two decades of the twentieth century and became predominantly
Kentian.
In this form it was taken up by a number of lay homoeopaths.
As we have already seen, there had been non-medical homoeopaths
right from the beginning, but they had been exceptional. In
Britain, however, there were few or no legal restrictions on lay
practice, and it flourished. In part this was because Tyler's
writings were so distant from orthodox medicine that they were
immediately accessible to non-medical readers.
Margaret Tyler remained active in homoeopathy for many years
and wrote a number of books on it. Her principle contribution was
to establish the idea of constitution in homoeopathy, which is
often what appeals to people today.
Previously homoeopathy had been fairly firmly based on
Hahnemann's pharmacological experiments. The idea was to find a
medicine whose effects, as verified by experiments on healthy
people, were as similar as possible to those from which the
patient was suffering. For example, white arsenic causes severe
diarrhoea, vomiting, and thirst for small quantities of water.
These symptoms are similar to those of acute gastroenteritis, so
white arsenic would be the similimum in such a case and could be
used to treat a patient who showed these symptoms.
Under Tyler and her associates this way of prescribing was
not abandoned but it was complemented, and partly overshadowed,
by a new theory that seems to have originated in America with
Hering. This was that there are certain personality types, each
of whom is supposed to have a suitable kind of medicine. For
example, the 'white arsenic' patient is fearful, chilly, tidy and
fussy; he dresses neatly, can't bear anything out of place, and
is therefore known as the 'gold-topped cane' patient. The sulphur
patient is in many ways the opposite: intolerant of heat, untidy,
careless, given to abstract thought, he is called the 'ragged
philosopher'. Or there is the Sepia patient (usually a woman);
she is pictured as a sallow tired mother of a large family, with
whom she is totally fed up. Tyler says that she longs to escape
from the house, and feels exhausted. Her six-year-old son starts
drumming with a spoon on a tin pot; she snatches the pot away and
smacks her son, who starts to howl. The whole kitchen is in
uproar, and she doesn't care.
Obviously these constitutional indications are not directly
derived from experimental testing of drugs - which homoeopaths
call "proving". It is hardly likely that taking sulphur, say,
would make someone untidy who was not so already. The idea of
constitution must therefore come from homoeopaths' theorizing or
observation, although there is unfortunately no way of verifying
this from the homoeopathic literature. There are a few hints of
this way of looking at medicines in Hahnemann's writings but
nothing more than hints; mainly it seems to come from Hering and
Kent but especially from Tyler. So-called classical homoeopathy
today is really Kentian/Tyler homoeopathy and is certainly not
identical with what Hahnemann taught and practised - a fact that
is unknown to many modern enthusiasts.
A consultation with a modern homoeopath who adheres to this
"classical" system is thus likely to involve a great deal of
questioning about the patient's moods, fears, reactions to
weather, food likes and dislikes, and so on. These are
deliberately not directly related to the main complaint that has
brought the patient to the homoeopath, because for the purist
this complaint, if not exactly irrelevant, is simply the end
point of a deep-seated disorder affecting the patient's whole
physical, mental and spiritual being.
For homoeopaths of this persuasion the "pathological"
(disease-based) prescribing of Hughes and his disciples is a very
inferior method. Ostensibly for this reason, Hughes and his ideas
were displaced from their former pre-eminence shortly after
Hughes' death in 1902. I think it likely, however, that another
and probably more important reason for Hughes's posthumous fall
from favour was his enthusiasm for reconciling homoeopathy with
the orthodox medicine of his day. The Kentians who came to
dominate British homoeopathy throughout most of the twentieth
century were isolationist and rather hostile to orthodox
medicine, a trait they inherited from their mentor, Kent,
himself.
Anton Mesmer and hypnotherapy
Many people think of Mesmerism and hypnosis as simply
different names for the same thing. There is however rather more
to it than that, and the story of Mesmerism is worth looking at
in its own right, since it exemplifies many of the difficulties
that attend the attempt to introduce an unconventional form of
treatment into orthodox medical practice. There are also some
curious and interesting resemblances between the careers of
Mesmer and Hahnemann which do not generally seem to have been
noticed.
Franz Anton Mesmer (1734 - 1815) was almost an exact
contemporary of Hahnemann (1755 - 1843). He grew up on the shores
of Lake Constance, on the border between Germany and Switzerland,
in a Swabian town called Iznang. His father was gamekeeper to the
Bishop of Constance and Mesmer was brought up as a Catholic;
indeed, as a youth he contemplated entering the priesthood, but
he soon realized that he lacked a vocation. For a year he studied
law, but in 1760 he became a medical student in Vienna, where he
qualified MD and PhD in 1767 at the fairly advanced age of 32.
Mesmer was thus, like Hahnemann, well grounded in the
science of his day, and he showed no leaning towards occultism or
mysticism. It is therefore somewhat ironic that his name should
have become linked with these qualities.
His early career after qualifying was, in fact, conventional
enough. He married a rich aristocratic widow, ten years older
than himself, and thanks to his wife's connections soon
established a prosperous practice in Vienna, where he met and
became friendly with the young Mozart and his father. Not until
the 1770s did he begin to move in the direction that was later to
bring him such renown and notoriety.
A young girl called Franzl Oesterlin, a relative of Frau
Mesmer, became Mesmer's patient. She was suffering from symptoms
that would now be regarded as psychological, possibly associated
with hyperventilation. In order to make herself more easily
available for treatment she came to stay with the Mesmers, and as
he studied her case Mesmer was led to formulate remarkable
theory.
Mesmer's doctoral thesis had been concerned with the
influence of gravitation on human physiology. He had suggested
that gravitation depends on a subtle universal fluid which he
imagined to pervade the whole cosmos, including living organisms,
and to set up 'tides' in the bloodstream and nerves of human
beings. This thesis, which in later years he referred to as The
Influence of the Planets on the Human Body, sounds as if it
should be concerned with astrology, but Mesmer intended it to be
fully scientific. Ideas of this kind were acceptable scientific
currency in the eighteenth century, and indeed Mesmer had lifted
whole sections of his theory from the writings of the respected
English physician Richard Mead.
Contemplating Franzl's symptoms, he made the 'obvious'
connection. He now understood what was causing the ebb and flow
of her attacks: nothing else than the gravitational tides he had
described in his dissertation.
How to use this discovery to effect a cure? Why, by
magnetism. Magnets were already in use by at least some doctors,
though admittedly this was a contentious subject; and of course
magnets, with their polar attraction and repulsion, could be
plausibly supposed to act in the same general way as gravitation.
Mesmer's friend Maximilien Hell, professor of astronomy at
the University, had a number of magnets made for him in the
astronomy department, with different shapes according to the part
of the body they were intended to treat. The effects were
gratifying. As soon as the magnets were applied to Franzl she had
an immediate strong reaction followed by a dramatic improvement,
and after further experiments Mesmer convinced himself that he
had succeeded in controlling the ebb and flow of the universal
gravitational fluid.
Almost immediately after this, Mesmer quarrelled with Hell
about who should have credit for the discovery. Hell claimed that
it was the magnets themselves that had effected the cure, but
Mesmer insisted that their only role was to channel the cosmic
flow through the patient. It was in fact unnecessary to use
magnets, he discovered; objects made of cloth or wood worked just
as well. The explanation, he concluded, was that he himself was
touching them; he was an 'animal magnet' who acted on objects and
people in an analogous way to a mineral magnet acting on metal.
Mesmer now tried to persuade the medical Establishment in
Vienna of the validity of his discovery. In this he was
unsuccessful, but Franzl made a complete recovery and eventually
married Mesmer's stepson. (Mozart, in a letter, records a meeting
with this lady, now grown stout and the mother of three
children.) Mesmer's fame increased, and so did his practice; in
1755 and 1776 he travelled in Swabia, Bavaria, Switzerland, and
Hungary, treating the famous.
He was less successful in the case of Maria Theresa
Paradies, a girl suffering from psychologically caused blindness
since the age of three who was nevertheless a professional
pianist. She had been treated with the conventional drastic
methods of the time - bleeding, purging, blistering - and
also with some experimental techniques, including the application
of a tight plaster helmet and painful electrotherapy.
At first Mesmer was successful; Maria Theresa recovered her
sight, at least temporarily. But the ophthalmologist who had
failed to cure her was, not unnaturally, jealous of Mesmer, and
claimed the cure was not genuine. Eventually, for reasons that
are unclear, the patient's father reacted violently against
Mesmer, finally appearing at his house, sword in hand and
demanding that the treatment of his daughter be stopped.
Partly, at any rate, the explanation for the fiasco is that
as the girl's sight improved her piano-playing deteriorated; she
ceased to be so much of a public curiosity and was in danger of
losing a pension that she was in receipt of from the Empress.
Perhaps, too, there were other causes connected with the
Paradies' family life (child sexual abuse?) which may have been
responsible for the girl's initial blindness. At any rate she
relapsed; eventually she achieved a reasonably successful career
as pianist and composer, but she never again recovered her sight.
Mesmer, meanwhile, was the centre of a scandal. Many people
suspected him - almost certainly unjustly - of having had
improper relations with Maria Theresa, and the hostility of the
Viennese doctors increased. In 1778 Mesmer, by now informally
separated from his wife, left Vienna for Paris.
Once established in Paris, Mesmer began a long series of
feuds with the French medical Establishment. The Academy of
Sciences, in spite of attending demonstrations, were unconvinced
by the animal magnetism theory. Mesmer therefore approached the
newly founded Royal Society of Medicine, which he hoped would be
more amenable than the long-established Paris Faculty of
Medicine.
His initial demonstration at his suite in the Place Vend�me
was not well received. In 1778, therefore, he moved out of Paris
and set up a clinic at a nearby town, Cr�teil, where he had more
room to treat the large number of patients who flocked to him.
Some received individual therapy, while the less seriously ill or
the convalescent were treated in groups. For this purpose Mesmer
invented the baquet, a large wooden tub containing bottles of
magnetic metal, stone, glass and so forth. Mesmer had magnetized
all these items himself, by touching or pointing at them. The
baquet had iron rods projecting from it; the patients pressed
these against the affected parts of their bodies, and they also
held hands to allow the animal magnetism to flow through the
group.
Many grateful patients wrote testimonials to the efficacy of
the treatment, but the Royal Society was unimpressed and refused
to attend the demonstrations. However, Mesmer was more successful
with the Paris Faculty of Medicine, a prominent member of which,
Charles Deslon, became a convinced believer in animal magnetism.
He had himself magnetized, served as Mesmer's assistant, and
eventually established his own clinic.
Having moved back again to Paris, Mesmer now accepted
Deslon's suggestion that they should try to gain the endorsement
of the Paris Faculty. Three prominent members of the Faculty
agreed to watch Mesmer at work. They were shown a number of
remarkable cures, but remained obstinately unconvinced.
Mesmer now gave up hope of obtaining the Establishment's
approval, and concentrated on his clinical work. It is important
to notice that he distinguished between what we would now call
psychological and physical disorders, and refused to treat the
physical. His patients ranged from the rich and aristocratic to
the poor; everyone received an equal amount of attention and
those who could not afford to pay were treated free.
One feature of Mesmer's methods which attracted a good deal
of unfavourable comment was the 'Mesmeric crisis'. Some patients,
especially those suffering from more serious symptoms,
experienced nervous trembling, nausea, occasionally delirium or
convulsions. Mesmer regarded these as an inevitable accompaniment
of the process of normalization of the flow of animal magnetism,
and he had special padded 'crisis rooms' in which patients could
throw themselves about without hurting themselves, while Mesmer
or his assistants gave them individual attention. The depth of
the crisis naturally varied from case to case, but Mesmer
insisted that some degree of crisis, no matter how slight or
transient, would always be found if it was looked for carefully
enough.
Even more dramatic than the crisis, however, was the
Mesmeric trance. Mesmer discovered this phenomenon only after he
had been practising his method for some considerable time; the
trance then became for him a method of inducing the crisis.
Another of his followers, the Marquis de Puys�gur, discovered
that it was possible to communicate with people in trance,
getting them to answer questions, remember long-forgotten
childhood events, and so on. The Marquis came to believe that it
was possible to produce cures without a crisis, but Mesmer,
constrained by the demands of his theory, did not agree.
It is generally held that Mesmer was practising
hypnotherapy, but it is probably more accurate to say that he was
a shamanistic healer whose methods certainly included
hypnotherapy but were not identical with it. Mesmer's conduct
during therapy sessions was highly impressive, being intended to
augment the drama of the situation as much as possible. His
clinic was meticulously furnished to maximize suggestion: the
light was dim, everyone conversed in whispers, and music was used
to alter the patients' mood according to what was required at
each stage of the process. There were four baquets in the room,
three for paying patients and the fourth for those being treated
free. Mesmer, as Master of Ceremonies, was elaborately dressed
and carried a wand, which he pointed at patients or used to touch
or stroke them. The patients gasped, twitched, went into trance,
or experienced convulsions or catalepsy. Mesmer's assistants
ministered to the more severely afflicted and if necessary
brought them into one of the padded crisis rooms.
Although Mesmer made some influential converts, especially
Deslon, he was eventually to break with almost all of them. He
was autocratic and dictatorial (like Hahnemann) and would brook
no opposition. A lawyer called Nicolas Bergasse became converted
to Mesmerism and suggested to Mesmer the establishment of a
private academy to propagate his ideas. The result was the
grotesquely misnamed Societ� de l'Harmonie.
The Society was secret. All the members had agreed to sign
an undertaking that they would not pass on any part of Mesmer's
teaching without his written permission, nor would they establish
a clinic without such permission; they were permitted to treat
only individual patients. It was this last condition that
destroyed the Society within two years of its foundation in 1783.
The Society combined the roles of institute, medical school,
and clinic. Students learnt the theory of Mesmerism and how to
apply it in practice to patients. Schools were set up in Paris
and also in several other cities in France, and thousands of
pupils attended the courses. Bergasse took on much of the
administration and became correspondingly powerful within the
organization.
Meanwhile Mesmer's erstwhile assistant Deslon had set up on
his own account, and in 1784 he was investigated by a royal
commission. The committee was convinced by his cures but denied,
once again, the reality of animal magnetism. Another commission,
set up by the Faculty of Medicine, reached the same conclusion.
Mesmer objected that it was he, rather than Deslon, who should
have been investigated, but there was nothing he could do about
it.
Bergasse, Puys�gur, and other disciples of Mesmer now began
to make public the knowledge of animal magnetism. Mesmer was
furious, and the Society dissolved amid scenes of rancour and
confusion. In any case the Revolution was coming and Mesmerism
began to be overtaken by politics; Bergasse was later to adapt
the doctrine of animal magnetism to support his views on
revolutionary politics.
Mesmer kept aloof from politics. He travelled about in
Europe for a number of years, though he was back in France from
1798 to 1802; he sued for his losses under the Revolution and was
awarded enough to keep him in reasonable comfort for the rest of
his life.
He now recommenced his wanderings, and began to develop more
outlandish ideas than he had entertained hitherto, starting to
speculate on what we today would call paranormal phenomena and
extrasensory perception. During the trance, he said, the mind
comes into contact not only with other minds but also with the
cosmos, and so in principle is capable of acquiring universal
knowledge. In this way it is possible for seers and fortune-
tellers to foretell the future. He published these ideas in a
book in 1799, and as a result gained the reputation of an
occultist.
Mesmer died in Switzerland in 1815. He was in his eighty-
first year; a gypsy in Paris had foretold long ago that he would
die at this age, and he believed her, so he was prepared for the
end when it came.
In his own terms, Mesmer must be judged to have failed. His
dominating ambition was to achieve scientific recognition for his
theory of animal magnetism and this did not occur. His methods of
treatment, however, were reinterpreted as suggestion and were
rechristened hypnosis or hypnotherapy, and in this form they were
taken up by, among others, Jean Martin Charcot, Pierre Janet, and
Sigmund Freud (although Freud later abandoned hypnosis). Although
a faint aura of the disreputable has clung to hypnosis, there has
always been a minority of doctors and psychiatrists who have
valued and practised it. There is still a Society of Medical and
Dental Hypnosis in Britain.
Like Mesmer himself, some people have been attracted by the
idea that hypnosis facilitates telepathy and clairvoyance.
Numerous books, some by doctors, appeared in the mid-nineteenth
century describing remarkable cases of thought transmission and
other marvels during trance. It is interesting, however, that
Mesmer's name is not mentioned at all in some of these books; the
aura of charlatanry could not be dissipated. Matters were not
helped by the development of hypnosis as a stage entertainment.
There was also the fear that hypnotists might be able to
manipulate their subjects for their own purposes; Svengali might
be fictional, but could there not be real-life Svengalis?
Mesmer regarded his ideas as thoroughly scientific, although
admittedly he did later flirt with the occult. In the nineteenth
century hypnosis was part of the stock-in-trade of occultists
such as Helena P. Blavatsky, the founder of Theosophy, and there
is still a widespread belief that the hypnotic trance affords a
way into hidden depths of the mind. And although the term animal
magnetism is little used today, very similar ideas keep surfacing
under other names: for example, Wilhelm Reich's "orgone energy".
MESMER AND HAHNEMANN
The sixth edition of Hahnemann's textbook THE ORGANON
contains a number of approving references to the then topical
subject of Mesmerism. Hahnemann apparently used Mesmeric
techniques himself, and he made a connection in his mind between
the 'vital force' which, he believed, brought about healing, and
Mesmer's 'animal magnetism'. Subsequent generations of
homoeopaths have made little of the connection, however, probably
because of the reputation for charlatanry that later became
attached to Mesmer's name.
The similarities between Mesmer and Hahnemann, both in
career and in character, are in fact striking. It is worth
listing them.
1. They were almost exact contemporaries.
2. Both came from fairly humble backgrounds (Hahnemann was
the son of a worker in the Meissen pottery trade.)
Neither had very much to say about his childhood, which
may have been because neither was particularly happy.
3. Both qualified, rather late in life, as orthodox
physicians and both adopted heterodox ideas that brought
them into conflict with the medical Establishments of
their day and came to dominate their lives and thought
completely.
4. Both spent a considerable time in Paris.
5. Both had lawyers as prominent followers.
6. Both started as scientists and then moved gradually
towards more occult or metaphysical ideas.
7. Both were characterized by feelings of injustice and
persecution.
8. Both were intolerant of any deviation on the part of
their followers, with whom they became involved in
acrimonious and destructive disputes, which led to the
closure of establishments set up to propagate their
ideas (Mesmer's Society of Harmony, the Homoeopathic
Hospital in Leipzig).
9. Both insisted that cure must always be preceded by an
aggravation or crisis, no matter how brief and slight.
10. There are close resemblances between Hahnemann's vital
force and Mesmer's animal magnetism. It is significant
that some American homoeopaths actually suggested the
existence of a homoeopathic force, which they called
Hahnemannism by analogy with galvanism.
CONCLUSION
It seems that there is an inevitable contradiction
inherent in the attempt to get alternative medicine accepted
"officially" as valid. It can be done if its practitioners are
prepared to compromise with the "establishment", but in the
process they to may have to give up some of their cherished
ideas and theories. It is usually this, quite as much as the
difficulty of providing hard evidence for the efficacy of the
alternative system in question, that causes so much heart-
searching and agonizing. There will probably always be some
people who feel that the sacrifice is simply not worth while,
and who prefer to remain aloof from mainstream medicine
altogether.
The converse of this, however, is also true: increasing
contact with the alternative forms of medicine is likely to
alter doctors' thinking in ways that are not easy to foresee
in detail; indeed it is already beginning to do so.
4: IDENTIFYING FEATURES
People who subscribe to the view that unorthodox medicine
should be alternative rather than merely complementary nearly
always base this opinion on a number of characteristics which
they think distinguish the kind of medicine they favour. These
apply to most forms of alternative medicine but especially to
the medical and physical therapies (Groups A and B, Chapter 2,
p.00).
Alternative medicine, we could say, is supposed to be:
1. natural.
2. traditional.
3. holistic.
4. vitalistic.
5. supported by modern physics.
6. more truly scientific than orthodox medicine.
7. optimistic
8. ecological
9. anti-authoritarian
10. capable of dealing with the real causes of disease
But what do these claims really amount to?
ALTERNATIVE MEDICINE IS NATURAL
This is probably the single most important claim made on
behalf of alternative medicine; no form of therapy is complete
without it. It stems from a nostalgic yearning to return to
Nature, to our Source. In its extreme form, this is a quest for
what Marghanita Laski called the Adamic state. The designers of
travel advertisements and brochures draw on this longing when
they try to seduce us with their specious images of blue skies,
empty beaches, and laughing figures redolent of eternal youth.
'For ever wilt thou love, and she be fair!'
All the same, Mr Squeers was right: Nature is a curious
concept. How we think of it at any given moment depends a great
deal on social and economic circumstances. In Victorian times,
Nature (the capital N was almost invariable then) was thought of
as an arena of battle: 'Nature red in tooth and claw.' This
interpretation of Darwinism derived, not from Darwin himself, but
from philosophers such as Herbert Spencer who based themselves on
Darwin, and it reflects the competitive entrepreneurial spirit of
Victorian England. Survival of the fittest could be seen to be
part of the 'natural law'; a satisfying idea for those who
happened to have reached, or been born into, a superior economic
and social position.
For us, the ecology-minded descendents of those Victorians,
the natural world has become a cooperative effort rather than a
battlefield. We know, of course, that animals eat one another and
members of the same species fight one another for territory or
mates, but they do so only within certain limits. Predator and
prey are not deadly enemies; the lion wants to eat the individual
antelope but it doesn't want to destroy the whole herd - if it
did it would have nothing left to eat. Predator and prey depend
on each other in a delicate symbiosis, so that their relationship
is more like a partnership than a struggle for survival. As for
battles between members of the same species, these seldom lead to
death for the defeated individuals, and in any case the conflict
results in greater health and fitness for the species as a whole.
Today we are taught to think of nature as forming a vast
ecosystem, which would persist indefinitely in harmony with
itself were it not for us. We are the wild card, the unnatural
joker in the pack, who has entered the ecosystem and disturbed
it, perhaps irreversibly. The evidence of our meddling is
continually brought home to us in television programmes, books,
and newspaper articles. We are made to feel guilty because we are
destroying our planet by pollution, by upsetting its temperature
control mechanism with carbon dioxide, by deforestation.
Alternative medicine sees our orthodox medical treatments as
one aspect of the ecological catastrophe we are in the process of
bringing about. Our medicine, it could be said, is flawed in the
same way as our management of the planet is flawed, and for the
same reason: because we have moved too far from our roots in
nature. Just as we insensitively try to 'conquer nature' on the
outer level, so too on the inner, physiological, level we try to
bulldoze our way to health.
Antibiotics, corticosteroids, antidepressants, and the rest
of the conventional therapeutic armamentarium may 'work' in a
sense, the alternative purists admit, but they are 'against
nature' and so can only lead in the end to worse catastrophes
than those they are designed to cure.
Notice that word 'armamentarium'. As Susan Sontag has
pointed out, a lot of the vocabulary we tend to use (the 'fight
against cancer') implies a military model for treatment, in which
disease is the enemy, to be conquered by the doctor; an idea that
is unappealing for alternative medicine, which more often sees
your symptoms as your body's attempt to heal itself, and
therefore not to be suppressed as in 'allopathy'.
'Primitive' peoples who live or lived close to nature -
the Australian aborigines, the North American Indians, the forest
dwellers of the Amazon - are said to preserve valuable
information about the uses of plants and to possess sophisticated
rituals of healing and psychotherapy that we have arrogantly
spurned or even tried to suppress. Our own pharmacology, in
contrast, is seen as crude, dangerous, and, inevitably,
'unnatural'.
Some forms of alternative medicine make less claim to be
natural than others. Patients who ask for homoeopathy often
explicitly say that they want it because it is natural, but
naturalness was not a selling point for homoeopathy originally -
the quality was not so highly prized in the early nineteenth
century - and even today more emphasis is placed on the safety
and effectiveness of homoeopathy, and its 'holistic' character,
than on its naturalness.
However, homoeopathy is supposed to stimulate the natural
healing properties of the body, instead of suppressing them as
orthodox treatment is held to do, and the starting point of
practically all the traditional homoeopathic medicines is a
natural vegetable, mineral, or animal extract; often the plant or
animal is used whole. In this respect homoeopathy is rather
similar to herbalism, in which the medicines are typically
prepared from the whole plant. This is said to be natural, in
contrast to the products of the modern pharmaceutical industry,
which are isolates of the 'active principle'. Using the whole
plant is said to prevent adverse effects, because the various
components balance one another instead of acting unopposed, as in
'allopathy'.
Even within orthodox medicine, the use of whole plant
extracts died out only quite recently. As late as the 1960s, when
I was a medical student, some of the older physicians were still
using digitalis (foxglove) leaf tablets to treat heart failure,
in preference to the active principle, digoxin.
There is a deep-seated belief in alternative medicine
circles that herbal medicines - and by extension, 'natural'
methods of treatment in general - are safe and somehow
intrinsically virtuous, whereas 'drugs' are nasty and even
vaguely immoral; a belief that slides rather easily into
sentimentality. "Clear your mind of cant, sir," as Dr Johnson
used to say.
The natural world abounds with toxins - the deathcap
mushroom, snake venom, puffer fish toxin; and of course bacteria
and viruses, are all natural too. Comfrey, which has been widely
recommended as a cure for migraine, and indeed does seem to work
for this purpose, has been suspected of causing liver damage. The
idea that nature is inevitably benevolent is extraordinarily
sentimental. Mother Nature is not only Mother Divine, taking care
of her children; she is also Kali, dancing naked on the bodies of
her victims and wearing a necklace of human skulls. She cares
nothing for the survival of the individual, only for the species.
The corollary of the view that natural = good is,
inevitably, the corresponding equation: artificial = bad. I think
it is this notion that underlies the belief, taken seriously by
some people, that the Aids virus was manufactured deliberately by
bacteriological warfare laboratories in the USA or the USSR (take
your pick according to your political attitude) and then either
escaped or was disseminated deliberately. The psychological basis
for this belief seems to be the feeling that a benign nature
would not have produced such a terrible plague; it must have been
due to human malevolence.
But even if it were true - even if Aids had really been
produced artificially, by genetic engineering (a telling
expression), would that make it 'unnatural'?
An important question, surely. Can anything that happens, no
matter how technological, really be outside nature? After all, we
ourselves are part of nature, not separate from it. In fact, it's
the delusion that we can escape from the natural consequences of
our actions that has led to the seemingly disastrous situation we
find ourselves in today. The physicists who made the first
nuclear explosion depended after all, on the cooperation of the
laws of nature.
Usually, however, we do tend to think of ourselves as in
some sense having lost contact with nature, and this is perceived
as a Fall from Grace. There is a clear moral implication in this
perception, which emerges in the kinds of things patients say.
They announce: "I eat all the right things," with the unspoken
implication that they deserve praise for this. And if, in spite
of eating all the right foods, doing all the right things, and
thinking all the right thoughts they nevertheless become ill,
they feel aggrieved. It wasn't fair, they complain.
When we set the word 'fair' down on paper we at once see the
absurdity of applying it to nature; we don't, rationally and
consciously, expect nature to be fair. But emotionally and
unconsciously we do, thanks to an enormous amount of propaganda
on its behalf in recent years in books, magazine articles, and on
television.
Part of the reason we expect this is probably the decline of
formal religious belief. In other times people looked to God to
hand out appropriate rewards and punishments, either in this life
or the life to come. Now that many of us no longer believe in a
future life or, except vaguely, a God, we transfer our longings
for justice to a semi-personalized Nature. (The Victorians spoke
of Providence in this way, and I remember, as a child, puzzling
over the question whether Providence was or was not the same as
God, and, if not, what the difference was.)
"When people stop believing in God, they don't believe in
nothing, they believe in anything." (G.K.Chesterton)
The problem with casting Nature in the role of God is that
she inherits the metaphysical uncertainties that used to attend
Divinity. 'If God is all-powerful and all-good, why does He
permit evil to exist in the world?' we used ask. Now it's Nature
who has to answer this question.
In fact, however, we don't expect quite so much from Nature
as we used to expect from God, if only because most enthusiasts
for purist alternative medicine are not much given to
metaphysical speculation and don't ask the really awkward
questions. Nature can get away with more than God used to do.
ALTERNATIVE MEDICINE IS TRADITIONAL
Nature and tradition are closely allied concepts in
alternative medicine. The underlying assumption is that our
hunter - gatherer ancestors lived happy lives in total harmony
with nature, free from environmental poisons and pollutants,
successfully treating such few illnesses as they might acquire
with plants gathered from the forest. Those happy days are long
gone, but we can, via our television screens, glimpse people
still leading a version of this idyllic existence in what remains
of the Amazon or African rain forests.
Several overlapping myths seem to be present in this idea,
or perhaps it is the same myth that has reappeared more than once
in history in different guises. There is the myth of the Garden
of Eden. There is the myth of Arcadia, the idyllic rural setting
where every prospect pleases. And there is the nineteenth-century
myth of Rousseau's Noble Savage, uncontaminated by civilization.
The combination of these fantasies is extraordinarily powerful,
and not necessarily wholly delusive. The forest dwellers do still
exist, just, and there are important lessons that we could learn
from them before it is too late. But they are not 'primitive';
their societies are complicated and sophisticated, even if not in
the way that ours is, and it is patronizing of us to say
otherwise.
Probably the nearest we can get to the primitive origins of
our species is to study the way of life of our closest living
relatives, the chimpanzees. Thanks to Jane Goodall's work at
Gombe we now have a much better idea about this, but the
implications are not wholly reassuring. True, chimpanzees have
the beginnings of a 'culture', and they also take 'plant
medicines' when ill: evidence, if you like, that these things are
'natural'. But in that case, murder, infanticide, and warfare are
also 'natural' since chimpanzees seem to indulge in these
activities too.
But we don't have to go so far back as that, you say. Are
there not more recent societies or civilizations from whom we
could learn: the Indians of North America, for example? We read
moving statements by American Indian shamans and chiefs,
lamenting the destructiveness of the white man. (It is
remarkable, incidentally, how radically the popular image of the
'Redskin' has been transformed in the last twenty or thirty
years, from tomahawk-wielding savage, fit only to be mowed down
by the superior courage and technology of the white man, to sage
guardian of truths we are in peril of losing for ever.) Indeed it
is probable that a considerable number of herbal medicines were
borrowed from the Indians by nineteenth-century American
settlers.
The idea of looking to the New World for traditional
knowledge is a fairly new development, however. The favourite
region in which to seek wisdom remains the East, as it has been
since Roman times. Acupuncture has been with us for a long time,
but there have been fresh imports recently: Japanese, Indian
(Ayurvedic), and even Tibetan traditional medicines are beginning
to arrive in the West.
It is not every alternative therapy that can claim an
antiquity as impressive as that of acupuncture or Ayurvedic
medicine. Even so, practically all the therapies make at least
some claim to have roots in tradition; certainly it is very
difficult to think of any system that makes a virtue of being
completely new and original. Those therapies that are not
obviously ancient, such as osteopathy and chiropractic,
homoeopathy, Anthroposophical medicine, and the Alexander
technique, do the best they can by pointing to a Founding Father
(or sometimes Founding Mother).
This may seem like a trivial comment, since it is clear that
if a system did not originate in the mists of antiquity or even
prehistory, as did acupuncture, for example, there must have been
someone who invented or discovered it in the first place; but the
important thing is that this person almost invariably becomes
invested by practitioners of the system with an aura of near-
infallibility. As Jung (who is himself an illustration of the
process) would say, this is an activation (or 'constellation') of
the archetype of the Wise Old Man.
Even if a therapy is relatively recent, there is often a
tendency for its advocates to try to trace the underlying
concepts as far back as possible, as if proving their antiquity
would somehow validate them. Claims are often made that the
treatment in question was anticipated by Hippocrates, always a
favourite ultimate progenitor. This is true of homoeopathy, which
seems to be exceptionally richly endowed with authority figures,
starting, of course, with Hahnemann himself.
ALTERNATIVE MEDICINE IS HOLISTIC
This is another pretty well universal claim of alternative
medical systems; indeed, the description of a treatment as
natural and holistic could be said to identify it as alternative.
But it can sometimes be difficult to ascribe any definite meaning
to the term except as an indication of approval. What does being
holistic actually amount to? Indeed, is it really much more than
a card of identity, a label that people attach to themselves or
their method to indicate their allegiance to a cause?
One might expect that a truly holistic practitioner would be
one who had a practical grasp of several methods of treatment, or
was at least sufficiently familiar with a large range of
alternative (and, ideally, orthodox) treatments to be able to
advise patients about which would be most likely to help them.
But this seldom seems to be the case; more often therapists seem
to be firm adherents of one or two kinds of treatment, and indeed
there seems to be a certain amount of suspicion of a more
eclectic approach, people who use it being regarded as dabblers.
Each therapy tends to have its own view of what holism
means. For some it is a good deal more elaborate than for others.
The Western manipulative methods, osteopathy and chiropractic,
are probably the least concerned with constructing comprehensive
theoretical frameworks. The oriental therapies, on the other
hand, arrive equipped with ready-made and very detailed schemes.
Homoeopathy, in this as in some other respects, is somewhere in
the middle.
Homoeopathy does have a tendency to take on philosophical or
metaphysical characteristics. This has happened a number of times
in the past, most notably in the USA in the late nineteenth
century, when it became interwoven with Swedenborgianism. In
Britain, homoeopathy has on the whole been more down-to-earth,
and the claim that it is holistic is usually based not so much on
philosophical ideas as on the fact that it takes the patient's
personality and individual reactions into account. The main
weakness of this claim is that the commonly used homoeopathic
history-taking, although elaborate, is somewhat stereotyped, and
usually ends in the selection of one of a fairly small group of
medicines. (A number of computer programmes for selecting
medicines have been introduced in the last few years, and it is
hoped that these will improve the accuracy and scope of the
process.)
Another way in which alternative medicine is often said to
be holistic is that it is not supposed to deal in disease
categories; these are said to be a feature of conventional
medicine, and derive from its insensitive lack of concern for the
individual. 'There are no such thing as diseases, only sick
people.' Taken to an extreme, this would mean that an alternative
practitioner would have no interest at all in making a
conventional diagnosis, and some practitioners do indeed adopt
this viewpoint.
Rejection of diagnostic labels is an ancient idea that
surfaces a number of times in the history of alternative
medicine. It was held, for example, by Paracelsus, that maverick
among physicians and forerunner of many alternative practitioners
down to our own day. Hahnemann held the same view, which he had
probably arrived at independently. Modern non-medical
practitioners also advocate it at times and it is easy to
understand why: it exempts them from the need to bother about
orthodox medicine.
Even within orthodox medicine the concept of disease
categories is challenged seriously from time to time, especially
by psychiatrists. There are for example considerable differences
in the ways that British and American psychiatrists diagnose
schizophrenia. Indeed, it is in psychiatry that the conventional
medical model seems most open to question, as Thomas Szaz has
pointed out in The Myth of Mental Illness, and since alternative
medicine has much in common with psychotherapy it is not
surprising that we find alternative practitioners expressing
reservations about the value of diagnosis.
Probably the truth lies somewhere in the middle. It is
undeniably often convenient, in fact pretty well unavoidable, to
use disease categories. (Could you go through life without using
the concept of the common cold?) Problems arise, however, if we
adhere to them too rigidly, or fail to recognize that there can
be many individual variations among people who have been affixed
with the same disease label. But awareness of this truth is not
confined to alternative medicine; it is characteristic of good
conventional medicine too.
The commonest problem with conventional diagnosis is not
that diagnostic labels are used, but that they are used
inappropriately, as a cover for ignorance. All of us (not just
doctors) feel more secure if we think we have identified
something and given it a name. Patients, too, feel this; they
constantly ask: 'Is it arthritis?' (or ME, or allergy, or
whatever is fashionable at the moment). Having a label does not
necessarily help in treatment, but it gives a (usually spurious)
sense of control.
However, labels can also inhibit further thought and action,
and this is my real objection to them. Many patients, for
example, have pain in their neck radiating down into their arms
or shoulders. On the basis of an x ray which has shown the kinds
of changes that almost everyone acquires as they age they have
been told that they have arthritis and nothing can be done about
it. But this is doubly misleading.
First, the x ray changes may have little or nothing to do
with the symptoms patients experience; there are plenty of people
with severely abnormal x ray findings and few or no symptoms, and
conversely others who have a great deal of pain and hardly any x
ray abnormalities. Very often neck pain arises from the muscles
and other soft tissues rather than from the bones and joints.
Secondly, quite a number of these people can be helped a
good deal by physical methods: I use acupuncture for this, but
manipulation or other forms of treatment (all of which, probably,
act in much the same way) can work well too. To label such people
as arthritic is both inaccurate and unhelpful, since it tends to
paralyse further thought.
This is one of the ways in which the use of excessively
materialistic ways of thinking can be damaging. As Dr R.S.
Macdonald, an osteopathic physician, has put it:
Orthodox doctors are used to seeing such
abnormalities as tight muscles, restricted joints,
and tenderness, around areas like a fractured bone,
inflamed joint, abscess, or cancer. Therefore,
whenever these abnormalities are found, it is not
surprising that the orthodox doctor presumes there
is some pathological cause. In similar
circumstances, the osteopath will always consider
the possibility of pathology but, when no evidence
for it can be found, the osteopath will diagnose
only the dysfunction observed. [Natural Health
Handbook, 128].
This is an important principle that ought to be applied much
more widely in medicine, not just in osteopathy. Doctors are
trained to look for pathology: that is, for definite
abnormalities which can be detected by x rays, blood tests and so
on, and they are taught to regard it as a failure if they miss
such an abnormality. And this is how it should be; the doctor
should make every effort to reach an accurate diagnosis if
possible. But the concept of 'accurate diagnosis' needs to be
expanded to include the idea that there are many medical problems
which must, indeed, have a 'cause' in the widest sense of the
word, but not necessarily a cause that can be detected by
conventional tests. The abnormalities exist but they are subtle
and sometimes transient.
A good example is the muscle trigger point, or trigger zone.
These are tender areas in muscles which hurt when pressed and can
give rise to 'referred' pain and sometimes other symptoms in
areas of the body some distance away. Trigger points in the back
of the neck, for example, can give rise to headache often
localized in the forehead or around the eyes, and this is often
labelled incorrectly as 'sinus headaches'.
No one knows what muscle trigger points are, though there
are several theories. Nearly everyone has a few, which are
usually latent, not causing any problems; but unaccustomed over-
use of a muscle, psychological tension, and probably many other
things can cause them to become active and give rise to symptoms.
It is very easy for any doctor to convince himself that trigger
points exist - he need only examine a few patients and look for
them - so why are they not generally recognized? Because they
are not taught in medical school. This in turn is presumably
because they cannot, so far, be detected by laboratory or other
tests; they are outside the scope of present-day medicine.
Describing a patient as suffering from a muscle trigger
point disorder is still attaching a label, making a diagnosis,
even if an unconventional one. For that matter, it is attaching a
label to say, as many homoeopaths do, that a patient is a
'sulphur type', an 'arsenicum type', or whatever. We cannot speak
or think about anything without using categories. Instead of
deluding ourselves that we can we ought to be more relaxed and
undogmatic about the labels we do apply.
As a rule, the label 'holistic' is used so loosely as to be
nearly meaningless. It is almost invariably attached to any kind
of alternative medicine you care to think of, but often all it
seems to mean is that the practitioner is applying the principles
of his own particular form of therapy. These are different,
certainly, from those of orthodox science, but they are often
just as rigid, just as stereotyped, in their own way.
The real problem is that we as a society have no definite
agreement about what constitutes a human being. The dominant
scientific model is a mechanistic and materialistic one, in which
human beings are thought of as flesh and blood computers
transported about in bodies. To this view the alternative
medicine movement opposes its body, mind, spirit model, but this
is simply a set of words and is so vague as to be able to
accommodate pretty well any theory you want to think up.
It seems preferable to avoid both these models. If holism
means anything in this context, it should indicate an ability on
the part of the practitioner to assess the patient's needs in
relation to a wide range of possible therapies, some orthodox,
some alternative, without necessarily distinguishing rigidly
among them. It should also include the ability to know when it is
more appropriate not to give any treatment at all. Holistic
treatment in this sense is undogmatic, not tied rigidly to any
view of human nature, able to select from a wide range of
therapeutic possibilities.
ALTERNATIVE MEDICINE IS VITALISTIC
The debate between vitalists and mechanists is an ancient
one, indeed it goes back to the dawn of philosophy. Until
relatively recently the vitalists appeared to be winning, which
is hardly surprising. After all, living creatures are 'obviously'
different from non-living matter, and it seems a matter of mere
common sense to classify the world into two broad categories,
living and non-living. We can then subdivide the living in
various ways: plants and animals, fish, birds, beasts, and so on.
But the gulf between living and non-living systems is apparently
the widest of all and is fundamental, underlying all the others.
In earlier times it was generally held that there is some
kind of subtle substance or force that is responsible for life.
In the case of animals and human beings, at least, this principle
of life was often identified with the breath, doubtless because
we only stop breathing when we are dead. This might be conceived
of in a fairly literal way, so that the soul was thought of as
escaping from the dying body in the last breath. In Greek, pneuma
refers both to breath and to spirit, and the same idea is found
in the Sanskrit prana; yogic breathing exercises are called
pranayama, but prana is also the universal breath of life. We
tend to interpret such statements poetically or figuratively, but
for the ancients they were literal equivalents.
The corresponding Chinese concept is chi. In keeping with
the rather materialistic character of much Chinese thought, chi
is supposed to have a number of specific functions in the body,
which are worked out in considerable detail, and it circulates in
well-defined channels, the so-called meridians. But an
individual's chi is not self-contained in the way that Western
science thinks of each person's blood volume as an isolated
entity; rather, chi is constantly flowing in and out of the body,
which is therefore in communication with cosmic chi. The actual
nature of chi is difficult to specify in Western terms; it is
neither energy nor matter but has characteristics of both of
these, and so lies on the border between them.
Even in ancient times, however, in India and elsewhere there
were materialists who did not accept that there is anything like
a soul in living creatures. This minority view gradually gained
increasing acceptance in Western thought after the Middle Ages,
as the mechanistic outlook came to predominate; William Blake's
hostility to Newton reflects an awareness of the coming change in
our perception of the world. Descartes took matters further by
claiming that animals were automata, though for religious reasons
he stopped short of applying the same idea to human beings.
Ideas that were surprisingly similar to those of ancient
China and India continued to be current in Western medicine until
as late as the nineteenth century. Vitalism was taught in France
at the respected University of Montpellier, where it was held
that the vital force had its seat in the brain, whence it
travelled via the nerves (thought of as hollow) to reach the
different parts of the body.
But major changes were on the way. Hitherto it had been
supposed that there is something uniquely special about the
chemical processes that occur in living creatures, a belief that
is enshrined in the name 'organic chemistry'. Then a chemist
synthesized urea. This may not seem a world-shaking event, but in
fact it was, because hitherto urea had been thought to be
produced only by animals. And urea was only the first of numerous
other organic compounds to yield to chemical synthesis, until it
was finally realized that organic chemistry was simply the
chemistry of carbon.
The reason that carbon is so special and is capable of being
the essential building block of life is that it has four
valencies or 'hooks' by which it can link up to other atoms,
including other carbon atoms, to make long chains or rings; but
otherwise there is nothing mysterious or 'living' about it.
Vitalism was not immediately discredited by this discovery. But
it was now definitely on the defensive, and as time went by it
began to look less and less convincing. The last major
philosopher to base his thinking on vitalism was Henri Bergson.
In modern science vitalism is no longer discussed at all; it has
gone the way of the phlogiston theory as an explanation of
combustion and of the cosmic ether as a conductor of
electromagnetism in space.
It is doubtful how far such thinking has penetrated the
thinking of non-scientists even today, however, and this may help
to explain some of the popularity of alternative medicine, which
is firmly vitalistic in outlook. Hahnemann, after an initial
hostility to vitalism, adopted it as a principle of homoeopathy;
healing, he said, depended on the operation of the vital force or
dynamis, and so did the process of 'dynamization' which he used
to make his medicines. Homoeopathic medicines, as conceived of by
Hahnemann, could thought of as the vital force caught in a
bottle. Pragmatic British homoeopaths, such as Richard Hughes and
Robert Dudgeon, rejected both vitalism and dynamization.
The concept of vital force is closely intertwined with that
of energy; indeed, the two are often almost synonymous. 'Energy'
is a precise term in physics, but in alternative medicine it is
used far more loosely, and generally amounts to a little more
than a metaphor. In spite of or because of this vagueness, energy
is a near-universal item of conceptual currency for people in
alternative medicine circles. There is much talk of healing
energies and of energy centres in the body (these usually derive
from the chakras of yogic physiology), and patients sometimes
talk of feeling that their energy is blocked.
This borrowing of 'energy' from physics (together with
certain related terms, such as 'vibration') is symptomatic of a
curious symbiosis that exists between alternative medicine and
physics.
ALTERNATIVE MEDICINE IS SUPPORTED BY MODERN PHYSICS
Mainstream physics and cosmology today are so strange, so
contrary to common sense expectations, that it is hardly
surprising if those of us who are not physicists begin to get the
impression that almost anything goes - that there is hardly any
conceivable possibility that is too strange not to have at least
the chance of being true; we remember J.B.S. Haldane's celebrated
remark that reality is not only queerer than we suppose, it is
queerer than we can suppose.
Numerous books by physicists have appeared, popularizing
quantum physics and cosmology. What is more, some physicists have
espoused the kinds of thinking that appeal to people interested
in alternative medicine and the paranormal. The connection
between physics and the occult is hardly new, for no less a
scientist than Isaac Newton spent many years working on practical
alchemy, but more physicists seem to be willing to look at such
matters today. To name just a few, Wolfgang Pauli collaborated
with Jung in formulating a theory of psychologically meaningful
coincidences, Henry Margenau has written a good deal about the
paranormal, and Fritjhof Capra has written best-sellers about
the apparent similarities between mystical and scientific world
views and about New Age thinking, including alternative medicine.
And if some physicists have expressed interest in unorthodox
ideas such as alternative medicine, alternative practitioners
have not been slow to return the compliment. There have been
attempts by homoeopaths to construct physical theories to explain
the apparently paradoxical claim that medicines which are so
dilute that none of the original substance is left can
nevertheless have a beneficial effect. These theories have
usually been based on somewhat esoteric physics concerning the
properties of water. Other alternative medicine enthusiasts have
written at length about electromagnetic fields that are supposed
to surround living organisms, including trees as well as human
beings.
Sometimes speculations of this kind remain at a fairly
theoretical level, being designed to provide scientific support
for pre-existing systems of ideas derived from other sources, but
often they merge insensibly with practical techniques of
diagnosis and treatment. These techniques can rely simply on the
operator's hands, but more often they use apparatus, which may be
as simple as a pendulum or as complicated as an electrical
machine costing hundreds or even thousands of pounds.
The starting point of much of this is radionics and
radiaesthesia. A number of lay practitioners of various
therapies, and some doctors also, use a pendulum to diagnose
allergies and other problems and to decide which medicine to
prescribe. This can go to extreme lengths; it is somewhat
alarming to see an otherwise intelligent person who is so
convinced of the validity of these methods that before she eats
or drinks anything she has to test it with her pendulum to see
whether it is suitable for her.
Numerous machines have been manufactured to do the same sort
of thing in a more complicated way. In some, the patient merely
holds a metal contact to connect her to the machine, while the
therapist adjusts the settings to obtain a reading. This may
indicate the homoeopathic or other medicine that is required or
may give an indication of what sort of acupuncture treatment
should be given. More elaborate and expensive machines take
readings from the whole of the patient's body as she lies on a
special couch. As a variant on this, machines exist that
purportedly make homoeopathic medicines by radionic means without
the need to go through the steps of manufacture traditionally
used.
There are other diagnostic methods allegedly based on
physics. One of these is Kirlian photography, which is sometimes
claimed to produce a picture of the human aura. It does this by
placing the object (usually a human hand) in a strong electrical
field and photographing the consequence emission of electrons.
In spite of the apparent technological sophistication of
some of the devices used, there is almost no independent
objective evidence that any of them produce any meaningful
information at all. Most of the machines now in use appear to
depend heavily on self-deception. There has, however, been one
curious apparent exception to this generalization, in the
investigations carried out many years ago by Dr William Boyd, a
homoeopathic doctor in Glasgow.
Boyd was a careful scientist, who made a number of
pioneering studies of homoeopathy between the wars. One series of
these concerned a machine he invented called the Emanometer, with
which he claimed he was able to detect an 'energy' of some kind,
which he thought was similar, though not necessarily identical,
to radio waves (radio was at the time a fairly new invention,
still, literally, very much 'in the air'). He was apparently able
to detect various abnormalities in patients, sometimes before
they themselves were aware that anything was wrong, and he could
also distinguish various homoeopathic medicines from one another.
In 1924 a committee under an eminent physician, the future Lord
Horder, investigated the Emanometer; later the committee was
joined by E.J. Dingwall, research officer of the Society for
Psychical Research and an authority on fraud.
The committee concluded that Boyd was certainly able to
detect something with the Emanometer, but they had no idea what
it was or what it meant. They were also careful to say that there
was as yet no good evidence that the Emanometer could be used in
diagnosis or treatment - a cautious attitude that Boyd himself
fully shared.
The Emanometer was difficult to use in practice, and after
Boyd died work on it was abandoned. It is impossible now to say
whether some form of 'energy' was detected in the experiments or
whether there was, after all, some subtle error in the set-up
which no one noticed (that Boyd produced his results in good
faith seems beyond doubt). This unsatisfactory result is rather
similar to the uncertainty that afflicts scientific research into
the paranormal, which often seems to be on the verge of yielding
definite proof but somehow always fails to do so at the last
moment. The resemblance may not be accidental; it is conceivable
that, if paranormal abilities do exist, these are what Boyd
possessed.
All this work was carried out a considerable time ago, and
is remote from the main direction of research in homoeopathy
today. I will return to this later, but for the moment I want to
look at the question of science and alternative medicine from a
different angle.
Alternative medicine is the only truly scientific form of
medicine.
This claim keeps being made, especially by the more
philosophically-minded non-medical homoeopaths. Harris L.
Coulter, for example, writes that:
The principal difference [between homoeopathy and
allopathy] is that homoeopathy is a precisely structured
doctrine. Even though most of its ideas find their
parallel in allopathy, it differs from the latter in
that the homoeopathic ideas are mutually consistent and
coherent... Allopathy, in contrast, lacks a precisely
defined and delineated set of ideas. It accepts
concepts, principles, and procedures from any number of
sources, with the result that the various parts of
allopathic doctrine are at times inconsistent, and even
incompatible, with one another... [Homoeopathic Science
and Modern Medicine, 93 - 94]
This is a fascinating passage, for it beautifully
encapsulates the difference between a scientific and a dogmatic
approach, although not quite in the way Coulter intends.
Everything depends on what we understand by the scientific
method. Coulter evidently believes in the Baconian model, which
is based on the principle of induction. According to this model,
what we have to do is to keep accumulating facts until at last we
discern the theory that fits them; the more facts we can find to
support the theory the better.
There is a fallacy in the idea of induction, which was
pointed out long ago by David Hume and has continued to perplex
philosophers ever since. It would take too long to discuss it in
detail here, but we can get at the essence of the matter by
considering the question of apotropaic magic.
For many traditional societies, an eclipse of the sun or
moon was, understandably, an awe-inspiring and alarming event.
Often it was thought that a dragon was eating the sun or moon; in
order to frighten it away the people would beat drums and perform
magical rites. Fortunately these always worked. The success of
the method proved, naturally, that it was the right one, and no
one would be rash enough to try the experiment of doing nothing
to see what happened.
In this case, clearly, the theory was fully confirmed by the
facts. It was nevertheless mistaken. The extraordinary scientific
advances that have occurred in the last three hundred years or so
have come about because this way of confirming theories gave way
to another approach, which might be called the iconoclastic
method.
The iconoclastic method consists, essentially, not in
looking for facts that support our theory, but in trying to find
facts that contradict it. To put the matter less paradoxically,
we ask what things the theory predicts should happen or should
not happen, and then see if they do (or don't). The critical word
here is 'predicts'; a genuine scientific theory has to be ready
to risk its reputation by making predictions which, if falsified,
disprove the theory or at least demand that it be modified.
On this view of science (which I have, of course, taken from
Karl Popper, currently regarded as the foremost modern
philosopher of science), any theory which is truly scientific has
to have a provisional character. There are no absolute truths in
science. We can never know for sure whether any scientific theory
is really true; all we can say is that it has not been found
wanting so far. No matter how many facts you find to support your
pet idea, this will still not make it into a law of nature. In
fact, there are no natural 'laws' in this sense; all are in the
last resort provisional and open to challenge. And this sometimes
happens in practice: for example, Newton's gravitational law, for
so long regarded as the ultimate example of an immutable
scientific principle, has in our own day had to be modified in
the light of Einstein's Special Theory of Relativity.
The reason I have laboured this question is that the modern
view of science stands Coulter's argument on its head. He may
well be right in claiming that homoeopathy is a 'precisely
structured doctrine', based on 'mutually consistent and coherent'
ideas (although it would be possible to argue that they are not
quite so consistent and coherent as he says they are), but in so
far as it is so based, it is not scientific. The more you make
homoeopathy or any other set of ideas immune to challenge and
criticism the less truly scientific they become.
Conversely, of course, the more you try to make homoeopathy
scientific by carrying out clinical trials and subjecting its
basic concepts to the kind of criticism that other scientific
theories have to withstand, the less of a 'doctrine' it will be.
This is the dilemma that confronts all would-be homoeopathic
purists who want to represent themselves as scientific. Similar
difficulties are faced by purist supporters of other kinds of
alternative treatment. It may indeed be possible to make some of
these methods more scientific, but there will be a price to pay
in terms of the 'purity' of the system.
ALTERNATIVE MEDICINE IS OPTIMISTIC
If there is one feature of alternative medicine which, more
than any other, distinguishes it from orthodox medicine, it is
the extent of its optimism. From an advertisement for a
homoeopathic clinic:
Most certainly, the alarming rise in all killer
diseases, such as asthma, epilepsy, and heart-related
chronic disorders, claim hundreds of thousands of
precious lives each year. Yet there is hope, for at
..... we are helping all types of people suffering from
a vast array of chronic life-threatening diseases,
termed incurable by conventional medicine...
This a particularly naive example of the genre, no doubt,
and the implied claim of a universal panacea is certainly
unusually blatant. But the confidence that alternative medicine
has a cure for practically everything that orthodox medicine
can't help is not unusual.
Anything that the body can regenerate, homoeopathy can
encourage happening. Uterine fibroids can dissolve,
brittle nails can go away. All kinds of viral problems
can abate. Aids. Obesity. Anything that the body can
throw off, we have mechanisms against. The idea is just
to stimulate the body and get those mechanisms working.
[Quoted by Coward, 47-48, from Homoeopathy Today, 1986]
Although some non-medical alternative practitioners are
commendably cautious about what kinds of problems they will take
on, others are not; and the result is that many patients acquire
quite unrealistic expectations of what can be achieved. It is
quite common, for example, to find patients whose blood pressure
is dangerous raised, to a point at which they are at considerably
increased risk of a stroke, asking for alternative treatment in
place of conventional medicines, or patients with troublesome
gallstones who expect them to be 'made to dissolve'
homoeopathically. Sometimes it can be quite difficult to convince
such people that what they are asking for cannot be done.
I sometimes get the impression that one reason for the
existence of this over-optimism among patients is their belief in
a conspiracy theory. Conventional doctors are seen as
deliberately blackening the reputation of alternative medicine
out of a misplaced sense of professional pride. But this is by no
means the whole of the story.
There is a deeply held belief in alternative medicine that
the body has its own wisdom and, left to itself, will heal
itself. Indeed, our 'natural' state is said to be health; disease
is unnatural. In a sense, disease (often rendered as dis-ease, to
emphasize the point) is almost an irrelevance, a distraction from
the real business of staying healthy.
In this respect, as in some others, there is an increasing
amount of common ground between orthodox and alternative
medicine. The government - responding, no doubt, to popular
pressure - is placing more emphasis now on the prevention of
disease; general practitioners are being encouraged, in fact
almost compelled, to practise 'preventative medicine', to such an
extent that we read of doctors who strike patients off their
lists because they refuse to attend for 'health checks'. Many
doctors are sceptical, probably rightly, about the value of much
of this screening, but it is difficult for them to resist the
demand.
ALTERNATIVE MEDICINE IS ECOLOGICAL
Interest in alternative medicine often shades off
imperceptibly into wider concerns, for example with the state of
the environment. The word 'ecology', which ten or fifteen years
ago would probably have been unknown to many people, now turns up
all over the place, and we are all being reminded constantly of
our responsibility for the condition of the world. Although I
have no figures to prove it, most of the people who feel strongly
about environmental matters would probably also be sympathetic to
alternative medicine, and the reverse is likely to be true as
well. Probably the equation is not always fully worked out
consciously, but there is a sense in which avoiding causing
pollution in the world can be related to not taking harmful
'drugs' into our inner environment, while a concern for
preserving the balance in nature outwardly can be correlated with
allowing the body to heal itself instead of disturbing its
equilibrium as conventional medicine is said to do. (I return to
the 'public health' implications of alternative medicine in
Chapter 12.)
ALTERNATIVE MEDICINE IS ANTI-AUTHORITARIAN
The expression 'doctor's orders', which used to be heard a
lot forty or fifty years ago, may not have disappeared
completely, but it is certainly much less common today. The
notion of the doctor as the expert who must be deferred to is
becoming unfashionable, and instead we are encouraged to take
responsibility for our own health, and to view the doctor as a
co-worker in the enterprise rather than an authority figure.
In some ways this change is more apparent than real. People
may say they want to have more responsibility for their health,
but when it really matters they are often quite happy to leave
decisions to the doctor. Partly this is because the complexity of
modern medicine means that patients can't easily assimilate
information when they are given it, but partly, also, it is
because people who are seriously ill don't necessarily want all
the information which, in health, they might have thought they
would.
A personal account written by a doctor a few years ago
illustrates this. He was a retired physician who had to go into
hospital for a major operation. As he was a colleague, the
surgeon started to explain all the technical details of the
treatment he proposed to carry out, but the physician did not
want to know, and simply asked the surgeon to get on with things
as he thought best and spare him the details. If this is how a
medical patient felt, many who are not medically qualified would
surely react in the same way.
But some people do want to know what is being done to them
and some want to be actively involved in their treatment. In
theory, alternative medicine is supposed to encourage patient
participation, but there often seems to be a tendency for the
alternative therapist to take on the role of the expert which the
doctor is supposed to have abandoned. And patients usually go
along with this, which is hardly surprising; for unless you
regard a therapist as an expert in his field, what is the point
of asking his opinion?
A recent survey of complementary practitioners in the
Midlands, which was carried out by Ursula M. Sharma of the Centre
for Medical Social Anthropology at the University of Keele
investigated this question among others. Dr Sharma found that
although the therapists she interviewed generally believed in
treating the patient as an individual and expected her to be an
active partner in treatment, they were also pulled in the other
direction by their wish to be more 'professional' and to lay
claim to genuine forms of specialized knowledge. As Dr Sharma
remarks, 'The practice of non-orthodox medicine abounds in
contradictions, some internal and others imposed from outside.'
[Complementary Medical Research, 1991, 5, 12 - 16]
The Founding Fathers and Mothers of alternative medical
systems are often, indeed nearly always, strongly authoritarian.
Hahnemann, for example, would tolerate no deviation on the part
of his disciples. He referred contemptuously to those who
combined homoeopathy with allopathy as "half-homoeopaths". When
one of his closest disciples, called Gross, who had had the
misfortune to lose a child, remarked that the experience had
taught him that homoeopathy was not the answer to everything,
Hahnemann was furious and never fully restored him to favour. And
when a Homoeopathic Hospital was established in Leipzig
Hahnemann, by now living at Kothen, took exception to the Medical
Director on the grounds that he was not sufficiently committed to
homoeopathy and had him replaced; unfortunately the new Director
soon left and his successor, who bore the appropriate name of
Fickel, took the job with the undeclared aim of discrediting
homoeopathy, and the ensuing debacle led to the closure of the
hospital.
We have already noted the similarities between Hahnemann and
Mesmer (p.000); Mesmer, like Hahnemann (and Kent) was an extreme
authoritarian. (The same, incidentally, is true of Freud; and
psychoanalysis has many of the features characteristic of an
alternative medical system.)
The trend towards authoritarianism in alternative medicine
persists undiminished today. It is not difficult to think of
practitioners who have built up considerable followings of
patients and pupils who accept their gurus' ideas unquestioningly
and proselytize for them enthusiastically.
Alternative medicine deals with causes
Many patients say: "I don't just want to take a drug to
suppress my symptoms, I want to find the cause." This idea is
very prevalent in alternative medicine; we constantly see claims
that conventional medicine merely deals with the manifestations
of disease instead of eradicating it at the root.
On the face of it this is rather strange, for if you asked
most orthodox doctors what they think of alternative medicine
their main criticism of it would be that it is merely a placebo
which may help on a symptomatic level but does not tackle the
causes of disease. We are therefore confronted with the curious
paradox that both sets of practitioners believe that they are
treating the causes of disease while their opponents are merely
offering palliatives.
The explanation is that the two groups have different ideas
about what counts as a cause. Medical students are sometimes
taught a little mnemonic for the possible causes of disease:
Tumour, Trauma, Toxin, Degenerative, Deficiency. This scheme does
not cover all the recognized possibilities and is old-fashioned
in certain ways, but it does help to prevent one forgetting the
major causes.
Tumour and trauma are fairly self-explanatory. Toxin
includes not only poisons of various kinds but also two very
large subdivisions, bacterial and viral infection. Degenerative
includes the inevitable accompaniments of aging and also the
'autoimmune' disorders, such as rheumatoid and certain other
kinds of arthritis. Deficiency includes food, mineral, and
vitamin deficiencies and also internal failures of glandular
secretion such as thyroid deficiency and sugar diabetes.
To these groups of causes we must add one large and
important category, Unknown. Very gradually, diseases move out of
the Unknown into one of the other groups. There is also movement
among the (more or less) Known groups, so that, for example,
Alzheimer's disease, which twenty or thirty years ago was thought
of as more or less an inevitable accompaniment of aging, and
therefore Degenerative, is increasingly suspected of being a
Toxic disease, in some way related to aluminium accumulation in
the brain. Parkinson's disease, which similarly used to be
classed as Degenerative, is likewise now thought to be perhaps
caused by an environmental toxin or possibly by a dietary
deficiency of some kind.
There is another way of thinking about causation of disease,
which is to look at what happens pathologically. A good deal of
the space in medical textbooks is concerned with this aspect.
In the second half of the nineteenth century it came to be
recognized that the organs and tissues are made up of cells, and
techniques were developed by Virchow, Ramon y Cajal, and others
to allow these microscopic structures to be investigated in
health and disease. In this way it came to be seen that disease
processes could be understood at the cellular level. At much the
same time, other workers were exploring the chemical constitution
of the body, and finding that alterations in what came to be
called biochemistry underlay many manifestations of disease.
In our own day these trends have been taken much further. We
no longer are confined merely to studying cells; now it is
possible to analyse the molecular processes that occur inside the
cells. As well as chemistry, we have a whole new science,
immunology, with its own concepts and vocabulary. Viruses, which
previously were too small to be analysed, can now be taken to
pieces to allow their method of working to be understood. It is
even becoming possible to replace individual faulty genes with
good ones.
And it is not just at the microscopic level that so much has
been achieved; now it is possible literally to see into the
living body without damaging it. Until quite recently almost the
only tool available for doing this was the X ray. This merely
provided pictures of 'shadows from shadowland', as the actor
representing a radiologist in an American film once absurdly
expressed it. Now radiology is simply one part of the much
grander subject of 'medical imaging'. There are ultrasound echo
techniques, which can be used to show the working of the heart or
the condition of the fetus before birth. We have computer-
assisted tomography, magnetic resonance imagery, and positron
emission tomography, all of which are capable of giving the most
astonishing three-dimensional pictures of the interior of the
body. And it is possible to insert fibre-optic devices into all
kinds of body cavities to allow the surgeon to see what is going
on there.
It is hardly surprising that, with all this in mind, modern
doctors feel that they are able to say a good deal about the
causes of disease. For alternative medicine, however, much of
this is beside the point. No matter how much you understand about
the mechanisms of disease, the argument goes, you still are not
really dealing with The Cause. Bacteria and viruses may be
proximately responsible for disease (that much is generally
admitted by even the most radical enthusiasts for alternative
medicine), but these organisms couldn't gain a purchase on us if
we were not already weakened by other things. Alternative
medicine makes a great virtue out of the fact that it
distinguishes between the 'seed' and the 'soil'.
It is only by understanding what alternative medicine means
by 'causes' that we can explain the otherwise puzzling paradox
that, according to alternative medicine, we are supposed to be
naturally healthy, yet we continue to suffer from disease.
5: ALTERNATIVE CAUSES OF DISEASE
It's worth looking at this concept of causation in alternative
medicine in a little more detail. The main causes of disease
according to alternative medicine are:
1. diet
2. stress
3. faulty ways of thinking and feeling
4. allergy
5. orthodox medicine (allopathy)
6. miasms
The role of diet.
Since the natural is generally equated with health and
virtue, it logically follows that living unnaturally is likely to
be harmful. There are of course many respects in which our
present way of life can be seen to be unnatural. Pollution in all
its forms is widely regarded as a cause of disease. There is not
much we can do individually about environmental pollution, but we
can limit the amount of pollution we ingest by not eating things
that will harm us.
Diet, in fact, is a central cause of disease for nearly all
alternative practitioners, and this idea has taken firm root in
the population as a whole; about half the patients who come to
see me raise the question at some stage, and nearly all are
interested in discussing what they eat.
This is hardly surprising, for orthodox medicine, too,
attaches a lot of importance to a healthy diet in the prevention
of coronary heart disease. Alternative and orthodox medicine
agree on the desirability of reducing animal fats, sugar, and
salt, and increasing the intake of vitamins and minerals; but for
alternative medicine this is just the beginning. Diets exist to
help control eczema, sinusitis, arthritis, colitis, multiple
sclerosis - almost any disease or symptom you like to think of,
in fact. Hardly any of these diets is based on proper scientific
assessments, and many seem to have been composed at the whim of
the author; few have any discernible scientific basis. But this
is not why people follow them.
And follow them they do, in considerable numbers and often
with extraordinary tenacity, sometimes in spite of the
unpalatability of the diet, its practical inconvenience, and even
its manifest nutritional inadequacy. It is difficult to
understand why this should be so, but possibly it is partly
because we feel that changing our diet is something that lies
wholly within our own control; it is something we can do.
But it is not only that. Food and cooking customs have
stronger emotional and cultural roots than almost any other human
activity, perhaps stronger even than sex. We mostly acquire our
eating habits literally at our mother's knee, and many of us
never change them much for the rest of our lives. The
anthropologist Claude L�vi-Strauss sees the cooking of food as a
central theme in the development of human culture. Because
cooking can be thought of as a form of technological processing,
the back-to-nature movement prefers to eat raw food as much as
possible - vegetarian, naturally, because vegetarianism, though
not obligatory for a healthy diet, is preferable for a number of
reasons, moral, aesthetic, and nutritional. If people must eat
meat, they should eat white meat such as chicken rather than red
meat, and fish is better than chicken. Partly, no doubt, this is
because even orthodox medical authorities say that too much red
meat is undesirable, but Coward may be right [141-143] in
believing that red meat, because it contains blood, is thought of
as 'too strong'.
Coward also remarks on what she calls 'magical foods' such
as ginseng and royal jelly, to which I would add vitamins, which
are sometimes taken in such large doses ('megavitamins') that
they cease to be a mere supplement and become a food in their own
right.
Many people invest much time, energy, and money in their
diet, because they regard errors in this matter as a potent cause
of ill-health. 'You are what you eat,' the saying runs, and this
has been taken profoundly to heart by alternative medicine
enthusiasts. My objection is not that diet is unimportant, for I
am sure it does matter a great deal, but many alternative
therapists have no idea of the standards of evidence, the quality
of the research, that would be needed to establish the facts and
to sort out the real from the imaginary.
STRESS
This rivals incorrect diet as a putative cause of illness
and many of the same criticisms apply. It is almost invariably
held that we are more subject to stress than previous
generations, although the reasons for saying this are not spelled
out in any detail and the statement often seems to betray a lack
of historical awareness. There seem to have been plenty of causes
for 'stress' in earlier times. A hundred years or so ago, for
example, you could routinely expect to lose several of your
children in infancy, and giving birth to the children in the
first place was a risky undertaking for a woman. Throughout most
of history, if you had to undergo an operation it would be
without anaesthesia. These, one would think, were ample causes
for worry and stress, quite apart from noisy or otherwise
objectionable neighbours, poverty, bad housing, and all the
thousand and one causes of unhappiness that people have always
had to endure.
Stress is not always regarded as bad for you; a great deal
depends on how much there is, and of what kind, and on how you
respond. What one person would call stress, another might call
challenge.
The problem is that 'stress' is never clearly defined. Often
it seems to amount merely to any experience you don't wish to
have, which is so wide as to be almost meaningless. And why is
stress so bad for you, anyway?
The usual explanation is that repeated exposure to
challenging situations stimulates us to produce a primitive
'fight or flight' reaction. Our blood pressure rises, our heart
rate increases, the blood flow to our muscles increases while
that to our intestines decreases: in short, we are prepared for
action. But as a rule, in a modern urban society, no physical
action is needed. If we are cut up by another driver while in our
car, or if we are reprimanded by our boss at work, we can't
resort to physical violence, much though we might like to. The
result is that the aggression is internalized; our blood pressure
remains up for a long time, we may develop a gastric or duodenal
ulcer, and so on.
It is a persuasive theory, and may even be true. But it is
difficult to prove, and possibly is misleading. The medical
writer Richard Asher once played a trick on his readers to
illustrate this point. He quoted a description from a medical
text written in 1871, in which the eminent author explained how
the stress of modern life was causing people to suffer from
peptic ulcers. It all sounds rather convincing, and, reading it,
one is mildly amused, and rather impressed, to find that someone
was saying this kind of thing as early as that. If that's what
life was like in 1871, you think, how much worse must things be
today. Then Asher pulls the carpet from under our feet. He admits
to having practised a deception; the article he was quoting
wasn't really about duodenal ulcer at all, it was about general
paresis - syphilitic dementia, the true cause of which was
unknown when the article was written. So much for the stress
theory in this case.
(In fact, even the hitherto accepted wisdom that duodenal
ulcers are due to stress may have to be revised. Modern research
suggests that ulcers may be caused by infection with a bacterium
called Helicobacter pylori.)
Anyone who practises medicine is bound to see patients who
have been through appalling experiences, some of whom (though by
no means all) then suffer various physical and mental disorders
which it is very difficult to avoid linking with the stress that
they have undoubtedly suffered. At the other end of the scale,
people come with symptoms they attribute to stress, but the
experiences they relate seem to be nothing more than the ordinary
troubles inseparable from living. In these latter cases it is
questionable whether the concept of stress really has any useful
contribution to make.
Stress, like diet, is invoked too easily by many alternative
therapists as an explanation for patients' symptoms. It is
essential not to be simplistic about it; during the Second World
War, we are told, the incidence of anxiety neurosis and similar
relatively minor psychiatric disorders fell considerably,
presumably because people had more important things to worry
about than their own symptoms.
And yet it would be going too far to dismiss stress as a
cause for disease. Very many of the symptoms that patients
complain of are transparently related to painful psychological
experiences that they are undergoing: financial worry, family
problems, housing difficulties. Either these things cause the
symptoms directly or they make existing fairly trivial symptoms
appear intolerable.
Naturally there are wide individual variations in
susceptibility to stress and the kinds of effects it produces.
Perhaps as a result of behaviour patterns learnt in childhood,
some people seem to be incapable of recognizing mental suffering
for what it is and so they express their unhappiness in a
physical way, as stomach pain, chest pain, nausea and so on. This
is the phenomenon the Americans call somatization, and most
doctors groan inwardly when they recognise it in a patient. Other
people seem actively to seek and increase stress, almost as if it
were a drug; this is the so-called Type A personality, who is
supposed to be vulnerable to coronary heart disease. Such people
are described as ambitious, perfectionist, and governed by time,
unable to delegate, constantly driving themselves to try to
achieve more and finally cracking under the strain. Lately there
seems to have been less emphasis on this aspect of heart disease,
and the question whether there is a particular kind of individual
who is especially liable to it still is not decided.
There have been many claims that modifying people's
reactions to stress and teaching them to relax can reduce their
blood pressure and hence their liability to strokes and heart
attacks. Falls in blood pressure with meditation have indeed been
demonstrated fairly convincingly, but whether the hoped-for
reduction in disease will follow is still uncertain. Some studies
seem to show that there is such an effect, but the numbers of
patients involved have been small. A recent study reported in THE
BRITISH MEDICAL JOURNAL (10 April 1993), which used larger
numbers, puts this in doubt.
Patients with mildly raised blood pressure were recruited
for the study and were taught to take their own blood pressures
over a 12-week period. They were then randomly allocated either
to a stress management programme (passive relaxation, meditation,
and the use of relaxation in daily life) or to a programme of
simple stretching exercises that would not be expected to reduce
blood pressure. The effects of these two programmes were assessed
by subjecting the patients to a mildly stressful interview
designed to elicit Type A behaviour. Ninety-six patients were
studied; 48 were allocated to stress management and 48 to gentle
exercise.
Neither stress management nor gentle exercise had any
detectable effect on the patients' blood pressure. This is in
contrast to previous studies that have shown an effect, so why
the difference? The researchers think the answer is that they
allowed a long (12-week) "run-in" period for the patients to get
used to recording their own blood pressures. It is known that if
patients have their blood pressure measured repeatedly it often
tends to fall progressively towards normal, and these researchers
think that this effect was not allowed for sufficiently in
previous studies.
Notice that this research does not necessarily prove that
stress reduction has no effect in reducing the incidence of heart
attacks over a period of several years. At least one study
suggests that it does, but if so it probably works in other ways
than simply by reducing blood pressure. All of which goes to show
how difficult it is to get definitive answers to questions of
this kind.
Faulty habits of thinking and feeling
Attempts have been made to try to link personality patterns
with susceptibility to cancer. These apparently show that the
chances of surviving cancer are better for some kinds of people
than for others; patients who simply accept the diagnosis
fatalistically seem to do worse than those who 'fight' the
disease energetically, and also (which is perhaps more
surprising) worse than those who deny that they are ill at all.
The validity of these conclusions has been questioned, however,
and even if they are correct one could still interpret them
differently. It is possible that patients who simply accept the
diagnosis without resistance do so because they already know, at
some subconscious level, that they won't recover.
It is also been claimed that it is possible to detect which
kinds of people are most at risk of cancer many years before they
actually acquire the disease. Cancer patients are supposed to be
self-sacrificing individuals who for much of their lives have
done what other people wanted rather than what they themselves
wanted. They are therefore repressed and suppressed, full of
unacknowledged anger.
The studies I refer to have been made by orthodox
researchers, some of whom are eminent, so it is not surprising
that they have been welcomed by many alternative practitioners,
who have adopted them unquestioningly, even though they are by no
means full accepted as valid within orthodox medicine. Rather
similar pen portraits have been drawn of the kinds of people most
liable to suffer from other serious chronic diseases such as
rheumatoid arthritis and multiple sclerosis.
I must admit to finding this linking of personality with
disease one of the least attractive ideas in alternative
medicine. Firstly, it may not be true; the evidence is still
unclear, and if the history of medicine in general, and
psychiatry in particular, is anything to go by it is likely to
remain so for some time. Secondly, as Susan Sontag writes in
ILLNESS AS METAPHOR, although these portraits are presented
sympathetically the kind of personality depicted is not the one
most valued in the twentieth century. We may pity such people but
we regard them as social failures.
Miss Beal and Miss Buss
Cupid's darts do not feel.
How different from us,
Miss Buss and Miss Beal.
And, because they are different, we are enabled to feel
comfortably superior to them. We are not repressed and
frustrated, so we are not at risk of getting cancer.
It is bad enough to know you have got cancer (or cancer has
got you) without having to feel that it is happened because you
are psychologically and emotionally inadequate. Even if it is
true, but especially if it is not true.
Allergy in alternative medicine
Allergy: a difficult word, because it is used so widely and
loosely, sometimes even figuratively ('I am allergic to him').
In orthodox medicine, 'allergy' has a fairly precise
meaning. It refers to a particular type of antigen - antibody
reaction. The commonest form of this is hayfever, in which the
antigen is pollen; antibodies of a particular kind (IgE) are
present on the linings of the nose and elsewhere and react with
the pollen to give the familiar symptoms of sneezing, running
nose, and itching eyes. But although alternative medicine
certainly recognizes hayfever as allergic, when alternative
medicine practitioners speak of allergies it is usually food they
have in mind.
Orthodox medicine also recognizes the existence of food
allergies. Some people have an immediate reaction to food which
is usually easy to spot. Their lips swell, their mouth and tongue
tingle, and blister-like swellings develop inside the cheeks;
there may also be asthma and nettle rash. All these symptoms
develop within ten minutes of eating the offending food and are
certainly due to allergy. About 60 per cent of children with
eczema develop symptoms in their skin and elsewhere in response
to certain foods; many different foods are responsible in such
cases, but eggs, citrus fruit, wheat, and milk are among the
commonest offenders.
There are also reactions caused by food that are not due to
allergy but are produced in other ways. In a certain number of
patients with migraine the attacks are brought on by food,
especially chocolate, cheese, and red wine, though this is less
common than many people think. Some patients have enzyme
deficiencies that interfere with digestion and can cause
intolerance to certain foods; for example, 80 per cent of
Africans and Asians lack the enzyme needed to digest milk sugar.
If they drink milk they experience bloating and diarrhoea. Some
patients with the irritable bowel syndrome react adversely to
certain foods, but this is not a true allergy; the bloating and
discomfort experienced by such patients is probably due to the
action of bacteria in the intestine, which ferment the food and
produce gas and acid.
Skin tests for allergy, though fairly satisfactory for hay
fever, don't work well for food allergy, and there are no really
satisfactory laboratory tests either. The RAST
(radioallergoabsorbent test) is only moderately helpful, and
optimistic attempts to detect food allergies by mixing samples of
the patient's blood with various foods (cytotoxic testing), by
hair analysis, or 'iridology' are hopeless. There is no
satisfactory method of confirming the diagnosis except to get the
patient to take a strictly controlled diet (elemental diet) for
two to four weeks and see whether the symptoms improve, but this
is not something to do lightly; it is easy to mistake a
psychological improvement due to suggestion for an improvement
due to the diet, and diets of this degree of severity are not
safe to maintain for any length of time and are not safe at all
for children.
It is of course the suggestion factor that bedevils the
whole question of food allergy. Thanks to an enormous amount of
publicity, many people, including many alternative practitioners,
are firmly convinced that their miseries are caused by food,
especially the dreaded 'E numbers'. Some unfortunates have
dedicated their lives to this idea and have become victims of the
so-called 'total allergy syndrome'. They are said to be 'allergic
to the twentieth century'. Some have lost their families, their
jobs, and their money in consequence and a few have committed
suicide. Such extremes are luckily rare, but many patients are
victims of this delusion in a less catastrophic form. We are told
on dubious evidence that food sensitivity is a common cause of
headache, insomnia, tinnitus, palpitations, breathlessness, ankle
swelling, abdominal bloating, and fatigue; in children it is
supposed to cause hyperactivity, bed-wetting, and poor school
performance.
The delusive nature of much of the food allergy idea has
emerged clearly from several recent studies. In a recent survey
in Buckinghamshire, in which over 18,000 people took part, over
4,000 claimed to have adverse reactions of kind or another to
foods, food additives, or aspirin. Reactions to food additives
were reported by 7.4 per cent of the responders, but when they
were tested objectively only three people were found to be
affected.
Another investigation was carried out in Manchester a few
years ago. Twenty-two patients attending an allergy clinic for
suspected food intolerance were assessed by a psychiatrist, after
which they were tested for food intolerance with exclusion diets
and by being given the suspected foods 'double-blind'; that is,
with neither the patient nor the tester knowing whether they were
receiving the food or a placebo.
Only four of the patients had definite evidence of food
intolerance and all four were psychologically normal. Of the 18
in whom food intolerance was not confirmed, only one was found to
be normal psychiatrically; ten of the remainder were depressed,
and the others were thought to suffer from other kinds of
psychiatric disorder. The group in whom food allergy was not
confirmed was then compared with another group of patients who
did not complain of food allergy but who had been referred to a
general psychiatric clinic. The two groups turned out to be
exactly the same in respect of their symptoms and psychiatric
abnormalities.
However, there was one significant way in which they
differed: social class. The psychiatrically abnormal group whose
members believed that they were allergic to food was composed
predominantly of professional people.
In the United States, and to some extent in Britain and
other countries too, interest in the question of food allergies
has led to the development of a form of treatment often called
clinical ecology. Extracts of what are thought to be the
offending foods are injected into or under the skin; if the
patient is indeed sensitive to the food, the relevant symptom
(wheezing, headache, or tinnitus, for example) occurs within a
few minutes. The clinical ecologist can then stop the reaction by
giving a different, 'neutralizing', dose of the same substance.
Clinical ecology is practised both by doctors and by
therapists who are not medically qualified. It has attracted a
great deal of criticism from within mainstream medicine, but
until recently there was little objective evidence available to
help one to make up one's mind. A short while ago, however, a
study was carried out at the University of California which sheds
a lot of light on the subject.
Several experienced clinical ecologists took part. They
selected a total of 18 patients who they believed were
undoubtedly sensitive to foods, on the basis of repeated
injections with a variety of food extracts. The patients had
known what they were receiving on these occasions; none of them
had reacted when given control injections of what they knew to be
just the diluent, without the food extract.
In the study they were retested with the same substances in
the same office, with the same technician giving the injections
as before; the only difference was that now they did not know
when they were receiving the active injection and when they were
receiving the control. The technician and the observer who was
assessing the result were also ignorant of what was being
injected on each occasion.
The results were clear-cut. Various symptoms were indeed
produced by the injections, but the patients correctly identified
only 16 out of 60 active injections (27 per cent) as having
provoked symptoms. They also thought that 44 out of 180 control
injections (24 per cent) were active. There was no difference in
the symptoms produced by active and control injections.
Seven patients who had produced symptoms were given
neutralizing injections. In most of these cases, as it later
turned out, the initial injection which had produced the symptoms
had been a control one; but the neutralizing injections relieved
these symptoms just as effectively as they did the 'real'
symptoms provoked by active injections.
The conclusion of this study seems to be inescapable:
although (or because) these clinical ecologists genuinely
believed in the technique they were using, on the basis of their
experience, the effects they were seeing were due to suggestion
and not to the substances they were injecting.
The moral of this, as pointed out by Dr Anne Ferguson in a
leading article on the subject in the same issue of the New
England Journal of Medicine [1990,323:429-33; 476-478] is that
'Self-deception affects doctors as well as patients, and through
kindness and enthusiasm many of us may be doing a great
disservice to ill persons anxiously seeking a non-psychiatric
diagnosis. If we apply the wrong label with conviction, and then
treat the symptoms with suggestion and placebo, relief is likely
to be transient, and psychopathology will probably emerge.'
As a footnote to this story, it is worth mentioning a recent
study of another alternative diagnostic technique, Iridology
(Chapter 2, p.00). It depends on the theory that diseases can be
diagnosed from the appearance of the iris (the coloured part of
the eye), which is divided into segments like a clock face; if a
segment is flecked or coloured unusually it is supposed to point
to a disorder of a particular organ.
Iridology is used not only by clinical ecologists but also
by osteopaths, acupuncturists, herbalists, homoeopaths and
others. Often they inspect the iris simply with the help of a
torch and a magnifying glass, but professional iridologists have
special equipment with which to photograph the iris and make
slides which can be projected on a screen.
The method has obvious attractions. It appears to be
scientific; after all, orthodox doctors pay a great deal of
attention to the appearance of the back of the eye (the fundus),
so why not the iris? It is also safe and painless, and its
practitioners claim that it can provide information that is not
otherwise available, not only about past health but even about
what is to come. 'The beauty of the iris diagnosis is that it
reveals tendencies that may not yet have begun to express
themselves as actual symptoms. This makes it possible to plan our
lifestyle, including appropriate treatment, according to our
natural strengths and weaknesses, likes and dislikes.' [quoted by
Inglis and West, 279].
Unfortunately, however, it seems that it does not work. In a
careful study [BMJ (1988) 297, 1578 - 81], a Dutch researcher,
Paul Knipschild, tested the ability of experienced iridologists
to diagnose the presence or absence of chronic cholecystitis. All
the iridologists agreed that his study design was fair, and they
were confident of their ability to make the diagnosis.
However, the outcome was no better than chance. In spite of
analysing the results with a variety of sophisticated statistical
methods in an attempt to detect some pattern that was not
immediately obvious, Knispschild was forced to conclude that the
iridologists had completely failed the test. When shown these
results they were puzzled and couldn't explain them.
In an interesting sequel to this study Knipschild went on to
investigate the effects that research of this kind has on
doctors' belief systems. Three weeks before his paper on
iridology appeared in the British Medical Journal he sent a
questionnaire to 200 doctors, including some who had written
articles in journals of alternative medicine, asking them whether
they believed in iridology as a useful diagnostic aid for certain
diseases. Later, he sent them copies of his paper and asked them
to say whether their opinion had changed.
Knipschild obtained replies from 78 doctors. Fifteen who did
not believe in iridology before reading the report continued not
to believe in it afterwards. Most were initially uncertain, and
two-thirds of these became disbelievers as a result of the
report. However, four who were strong believers initially
continued to believe in it afterwards. [BMJ, 299, 491-2. 1989].
It would be interesting to know what effects reading this report
would have on non-medical practitioners' attitudes.
THE CANDIDA THEORY AND ME
This is an example of how ideas gleaned from orthodox
medicine can be combined with long-standing alternative beliefs
to produce a theory of disease that can be applied to almost any
set of symptoms.
Candida albicans is a fungus that gives rise to thrush, a
superficial infection of moist surfaces such as the vagina and,
in babies, the mouth. It is in fact often present in the vagina
without causing symptoms, but sometimes, for unknown reasons, it
gives rise to discharge and itching; some women seem to be
particularly susceptible to it. It is also found in the lower
part of the bowel, where again it usually causes no problems.
As a rule it is a nuisance rather than a threat to life, but
in people whose immune system is damaged, perhaps by drugs given
to suppress tumours, candida may spread inside the body,
affecting many internal organs and leading eventually to death.
This much is well recognized in orthodox medicine. In
alternative medicine, however, there has grown up a wide-spread
belief that there is another set of symptoms due to candida
overgrowth in the intestines. These include almost anything you
like to name: fatigue, headache, listlessness, spots before the
eyes, abdominal bloating, looseness of the bowels... the list
goes on and on. It is, in fact rather reminiscent of Hahnemann's
list of symptoms due to the psora 'miasm' (see p.000), and there
is another indirect link with Hahnemann's ideas as well.
Hahnemann believed that orthodox treatment was responsible
for many of the ills suffered by his patients. This idea comes
into the candida story too, for the reason for the overgrowth of
candida is supposed to be the use of antibiotics. A recognized
unwanted effect of some antibiotics (the so-called broad-spectrum
group) is that they tend to alter the proportions of the bacteria
that normally live in the lower part of the intestines, and in
rare cases this can have serious or even fatal consequences. The
candida theory builds on this fact; if you have had a course of
antibiotics in the past, especially a long one or a repeated
series of courses, this is said to make you vulnerable to
candida.
The trouble with the candida theory, as with most theories
of this kind, is that it is very hard to assess objectively.
Candida certainly does exist in the gut, but it is difficult to
say at what point it becomes abnormal in quantity. It is still
more difficult to explain how candida could give rise to the
remarkable range of symptoms that it is blamed for. But this
comprehensiveness is of course just what recommends it to many
patients and alternative therapists.
The Candida theory has, not surprisingly, been proposed as a
main cause for what has come to be the very model of an
'alternative disease', myalgic encephalomyelitis (ME). The
Myalgic Encephalomyelitis Association estimates that there are
currently 150,000 sufferers in Britain.
The first description of what may or may not have been the
same disorder was given in the 1950s, following an outbreak of a
mysterious disease at the Royal Free Hospital in London; it was
therefore called Royal Free Disease. The term Postviral Fatigue
Syndrome has also been applied to more or less the same clinical
picture. This confusion about what to call the condition reflects
the considerable uncertainty that exists about ME.
None of the names that have been suggested is satisfactory.
"Myalgic encephalomyelitis" means inflammation of the brain and
spinal cord accompanied by aching muscles, but neither of these
is necessarily present in ME. "Postviral Fatigue Syndrome" is
likewise unsatisfactory, since the condition is not necessarily
preceded by an identifiable viral infection. 'Chronic Fatigue
Syndrome' would be a suitably non-committal expression, conveying
our ignorance of its cause, or causes, but ME seems to be the
name that has established itself. (It is also been called 'yuppie
flu', probably reflecting a tendency for it to afflict people in
the professional classes; a feature that recalls food allergy.)
A typical way for ME to begin is with a sore throat, running
nose, and enlarged nodes ("glands") in the neck. This is of
course what most people would describe as "flu". In addition,
there may be diarrhoea and vomiting, or sometimes giddiness and a
fast pulse rate. Some patients at this stage suffer from
headaches, blurring of vision, and double vision. However, the
worst complaint is usually severe muscular weakness, together
with a feeling of intense physical and mental misery.
As time passes the physical and mental debility persist,
though they may vary in intensity from day to day or even within
the same day. Some patients are so badly affected that they have
to stay in bed all the time, and if they do get up they may find
that the smallest household task is too much for them; going to
work is out of the question. The muscles may be tender to the
touch.
Memory is often affected. The ability to concentrate is
impaired or lost, and patients may be more emotional than normal,
being liable to outbursts of tears or anger at things that would
normally seem trivial. Sleep patterns may be disrupted.
Other symptoms include cold hands and feet, extreme
sensitivity to changes in temperature and weather, bouts of
sweating, and palpitations. The patient may have to pass urine
more frequently than normal.
As the months go by, these symptoms may diminish in
intensity although without going away completely; the patient can
go back to work, but finds that he is exhausted at the end of the
day and has no energy for anything else. This may persist for
months or even years. A few more severely affected patients do
not recover even to this limited extent, and have to spend most
of their time in bed.
There is no agreement about what causes ME. At one extreme
some doctors regard it as a wholly psychological disorder, while
others are convinced that it is due to a preceding viral
infection. It is also been thought to be due to hyperventilation.
This is an interesting disorder, thought to be fairly widespread,
in which people tend to breathe just a little too deeply for long
periods. As a result the chemical balance of the blood is
altered, with a shift towards the alkaline pole, and numerous
symptoms such as tingling, palpitations, and anxiety can result.
Hyperventilation is almost certainly part of the picture in a
number of cases of ME but the two disorders are probably not
identical.
ME is probably not a new disease. It is very similar to
'neurasthenia,' which was first described in 1867 by an American
neurologist, George Beard. The symptoms he gives are almost
identical with those of ME; he attributed it to an organic cause
(depletion of the stored nutriment of nerve cells). It chiefly
affected the middle classes, like ME, and the treatment he
advocated (complete rest) was again similar to that now advised
for ME.
Chronic fatigue without a diagnosis of ME is extremely
common. In the USA a survey in 1988 found that chronic fatigue
was a major problem for 24 per cent of all adults attending
primary care centres, and in this country the findings are
similar; a community survey in 1987 showed that 25 per cent of
women and 20 per cent of men 'always feel tired'.
There is no way of diagnosing ME by means of laboratory
tests. The commonly used tests give normal results as a rule,
although thyroid function may be at the lower end of the normal
scale and certain enzymes in the blood may be a little raised. A
test for infection with a particular group of viruses
(enteroviruses) has recently been developed at St Mary's
Hospital, Paddington, and gives positive results in a number of
patients with ME. Many patients think that this a specific test
for ME, but in fact all it shows is whether or not a patient has
at some time been infected with the virus in question; it cannot
show that this virus is the cause of the present symptoms. For
the moment, therefore, ME is a purely clinical diagnosis. Tests
may be used to eliminate other possible causes of the patient's
symptoms, but once this has been done ME can be said to be the
diagnosis if the symptoms correspond with the description of the
condition.
Patients often ask: 'Is it ME, doctor?' The answer is that
if you have the symptoms, you have ME by definition, because ME
is, at present, simply a collection of symptoms. What underlies
the question, however, is a request for reassurance that it is
not 'all in the mind'; patients who believe that they have ME
usually resist any suggestion that they might be depressed. But
in fact there are many resemblances between ME and depression.
Depressed patients typically do complain of severe tiredness
after even minimal effort. (Manic patients, in contrast, have
boundless energy.) In fact, loss of energy is a common way for
depression to appear, and depression often comes on suddenly,
just as ME does. Both depression and ME are twice as common in
women as men, and rare in children. When patients suffering from
chronic fatigue are assessed psychiatrically in standard ways,
between 50 and 80 per cent fulfil the criteria for diagnosis of a
psychiatric disorder.
Mental as well as physical fatigue is common in ME, but in
neuromuscular disorders such as myasthenia gravis there is little
mental fatigue.
Patients' resistance to the idea that their ME symptoms may
be due to depression is understandable, but if we accept the view
that depression itself is an organic disorder, due to some
impairment of brain function, much of the ground for argument
disappears. A diagnosis of depression says nothing about the
cause of the depression; it may come on after a viral infection,
and conversely depressed people may be more liable to viral
infections through an effect on their immune systems. But a
diagnosis of depression carries a certain undesirable connotation
for many people, hence their reluctance to accept it.
At present treatment of ME is inevitably unsatisfactory, in
view of the uncertainty about what causes it or even whether it
exists. This frustrates many doctors and can breed resentment in
the patients, who feel that no one has adequately recognized the
serious nature of their condition.
Almost every form of alternative medicine has been tried for
ME. Candida overgrowth, as I have said, is a popular theory about
its cause, and therapists who believe in this, and who are also
doctors, may give patients courses of antifungal drugs. Non-
medical practitioners often try a dietary approach to reduce
candida. Undue sensitivity to carbohydrates (reactive
hypoglycaemia) and allergies to foods are also popular as
explanations. Some patients do seem to improve if refined
carbohydrates are eliminated from their diet, and others can be
helped by elimination diets to try to find the offending item or
items, but both of these measures, especially elimination diets,
are difficult to put into practice and should never be undertaken
lightly or without skilled supervision. As always, the role of
suggestion is hard to exclude.
Homoeopathy helps some patients, and so does acupuncture,
but neither of these can offer a sure cure.
It seems likely that ME is not just one thing. There are
some patients in whom it is the result of a persisting viral
infection, but these are a probably a minority. In most cases
psychological factors appear to be playing a large part, but it
could certainly be objected that these are the result of the
disease rather than its cause, and this is usually hard to
disprove. Perhaps in the end it is a meaningless question.
As a rule the best plan of treatment is to encourage
patients to find out how much activity they can sustain without
making themselves worse. "Overdoing things" can easily bring on a
relapse and is to be avoided, but on the other hand complete
inactivity is also undesirable, partly because it is likely to
increase the patient's depression and partly because the muscles,
if not used, will deteriorate further and become still weaker,
and this weakness due to disuse will then be superimposed on that
due to the illness. A gradual increase in activity as the
condition begins to improve is the thing to aim at.
What happens instead in too many cases is that the
unfortunate patient goes from therapist to therapist, seeking a
cure and never finding it, trying endless methods, swallowing
innumerable medicines, vitamins and minerals; some people take
thirty or more medications daily. To persuade such patients to
give up the quest is nearly hopeless.
Orthodox medicine (allopathy)
Running through much of alternative medicine like the wire
thread in a banknote is the notion that orthodox medicine is bad
for you. Like many of these ideas, this one goes back to
Hahnemann, who believed in it strongly. Indeed, it was so
entrenched in homoeopathy in the early days that when The London
Homoeopathic Hospital was founded in the nineteenth century the
rule was laid down that no 'allopathic' medicine was to be kept
in the pharmacy, and even the use of homoeopathic medicines in an
undiluted form was discouraged. (However, it appears that on
Hahnemann's death a bottle of Bryonia tincture [the undiluted
plant extract] was found in his medicine set.)
Certain kinds of orthodox drugs are held to be particularly
harmful; these include corticosteroids and antibiotics. There is
of course a good deal of support for this idea in orthodox
medicine itself. Every drug has potential undesirable effects and
some have a great deal of them. Every prescription is a balancing
act; the doctor has to weigh up the possible benefits of his
medicine against the possible dangers. But alternative
practitioners seldom base their criticisms on detailed lists of
the unwanted effects of drugs, and their objection is as much
emotional as rational.
It sometimes happens that patients are advised by their
alternative practitioner to stop their orthodox treatment; they
may be told that they cannot have alternative treatment until
they have done this. The results of this can be unpleasant or
even catastrophic. If the orthodox medication is doing no good,
as may be the case, no harm will result, of course, but it may be
affording a lot of symptomatic relief, for example by dulling
pain or suppressing a rash, and stopping it will then make the
patient much worse. In some cases stopping a medicine could have
serious or even fatal consequences.
The evidence that orthodox medicines really do interfere
with the action of homoeopathic medicines or acupuncture is
flimsy, being based mainly on prejudice or hearsay. On principle
it is always a good thing to reduce medication if this can be
done safely, since many patients, especially the elderly, are
over-medicated; but the important word is 'safely'.
Belief in the adverse effects of allopathic drugs,
especially antibiotics, has given rise to the idea, held by some
alternative practitioners, that the cause of Aids is not the HIV
virus, which is supposed to be merely a harmless 'passenger'. The
alternative theory has it that Aids is really a form of
'suppressed syphilis' (a miasm, in fact), which has taken on this
aggressive form because people's immune systems have been
weakened by antibiotics. The appeal of this theory seems to be
mainly that it provides yet another reason to condemn the use of
antibiotics.
THE MIASM THEORY.
This discussion of the causes of disease according to
alternative medicine would not be complete without mention of the
miasm theory proposed by Hahnemann, which is still taken
seriously by some homoeopaths, especially in South America.
Although its main relevance is to homoeopathy, somewhat similar
ideas crop up from time to time in other contexts too.
In outline, Hahnemann postulated that the vast majority of
chronic disease is due one of three pollutions or 'miasms'. These
are supposed to operate very much like infections; two are
venereal (syphilis and sycosis), while the third, called psora,
which is much the most important, is non-venereal and extremely
widespread; so widespread, indeed, that the only person not to
have been infected appears to have been Hahnemann himself.
Psora enters via the skin, where it gives rise to an itchy
rash, which may however be localized and transient and so not be
noticed. Nevertheless it becomes generalized throughout the body
immediately, and lies in wait, possibly for many years, until at
some later stage it bursts forth in a terrifying explosion of
manifestations of chronic disease.
In his book on chronic disease Hahnemann devotes over thirty
pages to the chronic results of infection with this Hydra-headed
monster. He names almost every ill known to man, so that it is
almost impossible to think of any disease or symptom (he does not
distinguish clearly between these) that would not be due to
psora. As a result, the psora theory becomes so universally
explanatory as to be practically useless; by explaining
everything it explains nothing.
This has not prevented numbers of later homoeopaths from
trying to adapt the theory to fit subsequent discoveries. Psora
has been equated at various times with, among other things,
chronic infection, autoimmune disease, viral disease, and
hereditary disease. The most dramatic development was in
nineteenth century America, where psora acquired a strongly
moralistic flavour and was regarded as a moral as well as a
physical contagion.
Moreover, it was now held to be passed on from generation to
generation. In the words of James Tyler Kent, one of the best
known American homoeopaths of the late 19th century: 'The human
race walking the face of the earth is little better than a moral
leper. Such is the state of the human mind at the present day. To
put it another way, everyone is psoric... A new contagion comes
with every child.' As critics remarked, psora took on many of the
characteristics of Original Sin.
This perhaps rather unlikely development was due to the
influence of the ideas of the Swedish philosopher and mystic
Emanuel Swedenborg, which profoundly affected the course of
homoeopathy in America and, later, in England as well. (Many of
the more extreme features of modern homoeopathy are due to
Swedenborgianism, a fact that has not always been given the
attention it deserves. See Appendix I.)
We seldom read quite such blatant equations of disease with
morality today, but the implication that healthy living is
virtuous living often lies just below the surface. The expression
'I try to eat the right things' is heard very frequently, and
there is usually the unspoken implication that the patient has
earned merit by this.
6: IS IT SAFE AND DOES IT WORK?-
Why have doctors usually been so resistant to these
'unorthodox' forms of treatment? There does not seem to have been
any one reason for their hostility, and it probably varied from
therapy to therapy. It certainly was not on the grounds of
safety, for in many cases the unorthodox treatment was a lot
safer than the orthodox treatment of the day. Homoeopathy, for
example, was at least harmless, if nothing else, whereas the
orthodox doctors in the early nineteenth century were happily
giving their patients enormous doses of highly toxic substances
such as mercurous chloride and extracting large quantities of
their blood, sometimes to the point of literally bleeding them to
death. (To be fair, we must also remember that the patients
demanded this treatment and felt aggrieved if they did not get
it.)
It seems likely that some of the hostility felt by the
orthodox was simply the customary human dislike of anything
unfamiliar, coupled with financial interest; the new homoeopathic
treatment tended to attract patients. But naturally the orthodox
tried to rationalize their objections in various ways.
In our own time the usual reason given for rejecting
alternative treatment is that it has not been tested
scientifically. 'Carry out proper clinical trials,' orthodox
doctors say, 'and we'll listen to you; until then, don't waste
our time.'
The background to this is the change that came over orthodox
medicine just after the Second World War. Up to then medicine had
been largely 'anecdotal' (a term applied today in a derogatory
sense); doctors published accounts of their experiences but did
not make a serious attempt to validate them objectively. Now it
has become increasingly recognized that it is very easy to fool
oneself. There is a natural human tendency to remember one's
successes and forget one's failures, so that in retrospect one's
results are surrounded by a comforting rosy glow.
A closely allied source of error arises from the almost
universal belief that if someone recovers after receiving a
particular treatment it must be because of that treatment. The
history of medicine affords many curious instances of this. For
example, in the FOUR BOOKS OF THAT LEARNED AND RENOWNED DOCTOR
LAZARUS RIVERIUS, published in 1678, we read of the remarkable
cures effected by 'Powder of Woolfs Guts': one case concerned a
woman suffering from abdominal pain, and another was a woman with
a 'Hysterical Epilepsie'. A cancer of the upper lip was cured by
Oyntment of Green Frogs. To make this, 'Take Green Frogs that
live among trees, or in pure waters, and put them in an Earthen
Pot full of small holes in the bottom, and fill their mouths with
butter, cover the Pot close, and daub the juncture with clay, and
set over it another empty pot which must be set in the ground up
to the brim; then make a fire around fit for distillation, and
gather the Oyl that drops into the pot in the ground, and mix the
powder of frogs into a Liniment.' [The Lancet, (1990) Burton,
J.L., 'Herbal remedies - an alternative.' 336, 1565 - 66]
'Oyl of scorpions' was regarded by Dr Riverius as an
'ordinary remedy'; applied externally, it could be useful in
treating cough and fever. This recalls rat oil, still apparently
much in demand in the monasteries of Mount Athos, where it is
used as an external application in all kinds of disorders. To
make it, you catch a baby rat, immerse it in a bottle of olive
oil, and expose it to the sun. Gradually it dissolves in the oil,
which can then be used medicinally: rubbed on the head for
headache, instilled in the ear for earache and so forth. [De
Loverdo, C. (1956), J'ai ete moine au Mont Athos. La Colombe,
Paris.]
All these remedies have been found to 'work'. Nevertheless,
the unprejudiced observer is left with the feeling that there is
something rather improbable about them, and it was in an
endeavour to weed out the modern equivalents of Oyntment of Green
Frogs that doctors began, after the Second World War, to carry
out 'clinical trials'. The practical details of these vary, but
the general principle is quite simple. It is to make a
comparison. One can, for example, compare two different
treatments with each other, or one can compare the effect of
giving a particular treatment with that of not giving it.
Two things to notice about this idea. Firstly, clinical
trials nearly always compare groups of patients, and the results
are analysed statistically by means of mathematical techniques
that are often complex. They therefore don't tell you much about
the reactions of individual patients, a failing that bothers many
advocates of alternative medicine.
Secondly, clinical trials usually include the use of a
'placebo control', which in the case of a medicine is a tablet or
capsule that is supposed to be indistinguishable from the
'active' substance. This is to try to eliminate the effects of
suggestion. If the doctor knows what the different patient groups
are taking but the patients don't the trial is said to be 'single
blind', but whenever possible the doctor is kept in ignorance as
well, in which case the trial is 'double blind'.
Alternative practitioners, especially those who were not
medically qualified, were at first not very interested in the
idea of carrying out clinical trials. Moreover, they tended to
object to the methods used in these trials, saying that treating
patients as groups, with standardized treatments, was contrary to
the spirit of alternative medicine, which regarded everyone as an
individual. And even those practitioners who were willing to
participate in trials generally lacked the necessary resources
and expertise.
Some clinical trials were carried out by doctors practising
alternative medicine, however, mainly in homoeopathy. Probably
the earliest of these was the mustard gas experiments during the
war, in which homoeopathy was shown to be effective in preventing
the effects of skin burns with the gas. Placebo controls were
used in this study. There was then a long gap until the late
1970s, when a group of homoeopathic doctors in Glasgow carried
out trials of homoeopathy in the treatment of rheumatoid
arthritis. Since then further studies of the homoeopathic
treatment of other disorders, notably hay fever, have appeared,
and some of these have been published in well-known medical
journals such as The Lancet. There have also been trials of
homoeopathic medicines in veterinary practice.
In France, as well as in other countries on the continent of
Europe, there have been many elaborate scientific laboratory
studies of homoeopathic medicines. It is therefore no longer
correct to say that there is no scientific evidence for the
efficacy of any alternative medicine; for some kinds, at least,
there is quite a lot. (I will return to this question later.)
Another development in the 1980s was the setting up of the
Research Council for Complementary Medicine. This is a group
consisting of both doctors and non-medical practitioners; its
main task is to foster research in all kinds of alternative
therapy. It gives advice to would-be researchers, helps them to
design their projects, and tries to obtain funding for these
schemes from Government and other sources.
This all sounds very optimistic. But difficulties still
exist, and most of these stem from a deep division in attitude
which often separates doctors, including those sympathetic to
alternative medicine, from non-medical practitioners. Ardent
supporters of alternative medicine often do not acknowledge the
need to offer objective evidence for their claims even today.
Inglis and West provide an illustration of this, for in their
book THE ALTERNATIVE HEALTH GUIDE neither 'placebo' nor
'suggestion' are mentioned in the index.
Reservations of orthodox doctors.
An anxiety often voiced by orthodox doctors is that those
alternative practitioners who lack an orthodox medical training
may fail to realize when their patients are seriously ill and
need ordinary medical attention. Alternative practitioners say
that this worry is exaggerated, although many of them would like
to have some training in diagnosis if it were available. They
also suspect that doctors are tempted to use the danger of missed
diagnosis as a weapon against the alternative competition.
There is no doubt that diagnoses are missed by alternative
practitioners. They are also missed by orthodox doctors, of
course, but at least one can say that they should not be.
Alternative practitioners, on the other hand, are not expected to
make pathological diagnoses. The important, but at present
unanswerable, question is how frequently these disasters occur.
I doubt in fact whether missed diagnoses by alternative
practitioners are all that common, though there are no
statistics. Still, the possibility is alarming, and instances of
it certainly do occur. It is particularly worrying in the case of
acupuncture, because this sometimes relieves pain effectively
even though there is a serious cause for it. In a study reported
a few years ago from the National Hospital for Nervous Diseases
it was found that acupuncture was capable of temporarily
relieving headache due to brain tumours. It certainly is possible
to imagine that this kind of treatment might lull both patient
and therapist into a false sense of security, and the risk
probably is not confined to brain tumours; disease in other parts
of the body might be similarly masked.
It is sometimes said that non-medical practitioners should
receive at least a brief training in diagnosis, so that they
could detect problems that needed referral to a doctor. It sounds
like a good idea, but given that an orthodox doctor has six
years' training and even after that is not regarded as safe to
practise unsupervised until he has had a further period of post-
graduate supervision, it seems unlikely that much could be
achieved for non-medical trainees in a few weeks or even months.
A much worse problem that I have occasionally encountered
is, in a way, the reverse of this. There are a few alternative
practitioners who use various unorthodox diagnostic methods, on
the basis of which they claim to detect that the people who
consult them are at risk of developing serious diseases such as
cancer, multiple sclerosis, or even Huntington's chorea, one of
the most unpleasant disorders it is possible to suffer from.
There is no reason whatever to believe that these prognoses means
anything at all, but it can place any unfortunate recipient in
the most horrible dilemma. Some of the people who have been given
such a diagnosis (the son of a personal friend, in one instance)
have not believed my reassurance and have continued to worry,
eventually embarking on a long and costly regimen of treatment to
prevent the onset of a non-existent disease.
Out-and-out charlatanry of this kind is fortunately rare.
But even when practised in good faith, some treatments, such as
acupuncture, are potentially dangerous. They may nevertheless be
used by people who have no anatomical knowledge or training
whatever. There certainly is a good case to be made out for
requiring anyone who practises these techniques to have undergone
at least a minimum period of instruction, but a proposal of this
kind raises the whole question of accreditation and this will not
be easy to resolve.
Leaving aside the thorny question of safety, I pass on to
look at some of the evidence regarding efficacy.
THE QUESTION OF EFFICACY.
You may remember the epithets used by the authors of 1066
AND ALL THAT to describe the two sides in the Civil War. The
Republicans were Right but Repulsive, the Royalists were Wrong
but Wromantic. Not so long ago a sympathetic but uncommitted
observer of the medical scene might have been tempted to
categorize orthodox and alternative treatments in more or less
these terms. On the one hand there was mainstream medicine, with
its surgery and its drugs, able to cure or relieve many disorders
but doing so in an impersonal, soulless, mechanistic way, and on
the other hand there was alternative medicine of various kinds,
caring for individuals but able to offer nothing more than
placebo therapy.
Today the difference between the two is no longer so clear-
cut, because for some forms of alternative treatment, at least,
there is a certain amount of scientific evidence to show that
they work. In the case of the alternative physical therapies
(osteopathy, chiropractic, acupuncture), for example, a fair
amount of research has been carried out. Admittedly the quality
of some of this work is rather variable. Two recent reviews of
acupuncture, one of which listed 32 papers and the other 40,
found serious shortcomings in most of them. Making allowances for
this, however, it appears that there is good evidence that
acupuncture can relieve quite a number of kinds of pain, at least
temporarily, although treatment may need to be repeated at
intervals.
At one time there was a great deal of interest among
acupuncturists in the naturally occurring substances known as
opioids. These are found in many tissues, but particularly in the
brain, where some of them are apparently involved in the
mechanism that underlies pain perception. At first it was thought
that the discovery of these substances explained the relief of
pain by acupuncture, but this now looks unlikely. There are
probably two separate processes at work here.
When an acupuncture needle is inserted there is a short (90
minute) diminution in sensitivity to pain; this effect is
produced by the release of substances within the nervous system.
The use of acupuncture as an alternative to anaesthesia in
surgery depends on this, although acupuncture is now little used
for surgery even in China.
The other effect is a local reduction in pain, lasting for
several days or even longer, in an area of the body which was
previously painful. This is the effect which comes into play when
acupuncture is used as a treatment for disease, but unfortunately
very little is known about how it occurs. Partly this ignorance
exists because we also know very little about the mechanisms of
pain itself in many chronic disorders.
It seems quite likely that acupuncture and manipulation work
in rather similar ways. Certainly a good many of the disorders
that respond to acupuncture will also respond to manipulation and
vice versa.
One way in which acupuncture and other physical treatments
differ from medical treatments like homoeopathy is that they are
less amenable to placebo-controlled trials of the kind that
orthodox doctors expect. It is certainly possible to needle
patients in the 'wrong' places and to compare the effects of this
with needling them in the 'right' places, but for several reasons
this is not a satisfactory comparison, especially when it is non-
traditional acupuncture that is under consideration. (The
acupuncturist inevitably knows whether or not he is needling the
'correct' point and so may unconsciously influence the outcome,
the sensations excited at the two sites may well be different,
the depth of needle insertion at the 'real' and 'placebo' points
is often different, and so on. Moreover, it seems fairly certain
that there is some response to inserting a needle no matter where
it is done, so the question is whether one can improve on this
'baseline' effect by specific means.)
Practitioners of both herbal medicine and homoeopathy are
under pressure to justify their treatments through clinical
research, and both have encountered difficulties in carrying it
out. There is, however, one outstanding difference between the
two methods: herbalism is not faced with the difficulty of
proving that very highly diluted substances can have a measurable
pharmacological effect. If anything, in fact, it suffers from the
opposite problem: because it uses extracts of the whole plant,
often containing a large number of substances some of which may
not yet even be chemically identified, there can be a question
about the safety of some of the medicines as well as about their
efficacy.
As Simon Mills, himself a herbalist and Co-director of the
Centre for Complementary Health Studies at the University of
Exeter, has pointed out, although herbal medicines have been used
as far back as historical records go and no doubt long before
that, interest on the part of herbalists in research is quite
recent, partly because there has hitherto been little
organization to encourage this kind of work. Mills himself is
emphatic that research is needed: 'if what you say is so valuable
and powerful then it should be able to stand up for itself in any
forum.' [Complementary Medical Research, 1991, 5, 29 - 35] As he
also acknowledges, however, research in herbalism faces special
problems: one, which I have already mentioned, is the complexity
of the substances used, and another is the belief that herbs are
usually supposed to act on the body differently from orthodox
medicines.
Like homoeopaths, herbalists set much store by contact with
the patient; they see their work as 'healing', not just
prescribing a medicine. In spite of all this, Mills insists,
research in herbal medicine is possible, even by conventional
double-blind comparisons in some cases, but in general he favours
the use of different trial designs to take account of the special
characteristics of herbal prescribing. Laboratory research, and
even animal research if conducted without causing harm or
suffering to the animals, also have a place, he believes.
A most comprehensive review of clinical trials in
homoeopathy was carried out recently by three researchers at the
University of Limburg, in Holland; one of the three was Paul
Knipschild, the professor of epidemiology, whose work on
iridology I have referred to elsewhere. [Kleijnen, J.,
Knipschild, P., ter Riet, G. (1991). British Medical Journal,
302, 316 - 23]
This review looked at 107 controlled trials in 96 reports
published throughout the world. Most of the trials were found to
be poor in quality, but there were many exceptions. As a whole,
of 105 trials in which it was possible to make some kind of
assessment of the results, 81 had a positive outcome and 24 a
negative one. Positive results were obtained with all kinds of
homoeopathy, whether 'classical' or 'modern'. (The authors
rightly comment on the 'innumerable ways' in which Hahnemann's
principles have been applied in practice.)
The reviewers were surprised by the large amount of positive
evidence they found. 'Based on this evidence we would be ready to
accept that homoeopathy can be efficacious, if only the mechanism
of action were more plausible... The evidence presented in this
review would probably be sufficient for establishing homoeopathy
as a regular treatment for certain indications.' Although there
were shortcomings, these were no worse than those found in
comparable studies of conventional therapy. The authors conclude
that there is a great need for further research, in the form of
'a few well-performed controlled trials in humans with large
numbers of participants under rigorous double blind conditions.'
The mechanism of action is indeed the crucial issue; if this
were not such a problem homoeopathy would have been generally
accepted long ago. It is difficult for the unprejudiced observer
not to feel that there must be something odd about a treatment
that consists in nothing more than throwing a few drops of
medicine into a cattle drinking-trough, especially when the
medicine itself, on ordinary chemical analysis, would be shown to
contain nothing but water. For most scientifically trained people
this strains credulity to breaking point or beyond it.
SCIENTIFIC CONTROVERSY: THE BENVENISTE AFFAIR.
The extraordinary passions that this question can raise were
dramatically illustrated a few years ago by the feud between
Jacques Benveniste, a highly respected researcher in immunology,
and the journal NATURE. On 30th June 1988, the journal published
an article by Benveniste and his colleagues at the Unit for
Immunopharmacology and Allergy of INSERM at Clamart, in the
outskirts of Paris. The article appeared to provide support for
homoeopathy.
When a certain type of human white blood cell, the
polymorphonuclear basophil, is exposed to antibodies against IgE
(the protein concerned in allergic reactions), certain changes
occur. Histamine (the chemical that causes many of the clinical
symptoms of allergy) is released from the cell, and the cell
itself changes its appearance.
What Benveniste and his team claimed was that these changes
could occur even though the liquid containing the anti-IgE
antibodies was diluted to fantastically high levels (1 x 10-120);
that is, far beyond the point at which any molecules of the
starting substance could be expected to be present. As Benveniste
put it, perhaps rather over-dramatically, in an interview in LE
MONDE, it is as if one shook a car key in the Seine at the level
of the Pont Neuf in Paris and then collected a few drops of water
at Le Havre that would start that very car and not another.
Benveniste also found that in order to produce these effects
it was not enough just to carry out a plain dilution; vigorous
shaking, of the kind used in making homoeopathic medicines, was
required. Another interesting finding was that there were
successive peaks and troughs in the effect as the dilution
process was continued. (This feature has appeared repeatedly in
homoeopathic research as far back as the early 1900s, and
presumably must mean something; it suggests a kind of 'resonance'
phenomenon.)
As an established scientist with a sound reputation,
Benveniste was under no illusion about the storm of controversy
that his paper was likely to provoke. However, he can hardly have
been prepared for the scandal that broke over his head soon after
his paper appeared. The editor of NATURE, John Maddox, had
accompanied publication of the paper with an editorial expressing
considerable reservations: 'Benveniste's observations are
startling not merely because they point to a novel phenomenon,
but because they strike at the roots of two centuries of
observation and rationalization of physical phenomena. The
principle of restraint which NATURE applies in its editorial is
simply that, when an unexpected observation requires that a
substantial part of our intellectual heritage should be thrown
away, it is prudent to ask more carefully than usual whether the
observation may be incorrect.'
Benveniste was in full agreement that his results ought to
corroborated by other scientists - indeed, this had already
happened at five other institutions. (However, in a later
television discussion he also made the valid point that there was
no need to be quite so apocalyptic as Maddox had been in saying
that two centuries of science would have to be thrown away.
Benveniste's results, if correct, were certainly very interesting
and important, but they were not quite as world-shaking as that.
They were, he thought, in principle capable of being explained by
the electromagnetic properties of water.)
On 28th July NATURE published what was in effect a
recantation of its initial decision to endorse Benveniste's paper
at least to the extent of agreeing to publish it. An
investigative team, composed of John Maddox, the editor, James
Randi, a professional magician and debunker of claims for the
paranormal, and Walter W. Stewart, a specialist in errors and
inconsistencies in the scientific literature and scientific
fraud, had spent five days at Benveniste's Unit at Clamart.
Their report, entitled '"High dilution" experiments a
delusion', was dismissive of his results. It concluded that 'the
care with which the experiments reported have been carried out
did not match the extraordinary character of the claims made in
the interpretation; the phenomena described are not reproducible,
but there has been no serious investigation of the reason; the
data lack errors of the magnitude that would be expected and
which are unavoidable; no serious attempt has been made to
eliminate systematic errors, including observer bias; the climate
of the laboratory is inimical to an objective evaluation of the
exceptional data.' In other words, Benveniste, in the view of the
investigative team, had been guilty of extreme gullibility and
self-deception.
Benveniste, understandably, reacted with great anger - not
to the fact that an inquiry had been conducted, for he had been
quite willing for this to be done - but to the way in which it
had been conducted and to the implication that his team's honesty
or scientific competence were dubious. 'The only way definitively
to establish conflicting results,' he said, 'is to reproduce
them. It may be that we are all wrong in good faith. This is no
crime, but science.'
Several things occur to me about this sorry tale. One is
that it seems extraordinary that a scientific journal like NATURE
did not conduct its investigations before publishing Benveniste's
paper rather than afterwards. Another is that the composition of
the team, which did not include anyone competent to assess
Benveniste's work scientifically, must surely indicate the kind
of conclusion it was expected to reach. (Like the Latin num, it
expected the answer 'no'.) A third is that surely it was naive of
Benveniste not to anticipate this outcome when he was informed of
the composition of the team; it was then that he should have
objected.
Probably most people who knew little or nothing about the
subject before the occurrence of the NATURE controversy gained
the impression that Benveniste's research was unique in modern
times. This is very far from the case; a great deal of laboratory
work has been carried out, and is still continuing, in a number
of countries. France and Germany have been particularly prominent
in this, but centres elsewhere (in Italy, Israel, and Canada, for
example) have also contributed. A few years ago an international
society known as GIRI was established thanks to the efforts of
Professor Madeleine Bastide, of the University of Montpellier in
France, in order to coordinate and encourage this work. I was one
of the founding members of this group in 1987, and since then we
have seen it grow and develop rapidly. Researchers who are
members of GIRI have published their results in various
mainstream journals, but for some reason this work has so far not
given rise to anything like the furore that greeted the NATURE
publication.
One would like to believe that questions about the reality
of the high dilution effect and its possible mechanism of action
would soon be settled by further scientific studies.
Unfortunately this appears rather unlikely. What leads me to this
rather depressing conclusion is the fate that seems to have
befallen another recent scientific controversy that has excited
even fiercer argument: the cold fusion affair.
On 23rd March 1989, less than a year after the Benveniste
furore, Stanley Pons and Martin Fleischmann, two chemists working
at the University of Utah, announced to the world that they had
achieved nuclear fusion - the process that powers the Sun -
not in a huge apparatus costing many millions of dollars and
operating at thousands of degrees centigrade, but in a test tube
of water, at a cost of about 100 dollars, at room temperature.
This claim, if correct, would make the alchemist's hope of
making gold look trivial in comparison. Cold fusion would provide
the world with limitless supplies of energy, without causing
pollution or radiation. (It might also provide dictators of small
countries with an easy way of making nuclear weapons, but that is
another story.)
It sounded too good to be true; but was it? Pons and
Fleischmann chose to announce their discovery, not in the normal
scientific way by publication in a journal (such as NATURE), but
directly to the press. Few details emerged at first, although it
appeared that their technique depended on passing an electric
current through heavy water (water containing deuterium, a heavy
isotope of hydrogen) between palladium electrodes. This process,
they said, produced a huge amount of heat, which could not have
come from any electrochemical reaction but must be due to the
fusion of deuterium nuclei.
Immediately governments and scientists throughout the world
began to try to reproduce the phenomenon. Meanwhile the State of
Utah voted five million dollars for further research into cold
fusion and a National Cold Fusion Institute was established in
Salt Lake City.
Many scientists were sceptical, however, and bitter
controversy ensued, with claims and counterclaims; there were
allegations of fraud and of suppression of scientific evidence.
The scientific paper that Pons and Fleischmann eventually
published did not answer all the questions people were asking,
and scientists who tried to reach them by telephone were
generally unsuccessful. Most mainstream scientists, having failed
to confirm the existence of cold fusion, gave up and returned to
their regular work.
This side of the story has been presented recently by Frank
Close, a nuclear physicist, writing in NEW SCIENTIST (19th
January 1991). However, the same issue of the magazine contains
another article, by John Bockris, who is a distinguished
professor of chemistry at Texas A & M University. Unlike Close,
Bockris believes that Pons and Fleischmann had discovered
something important. 'There is already enough evidence... to
dismiss the widely held view that the original claims had no
value. [A remarkable use of double negatives to express a
contentious idea with the maximum of scientific caution!] It
seems now established that nuclear particles are, under some
circumstances, produced in bursts at electrodes in the cold. As
to the heat, there is no proof that it originates in a nuclear
process, though when it coincides with nuclear emissions it is
difficult to think that it does not.'
This conclusion is not based merely on an examination of the
claims of Pons and Fleischmann. Confirmation has been reported at
a number of centres, including Bockris's own laboratories. It
seems, therefore, that the matter still is not finally settled.
There are distinct similarities between this extraordinary
affair and the Benveniste controversy. Like the high dilution
effect, cold fusion poses a challenge to accepted ideas of what
is and is not possible according to established scientific
principles. In both cases there has been what NEW SCIENTIST
rightly calls a lack of mutual respect between scientists working
in different disciplines. 'The chemists failed to consult nuclear
physicists before making their claims, treating the nuclear
evidence for fusion with extraordinary carelessness. Physicists
adopted a dismissive, arrogant attitude to those some described
as "mere chemists", without appraising the possible significance
of the electrochemistry behind the reaction. The sneers that have
accompanied claims and counterclaims in both camps are a poignant
reminder of the fragmented specialism and tunnel vision that dogs
much research today.'
In spite of the enormous importance that cold fusion, if it
exists, would have for the world, there is still no agreement
about whether it is a mare's nest or not. Millions of dollars
have already been devoted to research, it has attracted some of
the best scientific minds in the world, and still we don't know
what to believe. If this is the case with cold fusion, what
likelihood is there that early clarification will be forthcoming
in the question of high dilution, whose potential importance is
comparatively so minor?
There is a widespread belief that scientists are objective
observers, who weigh up the evidence for and against hypotheses
dispassionately and then come to conclusions that are based on
facts and facts alone. Even a limited personal acquaintance with
real live scientists, however, or an exploration of the history
of scientific ideas, will show that this idea does not correspond
very closely with what is found in practice. One may have
reservations about some of the arguments put forward by Thomas
Kuhn in THE STRUCTURE OF SCIENTIFIC REVOLUTIONS, but it is
difficult not to agree that there is a fair amount of truth his
central thesis, which is that scientists, on the whole, don't
change their minds; changes in science occur as old men die off
and are replaced by younger ones with different outlooks. There
is, Kuhn seems to imply, a considerable element of fashion in
science, although Kuhn prefers to speak, more formally, of
paradigm shifts.
If Kuhn's view of how science develops is even approximately
right, it is still more true of medicine. Medicine is based on
science but can never be wholly scientific, for much the same
reason that politics cannot be scientific: medicine and politics
both deal with people, and people's behaviour cannot be analysed
with the rigour demanded by science. Doctors, whether they like
it or not, are constantly having to make up their minds about
diagnosis, prognosis, and treatment on the basis of inadequate
evidence. The results of investigations in individual cases, no
matter how sophisticated, are often inconclusive; it is notorious
that when postmortems to establish the cause of death are carried
out (this happens much less frequently now than twenty or thirty
years ago) there are liable to be some red faces among the
doctors looking on, even at the most renowned medical centres.
It is probably because of this inevitable degree of
uncertainty in medicine that doctors who come on training courses
to learn acupuncture or homoeopathy often seem less interested
than might be expected in research in these subjects. It may well
be that we are currently experiencing a paradigm shift in
medicine, as younger doctors, especially younger general
practitioners (hospital doctors seem more resistant),
increasingly accept the validity of using alternative methods
such as homoeopathy, acupuncture, and manipulation. (As I write
this, membership of the British Medical Acupuncture Society,
which was founded only a few years ago, has passed the 1,000 mark
and is still rising fast.) Not long ago the British Medical
Association set up a working party to study alternative medicine.
Its conclusions, as might have been predicted, were largely
negative and hostile; but, as also might have been predicted, the
BMA is already beginning to look like King Canute and there are
signs that it will shortly modify its stance.
7: PLACEBOS AND PSYCHOTHERAPY
Whenever a television programme about alternative medicine
is broadcast the result is a sudden, sometimes overwhelming,
influx of would-be patients at the homoeopathic hospitals. By no
means all of these people, unfortunately, are suitable for
treatment, and this can create difficult problems.
Many alternative practitioners might say that there are no
patients who are unsuitable for treatment. And in a way this is
true, at least as regards medical treatments such as homoeopathy.
(Acupuncture is rather different, for even in ancient China it
was never regarded as the only or even the main form of
treatment; many more texts deal with herbal medicine than with
acupuncture.) However, suitability for treatment is one thing and
prospects for success are another.
Here, for example, is a list of some of the kinds of
problems brought to the hospital in a month: spondylosis,
trigeminal neuralgia, rheumatoid arthritis, motor neurone
disease, osteoarthritis, migraine, irritable bowel syndrome,
hypertension, frozen shoulder, Parkinson's disease, intermittent
claudication, sinusitis, peripheral neuritis, peptic ulcer,
depression, tinnitus, rhinitis, epilepsy, unstable bladder,
rosacea, eczema, psoriasis, otitis externa, asthma, multiple
sclerosis, ulcerative colitis, piles, carpal tunnel syndrome,
recurrent urticaria, psychosexual problems... and, of course,
undiagnosed aches and pains and other obscure symptoms that no
one has managed to explain. How many of these are suitable for
alternative, or complementary, treatment?
Homoeopathic prescribing is based mainly on the symptoms
that patients describe, and in theory at least takes little or no
account of the orthodox medical diagnosis. It should therefore in
principle be possible to match a patient's symptoms to those of
some homoeopathic medicine or other and so find something to
prescribe. And so it is, as a rule; but unfortunately this does
not necessarily produce an improvement. Of course, it may do so,
and every experienced homoeopathic prescriber can point to
instances in which a seemingly hopeless illness has improved
dramatically following a homoeopathic prescription. But what
about the cases where it does not?
For the dyed-in-the wool enthusiast there is no real problem
here. He has immersed himself completely in a belief system, and
can always explain failures away in one way or another. If the
treatment has not worked in any individual case it must be
because it has not been applied properly. This was Hahnemann's
position.
Those who are less firmly committed to a principle have to
find another approach. There are several groups of patients for
whom this may be necessary.
Some people who come are suffering from serious, perhaps
fatal, diseases: not cancer, necessarily, though that is probably
what comes first to mind; there are plenty of other equally
unpleasant possibilities.
There are other patients with long-standing disorders that
are not fatal but for which there is no effective orthodox
treatment (tinnitus, Parkinson's disease). Or perhaps there is
reasonably effective orthodox treatment (asthma, high blood
pressure) but the patient wants a total cure, a complete freedom
from the need to take any kind of medication.
And then there are those who arrive saying: "Doctor, you're
my last hope." Many of these 'last hopers' have complex
psychological problems, which they insist are physical, and which
have taken them from specialist to specialist over months or
years. Commonly they arrive accompanied by a long-suffering,
over-solicitous spouse, who interjects remarks into what is
clearly by now a well-rehearsed descriptive routine. In extreme
cases such people may become therapeutic black holes, insatiably
sucking in therapists, investigations, and treatments. Like black
holes they can be destructive and dangerous; it is not uncommon
to find that they have already become involved in sagas of
complaint or even litigation against former 'last hopes'.
Any doctor will see a number of such patients like this in
the course of a year. Orthodox critics of alternative medicine
tend to think that the whole clientele of alternative
practitioners is made up of such patients, but fortunately that
is not the case; however, it is true that patients of this kind
tend to gravitate towards alternative medicine.
To say that none of the patients in these 'difficult'
categories can be helped by alternative, or complementary,
methods would be too sweepingly pessimistic. Some can; there are
many surprises. And even if nothing can be done, at least it is
possible to offer a little kindness and attention. Inevitably,
however, any doctor who is self-critical about what he is doing
is bound to recognize that in many of these cases any treatment
he gives is likely to have a placebo effect only.
For the critic of alternative medicine, of course, it is all
placebo. The clinical trials I discussed earlier have been
conducted to try to defuse this criticism, but there is another
way of responding to it which is favoured by some of the younger
and more self-confident medical practitioners of complementary
medicine. Instead of desperately trying to prove that none of
their cures are due to placebo, they want to turn the tables on
their critics by invoking what they have called an 'enhanced
placebo effect'. I find this an interesting concept, and up to a
point a persuasive one.
THE ENHANCED PLACEBO RESPONSE.
The placebo effect is a great deal more important and more
interesting than many people realize. It is generally said that,
in clinical research, one should expect a response to placebo in
about 30 per cent of the patients. Such responses are believed to
be fairly brief - about six weeks as a rule. However, it seems
that if you attempt to increase the placebo effect as much as
possible, by using the strongest possible suggestion, the
response rate can be much greater - as high as 80 per cent in
some studies. Richard Asher reports an experiment he carried out
in which more than 90 per cent of the group got some relief of
pain from a dummy pill and more than 50 per cent had complete
relief.
The duration of relief from placebo may also be much greater
than is usually believed: several months in some studies. There
are other surprises in store as well. 'Organic' symptoms respond
to placebo just as well as psychological ones, perhaps even
better. Most doctors tend to assume, rather patronizingly, that
placebo responders are likely to be somewhat inadequate,
uncritical, 'suggestible', individuals. But not so. There seems
to be nothing that distinguishes the placebo responder from you
and me. In fact, there probably is no such person as a 'placebo
responder' at all, for if you repeat your study later with the
same group of subjects, you find that the people who show a
response to placebo the second time round are not necessarily the
same as those who responded the first time.
Perhaps the most surprising thing of all is that even belief
in the placebo may not be necessary. In one study in America the
patients were told that they were being given sugar pills,
without any medication, which would have no effect on their
illness at all. In spite of this, quite a number of them had a
good response to the 'treatment'. Admittedly, this is only one
study, which has not been repeated; but it prompts some
interesting reflections.
Not long ago a study of the effectiveness of suggestion in
general practice was carried out in Southampton. Patients
suffering from not very serious illnesses that would be expected
to clear up spontaneously in a few days were interviewed in one
of two ways. For one group the doctor was non-committal and
simply asked the patient to return in a few days to report
progress; in the other group the patients were told firmly that
they would soon be better and there was nothing to worry about.
It was found that those who were given reassurance about their
condition recovered, on average, significantly faster than those
who were treated neutrally.
To use positive suggestion in this way is surely legitimate
and acceptable. But is it right to go considerably further?
It is often said, with some justification, that the methods
of alternative medicine are such as to maximize the effects of
suggestion. For the most part alternative medicine is private
medicine, and there is some evidence that patients who pay for
their treatment fare better than those who don't. The patients
get individual attention from the therapist, with whom they are
able to build up a personal relationship. The techniques used are
often impressive, nearly always involving elaborate diagnostic
rituals which are sometimes supplemented by impressive-looking
pieces of apparatus. Above all, the patient (often) and the
therapist (nearly always) believe strongly in the efficacy of the
therapy being used.
Advocates of the enhanced placebo response hold that it is
right to seek to increase the placebo element deliberately as
much as possible - and probably give it a different name, so as
to avoid the adverse association that 'placebo' carries with it.
In this way, they say, one augments whatever direct benefit may
be produced by the therapy itself in its own right. And they see
this as perfectly legitimate; after all, the aim is to help the
patient, and if suggestion can play a part in this, why not?
I can certainly see the logic of this argument, but there
are two aspects of it that bother me. The first is that, if you
deliberately set out to convey more belief and confidence than
you feel, you are deceiving the patient and, possibly, yourself.
There may well be occasions when this is justifiable, but to make
it into a general rule seems to be a rather dubious policy. For
some therapists, in fact, it may be psychologically difficult or
impossible.
Probably the most dramatic example of the use of therapeutic
suggestion on a large scale in the history of Western medicine is
that of Anton Mesmer. Mesmer used every device imaginable to
maximize suggestion and produce his cures. But he did not himself
think that his cures were merely the result of suggestion; on the
contrary, he believed strongly in his theory of 'animal
magnetism' as the explanation. Indeed, much of his life's work
was devoted to trying to get this idea accepted by the orthodox
medical authorities of his day.
The moral of this is that you are unlikely to have much
success with your enhanced placebo effect unless you believe
strongly in your treatment yourself. Of course there are examples
to the contrary - charlatans who have successfully duped the
public without having any belief in what they were doing - but
they are the exception rather than the rule.
A second difficulty with the enhanced placebo idea is that
it is condescending and 'paternalistic', in the pejorative sense
of the word. It puts the therapist, by implication, on a
different level from the patient. This is, or should be, contrary
to the spirit of complementary medicine, which usually claims to
think of patient and therapist as involved in a joint venture
together.
My own feeling is that whenever possible it is best for the
doctor or therapist to tell the patient the truth as he sees it.
I certainly accept that there will be many cases in which this is
impracticable or undesirable. 'Humankind cannot bear very much
reality.' However, not to be truthful in cases where it is
possible to be so is somewhat condescending.
Certainly it is always right to be as optimistic as possible
in every case. After all, none of us knows the future, and we all
see instances in which even the most hopeless-seeming problem
turns out very well. Nevertheless it is right to be as honest
with patients as circumstances allow, and to give them, in
general, a frank account at the outset of what one expects that
treatment can, and cannot, achieve for them.
There is another aspect of the placebo response that needs
to be kept in mind. Neutral treatments such as inert tablets can
do harm as well as good. (This is sometimes called the 'nocebo'
effect.) A remarkable example of this occurred in the course of a
modern homoeopathic 'proving' carried out a few years ago in the
north of England.
A proving is an experiment made to ascertain the effects of
a homoeopathic medicine on healthy people, according to the
principle enunciated by Hahnemann. In this case the medicine in
question was one commonly used in homoeopathy, called Pulsatilla.
It was given in the '3x potency', which meant that there was a
certain amount of the medicine present in the tablets, although
not very much. (This was the lowest dilution which could be used
without giving the game away by differences in appearance and
taste between medicine and placebo.)
The study was carried out on volunteers in the north-west of
England; most were members of a large philosophical society. It
was planned to last for three months, with the volunteers taking
one tablet twice daily and recording their symptoms in a diary.
During the first month all the 'provers' received a dummy tablet;
they did not know this, although the doctor who was conducting
the trial did. In the second month half the provers received
Pulsatilla and half dummy tablets, and in the third month those
who had received Pulsatilla previously now received the dummy
tablet and vice versa. In the second and third months neither the
doctor nor the provers knew which group was receiving Pulsatilla,
and indeed at this time the provers did not even know that it was
Pulsatilla that had been chosen for the trial.
The results were very interesting. Thirty of the 52
participants returned their diary sheets filled in to some
extent, although only 18 completed the whole three months. When
the diaries were analysed no evidence emerged to show that
Pulsatilla had produced any more symptoms than the dummy tablet.
What was very striking, however, was the fact that much the
largest number of symptoms occurred during the first month; that
is, at the time when all the volunteers were taking dummy
tablets. The incidence of symptoms declined progressively over
the whole three-month period, regardless of whether the
participants were taking Pulsatilla or dummy tablets. Several of
the provers experienced such severe symptoms while taking the
dummy tablets that they had to withdraw from the trial.
This experiment does not necessarily show that Pulsatilla is
incapable of causing any symptoms, but it does indicate that, at
least in these circumstances, any symptoms it did provoke were
completely swamped by those due to self-suggestion. It also
confirms the remarkable efficacy of self-suggestion as a cause of
severe symptoms.
Many years ago I had an experience which reflects this. A
patient holding an academic appointment came to see me at the
hospital. I had the impression that she might easily produce
symptoms through self-suggestion, so I cautiously gave her an
inert sugar tablet to start with. Sure enough, a few days later I
received an outraged letter from her, demanding to know what this
highly dangerous substance was which I had given her; she said it
had caused an acute psychotic reaction and her professor was very
worried about her. I wrote back saying that I was sorry to hear
this but did not think there was any way that the tablet could
have caused her symptoms, since it was only milk sugar. No
further correspondence ensued between us.
Many homoeopaths believe, following Hahnemann's dictum, that
homoeopathic medicines frequently give rise to 'aggravations';
that is, to temporary worsening of the patient's symptoms. One of
the best-known of the nineteenth-century English homoeopaths,
Robert Dudgeon, was sceptical about this, saying that
aggravations are much rarer than Hahnemann supposed, and I
entirely agree with this. If you tell patients firmly that there
will be no adverse effects from their medicine you hardly ever
see 'aggravations'. If, on the other hand, you tell patients that
aggravations are likely you will certainly see plenty.
Alternative medicine as psychotherapy.
Although I have reservations about the idea of the enhanced
placebo, I certainly do accept that much of what any alternative
therapist does is, in the broadest sense of the word,
psychotherapy.
Many practitioners of alternative medicine resist the notion
that psychotherapy plays any part in what they practise. Up to a
point this is understandable, since the notion that alternative
medicine is partly psychotherapy can too easily be used by
critics as an excuse to dismiss the whole thing; but as there is
now a fair amount of evidence to show that at least some of the
alternative therapies do have effects over and above what is
attributable to psychological factors there is no real need to be
so defensive.
In everyday clinical practice, as opposed to the rather
artificial setting of a scientific clinical trial, the
alternative therapist is constantly dealing with psychological
problems, either on their own or as part of a more comprehensive
clinical picture. Whether he likes it or not, therefore, and
whether he calls it that or not, a great deal of his work is
psychotherapy. Very many patients suffer from symptoms that are
due wholly or partly to psychological factors. One example of
this among scores of others remains in my memory.
A middle-aged woman was thought to be suffering from
multiple sclerosis. Her symptoms were typical of this disease,
although there was always a little residue of doubt about the
diagnosis, partly because she had had a test by a neurologist
which had not confirmed it. (This test, known as the visual
evoked response, is not conclusive proof either way, but a
negative outcome does make the diagnosis less likely.) After some
time it emerged that there was a definite psychological factor in
this patient's case; she was unhappily married, and although she
was separated from her husband he still used to beat her on
occasion.
Some years went by, during which she continued to attend the
hospital without any great change in her condition. Then she
divorced her husband and made a second marriage, which was happy.
As soon as she did this all the symptoms of her multiple
sclerosis disappeared.
Less clear-cut examples of psychologically caused illness
are extremely common. This, of course, is fully recognized by
orthodox medicine, and almost every doctor in clinical practice
- every general practitioner, certainly - sees numerous
examples. In some cases it is possible to put a formal
psychiatric label on the patients in question but often it is
not.
Although orthodox doctors vary in their attitudes much more
than most alternative therapists would allow, it is fair to say,
as a generalization, that they tend to look for a pharmacological
solution for mild or moderately severe psychological symptoms. In
a busy general practice there simply is no time to practise very
much psychotherapy even if the doctor's interests lie in that
direction, and although psychotherapy is available in National
Health Service psychiatric hospitals there are far more patients
than these units can cope with. In consequence, doctors often
take what seems the easiest way out, which is to prescribe a so-
called minor tranquillizer or a 'sleeping tablet'. Although this
practice has been discouraged in recent years there still are
many thousands of patients who have become dependent on these
drugs.
Alternative therapists, naturally, are critical of the
orthodox approach to psychological problems, and not simply
because it relies predominantly on drugs. They object to the
whole series of assumptions on which this treatment is based.
We touch here on what is probably the core of the difference
between the alternative and orthodox approaches. The assumption
that underlies much of mainstream psychiatry today is that
psychiatry should, ideally, be reducible to neurology. Admittedly
we are not at that stage yet, and perhaps never will be, but many
psychiatrists write and talk as if this is what they believe;
sometimes it is explicitly stated. Much modern theorizing about
depression, mania, and schizophrenia, for example, proceeds on
the assumption that an explanation in terms of brain chemistry or
structure will eventually be found. Biochemical hypotheses are
put forward to account for the ways in which the drugs used to
treat these mental disorders are supposed to work. The resulting
picture is of the human being as a mechanism - enormously
complicated, it is true, but a mechanism none the less.
The model that is assumed in much of this discussion is that
of the computer. Mostly it is the hardware - the nerve cells or
the chemical composition of the fluids in which they live -
that is supposed to be at fault; and even when more
'psychological' factors are admitted to be part of the equation
they often seem to be thought of as faults in the programme, the
software.
The view of the alternative therapists, I need hardly say,
is diametrically opposed to these ideas in almost every respect.
The central claim of pretty well all the various alternative
therapies is that they reject the materialistic outlook. We quite
often find it stated that human beings are composed of body,
mind, and spirit. Alternative treatments are supposed to act on
all these levels simultaneously, whereas orthodox medicine, in
contrast, only recognizes the first level, the physical, and even
then its outlook is thought to be pretty blinkered. This is
partly true of even the more physical forms of treatment, but it
becomes increasingly evident as we move towards the more overtly
psychotherapeutic end of the spectrum (Chapter 2, p.00).
If you ask for a clearer statement of what is meant by mind
and spirit in this context and how they differ from each other
you are unlikely to get a definite answer, except in the case of
those few systems, such as Anthroposophical medicine, which are
explicitly based on an elaborate philosophical theory. This is
hardly surprising, since few alternative therapists, after all,
are philosophers, but it does result in a certain haziness of
thought and language. Nevertheless the concept of a 'spiritual
dimension' underlies a great deal of the discussion of
alternative medicine. In a recent review of some aspects of
complementary medicine, Lorraine Nanke and David Canter quote an
earlier finding that 'nearly half of the holistic practitioners
replied that religious and spiritual experiences were important
in shaping their views about health, illness and healing, in
contrast to 13 per cent of family practitioners.' [Complementary
Medical Research, 1991, 5, 1 - 6]
It is of course perfectly true that many, perhaps most,
patients who seek alternative treatment have no definite
theoretical stance on the question. Nevertheless many forms of
alternative medicine do have these 'spiritual' aspects if one
looks for them. This emerges most clearly in the case of
homoeopathy.
Samuel Hahnemann, the founder of homoeopathy, was not a
mystic, but in his later years he did incorporate certain ideas
into homoeopathy (especially the potency theory and the notion of
the vital force) that verged on the metaphysical, and were so
regarded by his contemporaries. In the second half of the
nineteenth century a number of North American homoeopaths,
including some of the most respected and influential among them,
became ardent disciples of the seventeenth century philosopher
and mystic Emanuel Swedenborg. Swedenborg's teachings, which
derived from his accounts of contacts with spirits, gave a new
and distinct character to American homoeopathy, and in the early
twentieth century these ideas crossed the Atlantic to Britain,
where they took root strongly and largely transformed the native
school of homeopathy. (I have related this story in my book THE
TWO FACES OF HOMOEOPATHY.)
Homoeopathy is certainly not unique among alternative
medical systems in possessing this semi-mystical element.
Anthroposophical medicine, for example, was invented in the early
twentieth century by the Austrian philosopher and mystic Rudolf
Steiner, and incorporates numerous mystical ideas derived in part
from Paracelsus and Goethe. (Anthroposophical medicine has
something in common with homoeopathy but uses different medicines
prescribed in different ways.) Traditional Chinese acupuncture,
although not a mystical form of treatment in China itself, often
seems to appeal to Westerners sympathetic to ideas of that kind.
Then there is a large number of alternative psychotherapies
that possess a 'spiritual' dimension. Some, such as Silva Mind
Control, are frankly concerned with the attempt to enhance
people's paranormal abilities. Others make use of astrology or of
memories supposed to be derived from previous lives. Nor is it
only the 'far out' therapies that show these characteristics.
Even Freud, who was in many ways the perfect example of a 'left-
column' thinker, toyed with the paranormal, and his pupil Jung
was still more receptive to these ideas.
At the furthest edge, so to speak, alternative therapies
shade imperceptibly into other things such as meditation, methods
of self-development, paranormal healing and forms of prayer. At
this point alternative medicine begins to blend with New Age
thought. Although not everyone who uses alternative medicine is
necessarily much concerned with ideas of a New Age, many are, and
the converse is certainly true; there can hardly be anyone who
believes in New Age concepts who is not also firmly committed to
alternative medicine, as either a patient or a practitioner. In a
recent television programme on the New Age at least half the
members of the invited audience who spoke identified themselves
as therapists of one kind or another.
In appearance, the New Age movement originated with the
hippie movement in the 1960s, but it can be traced much further
back than that; William James describes what is essentially the
same phenomenon at the end of the nineteenth century in America,
while Norman Cohn has given us a brilliant analysis of similar
ways of thinking in the millenarian movements of the Middle Ages.
There is indeed something strongly archetypal about it, so that
it keeps on cropping up again and again in history.
It was, for example, particularly evident among the American
homoeopaths in the nineteenth century. They believed that
homoeopathy would eradicate the deeply rooted 'miasms' that were
poisoning human existence and were being transmitted from one
generation to the next; and this happy development, they
supposed, would not merely eliminate chronic disease but would
bring about a complete transformation in social conditions.
Similar ideas are still held today by some influential lay
homoeopaths.
8: THE NEW AGE
To discuss in detail all the causes for the rise of New Age
thought would take me too far from my theme. Several obvious ones
present themselves. War, famine, pollution, over-population, and
disease seem to crowd in upon us more and more as the twentieth
century draws to its close, and one would have to be stoical
indeed not to feel at least apprehensive about the future.
Then there is the dissatisfaction with science that I noted
at the beginning of this book. Even as recently as fifty years
ago, science seemed to most people to be benevolent; far fewer of
us would assert that so confidently today. There is a feeling
abroad that we have been too hubristic, too clever for our own
good, and are beginning to reap the consequences.
In addition to these causes for anxiety a growing number of
people, especially among those sympathetic to alternative
medicine, are taking seriously ideas that would thirty or forty
years ago have seemed like the rankest superstition. The
prophecies of Nostradamus are wheeled out and apparent
fulfilments of them are discerned. Biblical fundamentalists,
especially in America, see prophecies of doom in various parts of
Scripture: in the Apocalypse (Book of Revelation) ascribed to St
John, naturally, but also in a number of books of the Old
Testament. Astrology, though often declared dead, refuses to die;
and astrologers are convinced that the end of the second
millennium, coinciding as it does with the transition from the
Age of Pisces to the Age of Aquarius, must be accompanied by
dramatic changes in human fortunes.
So much is more or less self-evident. But why the close
connection with alternative therapy?
So far we have been looking at alternative medicine almost
entirely as something that affects just the individual. It does,
however, also have what might be called its public health
persona. For rather in the way that conventional medicine can be
thought of as linked with social measures to improve people's
lives (better housing, clean water, healthier food), alternative
medicine could be thought of as being concerned with the
spiritual as well as the material health of society and the
planet itself. And rather as on the individual level our
symptoms are said to be a sign that the body is seeking to heal
itself and are thus in some sense to be welcomed, so too on the
planetary level all is going to be well. Yes, we are in for a
period of tremendous turmoil and upheaval, but at the end of our
journey through the valley of despair we can expect to emerge
into the broad sunny uplands of a new Eden.
The close connection between New Age thinking and
alternative medicine is well exemplified by Transcendental
Meditation (TM). This technique was brought to the West in the
1950s by an Indian teacher, the Maharishi Mahesh Yogi. The
special features of TM, according to its founder, were that it
was easy to learn and did not require any commitment to strange
dress or postures or the adoption of a new way of life. It was
simply a technique, and could be learned by anyone without the
need to take on a belief system. At the same time - and this
was part of its appeal for many people - it did stem from an
ancient Indian tradition; it had an authentic background.
Maharishi was said to have been the closest disciple of a
renowned Indian teacher, Swami Brahmananda Saraswati, the
Shankaracharya of Jyotir Math in the foothills of the Himalayas.
(Shankaracharya is a title; four maths, or monastic seats of
learning, were founded in different parts of India, probably
about 800 AD, by the original Shankaracharya, the most renowned
philosopher of the Advaita Vedanta school of Indian philosophy.)
It was from his master that Maharishi obtained the system of
meditation he later taught. After his master's death in 1953
Maharishi remained for some time in seclusion but then begun to
teach; at first only in India, but later in countries throughout
the world, including the USA and Britain.
Initially his success was reasonable but not dramatic. In
1967, however, TM was taken up by the Beatles, and this certainly
brought it decisively to public attention. Maharishi was
interviewed on television by Malcolm Muggeridge and David Frost,
and articles appeared in almost every newspaper and in numerous
magazines. The Beatles went to India with Maharishi, and although
their involvement with TM was fairly short-lived the impetus they
gave to his movement was great enough to keep it in the public
eye long after their departure.
TRANSCENDENTAL MEDITATION AS A MEANS TO HEALTH
Transcendental meditation (TM) is at bottom a spiritual
technique, but it has always been described as having many
beneficial effects not only on psychological functioning but also
on physical and mental health. Among the benefits listed in a
current TM brochure we find:
- Increased mental clarity, alertness and creativity.
- Increased self-esteem, well-being, and vitality.
- Reductions in stress, anxiety and depression.
- Improved immunity and resistance to disease.
- Improved sleep patterns.
- Better relationships at home and work.
The basis for these effects is the state of deep rest
provided by TM. 'During TM, the mind experiences its quietest,
most settled state, while alertness is fully maintained: a state
best described as "restful alertness" or "pure consciousness".
Research has shown that TM gives rise to a unique state of deep
rest, accompanied by a high degree of integration in brain
functioning. This profound state of rest allows the body to throw
off deeply rooted stresses that are not removed by ordinary
relaxation or sleep.' [TM brochure]
These claims are supported by a large number of scientific
studies - more than 350, we are told. In one of these, a group
of more than 2,000 TM practitioners followed up for five years
was found to need only half the number of doctors' visits and
hospital admissions recorded for a comparable control group;
heart disease and nervous system disorders were particularly
infrequent, and so were tumours.
TM is said to help in a wide range of physical illnesses,
including asthma, hypertension, angina, multiple sclerosis, and
ME. It also has an important part to play in prevention: it
reduces all the major risk factors for heart disease, increases
resistance to stress and 'promotes positive health habits'. A
three-year survey of psychiatric hospital admissions in Sweden
showed that there was much less need for psychiatric care among
people practising TM.
One of the chief attractions of TM has always been the ease
with which it is learnt and practised. It is described as 'a
simple, natural and effortless technique practised for 15 - 20
minutes each morning and evening, sitting comfortably with eyes
closed. This technique can be easily learned by anyone,
regardless of age, educational background, culture or religious
belief, and requires no change of life-style or diet.'
While this is perfectly true, it is also the case that TM is
not just a technique. Like its founder, it is rooted in the
Indian tradition, and has an elaborate philosophical basis.
However, it is quite possible to meditate for years without
troubling oneself about this aspect.
In 1985 Maharishi set up a centre in New Delhi to study
Ayurveda, the ancient traditional form of Indian medicine. This
led to the development of 'Maharishi Ayurveda', which is
Maharishi's version of the ancient system, incorporating TM.
The basis of Maharishi Ayurveda is said to be the
establishment of balance within a person's mind and body, which
will then relieve stress and tension. TM is the main technique
for achieving this, but now it is supplemented by a variety of
means, including diet, exercises, breathing methods, and herbal
preparations. Claims are made for the alleviation of many
diseases, including Aids, and there is even a report that this
treatment can reverse some of the effects of normal ageing.
Public health is not neglected either. It has long been a TM
claim that there are beneficial effects on society at large -
the 'Maharishi effect' - including decreases in the incidence
of diseases, hospital admissions, suicides, accidents, crime, and
even reductions in national and international conflicts. Once
again, these claims are supported by numerous sociological
studies.
I first came into contact with TM shortly before the Beatles
arrived on the scene, and I used the technique for many years. I
thought then, and I still think, that it is a Good Thing. Whether
or not all the claims made for it can be substantiated is another
question and I have no first-hand experience of the recent
Ayurvedic aspect. But that the practice of TM does reduce one's
vulnerability to stress I have no doubt. The main effect seems to
be that after a year or two of meditation strong outside stimuli,
whether pleasant or unpleasant, tend to 'damp out' more quickly
than before; they push one off balance less than they used to do.
This may seem a fairly modest claim, but I think it is a genuine
and valuable effect which is not the result of suggestion.
In the late 1960s and early 1970s I attended a number of the
large international TM gatherings, or 'courses', as they were
known, which were held in various parts of the world. Numerous
young Americans used to attend these courses, and most of them
had absorbed the hippie values of the Sixties, which seemed to
blend easily with TM.
There was a good deal of talk of 'negativity' and
'positivity'. To have serious doubts about TM would certainly be
'negative', but it was also 'negative' to think or talk much
about illness, death, war, famine, over-population, or any of the
other individual or collective threats we might feel exposed to.
Instead we were supposed to concentrate on the beneficial effects
of TM. If the meditation were only practised widely enough all
these problems would be solved. There was no need to go into the
details of how this would come about, but everything would be
taken care of automatically, thanks to the increased creativity
of meditators on the one hand and the beneficial effects of TM on
society at large on the other.
Maharishi himself appeared to believe this, at least in
public. He gave talks to large audiences in which he announced
the arrival of a Golden Age of Enlightenment - literally
golden, for all the literature of the TM movement was now
embellished by having the titles picked out in gold lettering. In
private, too, he was generally up-beat, although he continued to
emphasize the need to hurry to get people to start meditating in
order to counteract the harmful stresses of modern life, which he
blamed for such things as civil disorder and war.
This insistence on positivity and optimism, and on the
dawning of an Age of Enlightenment, fitted in very well with the
ideas of the alternative health movement, which was just
beginning to take off at the end of the 1970s.
The problem which quite a few of us found with all this
hyperbole was that it overstated what was actually quite a good
case to be made out for TM. Meditation done in the TM way really
did help many people to cope with the effects of psychological
tension and there were few serious adverse effects. Severely
disturbed individuals could certainly react badly to TM, but the
initial screening procedure was reasonably successful in
detecting such vulnerable people, who were regarded as unsuitable
for TM. (Some of them could however be given a different, less
far-reaching, practice to help them.)
The main weakness of TM was the fact that it was
stereotyped. This is a relative criticism only, for if you are
going to offer a form of meditation to many thousands or even,
ideally, millions of people, which is what Maharishi intended, it
clearly has to be done in a standarized manner. But this did
inevitably mean that meditators who came across difficulties of
various kinds had no easy way of resolving them within the TM
framework. Some people, for example, experienced personal
disasters of various kinds which they had been led to believe
should not have happened to them. (Not that it was ever stated
that meditators should not expect to have accidents or become
ill, but the implication that such things ought to become less
likely was there.) Others were sufferers from mild or moderate
anxiety, depression, or other psychological symptoms which were
not severe enough to exclude them from TM but were nevertheless
distressing.
Meditators who encountered problems of this kind naturally
tended to approach their teacher of meditation or one of the
other meditation guides specially trained to monitor the progress
of TM, but all these people were supposed to confine themselves
to the meditation itself, not to offer advice on meditators'
lifestyles or to diagnose their physical and mental ills. This
was a perfectly reasonable rule, given that few of the meditation
teachers or their assistants were professionally qualified to
give advice of that kind. Nevertheless there were inevitably a
considerable number of meditators who had need of something of
the sort in addition to the meditation itself.
Another kind of difficulty arose when people reported
strange, sometimes very powerful, experiences during meditation.
The policy was to play these down and not to attach much
importance to them, which again was sensible, given the large
numbers of meditators. But not everyone found this satisfactory;
some wanted to know what the experiences meant, and these people
required individual attention; it wasn't enough to give them
stock answers.
In the end I found the grandiose claims increasingly being
made on behalf of TM impossible to go along with. This tended to
induce a mood of disillusionment; Louis Macneice's line often ran
through my mind: "It's no go the yogi man, it's no go Blavatsky."
Yet it was necessary to remember that TM did, in a sense, appear
to work; it was not all a waste of time, and I still felt I had
gained a great deal from it, if not perhaps as much as I had been
promised. Which brings us back to the theme I hinted at in the
Introduction: the difficulty of keeping a balance between
credulousness and cynicism.
TM is not without parallels; there have been a number of
rather similar movements over the last 20 years, but I have
singled out TM partly because of my first-hand experience of it
but also because it includes pretty well all the components of
the New Age: the quest for individual spirituality, alternative
medicine, and the promise of collective transformation leading to
the dawning of an Age of Enlightenment. It exemplifies rather
well both the attractions and the drawbacks that characterize New
Age movements in general.
9: TRYING TO MAKE SENSE OF IT ALL
At the beginning of this book I posited an imaginary
situation to help you to define your own attitude to alternative
medicine. From what followed it should be apparent that I don't
myself believe that there is any one 'right' answer to questions
about the value or otherwise of these therapies. Much depends on
your initial assumptions and the belief system you bring with
you, as well as on the exact nature of the therapy being
considered. A few general conclusions do, however, seem possible.
Clinical research provides a fair amount of evidence to show
that the better-established therapies (acupuncture, manipulation,
homoeopathy, hypnotherapy) do work part of the time and for
certain kinds of disorders. Indeed, all those I have mentioned
have already made a greater or lesser amount of progress from the
'fringe' towards medical respectability, and in so doing have
begun to lose something of their alternative character. Whether
you find this a matter for rejoicing or regret is a matter of
individual reaction.
We have also seen, however, that part of the appeal of
alternative medicine for many people is precisely that it is
perceived as being anti-mechanistic, non-reductionist - that is,
a right-brain phenomenon. This version of therapy is inevitably
more or less at odds with the prevailing medical orthodoxy, which
is mechanistic, reductionist, left-brain. Here your choice of
attitude is largely determined by where on the left-brain/right-
brain spectrum you happen to find yourself. (You probably can't
do much to alter your positioning on this spectrum; it seems to
be determined largely by factors outside your control.) What
follows, therefore, is determined by my own position (somewhere
in the middle, I think, but more towards the left in respect of
many topics). In reading what I write you should make appropriate
allowances, but don't overdo these because I have done my best to
allow for my own biases and to be as fair to both views as I can.
A FRANKLY PERSONAL APPRAISAL
The principal failing of the philosophical alternative
medicine enthusiasts, it seems to me, is their facile over-
optimism. From some popular books about alternative medicine you
would infer that there is almost nothing that can't be cured. And
quite a number of patients do indeed draw just this conclusion,
and are bitterly disappointed by the outcome. As for the
therapists, they sometimes seem to believe that, if their
treatment fails to cure a patient, this must be because they
haven't yet found the right combination of medicines, acupuncture
points or whatever that would do the trick; they are usually
strongly resistant to the idea that their treatment might simply
not provide the answer in every case.
Of all the uncomfortable facts that need to be faced, the
starkest and most uncomfortable of all is of course death. It is
often said, with a fair amount of justification, that
conventional medicine is inadequate when it comes to coping with
the dying. Hence the hospice movement. This inadequacy is
probably at least in part due to the difficulty that doctors,
like other people, experience in coming to terms with their own
mortality. But what about the alternative movements? Do they do
any better? It hardly seems likely. Few of them, after all, have
much to do with the dying; most patients these days die in
hospital.
The difficulty that many doctors experience in confronting
the fact of death is not wholly their fault. Patients, too, often
collaborate in the conspiracy of denial. We seldom talk much to
our patients about death; perhaps we should do so more. But there
is a strong cultural resistance against it; as many people have
noted, death has become the ultimate unmentionable. Patients are
usually quite happy to discuss intimate details of their sex
lives, but they are nearly always much more reticent about death.
And naturally doctors, too, experience the same reluctance. 'For
those who live neither with religious consolations about death
nor with a sense of death (or anything else) as natural, death is
the obscene mystery, the ultimate affront, the thing that cannot
be controlled. It can only be denied.' (Susan Sontag, ILLNESS AS
METAPHOR, p. 55.)
Denial is certainly the rule, although one can sometimes
discern a different note. The middle-aged and elderly may voice
their anxieties indirectly, often making a little joke of it, as
we tend to do when we are afraid of something: 'it's anno domini,
I suppose,' or, more sombrely, 'don't grow old, Doctor, it's a
mistake, I can tell you.'
Denial can take very odd forms indeed. Now we are offered
the prospect of technological immortality. Certain entrepreneurs
invite us to pay them huge sums of money for the privilege of
being frozen in liquid nitrogen (head down to preserve the brain
in case the refrigeration fails temporarily), in sure and certain
hope of resurrection when at some future time it has been
discovered (a) how to revive us and (b) how to cure whatever it
was we died of. For people who cannot afford to have their whole
body frozen there is a cut-price alternative which consists in
freezing just the head.
There is an interesting resemblance here to the Egyptian
practice of embalming the dead in order to ensure their
immortality. Like our modern 'cryonics', embalming was a very
costly affair; only a small minority of the population could
afford the full treatment, although, as in our case, a cheaper
alternative version was also available. The modern transformation
of a 'spiritual' conception of immortality, as held by the
Egyptians and other peoples of the ancient world, into a
materialistic and technological one is surely very significant.
What is astonishing about the whole cryonics idea is not so
much the implausibility of the 'science' involved as the
extraordinary and probably unwarranted optimism it implies about
the future stability of our sophisticated technological
civilization. There is also a remarkable degree of egotism in the
assumption that a future society would actually want to revive
large numbers of unknown people.
It is certainly not for the doctor to try to make patients
confront things they don't wish to confront. We all have the
right to our reticence and our escapes from reality. On the other
hand, probably no therapist can achieve very much for many of his
patients unless he has at least begun come to terms in one way or
another with his own mortality.
No choice is uninfluenced by the way in which the
personality regards its destiny, and the body its
death. In the last analysis, it is our conception
of death which decides our answers to all the
questions that life puts to us. [Dag Hammerskjold,
United Nations Secretary General: 1966 Markings,
tr. W.H.Auden and Leif Sjoberg, Faber and Faber,
p.136]
This coming to terms with mortality may have been an easier
task in more religious ages; certainly the Victorians had no
false shame about discussing death. When I was a boy in a Roman
Catholic school we were frequently exhorted to remember, on going
to bed, the Four Last things: Death, Judgement, Hell and Heaven.
It is, or at least was, one of the great strengths of Catholicism
that it did not shrink from acknowledging the reality of death.
Our headmaster used to boast that, when he attended the annual
Headmasters' Conference and was asked what he thought he was
preparing his pupils for, he used to reply: "For death." That
reply would probably be considered morbid today; I have no idea
if his modern successor would say the same thing.
Of all the great world religions it is, I think, Buddhism
that faces the fact of death with the greatest degree of honesty.
In the Theravada Buddhist tradition, for example, the monks and
nuns regularly chant: "I have not gone beyond sickness, I have
not gone beyond aging, I have not gone beyond death." Morbid? No:
wholly admirable.
The onset of a serious or fatal illness is one way in which
our inevitable mortality may be brought home to us. The slow
breakdown of our physical or mental faculties is another. Like
Peer Gynt, we find ourselves gradually peeling away the layers
that went to make up our physical and mental selves, until at
last we reach the end and nothing is left at all. It can seem
like a bad cosmic joke: "Nature is witty."
Of course, I am deliberately putting the matter in its
starkest terms. In many instances a certain amount of compromise
is possible. Useful treatments, conventional or alternative, do
after all exist for many diseases, and some at least of the
disabilities of aging can be mitigated in various ways. There is
also a lot we can do to help ourselves, especially by prevention:
we can avoid tobacco and excessive amounts of alcohol, we can
take exercise and prevent putting on weight by eating sensibly,
we can keep our minds active. Not to do these things is doubtless
foolish.
But we ought also to recognize that we may do all this and
still become ill, and our illness may be of a kind that no
presently available treatment can help. We ought also to
recognize that there can be no guarantees of immunity from the
attrition of time. Sometimes patients say: 'Why should this have
happened to me?' To which there can be only one honest, if
brutal, answer: 'Why not you?'
The implied message of technology and of the Welfare State
is that pain and suffering should not be part of life and we have
a right to be relieved from them. It is not a message that would
have made much sense to earlier generations, who seem to have
accepted these things as inevitable. And alternative medicine,
although it rejects technology as such, generally colludes in
fostering the delusion that we should be perpetually healthy.
There is therefore nothing surprising if many patients with
incurable disorders believe that a cure must exist somewhere. But
for many such people there will be nothing but an incessant
progression from one specialist to another, from one form of
alternative therapy to another.
It is never right to deny a patient hope. At the same time,
however, it is equally wrong to buoy people up with false
promises. A fine balance is to be struck.
ALTERNATIVE MEDICINE AND THE SPIRITUAL DIMENSION
We saw a little earlier (p.000) that nearly half of a group
of alternative practitioners who were questioned said that
religious and spiritual experiences played an important part in
forming their clinical practice, whereas only 13 per cent of
orthodox general practitioners thought in this way. This is
surely a most important difference. It points to the fact that
many alternative practitioners don't hesitate to assume the role
of guide, guru, shaman or what you will. In other words, they are
not content to confine their activity to giving fairly mundane
advice about diet, exercise, and the avoidance of stress, but
believe that they can communicate to their patients a wider
vision of human nature and its relation to spiritual forces.
In this respect the alternative practitioners are reverting
to an older view of the place of the healer. In many traditional
societies, healing and religion were closely connected; in fact,
healer and priest were often one. The shaman was a man or woman
who had undergone certain initiations, often of a very exacting
kind, that enabled him or her to communicate with the spiritual
world and to mediate between that world and ours. Practices of
this kind were not confined to so-called 'primitive' peoples such
as the tribes of Central Asia or the North American Indians; they
persisted in one form or another into Classical times and even
later.
The use of dreams as an aid to diagnosis, for example, was
widespread in antiquity, and patients would visit well-known
shrines in order to sleep there and have dreams which would be
interpreted by the resident priest, who would then prescribe the
necessary treatment. And even the medicine of the ancient world
(for example, that corpus of knowledge ascribed to Hippocrates)
preserves a good deal of its religious origins.
Gradually, however, conventional doctors abandoned this
connection with religion and the spiritual. We find little
evidence of it, for example, in Galen's writings, and by the time
we reach the rational eighteenth century the physicians of the
day are eager to distance themselves as much as possible from any
such cultic connections. In our own time this separation has
become pretty well complete. For example, the phrase 'a good
bedside manner', which some thirty or forty years ago could still
be applied to a physician as a term of praise, today has
connotations of the slightly bogus if not of outright
charlatanry; it is taken to imply the use of positive suggestion
beyond the limit of reputable practice. Modern doctors insist on
their scientific credentials and on objectivity.
Alternative practitioners are seldom sufficiently detached
from the prevailing climate of opinion to ignore science totally,
but they reinterpret it in their own terms. And this is an
important part of the appeal of the alternative therapies for
many people. Even the most way-out practices usually have at
least a veneer of science, but they are also perceived as
partaking of the spiritual dimension. Hence their practitioners
and their patients can claim the best of both worlds.
The wish to link the spiritual and the mundane in this way
is surely valid in principle. Given that many patients do come to
therapists (of all kinds) with problems that are not amenable to
treatment in the ordinary sense of the word, there really is no
choice. Either the therapist has to do the best that he or she
can, or the patient must be sent elsewhere. But to whom? To a
psychiatrist? Sometimes that is the right solution, but not very
often. To a priest? Yes, sometimes; but not many patients these
days want an overtly religious solution, and in any case, many
clerics, at least in the West, appear to be quite as much at sea
about what they believe as the rest of the population -
sometimes, one suspects, even more so.
The therapist must often, therefore, fall back on his or her
own inner resources. This presupposes that he or she has some
kind of metaphysical framework to rely on, or has at least given
the matter sufficient reflection and attention to have something
to offer. A conventional medical education today clearly does not
supply anything of the kind. The strength of many alternative
practitioners is that they have found some kind of Answer that at
least satisfies themselves and may appeal to other people as
well. Admittedly some of these Answers may well appear bizarre to
many uncommitted outsiders, but there are likely to be some who
will find them to be what they have been looking for.
Probably the person who has understood this need most
clearly in modern times was C.G.Jung. His form of psychotherapy,
which he called analytical psychology, is professedly scientific;
he himself always insisted that he was a scientist and based his
ideas on practical observation. But however this may be, there is
no denying the fact that Jung's ideas and methods have many of
the features of alternative psychotherapy, especially the use of
dreams as the gateway to the unconscious.
As is well known, Jung paid an enormous amount of attention
to religion. Indeed, he is on record as saying that all those
middle-aged patients with whom he worked who achieved a
substantial degree of self-integration (which he called
individuation) did so because they succeeded in resolving a
religious dilemma, in the widest sense of the term.
But although Jungian analysis might be described as
alternative psychotherapy, at least in the sense that it is not
fully accepted as valid by mainstream psychiatry, it emphatically
could not be accused of sentimentality or refusal to face facts.
Many of Jung's own patients were middle-aged, and this is still
true of many people who undergo Jungian analysis today. (The term
'midlife crisis' originates with Jung.) A Jungian analysis is
therefore very likely to lead, at some stage, to an encounter
with the idea of death, and facing this and other unwelcome
thoughts is a central part of the process of 'individuation'.
What follows from all this is the perhaps rather
uncomfortable conclusion that the only therapists who can help
people to encounter the deep problems - incurable illness,
awareness of death - are likely to be those who have at least
begun to resolve these questions for themselves. It probably
doesn't matter so much exactly how they have done so, although
certain paths are intrinsically more promising than others; but
what does matter is the personal qualities of the woman or the
man who is conducting the therapy.
I should not wish to imply that this is necessarily a matter
of arriving at a formal set of metaphysical or religious beliefs.
Indeed, it may be that what some people need is the ability to
transcend belief systems that have become too constricting. This
often seems to be true of patients whose suffering stems in part
from the fact that they are perceiving their life situation too
exclusively from one narrow point of view.
Yet still we are not at the core of the matter. Maybe it is
really the word 'therapy' that we keep stumbling over, for it
implies that there is something 'wrong' that needs to be 'fixed'
by the expert. But perhaps we should do better to stop thinking
so much in terms of health versus disease.
Many patients come to alternative therapists with a request
for a 'natural' form of treatment. As we have seen (p.000), the
word begs many important questions. But even beyond this, perhaps
the whole idea of 'treatment' - the implied model on which it is
based - is inappropriate for some people. Perhaps some of us need
to abandon the notion of an expert therapist 'treating' a
'patient' and instead to think more in terms of a dialogue
between two people caught in the same situation.
A dialogue of this kind naturally demands a fair degree of
maturity in both participants, and it is by no means what is
needed in every case. But there are times when the so-called
therapist will be best advised, not to prescribe a medicine,
whether natural or not; not to stick needles into the 'patient';
indeed, not do anything at all, even to give advice about life
style or anything else, but simply to listen and to reflect back
the situation to the sufferer without making a judgement or a
recommendation about what to do or not to do. The result of this
can be an increased willingness to accept things as they are, and
to recognize that ill health, aging and death lie in wait for all
of us in one form or another.
If we can do this, without making up metaphysical theories
to account for our situation and without trying to explain it
away, there may be a way forward. It isn't an easy one, for it
requires the development of an ability to tolerate physical and
mental discomfort and uncertainty. Our minds dislike uncertainty
and much prefer the apparent security of fixed views. But we have
it on good authority that it is by facing uncertainty that
ultimate freedom from suffering can be attained. Speaking of his
own experience on the way, the Buddha said: "If I stood still, I
sank; if I struggled, I was carried away. Thus by neither
standing still nor struggling, I crossed the flood."
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[End.]
