Mind, Body and Soul in Healthcare
Actuarial thinking about health and disease is, perhaps unthinkingly, entrenched in the biomedical paradigm. It has served actuaries in life, health and disability products well over many years but the paradigms around us are changing and a “brave new world” of energy and vibrational medicine is emerging.
Helman1 tells us that from an anthropologists perspective, a society’s healthcare system cannot be studied in isolation from the social, religious, political and economic organisation of that society. We should thus not be surprised that as these other elements are challenged in societies around the world, so too are the paradigms of healthcare being challenged. Tarnas2 speaks eloquently of the thinking that has shaped our Western worldview, of the paradigm shifts that have occurred before and what we are now experiencing. We need to accept that our old worldview is changing – and very rapidly.
We are in the midst of a change in paradigms in understanding health and dis-ease and hence the forms of healthcare that are used for treatment. We are moving away from healthcare that was developed in the West in a biomedical paradigm, a Newtonian paradigm. We are moving rapidly to a new paradigm based on Einsteinian thinking and one of humans as energy beings. Body, mind and soul. It means that healthcare actuaries will need to think of what it means for treatment options, funding and our approach to underwriting.
Although terminology is sometimes problematic, the term ‘biomedicine’ is the preferred term for what some have called conventional medicine, scientific medicine, Western medicine or allopathic medicine. It is the dominant system of medicine in the West and is the one on which actuarial work has almost exclusively been based.
Helman describes medical anthropology as the study of how people in different cultures explain the cause of ill health, the types of treatment they believe in, and who they turn to when they are ill. He reminds us that biomedicine has organized itself to become the legally-sanctioned profession in the industrialized world but that for all its power and prestige, biomedicine provides only a small proportion of healthcare in most parts of the world.
The World Health Organization (WHO)3 says that between 70% and 95% of people in Asia, Africa, Latin America and the Middle East use traditional medicine for primary health care. Traditional medicine, when used in other parts of the world from where it originated, is called complementary and alternative medicine (CAM), or simply complementary medicine. Surveys of consumers in recent years have shown substantial growth in the use of complementary medicine and the WHO 3 says that in developed countries usage is equally significant. The examples of Canada, France, Germany and Italy are given where between 70% and 90% of their populations have used some form of complementary medicine.
Biomedicine has as some of its basic premises1: an emphasis on physiochemical data; mind-body dualism (mind and body are separate); the view of diseases as entities (the germ-theory of disease which proposes that microorganisms are the cause of many diseases) ; reductionism (a concentration on a particular organ or system or type of cells); and an emphasis on the individual patient (rather than the family or community).
Biomedicine has usefully adopted a paradigm of the body-as-machine with mind as the computer or controller1. The machine and engine metaphors are a product of our industrial society and have served medicine well for the last century. We think of the heart as a pump; the arteries and veins as tubes in which pressure and flow can be measured; food as fuel; and the idea that worn-out or damaged parts can be replaced. Mind is conceived of as a computer or controller with metaphors of the storage of information and processing of information. Mental illness thus comes to be seen as requiring re-wiring or re-programming of the mind, either electrically or chemically.
Complementary medicine on the other hand, for all its diversity, has a different paradigm and uses a different set of metaphors. Coulter4 describes the philosophical basis as encompassing: vitalism (dealt with more thoroughly below); holism (the balanced integration of body, mind and spirit, as well as interpersonal relationships and our relationship to nature); naturalism (the body has by nature the capacity to heal itself); therapeutic conservatism (Hippocrates’ dictum of “First do no harm”); humanism (recognition of the personal, social and spiritual aspects of health, not just the biology of health) and critical rationalism (knowledge is not objective but can and should be rationally criticized).
Vitalism is the core understanding that holds the divergent complementary medicine modalities together. Coulter4 describes vitalism as having a very long history in health: “[vitalism] accepts that all living organisms are sustained by a vital force that is both different from and greater than physical and chemical forces”.
As befits a force which our current state of knowledge makes it difficult to measure or quantify, there are explanations ranging from “vix medicatrix naturae” (the healing power of nature), to the metaphysical and supernatural. The name for this force varies across cultures; qi in Chinese medicine, ki in Japan, gi in Korea, prana in Ayurveda (the traditional medicine of India), and pneuma or spirit in Unani Tibb (the traditional medicine of Islam, derived from ancient Greek medicine. In the West, names used include vital force, bioenergy, vital spark, élan vital and soul.
Mayor & Micozzi 5 examine the history of the phenomenon of a vital force and quote the Nobel prize winner Szent-Gyӧrgi as saying: “In every culture and medical tradition before ours, healing was accomplished by moving energy”.
A prescient book by Gerber entitled “Vibrational Medicine”6 was one of the earliest texts by a Western doctor trying to bring together the knowledge of traditional medicine traditions in a new paradigm for understanding the human body. He refined his thinking over the next 15 years and in a later book7 said:
“The current practice of medicine is based upon the Newtonian model of reality. This model is primarily a viewpoint which sees the world as an intricate mechanism. Doctors conceptualize the body as a type of grand machine which is controlled by the brain and peripheral nervous system: the ultimate biological computer.” … “This book is a new viewpoint of healing that encompasses an evolving picture of matter as an expression of energy. This new field of healing, based upon the Einsteinian paradigm, is called vibrational medicine”
“The Einsteinian paradigm as applied to vibrational medicine sees human beings as networks of complex energy fields that interface with physical/cellular systems. Vibrational medicine uses specialized forms of energy to positively affect those energy systems that may be out of balance due to disease states. By rebalancing the energy fields that help to regulate cellular physiology, vibrational healers attempt to restore order from a higher level of human functioning”.
Gerber goes on to link what had previously been seen as different systems of healing, showing how homeopathy and flower essences, Traditional Chinese Medicine and acupuncture, Ayurveda, the use of sound and light, and energy therapies like radionics are all understood in this paradigm of humans as energy beings.
In a foreword to Gerber’s book, Professor William Tiller of the Department of Material Sciences and Engineering at Stanford University described his personal view, which goes much further: “We are all elements of spirit, indestructible and eternal, and multi-plexed in the divine. We contain a unique mechanism of perception which is mind. In my theoretical modelling, mind consists of three levels – the instinctive, the intellectual, and the spiritual - and mind is postulated to function in a six-dimensional space lattice”.
Actuaries in healthcare have tended to be sceptical about complementary medicine and surprisingly hesitant to include it in product designs. Their reluctance to accept that there may be another paradigm of healing has meant that few health plans are designed to include energy medicine modalities like homeopathy and Traditional Chinese Medicine, although the latter has made inroads as more Western-trained doctors have become trained in acupuncture.
But while actuaries have held back, doctors, healthcare providers and our clients have begun to move dramatically into the new paradigm. And they are not afraid to use the words “spirit” or “soul”. Some examples from the USA, where one might least expect to hear that terminology:
A survey of USA hospitals in 20108 found that more than 42% of responding hospitals indicated they offer one or more CAM modalities, up from 37% in 2007, 26% in 2005 and 7.7% in 1999. An accompanying press release said “Hospitals across the nation are responding to patient demand …. CAM services also reflect hospitals’ desire to treat the whole person—body, mind and spirit.”
b) Kaiser Permanente, the large healthcare group that was the originator of the concept of managed care in the USA in the 1940s has developed an “integrated delivery system” under which complementary medical practitioners, primary care physicians and specialists can share information about patients. Kaiser Permanente says9: “Today more Americans are using complementary and alternative care to help manage or prevent many health conditions. Many adopt them as part of their cultural and personal beliefs and to promote a greater sense of emotional, physical, and spiritual well-being.”
Doctors in the USA are developing a new medical speciality in Integrative Medicine. The American Board of Integrative and Holistic Medicine (ABIHM) describes Integrative Holistic Medicine as10 “an emerging medical specialty that incorporates caring for the whole person — body, mind, and spirit — to treat and prevent disease; and empowering patients to create a condition of optimal health.” The ABIHM goes on to say “Both outside and inside the medical profession, this concept of medicine of the whole person is gathering increasing support. The body-mind-spirit approach integrates many disciplines and modalities, including physiology, biochemistry, nutrition, exercise, environment, emotions, attitudes, beliefs, social relationships, manual medicine, herbs, homeopathy, energy medicine, prayer, acupuncture, meditation, spirituality, and biofeedback.”
In the western world a new group of consumers, the “cultural creatives” has been identified and studied. Ray & Anderson 11 estimated more than a decade ago that 50 million people in the USA and some 80 -90 million across Europe have a shared value system that is changing society. Amongst other values, “cultural creatives” see the world as interwoven and connected, are concerned about sustainability and the environment, authenticity and the equality of women. They tend to be activists and volunteer for one or more causes. Just under half of the group were described as “core cultural creatives” who also value altruism, self-actualization, and spiritual development.
Are actuaries ready to finally bring not only mind and body into their thinking, but mind, body and soul?
I would be interested to hear from those who wish to challenge our current paradigms. Please be in touch.
Professor Heather McLeod
Heather is an actuary by training and has been involved in healthcare consulting since 1993. She has worked extensively in health policy at government level over the last 15 years. Unusually for an actuary, she also studied complementary medicine and was a registered Ayurvedic primary care practitioner, with a particular interest in naturopathy and homeopathy. She has been chair of an IAAHS topic team on traditional and complementary medicine since 2004. She now lives in New Zealand where her primary work is in palliative care for the Ministry of Health. She writes a regular newsletter for ENZCAM, the New Zealand Centre for Evidence‐based Research into Complementary and Alternative Medicine at the University of Canterbury.
[Much of this article first appeared as a guest editorial in the South African Actuarial Journal, Volume 12 (2012). See http://www.actuarialsociety.org.za/Professionalresources/SAActuarialJournal.aspx ]
1. Helman C. Culture, health, and illness. 5th ed. London; New York, NY: Hodder Arnold; Distributed in the U.S.A. by Oxford University Press; 2007:viii, 501 p.
2. Tarnas R. The passion of the Western mind : understanding the ideas that have shaped our world view. 1st ed. New York: Harmony Books; 1991:xii, 543 p.
3. Robinson MM, Zhang X. Traditional Medicines: Global Situation, Issues and Challenges The World Medicines Situation 2011. Geneva: World Health Organization; 2011.
4. Coulter ID. Chiropractic : a philosophy for alternative health care. Oxford ; Boston: Butterworth-Heinemann; 1999:xvi, 117 p.
5. Mayor DF, Micozzi MS. Energy medicine East and West : a natural history of Qi. Edinburgh ; New York: Churchill Livingstone/Elsevier; 2011:xxvi, 393 p.
6. Gerber R. Vibrational medicine : new choices for healing ourselves. Updated ed. Santa Fe, N.M.: Bear & Co.; 1996:601 p.
7. Gerber R. Vibrational medicine : the handbook of subtle-energy therapies. 3rd ed. Rochester, VT: Bear & Co.; 2001:607 p.
8. American Hospital Association, Samueli Institute. Complementary and Alternative Medicine Survey of Hospitals 2010; 2011. URL: http://www.siib.org/news/2468‐SIIB/version/default/part/AttachmentData/data/CAM%20Survey%20FINAL.pdf
9. Kaiser Permanente. Center for Complementary Medicine. Vol 2012; 2007. URL: www.kpccm.org
10. American Board of Integrative and Holistic Medicine. The Creation of a New Specialty. Vol 2011; 2011. URL: www.abihm.org/about-us/the-creation-of-a-new-specialty
11. Ray PH, Anderson SR. The cultural creatives : how 50 million people are changing the world. New York: Harmony Books; 2000:xiii, 370 p.