by clicking the arrows at the side of the page, or by using the toolbar.
by clicking anywhere on the page.
by dragging the page around when zoomed in.
by clicking anywhere on the page when zoomed in.
web sites or send emails by clicking on hyperlinks.
Email this page to a friend
Search this issue
Index - jump to page or section
Archive - view past issues
Chiropractic Journal of Australia : CJA June 2012
Chiropractic Journal of Australia Volume 42 Number 2 June 2012 49 themselves; on their idiosyncrasies (fear, motivation to get well, compliance with instructions, home care, etc.); on types of health care systems; on cultural origins or professional situations. In his discussion of health care systems Ivan Illich noted that patients who were self-employed were eager to get well, whereas those who were employed might be eager to be off work.34 At least till the economic meltdown! In many instances patients impose a style of partnership: they may ignore or resent the proclaimed holistic motto and merely expect to be treated for signs and symptoms that they have diagnosed. Guidance and counselling imply patients’ active participation. Practitioners are thus expected to take into account what is not readily observable but may organize apparently incoherent data in order to establish a diagnosis and a therapeutic program. In this asymmetric encounter they should beware of value judgments and of the risky situation of tutor or paternal authority. Needless to say that they may be perplexed with such demanding requirements, their scope of practice, and legal obligations. Cooperation of several professionals may be necessary. Anxiety and Expectations Our contemporaries have ambiguous feelings toward biomedicine. Medical expertise and widely publicised advances, sometimes ephemeral, support strong demands. However when ill persons become patients they discover that practitioners may hesitate on diagnoses and treatments; they feel that they are treated as fragmented consumers who should abide by, rather than participate in, administrative and therapeutic protocols. Impaired health is a life adventure that is not always recognised to patients’ satisfaction. Social groups and individuals have an intuitive perception of this situation. This may explain the persistence of explanations that associate medical knowledge, psychological and symbolic interpretations, popular and exotic beliefs, but illustrate satisfactorily illness and sickness. As patients realise the sometimes inevitable poor compliance of one or several physicians, psychologists, or chiropractors, with their expectations and subjectivity, when partnership is inadequate or awkward, they are likely to turn to other practitioners, according to their claims and repute, in an attempt to compensate for the limitations of approaches that do not fulfl queries for signifcation. A broad array of procedures is on the market and anxious sufferers may engage on disconcerting itineraries from one method to another, the more so if the condition is chronic. In spite of apparently illogical attitudes, these initiatives show determination and desire for autonomy.35 They are also meaningful since sufferers expect a message that appears to re-establish harmony in a devastating confusion, and to soothe the symbolic body of intimate self, as much as a therapy that complies with standardised protocols. A remedy, or a chiropractic adjustment, or a ritual, is more than a technical procedure; it is a message. Even if it is a lie as a procedure (e.g. placebo, sham chiropractic adjustment), it is not a lie as an interpersonal relation, as a psychological mediator. The role of suggestion in practitioner- patient relationships has been extensively studied. When biomedicine or any other method fail to take into account existential perspectives they may awake resentment and justify to resort, at least feetingly, to methods that seem to privilege a humanistic attitude even though they may be unsubstantiated. AN ELUSIVE ENDEAVOUR The multifarious holistic quest permeates cultural backgrounds, societal circumstances, individuals’ attitudes and roles. It is strongly infuenced by state of the art in scientifc felds, by ambiguity of public health policies, and by interpretations of health care methods. What is its actual signifcance in demanding modern societies, highly competitive and individualistic, together eager of technical procedures and of naturism? Consideration of multiple causations, intricate situations, and ill-defned expectations may paradoxically, after an apparently enriched clinical picture, result in uncertainty. It may indeed be diffcult to assign the precise role and import of factors that are intertwined in not necessarily logical interactions. Equating different felds of knowledge, different levels of reality -- measurable observations, representations, and metaphors; some tested, some subjective, some symbolic – may blur the clinical picture rather than refne it in a heuristic manner. For these reasons it is frequently diffcult to appreciate patients’ health past immediate assessments. With respect to worldviews of religions and esotericism, they belong to belief systems and should be shared by practitioners and patients unless they are imposed on the gullible. In frequent cases the ambitious motto of holistic care may be used indiscriminately and turn into a catch-all terminology or a washed-out invocation that appears to give coherence to all sorts of vain speculations. Being highly polysemic, the term holism should be understood as a notion (a useful tool) rather than a concept. Successful discourses, such as interpretations of holism, or energy and vital force, originate “as socially engendered linguistic practices.” They refect representations and may associate inconsistent or contradictory data: “They cohere not because of inner logic or empirical proof but because networks of conditions and practices hold them together.” 36 Discourses have strength and power; they exercise infuence regardless of their adequacy to truth or reality. What actually matters is symbolic meaning and belief. The holistic quest may be an endeavour, essential although elusive, to maintain individuals as full-fedged persons. It will be in vogue as long as needed in contemporary societies. For all these hurdles holism in health care seems to be an evanescent objective rather than a reality. It has been interpreted as the biopsychosocial model which is a middle course likely to compensate for rigid reductionism or extravagant holism, and to maintain the analytical approach that cannot be dispensed with. Beyond this model, beyond the defnition of techniques and protocols, the ailing person is different from a technical object: biology is still rebuffed by life and its enigmatic character; and by puzzling relationships between body and mind. A subtle blend of humanities, social sciences, and technical expertise is therefore desirable at a time when health care and societies face complex challenges. It should also be remembered an exceptional dimension of “skillful patient-practitioner interaction.” Good old TLC HOLISM IN HEALTH CARE JOLLIOT
CJA March 2012
CJA September 2012