Richard Sobel, MD

Ben Gurion University of the Negev, Israel

Origin of the term

Jan Christian Smuts (1870-1950)—general, statesman, twice Prime Minister of the Union of South Africa, and philosopher, published his political treatise, “Holism and Evolution,” in 1926. It is said that Albert Einstein thought Smuts was one of only eleven people in the world who understood his Theory of Relativity. Conversely, Einstein believed that Smuts’ Theory of the Whole was equally as important. The Theory of the Whole says that every whole, starting with a subatomic particle, is driven to evolve into a larger whole, the biologic pinnacle being the “human personality”—the "apex of perfection”.1 Holistic philosophy states that “what a thing is in its sum is of greater importance than its component parts”.1 In this philosophy, nature is regarded as consisting of constantly evolving wholes that are greater than their parts. In politics, a village evolves into a town, a town into a city, and so on. Einstein may have overestimated the importance of “Holism and Evolution” but the treatise did serve to introduce the term “holism.”

“Holism” is the Greek word holos for “whole,” used by Smuts to define an evolutionary drive for progressively more complete wholes. Holism and wholism are interchangeable, as are holistic and wholistic. When you Google the term, “etymology” and the words “holism,” “holistic,” “whole,” “hole,” “holy,” you will find yourself in a historical hall of mirrors that reflects linguistically linked etymons. Holism, whole, hole, holy, hal, hollow, holos, halig, health are all part of an extended family stretching back to ancient Greece and Old English, with relatives in Germany, Denmark, and elsewhere. The common threads that tie the words together are two senses of whole: a reference to completeness, intactness, perfection, and a reference to a state of soundness and health.2 These two strands may be explained by the different Indo-European roots of the Greek “whole,” (solo which has to do with solid) and the Indo-European root of the English “whole,” (keilo which has to do with hale, healthy).3 So, if holism and wholism have the same meaning, why not speak of wholistic instead of holistic medicine?

Holistic medicine

This is a New Age term. Physicians practicing an alternative medicine, whatever they choose to name it, have appropriated the word holistic to describe their philosophy of medicine.4 Holistic medicine asserts that it attends to all aspects of well-being: physical, mental, emotional, spiritual, environmental, and social. It claims to meet this remarkable but utopian goal by using all species of alternative, complementary, and integrative medicine-- mostly implausible and rarely evaluated scientifically to establish a meaningful benefit. As applied to medicine, “holistic” is a euphemism for non-conventional medicine. Considering that alternative medicine is based more on faith than on science and that believers are often humorless about the subject, perhaps “holyistic” would have been a better term. Ironically, Smuts' construct was not especially spiritual or transcendental: there is a complex ultimate Whole Watch but no Master Watchmaker, just an intrinsic evolution of wholes.1 Although holistic medicine does look at the whole person, the connection to Smuts’ theory seems tenuous, perhaps adopted because it is catchier than wholistic.

Why not holistic?

A patient, on learning that a physician is holistic, can correctly assume that this physician will relate to him as a whole person and not as a disease. He can also assume that the physician uses non-conventional diagnostic and therapeutic tools in addition to, or instead of, conventional ones. But what then, does this imply about a physician, like me, who is not holistic?

Besides the occasional referral of a patient disabled by anxiety symptoms to an internist who teaches him helpful techniques of stress control, I limit myself to conventional methods of diagnosis and treatment. I accept the concept of evidence-based medicine (EBM) while recognizing that this is far from the Holy Grail, as its consensus guidelines are sometimes based on weak evidence and are less useful than a thoughtful review by someone who has worked in the field for a lifetime. But I take issue with the philosophy of holistic medicine, whether attainable or not, because it implies that a physician who is not holistic is second rate and lacking in something critical to the patient’s well-being.

Additional principles of holistic medicine include a relationship with the patient that respects his autonomy, recognizes the uniqueness of the individual, pays attention to lifestyle and disease prevention, and sets an example for the patient.4 Non-holistic physicians share these basic practices but disagree on their execution--for instance dietary advice is quite likely different. Conventional and holistic physicians part ways entirely when it comes to more numinous, elusive principles, such as evoking innate powers of healing and applying the healing power of love—although being a conventional physician does not preclude humane patient-physician encounters.5

What then should a patient expect from a physician who does not practice holistic medicine? It could be a nightmarish experience: an invasive procedure performed by a physician who is insensitive, detached, paternalistic, and interested only in the procedure itself. This is one of the reasons why patients who desire a totally different reception may chose holistic physicians. It is more than likely however, that the experience with a conventional physician will be no less satisfactory than a visit to a holistic physician. Furthermore, if the patient’s problem is primarily a physical one for which an effective treatment is available, any added holistic treatment may be more ornamental than useful.

The paths of holistic and conventional medicine diverge when the patient’s symptoms defy explanation, when there is no effective treatment and even symptomatic relief fails because the limits of medical knowledge have been reached. The conventional physician will be dismayed, but will recognize this. The only rational hope for the patient at this point is that the physician will not abandon him and that an advance in basic scientific research may come soon enough to be of help, which generally is a dim prospect. By contrast, a holistic physician is more likely to offer treatment of some kind—an herb, a dietary change, a hands-on physical technique—along with a lack of recognition that a limit has been reached. This refusal to recognize limits is a bedrock difference between conventional medicine, which recognizes its limits, and holistic medicine, which doesn’t. This willingness to give false hope is a dangerous and harmful flaw, a large hole if you will, in holistic medicine.

Conclusion

Non-conventional medicine, however we choose to label it—alternative, complementary, integrative, or holistic—is here to stay. The label, “holistic medicine” is particularly troublesome because it suggests that it is a more complete and satisfactory approach than conventional Western medicine. This implication is as unfortunate as it is untrue. Ultimately, it is the failure of non-conventional medicine to recognize limits to knowledge and the advocacy of false hope that makes holistic medicine a hazardous choice for patients.

Notes

  1. Armstrong, HC. Grey Steel (J.C.Smuts): A study in arrogance. Middlesex England: Penguin; 1939.
  2. Webster’s English Unabridged Dictionary of the English Language. New York: Gramercy Books; 1983.
  3. Aronson, J. When I Use a Word: Wholly, holy, holey. BMJ 2003; 15:392.
  4. Principles of Holistic Medicine. American Holistic Medical Association. Accessed at http://www.holisticmedicine.org/displaycommon.cfm?an=1&subarticlenbr=1. Retrieved 24 September 2008.
  5. Sobel, R. Beyond Empathy. Perspect Biol Med 2008; 51:471-478

 


DR. RICHARD SOBEL is an Associate Professor of medicine at Ben Gurion University of the Negev in Israel and works part time in the Endocrine Clinic at Soroka University Hospital. He also teaches a course in Medical Humanities for the Columbia-BGU School of International Health. His 50+ year medical career has always been a combination of tertiary care academic medicine and small town or kibbutz primary care.