Wednesday, July 14, 2010

Health Care Needs A Fundamentally New Approach

Introduction:

While modern medicine has made great strides, in terms of health care of the population the diagnosis and treatment of diseases has become more complex and expensive while the disease burden remains high.

There is a lesson to be learnt from the many alternative systems of medicine, which consider mind-body-spirit as an integrated whole.[1] Because of their simplicity and demonstrated efficacy, these wholistic systems have become increasingly popular throughout the world. There is a general perception among academic circles that modern medicine complimented with alternative systems of medicine has therapeutic benefits. However the reason why the wholistic systems work has not been enquired into.

The focus of this article is to show that there is enough scientific evidence for the presence of a spiritual dimension to the human structure and function, which accounts for the apparent success of "mind-body-spirit' systems of medicine. The spiritual dimension when understood and harnessed has far reaching implications on how modern medicine is taught and on the way diseases are managed.

What is Health?

The World Health Organization has defined health as a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity. Some people do enjoy such a state of complete wellbeing. Their life is in harmony with themselves as well as the world around them. They feel contentment and enjoy peace; they understand problems pertaining to themselves as well as the world around them and are inclined to solve them. This is the state of spiritual wellbeing, which can be felt and enjoyed but is difficult to be expressed in words. The state of complete physical, mental and social wellbeing referred to by the WHO, in reality implies an all-encompassing spiritual dimension perceivable by the individual.

Spiritual Dimension:

Modern medicine is based on objective evidence. The physician makes use of knowledge based on the truth of science. The feeling of spiritual wellbeing is subjective truth, which is equally true from the physician's point of view. The epistemology or the grounds of knowledge may be different, yet it makes no difference from the point of view of application of that knowledge. While modern medicine offers solutions to problems affecting the tangible dimensions, due to epistemological reasons it is unable to consider health in its totality, which includes the spiritual dimension. It is left to the individual physician to grasp this subjective truth and suggest remedies to problems viewed best from this perspective. The emergence of stress-related diseases as a major problem in recent times has focused attention on the spiritual dimension.[2]

The Basis for Spiritual Wellbeing:

If spiritual dimension of health is a fact then there should be a basis for it, just as body has matter as its basis and the mind has thought as its basis. The basis for spiritual dimension is a subtle faculty within us called Spiritual Intelligence. While cognitive intelligence (IQ) is about "thinking' and emotional intelligence (EQ) is about "feeling', spiritual intelligence (SQ) is about "being'.[3] Acquiring an integrated view of oneself and the environment is necessary for the individual's feeling of contentment or the bliss of "being'. This bliss of "being' may be termed as spiritual bliss to distinguish it from sensory bliss or bliss related to the senses.

Spiritual intelligence comes into play whenever the individual dwells on his 'self' or "the individual's perceived reality', a process that happens on and off and underlies our consciousness. The "inner self' (also called "pure consciousness' or "Self') is reached and experienced as pure bliss in deep sleep. While the "self' perceives duality and is subject to a variety of feelings, the "inner self' perceives unity and experiences pure bliss. Once this core reality of blissful "being' is reached, all information in a person's life is reconciled around it. A person waking up after a good deep sleep feels refreshed and blissful. This feeling of pure bliss fades once the individual starts perceiving the world of duality. Shortfall in the process of reconciliation around the core of pure bliss, results in stress or absence of spiritual wellbeing.

Maintaining Spiritual Wellbeing:

Thus we understand that the state of spiritual wellbeing and the total health encompassed by it ultimately rests on our spiritual intelligence, though most of us are not aware of this faculty. A person in normal health subconsciously maintains his spiritual wellbeing through his built-in spiritual intelligence. He is able to enjoy the bliss of his "self', which is refreshed and sustained by the pure bliss of his "inner self'. However spiritual intelligence can also be voluntarily cultivated to heal stress related disorders.[4] Meditation is basically a method of cultivating spiritual intelligence. It is a method of consciously transcending one's "self' to reach the "inner self'. Meditation enables the individual to perceive in reality the pure bliss of the "inner self'. A fleeting perception of this bliss occurs in the twilight zone between a good sleep and the fully awake state. Keeping the mind focused on this subtle perception of pure bliss is a simple method of meditation that can be practiced by all. Constant contemplation of the pure bliss of "inner self' helps to restore spiritual wellbeing and heal stress.

While we understand the value of meditation for healing stress in a given patient, we also gain insight on how physician's themselves can enjoy lasting spiritual wellbeing and thus stand to gain personally and professionally by practicing the technique of meditation in their daily lives.

The Pathophysiology of Diseases:

While the disruption of spiritual bliss and its healing through the process of meditation can be easily appreciated in stress-related disorders, the new science of psychoneuroimmunology indicates that spiritual wellbeing needs to be taken into consideration while understanding the pathogenesis of nearly every disease,[5] [6] [7] including the so called physical diseases. Studies indicate that the psychoneuroimmuno axis is at work in many disease states and this may determine the outcome of disease processes.[8] [9] Since the state of the mind largely depends on the state of spiritual wellbeing, it is evident that all diseases need to be considered not merely from the body or mind-body perspective but from a wholistic mind-body-spirit perspective.

The Art of Healing:

It is well known that good practice of medicine is both a science as well as an art. The "art of healing',[10] largely depends on the quality of empathy[11] present in a physician. A compassionate physician presumably acts a catalyst for healing through the patient's own built-in mechanisms. The role of the physician in providing the humane touch is crucial, which cannot be replaced by any technology. Being a good listener, speaking a few kind words and spending a few more minutes with a sincere body language may be all that is needed to have a healing effect on the "self' of the patient. Modern medicine becomes "modern mind-body-spirit medicine' when the physician incorporates the "art of healing' in his professional practice.

From being considered merely as a desirable virtue, it is time for the "art of healing' to be considered as a basic component in any attempt to restore normal health from a diseased state.[12] Ignoring this fact and viewing disease merely from a body or a mind-body perspective would amount to intervening into a problem that may be causally downstream while a possible cause upstream is left unattended. The current bio-medical approach, which considers body and the mind as the basis of health is truth but not the whole truth.

Medicine - the present and the future:

The world of medicine today is based on scientific lines and the quality of empathy is considered desirable among health care providers rather than as a basic necessity. The bio-medical approach to health and disease has made the delivery of health care predominantly lab-oriented and mechanical. Valuable resources are spent for understanding the physical aspects of disease, while the bigger picture that includes the spiritual dimension is neglected. Increasing technological sophistication is valued more than the therapeutic potential of physician's compassion. As a result tertiary care gets preference over primary care. The society as well as the medical professionals themselves, finds physician-based primary care unattractive.

Inevitably, the consequence of this is felt in the way medicine is taught to students. An impersonal "matter of fact' approach is appropriate to teach the physical, mental and social aspects of diseases. In the absence of an academic framework to teach the spiritual aspect, students are not briefed about it and frequently fail to gain spiritual insight. Setting a personal example by practicing the "art of healing' while treating patients is an effective way of teaching the spiritual aspect. However in the academic setting there is need for this effort to be supplemented by a curriculum that is built around the core of the individual's spiritual wellbeing. The importance of cultivating and maintaining spiritual wellbeing by the physician himself so that he can practice the "art of healing' needs to be emphasized.

Conclusion:

The basis of health and the pathogenesis of diseases have subtle spiritual underpinnings necessitating an integrated mind-body-spirit model of health and disease. The importance of spiritual wellbeing of the patient, its influence on the mind and consequently on the healing process of the body have been highlighted by recent advances in psychoneuroimmunology. Disease management becomes more effective if the patient's own immune mechanisms are harnessed through the age-old "art of healing'. Medical education being a key input in disease management needs to be suitably modified to emphasize the central role of spiritual wellbeing and the value of the practice of meditation by the physicians themselves.

Modern medicine is at cross-roads. With further scientific developments modern medicine would continue to benefit from newer technologies. At the same time what is immediately required to improve the effectiveness of modern medicine and decrease health care costs would be to formally integrate the "art of healing' with the science of medicine. Incorporating the philosophy of mind-body-spirit medicine within the medical curriculum and health care structures would, in addition, place the job of the primary care physician at a higher level. Health care thus needs a fundamentally new approach to address the twin problems of escalation of costs and increasing neglect of primary care.

References: (All references accessed on June 2, 2010)

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10. Bernard Lown: The Lost Art of Healing. BMJ 1997 (20 Sept.); 315:755 http://bmj.bmjjournals.com/cgi/content/full/315/7110/755

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