Last week I discussed the book Healing, Hype, or Harm? edited by Edzard Ernst. I was particularly struck by one of the essays in that book: “Healing but not Curing” by Bruce Charlton, MD, a reader in evolutionary psychiatry at the Department of Psychology of the University of Newcastle upon Tyne.
Charlton proposes a new way of looking at CAM. He describes three common attitudes:
- CAM does good and should be integrated with orthodox medicine.
- CAM is worthless and should be discarded.
- CAM may or may not do good and this should be decided using science.
He rejects all three. In his view,
- Alternative therapies do good.
- From a strictly medical perspective they are worthless.
- They should not be integrated with orthodox medicine.
- Because they are explained non-scientifically, they cannot be evaluated using the criteria of medical science.
He suggests that alternative therapies be regarded as spiritual practices. They are about making people feel better (‘healing’) not about mending their dysfunctional brains and bodies (‘curing’).
This struck a chord with me. I remember watching a TV documentary on the Brazilian healer John of God. They interviewed a woman who had rejected conventional treatment for breast cancer and was dying of that cancer but who considered John of God’s treatments a success because she felt better psychologically and was more accepting of her fate. She was not cured; she was dying. But she felt she was “healed.”
Acupuncture is based on mythical meridians, chiropractic on a mythical subluxation, and homeopathy on magical thinking. They are among the most successful and professionalized of alternative therapies. The basis of lesser methods like crystal healing and aromatherapy are even more imaginative and less scientific. These methods all remain popular despite the fact that after decades or even centuries of experience “there is not one clear-cut instance in which any alternative therapy is unequivocally effective and indicated for any particular disease or symptom.” CAM clearly constitutes a different, nonscientific universe of discourse.
CAM is far more compatible with New Age spirituality, which “focuses on
subjective psychological states such as integration, authenticity and self-expression.” Old spirituality was the province of organized religion and churches; this new spirituality “consists of individuals pursuing their own spiritual goals in their own way.” In New Age healing, “…what matters is the subjective ‘meaning’ to the individual – the self-evaluated effects it has on a person’s sense of well-being.”
When cancer is cured by surgery or chemotherapy, the patient is better off in the long run but feels worse in the short run from the effects of the operation or the drugs. When pneumonia is cured by antibiotics, the patient usually feels better; but even if he doesn’t, the cure is worth having.
…orthodox medicine must cure, and should aim to heal – but it does not need to heal; while alternative therapies do not cure – so they must heal in order to be worthwhile.
Concepts like meridians serve as myths, poetic symbols that have personal meaning. When CAM talks about “energy” it refers to a positive subjective sense of vitality and harmony that has nothing to do with the definition of energy in physics. Patients find concepts that have intuitive validity for them. It’s a matter of “what works for me” – individual experience is the ultimate authority.
When science is talking about demonstrating facts and treating disease and CAM is talking about reaching subjective personal and spiritual goals, there can’t even be any meaningful communication. It is misguided for CAM to seek validation through scientific studies.
Alternative medicine will survive and grow most effectively by dropping its scientific pretensions and becoming candidly mythic, poetic, fictive, symbolic, metaphorical and fantasy-based.
…randomized trials of New Age therapies are as inappropriate as randomized trials of prayer or the enjoyment of Mozart – such investigations will inevitably be inconclusive, confusing and irrelevant.
…so long as the therapy does no significant harm, intuitive benefit is the beginning and end of evaluation in alternative medicine…alternative therapies are neither medical nor scientific, but they should be respected as a potential contribution to modern spiritual well-being.
Charlton envisions a future where both scientific medicine and CAM thrive, but separately. I find it difficult to imagine how this could come about. CAM recognizes that science matters, and it will not willingly give up its scientific pretensions. And I don’t envision the average patient having the judgment to decide when to see an MD and when to see a CAMtherapist.
I don’t think his proposal is practical, but I do think he has hit the nail on the head about the meaning of “healing” and its role in explaining the attraction of CAM. Pain is not the same as suffering. Curing is not the same as healing. It behooves us to keep this constantly in mind.
This article was originally published in the Science-Based Medicine Blog