Critically examine whether complementary and alternative medicines offer a distinctive

understanding of health and illness?

The old scientific discourse of biomedical medicine has encountered a ‘threat’ to its hegemonic

position; the new arising form of health care, the Complementary and Alternative Medicine, has

given birth to a new pluralism in the medical system (Cant & Sharma, 1999). Complementary

and Alternative Medicine can be generally described as a distinctive form of health care that is at

odds with the conventional medicine which mainly subscribes to scientific scrutiny and proof

(Yuill, Crinson & Duncan, 2010). However, this broad definition has been subjected to criticism

because within the area of this complementary and alternative medicine there are significant

differences in their practice and philosophy; for example the degree of ‘holism’ (i.e. discussed in

the main body of the essay) in one practice can be higher or lower than in another. This is also

where the distinction between ‘alternative’ and ‘complementary’ takes place: alternative

medicine totally refuses to recognize any similarity with biomedicine (i.e. conventional

medicine), whereas complementary medicine is seen as an addition and not a challenge to the

orthodox medicine. Nonetheless, this essay will refer to these practices in their totality as

Complementary and Alternative Medicine (i.e. CAM) (Cant & Sharma, 1999; Heller et al., Yuill,

Crinson & Duncan, 2010). This essay will analyze the claims of CAM and their actual impact on

how health and illness are understood, treated and integrated in people’s life and how these differ

from biomedical practice. Thus several different characteristics of the alternative approach are

going to be proposed for this discussion and critically compared to the conventional health care

system. The main CAM aspects such as its: holistic view, individualistic approach, consultation

environment, relationship between patient and practitioner, naturalistic approach, and integrative

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or independent status. These main characteristics will be then considered, explained and

expanded in the main body of this essay so as a better understanding of CAM’s discourse shed

light on its genuine or apparent distinctiveness from conventional medicine.

Firstly, we will explore the concept of ‘holism’ and individualism in relation to CAM. The

concept of health is seen here not just as the absence of disease, which is maintained by

biomedicine, but as a relationship between body and other aspects in an individual’s life such as

spirituality. This philosophy can also be traced back in Western history with the Christian

ideology of morality. The habit of eating meat was seen as a stimulant for weak morals and

sexuality, the ascetic idea of vegetarianism was then promoted for the cleansing of both body and

soul (O’Connor, 1995). Thus, the reductionist attitude of conventional health care, which strictly

deals with parts of the body, as if they were parts of a machine that have to be assembled again

in order to function at their maximum capacity; is confronted by CAM. “By rejecting the

either/or thinking characterizing the biomedical model in favour of multiple realities or ‘ways of

knowing’ CAM allows for a wide variety of belief systems and cosmologies” (Stone and Katz

cited in Heller et al., 2005: 159). The main CAM healing treatments are, however, unique

varying from one alternative practice to another. The more mechanistic way and similar to

biomedicine’s way of dealing with pain is encountered in some osteopathic and chiropractic

approaches, homeopathy and ayurvedic medicine (i.e. traditional Chinese healing practice) are

more inclined to regard illness as an imbalance in the human’s entire system, which does not

only result from the physical components of an individual but from their entire way of living,

their personal health history, how they react to pain and what meanings they attach to different

things. Nonetheless, this can also lead to a clash between the practitioner’s and the patient’s

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belief’s and ideas of what illness is, which can then lead the patient to find another practitioner

that is in accordance with hers or his life experiences and ideas. This also puts the patient in a

position to ‘shop’ for health care, and consume the best alternative for him/her (Cant & Sharma,

1999; Heller et al., 2005; The Open University, 2005). The alternative medicine proposes a way

of living that maintains health and works with the imbalance or illness from the inside, leaving

the body to heal itself; standing at odds with orthodox medicine that is external, which views the

body as a battle field in which the illness needs to be exterminated in order to restore health.

Dissatisfaction with orthodox medicine is being illustrated in many alternative literatures (Cant&

Sharma, 2005; Lupton, 2003; Furnham, 2002), who point at its failure to cure chronic pain and

the lack of disregard for the individual’s personal history that might have an impact on her or his

health situation. In another words CAM “offers more meaning to the patients and allows them to

link their illness to wider cultural, personal and social frameworks” (Cant & Sharma, 1999: 42-

43). Stevenson et.al (2003) also point out that the iatrogentic fear (i.e. the complications that

might appear after taking a specific biomedical treatment or intervention) is also a factor of why

alternative medicine is increasingly sought, however, this will be discussed further on along with

medicalization and the ‘natural’ characteristics of CAM.

Going back to the holistic distinctiveness, the whole idea that: the body can heal itself, that it

maintains a certain balance and harmony in order to function correctly or that it requires the

natural flow of ‘energy’ arises certain problems. Lupton (2003) points out that from an ethical

point of view, alternative medicine does not eliminate the preaching attitude in teaching what is

good or bad in order to function properly and be a ‘healthy’ human being. He also acknowledges

that using the metaphor of ‘energy’ or the ‘flow of energy’ that is being used in many CAM

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discourses may indicate a capitalistic-mechanic mode of production. This also implies that the

individual as a whole (both with hers or his objective and subjective characteristics and not just

the physical body) has to function to its full capacity so as it can be efficiently used in the

production of hers or his life; “it suggests efficiency, a metaphor of the body as productive, not

wasteful or static, but in tune with its environment and expanding in productive possibilities”

(Coward cited in Lupton, 2003: 138). Moreover, even if the patient can better reflect and

perceive his/hers own body and emotions, the empowerment of the individual to self-regulate its

own body, takes much of the responsibility of restoring the health from the practitioner and

bestows it to the patient. This is also being a biomedical critique regarding CAM, that in the end

it is the individual’s own fault if health/balance is not restored (Albrecht, Fitzpatrick &

Scrimshaw, 2003; Siahpush, 2000).More so, blaming the individual and referring only to the

immediate and psychological experience of the individual only distracts the attention from other

underlying causes of illness, that is the social, structural and political impact that may affect the

individuals quality of life. This has been also tied with the self-help movement which is

criticized for being more or less a characteristic of the middle class and also blaming the agent

rather than the structure (Lupton, 2003; Radley, 1999). From a Foulcauldian perspective, the self

regulation of the individual and also in the self- helping groups (e.g. Alcoholics Anonymous

through public confession) can also present themselves as a normalizing practice which replaces

the physician scrutinizing gaze with the practice of personal surveillance, thus “ holism does not

empower the individual, for it does not provide effective social and political analysis of the

causes of ill health ( Cant and Sharma cited in Albrecht, Fitzpatrick & Scrimshaw, 2003: 429)

(Albrecht, Fitzpatrick & Scrimshaw, 2003; Cant & Sharma, 1999; Lupton,2003; Radley, 1999).

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Another distinctive feature of the heterodox medicine in relation to conventional heath care are

the conditions under which the consultation takes place. Jewson (2009) acknowledged that there

has been a major shift regarding the relationship between patient and practitioner after the rise of

modern medicine in the second part of the 18 th century. What he described bedside medicine

was a practice that resembles very much with the alternative care in contemporary western

society; the ‘whole’ patient was the centre of the attention and he/ she were the ones who

discussed the terms in which they preferred to be treated. In other words, the patient was

empowered, he/she had a say in the kind of treatment it was given and the nature of the “disease

was defined in terms of its external and subjective manifestations rather than its internal and

hidden causes. In accordance with this principle diagnosis was founded upon extrapolation from

the patient’s self report of the course of his illness” (Jewson, 2009: 294). Cant & Sharma (1999)

also argue that orthodox consultations are hierarchical and put the patient in a position where

she/he is seen as a broken object that is studied in order to fix it. The consultations in most of the

CAM practice can go up to 2 hours in which patients can develop a kind of relationship with the

practitioner, which can also be seen as a therapeutic treatment and an enabling factor to the

recovery of the patient. However, this lengthy time frame must not be generalized since as we

shall see in the last part of the essay, the integration of CAM in the conventional health care

system might not have the same benefits; for example some more mechanized therapies such as

osteopathic and chiropractic consultations may last only 20 minutes. These qualities, such as the

amount of time spent with one patient and the more equal relationship between patient and

practitioner is perceived to be one of the main reasons for CAM’s growing popularity. In this

environment the body is no longer seen an object but an active participant in its healing. Astin

(1998) argues in one of his study that users of CAM address more often feelings of not being

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well which can be explained by the fact that users are being affected by somatisation (i.e.

somatisation is described as feelings of pain and poor health that are not attributed to

physiological accounts) which can affect further studies in why people seek alternative care and

how this might helps them in their recovery. Moreover, he attributes the new western attraction

for alternative medicine to a new paradigmatic shift in cultural values and beliefs that are more

open to ideas of holism and spirituality.

Cartwright & Torr (2005) and Siahpush (1999) argue that conventional medicine produces

“alienated and dissatisfied patients” (Siahpush, 1999: 160) which is described as a Fordist health

care system; the consultations are short and often practitioners can seem disrespectful with the

patients. In contrast to this, because of the closeness that can develop between patient and

practitioner in a CAM environment, it can offer a more psychological, almost religious need

which can aid patients in making sense of their anxieties; as one homeopathic patient describes:

“I talk these things through... and just talking about them almost gets them out of my system I’m

sure, and then I feel better even without the remedy she is giving to me” (Cartwright & Torr,

2005: 563). The trust of the patient is also gained because in this relationship there is no expert

or ignorant patient but an egalitarian interaction, which makes the distinction between alienated

and active patients. Nonetheless criticisms of this beneficial relationship argue that CAM is more

or less just a placebo effect. That is, the healing of the patient does not depend on the treatment

involved but in the mind of the patient; this means that the healing is perceived and not totally

eradicated. Other shortcoming of the relationships between practitioner and patient is that the

therapeutic side of the treatment might make the patient’s health worst. Secondly, it might result

in a failure to communicate with the practitioner because of clashes in personal beliefs or that

Iulia Maria Coanda Page 6

boundaries between patient-practitioner might be breached and might end up in the patient’s

dismissal: “I still go now that I am well and talk to him about any old thing. But he has suggested

that I do not see him for a while” (Cant & Sharma, 1999: 41) (Cant & Sharma, 1999; Frank,

2002; The Open University, 2005). With regards to the orthodox hegemonic medicine, analyzed

from a Fouclaudian perspective is acting as a surveillance power for the purpose of normalizing

the population through the practice of its scientific discourse; that is the moment one is born it is

subjected to the watchful eye of biomedicine. However, alternative medicine is not so far away

from this criticism. The abundant exchange of information that takes place in the consultation

covers aspects that are not just physiologically important but also cover every other aspect in the

individual’s life, thus “medical surveillance becomes totalizing [...] humane and holistic

medicine is castigating as extending the web of medical power and surveillance” ( Nettleton,

2008: 165). Therefore, so far the analysis has covered the more personal aspects of CAM;

however, next we shall discuss the consumerism and biomedical integration of alternative

therapies in the new postmodern society.

Moving forward, alternative medicine must be also considered in the contemporary societal

landscape and not as an individual entity. As pointed earlier in this essay, the fear of iatrogenic

consequences has pushed users to search for more natural remedies that do not involve

conventional chemical treatments. However, this search for a ‘purer’ consumption has made

users of alternative medicine extremely concerned about their bodies and maintaining a healthy

lifestyle. This has been called “‘the body project’ whereby people increasingly see the body as an

unfinished project to be shaped by lifestyle choices” (Cant & Sharma, 1999: 27) (Cant &

Sharma, 1999; Cartwright & Torr, 2005). Rayer & Easthope (2001) have argued that

Iulia Maria Coanda Page 7

postmodernity (i.e. in economic terms, consumption has taken the place of Fordist mode of

production in the present market system) has integrated CAM in the economic landscape as the

new source for consumption. This mode of consumption he argues has shifted from a

chemicalized, risky and polluted purchase of goods, such as alcohol, to a new self-medicalized

ascetic cult, interested in organic food shops and herbal remedies. An estimation of CAM

consumption by The Pharmaceutical Society of Great Britain is of about 240 million pounds for

herbal products. The purchase of alternative medicine, as much as it is ‘holistic’ it is also prone

to inequalities. Lupton (2003) maintains that poor people are confronted with higher morbidity

levels than people who are on a higher socio economic ladder and who do not received their

health benefits from orthodox medicine but from the more costly alternative medicine: “the

barriers of the greater financial cost to the patient serves as an effective limitation of the services

of alternative practitioners to the more wealthy” (Lupton, 2003: 138). Moreover, criticising

orthodox medicine for medicalizing people and praising CAM for the liberation of conventional

therapies can be argued to be just a facade since alternative practices invite consumers to

succumb to a healthy way of living, monitoring their emotions, thoughts and embracing

spirituality. Nonetheless Rayer & Easthope (2001) write that not all studies relate a high social

economic status to the consumption of alternative medicine, but rather to the choices and values

that an individual possesses. The consumption of holistic medicine is mediatised from

aromatherapy advertisements which invite the consumer to a more holistic life to the individual

responsibility to protect one’s health by having a more active life. Thus, consuming health

products is not necessarily restricted to orthodox pharmaceutical products but also to CAM

practices that involve the purchase of products which resemble natural and pure.

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The last issue of this essay is the professionalization of CAM. The integration of alternative

medicine in biomedical settings by doctors and government was due to its popularity among

consumers. However, some had more success than others in doing so. For example, osteopathy

because of its more mechanized principles it was generally better accepted by the biomedical

power. Nonetheless, alternative medicine was in general dismissed on the base that it had no

empirical evidence to support it (Cant & Sharma, 1999). Stevenson (2003) indicates that because

of this mismatch patients were reluctant in telling physicians about consulting a CAM

practitioner and “appeared inhibited from discussing it according to perceptions of the legitimacy

of the remedy in question” (Stevenson, 2003: 525). Mizrachi, Shuval & Gross (2005) name the

integration of CAM in the conventional practices of medicine as reconciliation. They argue that

even though a more holistic approach is sought, the ethos of biomedicine is still prevalent in

physician institutions, such as the hospital. In their research, taking place in an Israelian hospital,

they interview a physician trained in alternative medicine, who clearly expresses that the only

way CAM would be fully be integrated in the biomedical system is through the validation of the

benefits of CAM by subjecting them to scientific scrutiny. He also argues that in the hierarchical

order of biomedicine’s environment alternative practitioners hold the lowest position and are

fully assimilated by morphing the appearance and the attitudes physicians have toward patients,

which are formal and cold. Hirschkorn & Bourgeault (2005) also noted that the bureaucratic

duties in the orthodox clinic impede them to give the patients same holistic treatment and lengthy

consultations that private practitioners have, also suggesting that the high costs of CAM

consultation also restrain physicians to recommend such practices. Adding to this, Frank (2002)

also finds that in his research involving the practices of homeopathic physicians, that the

constrains of the biomedical system can hinder their alternative physician’s practice; “for

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physicians acting within the system of public health insurance it is the limited time- frame which

causes most trouble. The economic pressure leads to shortened consultations and clashes with

some patients expectations of extensive care” (Frank, 2002: 1292). Thus, the integration and

professionalization of CAM in the conventional system is not a smooth transition but restraining

traditional practices and coercing them to mould according to the empiric medical practices.

In conclusion, we can map a generalized distinctiveness about alternative and complementary

medicine, being that it has striking differences ,compared to biomedicine, in how illness, body

and health are viewed: “the discourse of alternative therapies seek to recast the imaginary of the

body and disease by moving away from aggressive military metaphorical conceptualizations of

the body, to depicting the body as ‘natural’, self regulating and part of wider ecological balance”

(Lupton, 2003: 138). Nonetheless, this holistic and individualist approach does not leave behind

biomedicine’s shortcomings: it can be argued that it is a new form of surveillance, more

thorough and self learnt than the more coerced by the orthodox medical power; or that even if

CAM connect the physical wellbeing with the personal and psychological, it fails to recognize

and acts as a veil for wider structural inequalities that are one of the main causes for poor health,

by blaming the individual for emphasising a personal responsibility for a healthy lifestyle.

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