(Originally published as a Guest Editorial in The Journal of Alternative and Complementary Medicine, 2003.)
The term “Complementary and Alternative Medicine,” or “CAM” intrigues me. It always seems to imply something new or radical is occurring, and stirs a certain revolutionary excitement in me. It is as if CAM stands in sharp contrast to “conventional” medicine.
Then I think about the word “complementary” and find myself wondering: What is so new or radical about the notion of one treatment’s complementing another? Does not the surgeon’s work complement that of the internist or dietitian who is seeing the same patient? Has this not always been the case? I find myself leaning toward the conclusion that the term “complementary” became popular as a way to make more palatable to conventional practitioners whatever is truly revolutionary, and therefore perhaps threatening, about CAM.
My attention then turns to the word “alternative.” Again, the initial impression is one of a dramatic change in the way things are done, and even perhaps conceptualized. How novel and exciting! Then I realize that the next step in the evolution of theory and practice is always the “alternative” to what is current, and in this sense is always revolutionary. The germ theory of infectious disease, before it became accepted, would be an example of alternative medicine. Acupuncture is currently on the threshold between CAM and conventional medicine, and will soon be absorbed into mainstream practice. Homeopathy is not far behind.
So now I begin to wonder what is fundamentally new in CAM. I find a clue in the way I tend to grind my teeth when I see a reference to “evidence-based” alternative treatments. The clue is in the implied nature of the evidence; it is objective evidence. Treatments such as acupuncture, homeopathy, herbal remedies, reiki, and even prayer are subjected to the acid test of randomized double-blind controlled trials. Those that show statistically significant treatment effects compared to control groups are now (objectively) “evidence-based” and therefore accepted treatments.
What has not changed is the nature of the evidence which is acceptable. It must be objective evidence. I would propose that what is truly revolutionary about CAM is not the interesting and innovative treatments it investigates, but rather its challenge to the exclusive use of objectivity in determining treatment.
Enter subjectivity. When I started working on my Ph.D. in psychology 35 years ago psychology was increasingly proud of being an objective science. I remember how discussions of complex clinical situations were often met with an enthusiastic assertion from one of the discussants: “We’ve got data on that!” Translation: there is published objective evidence that points toward an answer to the question at hand. However, the other phrase that often came up in such discussions was in the form of a question: “What’s your clinical intuition?” The word “clinical” was really superfluous, and was only used to lend a certain professional tone to the discussion. The point is that intuition was valued as much as objective evidence.
Intuition, whether glorified as “clinical” or not, is clearly a form of subjective evidence. To be used as a basis for treatment decisions it must be valued and cultivated. It is precisely this valuing of subjectivity that constitutes the truly revolutionary element within CAM.
The use of subjective evidence need not be radical. Objective research can establish that a particular treatment is on average effective for a group of patients when compared to the average response of a control group not given the treatment. One then can use one’s subjective awareness to fine-tune the averaged data from the research groups in order to treat a particular individual. Such fine-tuning may be something as minor as adjusting the dosage of a drug or herbal preparation up or down from the normative optimum dose established through the statistical homogenization of the reactions of a group of patients studied objectively. This can be done through attunement to an intuitive awareness of the needs of the individual patient, or to the properties of a particular herb or drug as it may impact this particular patient.
There’s more. The admission of subjective evidence in evaluating a treatment is just the most superficial aspect of valuing subjectivity. The acknowledgement of the significance of subjectivity as a fundamental factor in any treatment procedure is the foundation of this revolutionary concept. The quality of the interpersonal relationship between provider and patient is a potent variable, and one which is inherently subjective, in treatment outcome. A valuing of subjectivity further implies that the patient is not merely a passive object of treatment, but rather is an active participant in terms of his or her subjective experiences in areas such as belief, expectation, faith, hope, feeling cared for or even loved by the provider, and the like. Feelings of caring for the patient are often in turn a function of the provider’s being deeply familiar with the patient’s subjective world. While it may be true that a superficial familiarity breeds contempt, it is almost certainly true that a deeper sense of familiarity with another’s subjective world will breed compassion. Such compassion in the subjective experience of the provider can be expected to have an impact on the subjective experience of the patient, with salutary effects on treatment outcome. Some psychological theories refer to this interplay of the subjective experiences between psychotherapist and patient as “intersubjectivity.” To the extent that such subjective factors may figure significantly in treatment outcome, it is irresponsible to ignore them.
While the valuing of subjectivity by CAM seems rather revolutionary, it is really quite ancient. It represents a return to the older models of healing as practiced by indigenous shamanic healers throughout most of human history. The journey of the shaman to alternative realms of reality for diagnosis and treatment is the ultimate affirmation of the significance of subjective experience. Similarly, the legacy of Asklepian healing (Tick, 2001) emphasizes the journey of the patient to other domains not visible to anyone else--i.e. subjective domains. As the limits of production-line objective medicine become more obvious, even to the point of possibly doing more harm than good (Fisher and Welch, 1999), the need to reexamine the importance of the subjective realms emerges from the shadows of objectivity. Practitioners who have spent much time and effort perfecting their capacity for objectivity may groan at the prospect of now having to cultivate their capacity for subjectivity. However, a certain attunement to one’s subjective world may be a much more natural state for humans than is usually assumed, and hence may be both easier to achieve and more intrinsically rewarding than one might expect. I personally consider it to be a serious possibility that the exploration of subjective experience, or “inner space,” may constitute the greatest adventure--and most profound science--of them all.
Tick E. The Practice of Dream Healing: Bringing Ancient Greek Mysteries into Modern Medicine, Wheaton, IL:Quest Books, 2001:291.
Welch G, Fisher E. Avoiding the Unintended Consequences of Growth in Medical Care: How Might More Be Worse? Journal of the American Medical Association 1999; 281: 446-453.