Sue EvansHealth and Human SciencesSouthern Cross University

Response to Baer and Colleagues:The Politics of Holism

Baer and colleagues’ article (this issue) raises questions regarding the poten-tial contribution of critical medical anthropology (CMA) to naturopathy. This isparticularly welcome as all four authors are deeply aware of the challenges andpracticalities of the discipline, and this gives the article a clear “insider” perspective.The authors query naturopathy’s claims to holism, a central philosophical tenetof naturopathic practice, and suggest that CMA challenges naturopaths to movebeyond a focus on individual health. They suggest that the definition of holism usedin naturopathy is limited as it refers to “body, mind and spirit” without due empha-sis on the broader political, economic, and ecological factors impacting on healthstatus. CMA, by contrast, is said to focus on the cultural context of disease and thesocial determinants of health. It emphasizes issues and interventions related to pub-lic health, and its proponents, it is claimed, are committed to social action to achievethese ends. Baer and colleagues suggest naturopathic practice would be more holis-tic should it engage with these debates. In this response, I comment on the historicaland cultural context of the issues raised, before discussing the interpretation anduse of the term holism in naturopathic practice, and particularly its relationship tovitalism.

The critique of naturopathy outlined in this article echoes that made of the (then-new) holistic medicine movement in the United States by McKee, and Berliner andSalmon 30 years ago (Berliner and Salmon 1979, 1980; McKee 1988). Now, asthen, there is merit in the suggestion that naturopathy broadens its area of concern,and the argument that, in an ideal world, naturopathy should address these issueswill not be contradicted here. Naturopathic practice is more complex—and morecomplete—when it goes beyond the individual and takes into account familial,social, and environmental influences, and some definitions of holism in naturopathyreflect this perspective (Myers et al. 2003).

At issue is the call by Baer and colleagues for naturopaths to demonstrate alevel of activism. Naturopaths in Australia do not have a history of participa-tion in public health debates, or of being agents of structural change in relationto health care. As a marginalized profession, naturopaths have found it difficult tomove beyond immediate concerns with professional survival. It remains problematicfor them to develop a public profile, or to be “heard”: their voices are not only

MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 26, Issue 2, pp. 271–274, ISSN 0745-5194, online ISSN 1548-1387. C© 2012 by the American Anthropological Association. All rightsreserved. DOI: 10.1111/j.1548-1387.2012.01205.x

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absent in public health debates, but also attempts to get traction in the mediaon issues that affect them, for example appropriate regulation of practitionersand products, are largely unsuccessful. Although “lifestyle medicine” has gainedsome attention, and its content clearly overlaps with naturopathy, its spokespeo-ple are often registered health professionals, and their discussions occur largelyin the absence of comment from naturopaths (see www.lifestylemedicine.net.au).Moves for naturopaths to gain professional acceptance via statutory recognitionare currently stalled. The Lin report to the Victorian State Government (Lin et al.2005) recommending statutory regulation has now (as of 2012) been “on hold”for seven years, and the data, so painstakingly collected to support this are largelyoutdated. Groups of naturopaths continue to lobby for statutory regulation (seewww.aronah.org), but no firm date has been given for its consideration. In addition,2012 has seen the launching of a new Australian lobby group, the ‘Friends of Sciencein Medicine,’ comprising more than 400 scientists and doctors, whose aim is to per-suade Australian universities to abandon the teaching of all natural and complemen-tary medicine (www.nytimes.com/2012/02/06/world/asia/australian-universities-defend-alternative-medicine). In these circumstances of instability in regards to thefuture of the profession, the roles and contributions of naturopaths to public healthare potential rather than realized.

It is significant that in this article, Baer and colleagues frame their challenge tonaturopathy through reference to its philosophy, in particular the centrality andmeaning of “holism.” The important issue of the philosophical underpinning ofthe discipline has been little discussed in the literature, and for this reason thecurrent debate is particularly welcomed. As stated above, the authors suggest thatnaturopaths subscribe to a “limited holism,” which does not incorporate the largersocial and environmental issues. This may be so, and naturopathic curricula do nottypically include these subjects in their undergraduate or practitioner educationalprograms. However, I would also suggest that holism is not limited to naturopathicpractice—any good health care practitioner, of whatever philosophical bias, willtake the factors suggested by Baer and colleagues into account. The concerns ofCMA belong in health care discussions among practitioners of all persuasions, andall practitioners should consider the ways in which they can be actively involved inthe development of health care policy.

More controversially, the authors of the article suggest that vitalism, a philosoph-ical concept closely associated with holism in naturopathic writings, has undergone“rejuvenation under the umbrella of the holistic health movement.” I questionwhether vitalism has been “rejuvenated” or whether the move toward holism hasbeen an attempt to replace it—a difficult concept, with a less controversial term. Togive some historical context, in 1926, Smuts first wrote about holism and stated thathe had coined the term holism as substitute for vitalism, which he thought a “vagueexpression, already ruined by popular use and abuse” (Smuts 1926). Subsequentphilosophers of science have developed the concept of holism further to account forthe behavior of complex systems (Capra 1982; Gell-Mann 1994; von Bertalanffy1975). Although these philosophers have not developed their ideas in the contextof naturopathy, their work has led to the term being used to underpin the com-ing together of naturopathy and science, and the rationalization of naturopathy asconsistent with other health sciences.

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There are clearly problems with using the term vitalism in such a context, but it isworth noting the range of views expressed on the subject. Coulter and Willis (2004)suggest vitalism is “the basis of the claim that biomedicine and CAM are distinctparadigms,” while Wohlmuth suggests it may be seen as “irrelevant, antiquatedand unhelpful” (2003). VanMarie (2002), in discussing the professionalization ofherbal medicine, has suggested that a desire for mainstream acceptance encouragesreinterpretation of the discipline and the excision of aspects that are problematicto its presentation as appropriately “scientific.” Not all practitioners agree withsuch excision, and some retain the traditional, premodern perspective that that alllife is interconnected and that the earth is alive, and that the processes of healingcan be understood as a connection to a “life force” that animates all (Evans 2009;VanMarie 2002). The French philosopher Georges Canguilhem suggests that sucha perspective has implications for therapy: he argues that practitioners who use thisperspective are likely to use minimal interventions as they trust the “healing powerof nature” over practitioner intervention (Delaporte 1994).Thus although holismmay play a more useful role than vitalism in the presentation of naturopathy as a“health science,” the question needs to be raised as to the effect of this change onthe philosophical basis of naturopathy.

Currently within naturopathy, little attention or curriculum space is given to theexploration of naturopathic philosophy, and few resources are available to enablethe development of appropriate research methodologies that are congruent withthis philosophical perspective. If the difficult work of maintaining and developingthe unique philosophical approach of naturopathy is not undertaken, techniqueswill be appropriated—for example, the practice of “herbal medicine” as using plantremedies to counter specific disease states, rather than to stimulate the self-healingand reconstructive forces of the individual.

In this context, it is relevant that, increasingly, the complementary nature ofpractice is embedded in an educational system for naturopathic practitioners thatemphasizes the overlaps and similarities between biomedicine and natural medicine.Further, the knowledge base and techniques of natural medicine such as herbalmedicine, massage, homeopathy, or nutrition are easily gained from many sources.However, naturopathy itself, as a distinct approach, extends beyond modality skillsto the philosophical perspectives they bring to the clinical encounter. The under-standing of the clinical application of that knowledge within a philosophical frame-work is complex and time consuming as practitioners develop their ability to applythese principles in the treatment of individual patients. Naturopathic education, atan undergraduate and practitioner level, must reflect this.

I agree with Baer and colleagues that the philosophical basis of naturopathy needsfurther articulation, and that the definitions of “holistic health” should be expandedbeyond “body, mind, and spirit” to include broader societal influences on health.However, the contribution of holism to naturopathy goes beyond these ideas andnecessarily involves consideration of the highly complex nature of naturopathicinterventions. There is a pressing need for research methodologies to be developedthat are both robust and appropriate to investigate the complexity that characterizesholistic naturopathic clinical practice. Thoughtful and scholarly debate, informedby such research, will allow the discipline to clarify its contribution to health care.The current debate is a welcome step in this process.

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