Abstract
Keywords: Participatory medicine, complementary, alternative, medicine, methods, treatment, mental health, self-directed care, self-determination.
Citation: Sweet, GK. The importance of complementary and alternative medicine in the participatory movement. J Participat Med. 2011 Jan 26; 3:e7.
Published: January 26, 2011.
To the Editors:
The Journal of Participatory Medicine (JoPM) call for papers was announced on a Yahoo Group which connects mental health clients. I was interested and took a look at the website. It is interesting and definitely a timely movement for all recipients and caregivers in medicine and particularly for mental health clients. A vital part of the current “Recovery Movement” among mental health clients involves participatory care.
One related aspect of the mental health caregiver-patient relationship is called “self-determination.” If and when a client takes medication, self-determination has to do with developing a cooperative relationship between the caregiver and client, and more broadly, it means clients determine for themselves what is good for them.
I am writing on behalf of mental health clients, as an advocate. I had post-traumatic stress disorder (PTSD) growing up and was diagnosed with bipolar disorder much later in my life. But by the time I was diagnosed I was well on my way to a state of overall healing, having overcome many of my symptoms by using alternative methods of treatment (aka, “complementary medicine”). I had used alternatives as “self-directed care,” as it is called in mental health circles. Since that time I have worked within the mental health system with clients and professional caregivers to further an understanding of alternative methods of care, and how to use these methods as self-directed care for their healing and recovery.
Alternative or complementary methods of care are being used in hospitals and clinics in growing numbers. Alternative methods are a significant and important support to healing and, I think, should definitely be included in your agenda. The awareness and accepted validity of complementary/alternative medicine is part of transforming the culture of medicine right along with taking a participatory role. There is no mention of Alternative/Complementary Care on the JoPM website, nor is there any topic for it in the call for papers. Since the mission of the Journal of Participatory Medicine is to transform the culture of medicine to be more participatory–with an invitation to participate to create a robust journal to empower and connect patients, caregivers, and health professionals–it makes sense that complementary medicine should be included, since so many people use it. While it remains true in medicine that most patients have been trained by our culture to depend upon the doctor to know what is best for them (and thus the reason for the participatory medicine movement), as you know, the growing trend is for patients/clients to take responsibility for their own care in a collaborative effort with caregivers. But we need to take it a step further. Patients/clients need to understand the importance of taking responsibility for themselves on all levels, not just physically, but emotionally, mentally, and spiritually. It’s time to acknowledge that human beings are one integrated being, and to go beyond the common “lip service” given to “holistic” in medicine. This includes the undeniable fact that all parts/aspects of a human being affect all other parts/aspects. We are much more than the sum of our parts.
One last thought about alternative care…the same idea of depending upon a practitioner or doctor in medicine also carries into alternatives or complements to medicine. The possible benefits of using alternative medicine as self-directed care are largely unknown, even among its proponents, and require education about how to use it in this way. But before education can begin, acceptance of its validity is essential. Whether alternatives are used through a practitioner or in self-directed care, I believe that awareness of their importance should be known. Thus, alternative/complementary care has a place in this work your journal is doing to transform the culture of medicine.
Copyright: © 2011 Grace Karen Sweet. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author(s), with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.
Editor’s Reply:
JoPM welcomes research or other scholarly works that describe methods or examples in which complementary or alternative medicine enhances patients’ involvement in participatory medicine. Since the focus of JoPM is on participatory medicine, and not on any one particular facet or form of health practice, we don’t believe it is necessary to create a separate category for complementary or alternative medicine.
–Charlie Smith, Editor in Chief
Great callout. Often, I think, those of us with a chronic ailment turn to “alternative” solutions (anything outside western practice). I always discuss with my primary doctor those implications. he carefully points out that being a Western Doctor he has certain tools he is familiar and comfortable with but does not rule out other possibilities. He has also flagged certain herbal aids that could either potentiate the effects of certain medicines or even erode the effectiveness of medicines I am taking. Did you know that Saint John’s wort can reduce the effectiveness of birth control pill or SSRIs. I use alternative medicine with quite regularity. I never thought the society specifically ignored it, but it has never specifically come up.
So, now the conversation can begin.
Complementary and alternative medicine (CAM) also now called integrative medicine, has an interesting place in participatory medicine. The growth of use and acceptance of CAM therapies has been driven solely by consumer demand and out-of-pocket expenditures, now approaching $40 billion annually. In the last say 12 years, we have seen several of these modalities – acupuncture, massage therapy, healing touch therapies – become part of conventional practice and hospital offerings. I have no doubt that one reason for that penetration has been the concurrent growth of social media across the web, carrying patient/client conversations that were not previously easily observable. (Online support groups, in fact, first formed on the closed online commercial services in the 1980s: The Source, CompuServe, The WELL, GEnie, Delphi and AOL.)
In other words, both CAM therapies and social media have taken the patient/consumer and his or her expectations deeper into the conventional healthcare enterprise, and as Grace points out, the therapies — but more importantly the thinking that accompanies them — are becoming more acceptable by the day.
The still unfortunate attribute afflicting CAM approaches is their exclusion from the care payment system. That state exists because of the erratic and incomplete research that has been directed to those therapies. On one hand, that simply reflects the ongoing evolution of re-defining the broadest acceptable set of therapeutic interventions. On the other, these therapies are completely way-out-of-the-box when it comes to physician training and experience.
As a result, much, if not all, of the growth and acceptance of CAM therapies and approaches has been due to an informal “participatory medicine” that travels primarily by word of mouth and its ever-expanding digital extensions. It is only recently that physicians, mostly individually, have become part of this participatory dynamic, in their clinical encounters. That is slowly starting to change in medical education centers and at med schools where students are introduced to CAM practices and where fellowships are now offered.
Which is a long way of saying I agree with Charlie that complementary and alternative therapies and approaches should be dealt with as any option might be in the participatory experience. I hope JOPM can help foster that inclusion, and regard the last 40 years of CAM-related experience as a kind of sustainable evidence that many individuals are indeed willing to drive their own health.