A Brief History of Naturopathic Medicine

In 1900 Benedict Lust “invented” naturopathy, a practice that combined many natural therapies and therapeutic systems under the umbrella of a comprehensive philosophy based upon the European nature cure movement that flourished in the 1800s, the vis medicatrix naturae (healing power of nature) and other vitalistic principles. As such, naturopathic medicine has deep historical roots and represents a lineage of Western natural medicine that can be traced back to the Roman, Greek, Egyptian, and Mesopotamian cultures, and conceptually, to many traditional and indigenous world medicines.

The modern naturopathic profession originated with Lust, and it grew under his tireless efforts. He crisscrossed the United States lecturing and lobbying for legislation to license naturopathy, testifying for naturopaths indicted for practicing medicine without a license, and traveling to many events and conferences to help build the profession. He also wrote extensively to foster and popularize the profession, and through his efforts, the naturopathic profession grew rapidly.^1–3 By the 1940s, naturopathic medicine had developed a number of 4-year medical schools and had achieved licensure in about one third of the United States, the District of Columbia, four Canadian provinces, and a number of other countries.^2,4

The profession went through a period of decline, marked with internal disunity and paralleled by the rise of biomedicine and the promise of wonder drugs. By 1957, there was only one naturopathic college left. By 1975, only eight states still licensed naturopathic physicians, and by 1979, there were only six. A survey conducted in 1980 revealed that there were only about 175 naturopathic practitioners still licensed and practicing in the United States and Canada.⁵ In contrast, in 1951, the number was approximately 3000.⁶

The decline of naturopathic medicine after a rapid rise was due to several factors. By the 1930s, a significant tension developed within the profession regarding naturopathic practice, as did the development of unified standards and the role of experimental, reductionist science as an element of professional development.^7,8 This tension split the profession of naturopathic physicians from within after the death of Lust in the late 1940s, at a time when the profession was subject to both significant external forces and internal leadership challenges. Many naturopathic doctors questioned the capacity for the reductionist scientific paradigm to research naturopathic medicine objectively in its full scope.^7,9,10

This perception created mistrust of science and research. Science was also frequently used as a bludgeon against naturopathic medicine, and the biases inherent in what became the dominant paradigm of scientific reductionism made a culture of scientific progress in the profession challenging. The discovery of effective antibiotics elevated the standard medical profession to dominant and unquestioned stature by a culture that turned to mechanistic science as an unquestioned authority. The dawning of the atomic age reinforced a fundamental place for science in a society increasingly dominated by scientific discovery. In this culture, standard medicine, with its growing political and economic strength, was able to force the near elimination of naturopathic medicine through the repeal or “sunsetting” of licensure acts.^1,2,11

In 1956, as the last doctor of naturopathy (ND) program ended (at the Western States College of Chiropractic), several doctors, including Drs. Charles Stone, W. Martin Bleything, and Frank Spaulding, created the National College of Naturopathic Medicine in Portland, OR, to keep the profession alive. However, that school was nearly invisible as the last vestige of a dying profession and rarely attracted as many as 10 new students a year. The profession was considered dead by its historic adversaries.

The culture of America, dominated by standard medicine since the 1940s, however, began to change by the late 1960s. The promise of science and antibiotics was beginning to seem less than perfect. Chronic disease was increasing in prevalence as acute infection was less predominant, and standard medicine had no “penicillin” for chronic diseases. In the late 1970s, scholars in family medicine proposed a biopsychosocial model of care in response to a prevailing perception of a growing crisis in standard medicine.¹² The publication of Engel’s “The Need for a New Medical Model” in April 1977 signaled the founding of the field of family medicine based on a holistic philosophy and paralleled a broader social movement in support of alternative health practices and environmental awareness. Elements of the culture were rebelling against plastics and cheap synthetics, seeking more natural solutions. The publication of Rachael Carson’s Silent Spring in 1962, an indictment of chemical pesticides and environmental damage, marked a turning point in cultural thinking. In Silent Spring, Carson challenged the practices of agricultural scientists and the government and called for a change in the way humankind viewed the natural world.¹³ New evidence of the dangers of radiation, synthetic pesticides, and herbicides, as well as environmental degradation from industrial pollution, were creating a new ethic. Organic farming, natural fibers, and other similar possibilities were starting to capture attention. A few began seeking natural alternatives in medicine. By the late 1960s and early 1970s, enrollments at the National College of Naturopathic Medicine began to reach into the 20s. The 1974 class numbered 23 students. In 1975, the National College enrolled a class of 63 students.¹⁴ The profession was experiencing a resurgence.

In 1978, with a desire to create a college based on science-based natural medicine, Joseph E. Pizzorno, ND, LM, and his colleagues, Les Griffith, ND, LM; Bill Mitchell, ND; and Sheila Quinn created the John Bastyr College of Naturopathic Medicine in Seattle, WA. With the creation of Bastyr, named after the eminent naturopathic physician, Dr. John Bartholomew Bastyr (1912–1995), the profession entered a new phase. Not only did this new college double the profession’s capacity to produce new doctors, it also firmly placed the profession on the ground of scientific research and validation. “Science-based natural medicine,” coined by Dr. Pizzorno, was a major driving force behind the creation and mission of Bastyr. Both Drs. Bastyr and Pizzorno had significant influence and leadership in achieving this focus.

One of Dr. Bastyr’s important legacies was to establish a foundation and a model for reconciling the perceived conflict between science and the deeply established healing practices and principles of naturopathic medicine. Kirchfeld and Boyle³ described his landmark contribution as follows:

Bastyr also saw a tremendous expansion in both allopathic and naturopathic medical knowledge, and he played a major role in making sure the best of both were integrated into naturopathic medical education.^3,15

Bastyr met Lust on two occasions and was closely tied to the nature cure tradition of Kneipp through two influential women: his mother and his mentor, Dr. Elizabeth Peters, who studied with Father Kneipp. He effortlessly integrated the clinical theories and practices of naturopathy with the latest scientific studies and helped create a new and truly original form of modern primary clinical care within naturopathic medicine. He spent the twentieth century preparing the nature cure of the nineteenth century for entry into the twenty-first century.^1,15 Today’s philosophical debates within the profession are no longer about science. They tend to center on challenges to the Nature Cure tradition. A current debate, for instance, is about the role of “green allopathy” within the profession: the tendency to use botanical medicine or nutritional supplements as a simple “green drug” or pharmaceutical replacement versus the importance of implementing the full range of healing practices derived from Nature Cure to stimulate health restoration alongside, or instead of, botanical medicine or nutritional supplements. Professional consensus appears strong that the full range of naturopathic healing practices must be retained, strengthened, and engaged in the process of education and scientific research and discovery in the twenty-first century.^16–18

Original Philosophy and Theory

Through the initial 50-year period of professional growth and development (1896–1945), naturopathic medicine had no clear and concise statement of identity. The profession was whatever Lust said it was. He defined “naturopathy” or “nature cure” as both a way of life and a concept of healing that used various natural means of treating human infirmities and disease states. The “natural means” were integrated into naturopathic medicine by Lust and others based on the emerging naturopathic theory of healing and disease etiology. The earliest therapies associated with the term involved a combination of American hygienics and Austro-Germanic nature cure and hydrotherapy. Leaders in this field included Kuhne, Lindlahr, Trall, Kellogg, Holbrook, Tilden, Graham, McFadden, Rikli, Thomson, and others who wrote foundational naturopathic medical treatises or developed naturopathic clinical theory, philosophy, and texts to enhance, agree with, and diverge from Lust’s original work.^19–27

The bulk of professional theory was found in Lust’s magazines, Herald of Health and The Naturopath. These publications displayed the prodigious writings of Lust, but did not contain a comprehensive and definitive statement of either philosophy or clinical theory. Lust often stated that all natural therapies fell under the purview of naturopathy. Several texts were considered as somewhat definitive by various aspects of the profession at different times. These texts included the seven-volume Natural Therapeutics by Henry Lindlahr, MD, which was published in the early 1900s. Lindlahr’s Nature Cure (1913) was considered a seminal work in naturopathic theory, laying the groundwork for a systematic approach to naturopathic treatment and diagnosis. Lindlahr ultimately presented the most coherent naturopathic theory extant, summarized in his Catechism of Naturopathy, which presented a five-part therapeutic progression:

In the 1950s Spitler wrote Basic Naturopathy, a Textbook,⁹ and Wendel wrote Standardized Naturopathy.¹⁰ These texts presented somewhat different approaches; Spitler’s text emphasized theory and philosophy, whereas Wendel’s text was written, as evidenced by the title, to emphasize the standard naturopathic practices of the day, with an eye toward regulatory practice. In contrast, Kuts-Cheraux’s Naturopathic Materia Medica, written in the 1950s, was produced to satisfy a statutory demand by the Arizona legislature, but persisted as one of the few extant guides of that era. Practitioners relied on a number of earlier texts, many of which arose from the German hydrotherapy practitioners^29–34 or the Eclectic school of medicine (a refinement and expansion of the earlier “Thomsonian” system of medicine)^35–39 and predated the formal American naturopathic profession (1900). However, by the late 1950s, publications diminished. The profession was generally considered on its last gasp, an anachronism of the pre-antibiotic era.

During the process of winning licensure, naturopathic medicine was defined formally by the various licensure statutes, but these definitions were legal and scope-of-practice definitions, often in conflict with each other, reflecting different standards of practice in different jurisdictions. In 1965, the U.S. Department of Labor’s Dictionary of Occupational Titles⁴⁰ presented the most formal and widespread definition. The definition was not without controversy. as it reflected one of the internally competing views of the profession, primarily, the nature cure perspective:

This definition did not list drugs or surgery within the scope of modalities available to the profession. It defined the profession by therapeutic modality and was more limited than most of the statutes under which naturopathic physicians practiced,⁴¹ even in 1975, when there were only eight licensing authorities still active.

Modern Naturopathic Clinical Theory: The Process of Development

After the profession’s decline in the 1950s and 1960s, a rebirth was experienced, more grounded in medical sciences and fueled by a young generation with few teachers. The profession’s roots were neglected out of ignorance, for the most part, along with a youthful arrogance. By the early 1980s, it was apparent that attempts to regenerate the progress made by Lust would require the creation of a unified professional organization and all which that entailed: accreditation for schools, national standards in education and licensure, clinical research, and the articulation of a coherent definition of the profession for legislative purposes, as well as for its own internal development. These accomplishments would be necessary to be able to demonstrate the uniqueness and validity of the profession, guide its educational process, and justify its status as a separate and distinct medical profession.

In 1987, the newly formed (1985) American Association of Naturopathic Physicians (AANP) began this task under the leadership of James Sensenig, ND (president) and Cathy Rogers, ND (vice president), appointing a committee to head the creation of a new definition of naturopathic medicine. The “Select Committee on the Definition of Naturopathic Medicine” succeeded in a 3-year project that culminated in the unanimous adoption by AANP’s House of Delegates (HOD) of a comprehensive, consensus definition of naturopathic medicine in 1989 at the annual convention held at Rippling River, OR.^43–45 The unique aspect of this definition was its basis in definitive principles, rather than therapeutic modalities, as the defining characteristics of the profession. In passing this resolution, the HOD also asserted that the principles would continue to evolve with the progress of knowledge and should be formally reexamined by the profession as needed, perhaps every 5 years.^43–48

In September 1996, the AANP HOD passed a resolution to review three proposed principles of practice that had been recommended as additions to the AANP definition of naturopathic medicine originally passed by the HOD in 1989. These three new proposed principles were rejected, and the AANP HOD reconfirmed the 1989 AANP definition unanimously in 2000. The results of a profession-wide survey conducted from 1996 to 1998 on these three new proposed principles demonstrated that although there was lively input, the profession agreed strongly that the original definition was accurate and should remain intact. The HOD recommended that the discussion be moved to the academic community involved in clinical theory, research, and practice for pursuit through scholarly dialogue.^49–53 This formed the basis for further efforts to articulate a clinical theory. AANP members stated in 1987–1989 during the definition process: “These principles are the skeleton, the core of naturopathic theory. There will be more growth from this foundation.”⁴⁵ By 1997, this growth in modern clinical theory was evident.

The first statement of such a theory was published in the AANP’s Journal of Naturopathic Medicine in 1997 in an article titled “The Process of Healing, a Unifying Theory of Naturopathic Medicine.”⁵⁴ This article contained three fundamental concepts that were presented as an organizing theory for the many therapeutic systems and modalities used within the profession and were based on the principles articulated in the consensus AANP definition of naturopathic medicine. The first of these was the characterization of disease as a process rather than a pathologic entity. The second was the focus on the determinants of health rather than on pathology. The third was the concept of a therapeutic hierarchy.

This article also signaled the emergence of a growing dialogue among physicians, faculty, leaders, and scholars of naturopathic philosophy concerning theory in naturopathic medicine. The hope and dialogue sparked by this article was the natural next step of a profession redefining itself both in the light of today’s advances in health care and with respect to the foundations of philosophy at the traditional heart of naturopathic medicine. This dialogue naturally followed the discussions of the definition process and created a vehicle for emerging models and concepts to be built on the bones of the principles. The essence and inherent concepts of traditional naturopathic philosophy were carried in the hearts and minds of a new generation of naturopathic physicians into the twenty-first century—these modern naturopathic students and naturopathic physicians began to gather to articulate, redefine, and reunify the heart of the medicine.

This new dialogue was formally launched in 1996, when the AANP Convention opened with the plenary session: “Towards a Unifying Theory of Naturopathic Medicine” with four naturopathic physicians presenting facets of emerging modern naturopathic theory. The session closed with an open microphone. The impassioned and powerful comments of the naturopathic profession throughout the United States and Canada engaged in the vital process of deepening and clarifying its unifying theory. Dr. Zeff presented “The Process of Healing: The Hierarchy of Therapeutics”; Dr. Mitchell presented “The Physics of Adjacency, Intention, Naturopathic Medicine, and Gaia”; Dr. Sensenig presented “Back to the Future: Reintroducing Vitalism as a New Paradigm”; and Dr. Snider announced the Integration Project, inviting the profession to engage in it by “sharing a beautiful and inspiring anguish—the labor pains of naturopathic theory in the twenty-first century. We know what we have done, and we know there is much more…The foundation is laid. We are ready now for development and integration.”⁵⁵

Days later, in September 1996, the Consortium of Naturopathic Medical Colleges (now the American Association of Naturopathic Medical Colleges [AANMC]) formally adopted and launched the Integration Project, an initiative to integrate naturopathic theory and philosophy throughout all divisions of all naturopathic college curricula, from basic sciences to clinical training. A key element of the project engaged the further development and refinement of naturopathic theory. The project was co-chaired by Drs. Snider and Zeff from 1996 to 2003. Steering members from all North American naturopathic colleges participated and contributed.⁴⁵ Methods included professional and scholarly research, expert teams, symposiums, and training. The result was the fostering of systematic inquiry among academicians, clinicians, and researchers concerning the underlying theory of naturopathic medicine, bringing the fruits of this work and inquiry into the classroom and into scientific discussion.⁵⁶

The Integration Project sustained both formal and informal dialogue since its inception in 1996, which continues today. The work has engaged faculty and scholars of naturopathic philosophy in the United States, Canada, and Australia. It has also engaged institutional leaders and practicing doctors and faculty in all areas of the profession. Why? Naturopathic philosophy is deeply felt as the “commons” of naturopathic medicine: a place where the profession meets—one that is owned by all naturopathic physicians—that reflects, holds, and deepens the heart of naturopathic medicine. Naturopathic philosophy is the foundation and heart of naturopathic medicine. It remains valid by evolving with the progress of knowledge, the progress of science, and the progress of the human spirit. It is for this reason medicine is seen as an art as well as a science. Because naturopathic philosophy engages the intuitively felt mission of nature doctors, it is vital that the profession periodically gathers to renew and revitalize progress regarding its unifying foundations.

The Integration Project sparked a wide range of activities in all six ND colleges, resulting in all-college retreats to share tools, retreats for training of non-ND faculty in naturopathic philosophy, integration of a basic sciences curriculum, expert teams revision of core competencies across departments ranging from nutrition to case management and counseling, development of clinical tools and seminars for clinic faculty, creation of new courses, and the integration of important research questions derived from naturopathic philosophy into research studies and initiatives.⁵⁷ The latest effort is the Foundations of Naturopathic Medicine Project (textbook and symposia series, www.foundationsproject.com) and its development and presentation of the educational module on Emunctorology, an essentially naturopathic science, during 2009 and 2010. This is a joint effort of faculty from several of our schools, led by Drs. Thom Kruzel and Stephen Myers.

North American core competencies for naturopathic philosophy and clinical theory were developed by faculty representing all accredited ND colleges in a landmark AANMC retreat in 2000. The AANMC’s Dean’s Council formally adopted these competencies in 2000 and recommended that they be integrated throughout curricula in all ND colleges. These national core competencies included the process of healing theory, Lindlahr’s model, and the hierarchy of therapeutics (the therapeutic order).^58,59

Finally, many meetings with scholars and teachers of naturopathic theory and other faculty and leaders—formal and informal—resulted in the further development and refinement of the hierarchy of therapeutics developed by Dr. Zeff in 1997.

Drs. Snider and Zeff and naturopathic theory faculty worked closely with other naturopathic faculty from AANMC colleges in a series of revisions. Drs. Snider and Zeff collaborated in 1998 to develop the hierarchy of therapeutics into the therapeutic order. The therapeutic order was subsequently explored and refined through a series of faculty retreats and meetings, as well as through experience with students and through student feedback. A key finding of the clinical faculty at Bastyr University was the emphasis on the principle “holism: treat the whole person” and respect for the patient’s own unique healing order and his or her values as a context for applying the therapeutic order to clinical decision making.⁶⁰ The therapeutic order, or hierarchy of healing, is now incorporated into ND college curricula throughout the United States, Canada, Australia, and New Zealand. For example, an important international outgrowth of the profession’s development of theory is the adoption of the unified “Working Definition of Naturopathic Nutrition” in June 2003 by the Australian naturopathic profession (Box 3-1). The 3-year project, fostered by Dr. Stephen Myers, brought together nutrition faculty from naturopathic medicine colleges throughout Australia. The project was co-hosted by the Naturopathy and Nutrition panel, an independent group of naturopaths and nutrition educators whose mission is to foster and support the development of the science, teaching, and practice of naturopathic nutrition, and the School of Natural and Complementary Medicine at Southern Cross University. The definition evolved over two retreats attended by more than 40 faculty members involved in teaching nutrition as part of a naturopathic medicine education. It commenced as a general agreement within the group that there was a real and distinct difference between conventional nutritional concepts and naturopathic nutritional theory. General agreement was that the distinction between the two had to date been poorly defined and had been the source of dissonance between the naturopathic and science faculty within the colleges. The obvious next step was to define that difference to ensure that nutrition curriculum within naturopathic medicine colleges reflected the core elements of naturopathic nutrition. At the second retreat held in June 2003, the working definition was adopted with a recommendation that it be widely circulated within the naturopathic medicine profession to commence a dialogue aimed at both appropriate revision and broad adoption. This process created a much-needed consensus definition on naturopathic nutrition. This definition is based on the AANP defining principles and incorporates the therapeutic order theory.

A Theory of Naturopathic Medicine

Standard medicine, or biomedicine, has a simple and elegant paradigm. Simply stated, it is “the diagnosis and treatment of disease.” In practice, this statement contains several assumptions. One assumption is that illness can be understood in terms of discrete diseases (i.e., human illnesses can be divided into identifiable entities, such as measles or specific forms of cancer, etc.). The next assumption is that “cure” is the elimination of the disease entity. The third assumption is that this is accomplished by the evidence-based application of pharmaceuticals, surgeries, or similar treatments to eliminate, palliate, or suppress the entity and its symptomatic expressions. These are so obvious that they are not commonly considered. They form the background thinking in medical decision making: identify and treat the disease.

The elegance of this model, and the science behind it, has taken medicine to its highest point in history as a reliable vehicle to ease human illness, and its application has saved countless lives. The understanding of the physician, at least about the nature of pathology, has never been as complete. However, illness has a near-infinite capacity to baffle the physician. New diseases arise, such as human immunodeficiency virus/acquired immune deficiency syndrome, and shifts occur in disease focus, such as the shift between 1900 and 2000 from acute infection to chronic illness as the predominant cause of death.⁶¹

Beyond these obvious changes, even with the current depth of understanding, the standard medical world often lacks the ability to effectively understand and cure chronic disease, and treatment tends to become a task of the management of symptoms and the attempt to reduce long-term damage and other consequences, rather than actual cure of the illness. So, even representing an apex of human achievement as it does, modern medicine is not without its weaknesses. Its greatest weakness is probably this inability to cure chronic illness as easily as it once cured pneumonia with penicillin or tuberculosis with streptomycin. Compounding the problem is the growing prevalence of antibiotic-resistant infections.^62,63 Part of the reason for the failures within modern medical science is its mechanistic basis. Breaking the body down to its constituent parts has led to a fundamental ignorance of and disrespect for the wholeness of the individual, the natural laws of physiology governing health and healing, and particularly for all things spiritual (the transpersonal domains). Inherent in the dictum—diagnose and treat the disease—is the general neglect of the larger understanding that disease is a process conducted by and within an intelligent organism that is constantly attempting to heal itself, with disease manifestations often expressions of this self-healing endeavor. As noted by Pizzorno et al,⁶⁴ this intelligent organism strives for optimal function and health. Human beings “…are natural organisms, our genomes developed and expressed in the natural world. The patterns and processes inherent in nature are inherent in us. We exist as a part of complex patterns of matter, energy, and spirit. Nature doctors have observed the natural processes of these patterns in health and disease and determined that there is an inherent drive toward health that lives within the patterns and processes of nature.”

The uniqueness of naturopathic medicine is not in its therapeutic modalities or the “natural” alternatives to the drugs and surgeries of standard medicine. It is in the clinical theory that governs the selection and application of these modalities, captured in the unifying definition adopted in 1989 and expressed more specifically in the continuing articulation of clinical theory. That is, it is the way the naturopathic physician thinks about illness and healing.

The first element of this theory is based upon the first defining principle: vis medicatrix naturae. It is based on the understanding that disease can be seen as a process, as well as an entity. One can analyze the process of illness and derive some understanding. However, to do this, one needs to examine the assumptions underlying this concept. The governing assumptions of standard medicine are principally that diseases are entities, and that drugs and surgery can eliminate these entities from the suffering person. These are not the governing assumptions of naturopathic medicine.

Illness and Healing as Process

Naturopathic medicine can be characterized by a different model than “identify and treat the disease.” “The restoration of health” would be a better characterization. Naturopathic physicians adopted the following elegantly brief definition of naturopathic medicine in 1989 in an AANP position paper: “Naturopathic physicians treat disease by restoring health.”⁴⁴ Immediately a significant difference is made clear: standard medicine is disease based; naturopathic medicine is health based. Although naturopathic medical students study pathology with the same intensity and depth as standard medical students, as well as its concomitant diagnoses, the naturopathic medical student learns to apply that information in a different context. In standard medicine, pathology and diagnosis are the basis for the discernment of the disease “entity” that afflicts the patient, the first of the two steps of identifying and destroying the entity of affliction. In naturopathic medicine, however, disease is seen much more as a process than as an entity. Rather than viewing the ill patient as experiencing a “disease,” the naturopathic physician views the ill person as functioning within a process of disturbance and recovery, in the context of nature and natural systems. Various factors disturb normal health. If the physician can identify these disturbances and moderate them (or at least some of them), the illness and its effects abate, at least to some extent, if not totally. As disturbances are removed, the body can improve in function, and in doing so, health naturally improves. The natural tendency of the body is to maintain itself in as normal a state of health as is possible—this is the basis of homeostatic principles.⁶⁵ The role of the physician facilitates this self-healing process.

The obvious first task of the naturopathic physician, therefore, is to determine what is disturbing the health so that these causative elements may be ameliorated. Disease is the process whereby the intelligent body reacts to disturbing elements. It employs such processes as inflammation and fever to help restore its health. In general, one can graph this process simply, as in Figure 3-1.

FIGURE 3-1 The process of healing.

(used by permission Jared L. Zeff, ND)