Philosophy of Naturopathic Medicine

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Chapter 5 Philosophy of Naturopathic Medicine

image Introduction

This chapter examines the philosophical foundation of naturopathic medicine and its modern applications. Unlike most other health care systems, naturopathy is not identified by any particular therapy or modalities (e.g., conventional medicine, drugs and surgery; chiropractic, spinal manipulation). A wide variety of therapeutic styles and modalities are found within the naturopathic community (Box 5-1). For example, there are still practitioners who adhere to the strict “nature cure” tradition and focus only on diet, “detoxification,” lifestyle modification, and hydrotherapy. There are also those who specialize in homeopathy, acupuncture, or natural childbirth. At the other end of the spectrum are naturopathic physicians who use botanical medicines, nutraceuticals, and pharmacology extensively to manipulate the body’s biochemistry and physiology. Finally, there is the majority, who practice an eclectic naturopathic practice that includes a little of everything.

Since its inception 120 years ago, naturopathic medicine has been an eclectic system of health care. This characteristic has allowed it to adopt many of this century’s more effective elements of natural and alternative medicine as well as to adopt conventional medicine’s basic and clinical sciences, diagnostics, and pharmacology. Through all of this eclecticism, naturopathic medicine has always identified the Latin expression vis medicatrix naturae (the healing power of nature) as its philosophical linchpin.

However, the expression vis medicatrix naturae, by itself, does not provide a clear picture of naturopathic medical philosophy or an understanding of the practice of naturopathic medicine in all of its varied forms. With the profession’s history of eclecticism, no two practitioners treat any individual patient exactly alike. This situation has its advantages (e.g., individualization of each patient’s care, more therapeutic options) but also makes it difficult to perceive the profession’s philosophic cohesiveness. Another major disadvantage of this eclecticism is the difficulty in developing consistent practice standards.

To attempt to solve this problem, the modern profession has articulated a general statement of naturopathic principles that expand on vis medicatrix naturae (Box 5-2). However, to gain a more in-depth understanding of naturopathic medicine, one must discuss medical philosophy in general.

BOX 5-2 The Principles of Naturopathic Medicine

image Medical Philosophy

The issues fundamental to a discussion of medical philosophy have changed little since naturopathy first appeared as a distinct profession at the end of the nineteenth century. What has changed is the level of understanding of the biological process and the language of science. Most people who study the early writers on naturopathic medical philosophy quickly get lost in the archaic language and arguments used to justify the theories. This chapter translates these concepts and issues into modern terms.

Vitalism Versus Mechanism

Historically, there have been two main medical philosophies, those of vitalism and mechanism. Their origins can be traced to the Hippocratic writings of ancient Greece. Throughout history, the line separating these two schools of thought has not always been clear, but their philosophical perspectives have generally been in opposition. The conflicting goals and philosophical foundations of these two concepts remain relevant as the modern practices of conventional and alternative physicians come into conflict. As will be seen, the foundations of naturopathic medical philosophy are found in vitalism. However, naturopathy also recognizes the practical value of the mechanistic approach to health care.

Mechanism

Up to the early part of the twentieth century, there was considerable debate over the issue of vitalism versus mechanism in the field of biology. The mechanists, or materialists, maintained that the phenomenon of life could be explained exclusively as the product of a complex series of chemical and physical reactions. They denied the possibility that the animate had any special quality that distinguished it from the inanimate. It was their contention that the only difference between life and non-life was the degree of complexity of the system.

Mechanism has several other distinctive characteristics. Its most obvious is that it is reductionistic. Reductionism is often used as a synonym for mechanism. Mechanistic science is also characterized by an emphasis on linear causality. Without this emphasis on reductionism and linear causality, Western science and medicine would probably have not been so successful. As the twentieth century advanced, each new discovery in biological and medical science reinforced the arguments for mechanism, until, by the middle of the century, the biology community had almost exclusively embraced the philosophy of mechanism.

Mechanism is the philosophical foundation of biomedical science and conventional medicine. It is especially visible in the treatment modalities of surgery and most pharmaceuticals. Mechanistic medicine identifies disease and its accompanying signs and symptoms as simply the result of a disruption of normal chemical reactions and physical activities. Such disruptions are caused by the direct interference in these reactions and activities of a “pathogenic agent.” (For the purposes of this discussion, the expression pathogenic agent refers to any known or unknown etiologic agent, influence, or condition; examples are microbial agents, autotoxins, genetic defects, environmental toxins, non–end-product metabolites, and physical and emotional stress and trauma.) A living organism, then, is simply a very complex machine that, due to external agents and influences and “wear and tear,” breaks down. Because the signs and symptoms of disease are thought to be due only to these mechanical disruptions and interference with reactions, they are considered to be completely destructive phenomena and are therefore to be eliminated. Disappearance of the signs and symptoms indicates that the pathogenic agent and its resulting disease have been eradicated or, more likely, controlled. The goals of mechanistic medicine tend to be the quick removal of the signs, symptoms, and pathogenic agent.

Mechanistic medicine is being practiced in cases in which the intention of the therapy is to intervene in the perceived mechanism of the disease and/or to relieve the symptoms. Examples would be the use of antihistamines to relieve rhinitis, vitamin B6 to help carpal tunnel syndrome, emergency care for traumatic injuries, coronary bypass surgery for blocked arteries, and insulin in juvenile-onset diabetes. Mechanism is also being used when an identified pathogenic agent is directly attacked or eliminated, for example, the use of antibiotics or the isolation of a patient from a particular allergen. Clearly, mechanistic medicine can be very effective in achieving its goals. In the presence of modern medical technology, it is easy to see how this philosophy came to dominate biology, medicine, and the attention of the public.

However, the unsolved problems of mechanistic medicine—particularly those of chronic degenerative disease; authoritarianism, which alienates patients from responsibility for their own health; and the rising cost of health care—suggest that there are limits to the mechanistic perspective and explain why vitalism has not disappeared and is in resurgence.

Vitalism

The philosophy of vitalism is based on the concept that life is too well organized to be explained simply as a complex assemblage of chemical and physical reactions (i.e., a living system is more than just the sum of its parts). This is in contrast to the mechanist’s contention that “the only difference between life and non-life is the degree of complexity.”

Throughout the nineteenth century, the debate between vitalism and mechanism was carried out mostly by biologists and, in medicine, between the “regular” doctors and those doctors who would now be called alternative. In the medicine of the nineteenth and early twentieth century these would have been homeopathic, hydrotherapy, nature cure, and eclectic doctors—all medical doctors with equivalent credentials under the laws of the time. Although the specific terms of “vitalism” and “mechanism” were not necessarily the nomenclature of their debate, the perspectives were the same.

Interestingly, through most of the nineteenth century this debate within the medical community was distinctively not based on science as we currently think of it. The “regular” doctors of the era, as represented by the American Medical Association, were still strongly influenced by Galen’s theory of disease of the four humors with its imaginary anatomy and physiology, bleeding, leeches, mercury, and other horrific treatments. Both the homeopaths and eclectic doctors argued based on empirical evidence; on the other side, the regular doctors argued based on a dogmatic theory that was more than 1500 years old and unsupported by any evidence. Harris Coulter produced the seminal work on this debate in his three-volume book The Divided Legacy.

The debate between vitalism and mechanism within the field of biology is well documented within the biology journals of the time. This was an era of amazing discoveries about how life functioned. Naturally, this is where the focus of this debate took place for biologists. As the secrets of cellular metabolism were revealed, this debate lurched from one specific argument to the next. The issue was where in the living organism did “God” have direct control. For example, at one point it was argued that the “seat of the soul” was the cell. As the cell was better understood, the place that was the point of God’s intervention was postulated to be the nucleus. As research further revealed how the organelles functioned, the vitalistic biologists gave up ground until vitalism as a distinct philosophy in biology was finally abandoned.

The error that doomed the vitalistic oriented biologists was that they were all reductionistic in the same way as the mechanistic biologists. Reductionistic science seems completely able to learn how life functions from a biochemical and biophysical perspective. Eventually, all of the individual chemical and physical reactions that are found in the processes of life will probably be identified. However, the vitalistic biologists missed the most essential aspect of vitalism: holism.

In naturopathy’s early years there were few interactions between it and the academic and research worlds. The great authors and practitioners came to naturopathy through “conversion,” in other words, most had been cured of some health problem by a natural cure and felt naturopathy and curing the sick was now their calling. There is no evidence that these naturopaths even knew that this debate between vitalism and mechanism was going on in the biology literature. Research in this early era of naturopathy consisted of observing nature and applying these observations to treating patients. This led to a deep appreciation of “nature’s” desire for balance and order (what a physiologist would call homeostasis). This holistic perspective, combined with the results of the naturopathic treatments, was the empirical evidence that drove their understanding of health and disease. It was only in the later half of the twentieth century that the field of naturopathic medicine began to converge with the academic and research worlds. Since the 1970s this convergence has moved at breakneck speed, until today there is no longer any real distinction (although this is not evident in some of the politically motivated diatribes against the field of natural medicine). However, by this time the academic and research worlds had long since forgotten about vitalism.

An organism’s unique complexity—as demonstrated by its ability to grow and develop, respond to stimuli, reproduce, and repair itself—requires a level of organization and coordination that suggests a distinct quality that is not readily explained by mechanism. This is studied extensively by all medical students in physiology class as the “normal” homeostatic process common to all living organisms. However, the tendency in conventional medical school is to put the concept aside when the student moves on to study pathology and the clinical sciences. Yet, up to the point of death, maintaining homeostasis is a prime, if not the primary, driving force in all living organisms. To think that homeostasis is only an important factor in “normal” physiologic processes and has no relevance in pathology is to ignore all of the basic sciences. All life is attempting to return to this ideal state whenever injured or ill. The only point in the life cycle that an organism is no longer “trying” to maintain homeostasis is death.

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