Friday, March 15, 2013

Reflections on a Dialogue between NM & CMA: Holism on the Ground

What is holistic health? This question was the focus of a recent dialog between critical medical anthropologists (CMAs) and naturopathic doctors (NDs) staged in a special issue of Medical Anthropology Quarterly (v.26, no.2). To summarize, each side has a different viewpoint on what true holism comprises. CMA sees health as determined holistically by sociopolitical and economic factors that pattern human behavior and human ecology while naturopathy sees health as a state of holistic balance between an individual’s mind, body, and spirit (Baer et al 2012); NDs subscribe to vitalism and assume that everyone has an innate capacity to heal oneself under certain circumstances as a unified mind-body-spirit. CMAs subscribe to critical theory and assume that a person’s health is a product of local-national-global power relations.

Although the dialog is well-needed, as ‘holistic health’ is generally used too vaguely to be useful theoretically, we contend that keeping the debate to specific disciplinary agendas without grounding the understanding in a user perspective is limiting. We believe that a user-grounded perspective is necessary if scholars are to craft and agree upon a clearly delimited way to understand and deploy the term.

We found, in the dialogues by Baer et al. (2012) and associated responses by other scholars (Tippens et al. 2012; Evans 2012; Hunter 2012; Calabrese 2012; Hess 2012; Flesch 2012; Jordan 2012; Baer 2012), that both CMA and naturopathy aim to create a holistic approach to health, but that each saw the other as maintaining a self-limited scope. CMA critiqued naturopathy, along with other complementary and alternative medicine practices, for being too focused on the individual and not addressing the sociopolitical and economic institutions and structures that pattern health politics. Naturopathy critiqued CMA for ignoring the individual as an agent for sociopolitical and economic change.

We concur with Tippens et al. (2012) that “the two fields have common goals, and, with improved understanding of similarities and differences, have much to offer to one another. Each can learn from the strengths of the other to enhance health care delivery” (258). However, the historical differences that have shaped each discipline leave the two highly dichotomized and seem to mitigate creating a satisfactory definition of holistic health.

While both parties provide an important perspective, and each discipline can carry forward applying its own philosophies, the distinction between them may be academic: that is, it may be elided in real world practices. In other words, the excessive concentration on their respective disciplines and actual behaviors may have caused the scholars in this debate to neglect the voices of those who are seeking health. We contend that the individual who is searching for health care, either for him- or herself or for those he or she cares for, occupies the crossroads between mind-body-spirit and political economic experiences and concerns.

To better understand holistic health, we propose to take into account the seeker’s point of view. We have been granted the opportunity to do just that using data from EJ Sobo’s Healthy Child Development Project (e.g., Sobo 2013), which explores the developmental pediatric framework undergirding Waldorf education from both teachers’ and parents’ points of view (Waldorf education is an independent alternative to public schooling). The project entailed ethnographic observations in classrooms, focus groups, and interviews, some of which served to provide formative data for the development of a home health survey for parents. We helped collect and process parent data for the project, and are assisting with the analysis of the parent data. The analysis is still in its initial stages but so far we have been struck by several themes that we believe may predominate in the data—themes relevant to the dialog between CMA and ND.

The perspective of parents on the topic of vaccinations has been particularly interesting while we reflect upon the holistic health definitions framed by CMA and NM. Here we must note that vaccination was not the study’s focus; parents mentioned it, however, while describing their overall approach to child health. Participants said that delaying or avoiding vaccinations for their children, particularly for diseases such as chicken pox, was not uncommon among Waldorf parents. In vaccination decisions, participants addressed the individual needs of their children while also acting as informed consumers rather than simply bowing unthinkingly to sociopolitical pressures, such as biomedically-oriented health discourse. In the words of one participant in the first focus group, parents in this community are “maybe a little more discriminatory, a little more educated” than those parents who simply follow the doctor’s orders.

In the second focus group, one of the participants again brought up the point that parents in the Waldorf community might opt out of certain vaccinations and focus instead on trying to maintain a good diet and otherwise healthy lifestyle. Here, parents seem to be in agreement with the NM definition of holistic health, and similarly focused on the body’s capacity to heal itself. Accordingly, some also seem to feel that by vaccinating children they might be causing more harm than good. Parents’ recognition of their choice to vaccinate allows them to promote the natural processes carried out by one’s immune system and combat the hegemonic forces of pharmaceutical companies and health policy, which pressure vaccination of children through the education system. As one interview participant noted, “It shows that the parents are individual thinkers and are thinking, and it takes a lot of work to go against the grain of society, you got to sign [waivers] and the parents are talking creatively and individually” [ST-11]. Here, parents are also employing the CMA definition of holistic health as they view themselves as well as others in the community as “individual thinkers,” who are able recognize extra individual forces that are responsible for patterning human behavior.

Indeed, from the participants’ perspective, holistic health seems to be a framework for medical pluralism that places biomedicine and all other forms as equivalent resources to use according to specific and individuated needs. As one focus group participant explained, “It’s not like [it’s] just alternative medicine. It’s sort of this holistic approach, so that every aspect becomes important” [FG1]. In the words of another, “I’m making the choice” [FG1]. Participants would draw on medical modalities according to the specific issues they were facing and the characteristics of the individual child they were caring for. They would assess each child’s needs according to his or her individual history.

While holistic health has recently been differentially defined by CMAs and NDs as either determined by sociopolitical and economic factors or by an individual’s mind, body, and spirit connections (Baer et al 2012), this theoretical division does not seem to sustain in actuality when there are a range of flexible choices for persons to draw on as agents of their own health. Participants in this research seem to transcend the dichotomy presented in the CMA-ND dialogue, employing specific techniques that corresponded with specific health issues. From the transcribed data we have reviewed thus far, this transcendence is recognizable as parents choose whether or not to vaccinate. They seem to draw not on a dualistic framework but instead one of pluralism, and their definition of holistic health hinges on this perspective.

Sean Tangco, Erik Hendrickson, & Samuel Spevack
San Diego State University, Anthropology


Baer, Hans A. 2012.  "Rejoinder: A Long and Convoluted Journey: Medical Pluralism, Naturopathy, and Critical Medical Anthropology." Medical Anthropology Quarterly, 26.2: 299-303.

Baer, Hans A, Cheryl Beale, Rachel Canaway, and Greg Connolly. 2012. "A Dialogue Between Naturopathy and Critical Medical Anthropology." Medical Anthropology Quarterly, 26.2: 241-256.

Calabrese, Carlo. 2012. "An Invited Contribution to 'A Dialogue Between Naturopathy and Critical Medical Anthropology: What Constitutes Holistic Health?'." Medical Anthropology Quarterly, 26.2: 279-282.

Evans, Sue. 2012. "Response to Baer and Colleagues: The Politics of Holism." Medical Anthropology Quarterly, 26.2: 271-274.

Flesch, Hannah. 2012. "Comments on Baer and Colleagues’“A Dialogue Between Naturopathy and Critical Medical Anthropology." Medical Anthropology Quarterly, 26.2: 287-291.

Hess, David J. 2012. "Notes on the Relations Between CAM and the Social Sciences." Medical Anthropology Quarterly, 26.2: 283-286.

Hunter, Assunta Elena. 2012. "Commentary: Naturopathy, Holism, and Critical Medical Anthropology." Medical Anthropology Quarterly, 26.2: 275-278.

Jordan, Meg. 2012. "A Dialogue Between Naturopathy and Critical Medical Anthropology." Medical Anthropology Quarterly, 26.2: 292-298.

Sobo, EJ. 2013. “High physical activity levels in a Waldorf school reflect alternative developmental understandings” Education and Health. 31.1.

Tippens, Kimberly Michelle, Erica Oberg, and Ryan Bradley. 2012. "A Dialogue Between Naturopathy and Critical Medical Anthropology." Medical Anthropology Quarterly, 26.2: 257-270.

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