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Healing But Not Curing

Last week I discussed the book Healing, Hype, or Harm? edited by Edzard Ernst. I was particularly struck by one of the essays in that book: “Healing but not Curing” by Bruce Charlton, MD, a reader in evolutionary psychiatry at the Department of Psychology of the University of Newcastle upon Tyne.

Charlton proposes a new way of looking at CAM. He describes three common attitudes:

  •  CAM does good and should be integrated with orthodox medicine. 
  • CAM is worthless and should be discarded.
  •  CAM may or may not do good and this should be decided using science.

He rejects all three. In his view,

  •  Alternative therapies do good.
  •  From a strictly medical perspective they are worthless.
  •  They should not be integrated with orthodox medicine.
  •  Because they are explained non-scientifically, they cannot be evaluated using the criteria of medical science.

He suggests that alternative therapies be regarded as spiritual practices. They are about making people feel better (‘healing’) not about mending their dysfunctional brains and bodies (‘curing’).

This struck a chord with me. I remember watching a TV documentary on the Brazilian healer John of God. They interviewed a woman who had rejected conventional treatment for breast cancer and was dying of that cancer but who considered John of God’s treatments a success because she felt better psychologically and was more accepting of her fate. She was not cured; she was dying. But she felt she was “healed.”

Acupuncture is based on mythical meridians, chiropractic on a mythical subluxation, and homeopathy on magical thinking. They are among the most successful and professionalized of alternative therapies. The basis of lesser methods like crystal healing and aromatherapy are even more imaginative and less scientific. These methods all remain popular despite the fact that after decades or even centuries of experience “there is not one clear-cut instance in which any alternative therapy is unequivocally effective and indicated for any particular disease or symptom.” CAM clearly constitutes a different, nonscientific universe of discourse.

CAM is far more compatible with New Age spirituality, which “focuses on
subjective psychological states such as integration, authenticity and self-expression.” Old spirituality was the province of organized religion and churches; this new spirituality “consists of individuals pursuing their own spiritual goals in their own way.” In New Age healing, “…what matters is the subjective ‘meaning’ to the individual – the self-evaluated effects it has on a person’s sense of well-being.”

When cancer is cured by surgery or chemotherapy, the patient is better off in the long run but feels worse in the short run from the effects of the operation or the drugs. When pneumonia is cured by antibiotics, the patient usually feels better; but even if he doesn’t, the cure is worth having.

…orthodox medicine must cure, and should aim to heal – but it does not need to heal; while alternative therapies do not cure – so they must heal in order to be worthwhile.

Concepts like meridians serve as myths, poetic symbols that have personal meaning. When CAM talks about “energy” it refers to a positive subjective sense of vitality and harmony that has nothing to do with the definition of energy in physics. Patients find concepts that have intuitive validity for them. It’s a matter of “what works for me” – individual experience is the ultimate authority.

When science is talking about demonstrating facts and treating disease and CAM is talking about reaching subjective personal and spiritual goals, there can’t even be any meaningful communication. It is misguided for CAM to seek validation through scientific studies.

Alternative medicine will survive and grow most effectively by dropping its scientific pretensions and becoming candidly mythic, poetic, fictive, symbolic, metaphorical and fantasy-based.

…randomized trials of New Age therapies are as inappropriate as randomized trials of prayer or the enjoyment of Mozart – such investigations will inevitably be inconclusive, confusing and irrelevant.

…so long as the therapy does no significant harm, intuitive benefit is the beginning and end of evaluation in alternative medicine…alternative therapies are neither medical nor scientific, but they should be respected as a potential contribution to modern spiritual well-being.

Charlton envisions a future where both scientific medicine and CAM thrive, but separately. I find it difficult to imagine how this could come about. CAM recognizes that science matters, and it will not willingly give up its scientific pretensions. And I don’t envision the average patient having the judgment to decide when to see an MD and when to see a CAM therapist.

I don’t think his proposal is practical, but I do think he has hit the nail on the head about the meaning of “healing” and its role in explaining the attraction of CAM. Pain is not the same as suffering. Curing is not the same as healing. It behooves us to keep this constantly in mind.

Posted in: Science and Medicine

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67 thoughts on “Healing But Not Curing

  1. billga says:

    I wonder if Dr Charlton is willing to entertain the notion that spiritual practices have a record of doing harm!

  2. Mojo says:

    “Because they are explained non-scientifically, they cannot be evaluated using the criteria of medical science.”

    Is this a direct quotation or a paraphrase?

    Surely it is a massive non-sequitur? CAM therapies are used with the intention of producing a measurable effect: improved health, or reduced pain, or whatever. If they achieve this, the effect can be measured. The various explanations offered, whether invoking “Qi”, magic, or quantum flapdoodle, are beside the point: the therapies are claimed to have real effects.

    This looks like the same special pleading we see from homoeopaths when they claim that DBPC trials are “not a fitting research tool with which to test homeopathy”.

  3. Dr Benway says:

    Ah, we can sort CAM with NOMA! After all, it worked so well to sort the science-vs-religion debate.

    /sarcasm

    I think the jig is up when the doctor says he’s only pretending.

  4. Dr Benway says:

    The “healing” vs “curing” is a crock of poo.

    Disappointed patients we can’t fix will continue wishing for some solution to their problems. Of course they’ll seek out unproven ideas. I would do the same. But let’s not reify this groping in the dark as “healing.” The transient good feeling one enjoys while entertaining a wish isn’t “healing.”

  5. Harriet Hall says:

    The full quote: “Because alternative therapies do not ‘cure’ disease, they have no role in orthodox medicine; and because they are explained non-scientifically, they cannot be evaluated using the criteria of medical science. ”

    Of course, you can do objective imeasurements on patients receiving CAM treatments, but there is no way to measure meridians, qi, Innate, psora, the human energy field, etc. They are accepted on belief.

    I think of healing as what happens to a wound. I don’t think “feeling better in some way” equates to healing. The point is, many consumers of CAM do. We are not even speaking the same language. If the only objective is to feel better while you are dying of your untreated cancer, CAM may be a success. If the distinction could be made clear, perhaps fewer patients would choose CAM.

    Also, I think doctors sometimes fixate on an improvement in a blood test instead of on how the patient is feeling. We could do a better job.

  6. Dacks says:

    Devil’s advocate: Is it possible that patients who experience “healing”, that is, who feel more at peace with their physical state, have less stress than those who are anxious about what is happening to them? Certainly that would lower subjective feelings of pain and discomfort. And perhaps lowering anxiety might have measurable health benefits (lower blood pressure, etc.)?

  7. Harriet Hall says:

    Dacks,
    Sure, it might. That would have to be tested and, and we would want to know if the lowered blood pressure, etc. translated into longer life or better outcome (POEMS – patient-oriented evidence that matters). And if it is true, it is an argument for scientific medicine to pay more attention to the patient’s state of mind, not to go outside medicine and play imaginary games.

  8. Richard says:

    I like what he has to say, although CAM does have its dangers and we needn’t agree with it or like it. I believe that the chief issue for medicine, in this regard, should be to protect its integrity as a science and to guard its turf from illegitimate encroachments of pseudoscience. While doctors should always feel free to express their concerns to patients, they should respect patients’ choices to use CAM if it is not harmful. I don’t want other people imposing their beliefs on me, and the last thing I’d want to do is impose my beliefs on others.

  9. Dr Benway says:

    “I don’t want other people imposing their beliefs on me, and the last thing I’d want to do is impose my beliefs on others.”

    If my doctor believes X is the best treatment for my cancer, though I might have thought otherwise, I really would like for him to “impose” his belief upon me.

    As a patient, I’m interested in what is true, what is known. “Belief” per se isn’t really relevant.

  10. Karl Withakay says:

    The whole concept strikes me as a logical non sequitor and dead end.

    Most CAM modalities and scientific medicine are mutually exclusive and incompatible. (Most CAM modalities are also incompatible with each other) They represent competing theories of the function of health and disease, and can’t really coexist without cognitive dissonance.

    Meridians, subluxations, and the law of similars claim an understanding of biological function that is unsupported by and contrary to scientific evidence and contrary to scientific understanding of biology and anatomy. As long as acupuncture, chiropracticy, and homeopathy maintain their underlying pseudoscience, they will be incompatible with scientific medicine.

  11. pmoran says:

    While anything can be measured (and even states of mind can be) it can be investigated by the methods of science. So I strongly disagree with the kind of divide being suggested here.

    The author is not alone in assuming that science ends at the reach of the “working better than placebo” randomized controlled trial. Many skeptics go even further, implying that anything beyond that is just not worth worrying about. This is approximately true in very many medical contexts but it is ultimately a very restricted view of both science and of practical medicine, in my view.

    Researching the placebo and other non-specific influences of medical interactions is certainly difficult, but we can infer a lot from the anecdotal material, as well as from the few studies now being performed to look specifically at this component of medicine.

    Such evidence does not (of course) support the existence of supernatural or obscure, undetectable mechanisms. It is entirely consistent with everything else that we know about the human psyche. It is also consistent with a view that CAM comprises claims ranging from the fraudulent and dangerous to relatively harmless practices having limited but potentially valuable benefits in terms of symptom relief, coping with illness, and modifying illness behavior. As a corollary, some discrimination is appropriate in our approach to its various elements.

    In my view, anything else goes beyond the present state of the scientific evidence.

  12. wertys says:

    I agree that we are speaking a different sociological language from sCAM, but I think the quoted article probably represents a wishful thinking approach. In pain medicine we almost never ‘cure’ chronic pain, but a range of treatments from gabapentinoids through interventional techniques to CBT are employed to assist the sufferer to briing about positive change and adaptive coping. The people whose pain responds well to the first drug you try are equally as grateful and pleased with their treatment as the ones who eventually find that acceptance of the pain and adaptive coping techniques represent the best that anyone can do.

    I think the non sequitur at the root of the quoted position is the old warhorse that the failings of medicine are not a proof of the need for sCAM. We have to do better at influencing the social discourse and better at relating to patients amid the welter of scientific and technical babble. In short we need more awareness and research on ‘human factors’ as it is called in aviation circles.

    I do believe this awareness is growing and at least in the medical schools at which I teach, there is considerable time and effort devoted to training young doctors to be better at these skills than their predecessors. Generational change is constant, and the young doctos of the very near future are extremely techno-savvy and much better communicators on the whole than I and my colleagues were 15 years ago. Systematic correction of the deficiencies of medicine will help remove the perceived need for any alternative.

  13. Sastra says:

    While I agree that the “healing” vs. “curing” dichotomy is likely to be misused (as it will not be made clear that “healing” is not limited to the psychological), at least admitting that alternative medicine is a religious, spiritual belief system is more honest. The whole argument about patients being allowed the “freedom to choose” their health care falls apart if they are not given clear and honest information on their options.

    “Science supports this” and “there are many studies that show that it works” are lies — and yet the practitioners of SCAM make them again and again. Question the advocates and it’s not uncommon that within 10 minutes the same people who first insisted that healing energy or homeopathy is “very scientific” — and pretended to be puzzled at the unexpected skepticism — are now castigating science as a dogma and deriding the scientific community as narrow-minded. They lie and at some level they know they lie.

    So if the alties tell people “no, this is not scientific, and none of this is verified by good studies done under controlled conditions. I’m offering you faith healing” then at least the consumer is finally being given accurate information they can use in making their choice.

    Faith is guaranteed. They will discover that alt med “works” the same way they discover that God “answers” their prayers. It is up to them to come up with some rationalization for why they are satisfied, no matter what happens.

  14. Fifi says:

    Of course, the issue remains whether there’s even any psychological/emotional/spiritual “healing” going on via many sCAM modalities. While a psychotherapist is trained to be able to recognise transference and counter-transference, an untrained sCAM “healer” isn’t (likewise many “spiritual leaders”, cults often seem to be reenactments of abusive family situations and it’s often people from abusive family situations who end up in them since they’re vulnerable to these kinds of psychodynamics). So, you have lots of people unconscious of boundaries, projection and needs playing at being psychotherapist. This doesn’t mean religion can’t provide people with a sense of belonging and community – or that there aren’t sCAM practitioners who aren’t innately quite good therapists (people with borderline personalities or who are on that spectrum can often make great therapists, as long as they’re aware of their own fluid boundaries and know how to manage them). Poeple always feel good while they’re being conned – it’s part of why and how cons work – it’s only after the fact that they feel betrayed, ripped off and angry.

  15. Dacks says:

    Here’s a hypothetical:
    A patient is diagnosed with cancer. She becomes anxious, can’t sleep, doesn’t eat, her health suffers.

    The doctor recommends yoga, or meditation, or even guided visualisation. She gets a tool to deal with her emotions, she sleeps, better, eats better, is able to concentrate.

    These modalities have not done anything to cure her cancer; however she is more comfortable and resilient. Perhaps (only conjecture) her treatment is more likely to be effective, because she is maintaining her overall health.

    Of course, it might depend on how much buy-in occurs. But it seems like there might be a place for therapies that don’t actually directly affect the condition for which they are prescribed.

  16. LindaRosaRN says:

    In my dictionary “heal” and “cure” mean the same thing. This is word hijacking. Most annoying.

    This heal vs. cure crap may have started in nursing when Janet Quinn (U of Colorado) talked about the word “heal” coming ‘haelen’, an old word meaning to make or become whole. (“On Healing, Wholeness, and the Haelen Effect” 1989)

    Nurse academics thought it would be really cool to be “healers” (i.e. facilitate self-healing through good intentions) and leave mere “curing” (said with a sneer) to doctors. Healers would deal with everything: mind, body, spirit, and those cute, fluffy energy fields. Bottom Line: It’s an intellectually lazy movement that blames patients for poor outcomes.

    It would be nice if CAMsters like this stayed out of nursing/medicine, but that won’t happen.

  17. Skeptic says:

    Agree with LindaRosaRN and others about the false dichotomy of “healing” and “curing.”

    I think it is ridiculous to try and hijack the word “healing” to mean “not healing”–where “healing” is supposed to mean giving the false impression of healing where no actual healing is involved. Yes, placebo effects can reduced anxiety and perceived pain but there is no “healing” involved.

    Looking at common usage of the word “healing” we refer to the healing of wounds. This refers to an actual physical “cure” not to an imaginary state of believing one’s wound to be healed. It is dangerous to confuse the two.

    Bruce Charlton’s attempt at creating a NOMA between scientific medicine and imaginary medicine is a terrible idea.

  18. Skeptic says:

    “Because they are explained non-scientifically, they cannot be evaluated using the criteria of medical science.”

    And, of course, this is also a canard. The outcomes are still testable even if the sCAM treatment has no biological plausibility. It isn’t that sCAM can’t be tested by controlled, double-blind clinical trials but that sCAM practitioners have discarded such tests as defective because they fail to deliver the results they want.

  19. bigjohn756 says:

    I have a problem with the term Complementary and Alternative Medicine. It seems to me that complementary medicine would be used in addition to real medical procedures, whereas, alternative medicine will be used instead of real medical procedures. What’s wrong with using unproven medical procedures, as long as you’re using proper medical procedures as a main course of treatment, and a side order of complementary medicine makes the patient feel better and is not too expensive?

  20. Mark Crislip says:

    personally i am completely tone deaf to all things spiritual. But I recognize in patient care that there is more to making people better than killing what ever germ is infecting them. i recognize the difference between healing curing in this context, but I don’t like words either. it may be all the social interactions that people require that helps them feel better; what scamers excell at is grooming the ape, picking off the nits and eating them. it makes the ape feel better.

  21. Dr Benway says:

    “Wholism” always comes up in the context of cancer and a few other nasties. Never hear about it in the context of community acquired pneumococcal pneumonia.

  22. Fifi says:

    Dacks – “These modalities have not done anything to cure her cancer; however she is more comfortable and resilient. Perhaps (only conjecture) her treatment is more likely to be effective, because she is maintaining her overall health.”

    There was a study done in BC, Canada a number of years ago to discern whether people with cancer who were in support groups survived long than people who aren’t, there was no difference in survival rates (though people obviously felt more supported so there was a pscyhological benefit). There was another study done (in Australia, if I remember correctly) on whether “positive thinking” had an effect on cancer progression and survival – it didn’t. We all like (or have a neurological/psychological tendency it seems) to think that if we wish really hard or focus our will to something (essentially the same thing) that we can influence matter with our mind.

    What people fail to realize is that optimism, when taken to an extreme, is just as delusional and useless/harmful as pessimism. If anything proves that, it’s sCAM!

  23. Dacks says:

    “There was a study done in BC, Canada a number of years ago to discern whether people with cancer who were in support groups survived long than people who aren’t, there was no difference in survival rates (though people obviously felt more supported so there was a pscyhological benefit).”

    Do you happen to know whether there were ANY differences between these groups? Just wondering whether the support group helped with the need for pain medication, or any other needs that can be influenced by subjective experience.

    “There was another study done (in Australia, if I remember correctly) on whether “positive thinking” had an effect on cancer progression and survival – it didn’t.”

    My hypothetical did not involve “positive thinking” – I was musing on the idea that relieving anxiety might cause an improvement in overall health by promoting better sleeping habits, eating habits, etc.

  24. Fifi says:

    Dacks – My understanding is that there was no difference in clinical results (which would include reduction of pain symptoms I’d guess but that’s a bit hard to compare since pain is subjective and ideosyncratic). I’ll see if I can find the study or an article on it and the Australian study.

    It leads me to wonder why do you/we now tend to assume anxiety would promote better eating habits? Anxiety may well actually motivate someone to change their diet for the better and complacency (lack of anxiety) may mean they continue eating their normal unhealthy diet. Anxiety may also push someone to exercise too. The assumption that stress (or even anxiety) is always a bad thing is ignoring the fact that stress/anxiety can actually be very useful as a motivator and exists for a reason. Chronic unresolved or unresolvable stress or anxiety may not be desirable or healthy but stress isn’t bad or unhealthy in and of itself if it’s responded to by an action that improves the situation.

  25. Dacks says:

    I wasn’t thinking of the quality of the diet, but more to the fact that people experiencing high stress levels tend to lose their appetites.

    The idea of stress being a motivator is fine; it seems to me that this wouldn’t be the case with anxiety related to a diagnosis of cancer. The huge disruption this kind of news creates in a person’s life, combined with health effects of impaired sleep, loss of appetite, inability to concentrate doesn’t seem likely to produce benefits.

  26. daedalus2u says:

    What CAM proponents seem to be forgetting is that there are pharmacological ways of making people feel better too. It is my understanding that injections of cocaine and heroin do wonders for how people “feel”. Is there any way to distinguish the “feelings” from cocaine and heroin from the “feelings” of CAM? Other than the unsupported statements of CAM proponents that they are different?

    I appreciate that there are potential ways to distinguish that the feelings are different, but these are not methods that CAM proponents have ever used to test that the “feelings” that their treatments produce are qualitatively or quantitatively different than pharmacologically induced feelings.

  27. tmac57 says:

    I think that the existence of CAM et al suggests there is a missing ‘human’ element in the way most patients are receiving treatment today,as has been acknowledged above by some of the comments by the Drs.
    CAM’s problem for me is that it pretends to be science based, when it doesn’t seem to meet that challenge. Surely there are reality based ways to meet the physical and mental needs of patients that are facing grave illness, and not some hocus-pocus “let’s pretend” type of charade .
    The medical community will either have to step up to the plate on this, or CAM will continue to make inroads to fill this gap.

  28. Fifi says:

    Dacks – People on pain medication and many cancer treatments often lose their appetite – smoking or eating pot helps some people regain their interest in food. It’s why medical marijuana exists and is being studied and used by quite a lot of people. At this point, medical marijuana seems to have more clinical evidence as an appetite enhancer than yoga or relaxation.

    The yoga world is full of myths about stress, disease and how yoga/relaxation cures and prevents disease – and often points to anxiety/stress and “bad” feelings being the cause of disease. Apparently this resonates with most of us on a psychological level – particularly in a society where we’re taught that good things happen to good people and everything will be okay if we’re just good people AND conversely that bad things happen to people because they’re bad and deserve it. Who doesn’t feel “good” when relaxed? The question remains whether feeling “good” or “happy” is equivalent to being healthy. The reality is, lots of people get cancer and don’t even know they have it (they feel “fine” or “good”) until they’re diagnosed with it.

  29. Dacks says:

    Fifi,
    i’m not sure what you’re getting at. It sounds like you’re responding to points that I haven’t made. I’m not making any claims concerning any CAM treatments, because they don’t have measurable effects.

    It does seem possible that making patients “feel” better might have benefits not related to the CAM that they use. This could be lumped into placebo effect, but there might be a way in which it could be used without deception being involved. It would be unethical for doctors to prescribe CAM to treat an illness, but it might not be unethical to suggest that they try something that might help them cope. Some people already have mechanisms in place – religion, meditation, etc. – but for those who do not it seems a little churlish to say ‘don’t bother with that because it won’t cure your cancer.’

  30. James Fox says:

    I would think cure and heal are regarded as synonymous by most people and any attempt to parse these words as having a substantially different meaning would be a disservice to health care consumers.

  31. Fifi says:

    Dacks – I’m not saying “don’t try to feel better” and that’s not how any oncologist I’ve met approaches their patients. Seeking emotional support through a support group or grief counselling is often recommended. That’s why I brought up the Canadian study. Feeling better and not alone in what can be a frightening experience is a benefit within itself. Support groups are free so there’s not the added burden of paying for yet another thing (since being sick tends to be expensive, paying for more treatments can only add to a patient’s stress). The Canadian study showed that there was no “healing” effect of being in a support group, though the participants obviously appreciated being able to share their experience with other people who understood. I’m not against support groups, grief counselling, massages to relax, blowing the rest of your savings on a dream vacation or doing yoga – I’m just against spreading the myth that they cure cancer or help to cure cancer.

  32. When I think of healing, I think of biological self-repair. The curing vs. healing dichotomy seems like a misleading distinction to apply to CAM because it seems to imply “healing” with CAM is expediting an objective physical process of repair or regeneration.

    Sure, we also use the word “healing” to describe whatever happens as we come to terms with emotional upheavals–but that seems more like a metaphor or an unproven conjecture. All psychological processes are physiological processes, but it’s not obvious that every loss or frustration or fright causes damage or dysfunction to a person’s brain in the same sense that a laceration damages her finger. Sometimes feeling bad is a sign that our brains are doing what they’re supposed to do–processing information and generating reality-based, proportional emotional responses.

    If we’re sure we’re talking about a frank mental illness like major depressive disorder or schizophrenia, we’re usually looking for a cure, or at least an effective treatment, not some nebulous form of healing.

    If you want to distinguish between curing and the other ways clinicians help their patients, better to focus on differences like curing vs. comforting, or curing vs. reassuring.

    Doctors aren’t the only professionals who can do these other beneficial things. I had a great interaction with a lawyer the other day. I know people don’t say that very often. This guy had an amazing “deskside manner” or whatever the legal analog is to a bedside manner. I was extremely upset about a problem I was having, to the point of feeling physically sick. He couldn’t actually solve the problem, but he was so compassionate and competent and respectful that I felt dramatically better after talking to him. I was objectively coping better, too–partly because he gave me some good practical advice, but mostly because somebody cared enough to really listen and give me a reliable “prognosis.”

  33. I meant to add that this lawyer helped me in ways that were at least as much social/psychological/emotional as strictly legal. It’s easier to differentiate between these dimensions of professional helping with law because there’s little chance that making the client feel better changes the legal facts on the ground. Whereas with medicine, we’re still talking in circles about how feeling better relates to getting better.

    The guy wasn’t practicing “complimentary” or “alternative” law when he helped me feel better about my problem. He was just practicing law. That kind of client-centered (or patient-centered) helping has always been a the core many kinds of professional relationships from law to medicine to nursing to some kinds of teaching. It’s not based on anything magic.

    I don’t buy the argument that the helping aspects of a professional relationship are ineffable. Ask people how satisfied they are with the care they receive, how much they trust their lawyer/doctor/nurse/professor, how often they recommend him/her to their friends. If anything, differences in self-reported satisfaction from one practitioner to another are probably larger and easier to measure than most differences in outcomes.

  34. Fifi says:

    Lindsay – “Sometimes feeling bad is a sign that our brains are doing what they’re supposed to do–processing information and generating reality-based, proportional emotional responses.”

    Well said! I also appreciate your lawyer anecdote since it illustrates how we can all benefit from being treated compassionately and feeling heard when we’re in a stressful situation. However, brilliant deskside manner aside, I presume you won’t be referring people to your lawyer for cancer treatments? ;-) It sounds also as if his ability to help you get a good handle on the reality of the situation was helpful.

    I agree wholeheartedly that how much someone “likes” their doctor or lawyers has a lot to do with individual personalities and is very variable because of this. Besides, it’s not like con artists don’t work extra hard to be “likable” so it’s hardly a good measure of anything other than “likability” (which would undoubtedly diminish as soon as one realized they were being conned, conmen tend to be very “likable” as part of their professional arsenal).

  35. Thanks, Fifi.

    Unless a person’s an out-and-out con artist, chances are, their likable demeanor has a lot to do with the fact that they actually know what they’re doing.

    My underlying point is that Charlton’s curing vs. healing distinction is mistaken.

    First off, CAM doesn’t heal people in sense of knitting their broken bones or closing their flesh wounds. (If it did, and we could prove it, it wouldn’t be CAM.)

    Second, if people are getting anything out of the CAM experience at all, it’s not an ineffable, mystical benefit that can’t be compared to the benefits of traditional medicine. On the contrary, we know that CAM practitioners don’t benefit patients as much as real doctors. Good doctors have good bedside manners and real expertise. Whereas, CAM practitioners have only their social skills to fall back on.

  36. pec says:

    “When CAM talks about “energy” it refers to a positive subjective sense of vitality and harmony that has nothing to do with the definition of energy in physics.”

    Then how do you explain all the scientific research on biological energy? You have made up your mind that there is no biological energy, but what is the evidence that convinced you?

  37. Dr Benway says:

    pec,

    By “biological energy,” do you mean glycolysis and the Kreb’s cycle?

  38. (Fifi, this is off-topic, but I’m really curious about something you said upthread. You mentioned that people on the borderline personality spectrum can make great therapists. What is it about the borderline personality type that lends itself to being a therapist? I always thought of borderline personality traits as the exact opposite of what would be required to be a good therapist: unstable, self-centered, unable to form lasting emotional attachments. Sorry to threadjack, I would have sent this question in an email, but I don’t have your address.)

  39. pec says:

    [By “biological energy,” do you mean glycolysis and the Kreb’s cycle?]

    No, I mean forms of energy not yet recognized or measured by physicists.

  40. daedalus2u says:

    Lindsay, (If I might answer your question to Fifi as it does somewhat relate to my research and I have had some rather close experience with someone who is borderline).

    What is needed in a therapeutic relationship is for the patient to attach to the clinician and for the patient to “transfer” their attachment to other individuals to the therapist, such that the dysfunctional aspects of those relationships and attachments can be “worked out” in the therapy.

    People who are borderline are exquisitely good at imputing attachment. They can impute attachment when there is none. They are in that sense “attachment magnets”. Lasting emotional attachments and relationships are problematic for them because they project too much. They base their relationships on what they feel, not necessarily what is actually going on in the dynamic between themselves and someone else.

    A therapeutic relationship is not meant to be long lasting. It is malpractice for a therapist to try and make a therapeutic relationship into something non-therapeutic. Figuring out when the therapy is no longer being therapeutic is important so it can be stopped. Someone who is borderline can be attached to easily and can then be non-attached as the therapy progresses. The therapist needs to represent multiple attachments and relationships in the patient’s real life, not be a real person in the patient’s life.

    How this relates to my research is that there is some evidence that as you move along the autism spectrum, at one end you have autism-type disorders, and at the extreme non-autism end you have psychosis-type disorders. I see these as trade-offs of a “theory of mind” for a “theory of reality” (and have blogged about it). A “too powerful” (but powerful is not the right word) theory of mind can see mental states that are not there, can project their own mental states onto other individuals or even onto inanimate objects. Hearing voices is an example of imputing communication when there is none. I think this is the source of much of the anthropomorphizing that imputes spirits, demons and “intelligence” into the natural world and inanimate objects.

  41. Dacks says:

    “Good doctors have good bedside manners and real expertise. Whereas, CAM practitioners have only their social skills to fall back on.”

    What if a doctor does not have a good bedside manner, but can refer you to someone who does – a clergy member, support group leader, etc. Does that help the patient, and is the doctor a better practitioner for it?

    (BTW, I don’t use any of the cam methods I’ve mentioned in this thread – from yoga to meditation to religion – but I know those who do, and who find them very helpful in dealing with life’s upheavals.)

  42. daedalus2u, that’s fascinating. Thanks.

    Dacks wrote: “What if a doctor does not have a good bedside manner, but can refer you to someone who does – a clergy member, support group leader, etc. Does that help the patient, and is the doctor a better practitioner for it?”

    Making good referrals is part of being a good doctor, I’d say–whether it’s matching up patients with medical specialists, or social workers, or chaplains, or whoever.

  43. Dr Benway says:

    pec: “No, I mean forms of energy not yet recognized or measured by physicists.”

    Ok. Is this energy recognized and measured by others? If so, how do they measure it?

  44. weing says:

    With Ouija boards?

  45. Fifi says:

    Lindsay – To answer your questions about therapists and borderline personality disorder (it has nothing to do with “imputing attachment”). And I’m not suggesting people with unacknolwedged borderline personality disorders should be psychotherapists (just to be clear! :-). What can make people on this personality disorder spectrum good therapists is their ability to empathise and “feel” other people’s emotions (part of the disorder centres around being finely attuned to the emotions of others and not being able to discern where their own feelings end and those of others begin, if someone can learn to distinguish between their own and other’s feelings, the empathic abilities can be very useful for a therapist and there are obvious reasons why people with these kinds of personality disorders or tendencies are attracted to being therapists of various kinds). Obviously, for CAM practitioners who can’t distinguish between their own and other’s feelings because they have no training in clinical practice and haven’t undergone therapy themselves, it can be highly problematic. I’ve met a lot of CAM healers – who often call themselves “empaths” – who seem to fit this discription.

    Dacks – Doctors do often refer people to outside support groups. I don’t know of a cancer treatment centre at a hospital in my city that doesn’t have a support group. I find it odd that you seem to keep assuming or wanting to promote the idea that doctors don’t suggest support groups or grief counselling when it’s standard practice. (I also find it odd that you keep mentioning “clergy” – why would a doctor suggest religious support unless the patient was already part of a religious community and had a priest/rabbi/guru/mullah/high funtioning Thetan they already used in the context of emotional support?)

    I DO practice yoga and meditation so I’m personally aware of what they can and cannot do. Plus I’ve taught basic awareness meditation, relaxation and body/mind awareness at a pain clinic so I’m quite aware of their usefulness and limitations within a clinical context. I know people who find video games very useful for dealing with stress and life’s upheavals. Exercise is also fantastic for stress reduction (after all, yoga is really just exercise). Personally I find climbing just as good as yoga since it requires more intense focus (though one can do the same with yoga). Any physical activity you enjoy – particularly if it also has a social element and teamwork – will help most people reduce stress. Meditation is different than yoga and what results you get are highly dependent upon what kind of meditation is being practiced. It’s essentially a brain exercise – a workout – to physically build up your brain. (Incidentally, some people find meditating or trying to meditate very stressful since it’s essentially a form of cognitive awareness therapy without the guidance part. I wouldn’t advise it for someone in extreme distress unless they also had a psychotherapist to help them make sense of what they start to learn about their thoughts and feelings.) Someone who has been meditating for a long time already, obviously has a tool that can be useful in a situation like discovering one has cancer (as long as they don’t wander off into sCAM land and refuse medical treatment in favor of wishful thinking). Someone who has been running as their stress release practice also has a tool that can be useful.

    I find it interesting that everyone here has spoken only of “chaplains”. When I worked at the pain clinic, our patients were from many, many different religions or not religious at all in many cases. One of the biggest issues with patients who were quite religious (particularly ones who were superstitiously so) was the belief that they were being punished by theirr God for something. The vast majority of the time their clergy and religion weren’t making them feel better, they were actually making them feel worse! I’d often work within the context of someone’s belief system to try to help change this perception or to understand something but, overall, religion didn’t seem to actually be particularly positive vis a vis people with chronic pain. (I’m presenting this anecdotally, of course, so take or leave it as you will.) :-)

  46. The Blind Watchmaker says:

    “Because they are explained non-scientifically, they cannot be evaluated using the criteria of medical science.”

    So how does one evaluate its worth? We cannot assume worth without said worth being demonstrated.

    If patients were aware that their medical professional was knowingly giving them worthless treatment, I don’t think that they would be very happy.

  47. Dacks says:

    Fifi,
    I feel like we’re back full circle on this discussion. I was wondering whether what I’ll call “self-help” methods (not quite the right term, but I don’t know what is) can add anything to standard treatment when they don’t actually affect the patient’s progress in any direct way. Originally I was playing with the idea that reducing the stress of a person in a high stress state could have benefits other than treatment of their disease, by allowing them to regain normal sleeping, eating and mental patterns.

    It sounds like you have a lot of experience in this area, and that you find yoga and exercise in particular to have a stress reducing capacity. When you worked at the pain clinic, did you find any of these practices helpful for your clients? (I mean, assuming that high stress is not a desirable state.)

    You mentioned a study that found that being in a support group does NOT confer benefits in terms of life expectancy. So why do doctors refer patients to these groups? Do any of the methods mentioned – yoga, meditation, exercise (used here as stress relief, not for improving overall fitness), clergy – help the patient overcome disease?

    If they do not help at all, what is the ethical position for a doctor to take? Is there a continuum along which a doctor can more or less responsibly recommend a non-medical adjunct to treatment? Are support groups better than a yoga class ( maybe they can find a free yoga class!); is a daily jog better than a chat with clergy? Or should doctors try not to make recommendations in this area?

    I’m trying to clarify my understanding of your point of view, and to think a little more deeply about how one’s sense of well-being (if not the well-being itself) can be affected by attitude and behavior.

  48. Thanks, Fifi.

    I can see why a doctor might recommend a chaplain to a patient who wanted some kind of one-on-one counseling but who was resistant to working with a secular therapist or a social worker. I wouldn’t see much good in a doctor telling a patient to go to church–presumably that would have occurred to the patient already, if it was a good idea in the first place–but I can definitely see why a trained counselor with a spiritual bent might be a good choice for some patients, assuming the doctor had already ruled out serious psychiatric problems that only a psychiatrist or other highly trained psychotherapist could address.

    If a doctor recommended that I see a chaplain, I’d conclude that s/he didn’t know me very well. But it might be exactly the right referral for someone who’s spiritually inclined but “unchurched” (or “unmosqued”, as the case may be).

    The other day, I saw a neat photo essay in the paper about a multi-faith team of chaplains who specialized in free counseling for people with terminal illnesses. One of the guys on the team was a middle aged Buddhist monk, who oddly enough, seemed to specialize in pastoral care for elderly Jewish atheists. All the chaplains had relationships with doctors at the hospital that sponsored the program. If I were a doctor caring for a patient with a terminal illness, I might seriously consider referring folks to members of that team.

  49. Fifi says:

    Lindsay – I’m curious, do you think doctors should be asking patients what their religious beliefs are? And, why would it be any different to refer them to a chaplain than suggesting someone see a reiki practitioner? And do you think an oncologist is qualified to diagnose mental illness? Are you a doctor or medical professional of any kind? I ask, because unless you are it’s a bit meaningless to say “if I was a doctor…” Clearly you think religious support is a good idea and found the photo essay attractive. I’m not sure why you’re so sold on this idea if you’d question your doctor if he suggested it to you. Personally I’d think a doctor was both out of bounds suggesting religious counselling (suggesting counselling and then laying out option is a different thing).

    I’m not surprised that a Buddhhist monk was more capable of counselling atheists than the other denominations since there are secular/atheist Buddhists (just as there are Fundamentalist ones) – this means he has other philosophical tools than “eternal life” or heaven/hell to offer up to the discussion of dying. Of course, it’s quite telling that they weren’t counselled by a Rabbi but by the most likely to be atheist of the religious professionals. It makes a good case for secular counselling it seems to me!

    Clearly the team you saw the photo essay on was integrated into the hospital and worked with doctors – the doctors weren’t just randomly recommending religious counselling, they were working with religious professionals who had specific training in working with people with terminal illnesses and collaborated with the doctors. This is quite a different context since the religious professionals had training in grief counselling. All in all,I see no reason for a doctor to recommend religous counselling but I take no issue with it being offered as one of a variety of options. Why do you feel religious counselling is more effective or useful than secular counselling?

  50. Fifi says:

    Dacks – There’s a difference between quality of life and quantity (though people often confuse the two). When dealing with terminal illness, quality and quantity of life issues become incredibly important. This can only be an individual’s personal choice. Support groups often improve quality of life, though studies seem to indicate that they don’t improve quantity of life (you don’t live longer). Quality of life is worth considering and pursuing for most of us.

    I worked with patients with chronic pain, what I was teaching was certain techniques that can help some people with chronic pain manage their pain (though not all). It’s quite different than helping people with terminal illnesses (something I have a lot of personal experience with but no professional experience).

    Stress management – Regular exercise helps almost everyone manage stress by both using extra energy and increasing endorphin production. It’s one way to keep our body/brain and ergo our mind healthy and supports happiness. Regular exercise and being healthy obviously has a preventative effect for all kinds of diseases and against mild depression. It doesn’t cure anything as far as we know, however.

    Purely anecdotal….my favorite yoga teacher (who was also a yoga therapist/healer) was diagnosed with ovarian cancer. Because the organization she belongs to believes yoga and supplements cure cancer she decided not to have medical treatment. Not surprisingly, the cancer ended up progressing and she did finally undergo cancer treatments but by that point her cancer had advanced too much. Sadly, her daughter lost a mother quite possible because of erroneous “spiritual” beliefs about disease and cancer. Before she died she told me of other members of the organization who had refused treatment and died of their cancer rather than be ostracized from the organization or give up their beliefs that disease is caused by having bad thoughts and feelings. So, ultimately because much of the yoga community is heavily invested (both commercially and in terms of beliefs) in demonizing medicine and promoting faith healing, they’re not actually a great community to refer cancer patients to since cancer patients are vulnerable to being exploited (and their doctors shouldn’t be sending them off to be exploited).

    Support groups are people sharing with their peers who have gone through or who are going through a similar experience. They’re much more useful than clergy for practical reasons (not that someone might not find speaking to their religious leader comforting if they’re a person of faith). As noted above, what I was doing was quite diffferen than working with people with terminal illnesses (even though I have a lot of experience with terminal illness – though none of my friends wanted a priest anywhere near them before they died for reasons that included sexual abuse by priests as children). Management of chronic pain is all about quality of life so that was very specifically what I dealt with helping people learn how to create or recreate for themselves (and I did so as part of a team which included a variety of medical professionals).

  51. pec says:

    “Is this energy recognized and measured by others? If so, how do they measure it?”

    There is a lot of research on biological energy, some of it in mainstream journals, most in alternative journals. I had posted links last year.

  52. Harriet Hall says:

    The evidence is of very poor quality, not replicated, and nowhere near enough to convince mainstream science that such energy is real. There was a book reviewing all the evidence to date for energy medicine. I reviewed it and concluded the actual scientific evidence added up to zilch. http://quackfiles.blogspot.com/2006/01/review-of-energy-medicine-scientific.html

    Many of the proponents of energy medicine even boast that is is a kind of energy unmeasurable by science.

  53. I’m not arguing that a doctor is obliged to find out what a patient’s religious beliefs are, or that pastoral counseling is something that doctors should be promoting across the board.

    I’m just saying that I don’t see any problem with physicians presenting pastoral counseling as an option, provided that when we speak of “chaplains” or “pastoral counselors,” we’re talking about certified paraprofessionals who have been trained in mainstream counseling in addition to whatever theological training they have–not just any random clergy member who calls themselves a counselor.

    As with any other referral, the physician would have to know the counselor and be confident in their skills and professionalism.

    Physicians are generally given broad discretion to refer patients to any of a wide variety of counselors from psychiatrists to social workers. All doctors get a certain amount of basic psychiatric training in medical school. The prevailing assumption seems to be that this training, coupled with their clinical experience, qualifies them to determine roughly what level of mental health care a patient needs. Maybe that’s a problem with the system, but if so, it’s just as wrong to assume that an oncologist is competent to recommend counseling from a social worker as from a certified pastoral counselor.

    Presumably, trained paraprofessionals are also taught to recognize patients who are too sick for them to handle alone and refer them back to the medical side.

  54. Fifi says:

    “As with any other referral, the physician would have to know the counselor and be confident in their skills and professionalism.”

    So, do you believe that doctors who know trained religious counselors don’t suggest them to their patients of the same denomination? And do you believe doctors should seek out trained religious counselors in all denominations so they’re not merely promoting their own faith? You’re making a lot of assumptions about how qualified a GP or oncologist is to make a psychiatric diagnosis. You’re also missing the point since a GP referring someone to another medical specialist isn’t making a diagnosis, they’re referring them to be seen by someone who is more of an expert in a medical field so that specialist can make a diagnosis. I see no reason to believe that religious professionals have a solid understandstanding of mental illness or delusions – particularly since the Catholic Church still believes in demons and exorcisms.

    It’s not an oncologist’s place to tell someone to get counseling. What they can do – and usually do – is let people know about support groups associated with their hospital. Would you also like to see Scientologists on your recommended support list? Or new age healers? As a non-religious person I don’t really see much difference between them and the Catholic church (and the beliefs of the Catholic faith). I find it odd that you’re so keen that doctors *recommend* religious counseling and you consider it exactly the same as going to see a social worker (though I have no idea why you’d think a terminal patient would be referred to a social worker, that’s outside the domain of social workers doing anything but hospice work).

  55. Fifi says:

    eh, that should have read….

    “Do, do you believe that doctors who know trained religious counselors don’t suggest them to their patients if they’re not of the same denomination? Or should everyone be sent to see a Christian pastor or chaplain even if they’re of another faith?

  56. Fifi says:

    Eh, I’m confusing even myself….

    What I meant to ask is “do you believe that doctors don’t currently recommend religious consellors to their patients if they know a qualified religious counsellor of the same denomination as their patient? Do you believe doctors withhold information? If so, why?

  57. Dr Benway says:

    pec: “There is a lot of research on biological energy, some of it in mainstream journals, most in alternative journals. I had posted links last year.”

    Can’t search by comment author on this site.

    Sometimes it helps to put references you use a lot on web page you can link to, so you don’t have to type them in repeatedly.

  58. pec says:

    “The evidence is of very poor quality”

    Nonsense. You never acknowledged any of the studies I linked. You never explained what you thought was wrong with them.

  59. pec says:

    And Harriet’s review of energy medicine was hardly objective. There was one study showing that 20 self-proclaimed energy healers could not detect energy from the experimenter’s hand. Harriet accepted the results of that study without question, but rejected all the other studies (most of which she never mentioned and probably was not aware of) that seem to confirm energy healing.

    She would never accept the results of one study if it contradicted what she already believes. But one study is enough if it seems to confirm her beliefs. She did not even try to explain all the research showing positive results for energy healing.

    And of course the anecdotal and experiential evidence for biological energy is enormous. But it doesn’t count for Harriet, because she knows that people are fools and their experiences can all be discounted.

  60. pmoran says:

    Pec: “There was one study showing that 20 self-proclaimed energy healers could not detect energy from the experimenter’s hand. Harriet accepted the results of that study without question, but rejected all the other studies (most of which she never mentioned and probably was not aware of) that seem to confirm energy healing. ”

    You don’t understand. The Rosa study totally demolished a core claim of Therapeutic Touch at that time, and not because it was necessarily a definitive and final answer to anything.

    The problem was that those promoting TT were unable to come back with a single study that showed that they really *could* detect a unique human energy field. They had formulated an entire “healing” theory. promoted it, and even spent good money on clinical studies of it, without ever bothering to validate core precepts in such simple, obvious and NECESSARY ways.

    So it is no wonder that few took them seriously, thereafter.

  61. pec says:

    [The problem was that those promoting TT were unable to come back with a single study that showed that they really *could* detect a unique human energy field.]

    You are wrong, there have studies showing that. The Rosa study got all the publicity because that’s what the current mainstream wants to believe.

    Maybe the 20 healers that Rosa tested were not very good, on average. Maybe the testing situation was too different from a normal healing context. Or whatever. It was a single experiment, and Harriet made a big deal out of it, hoping we wouldn’t notice she could not explain the positive experiments. She could not explain why — and didn’t even try — Gary Schwartz has demonstrated life energy in many of his experiments.

    I posted links to energy healing research published in mainstream journals and no one here could provide scientific reasons for rejecting them.

  62. Harriet Hall says:

    I will explain why. Schwartz is a sloppy researcher who does not use adequate controls or rule out confounding factors. That goes for all the so-called energy research. They are doing Tooth Fairy research, measuring the money under the pillow without making any effort to find out whether the Tooth Fairy is real or whether they are simply measuring the behavior of parents.

    The TT folks could have immediately squelched Emily Rosa by simply getting some of their best practitioners together and demonstrating to everyone’s satisfaction that they can detect the human energy field. And they could have won a million dollars from James Randi in the process. Only one practitioner tried – and she failed.

    pec, we’ve been through this many times before, and I’m not going to get into another argument with you. No matter how much you want to believe, the science simply isn’t there. You are not playing by the rules.

  63. Dr Benway says:

    pec, I wasn’t reading this blog last year.

    I’d just like to point out that you’ve repeatedly asserted that studies supporting your position are out there. However you haven’t provided any links.

    Without a reference, all I have is your word. Would my word convince you of anything?

  64. pec says:

    “I will explain why. Schwartz is a sloppy researcher who does not use adequate controls or rule out confounding factors. That goes for all the so-called energy research.”

    You make that kind of statement but you do not provide any examples. You’re just hoping your credulous “skeptical” readers won’t notice.

    Schwartz has done pilot studies that, like any typical pilot study, are relatively informal. An he also has done carefully controlled, formal research. Your review did not explain what you thought was wrong with it. You just made some vague statements, hoping no one would notice that you had no specific criticisms.

    But what about the other energy researchers? What about the research I cited last year? You completely ignored it.

  65. pmoran says:

    Pec, supply an example, but firstly exclude any research findings that have not been replicated by independent investigators using the same methods. Also don’t bother with claims that depend upon weak statistical findings –there are many reasons why they are likely to be false, ranging from statistical flukes to publication biases. Give preference to studies that directly demonstrate the existence of special human energy using objective or water-tight methods.

    Otherwise we are wasting our time. It is just too, too improbable that there is some special form of energy that only manifests itself in erratic, feeble effects upon human healing, suspiciously close in scope and strength to those seen with placebo.

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