What is holism? The dictionary definition of holism (from the Greek holos) states that nothing can be fully understood unless one sees the whole system of which it is part; that is the whole is always more than the sum of its parts. (Oxford Dictionary, 2013) What is a holistic approach with regards to health care? The holistic approach is a model, which is made up of 5 different dimensions, and would be perfectly suited to use in the treatment of mental illness. What this means is, that the illness (disease) is viewed as affecting a person’s mind, body and spirit, and each of those dimensions are equally as important as the other. Holism is a reaction to medical approaches.
The holistic view acknowledges objective scientific explanations of physiology and accepts that people have inner experiences that are subjective, mystical, and spiritual or religious, which can affect their well-being and health beliefs.
The five dimensions of the model are physical, psychological, social, emotional and spiritual/personal meaning (The Open University, 2010, p.23). In the centre of the holistic model is the service user. When one of these dimensions is changed / altered there will be an impact on the other dimensions. This will then lead on to changes, and those changes can be seen in both the cause of mental distress, and the potential responses to it. The practice of holistic medicine integrates conventional and alternative therapies to prevent and treat disease, but more importantly, to promote optimal health.
The British Holistic Medical Association’s (BHMA) mission statement is:
“To educate doctors, medical students, allied health professionals and members of the general public in the principles and practice of holistic medicine”
BHMA (cited in The Open University, 2010, p. 44)
When deciding on the diagnosis of an illness, and how best to treat it, all dimensions of the holistic model must be considered. This will then lead on to the person being treated as a whole i.e., holistically. Treating the service user using other medical perspectives is of course possible; however, no other single model can do everything that the holistic model can. Two other perspectives that could be considered for treatment of the service user, who is suffering from mental distress, could be the biomedical model, and the bio-psychosocial model.
The biomedical model has governed the thinking of health practitioners for quite some time. It tells us that illness can be explained biologically and it assumes that psychological and social processes are independent of the disease process. The biomedical model emphasises a mind-body dualism in which the mind and the body function as separate entities. Examples of this would be the split between general nursing and mental health nursing, or the split between a medical doctor and a psychiatrist. (The Open University, 2010, pg. 109-112). In this model, the treatment of illness is emphasised over the promotion of health. Health is viewed as the absence of disease (Wise Geek, 2013)
George Engel (1977) challenged health care practitioners regarding their use of the then, widely used, biomedical model. He suggested moving towards a new medical approach. That new approach was the bio-psychosocial approach; named because of the importance of biological, psychological and social factors. Applying the bio-psychosocial approach to health care, requires recognition that good relationships are vital, for providing adequate and fulfilling health care. Self-awareness must be used as a diagnostic, and therapeutic tool, and decisions need to be made regarding what aspects of the biological, psychological and social domains are most important to understanding the service users’ needs; and how best to proceed in promoting optimal health. Multidimensional treatment is a must!! (Suchman et al, 2004).
The Bio-psychosocial model has a very good basis for a using the holistic approach.
Brom (cited in The Open University, 2010, p. 45), tells us that the principles underlying holism are, that every person is an integrated system, made up of many parts. He tells us that moving any one of those parts can be detrimental to the person. He also tells us the human system is an open system, and is in contact with outside environment; and inwardly, with spiritual dimensions. Brom concludes with telling us that the human system is not only biochemical; but it is multidimensional, and he says that there are many causes for diseases and no single cause can ever be found and/or singled out.
However, Seedhouse, cited in The Open University (2010) argues this case and tells us “A whole cannot be fully understood, even if all its parts are understood separately”. Therefore, from that perspective, we can see how by not knowing the ‘whole’; just because we know all the ‘parts’, shows that service users, and their intrapersonal boundaries are not solid or static. This is exactly like the boundaries between the dimensions of the holistic model. They are permeable, and they are forever changing. Changes can depend on what is going on within that person’s life that that particular time, and can change at any given moment.
Perspectives that can be used to treat illness are the medical model, the biomedical model, the psychological model, the bio psychological, the social model and the bio-psychosocial model. There are also religious, humanistic and transpersonal models that can be considered.
For example; a service user presents themselves at their local accident & emergency department with a broken arm, or a broken leg. The model that would be used in this instance would be that of the medical model. What this would entail is a doctor would prescribe medication for the pain that they are feeling because of the broken limb, and treatment will be given to ensure the bone will heal correctly, i.e., by means of a plaster cast.
Another example of a different model could be a service user making a routine appointment with their GP. On arrival for that appointment they speak with the GP and find themselves crying uncontrollably and in a highly emotional state. Once the GP has spoken to the patient and having witnessed the patient crying, along with them showing other very clear signs that they are suffering from a great deal of mental distress, the doctor can prescribe medication such as an antidepressant and a short tem tablet to deal with the overwhelming feelings that the service user is having now, and has had for the last few weeks/months. A couple of weeks later the service user feels they are still not at an acceptable level of healing they could go back to the GP and the GP could make a referral to a therapist and/or a psychiatrist, depending on how ill the service user is. With the doctor having had prescribed medication and referring the patient on for therapy, such as Cognitive Behavioural Therapy (CBT), the approach that is used in this case would be the bio psychological approach.
Diagnosis of a mental illness attempts to make sense of a range of human problems from a medical angle. Medical professionals who have experience of mental distress can be an advantage when working with those who may be having the same difficulties. It is much easier for them to be able to empathise with the service user and they will also have a better understanding of what they are going through. However, it has also been noted that sometimes powerful or distressing experiences can prevent people from working with other who have been through similar situations (The Open University, 2010, p 71)
Once diagnosed/labelled with a mental illness, issues surrounding stigma and discrimination can arise. Sayce (cited in The Open University, 2010, p.127) explains how people who have been diagnosed as being mental ill are seen to be dangerous, irresponsible and completely lacking in morals. This is often the case seen in films and through the media in general. Most of the time those suffering from mental distress are portrayed in a bad way, and we hardly ever get to see/hear from the perspective of someone who is actually suffering from mental illness.
Stigma and labelling can take many different forms. (Goffman 1968) speaks of three types of stigmatised identity. These are Abominations of the Body, i.e. Physical deformities, Blemishes of individual character, i.e. Alcoholism or homosexuality, and Tribal, i.e. religion or social class. The first two types are directly related to users of health and social care. Goffman refers to non-stigmatised people as ‘normal’; therefore, having a stigmatised identity can have many implications and leaves the person wide open to labelled insults such as lunatic or madman. This in turn, then leads on to the person being stereotyped, or having generalised assumptions made about their character. (Goffman, cited in K217, Chapter 5, p.10)
Even though the holistic model considers the whole person and believes that all parts are interconnected, some medical professionals still think that physical and mental illness should be treated as individual illnesses. This can be very challenging however, because of the amount of specially trained health care professionals within the health care field. Specialists such as psychologists, biologists and doctors have their own approach to health care and firmly believe that their method, is the correct method, so for them, finding a balance, or trying to move to holism can be extremely difficult.
Another problem that may arise for health care professionals when trying to treat someone who has a mental illness could come from the service user themselves. There could be many scenarios that would not fit in with the normal protocol of treatment with using the holistic approach. Examples would be (a) the user might just want the medication with no therapy, or (b) they could want therapy but no drugs. Or (c) could be that the user doesn’t want their details passed on to anyone else – for whatever reason that may be. I know from personal experience that many people are paranoid (even if they haven’t been diagnosed with a mental illness!!!!) with regards to seeing doctors, etc., and divulging personal information about them. This could be to do with other people knowing their business and talking about them, behind their backs to others, or it could be someone maybe passing on information regarding them. People worry that their details or private medical issues/file could fall into the ‘wrong hands’. However, I know this is not the case, but not everyone trusts the health service’s confidentiality policy.
Mental well-being can be improved and enhanced by using the holistic model. The holistic model supports the idea that body chemistry, spirituality, diet, nutrition, and other factors can impact the brain in diverse ways (Moore, N.D). This can only be a good thing. Using the holistic approach to help a service user heal has many benefits. It means the service user not only feels better physically, and mentally, but also ensures anything else that may come from their illness will also be dealt with at the same time. It can be a lengthy process to ensure full potential of the holistic model has been reached but it is definitely much better in the long run.
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