Health, the Individual, and Integrated Medicine: Revisiting an Aesthetic of Health Care

225 Pages·2004·0.78 MB·English

by  David Aldridge

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Health, the Individual,
and Integrated Medicine
Revisiting an Aesthetic of Health Care
David Aldridge
Jessica Kingsley Publishers
London and New York
Coverimage©DavidAldridge2004,fromaseries‘IslesofScilly’.
Allrightsreserved.Nopartofthispublicationmaybereproducedinanymaterialform
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FirstpublishedintheUnitedKingdomin2004
byJessicaKingsleyPublishersLtd
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Copyright©DavidAldridge2004
LibraryofCongressCataloginginPublicationData
Aldridge,David,1947-
Health,theindividual,andintegratedmedicine:revisitinganaestheticofhealthcare/David
Aldridge.--1stAmericaned.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN1-84310-232-3(pbk.)
1. Alternativemedicine.2. Integrateddeliveryofhealthcare.3. Medicalanthropology.4.
Medicine--Research--Philosophy.
[DNLM:1. BiomedicalResearch.2. ComplementaryTherapies.3. Esthetics--psychology.4.
PatientCare--psychology. WB890A365h2004] I.Title.
R733.A4342004
615.5--dc22
2004000479
BritishLibraryCataloguinginPublicationData
ACIPcataloguerecordforthisbookisavailablefromtheBritishLibrary
ISBN1843102323
PrintedandBoundinGreatBritainby
AthenaeumPress,Gateshead,TyneandWear
Contents
PREFACE 7
Chapter1 MakingandTakingHealthCareDecisions 19
Chapter2 Lifestyle,CharismaticIdeologyandaPraxisAesthetic 33
Chapter3 TheClinicalAssessmentof AcupunctureforAsthma 49
Chapter4 Of EthicsandEducation:StrategiesforCurriculum
Development 54
Chapter5 AestheticsandtheIndividualinthePractice
of MedicalResearch 61
Chapter6 ClinicalResearch,theIndividualPatient,andtheLimits
of RandomizedControlledTrials 73
Chapter7 ACommunityApproachtoCancerinFamilies 84
Chapter8 MusicTherapyReferencesRelatingtoCancerand
PalliativeCare 96
Chapter9 MusicTherapyandSpirituality:ATranscendental
Understandingof Suffering 107
Chapter10 PrayerandSpiritualHealinginMedicalSettings 120
Chapter11 AQualitativeResearchPerspectiveonHealing 130
Chapter12 TheBreathinHealing 149
Chapter13 MusicTherapyandNeurologicalRehabilitation:
RecognitionandthePerformedBodyinan
EcologicalNiche 163
Chapter14 GuidelinesforClinicalResearch 180
REFERENCES 197
SUBJECTINDEX 222
AUTHORINDEX 229
This book is dedicated to Lucanne Magill who integrates
music therapy into palliative care at Memorial Sloan-Kettering
Cancer Center, New York and who sings with me daily
no matter how far we are apart
Preface
Myresearchcareerbeganasanangryresponsetomyownlackofknowledge
andtotherecalcitranceof modernmedicinetotheneedsof thepeoplethatI
wascounselling.Turningtheenergyofthatemotionintotheflameofmotiva-
tion fuelling the research endeavour has taken some time. Apart from a few
burntfingersovertheyears,Ihopethattheheathasgeneratedalittlelightin
therealmofunderstandingwhatitistofallsickandbeapartoftheprocessof
healing.
Thestorybeginsin1980.IhadbeenworkingvoluntarilyfortheSamari-
tansonthenightshift.ItwastheusualFridaynightwiththeregularcallersand
somenewvoicesrequiringcomfortduringthedarkhoursofthemorning.As
theshiftclosed,acolleaguecameintothecentrefromhernursingshiftonthe
wardof thelocalhospital.Therehadbeenfivenewadmissionsforattempted
suicideinthenight.Fromtheirages,andwhatsheknewofthem,itwasclear
thatnonehadcalledthepreviousnight.Eitherwewerefailinginourserviceto
provideadequatecounsellingortheserviceitselfwasmissingagroupofyoung
peoplecompletely.Mostofmycallershadbeenolderandknowntome.Ithen
beganasearchtofindoutwhyweweremissingsuchdistressinwhatwasarural
community where it should have been easy to coordinate our initiatives. By
asking doctors and psychologists, nurses and social workers, priests and
teachers,itwasclearthataneedwaseasilyrecognized,butwewereallataloss
about what to do. Then the breakthrough came: ‘Why not ask the patients
themselves?’Thisperspectivehasbeenattheheartof myresearchsincethen.
Weknowitnowasqualitativeresearch,butasfarasIknewthenitjustseemeda
sensiblewayoffindingoutwhatweneededtoknow.Askandpeoplewilltell
you. What I didn’t realize at the time was that this would be seen as a rather
unusual stance to take.
Atthesametimeasthispersonalmethodologicalbreakthroughwastaking
place,Ialsorealizedhowangrymanyofuswerethatweweresohelplessinthe
7
8 HEALTH,THEINDIVIDUAL,ANDINTEGRATEDMEDICINE
faceofthechallengeofsuicide.Suicidalbehaviourthreatenedusinawaythat
made our every effort appear redundant. How easy it was to blame these
deviant patients for their non-compliance with our carefully structured and
well-meaninginterventions.However,whenweheardthestoriesofwhatwas
happening,mostofusknewhowfortunatewewerenottohavebeenfacedby
theirdifficulties.Yet,inthefaceofthishelplessness,therewasanangeratthe
psychiatricservices.OverandoveragainIwashearingmedicalpractitioners
saythatsuicidewasacompletelyunpredictablephenomenon.Althoughthere
wasavastliteratureaboutsuicide,theactwasaresultofindividualchoiceand
this choice was totally unreasonable and a sign of a disturbed personality.
Working with the suicidal revealed a completely different reality. From the
patient’s perspective, the causal chain of events leading to suicide was very
clear. This was no idiosyncratic response by a deviant personality but a final
response to hopelessness in a context of unmitigated distress. Knowing that,
whatwasIgoingtodoaboutit?AndwhatwasIgoingtodowiththeanger
that I felt at a profession?
Academiacalls
TherewasonlyonewaytogoandthatwastochangetheworldwithaPhD
study.Noweverybody,exceptdoctoralstudentsinthefirstflushofacceptance,
knowsthatyoudonotchangetheworldwithresearch.Inthoseheadydaysof
1982, aged 35 and with a grant from the Open University, the world of
academiabeckonedseductively.Atlast,thechancetodosomethingseriously
and make some contribution to science. Remember that this motivation was
fuelledbyanangeraimingtosettheworldtorights.ThismotivationiswhatI
seekinmydoctoralstudentstoday,thatsmallflamethatburnstounderstand,to
make sense of the world, to make a contribution. The whole process of
researchingwillattempttodousethatflame.Idealismbecomestemperedbythe
waysof theworld,andthearroganceof angerbecomesrefinedinthefaceof
broadenedknowledge.Thatistheprocessofresearching,buttheinitialflame
has to be present – we have to burn.
My research lasted three years and I emerged as a proud doctoral fellow
fromtheOpenUniversitywiththeconvictionthatthispieceofresearchabout
suicidal behaviour from an ecosystemic perspective would change the
landscape of professional practice (Aldridge 1984a, 1984b, Aldridge and
Dallos1986;AldridgeandRossiter1983,1984,1985).Wasn’tthatwhyIhad
doneresearch?AtlastIcouldbeginajobwherestudentswouldbetaughtfrom
PREFACE 9
myperspective,and,asIthoughtthen,theonlytrueperspective.Myacademic
careercouldreallybegin–therewouldsurelybeanoffertopublishanduni-
versities would see how audaciously new such ideas were. Out with the old,
andredundant,andinwiththenew,dynamicsystemsperspective.Wehaveto
rememberthatinthe1980severythingwassystemsthis,systemsthat.Ripefor
holism, we had outgrown both socialism and reductionism. Yet life has a
wonderful way of bringing us down to earth – from doctoral student to the
ranksoftheunemployedinonefellswoop.Somuchforresearchasapassport
to a golden future.
What was I going to do? When asked, I could only think about doing
research. Not only was a fire lit, it wasn’t so easily extinguished. However, it
was a totally impractical career stance to take as nobody wanted research.
Community services were being faced with massive cutbacks, teaching posts
werebeingloppedfromuniversitybudgets,researchwasseenasaluxury.Once
more I returned to voluntary work. The theme of dying had been a central
concept working with the suicidal and during this time I had begun to talk
with cancer sufferers and their families. Local church groups were working
together to help the dying and there was a growing ecumenical movement
around the concept of healing that emphasized a lay involvement (Aldridge
1986, 1987a, 1987b, 1987c, 1987d).
Assynchronicitywouldhaveit,ImadecontactwithabishopintheChurch
ofEnglandwhowasinterestedinthepracticeofhealingintheChurch.While
itwasdifficultenoughtogetotherchurchmembersinterestedinhealing,itwas
evenmoredifficultgettingmedicalresearchersinterestedinthephenomenon.
Althoughthereweregeneralpractitioners(GPs)interestedinhealing,whoina
universitydepartmentwasgoingtojeopardizetheircareerinlookingatsucha
concept?
Fortunately, someone without a career to jeopardize could take a look at
what was happening and this is what I did. It was the focus of my first book
about healing in the Church (Aldridge 1987a). Like the work with suicidal
patients,itwasconcernedwithwhatbothpractitionersandpatientshadtosay.
Bothwereexpertinformants.Linkingbothpiecesofworkwasaconcernwith
dying.Thecentralpartofhealingministrieswasworkingwiththechronically
illandthedying.Justassuicidepatientshadexhaustedtheresourcesofthose
withwhomtheyhadlived,manyofthecancerpatientsandtheirfamilieshad
exhaustedtheresourcesbothoftheirownbodiesandtheirmedicalpractitio-
ners (Aldridge 1987b, 1987c, 1987d, 1988b). Furthermore, for the suicidal
andthedying,allhopehadgone.Fromthisperspective,Ibegantounderstand