Stephen Bolles: Capstone View of MD-ND-CAM Bashing - Professions Seeking Wholeness Seek Integration
Written by John Weeks
Stephen Bolles: Capstone View of MD-ND-CAM Bashing - "Professions that Seek Wholeness Seek Integration"
Summary: The perspective on integration of Stephen Bolles, DC is shaped by leadership in developing the Woodwinds integrative clinic, service as a vice president at the multidisciplinary Northwestern Health Sciences University, a couple years inside United Healthcare and clinical practice as a chiropractor. So when Bolles wrote and said he had read the series of heated exchanges on MD-ND bashing and ownership of "integrative medicine," I was curious to see what he'd say. I wasn't disappointed: Bolles speaks of the "halo effect" of (MD) medical education, the depth of disenfranchisement of many MDs, political medicine, from political/AMA medicine, and how disenfranchisement has kept the non-MD professions from exploring integration to the same degree as MDs. Take a read.
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Stephen Bolles, DC
"The highly-charged issue of language,
ownership, and the tug of war over what 'integration' means." With these words Stephen Bolles, DC describes the series of Integrator columns and perspectives, with Drs. Benda, Rakel, Ballard and Glidden figuring prominently, over the last few months. The topics have been who owns "integrative medicine" and the bashing of one profession by another. It's been challenging content.
Bolles brings the seasoned perspectives of educator/executive (Northwestern Health Sciences University), hospital-based integrative clinic developer (Woodwinds), consumer health and web products designer (United Healthcare) and clinician to his perspective. Among his present projects is a conference/conversation on vitalism for Life University scheduled for April 17, 2009. Presenter/discussants include the Queen's physician, an array of thoughtful leaders in sociology, holistic medicine, chiropractic, integrative care, acupuncture and Oriental medicine and other fields. Looks intriguing.
As I said in my intro to the last piece in this series, if one cares about one's cultural
competency for practice with practitioners from other disciplines, this
set of comments is excellent, raw and eye-opening material for
reflection. Bolles' views are a thoughtful, Cliff's Notes commentary on much of the light and shadow that moves through the earlier pieces.(See list of prior columns at the bottom of this article.) As working with one of my Integrator-adviser teachers, Carla Mariano, RN, EdD, BC-HN on a multidisciplinary project two years ago underscored for me, the evidence we need to take into account as we seek optimal integration must include the impacts of each discipline's relationships to power and inclusion.
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A Profession that Seeks to Make Itself Whole
Seeks Integration
- Stephen Bolles, DC
John,
good morning.
I've
been reading the posts on the obviously highly-charged issue of language,
ownership, and the tug of war over what "integration" means. Like the
old story of the blind men feeling the elephant and each decrying the others'
description of the different parts they are feeling, it's often hard to even
agree on what the problem is.
Bolles:
"Integration" is derived
from integer, so 'integration' is 'to make whole.' In a sense, then, any
profession that seeks to make itself whole seeks integration.
I
don't know that I have much to add, but offer these thoughts. As I read and
think about all this, I am reminded that "integration" is derived
from integer, so 'integration' is 'to make whole.' In a sense, then, any
profession that seeks to make itself whole seeks integration.
To the extent
that any profession sees itself as 'less than whole'--whether economically,
clinically, sociologically, or in any respect--they are 'speaking from a
wound.' As clinicians, we understand that there's an emotional force when this
occurs, and that's certainly visible in many of the recent posts. I doubt any
profession is immune to this.
So
given that, I'm struck by a few observations on the back-and-forth that have
taken place.
First,
I think it's rare to have any dominant culture really understand the full
impact of its dominance. Medical doctors are products of a very codified
process of acculturation, and I think it's difficult to for even those who
thoughtfully reflect on the full effects of this to understand at times the
'halo' effect of authority that this process conveys.
Bolles:
Medical doctors are products of a very codified
process of acculturation ... It's difficult for even those who
thoughtfully reflect on the full effects of this to understand at times the
'halo' effect of authority that this process conveys.
Second,
we're all part of a dysfunctional American health care system, in that it is
fragmented, uncoordinated, economically unsustainable, and generates remarkably
poor outcomes. That is not to say there are not stunning successes and good
people who populate every segment of it; there are. But many of the plaints of
non-physician voices need to be heard with the understanding that there has
been systematic disenfranchisement of everyone butallopaths for over a century. That disenfranchisement has included areas of
finance, policy, professional relationship building, research, professional
development, leadership, education, and on and on.
I think it's important to
understand and remember Lou Sportelli's point about the difference between
clinical and political medicine. Political medicine, with what can only be
charitably described as a monopolistic agenda, is alive and quite well. At the
same time, I don't know many physicians I would say feel that they are 'at
cause' within their own system; their sense of disenfranchisement,
disillusionment and isolation often runs more deeply than those of naturalistic
professions. In a sense, the professional target has been moved farther for
Bolles:
Many MD's sense of
disenfranchisement,
disillusionment and
isolation often runs
more deeply than those
of naturalistic
professions.
them than for any of us. What was sold and what was bought are quite different.
And, with the healthcare ecosystem under the stress it is, the duress on even
the dominant culture produces behavior that I'm sure even its most ardent
proponents cannot always proudly defend.
I am
not suggesting that we need a 'truth and reconciliation' commission to rectify
the 'sins of their forefathers,' but I think to the extent physicians are
sensitive to the reality of this disenfranchisement is the extent to which they
will understand that being given a ticket to the party doesn't mean that it's
our party. Cultural assimilation looks quite different, depending on whether
you're looking down from on top of the mountain or up from the bottom. That
doesn't mean physicians should don hair shirts, beat their chests, shuffle
along and act as apologists, but it does mean that when non-physicians don't
hear an acknowledgment of cultural dominance--whether conferred or
assumed--it is hard to accept the concept of integration as a shared goal. The
perspectives--and what is at stake in both success and failure--are too
different.
And
finally, given the power of language, I think it's important to be careful what
we each try to own or claim as our province. I have little trouble letting
medicine own 'integrative medicine' as a term, as it acknowledges the reality
that 'medicine' alone is less than whole.
Bolles:
I don't know that anyone knows yet what 'whole medicine' looks like; perhaps Earl
Bakken has said it best when he has spoken of "blended medicine."
It also allows the establishment of
some sort of limits, as well; I will never forget the Hawai'ian healer who
decried 'CAM-grafting' some years ago at a sun-drenched conference on Maui. I
don't know that anyone knows yet what 'whole medicine' looks like; perhaps Earl
Bakken has said it best when he has spoken of "blended medicine."
But
by the same token, I have little trouble allowing naturalistic professions to
'own' their own versions of integration; in the spectrum of patient care, no
matter how complete or intact our individual cosmologies may be, I don't know
of any one who cannot claim an
'integrated' form of their profession. I suspect that the rest of us have just
not really had to explore it to the same degree, because paradoxically by being
disenfranchised, most of us have been able to hold our cosmologies more intact
and with less dilution. Medicine, it would appear, is crying out for healing.
The rest of us, it seems, are crying out for enfranchisement in a system that
does not appear prepared to effectively respond.
Respectfully,
Stephen Bolles, DC
Consultant, Minnesota
Comment: For those of you following this dialogue, neither Benda nor Glidden, in private emails to me since the most recent post, were entirely pleased with my views of their views, expressed in the last set of responses. I am thus (comfortably) in the position of the legislator who, on offering to the Committee of hte Whole a revised, substitute, amended version of a bill for passage says: I think we are getting close. No one likes this. I thank all the contributors deeply for this sharing. We need to go deep into understanding each other's cultures and perspectives to move together well. These have taken us deeply into our different experiences of power, and of each other. Now Bolles' column offers a new platform for looking at the issues. These may be some of the colors of this dialogue's parachute. What do you think of Bolles' perspective?
