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The "Integrative Healthcare Community" - Is it Kurt Vonnegut's Karass or a Granfalloon? PDF Print E-mail
Written by John Weeks   

The Integrative Healthcare Community: Is it Kurt Vonnegut's "Karass" or His "Granfalloon"?

Summary: An exchange with two friends over a decision about a bike trip in Moab, Utah brought to mind a distinction author Kurt Vonnegut made in his 1963 book, Cat's Cradle. Vonnegut describes as a "karass" a true community of people who are "often unknowingly, working together to do God's will." Against this he juxtaposes a "granfalloon," or false community. The reference led to reflection on the nature "CAM" and of the so-called "integrative healthcare community" or "integrative practice community." CAM may well be the definitive granfalloon. But is integrative healthcare karass or is it a granfalloon?
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Basic science researcher and former NIH NCCAM adviser Joel Pickar reached back to Kurt Vonnegut's
Cat's Cradle. He posed a question to Bill Meeker, also a former NCCAM advisory council member, and me via e-mail: Are we karass or granfalloon?

Author Kurt Vonnegut
The issue was not one of science. The issue was of community. Pickar was goading us to fulfill on a wine-induced plan to meet in Moab, Utah for a mountain-biking adventure. Pickar pulled out all stops. He went to the source. He cited
Cat's Cradle. perhaps the authoritative text on community. Pickar sent us these key definitions:

  • karass - a group of people who, often unknowingly, are working together to do God's will, ie. a group of people linked in a cosmically significant manner, even when superficial linkages are not evident. The group can be thought of as the fingers that support a Cat's Cradle.

  • granfalloon - a false karass; i.e., a group of people who imagine they have a connection that does not really exist. An example is "Hoosiers"; Hoosiers are people from Indiana, and Hoosiers have no true spiritual destiny in common, so really share little more than a name.
Pickar's question induced the intended shame from recollecting the commitment in our late night conversation. Then it resonated more deeply.

Is there an "integrative practice community" working together to do God's will (Vonnegut's phrase)? Or is the idea of an "integrative practice community" little more than granfalloon?   

"CAM" is classically "granfalloon"

Certainly "CAM" is classically "granfalloon." The diverse therapies and disciplines clustered in CAM categories is certainly as meaningless as "Hoosiers." Or in this case, given that CAM as category is framed by what it is not, "CAM" has all the internal magnetism of "Non-Hoosiers." No one likes the term. Lassoing chiropractors and Ayurvedic medicines and running them into a corral cohabited by Reiki practitioners, holistic nurses and flower essences does not a community make. 

But how about the "integrative healthcare community"?

Ten years ago, I helped create a not-for-profit styled the Collaboration for Healthcare Renewal Foundation (CHRF). We invited committed souls pioneering integration initiatives.
The common denominator was investment in a new, health and healing focused paradigm. They came 100 strong from massage, integrative and holistic medicine, hospitals and health systems, nursing, chiropractic medicine, insurance, acupuncture and Oriental medicine, managed care, naturopathic medicine, federal policy, employers and more.

In those early days of integrative medicine we seemed linked in a cosmically significant manner.

In our private moments, my co-founder Jery Whitworth sometimes referred to this apparent community of diverse stakeholders as a figment of our imaginations. Of mine, in particular. I left on a long-planned sabbatical in 2002. The group honored me with the gift of a gorgeous, foot-long, dark green, egg-shaped hunk of polished granite. The stone sits in my office, reminding me of Sisyphus. CHRF died.

Vonnegut's drawing of a cat's cradle
Vonnegut offers an easy standard for affirmation by a community that believes in energy, consciousness, homeopathy and distant prayer. The holistic nurse and the chiropractor could never invite the other to table and still see themselves as linked in a cosmic manner of presumed significance. That the integrative practice community is karass, as Vonnegut defines it, seems a no-brainer. Hey, look at this movement we're part of!

Yet that loose description makes me think a group of Hoosier fans self-congratulating on a basketball victory.

Vonnegut may think this "superficial." But the currently lousy state of healthcare induces a desire for more practical measures of karass. Here are some measures. Who is at your table? Do integrative practitioners actively confer clinically with those from other disciplines?

Here are measures for collective efforts. Are your organizations extending themselves beyond guild boundaries? Has the integrative practice community collaboratively identified and jointly engaged in policy initiatives? Do the diverse stakeholders invest in meeting together? Are leaders of the integrative medicine and "CAM" academic institutions and continuing education programs consciously connecting to each other? Are they expanding outside their silos? Are we paying into community chests to advance shared initiatives? Are we collaborating, proactively to advance health and healing?

Connections are forming

Recent experience weighs in on the negative side of the ledger. Extraordinary, legislatively significant (if not cosmically significant) federal policy opportunities to define the meaning of "integrative healthcare" and "integrative practitioner" received little input from any of these entities. Someone else is making up definitions. Members of Congress have opened doors for the integrative healthcare community. Few show up for the party.

As an intentional community, we find little significant presence. (See Brief Report, here.)

Yet in the last decade of this work, connective tissues are forming. Consortium of Academic Health Centers for Integrative Medicine. Integrated Healthcare Policy Consortium. The recent iMosaic conference. Bravewell Collaborative. Integrative Practitioner Online/Integrative Healthcare Symposium. Academic Consortium for Complementary and Alternative Health Care. The new Grantmakers in Health Complementary and Alternative Medicine Funders Network. The Institute for Functional Medicine.

These suggest the emergence of significant community. One can find the points of collaborative light and form a cat's cradle. Stories multiply of what the cradle holds. This is good.

Yet that stone of unfinished business sits on the office floor, like the invite to Moab.

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