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Misunderstanding addiction: The beat goes on…

Stanton Peele
Back in May I wrote a post titled Understanding Addiction, throughout which I bemoaned the fact that the National Institutes of Health (NIH) — one of the most powerful voices on matters of health and well-being in our society — continues to perpetuate the misunderstanding that “Addiction is a chronic relapsing brain disease.” Taking a partial truth and stretching it — so that it seems far more significant than it actually is — is the modus operandi of huksters in every sphere, and it’s becoming an all-too-familiar gambit of mental health “experts” these days. Shockingly, my blog posts don’t seem to be helping matters much. Stanton Peele, however, continues to be a lonesome but powerful voice of reason, calling out to those of us with ears to listen. Earlier this month, Peele reminded us on his blog that the NIH’s own alcoholism experts (within The National Institute on Alcohol Abuse and Alcohol) recently concluded the following:

1. 20 years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence.
2. About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and AA. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment.

These conclusions, based on the largest study of people’s life histories of alcohol use ever conducted (43,000 people), completely undercut the accepted wisdom that addiction (to alcohol, at the very least) is a “relapsing brain disease,” and they also bring into sharp relief the utter ineffectiveness of the most commonly utilized treatment programs. Beyond this study, the accepted wisdom regarding addiction also fails the tests of sound reasoning, common sense, and an honest appraisal of existing evidence — a case that Peele has been persuasively making for decades. And yet when Americans want the best available information and recommendations about addiction to alcohol and other drugs, we’re told by Dr. Drew, HBO, and the NIH that addicts have a relapsing brain disease, that they can never learn to moderate their drug use, and that their incurable diseases can be most effectively treated by checking into rehab and attending twelve-step meetings. Is it any wonder why our best efforts to help people with drug problems are so ineffective?

Sadly, if we instead look to the most renowned non-government authority on matters of mental health, the American Psychiatric Association, we’ll find only further confusion. In another blog post, Peele describes the APA’s latest attempts to redefine the concept of addiction for the latest version of the Diagnostic and Statistical Manual, DSM-5. Peele was an advisor for the substance abuse disorders section of the current version of the DSM, DSM-IV, so he understands the process well. The upshot is that the DSM-5 Substance-Related Disorders Work Group, chaired by University of Pennsylvania psychiatrist Charles O’Brien, is proposing some major changes, including ditching the term “dependence” in favor of “addiction” (a term not used in the DSM-IV to describe substance abuse problems). Beyond that, the group also wants to create a whole new category–Behavioral Addiction–to refer to pathological gambling. The rationale behind designating only pathological gambling as an addiction (but not pathological sex-having or video game playing or anything else) is that, according to O’Brien, “substantive research” indicates that “pathological gambling and substance-use disorders are very similar in the way they affect the brain and neurological reward system.” Peele, as he’s done his entire career, clearly shows the fallaciousness of O’Brien’s reasoning, which suffers from the same confusions and category errors that have been holding our understanding of addiction (and mental health, more broadly) hostage for decades:

O’Brien’s statement represents a rear-guard effort to frame addiction as a brain disease. There is, indeed, imaging research on the ways various drugs affect the brain. But that’s not the key to addiction. I designed and administer an addiction treatment program, and I can assure you that not one person is sent to our program—or any other program—because of a PET scan. People enter rehab because of regular, habitual screwups connected to substance use—compulsive involvement and continued use of a drug (or other involvements) despite chronic harm.

Indeed, as O’Brien points out, powerful experiences like gambling impact the same “neurological reward system” that drugs do. But so do many other rewarding activities. If there is some such higher level “neurological reward system,” then it can’t be said to exclude anything, from sex to food to gambling to video games.

Nor is O’Brien correct in suggesting that cocaine, nicotine, alcohol, and marijuana follow the same neurological pathways in the brain. Each substance has a very different chemical profile, including the timing of effects and the rewards people derive.

And if gambling affects the same brain reward system as substances, as O’Brien claims, why is it a “behavioral” addiction and not simply an addiction? DSM-5 further muddies understanding of addiction in its handling of two other non-drug appetites—“hypersexuality” and “binge-eating.” Neither is regarded as an addiction. Is this because they do not follow the same “neural reward pathways” as drugs and gambling? Binge-drinking can bring on addiction, but not binge-eating? How come? And is gambling really more neurologically, or intensely, rewarding than sex?

The problem with the DSM-5 approach is in viewing the nature of addiction as a characteristic of specific substances (now with the addition of a single activity). But think about obsessive-compulsive disorder (OCD): People are not diagnosed based on the specific habit they repeat—be it hand-washing or checking locked doors. They are diagnosed with OCD because of how life-disruptive and compulsive the habit is. Similarly, addictive disorders are about how badly a habit harms a person’s life. Whether people use OxyContin or alcohol, people aren’t addicted unless they experience a range of disruptive problems—no matter how addictive the same drug may be for others.

Unfortunately, misunderstanding and misinformation are becoming part and parcel in health education across-the-board in our society. As with our political system, the agencies and organizations responsible for informing the public about matters of health and well-being have been way too corrupted by special interest groups (particularly) and the profit motive (more generally). Moving toward a sensible, fact-based, integral understanding of health requires that we critically appraise and analyze all information that comes to us, not only from the media, but also from the “leading experts” themselves. I have no doubt that the vast majority of individuals working at the NIH, the APA, as well as the countless mental health professionals across the country serving people in need, have only the best of intentions and want above all else to make a positive difference in the world. The same can be said of the members of the United States Congress, but a system can become corrupt, broken, and ultimately ineffective (even destructive) despite the good intentions of most individuals within the system. Our current way of understanding and treating addiction — like the broader “war on drugs” we’ve been impotently waging for years — just isn’t cutting it. Stanton Peele may not have all the answers, but his approach makes a lot of sense to me.

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The Embodiment of Freedom

At some point it occurred to me that my whole point of view, my basic mode of experiencing life, would shift during certain moments from a dissociated, half-alive, going through the motions type thing, to a wakeful, clear-minded, energized state of pure awesomeness. Basically, I became fascinated by my peak experiences. There seemed to be a quality about them that was not dependent on content or context. In other words I felt like the same process was happening regardless of what I was doing. I got the funny feeling that I was peaking or “peeking” into the same place, or entering the same state of consciousness, whether I was hitting a groove on the guitar, entering “the zone” on the athletic field, writing a poem or a song, having great sex, communing with nature on a hike, or getting showered with insight during meditation.

My master’s thesis was really nothing more than a sustained inquiry into this process of personal transformation, which I defined as a shift in one’s basic mode of experiencing toward greater vitality, awareness and expressiveness. I found that various theorists and practitioners understood transformation in different ways, but I also noticed a common thread between the approaches that moved me the most. Psychologists interested in transformation talked about the movement from unconsciousness to consciousness; the spiritual folks spoke of the journey from ignorance to awareness or enlightenment; creative thinkers were interested in moving from inside to outside “the box”; somatic practitioners worked toward refinement of sensitivity and an expanded range of movement.

It was the somatic perspective, I thought, that could ground an integral, multilevel understanding of the transformative process. I was searching for some basic principles of transformation with which I could generate a unique set of practices, in a sense building an Integral Health regimen from the ground up. I appreciated the maps of others, but I yearned to wander from the well-worn paths, to know the joy of making my own way through the wilderness. I also felt that the somatic perspective, especially as understood by Thomas Hanna, had the potential to radically transform our understanding of both psychological health and spiritual growth. I couldn’t shake the feeling that if these loftier endeavors were plugged into an understanding of somatic education, they would become far more efficacious paths, less prone to pitfalls.

Hanna rejected the distinction between psychological and physical problems, instead using the term “functional problem” to describe limitations of the unified organism in its capacity for both self-sensing and self-expression. Central nervous system functioning is fundamental to all behavior and experience, according to Hanna. Ken Wilber would agree with this, although he would point out that psychological and spiritual levels of being are more “significant.” In any event, from a somatic viewpoint, there’s no separation of psychological from physical health, and the majority of the typical “mental” and “physical” diseases of our society are learned as people adapt to a culture that supports dissociation and alienation.

So, if we want to ground our understanding of transformation in the living body, we can start with the most fundamental aspect of the central nervous system–the division between sensory and motor processes. Our perceptions of the world outside our bodies, as well as our perceptions of our internal bodily states, come into the brain via sensory nerves. And every action we express, every movement we make in the world and inside our selves flows out from our brain and down through the spine by way of motor nerves. This structural division is functionally integrated within a single neural system, the brain integrating the incoming sensory information with outgoing commands to the motor system.

The continual interplay of sensory information and motor guidance is referred to in contemporary neuroscience as a feed back system which operates in loops. As Hanna describes it, “the sensory nerves ‘feedback’ information to the motor nerves, whose response ‘loops back’ with the movement commands along the motor nerves. As movement takes place, the motor nerves ‘feedback’ new information to the sensory nerves.” Acknowledging that there are indeed physical and psychological problems that are the result of structural deformity and/or physiological imbalance, Hanna argues that many of the health problems afflicting people today are not about bodies or minds breaking down, but about individuals who have lost conscious control of their somatic functions. These functional problems are ones in which the person suffers from a loss of memory: the memory of what it feels like to move in certain ways, and the memory of how to go about moving in certain ways. This type of memory loss is what Hanna calls sensory-motor amnesia, a state of diminished self-awareness that is quite reversible–that is to say, a state that can be transformed.

Sensory-motor amnesia involves a dual loss of both conscious control of a particular area of motor action and conscious sensing of that motor action. As the human organism adapts to repeated stressful conditions, whether resulting from cultural conditioning or from uncontrived environmental circumstances (like extreme ecological conditions or biophysical trauma), there is a loss of conscious voluntary control of specific somatic functions. For example, faced with the stress of ridicule and/or punishment for crying or screaming out in public, the sad or angry child will contract certain motor areas of the soma (i.e., muscles) in an effort to hold back their authentic response. Crying or yelling out simply cannot happen when the corresponding muscle systems are held motionless, because crying and yelling are the movements of those motor areas. As this stressful response of contraction is activated again and again in similar situations, the response eventually becomes habituated and the child loses awareness of it (i.e., the muscle contractions can no longer be consciously sensed) and control of it (i.e., the child cannot voluntarily relax the contractions). The child has been successfully conditioned not to emote in public.

This innate tendency of human beings to develop automatic, unconscious responses in the face of stressful stimuli (i.e. the process of conditioning) was well documented by researchers such as Pavlov and Skinner. Hanna describes the loss of conscious volitional control as sensori-motor amnesia so as to emphasize two essential facts: 1) habituated, involuntary responses, like all somatic processes, are a reflection of sensori-motor functioning, and 2) what becomes unconscious, forgotten, or unlearned, can become conscious again, remembered, and re-learned. Thus, sensori-motor amnesia can be reversed by somatic learning.

Somatic learning is a process that results in the expansion of an organism’s range of volitional consciousness. This process takes advantage of the feedback/loop nature of the sensori-motor system and is described by Hanna in the following way:

“If one focuses one’s awareness on an unconscious, forgotten area of the soma, one can begin to perceive a minimal sensation that is just sufficient to direct a minimal movement, and this, in turn, gives new sensory feedback of that area which, again, gives a new clarity of movement, etc. This sensory feedback associates with adjacent sensory neurons, further clarifying the synergy that is possible with the associated motor neurons. This makes the next motor effort inclusive of a wider range of associated voluntary neurons, thus broadening and enhancing the motor action and, thereby, further enhancing the sensory feedback. This back-and-forth motor procedure gradually ‘wedges’ the amnesic area back into the range of volitional control: the unknown becomes known and the forgotten becomes relearned.”

So it is that a diminished state of self-awareness and a diminished range of conscious responsiveness can expand and transform at the basic level of sensor-motor functioning. Our emotionally inhibited child, now an adult, can learn to pay focused and sustained attention to subtle sensations in the forgotten contracted muscle areas and thereby recover in awareness the sense of being perpetually held back and fatigued. With this awareness that “I’m contracting my muscles” and “I’m holding myself back,” comes the realization that one can now begin to relax those inhibitions.

Although I’ve chosen to illustrate this transformative process with what would normally be considered a “psychological” example–the emotionally inhibited person–, the practice of somatic education (as typified by Hanna’s work and Feldenkrais’s Functional Integration) is normally applied to what are thought of more as “physical” problems. Middle-aged to older adults with gross-level range of motion restrictions or distortions, often the result of trauma or injury, are more typically the clients of somatic therapies. Many people who seek out and engage in somatic practices are primarily looking to feel better and healthier on a physical level, not especially considering the implications the work has for whole-person growth and healing.

The psychological implications of “body work,” although increasing evident and acknowledged, seem to be less than adequately understood. The example of the emotionally inhibited person hints at how an understanding of sensori-motor function can contribute greatly to psychological perspectives of personal transformation and vice versa. An integral viewpoint promises a deeper understanding of how various transformative practices can be utilized in a complimentary fashion to most effectively support an individual’s capacities for self-regulation, health and growth. This integral understanding also allows for the articulation of basic principles that can be applied to any number of experiences and life situations, principles that anyone can use to create their own unique practices and approaches to personal transformation.

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Erich Fromm interviewed by Mike Wallace, 1958

The Society for Humanistic Psychology blog posted the following video of Erich Fromm being interviewed by Mike Wallace in 1958. [A complete transcript of the interview can be accessed via the Harry Ransom Center (University of Texas at Austin) website.] A couple of things stuck me as I watched this fascinating exchange. First, Fromm’s essential critique of modern society is as relevant today as it was fifty years ago. Second, I find it difficult to imagine any news program today featuring this kind of in-depth, philosophical discussion. We’ll see weeks of non-stop news coverage on say, the death of Michael Jackson, but when it comes to exchanging thoughtful perspectives on our most pressing societal problems, we’re offered little more than partisan sound-bites and propaganda disguised as journalism.

The program below is introduced as a “Special series discussing the problems of survival and freedom in America”. Mike Wallace begins by saying that his aim in talking with Fromm is to “try to measure the impact of our free society on us as individuals. Whether we’re as happy as we like to think we are, or as free to think and to feel.” Imagine Bill O’Reilly or Brian Williams or Katie Couric devoting an entire program to such questions! These kinds of questions are incredibly important, yet conspicuously absent from public discourse. In terms of Integral Health, it is simply impossible to understand individual health and happiness without understanding the way our individual lives are shaped by societal forces.

During the discussion, Fromm talks about the “marketing orientation” of the American citizenry of the 1950s: “Our main way of relating ourselves to others is like things relate themselves to things on the market. We want to exchange our own personality – or as one says sometimes, our ‘personality package’ – for something.” Fromm (I’m paraphrasing here) goes on to describe modern social relationships as shallow, with real intimacy being hidden by a superficial friendliness. He suggests that the average American is only genuinely concerned with private affairs, never losing sleep about the pressing societal problems which threaten our very existence. He says the average person prefers to leave such things to specialists in the government, talking about problems shown on the news with friends and coworkers, but with no more sense of urgency than one would talk about a car that needs repair. Fromm asserts that, despite our apparent preoccupation with it, true love remains a relatively rare phenomenon. He laments that it is all too common that the most important things we talk about on Sundays are the very things that we pay relatively little attention to in our everyday lives. Again, he’s talking about life in the 1950s, but it’s easy to be struck with how little things have changed, at least in many respects. Like when he says: “I think our danger is that we talk one thing, and we feel and act another thing. I mean, we talk about equality, about happiness, about freedom – and about the spiritual values of religion, and about God – and in our daily life, we act on principles which are different, and partly contradictory.”

Speaking of the “religious renaissance” he was seeing back then, Fromm describes it as “the greatest danger that true religious experience has ever been confronted with.” He goes on to say that man today, being concerned with production and consumption as ends in themselves, has very little energy and time to devote himself to the true religious experience, which Fromm defines (in response to Wallace) as “the capacity to feel deep love and oneness with others and nature.” Wallace also asks Fromm to define “happiness” and “democracy”. Regarding happiness, Fromm offers: “People today seem to define happiness as the experience of unlimited consumption. Happiness should be something which results from the creative, genuine, intense relatedness – awareness, responsiveness, to everything in life – to man, to nature.” Regarding democracy he says: “Democracy once meant an organizational society and a state, in which the individual citizen is – feels – responsible, and acts responsibly, and participates in decision-making. I think what democracy means today, in reality, is to a large extent, manipulated consent – not forced consent, manipulated consent -and manipulated more and more with the help of Madison Avenue.” Fromm adds, “We have a mass man, a mass bureaucracy, a manipulation of everyone to act smoothly but with an illusion that he follows his own decisions and opinions.”

Fromm gives Wallace–and the people watching this ABC News Special–a lot to chew on. Again, I think many of Fromm’s concerns and observations are just as relevant today as they were fifty years ago. Without further ado:



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Understanding addiction

It seems reasonable to assume that if you want to know about a given topic, a good place to start is by checking out what the leading experts in the field have to say about it. For instance, if you google the word “addiction,” you pretty quickly are led to HBO’s Addiction Project site, which contains loads of information backed by such heavy-weights as the Robert Wood Johnson Foundation, the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). So what is addiction, according to the leading experts?

Addiction is a chronic relapsing brain disease. Brain imaging shows that addiction severely alters brain areas critical to decision-making, learning and memory, and behavior control, which may help to explain the compulsive and destructive behaviors of addiction.

Ah yes, the brain. The three pound hunk of tofu that is the ultimate source of all problems and all answers. (Deep, prolonged sigh.) Of course it’s true that any human behavior or experience can be understood in terms of neurobiology and brain states, and it’s also pretty clear that this understanding is valuable and worth pursuing. But it simply doesn’t follow—in theory or in practice—that therefore dysfunctional behaviors and experiences are neurobiological diseases. In our everyday lives, we take for granted that human life is complicated and plays out on many levels. And long before “neuroplasticity” became a buzz word, we already knew that what we do, how we use our attention, and how we relate to one another affects the quality of our lives (and the structure and function of our bodies/brains).

I worked on a chemical dependency unit in a psychiatric hospital for several years, and I’m fairly certain that most of the professional staff would accept information provided by NIDA (and most everything on the HBO site) uncritically, as I’m sure it fits seamlessly with what they learned in graduate school. But young people tend to question everything, and the patients I worked with were anywhere from 12 to 18 years old. Part of my job was to lead educational discussion groups with these kids several times a week. I also accompanied them to Alcoholics Anonymous and Narcotics Anonymous meetings several times a week. These kids constantly questioned staff members about all the contradictions they perceived between AA’s philosophy, the treatment center’s information packets, and their own life experiences. For the most part, the contradictions the kids brought up were crushed by the weight of authority, not cleared up by reasoned argument and explanation. I was quite often in the awkward position of covering for and/or attempting to recast the many misconceptions served up daily and repeatedly to patients, some of whom were desperate for accurate information. The kids (who were almost all cigarette smokers) would inevitably point out things like: “Nicotine is super addictive, right? Well, I personally know several people who quit smoking on their own, without any treatment centers or twelve step groups. So, why is everybody here telling me I can’t stop getting high on my own, that I’m powerless over the ‘disease of addiction’?”

As Stanton Peele (one of the few clear-thinking “leading experts” on addiction I’ve come across) has been pointing out for decades, addiction is and has always been politically and socially defined as much as it has been scientifically defined. Peele covers this ground thoroughly in his recent article The Fluid Concept of Smoking Addiction:

The neurobiological model of addiction is static. It is built on the difficulty – often stated as the near impossibility – of quitting or moderation. The model does not attempt to explain how (or, more accurately, why) people cease addictions – even though such cessation is more typical than not with every type drug. The neurobiological model really has nothing to say about why smokers quit (as a majority do), for example due to the pleading of a spouse or a child. In the terms of the model, cessation is unexpected, unexplained, unpredictable, and simply falls beyond its purview or boundaries.

I used an Integral Health framework to help my patients make sense of their substance abuse problems. In practice, our entire staff operated under the integral premise, i.e. that we must address every conceivable dimension of the patient’s life if we hope to make the most effective impact. Some patients, especially those who were heavy opiate users, were given (non-narcotic) drugs to deal with their withdrawal symptoms. Other than that, there was little about the treatment program that had anything to do with directly impacting brain chemistry. We helped patients become more aware of their thought patterns. We taught them healthy coping strategies to deal with the challenging situations and emotions that would inevitably continue to crop up in their lives. We brought their families in for counseling sessions. We contacted teachers, probation officers, judges—anyone who would be working with these kids once they were discharged back into their respective communities—and developed detailed aftercare plans. We covered all the bases, because we knew that substance abuse problems both develop and are potentially resolved in a multidimensional, bio-psycho-sociocultural context. Surely, most thoughtful people (including the folks at NIDA) know this to be true, and yet the “leading experts” continue to present their oversimplified, disingenuous “brain disease” model to the public (complete with brain scan images that often signify very little, and the obligatory lip-service footnote containing the term “biopsychosocial”). I confess, I’m not entirely sure why this is the case. I suspect it has something to do with how government and academic institutions secure their funds. The more influence the pharmaceutical industry has on research and policy processes, the more traction the brain disease model seems to get. And, of course, the public eats up (literally, in the case of pills) easy answers and quick-fix remedies that require as little life-style change and psychological work as possible.

So, although it may seem reasonable to rely on the opinions of leading experts in a given field, this doesn’t always hold true when it comes to the field of mental health. Integral and integrative understandings of addiction and other problems do exist, but they haven’t yet had the appeal and/or financial backing required to capture the imagination of either the leading experts or the general public.

On the bright side, I’m sure all this will change once I click the “Publish” button and everyone on the internet reads this blog post!

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Orgasm Inc.

It’s starting to become fashionable to call out the pharmaceutical industry for its corrupting influence on both the practice of health care and on the general public’s conception of what it means to be healthy. I, for one, think this ripping of Big Pharma is a good thing, a necessary thing, and a thing that’s been long overdue. As with our political system, the undue influence of corporate money is threatening not only the integrity of our health-related institutions (hospitals, university research centers, graduate school programs, etc.), but also the integrity of people’s bodies and psyches.

In an integral health model, moving toward optimal health is not possible without acknowledging, engaging with, and addressing all dimensions of our lives, including the dimension of social systems and institutions. And as long as corporate profit is the highest organizing principle of our health care institutions, our conceptions of health and well-being will be distorted accordingly, leading to interventions that can often cause more harm than good.

ORGASM INC., a new film by Liz Canner, “is a powerful look inside the medical industry and the marketing campaigns that are literally and figuratively reshaping our everyday lives around health, illness, desire — and that ultimate moment: orgasm.” Check out the trailer:

Orgasm Inc. Official Trailer from Astrea Media on Vimeo.

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Psychiatry’s sorry state

I just finished reading HEAD CASE: Can psychiatry be a science?, an excellent article by Louis Menand in the The New Yorker. The article makes clear what I’ve already come to realize over the last twenty years studying and working in the field of mental health — namely, that the field is a freakin’ mess. My field, the one referred to on those degrees I spent so much time and money on, is almost hopelessly mired in conflict-of-interest corruption, bad philosophy, and wrong-headed (although often well-intentioned) approaches to alleviating human suffering. The situation is almost hopeless I say, but despite the sorry state of the field, I continue to consider myself a psychologist at heart. And I’m getting tired of wallowing in the muck and mire of it all, tired of hearing myself whine about how stupid everyone must be not see things the way I see them.

So I’m making a concerted effort to be more constructive in my rantings and ravings instead of merely tearing into whatever pushes my buttons. I don’t want throw out the babies with the bath water, so to speak, because there’s usually some truth to be found in most perspectives. That’s the whole point of an integral approach to health, to weave together what’s useful so that problems can be approached more effectively.

The challenge though, is to figure out exactly which perspectives are appropriate or useful in what specific contexts, to articulate how various partial truths fit together into a comprehensive plan of action. I’m hoping to rise to that challenge in the coming weeks by diving deeper into this integral inquiry through engaging others’ perspectives, reflecting on my experiences, and writing about whatever struggles and insights come along the way.

I’ll sign off for today with what I think is the most interesting part of Menand’s piece, where he ventures into this integral territory with some provocative reflections:

Mental disorders sit at the intersection of three distinct fields. They are biological conditions, since they correspond to changes in the body. They are also psychological conditions, since they are experienced cognitively and emotionally—they are part of our conscious life. And they have moral significance, since they involve us in matters such as personal agency and responsibility, social norms and values, and character, and these all vary as cultures vary.

Many people today are infatuated with the biological determinants of things. They find compelling the idea that moods, tastes, preferences, and behaviors can be explained by genes, or by natural selection, or by brain amines (even though these explanations are almost always circular: if we do x, it must be because we have been selected to do x). People like to be able to say, I’m just an organism, and my depression is just a chemical thing, so, of the three ways of considering my condition, I choose the biological. People do say this. The question to ask them is, Who is the “I” that is making this choice? Is that your biology talking, too?

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“Integral?”

Question: What does “Integral” mean? What’s the difference between integral, integrative, holistic, mind/body, wellness, etc.?

My answer: As I use the term, “integral” refers to any approach that brings together multiple perspectives in an effort to address the multiple dimensions of human life. In this sense, the term “integral” is basically interchangeable with “integrative” and “holistic.” As a matter of personal preference, I like the term “integral.” I graduated from the California Institute of Integral Studies, which is grounded in the Integral Psychology of founder Haridas Chaudhuri, and I’m also a big fan of Ken Wilber’s “four quadrant” integral theory.

In general, however, the terms integral, integrative, holistic, mind/body, and wellness are all meant to convey “whole person” approaches to health and healing, as opposed to the disease-focused system associated with conventional medicine.

Keeping in mind that most, if not all, healthcare practitioners—whether in conventional settings or integrative health centers—would claim to be treating the “whole person,” I agree with the following distinctions Dr. Elliott Dacher makes between conventional, complimentary and alternative, integrative, and integral approaches:

[Article featured on Davi Nikent.org]

The evolution of medicine in modern times has been from allopathic or conventional, to alternative and complementary, to integrative and now to integral.

These can be defined as:

Conventional: The traditional approaches of medical science.
Alternative and Complementary: Healing approaches outside of the mainstream of western medical science.
Integrative: The merging of conventional, alternative and complementary approaches under a single “umbrella” of care.

Each of the preceding approaches, as they are currently and predominantly practiced in western culture, primarily focus on the biological or physical aspects of healing, emphasizing the role of professionals and their specialties, remedies and therapies in the treatment of physical disturbances. It is the recognition that these approaches have not addressed the whole person and therefore limit what can be achieved in health and healing that has driven the development of an integral approach.

Integral: The expansion of the health and healing process to address the entire range of the human experience: biological, psychospiritual, relational and cultural. All are seen to contribute to the disease process and to health and healing. The expansion of consciousness, the inner aspect of healing, rather than the outer “medical tool kit” is a central aspect of the integral approach. The aim of integral medicine is broader than all preceding approaches to health and healing. The aim is to gain freedom from suffering and to experience the flourishing of the full potential of our humanity – the natural arising of an inner peace, wholeness, love, compassion and joy – that can sustain itself throughout the life cycle irrespective of the presence or absence of disease. This can only be achieved with an integral approach to healing that considers all aspects of the human condition.

From the Practitioner’s Perspective:

As a conventional practitioner I would approach the individual from the perspective of the physical symptom and disease, limiting my diagnosis and treatment options to those of western science. As an alternative and complementary practitioner I would approach the physical symptom and disease from the perspective of my particular training (acupuncture, chiropractic, nutritional, etc.) and formulate a diagnostic and treatment plan in relationship to my specialty. An integrative care approach combines conventional and alternative approaches to offer a broader spectrum of choices when treating the individual’s symptoms or disease. As an Integral practitioner I would approach the patient first looking at their entire life circumstance – biological, psychosocial, relational and cultural – focusing on the whole person rather than the disease, symptom, or my particular specialty, my diagnosis would include concerns in each of these areas of life and my healing plan would cover the broad range of needs and possible approaches necessary to move towards a larger health of the whole person. Because as an integral practitioner my vision is broader so also is that which can be achieved, a human flourishing vs. a physical healing. As an integral healer I must be in a transformative process myself as the driving force for a larger healing is not merely biological knowledge but an understanding and growth into a larger consciousness. An expanding consciousness is a key ingredient of an integral process.

Elliott Dacher, MD
March 2005