Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2003; 8: 381–2
It was recently announced that senior nurses in UK hospitals might replace doctors when the latter are not available overnight and at weekends. A good idea perhaps, although our current nurse shortage makes me wonder how it will be achieved. And what about responsibility and continuity of care? If a nurse makes a therapeutic error while I am off duty, I will not be prepared to take responsibility for her actions: I did not appoint her and she does not answer to me. When I come on duty again I shall have to repair the damage.
However, what interested me most about the announcement was that the general secretary of the Royal College of Nursing commented that ‘nurses will not simply be replacing doctors; they will be adapting a holistic approach to patient care’.1 Her statement implied, among other things, that holistic care is what a patient needs during, say, an overnight attack of chest pain.
‘Holistic’ has become a buzzword, with the implication holistic good, non-holistic bad. But many people who use the term do not know what precisely it means. Here, a brief discourse on the etymology of holism and wholly, which I have discussed in more detail elsewhere,2 is merited.
The Greek word holos came from an Indo-European root ‘SOLO’, meaning whole, firm, sound, or correct: solid means wholly reliable and a holograph is written wholly in one’s own hand. But whole (and holy) are not from holos; they have a different Indo-European root, ‘KAILO’, which means of good omen or unharmed: someone who is hale is whole and healthy, and the greeting ‘hail’ is short for ‘be healthy’. Similarly, holism is not the same as wholism.
It was the South African statesman General Jan Christian Smuts who invented the concept of holism.3 The Oxford English Dictionary defines it as ‘the tendency in nature to produce wholes from the ordered grouping of unit structures’, which, Smuts said, ‘is seen at all stages of existence’. Some thought that this idea had been expressed in other doctrines, such as organicism (‘The doctrine that everything in nature has an organic basis or explanation; that everything in nature is part of an organic whole’) or monism (‘Any theory, or system of thought or belief, that assumes a single ultimate principle, being, force, etc.’). However, the idea of holism survived.
Then, in the 1930s, the idea of wholism was invented as a sort of pun on holism. It was defined as ‘the doctrine or belief that wholes must be studied as such and that the parts can only be understood in relation to the wholes to which they belong’. At first this was used in a philosophical sense to refer to events, but later it too drifted and became used in the context of psychology and psychotherapy.
There is now confusion about the distinction between the two terms. To philosophers holism means ‘any doctrine emphasising the priority of the whole over its parts’, with specific uses in linguistics and the philosophy of mind.4 To ecologists it means the black box approach to analysing ecosystems, studying inputs and outputs rather than the individual parts of a system.5 And to psychiatrists it means ‘the thesis that the study of parts cannot explain the whole’.6 Wholism, on the other hand, is rarely found in dictionaries, and in the rare exceptions where it is mentioned7 the reader is merely referred to holism. However, there is a distinction: holism presupposes that the whole is in some way greater than the sum of its parts; wholism does not.
Interest in holism has burgeoned in the last decade. In a Medline search for the forms holism/holistic and wholism/wholistic in the titles and abstracts of bioscience papers published in 1966–2002, I found 4034 examples of the former and only 108 of the latter. While the frequency of the use of wholism/wholistic has remained constant, at an average of about three per year, the frequency of the use of holism/holistic has increased from five instances in 1966 to 320 in 2002. This increase in the use of holism has not been monotonic: after an initial increase during 1975–80 there was a lull in the 1980s, followed by a further rapid increase in the ‘New Age’ 1990s (Figure 1).
Figure 1. The numbers of papers in whose titles or abstracts the words holism or holistic were used during 1965–2002 (drawn from data obtained from Medline, accessed 26 April 2003).
Among authors of standard dictionaries, Green gets closest to defining the modern meaning of holism: ‘[Holism] is now favoured by a variety of new therapies, all of which like to emphasise the relationship between biological and psychological well-being which together make up the ‘whole’ person.’7 But, as Campbell points out, ‘There are several sciences relating to the person, but no science of the person idn its totality.’6 Neither is there ever likely to be, despite the efforts of some to create one, such as the so-called ‘Science of Unitary Human Beings’.8
A wholistic approach to patient care is to be commended, although one should not be wholistier than thou–there are times when paying attention to all aspects of the patient’s life is unnecessary and indeed counterproductive. The patient with painful piles will benefit from having them removed and receiving instruction about good bowel habits; generally no more is required. However, the patient who has had a stroke will require close attention to the physical, psychological, and social problems that arise as a result. Like other forms of therapy, the wholistic approach has its limitations. It can, for example, subvert the patient’s autonomy. I often see patients being prevented from running their lives as they want to run them because someone, with the patient’s best interests at heart, believes that some aspects of the patient’s condition are inadequate to the challenge.
There is nothing new about the idea that wholism and holism are distinct,9 although the treatises in which holism is discussed are often riddled with jargon that obscures clarity of understanding. It is possible and often desirable to be wholistic, but holism is an unproven hypothesis. I have searched in vain for convincing evidence that paying attention to all aspects of patient care in the ways that the theorists propound in their many different models produces a better outcome than one would expect from straightforward attention to the individual components. This has important implications for patient care. Wholism implies, for example, that there is no single doctrine of care that is better than any other and that no one practitioner or type of practitioner has a monopoly of wisdom; in many cases a team approach can be highly beneficial, provided that the team works together as a single functioning unit. Holism, on the other hand, gives those whose therapies lack a strong evidential base a rationale for claiming that their approach is in some way superior because it (unprovably) adds something that cannot be quantified. This argument is implicit when anyone says that they will adopt a holistic approach; it is an argument of which we should be wary.
