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The Tripartite Nature of Integrative (Holistic) Medicine
By Michael W. Fox, BVetMed, PhD, DSc, MRCVS
The medical profession seems to have outdone the veterinary profession with a staggering incidence of adverse drug reactions (ADRs) in hospitalized patients. In one study, ADRs in the US ranked sixth in leading causes of death, with an estimated 2,216,000 ADRs, and 106,000 fatalities in hospitalized patients in 1994 (1). According to the FDA, 2 million people acquire bacterial infections while in hospital, and 90,000 die as a result. Alarmist as these figures may seem, they are symptomatic of the nemesis of modern medicine and of the urgent need for a more integrated, holistic approach to human illness that includes what we eat and how farmers farm (2)
The well-being of human patients’ spirits is most often left to nurses and visiting clergy, and that of animal patients to veterinary nurses and caretakers, all of whom may or may not have the needed time, or sensitivity and training to fulfill this basic patient need. By well-being of spirit we mean, in the vernacular, subjective sense, as being in good spirits, as distinct from being dispirited.
Well-being in spirit is linked in part to the spiritual sensitivity, awareness, and depth of concern of healers and care-givers. Maximizing both should be an integral part of veterinary and human medical practice and teaching curricula. Attention to patients’ well-being can be problematic for those who care but whose time is limited and treatments restricted due to the low reimbursements and dictates of seemingly one size fits all insurance directives.
Some veterinary practitioners have told me that they rigorously avoided having to hospitalize their patients because the adverse impact on animals’ spirits was detrimental to recovery. They deplored some of their peers who over-hospitalized clients’ animals, often for minor, ambulatory conditions for which more in-hospital tests and monitoring were advised.
The first duty is to make the patient as comfortable as possible by alleviating physical discomfort such as pain, and addressing compromising physiological states like fever and inflammation. Alleviation of fear, anxiety, agitation, and depression, all of which can aggravate physical signs of illness and compromise recovery, are also important responsibilities that good healers traditionally address.
The patient’s vitality and condition of spirit have great prognostic value, since they are the manifest expression of the body-mind connection as evidenced in the patient’s demeanor and changes therein during the course of the illness and treatment. The well-being of the spirit, an indicator of the will to live, is in part determined by physical and mental health. Sickness of the spirit, in extremis, the giving up of the will to live, has profound psychological and physiological consequences.
These concerns are gaining recognition today especially where elderly patients develop hospital psychosis or the hospitalism syndrome within a few days, becoming increasingly confused, disoriented, agitated, dispirited, anorexic, incontinent, and even hallucinatory. Comparable reactions may be seen in animals confined for treatment and either separated from their owners, regular care-takers, or from their own species-companions. Animals in some no-kill shelters become dispirited with inadequate human contact and environmental stimulation, becoming increasingly difficult to rehabilitate/re-socialize due to almost psychotic neophobia and fear of strangers. The cage-depression of such institutionalized animals, like those in poorly managed zoos and menageries, is often associated with stereotypic, obsessive-compulsive behaviors.
The well-being of the whole patient is addressed by the holistically oriented human and animal doctor who practices what I term integrated medicine. The cardinal signs of illness are closely evaluated, and diagnosis and treatment determined by considering the ways in which the illness in question is manifested. Physical and behavioral signs, called symptoms, may be treated directly, even in the absence of a formal diagnosis. Symptom-based treatments are supported by evidence-based medicine, drawing on prior experience with known remedies, not necessarily scientifically proven in terms of how the treatment actually works at the cellular level. When we, and the animals we care for, become ill, it always for some reason, most often a multiplicity thereof. Elucidating the causes is half the cure, and the ultimate prevention.
The holistic healer intuitively senses and feels, through empathy, close observation, and communication with the patient, the condition of the spirit. Reasons for being dispirited are identified as well as possible, especially social and environmental influences, in addition to physical and mental factors. Of these there may be many that have a synergistic effect throughout every disease process that includes dis-ease, from the onset of symptoms to ultimate recovery or death.
Concern for the patient’s spirit elevates medical and veterinary bioethics by incorporating values of compassion and empathy in patient treatment, care, and rehabilitation therapy. Decisions such as euthanasia, or discontinuing life-sustaining treatments, and evaluation of quality of life, can then be better made since the patient’s quality of life and prognosis cannot always be determined on the basis of physical indices alone.
Conventional practitioners of allopathic animal and human medicine primarily base their healing practices on the use of various drugs (and surgeries). Western medical practice has separated the patient’s body from the mind by obeying paradigms of a dualistic, mechanistic and reductionistic nature that have guided the approach to diagnosis and treatment. This has lead to some significant medical progress.
A further consequence has been the development of separate disciplines, beginning with psychiatry and internal medicine, and ending in oncology and dermatology, in part due to an exponential knowledge burden and demand for specialized skills. This development may contribute to the lack of conceptual and administrative integration, communication, and collaboration. The unforeseen sequelae of the birth of these specialized branches are breakdowns in public health and health-care services. The cost has been astronomical, despite miraculous breakthroughs in treatments and cures.
A similar breakdown secondary to this specialization-compartmentalization has been evolving in the veterinary profession. For example, some veterinary dermatology specialists and allergists, as well as general practitioners, fail to fully consider the role of manufactured pet foods in contributing to their patients’ condition. Many over-prescribe steroid drugs, and even prescribe expensive manufactured ‘prescription’ diets that have been especially formulated ostensibly to treat various health problems from diabetes to dermatitis. Yet they often contain the very same food ingredients that were in the pet foods that caused or contributed to their patients’ illness in the first place. (3)
Holistic veterinary and human doctors have gone beyond the false mind-body dichotomy in their approach to both diagnosis and treatment. The textbook edited by Dr. Frank McMillan entitled Mental Health and Well-Being In Animals,(4) and Schoen and Wynn’s Complementary and Alternative Veterinary Medicine,(5) are part of this revolution/evolution of Western veterinary medicine toward an integrated approach in addressing animal health and disease prevention, and animal welfare and well-being.
One integrative approach is to encourage the ability to regard the patient’s mind and body as his or her soul. One assumes that spirit is the animating principle of every living soul, whereby we will surely have a very different medical paradigm and approach to disease prevention and treatment. Once the separation of mind and body is rejected by conventional medical and veterinary practitioners, there is an opening for the integration of various alternative and supportive/adjunctive therapies.
Historically, the first breaking away from the dualistic dichotomy of psyche and soma came with the recognition of psychosomatic diseases in human patients, and subsequently in animal patients, (6). More recently, a major advance in integrative medicine has come with the recognition of epigenetic processes (7). These processes were inconceivable until the dualisms of organism and environment, genomes, nutrition and other prenatal influences, were overcome, along with the science-based fiction of genetic determinism.
The late Prof. Konrad Lorenz, MD, Nobel laureate and a founding father of ethology, asserted that before one can really study and animal, one must first love it. By extension, before one can heal, one must first love the patient in the spiritual sense of agape. Within the clinical setting this means compassion and empathy, innate qualities rarely taught through example nor encouraged in either medical or veterinary schools, with a few recent exceptions. This is regrettable because most human-socialized animals, like children, sense when they are loved, and whether someone is genuine or not. As with pediatricians, veterinarians who feign affection for their patients do not get very far.
The science of ethology helps resolve the artificial mind-body duality since it provides the tools to objectively determine the highly subjective condition of the animal's ethos, its spirit, sentiment, character, or disposition. The addition of applied animal ethology to the veterinary teaching curriculum has done much to dispel the long-held view that animals do not have feelings, cannot suffer psychologically or become dispirited.
The collective ethos of society in terms of how animals are perceived and ought to be treated has changed significantly over the past 3-4 decades. Humane concerns are being raised about how and why animals are being treated in certain ways. The veterinary profession is being called upon by society to address many of these concerns as they affect animals’ health and well-being. In the eyes of some critics, the profession has taken more reactive and defensive roles than proactive initiatives in order to protect the vested interests of their animal industry and commercial clients. This conventional view has deep cultural roots. The veterinary, medical, and medical research disciplines need to disentangle themselves from such corporate entities. They must refocus conceptually, perceptually, ideologically, and ethically on animal health and well-being for animals’ sake as well as for the public health and other community benefits.
The cultural blindness toward animals as living souls who are sentient beings is still very much in evidence today, reflected in the dispirited eyes of self-mutilating primates and purpose-bred dogs who spend most if not all of their lives in small laboratory cages or pens; in the eyes of arthritis-crippled breeding sows in factory farms who are so confined as to be unable to walk or turn around their entire lives; and in the eyes of performing circus elephants who spend most of their lives in chains and usually die from chronic foot infections and osteomyelitis.
The inability of animals to express their ethos, the normal range of behaviors essential for their physical and psychological well-being, because of the conditions under which we keep them, is to deny them expression of their natures, their spirits. To what ends and to what degree we chose to inhibit, even crush their spirits, is a bioethical issue that society has yet to fully address. But, along with the veterinary profession, society cannot address this issue with impartial objectivity until the chauvinistic notion of human superiority that puts people before other animals is tempered by humility and equalitarianism---giving all sentient beings equally fair consideration.
Charles Darwin asserted that ‘The difference in mind between man and higher animals, great as it is, certainly is one of degree and not of kind,”. (8). He wrote these words over a century ago, contrary to the prevailing anthropocentrism of the time, based upon his studies of comparative morphology and behavior. In a similar vein, the late Loren Eiseley, a professor of anthropology and paleontology, (9) observed, “One does not meet oneself until one catches the reflection from an eye other than human.” Such self-discovery would do much, I believe, to improve the health and well-being of our own kind, and the animals under our care.
The author gratefully acknowledges the comments and editorial suggestions of Susanne Dyby, PhD, Camilla H. Fox, MSc, and Robin Scott, MD.
1. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA.1998; 279:1200-1205.
2. Cox S, Sick Planet: Corporate Food and Medicine. Ann Arbor, Michigan, 2008.
3. .Fox MW, Hodgkins HE, Smart M. Not Fit For a Dog: The Truth About Manufactured Dog And Cat Food. Sanger, CA QuillDriver Books 2008
4. .McMillan FD. (ed) Mental Health and Well-Being in Animals. Ames, Iowa, Blackwell, 2005
5. Schoen AM, S.G.Wynn SG. (eds) Complementary and Alternative Medicine: Principles in Practice. St Louis, MO, Mosby, 1998
6. .Fox MW. (ed) Abnormal Behavior in Animals. Philadelphia, PA, W.B.Saunders, 1968
7. Fox MW. Integrative Development of Brain and Behavior in the Dog. Chicago, IL, University of Chicago Press, 1971
8. Darwin C. The Descent of Man and Selection in Relation to Sex. New York,
J.A..Hill & Co., 1904
8.9. Eiseley L. The Unexpected Universe New York, Harcourt, Brace and World, 1964,
For more information visit Dr. Fox's site.
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