Ten Essential Questions to ask Yourself While Choosing a Treatment Option Many people today are interested in alternative medicine have been disillusioned by the biomedical system and managed care, yet they have little faith in alternative options of health care. In order to make an educated decision about alternative health care it is beneficial to view the options from the systems of healing perspective. Proponents of the systems of healing approach support the notions that human consciousness, belief systems, and social worlds all affect the patient’s experiences of illness and the healing. Many researchers and theorists emphasize social and behavioral components that reflect a wide variety of effective healing systems in which human consciousness plays an essential role. The systems of healing approach can also be utilized when viewing healing systems within a spiritual context. The psychological changes resulting from these spiritually oriented interventions can be identified in physical, psychological, and spiritual frameworks. Jerome Frank, M.D., Ph. D. first published Persuasion and Healing: A Comparative Study of Psychotherapy in 1963. His daughter, Julia Frank, M.D., was added as a co-author for the third edition of the book in 1991. The Franks have devoted themselves to observing and understanding psychotherapy. They focused on finding the common denominators that exist in the process of psychotherapy. Commonalities may also be found in both indigenous and alternative healing systems. The essential elements of healing identified by Frank can also be found in both indigenous and alternative healing systems such as those in the Philippines. This author promotes that this spiritual realm exists, at least in the realm of human consciousness, and illness can be successfully treated utilizing spiritual and spirit directed medicine. Since ancient times, the cures for injuries and illness-causes mainly consisted of herbs, physical exercise, and fasts, all in combination with ritual. These were typical treatments in tribal, or kinship group's medicine. Rituals are performed in which either the shaman and/or the patient who perform active roles in prescribed treatment. Frank and Frank trace healing traditions back to a time when illness was regarded as primarily supernatural or magical. Treatment consisted of rituals that reversed the cause of the illness, such as the "spell casting or hexing" traditions that are still prevalent and practiced commonly by the mananambal or the tambalans in the Visayan Islands in the Philippines. Some of the traditional healing or curing rituals the Franks mention typically required the active participation of not only the patient but the patient’s family or community members as well. Active participation requires effort and activities on the part of the patient and others, towards a defined healing goal. This participation promotes either the creation of a cognitive shift or a cathartic experience in the patient and is supported by the patient’s family and social support system. In the introduction of Frank and Frank’s (1991) book, Persuasion and Healing, the authors contend that the brain acts not only as the seat of consciousness, but also as the control mechanism for bodily functions, the nervous system, the endocrine system, and the immune system. “It also involves the way attitudes, moods, and emotions, processed by the brain, can promote health or set the stage for illness” (p. xi). Additionally, one must have a shared cultural experience or at least comprehend the client’s belief about the illness to promote a cure. Although the Franks’ focus of healing principles is on psychotherapy, the authors address issues applicable to indigenous and CAM healing systems. “Examination of religious healing across cultures illuminates certain aspects of human functioning that are relevant to psychotherapy” (p. 87). Frank and Frank’s theory is congruent with those of Brody and Brody (2000) and Kleinman (1980, 1988a, &1988b), regarding the role of human consciousness in illness and healing experiences in which the brain functions as the seat of the soul and of inner healing mechanisms. The conclusion of Frank and Frank, whose focus was on different forms of psychotherapy, and yet included the similarities between psychotherapy and indigenous healing rituals, was the importance of shifting the emphasis from differences in therapies to similarities. “The interaction between particular therapists and patients, determined by the personal qualities, values and expectations of both, contributes more to the outcome than does therapeutic technique” (1991, p. 300). Essential elements of healing identified by Frank and Frank were (1) the instillation of hope and anticipation of a positive outcome, (2) emotional arousal, and a sense of mastery are brought about by the patient and healer taking active roles in the process of the healing. (3) the healer’s role incorporates acts of persuasion and includes the use of rhetoric. The three main factors prominent in effective healing experiences studied by Frank and Frank included (a) hope or positive expectation, (b) emotional arousal, and (c) enhancement of the sense of mastery. The authors determined that patients who were most improved experienced enhanced mastery feeling more control of their own life experience. E. F. Torrey, M. D., a clinical and research psychiatrist with a background in anthropology, published in 1972 The Mind Game: Witchdoctors and Psychiatrists. His revised book became Witchdoctors and Psychiatrists: The Common Roots of Psychotherapy and its Future, published in 1986. Torrey identified four fundamental elements operative in effective medicine, psychotherapy, and alternative healing systems. He pointed out the healer’s process of naming the affliction is the beginning of the therapeutic process. (1) A shared worldview making the diagnosing/naming process possible, a precursor to the instillation of hope. (2) Torrey discussed specific personal qualities of the healer appear to facilitate recovery. These personal qualities include empathy, nonpossessive warmth, and personal genuineness. These are also the principles promoted by Carl Rogers (1957) as the essential elements in his client-centered therapy. (3) Patient expectations of recovery assist in the healing process. Expectant faith, or the instillation of hope, was recognized by Sigmund Freud in 1940, positively affects the healing processes. Torrey also concluded that the fourth principle (4) specific techniques, the materials, and the healing procedures, all assist in empowering the patient and promote the patient’s sense of mastery over the problem or illness. The Torrey model determines essential mechanisms of various systems of healing. These four essential elements that affect psychotherapy also manifest, overlap, and blend with many of the other systems of healing frameworks employed by researchers. These principles apply not only to psychotherapy, but also provide a vehicle to transcend cultural barriers and are inclusive of indigenous healing practices and other alternative systems of healing. Torrey’s model includes these four elements:
1. A shared worldview.
2. Patient expectations of healing.
3. The personal qualities of the healer.
4. Specific techniques and materials (materia medica).
The various aspects of the healer’s procedures assist in empowering the patient and promoting positive outcomes. The same dynamic can be observed in shamanic healing ritual contexts. Taking an active role in one’s own healing process can give a patient the sense of empowerment. Torrey’s book title promotes the idea that there is not a huge difference between witchdoctors and psychiatrists, a notion which this author agrees. Torrey has identified essential elements of healing exemplify the role of consciousness in human beings’ illness and healing experiences. Given the times in which we live, it has become increasingly important to attempt to bridge the gap that exists in our experiences, between physical, psychological, and spiritual. Meaning-centered models of illness and health have contributed greatly in assisting this unification of our understanding. While the terms “treatment modalities”, “placebo response” and “faith healing” may describe very similar phenomenon, the role of faith and belief, has re-emerged as a focus of great importance in our lives and our experience of wellness. It is my intention to assist in bridging the gap between spiritual, psychological, and physical factors. I prefer the term faith healing to the placebo effect or response, but will defer to the meaning centered models of successful treatment modalities.
Due to the complexity of illnesses and healing experiences, several researchers have attempted to determine universal components of each. Many contemporary researchers and theorists have tried to define illnesses and healing experiences, and have created classifications as to cause and cure, in order to provide descriptions of particular systems of healing. Proponents of the systems of healing perspective strongly believe that not only physical symptoms, but also human consciousness (Krippner, 2000). Social and environmental experiences also play prominent roles in affecting human illness and healing experiences (Kleinman, 1980).
Researchers and medical scientists have worked diligently for many generations to try to describe, define, and classify illnesses and diseases as to cause and cure. The results of biomedical research are overwhelming in depth of detail and usefulness as diagnostic tools. Such research has yielded great authority and a firmness of belief in its classifications, which supposedly rivals no other. The biomedical system of classification and prescribed methods of healing are also always changing as new information is accumulated. Yet, western medicine does not generally allow for the integration of information outside of the empirical perspective, such as utilizing psychology to create a catharsis, a common result of spirit-directed medical techniques. It is necessary to include the use of systems of healing approaches to broaden the research into the avenues of spirituality, spiritism, subtle energies, and other spirit-directed therapies. The systems of healing approach can be utilized to assist in understanding the effectiveness of indigenous and other spiritual healing systems.
Krippner and Remen (2000) summarized researchers’ findings and developed a model of systems of healing based on their perceived essential elements of illness and healing experiences. Krippner and Remen presented a model for describing systems of healing consisting of these categories: (a) the illness, (b) the healer, (c) the healing relationship, (d) the healing transaction, (e) the social issues, and (f) the ethical issues. Specific questions were proposed to assist in developing a description of a healing system.
Krippner and Remen (2000, p. 36) also formulated a grid listing four essential healing principles. Placed on the horizontal axis are: (a) shared worldview, (b) personal qualities of the healer, (c) patient expectations, and (d) techniques and procedures. And there are five common factors in healing on the vertical axis: (a) the nature of the ailment, (b) nature of the patient, (c) nature of the environment, (d) nature of the treatment, and (e) interactive factors. This grid exemplifies the variables affecting human beings’ illnesses and healing experiences.
Essential Healing Principles and Common Factors in Healing
SharedPatient Personal Techniques & WorldviewExpectationsQualities Procedures of the Healer A.Nature of the ailment 1A2A3A4A B.Nature of the patient 1B2B3B4B C.Nature of the environment 1C2C3C4C D.Nature of the treatment 1D2D3D4D E.Interactive factors 1E2E3E4E Krippner and Remen contended that, regardless of which model one uses, several essential healing principles will persist. The universal principles are: (a) naming the ailment, (b) patient’s expectancy and attitude, (c) the nature of the environment (e.g., family, friends, and community), (d) the nature of the treatment, and (e) the interactions of these factors. There are many elements affected by human consciousness, which require further research; the power of faith, subtle energies, placebo or expectancy effects and the patient-healer relationship, to name a few. Many writers and researchers have contributed to this emerging body of thought. The system of healing approach is the overarching method used to describe the relationships between patient, healer, and cure. The Ten Essential Questions These ten essential questions regarding the choice of an alternative health care modality were developed as a result of studying the role of the essential elements of human consciousness in successful healing experiences. In accordance with a much cited research, the essential elements of healing are summed up as: (1) patient expectations, or expectant faith (Frank & Frank, 1991) in the healer and the process, an instillation of hope in the mind of the patient (Torrey, 1972). The instillation of hope may occur during the diagnostic process; yet will usually occur even prior to the diagnostic process. (2) The diagnostic process. These first two dynamics are largely affected by (3) the qualities of the healer, empathy and unconditional positive regard (Torrey, 1972), expert knowledge or dynamic “trickster” characteristics, which can enhance cathartic healing experiences (Hansen, 2000) by creating awe and by breaking cultural expectations. The healer promotes the expectations of the patient (Frank & Frank, 1991) for healing by utilizing, (4) culturally relevant procedures and materials (symbols, icons, technology) congruent with the patient’s value system, and the patient’s chosen form of treatment (Torrey, 1972). A western educated individual may experience faith in the current biomedical system of health care. That person may have great respect for their general practitioner or specialist. They may experience an expectation of hope in modern technology and emotional arousal during the preparation for or during a medical procedure. The doctor may send them home with instructions such as changing their diet, lowering cholesterol, blood sugar etc., or exercising to build muscle mass, increase. Patients may experience a placebo effect from being given a prescription; they will sometimes feel that the experience is not complete unless they are prescribed a medication. However, healing takes place on more than just the physical level. This is where systems of healing approaches are helpful in understanding healing experiences, as they take into account the role of human consciousness. A person’s beliefs and value system must match the choice of treatment modality for optimum effectiveness. The first set of questions requires “yes” or “no” answers. The more yes responses a person has, the greater the chance of a successful treatment outcome. The most benefit will be derived from choosing the treatment modality that benefits the most yes answers. Proposed here is a series of questions based on the essential elements of healing which coordinate a person’s belief system and system of healing. Begin by asking yourself these questions about your current practitioner and the modality in which you are receiving treatment now. Then ask yourself these questions about your alternatives to that treatment modality and the practitioners that you have tried or are considering a switch to. The rationale behind this decision-making process is the focus of this book, as is the systems of healing perspective, social medicine, and this author’s experience with alternative healing systems. Attempting to bridge gaps between various schools of thought regarding faith healing, Kleinman and others explain faith healing from the academic perspective and often refer to this phenomenon as the placebo effect or the placebo response. However, the therapeutic action can often be traced back to the patient’s faith and belief. Because of the psychological effects of both modern medicine and alternative medicine, this author promotes the idea that all healing experiences are to some extent faith healing. These are helpful questions that should be asked when considering a change to a complimentary or alternative form of treatment:
Ten Essential Questions About Alternative Healing.
(yes / no answers)
Do you have faith in the system of health care where you are receiving your current treatment?
Do you go to the place where you receive your treatments with hopeful positive anticipation?
Do you like your current care provider?
Do you feel the practitioner possesses the expertise needed to address your problem?
Do you agree with the practitioner’s diagnosis of your problem?
Do you agree with the practitioner’s perspective by which he provides treatment for your problem?
Do you have input, or do you take an active role in your own treatments?
Do you feel good about your role in the treatments you receive?
Do you feel generally satisfied after receiving a treatment from your practitioner?
Was the experience meaningful to you?
If one answers no several of these questions then perhaps one should consider another treatment modality and or switch practitioners to maximize the option of a successful healing experience. Stanley Krippner (personal communication, February 9, 2004) a proponent of the systems of healing models, later suggested a version of the Ten Essential Questions that allow for more than yes or no responses, which are more well-suited for qualitative research projects and information gathering.
Ten Essential Questions About Alterative Healing.
How did you develop the faith you have in your practitioner?
With what attitude do you go to the place where you receive your treatment? (Do you go only when you are ill or do you go there for health maintenance?)
What are your general feelings toward your care provider and why do you feel this way?
To what extent do you agree with your practitioner’s diagnosis of your problem?
To what extent do you believe your care provider has the capability to treat your problem and how do you know this?
To what extent do you agree with your practitioner’s perspective utilized in treating your problem?
(Some patients take a very active role in their treatment, and some patients take a more passive role.) What role do you take in your own treatment, active participation or passive and accepting?
Describe how do you feel about the role you have in your own treatment and why?
Describe the degree of satisfaction you experience after receiving your treatment?
Describe the meaning or value of the healing experience for you?
I decided on presenting both sets of questions. Each set consists of ten questions. One set that requires only a yes or no answer (forced choice). The open ended questions are provided to produce more information for subjective study. The leading questions provide simple answers, which can be beneficial to individuals but can also be utilized in research. My original intent of the questions was to say, if one can answer yes to all of these questions regarding one’s current treatment modality and practitioner then one has a good chance (up to %70 could be claimed depending on which studies one cites) regarding successful outcome. These questions are based on the systems of healing theorists’ models and address the essential elements that exist in reported successful healing experiences.
Frank, J. D. (1974). Persuasion and healing: A comparative study of psychotherapy (2nd ed.). New York: Schocken Books.
Frank, J. D., & Frank J. B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore, MD: Johns Hopkins University Press.
Hansen, G. (2000). The trickster and the paranormal. New York: Orders@Xlibris.com
Kleinman, A. (1980). Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley, CA: University of California Press.
Kleinman, A. (1988a). Rethinking psychiatry: From cultural category to personal experience. New York: The Free Press/Macmillan.
Kleinman, A. (1988b). The illness narratives: Suffering, healing and the human condition. New York: Basic Books.
Krippner, S., & Remen, R. (2000). Learning guide for systems of healing course #4040. Retrieved September 9, 2000, from Saybrook Graduate School and Research Center Web site: https://www.saybrook.edu/app/lg/cr4040.asp
Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95-103.
Torrey, E. F. (1972). The mind game: Witchdoctors and psychiatrists. New York: Emerson Hall.
Torrey, E. F. (1986). Witchdoctors and psychiatrists: The common roots of psychotherapy and its future. Northvale, NJ: Jason Aronson.