THE EDITOR'S CORNER
Holistic medicine used to be thought of as whole person medicine, whose goals were to be achieved through a balance of body, mind, and spirit. It took on an added dimension when Hans Selye demonstrated physiologic changes due to stress; and it was hypothecated that the reverse should be true--that reducing stress through a proper balance of body, mind, and spirit could help to establish, maintain, and promote good health. There followed considerations in preventive medicine beyond Emil Coue's "Every day in every way I am getting better and better", beyond the "well-balanced diet", plenty of fresh air and sunshine; and emphasis was added on nonsmoking, control of weight, aerobic exercise, and substituting health foods for junk foods. There also followed the development of a great many physical, mechanical, chemical, and psychological techniques designed to achieve a holistic state. Some have enough anecdotal evidence that they work on some people to convince other people to try them. Many have very little such evidence and none seem to have evidence of a quality or quantity to satisfy the scientific method. It should be pointed out that, in all of medicine, there may be a large percentage of effectiveness attributed to what is really a placebo effect. So, the test of any therapy should not be whether it works on someone sometime, but whether its effect is incidental and momentary or whether it makes some real and lasting change in the physical, mental, or emotional state being treated.
If that is a fair thumbnail description and evaluation of holistic medicine, what is holistic dentistry? In a sense, there is no such thing as holistic medicine or holistic dentistry. There is only holistic health. Holistic dentists are saying that "anything they do or fail to do affects the entire person, rather than merely the tooth or the mouth" (Penzer, V.: Holism: treating the whole patient. JADA 102:27, February 1980). They say that we must use orthodox knowledge, but go beyond that to embrace new concepts. To the admonition that a professional should not be too quick to turn his back on the scientific method, the reply frequently is that we have given the scientific method and the therapies derived therefrom a chance and they have been found wanting in understanding and treating disease, particularly chronic disease, and some professionals are willing to follow their intuition and accept unconventional therapies based on what evidence there is. Again from Penzer: "We have at our disposal an impressive array of scientific instrumentation (such) as electrography, electromyography, tomography, kinesiometry, kinesiography, ergometry, occlusography, dermatronics, and myotronics. These are the tools of the ongoing and forthcoming validation of the proposed hypotheses."
Despite the impressive array of instrumentation, which itself requires some scientific evaluation, until some proof is offered that satisfies the scientific method everything that comes forth is intuitive medicine and anecdotal cures. This does not mean that there is nothing there. Indeed, those who are embracing the unconventional theories and practices of holistic medicine may some day be looked upon as the visionary pioneers of our era. In the future, dentistry may very well be a specialty of medicine, as a logical development stemming from the very concept that what the dentist does to people affects the whole person. Short of that happening, the dentist who assumes too much responsibility for the body and the mind would seem to be in real jeopardy of being charged with practicing medicine without a license, or he may join the myriad group of nonprofessionals who offer unconventional approaches to health. Either case is a matter for consideration by the profession as a whole. While some allowance ought to be found for unconventional thinkers, some restraints need to be enunciated by the profession, if it is to carry out its obligation to protect the public by policing itself and setting the boundaries within which practitioners will work.
Holism today "views each individual as an integrated totality, functioning not only physically, but also emotionally, mentally, and spiritually in close dynamic interaction with the universe as a whole" (Gray, B.:A test: are we curing or suppressing the illness? J Energy Med 1:31, 1980). For the most part, one would not have trouble with such a statement. The trouble arises in prescribing to achieve it. If a balance of body, mind, emotions, and spiritual values is to be achieved in an individual, it will probably not be done unless the individual takes responsibility for achieving such a state for himself. He might try to do this in a traditional manner by consulting a physician or physicians to treat his body, a psychologist or psychiatrist to treat his mind and emotions, and a minister to explore his spiritual values. This is not a very holistic approach, but would he do any better consulting one or more nontraditional therapists? Does any one human being exist who could be expected to integrate the knowledge and understanding of the whole body, the mind, the emotions, and the spiritual values of another individual?
If dentists were tempted to leap in to fill such a role, they ought at least to pause to consider why it was that a major effort in dentistry to change people's behavior with respect to preventive dentistry was not a success. Otherwise, dentists who failed to clear the bar at five feet will be raising it to seven. It failed because we didn't know how to change people's behavior; certainly not by trying to play the role of their conscience, their teacher, and their monitor. Dentists who choose to practice holistically will not be telling patients what is good for them. One f does not install a holistic health concept in a practice by manipulative techniques. It may be done by evolution of the doctor and the staff first to holistic attitudes. If they are joined in this attitude by a certain number of patients, that is fine. If not all join in, that is all right.
For a dentist who wishes to practice holistically, a dental office cannot be transformed overnight. The doctor cannot go out and buy one machine or another and start practicing holistically. If a dental office is able to achieve a holistic approach and if a patient is able to take from that office a feeling about himself that contributes to his holistic health, that should be the object of holism in the dental office. Nevertheless, the foundation upon which any concept of health through dentistry is based is the finest quality of treatment delivered in a most caring manner.
Norman Shealy is among the foremost advocates in the world today for living a holistic life and practicing holistic medicine. JCO is fortunate to count him among our friends and to present some of his thoughts about holistic health, with special reference to orthodontists and their patients. A two-part interview starts in this issue and is supplemented with some interesting material from Dr. Shealy's writings. You will note in these supplements in this issue a suggestion that readers send JCO, anonymously, two test scores from questionnaires about stress and stress symptoms that Dr. Shealy has allowed us to reprint. If we get an adequate number of responses, we will ask Dr. Shealy to interpret the results for us and publish the findings and his observations in a future issue. Readers may submit either just the two test scores or the completed questionnaires themselves or photocopies of the questionnaires. We will learn something about stress among orthodontists, and each reader will be able to compare his scores to the reporting group.
