Community Sustainability in the Grand Traverse Area: Health Arena

In order to build a sustainable world we must first evaluate how things actually work and how we wish them to work differently. As Jamake Highwater says, "All human beliefs and activities spring from an underlying mythology". What are the stories we tell ourselves in our culture and in our particular community about our health? What are the stories we tell ourselves about healthcare systems? About healthcare practitioners? What stories do we believe about how our individual health is related to (or separate from) the health of others? What are the sacred myths that we wish to embrace, and which stories are we ready to let go? Which stories are truly healthy and which stories make us (or keep us) sick? In this article we will explore three models of health care, what the underlying mythology is of each model, and how they may (or may not) contribute to a sustainable community and world.

One way of evaluating a model or a system's potential for sustainability in the rapidly changing post-modern world is to determine whether or not it is hegemonic. In the modern age, starting in about the 1950's in this country, we saw an invariant approach to reality, a conformist, singular, one-way mentality that dominated many of our systems. When this occurs within a culture there is a hegemonic world view. A hegemony, which is the ideology of the dominant class, or the ruling ideology, occurs in societies that are diverse in terms of language, race, culture, religion, political ideologies, values, and beliefs, but still, nonetheless, there exists a dominant world view in a particular system. When an ideology is hegemonic, most of the people espouse that ideology, and believe in it to some extent. It is something that has to be contended with, and everything else becomes alternative to that hegemony. In a small-scale society where everyone shares the same world view in terms of religion, politics, values, and beliefs, hegemony does not exist due to the singularity of the culture's world view. Only in large-scale, multi-cultural, diverse societies where, despite all of the diversity, one world view is dominant in the culture is there hegemony. In our society, according to cultural anthropologist Robbie Davis-Floyd, the medical model is such a hegemony. By definition, therefore, alternatives to the medical model are considered heretical (a belief opposed to the orthodox, official, or standard opinion). For example, "midwifery is a heresy in relationship to the medical hegemony of obstetrics" (Davis-Floyd, 1995). Likewise, homeopathy is a heresy in relationship to allopathy (medical model). Other modalities such as chiropractic and acupuncture are both heretical to a greater or lesser extent in relationship to the medical model, though both of these modalities are becoming more mainstream in many areas of the United States. It matters very little that acupuncture, for example, is a much older modality than allopathy and has been used widely and successfully in the Eastern world for centuries, because in this country it is not the ideology of the dominant class. What is equally interesting is that hegemonies need heresies to re-think their position and to revitalize themselves, lest they become rigid and crack in the face of rapid changes. Heresies point the way to change and assist in keeping things fluid, growing, and open-ended in the face of rapid changes, and if they are successful, they fundamentally change the way things are done. On the other hand, heresies can also become co-opted into the system and pressed into the service of the dominant ideology.

So what ingredients make for a sustainable model of health care in the post-modern world? In order to understand what it is we are analyzing, let us have a look, albeit brief, at the three current models of health care provided in the western world. These models, as defined by anthropologist Davis-Floyd, are described in three stages from most stable (hegemonic) to most dynamic (evolving). They are:

1) the technocratic or bio-medical model;

2) the humanistic or bio-psycho-social model; and

3) the holistic model.

Each model encompasses the elements of the previous model and expands beyond the limitations of its predecessor. It would take a longer article to give an adequate description of all of the elements of these three models, but at least a cursory review is necessary to understand where it is we are heading, in terms of sustainability. The dominant model in health care in the Western world is the technocratic or bio-medical model. As mentioned earlier, we inherited this model from Cartesian/ Newtonian physics and it is the foundation of modern scientific medicine. Some of the underlying principles are these:

1) it views the body as a machine;

2) disease is the consequence of the breakdown of the machine;

3) the physician is the master medical mechanic who cures disease and repairs dysfunction;

4) there is a reliance on external diagnosis;

5) the physician relies heavily on technology to diagnose and treat patients;

6) aggressive interventionist approach to treatment and diagnosis;

7) isolation and objectification of the patient;

8) alienation of practitioner from patient, the physician and the patient are separate and distinct entities;

9) authority and responsibility is inherent in the practitioner, not the patient;

10) hierarchical organizational structure of "one up, one down".

It is a linear system, the style of thinking is left brain unimodal, and the underlying principle is separation (Davis-Floyd, 1995, Capra, 1982).

The humanistic or bio-psycho-social model uses the existing bio-medical model but makes it more palatable and compassionate. This model is based on many of the tenets of the bio-medical model listed above but expands to include these underlying principles:

1) the individual is valued as unique and worthy;

2) the person is viewed as an organism, not a machine;

3) the whole person should always be considered;

4) the needs of the individual and the needs of the institution should be balanced;

5) information and decision making are shared between practitioner and patient;

6) empathetic communication is essential to healing;

7) there is a relationship that is necessary for healing, a partnership between the client/patient and the practitioner;

8) there is humanization in the midst of highly developed technology.

It is a circular system, the style of thinking can be both left and right-brained, and the underlying principle is relational (Davis-Floyd, 1995).

The holistic model is on the other end of the spectrum from the technocratic model. It espouses that the body is not a machine, it is an organism, and what's more, it is an energy system linked with other energy systems. This model insists that true healing requires attention to the body, mind, spirit, emotions, and environment, including the family, the community, and the world. Characteristics of the holistic model include the following:

1) a lateral web organizational structure rather than a hierarchical, one up, one down structure;

2) it utilizes networking in its communication and organizational structure;

3) authority and responsibility are inherent in the individual, not the practitioner;

4) the individual and the practitioner are engaged in a healing dynamic together, a unity;

5) it is understood that no one practitioner can attend to all of the needs of a patient/client;

6) the client/patient is at the center;

7) the body is defined as an energy system;

8) the individual is perceived to swim in a sea of other energy systems;

9) there is a focus on creating and maintaining well-being not just a disease-free status.

It is a fluid system, the style of thinking is right brain, multi-modal thinking, and the underlying principles are connection and integration (Davis-Floyd, 1995).

Thus, when the body is defined as an energy system then suddenly all kinds of healing are possible. The holistic model justifies many kinds of approaches to healing that would not be considered as valid under the technocratic model. For example acupuncture, which relies on energy meridians within the body, is now acceptable within this model; so are concepts such as intuitive diagnosis, laying-on of hands, healing via prayer, shamanism, psychic healing, water births, and "green burial". In addition, there is a reliance on collaboration, networking, and a web of connection between the healer and the healed, and indeed, there exists a potential for each person involved in the dynamic exchange to progress in their own healing process. Davis-Floyd gives three metaphors to define the three models of healthcare: the technocratic model is represented by a straight line; the humanistic model is represent by a circle; and the holistic model is represented by a spiral which encompasses both the straight line and the circle and is the symbol of the ever-changing, ever-merging character of nature. In the holistic model the physician is not the focus of healing, as in the technocratic bio-medical model, but the client/ patient is at the center, with a web weaving back and forth between ecologists, spiritual guides, health care practitioners, family, community, and the world. All aspects of the person's life feed into her/ his wellness story. In the holistic model there is a focus on creating and maintaining well being (not just health); a nurturant relational approach to diagnosis and treatment; and a unity of practitioner and client.

Each stage encompasses the one before it and goes beyond its boundaries. Therefore, stage three (holistic) embraces elements of stage one (bio-medical) and two (bio-psycho-social) and is larger and more encompassing, and also leaves room for expansion and creation of new ideas and practices, which is a major feature of a sustainable model.

Whereas the bio-medical model is most adaptive in times of crises because of its clearly defined principles and procedures, the holistic model is thought to be most adaptive in times of rapid changes and new input and it is thought to have the greatest potential for sustain-ability. However, in terms of sustainability, it becomes necessary to sort out which of our old world views are working and where we need to evolve new world views. It is also important to acknowledge that both perspectives are only models, developed from our cultural world view, from a personal and collective decision about what reality looks like. Through thousands of synaptic neuron connections in our brains, we have the potential for processing information in hundreds of different ways. And information gets highlighted in our brains in accordance to our culture, our up-bringing, and the stories about reality which we embrace. To make new pathways takes a lot of energy within our existing cognitive structure, but many people feel that their effort will be worth the new creation.

One of the built-in ingredients for sustainability is that it is future-oriented. Models of healthcare that are sustainable require new ways of thinking, new ways of meeting peoples' basic needs, new means of being interdependent, ways to incorporate visions and behaviors that are cooperative and collaborative, and the means for providing satisfying and compassionate care. In a previous Synapse article Crowfoot (1998) reviews several books on sustainability and states some of the following concepts from his reviews: "Sustainability…represents a new way of thinking about matters that places equal value on environmental, economic, and social issues….Changing our ways of thinking invariably affects the way we make our decisions and the outcomes of these decisions" (p. 16). When contemplating the health care models that will sustain our community well into the 21st century, let us keep focused on these ideas, and indeed, let us have fun with our visions and our creations. Although this leap into uncharted territory may seem frightening, the crisis in our health care system carries within it the seed for unimaginable growth and opportunity and the creation of new and exciting models of health care and wellness consciousness, for ourselves, other species, Mother Earth, and beyond our known universe.

After a time of decay comes the turning point. The powerful light that has been banished returns. There is movement, but it is not brought about by force….The movement is natural, arising spontaneously. For this reason the transformation of the old becomes easy. The old is discarded and the new is introduced. Both measures accord with time: therefore no harm results. &emdash;I Ching

References:

Capra, Fritjof, (1982). The Turning Point, New York, NY: Bantam Books.

Crowfoot, Jim, (1998). "Resources for Sustainable Local Communities&emdash;Part Three", Synapse, Issue 43.

Davis-Floyd, Robbie, (1995). Midwifery in the Post-Modern World. Austin, TX: Midwives Alliance of North America Conference.

Kath-Rothman, Barbara, (1991). In Labor. New York, NY: W.W. Norton & Company.

Geradine Simkins, CNM, MSN, twenty-two years of experience in our community offering complete maternity services for homebirth and well-woman care.

Return to the Index of Synapse 44, Summer 1998