The problem of holism - Letters to the Editor - Letter to the Editor

John Ruscio's disdain for holistic approaches ("The Emptiness of Holism," March/April 2002) is so clear that I doubt his capacity for the very objectivity he claims that the condemned approaches lack. Who but someone who wishes only to deride would allow his treatise to expand from a quote by a fictional character. Are we to assume that John Updike is a scientific authority disguised as a novelist? If not, were there not other more learned commentators to support his premise?

In that same paragraph Ruscio illustrates his lack of objectivity by using a captious argument that allows only for the polar choices in a false dichotomy: if one would choose to treat a broken leg with a cast, one must (if one follows Ruscio's logic) reject "holistic" treatment options such as magnets, acupuncture, or nutritional supplements. Treating a fracture with a cast does not in itself induce optimal healing, whereas nutritional supplements that help the body recover from the trauma of the injury may facilitate healing. The rational practitioner would potentially choose both of Ruscio's options: treating the leg to restore function and the person to promote health.

Ruscio is so intent on the absolute condemnation of holistic approaches that he deteriorates into sophistry. Rather than attack the approaches for which some evidence base exists, he chooses astrology--an approach that all but the most lightheaded of practitioners would disdain....

I agree with Ruscio that clinical methodologies must be evidence based. Evidence, however, is accumulated over years of practice. Ruscio's point of view is so prejudicial that it seems to preclude further inquiry. For him the jury is in. He wishes it to be so for us as well....

My greatest concern arises from years of experience with psychological practitioners who, like Ruscio, insist that the patient or client is nothing more than a constellation of features that can be understood with statistical methodologies and profiles. Treatment then consists of interventions applied because "science" says they should work. When these interventions are unsuccessful, the blame is often assigned to the patient or client through the label "non-compliant." While it is convenient and messy for the "scientific" practitioner to view each human being as unique, those with whom I have interacted over the years have expressed great appreciation for my willingness to view them thus.

Far from representing modern shamanism, holistic approaches simply attempt to compensate for the fact that, despite their scientific basis, current "scientific" methodologies are not always successful, and, even when clinically effective, sometimes leave the patient with pain, suffering, or lifelong disability. Do holistic methodologies need rigorous testing and study? Yes. Should those that are wholly ineffective be exposed? Yes. Is Ruscio in danger of pitching our the baby with the bathwater? Yes.

If you will allow me the license afforded Ruscio, Shakespeare's Hamlet said it best "There are more things in heaven and earth ... than dreamt of in our philosophy." Or our science.

Norman M. Council

Associate Director

Behavioral Counseling Sciences

MCP/Hahnemann University

Philadelphia, Pennsylvania

John Ruscio loses me with several of the examples in his critique of holism. When a patient presents with a broken leg, the right solution may or may not be "a cast and some crutches." Yes, the "broader problem" should be considered: Is the patient an infant? Then cue models of possible abuse. Is the patient elderly? Or a professional athlete perhaps, with a career riding on nuances of treatment? The variables and statistics for each context are quite different, and for many areas definitive research doesn't exist.

Regarding his next example, I do prefer treatment of "the whole car." Adding oil when the oil light comes on may or may not be the right solution. Are the seals defective? Is the car still under warranty? Does the owner ever add oil? Does the owner know to shut the car off immediately after the light appears? The broader problem indeed requires a type of clinician with a feel for a spectrum of probabilities and unknowns, the assessment of which requires at least a modicum of induction. I don't mind calling "holistic" an approach that tries to surround a problem in these ways, with as much rigor and wit as is available. There seem to be many types of holism. Some are indefensible, as the astrological materials he cites, but Ruscio wrongly lumps all types of holism together. I want the right kind of holistic doctor, and auto mechanic. I realize this is a difficult and quack-prone search, but all this article offers are statisticians.

Charles J. Palus

Research Scientist

Center for Creative Leadership

palusc@leaders.ccl.org

John Ruscio says "undoubtedly" the smartest course of action" in the case of a car with a low oil warning light is to add oil. "By contrast, holism is empty rhetoric." However, I would prefer a more holistic approach; examine the whole engine and find where the oil is leaking out.