PEER GYNT'S ONION by ANTHONY CAMPBELL Posted to Wiretap 10/13/94. (C) Copyright 1994 Antho

Go to Human Rights activist Keith Henson

Skeptic Tank!

PEER GYNT'S ONION by ANTHONY CAMPBELL Posted to Wiretap 10/13/94. (C) Copyright 1994 Anthony Campbell This text is COPYRIGHTED, but freely distributable. COPYRIGHT NOTICE This book is copyright. I am distributing it electronically as an experiment. Permission is granted to make and distribute verbatim copies of this book provided the copyright notice and this permission notice are preserved on all copies. Comments, questions etc. should be sent to the author at acampbell@achc.demon.co.uk. Anthony Campbell Consultant Physician, Royal London Homoeopathic Hospital, London, UK. --------------------------------------------------------------------- PEER GYNT'S ONION An Alternative Alternative Medicine Book Anthony Campbell [Peer Gynt addresses the onion] I'm going to peel you now, my good Peer! You won't escape either by begging or howling. [Takes an onion and pulls off layer after layer.] ... What an enormous number of sheaths! Isn't the kernel soon coming to light? I'm blessed if it is! To the innermost centre, It's nothing but sheaths - each smaller and smaller - Nature is witty! [Henrik Ibsen, PEER GYNT, Act V, Sc.5] (C) Anthony Campbell 1992, 1994 For Marie-Christine CONTENTS ________________ INTRODUCTION 1. THE CHANGING FACE OF MEDICINE 2. WHAT IS ALTERNATIVE MEDICINE? 3. COMPLEMENTARY OR ALTERNATIVE? 4. IDENTIFYING FEATURES 5. ALTERNATIVE CAUSES OF DISEASE 6. IS IT SAFE AND DOES IT WORK? 7. PLACEBOS AND PSYCHOTHERAPY 8. THE NEW AGE 9. TRYING TO MAKE SENSE OF IT ALL INTRODUCTION Like Peer Gynt's onion, alternative medicine has many layers: practical, sociological, philosophical, even mystical. In this book I have sought to peel my own version of it, discovering in the process a variety of opinions both in others and in myself. And if in the end I find, like Peer, no centre to my onion, no one fixed viewpoint I can confidently label as right to the exclusion of all the rest, perhaps that is no bad thing; the world seems over-supplied just now with people convinced of their own rightness. I have been practising a combination of unorthodox and orthodox medicine for nearly twenty years, and this seemed a good time to put down the conclusions I have arrived at up to now, although without claiming that they are final (the only final conclusions should be those we hold when we die). Their merit, such as it is, comes from the fact that I am not a journalist or other armchair critic but a labourer at the coal face. (Not that I have anything against journalists; indeed, I was a medical journalist myself for a number of years.) Patients quite often ask me how an orthodoxly trained doctor like me came to practise homoeopathy and acupuncture. I think they often expect to hear about a 'road to Damascus' conversion experience, but really it wasn't at all like that. It happened more or less by chance, as these things so often do. As a medical student in the late 1950s I learnt nothing whatever about any form of alternative medicine. I can only remember homoeopathy, for example, being mentioned on one occasion, and I assumed, without thinking about it very much, that homoeopathy had probably ceased to exist as a medical system in the nineteenth century. As for acupuncture, I knew, of course, that it was still practised in China, and at some time in the 1960s I happened to read a letter in the British Medical Journal from a doctor who described with amusement his experience of being treated with acupuncture for a sprained ankle in France. This was pretty much the total of my knowledge of alternative medicine until the 1970s. At that time I was working for a journal called ABSTRACTS OF WORLD MEDICINE, which was published by the British Medical Association. Sometimes as I walked about the streets in the neighbourhood of BMA House I would chance to pass by a building that bore the legend "Royal London Homoeopathic Hospital". I used to wonder about this a little; I supposed that the name was probably a quaint survival from the nineteenth century, but it seemed unlikely that homoeopathy was still practised there today. I found out my error thanks to some friends who were ardent homoeopathic patients. They told me that homoeopathy, far from being extinct, was still alive and flourishing and was practised by doctors as well as by people without a formal medical training; the homoeopathic hospital I had noticed was in fact the foremost institution for the study and practice of medical homoeopathy in Britain and perhaps the world. By this time I had for various reasons (including the demise of the journal for which I worked) left medical journalism and returned to clinical medicine. I had just obtained the membership of the Royal College of Physicians, which is the essential higher qualification needed by anyone who wants to become a consultant in medicine in the National Health Service, and I was looking for a new career direction. Owing in part, perhaps, to a certain contrariness of character, I was also interested in exploring unorthodox medicine. What attracted me most was acupuncture, but I did not know of any way to take this interest further, while homoeopathy was evidently a practical possibility. I therefore made enquiries at the hospital. As it happened, British homoeopathy was in crisis at that time. A short while previously a British Airways Trident had crashed just after taking off from Heathrow, killing all aboard. Among the passengers were several of the most prominent homoeopathic doctors of the day, who had been on their way to an international congress in Belgium. There was accordingly an urgent need to find new recruits for homoeopathy in Britain and to secure the future staffing of the Royal London Homoeopathic Hospital, and I was one of the doctors who eventually filled this gap. The Hospital is within the National Health Service, and sees a large number of patients annually (over 20,000 consultations in a year). It offers not only homoeopathy and orthodox medicine (all the doctors who work there are qualifed in both areas) but also a range of other complementary therapies, including acupuncture, osteopathy, and autogenic training. Some patients are admitted for more intensive treatment or for investigation, but the majority are outpatients. Most have long-term disease; we see few acute problems, partly owing to the length of our waiting lists. In the time that I have been at the hospital public attitudes, and doctors' attitudes, have changed considerably. I have noticed this in connection with the acupuncture courses for doctors which I hold. Ten years or so ago I had to spend a certain amount of time on courses answering questions from doctors who were sceptical. Nowadays this very seldom happens; they nearly all assume unquestioningly that acupuncture works and simply want to get on with learning it. As might be expected, however, the enormous outpouring of popular interest in alternative medicine has not gone unchallenged. There has been a reaction. Books and articles criticizing various aspects of alternative medicine have begun to appear, and the British Medical Association carried out an investigation whose findings were largely unfavourable to unorthodox treatments. However, the mistake of the 'anti' lobby is usually to pick off the easy, obvious targets without really going into the subject in any depth. Of course there is a large element of nonsense in alternative medicine, and it is tempting, and sometimes legitimate, to make fun of it. But some of the treatment that is included under the rubric 'alternative' does actually work, and has been shown to do so in proper scientific studies, so it is wrong to dismiss the whole lot as mumbo-jumbo. Reading some of these books, I seem to hear the despairing gurgles of some quite presentable babies as they disappear down the plug hole. Moreover, the critics of alternative medicine usually fail to see that, even if a lot of what they attack so vehemently is foolish and misguided, there must be a reason why it has become so popular. There must be something wrong with orthodox medicine, there must be a need that it is not responding to. It can be difficult and uncomfortable for people trained in Western mainstream medicine to come to terms with unorthodox practices. I have noticed, for example, that many of the doctors who come on my acupuncture courses seem quite happy to use the technique for treating painful disorders of muscles and joints, but relatively few go on to apply it to the treatment of other things like allergies, gynaecological problems, or colitis, to mention just a few which often respond well. Yet treating these disorders is no more difficult than treating muscles and joints; in fact, in some ways it is easier. What prevents them is probably a psychological block; they can just about imagine that acupuncture might work for a painful back, but they cannot see any reason why it should work for, say, ulcerative colitis. For that matter, nor can I; but it certainly appears to. At the other extreme a few doctors switch allegiance almost completely after they qualify and become, in effect, alternative practitioners, using almost no conventional treatment at all. However, these are very much the exception, and the vast majority continue to use the two approaches together. In so doing they attract the scorn of many non- medical therapists, who regard them as dabblers. However, I am quite unrepentant about mixing methods in this way. I am thoroughly convinced of the value of sustaining creative tensions within oneself. It is no doubt more comfortable to be a whole-hearted believer or a whole-hearted disbeliever in anything, but either of these attitudes tends to cut one off from many possibilities. I am reluctant to do this; I like to keep my options open. This book should be seen as an exploration of the (I hope creative) tension that results from trying to keep both the orthodox and the alternative perspectives in view simultaneously. 1: THE CHANGING FACE OF MEDICINE To begin with, a thought experiment, which will help you to define your own attitude to the ideas I want to examine in this book. Suppose that an old friend whom you have not seen for several years telephones you unexpectedly and says she would like to talk to you. When you meet, she tells you that she is seriously ill and has not long to live. She has no close relatives, so she wants to leave her considerable fortune to a medical charity of some kind. She has two ideas, and finds it difficult to choose between them. The first idea is to leave the money to buy a scanner for her local hospital, where she has been well treated. She knows that there is a need for such a machine in the district, and it would undoubtedly benefit many patients. The other idea is more unorthodox. She has received a lot of help from a practitioner of alternative medicine, who is keen to set up an institute for the study and practice of various kinds of therapy. This person has plenty of enthusiasm and many plans and your friend is convinced of the value of what he is trying to do. Although your friend is well off, her legacy would not be enough to fund both of these projects fully. She wants your advice about what she should do. How do you advise her? 1. She should leave all her money to fund the scanner. 2. She should leave it all to fund the institute for alternative medicine. 3. She should divide it between them in the hope that the balance will be made up from elsewhere. If so, what proportion would you suggest she ought to leave to each? (Give your reasons.) It is a fairly safe prediction that this imaginary situation has at least made you pause for a moment to wonder about your attitude to alternative medicine. Fifteen or twenty years ago, unless you happened to belong to the then tiny band of stalwart supporters of homoeopathy and other unconventional forms of therapy, you probably would not have hesitated for a moment in dismissing it all as quackery. As we know, things are very different today. Recently I was in the Casualty Department of my local general hospital. The notice board contained advertisements for local services of various kinds; nothing very remarkable in that, except that included among them were a group of local osteopaths and a hypnotherapist. Only a very short time ago such a thing would have been inconceivable. Indeed, it is not very long since an orthodox doctor would have been liable to erasure from the Register if he 'associated' with an alternative practitioner. Things are certainly changing fast. Nowadays we hear more and more about osteopathy, homoeopathy, acupuncture and other kinds of unconventional treatment. Once they were a minority interest, pursued by just a few cranks. Now they are constantly in the news, on television, in articles in popular magazines. But there is a correspondingly large amount of confusion in the minds of both patients and doctors. What are these things? Do some of them work? All of them? None of them? Is it all a media hype? And it is difficult to find definite answers to questions such as these. There are so many different alternative treatments available, and the number seems to grow all the time. It is not even clear what we should call the phenomenon. Once it was 'fringe medicine', then 'alternative medicine', and now often 'complementary medicine'. (The progressive change reflects the increasing respectability of the thing in question.) Nor can one easily define alternative medicine. At one time it would have been safe to say that it was any kind of treatment that is not taught to medical students or practised in National Health Service Hospitals, but that definition is no longer valid; many hospitals now use acupuncture, and other forms of alternative treatment, such as osteopathy or reflexology, can be found in some. So far no form of alternative medicine is officially part of an orthodox medical course in this country, but a number of medical schools have included occasional lectures on homoeopathy or acupuncture, and a University Chair of alternative medicine is now about to be established. At a postgraduate level these subjects are already well accepted; many doctors have attended courses in them. So why are these forms of 'rejected knowledge' suddenly so acceptable? An important part of their appeal must surely be that they provide answers to questions that orthodox medicine fails to address or answers unsatisfactorily. Sometimes these questions and answers are quite down-to-earth and practical (What can I do to relieve my migraine? Take feverfew), but sometimes they are psychological or spiritual (Why have I got cancer? Because you failed to resolve your deepest psychological and emotional problems). Philosophical ideas are seldom far from the surface in alternative medicine. Partly, too, it is simply a question of time and attention. When patients visit their family doctor they usually expect a prescription, certainly, but they also want (but probably seldom really expect) something less tangible: to be listened to, to be given sympathy and reassurance, and especially to be allowed time to talk about themselves. This tends not to happen in consultations under the National Health Service, simply because there are too many patients. But in any case doctors are not always well equipped to provide this kind of service. Their education does not necessarily prepare them to cope with the social and emotional problems they encounter, especially in general practice. A modern medical training is largely concerned with the diagnosis and treatment of identifiable physical disease, and even the psychiatry that a medical student learns is likely to be based on physical models. Orthodox medicine has fallen into difficulties that in large part have been created by its own successes. The roots of this lie in the late nineteenth century, when medical scientists such as Pasteur, Koch, and Virchow were making discoveries that, for the first time, gave doctors an insight into the way the body works and what happens to it in disease. This was a most exciting time for young medical men, as we can see in George Eliot's portrait of Lydgate in Middlemarch. And the excitement continued into the twentieth century, with the discovery of insulin and other hormones, vitamins, and the sulphonamides and penicillin. Later, effective treatment was introduced for tuberculosis, and vaccination against poliomyelitis more or less eliminated this disease from the rich countries. Smallpox was finally eliminated world-wide, the first (and so far the only) time that a major infective disease has succumbed to the advance of science. In Britain, the setting up of the National Health Service made all these medical advances freely available to the whole population. Aneurin Bevan, who introduced the scheme, apparently believed that it would eventually result in many fewer people going to their doctor. Possibly this thought was suggested to him by his Socialist ideals; it sounds a little like the withering away of the State which was supposed to occur in Communism, and it proved as delusive. Instead of diminishing, the numbers of patients coming for treatment increased steadily, as people came to think of health as their right. Gradually, however, medical optimism began to receive set-backs. Perhaps the first major disappointment was the discovery that cortisone, which at first had been greeted enthusiastically as the scientific answer to arthritis, proved to have serious unwanted effects. Since then the same story, with variations, has been repeated again and again, most notably in the thalidomide disaster in 1962. A certain degree of naive optimism about medicine does still exist, especially in the popular press, which continues to trumpet the arrival of new miracle cures for various ailments, as it has done for many years; and we feel aggrieved if we learn from our doctor that there is still no effective treatment for many people suffering from quite common diseases - asthma, for example, or migraine. A lot of these patients can be helped to a greater or lesser extent, of course, but they cannot be cured, and a sizable minority still cannot be helped at all. Along with our expectations of modern medicine, however, many of us have also grown suspicious of it. There have been too many cases in which people have been harmed or even killed by treatment, and some of us therefore reject scientific medicine - 'drugs' - partially or even wholly. There is a paradox here - modern medicine is perceived as both good and bad - and there is another paradox in the way we think about doctors. The old paternalistic image of the doctor as a benign bespectacled figure in a white coat dispensing wisdom as well as medicines still persists in many people's subconscious, but it is beginning to coexist uneasily with another image, that of the coldly dispassionate scientist, who is more interested in research or diagnosis than in actually treating patients. Nevertheless, surveys continue to show that people rate doctors very highly in terms of trustworthiness. And the persistence of the avuncular image leads us to bring to the doctor many problems that in other times might have seemed more appropriate for a clergyman to deal with - unhappiness, loneliness, guilt. Many people become deeply emotionally dependent on doctors because, in a secular age, they have no one else to turn to. Doctor-dependency is quite a new phenomenon, and so is the degree of respect commonly accorded to doctors and medicine today. In former times doctors were often considered as little better than tradesmen. (Within living memory physicians were excluded from the Turf Club at York because they sent in bills.) As for surgeons, their original associations were, we remember, not with the consulting room or the operating theatre but with the barber's shop. Nous avons chang‚ tout cela. But doctors today find it difficult to live up to their reputation; most of them know they do not have all the answers, and, increasingly, so do their patients. A large part of the appeal of alternative medicine stems from patients' rejection of the god that has failed them. "Much of today's revolt against orthodox medicine is not so much kicking the habit completely as seeking an alternative guru, a drug that is more satisfying... Faced with life's problems, more and more people become doctor-dependent or medicine-dependent." (Roy Porter, Senior Lecturer in the History of Medicine at the Wellcome Institute, writing in The Listener in 1985). But there is an additional reason for the rejection of orthodox medicine by many people today. This has to do with the popular image of the doctor as a scientist - a picture of themselves which many doctors share. Modern medicine, in keeping with the rest of our lives, becomes ever more dominated by technology. This makes it more expensive, but also widens the range of problems it can tackle. In one way this is perceived as good, but it can also appear soulless and impersonal. And it is easy to understand this idea. There is undoubtedly something intimidating - terrifying to some people - about a large modern hospital; it is not hard to imagine oneself being swallowed up in it for ever more, like a Kafka protagonist (hero does not seem quite the word here), or like Russell Hoban's Kleinzeit. (Not that there is much new about this. The hospitals of former times were also perceived as frightening, though for different reasons; admission to hospital was often regarded as little better than a death sentence, which in view of the lack of sterility, anaesthetics, and effective treatment of almost any kind it often was.) Why is this image of the doctor as scientist so off- putting for many of us? Partly because we fear - with some justification - that care for the individual patient may sometimes conflict with the demands of research, and it may not always be the interests of the patient that come out ahead. But it goes deeper than that. When I was a boy in the 1940s I had a series of books called the Wonder Books. There was, I remember, The Wonder Book of Why and What, The Wonder Book of How and Why, and various others whose titles I have forgotten. The general theme (still based on pre-war euphoria) was the conquest of the natural world by human science and technology. If I had those books today they would seem impossibly dated, and not only because the information they contained has long been superseded by later discoveries. An even more significant change has been the abandonment of our triumphalist convictions about the very notion of 'conquering nature'. Our self-praise is more muted than it used to be; we are a good deal less sure of ourselves. At the same time as we have begun seriously to question the attitude to nature that almost everyone took for granted in my youth (along with a pride in, and conviction of, the durability of the British Empire), there has been a subtle but important shift in the kind of thought and sensibility that many of us value. One way of representing this shift is to construct a table containing opposed pairs of ideas, which could conveniently be labelled 'head' and 'heart'. If you prefer a more up-to-date way of saying the same thing, they could also be called left-hemisphere and right-hemisphere thinking. HEAD HEART left brain right brain reductionism holism tough-minded tender-minded rational intuitive scientific artistic materialistic spiritual mechanism vitalism astronomy astrology chemistry alchemy artificial natural yang yin male female complementary alternative The psychologist and philosopher William James identified a quite similar polarity when he divided people up into two groups, which he called tough-minded and tender-minded. TOUGH-MINDED TENDER-MINDED empiricist rationalistic sensationalistic intellectualistic materialistic idealistic pessimistic optimistic irreligious religious fatalistic free-willist pluralistic monistic sceptical dogmatic For the last several hundred years, Western thought has been dominated by left-column attitudes, but now there seems to be a movement towards the right column, at least at a popular level. For many people - certainly for nearly all who are involved in alternative medicine - the left-hand column represents BAD and the right-hand column GOOD. I have arranged the columns in this way because the right side of the brain, which controls mainly the left side of the body, is supposed to be artistic, creative, and so on, therefore 'good', while the left side of the brain, controlling mainly the right side of the body, is analytical and language-dominated, and therefore, if not actually 'bad', at least not entirely approved of. (It would be possible to tease this distinction out further. For example, left-handedness, because of its association - sometimes - with a dominant right hemisphere, has a certain aura of virtue and value in alternative circles. Again, there are political overtones in the idea of the right hemisphere as somehow occupying the place of a repressed, non-vocal, minority vis … vis the dominant left hemisphere.) You may have noticed something odd about the first table. I have listed 'alternative' and 'complementary' as polar opposites, yet a little earlier I used these terms more or less interchangeably. In fact, the difference between them is, in a way, what this book is about. 'Complementary' implies a fairly amicable relationship between orthodox and unorthodox medicine. The recently founded Research Council for Complementary Medicine includes both orthodox and unorthodox practitioners among its trustees. 'Alternative', on the other hand, implies a rejection of the conventional approach and the substitution of something different. For the most part, my focus in this book is on the philosophical and emotional rejection of conventional medicine, which is why I have generally used the term 'alternative'. I realize that many people practising various forms of unconventional medicine would claim that their methods are complementary, not alternative, and that they have no hostility to orthodox medicine. I fully accept this, and in so far as anyone does maintain this position, what I say about alternative medicine may not be applicable to him or her. However, there are undoubtedly many others who are hostile to conventional medicine at least to some degree, and it is their attitude that I have in mind in much of what follows. Believers in alternative medicine tend to act in one of two ways. Either they try to build bridges between the orthodox and the unconventional methods as much as they can, or they think of them as mutually antagonistic and not only do not build bridges but often devote a good deal of energy to trying to blow up those that may already exist. When one listens to some of the more radical advocates of alternative medicine one often gets the feeling that they are saying medicine is too important to be left to the doctors. And doctors who use alternative medicine themselves often seem to be regarded as the worst of the lot; it is as if they have committed a kind of trahison des clercs in reverse. Hahnemann spoke contemptuously of 'half-homoeopaths', meaning doctors who used orthodox medicine together with homoeopathy; nearly 200 years later this practice attracts the same scorn from the ultra- committed. Inglis and West, for example, are dismissive of most doctors who claim to practise alternative medicine: 'Medical qualifications do not in themselves make anybody a better therapist than somebody who has not done the standard medical training. Rather the reverse, in fact, as the standard training is only too likely to condition medical students into accepting ideas and attitudes inimical to the practice of natural medicine' [295] It is clear what they have in mind; in terms of the table on p.000, the standard medical training is supposed to condition you to think in the left-hand column (assuming, that is, that you were not initially selected for medical school precisely because you thought like that, which you probably were). What comments like that of Inglis and West tell us is that there are important differences between the underlying assumptions of nearly all non-medical alternative practitioners on the one hand and most, though certainly not all, medically qualified ones on the other. (But I must emphasize once more that I am, inevitably, generalizing, and exceptions on both sides can always be found.) A remarkably clear statement of the alternative position appeared quite recently in The Homoeopath [1990, 10, 110 - 113]. Its author, Dr Denis MacEoin, is an academic who is not professionally involved in homoeopathy; however, he feels strongly on the subject, as he indicated in his response to a talk given by a senior homoeopathic doctor at a seminar on the relations between medical and non-medical homoeopaths. Most of the audience, one gathers, approved of the sentiments expressed; not so Dr MacEoin. He is entirely hostile to any attempt to integrate the two brands of homoeopathy. Orthodox doctors, and this often includes those with a smattering of homoeopathic training, are not competent to lay down the parameters for the management of a homoeopathic case. It is axiomatic that homoeopathy represents, in the broadest sense, a philosophical and clinical contradiction of allopathy and a system of medicine in its own right. MacEoin correctly identifies the dilemma that has always faced homoeopathy. Either it tries to go it alone, and risks isolation, or it tries to integrate itself with orthodox medicine, in which case it risks being taken over. MacEoin has no doubt that independence is the right course, and he believes that this will eventually lead to a situation in which homoeopathy will become 'a distinctive, broadly-based medical system capable in the fullness of time of usurping the current role of allopathy...'. There must, he insists, be no compromise on essentials: 'to seek for anything less than freedom to pursue the goal of raising homoeopathy to the status of a primary system of medical treatment to which surgery and drug treatment will be complementary would be to betray the vision of generations of homoeopaths and the hopes of thousands of patients like myself.' There is evidently an almost unbridgeable gulf between alternative views of this kind and the more moderate 'complementary' version of unorthodox medicine. I shall look at this in more detail in Chapter 3. First, however, we need to try to establish what it is we are talking about. 2: WHAT IS ALTERNATIVE MEDICINE? About the only way one can define alternative medicine is negatively, by saying that it is all those forms of treatment that are not taught in conventional medical schools. It would be impossible to list all the different kinds of alternative medicine, partly because new ones keep appearing, and partly because in some cases it is a matter of opinion whether or not a particular method is 'medical' at all. Homoeopathy and osteopathy, for example, obviously do qualify as therapies, but what about yoga, 'sacred Native American exercises', and 'techniques for releasing Karmic patterns that may be inhibiting your growth and well-being', all of which were on offer at a recent exhibition of alternative medicine and complementary therapies in London? It is hard to classify these as treatments, but they are certainly intended to be methods of improving your physical and mental well-being. But methods of treatment as such were on offer at the exhibition too, of course. They included reflexology, therapeutic massage, kinesiology, Feldenkrais, the Alexander technique, Touch for Health, biofeedback. Aroma therapy, shiatsu, and polarity therapy, as well as other methods, some of which I had not heard of previously. Prevention was not forgotten either: there were lectures about the technological dangers that surround us. 'An academic teacher and scientist' looked at 'how computers, microwave ovens, electronic watches, and geopathic stress can make you ill and what you can do about them,' and another lecturer gave a timely warning about 'how the misuse of Kundalini energy can cause mental, physical, and emotional problems.' There was a good range of alternative treatments on offer at this exhibition, but even so only a fairly small proportion of those that exist were represented. A survey carried out in New Zealand found that among 270 people advertising some kind of alternative medicine a total of 94 distinct therapies were mentioned and 81 practitioner qualifications were listed. We need some kind of scheme to make sense of this plethora of treatments, to fit them into categories of some kind. But it is not easy. In their book THE ALTERNATIVE HEALTH GUIDE, Brian Inglis and Ruth West use four main groups, with subdivisions. Their main groups are Physical Therapies, Psychological Therapies, Paranormal Therapies, and Paranormal Diagnosis. But, as they point out, the boundaries between the various therapies are tending to break down, which makes categorization difficult. Even so, their scheme contains some curious illogicalities: it is not obvious, for instance, why Iridology, which purports to be a scientific method of diagnosing disease, should be classed as paranormal, or why art therapy and music therapy should be included as Physical Therapies instead of as Psychological Therapies. My task, fortunately, is easier than theirs, since I am not trying to survey the whole field of alternative medicine but only to pick out certain items to look at in more detail. For my purpose it will be sufficient to use the following scheme. A. Medical therapies: that is, therapies which use pharmacopoeias of some kind (herbalism, homoeopathy). Anti-allergy treatments such as dietary manipulation and clinical ecology (Chapter 5) form a sub-group. B. Physical therapies: osteopathy, chiropractic, acupuncture; also polarity therapy, metamorphic technique, and Rolfing, which have additional psychotherapeutic aspects. C. Psychological therapies: psychotherapy, hypnotherapy, biofeedback, the humanistic psychotherapies, autogenic training, meditation, Silva Mind Control, psychosynthesis. D. Miscellaneous, including so-called paranormal therapies (spiritual healing, radionics and radiaesthesia, 'psychic surgery'.) I include this category for the sake of completeness, but I don't want to say very much about it. E. Diagnostic methods (Kirlian photography, Iridology, astrological medicine). Many of the categories overlap to some extent. Although I have included psychological therapies as one of the categories in its own right, there is an element of psychology in all the treatments, as of course there is in orthodox medicine too; but in some of them it is much more prominent than in others. On the other hand, there are some therapies that are mainly intended to produce psychological effects but which use physical methods such as massage and posture to do so. There is another way of classifying alternative treatments which is more contentious. This is to divide them into those that are semi-respectable from the point of view of orthodox medicine and those that are not. Obviously this cannot be a rigid distinction, if only because the tolerance of individual doctors for the unorthodox varies from doctor to doctor. However, it is fair to say that homoeopathy, acupuncture, manipulative medicine (a deliberately vague term to include both osteopathy and chiropractic), and hypnotherapy are semi-respectable, in the sense that there are appreciable numbers of orthodox doctors who have studied these methods and use them at least part of the time, whereas the remainder of the therapies are used hardly at all by doctors, although even here there are a few exceptions (some doctors, for example, use radionics and radiaesthesia). A third classification has been used by some people. This has three main categories: (1) well-established treatments (acupuncture, osteopathy, homoeopathy, naturopathy, herbal medicine, hypnotherapy); (2) 'core' treatments, used by a wide range of alternative 'specialists' as an adjunct to their own methods (advice, diet, vitamins, relaxation, stress management, massage, exercise); (3) fringe treatments and diagnostic methods (colour therapy, music therapy, radionics, aromatic oils, gem therapy, biofeedback, iridology, Kirlian aura diagnosis, hair analysis). Although the vast majority of alternative practitioners lack conventional medical qualifications, some alternative techniques are used by doctors. In Britain there are very few legal restrictions on the techniques that a doctor can use, even within the National Health Service. Provided the doctor is either a principle in general practice or a consultant, he is remarkably free to do what he thinks best for his patient. If he wants to attend a course in homoeopathy or acupuncture, for example, he can do so, even if it is given by people without orthodox medical qualifications, and he can use the techniques he learns to treat his patients, provided they agree. Under the new provisions of the National Health Service general practitioners can employ alternative practitioners to work under their supervision in their practices. Non-medical practice is also very free in Britain. A few diseases, such as venereal infections, may only be treated by doctors, but otherwise anybody may call himself or herself a therapist of any kind, with or without having received any kind of training. The situation is different in many other countries, where often it is only doctors who are allowed to treat patients. One tends to think that interest in alternative therapy on the part of doctors is quite new. But this is due to our historical parochialism. The Scottish surgeon James Braid used hypnosis in the 1840s to relieve pain during surgery. He coined the term hypnosis to dissociate the phenomenon from Mesmerism and he tried to get the method generally accepted, but shortly afterwards anaesthetics were introduced and hypnotism was abandoned. However, a French country doctor named A.A.Li‚bault took up hypnotism as a method of relieving symptoms by suggestion, and later it was used in Paris at the SalpetriŠre hospital by the celebrated neurologist Charcot. Hypnotism is still used today by some doctors in Britain and elsewhere, and it has now largely completed the journey from quackery to orthodoxy. There has been a Society of Medical and Dental Hypnosis in this country for many years. Acupuncture has likewise been known in the West for a surprisingly long time; as early as the seventeenth century, in fact, although it only became widely known in the nineteenth. At that time it was practised quite extensively in France and in England, where the Leeds Infirmary became a major acupuncture centre in the 1840s. Shortly afterwards, however, it fell into disuse, and only revived after President Nixon's visit to China in 1972. Today the British Medical Acupuncture Society has over 1200 members and the number is constantly rising. The position of homoeopathy is more curious. For a variety of reasons it has attracted more hostility from orthodox doctors than either acupuncture or hypnotherapy, yet there has always been a small but resolute body of medically qualified homoeopathic doctors. When the National Health Service was set up after the war the homoeopathic hospitals were included, perhaps because there were influential people who habitually received homoeopathic treatment, and later the Faculty of Homoeopathy, the official teaching body for medical homoeopathy in Britain, was incorporated by Act of Parliament. This gives homoeopathy a greater degree of official recognition than it enjoys in any other country except, perhaps, India, yet British medical students learn nothing whatever about the subject and indeed are (or were until very recently) not likely even to have heard of it except in the dismissive phrase 'a homoeopathic dose', meaning an absurdly small dose. In the next chapter I return to some of these issues and look at them in a little more detail. 3: COMPLEMENTARY OR ALTERNATIVE? In her recent book on alternative medicine, Rosalind Coward made an important point. The alternative health movement has given voice to a fundamental philosophical opposition to past ways of viewing health... For many, the notion of being alternative is considerably more than just doing it differently from orthodox medicine. It is also a symbolic activity. It is a profound expression of a new consciousness which individuals have about health and the body. [THE WHOLE TRUTH, 11] This is exactly right. Another way of putting the same thing would be to use William James's term "over-belief". For many alternative medicine enthusiasts the over-beliefs are far from being incidental additions to practical methods of treatment; one could almost say that the practical therapies emerge from the philosophical presuppositions than the other way round. All the same, an important qualification is needed here. There are certain "major" forms of alternative medicine - acupuncture, homoeopathy, osteopathy and hypnotherapy - that are practised by quite large numbers of doctors as well as non- medical practitioners. The British Medical Acupuncture Society, for example, has over a thousand members at present and the number is rising all the time. A few doctors who take up alternative medicine become "renegades" and abandon conventional medicine altogether, but this is exceptional; most remain more or less orthodox but modify their practice by adding one or more of the alternative therapies, which they generally practise part- time. These "major" alternative therapies therefore tend to exist in two forms. To use the terminology of politics and religion - not wholly inappropriately - one could speak of moderates and extremists. The problem here, however, is that opinions about these things are not sharply polarized but lie along a spectrum; it would be an over-simplification to represent all medical practitioners of alternative medicine as moderates and all non- medical practitioners as extremists. In the case of osteopathy, in fact, the distinction is not very relevant. The osteopaths have decided, for better or worse, to cast their lot with "the medical establishment", and it seems likely that within a few years osteopathy will be as "orthodox" and uncontentious as, say, physiotherapy. But some of the early osteopaths' theories and beliefs will have been jettisoned along the way. The distinction is however very relevant for acupuncture, homoeopathy, and hypnotherapy, and I should like to bring this out by looking briefly at the way these two forms of medicine have developed. ACUPUNCTURE In traditional Chinese medicine acupuncture has an elaborate theoretical basis. The most basic idea is yin-yang polarity, which underlies every phenomenon in nature. There is also said to be a universal subtle fluid or energy called chi which is responsible for the processes of life. Chi flows through the body in the blood vessels and also in special channels, usually misleadingly called meridians in English. The so-called meridians connect the various internal organs (liver, spleen, kidney and so on). Disease is held to result from imbalances in the flow of chi and hence in the proportions of yin and yang, and the task of the acupuncturist is supposed to be to restore the balance by judiciously adjusting the flow. This is essentially a hydraulic concept, and the acupuncturist is pictured as a kind of engineer. The theory of acupuncture is elaborate and complicated. It is said to be very ancient and may indeed be so, although most of the texts on which the modern practice is based are mediaeval. It is certainly very complicated, and it employs concepts and terminology that are exotic and strange for Westerners. This seems to be a considerable part of its appeal for Western enthusiasts, especially for those (the majority) who are not medically qualified. To learn it, you must put aside your Western concepts of pathology, physiology, and even anatomy; such a willing suspension of disbelief is obviously easier if you have not acquired them in the first place to any great extent. Moreover, acupuncture is part of Eastern wisdom, hence profound, and in studying it you distance yourself decisively from dull, mechanistic, materialistic Western science. In part the notion that acupuncture is vaguely mystical is illusory, for the ancient Chinese were remarkably pragmatic and mechanistic thinkers themselves, and there is nothing mystical about their view of acupuncture. Many Western enthusiasts for acupuncture, however, do think of it as an esoteric, mystical branch of knowledge. This is merely one example of the difficulty of making cross-cultural leaps of this kind. But there is another view of acupuncture. In the last fifteen year or so there has grown up a different version, which might be called modern or non-traditional. This is based, not on the ancient Chinese theory of chi, yin and yang, 'meridians' and so on, but on modern Western concepts of anatomy and physiology. It ignores the Chinese system of pulse diagnosis and assumes that the effects of acupuncture - many of which, obviously, it accepts as real - are produced via the nervous system as generally understood by modern science. And it assumes that there must be changes in blood flow in various organs, alterations in hormone levels, and other physiological effects to account for the effects. I originally learned acupuncture from a Western doctor who had written a number of books on the subject; these we were required to read before attending the course, which lasted a week, from Monday to Friday. When we arrived on the course we were told by our tutor that he no longer accepted the Chinese theories which his own books were about, though he still thought it was important to have a grasp of the traditional ideas so as to understand the subject. He said he had come to this iconoclastic position as a result of his own experience, which showed that you got the same kind of results even if you didn't practise according to the classic Chinese principles. I admired his honesty in reversing his thinking in this way. Nearly all non-medical acupuncturists in the West base their practice on the traditional system, though sometimes in a somewhat modified form. (I think it is in fact questionable how far it is possible for a Westerner to adopt traditional Chinese ideas and make them thoroughly his own, at least without learning to read Chinese and spending a considerable time in China.) In China itself, it seems, things are changing. According to Nathan Sivin, a sinologist who has studied the question at first hand, modern Chinese doctors do not use or understand the ancient system. They are unable to read the classical literature, which has to be translated into modern Chinese. Although acupuncture is still used, the diagnostic methods are modern. Patients, likewise, are no longer familiar with the yin - yang and five-element concepts. Sivin concludes regretfully that there can be no return to traditional Chinese medicine in its original form. (American Journal of Acupuncture 1990, vol. 18, 325, 341). The majority of Western doctors who take up acupuncture use the non-traditional version, although this is not universally true; adherents of both views can be found in the British Medical Acupuncture Society, whose members are all medically or dentally qualified. For a Western doctor, the non-traditional version has several advantages. There is no need to try to come to terms with obscure medical concepts, which are likely to seem incomprehensible or incredible, or both, to someone with a modern scientific training. Moreover, since the 'new' version is based on the orthodox medical ideas that the doctor is already familiar with, he or she can absorb the basic skills in quite a short time and start to practise them without a long delay. The traditionalists, not surprisingly, look on all this with horror. They say that doctors are looking on acupuncture simply as a medical technique, and neglecting the real treasures that the 'proper' version contains. They speak disparagingly of doctors who attend one or two weekend courses in acupuncture and then start to treat their patients. In reply, doctors point out that all their conventional medical knowledge is relevant to modern acupuncture and therefore they have in effect been studying for years. Who is right? There is no doubt that doctors can learn the basics of practical acupuncture in a short time, and by applying these principles in the light of their knowledge of medicine they get good results in many disorders. Naturally it takes time and experience to become thoroughly skilled in the techniques, but the contention of the modernists is that techniques is what they are; the ancient theory is irrelevant. And clearly if someone is not convinced that the traditional Chinese ideas are valid, he or she has little motive to spend years learning them. The traditionalists, of course, claim that acupuncture done according to the ancient theories gives better results. The modernists claim the contrary, and moreover point out that the Chinese themselves have in recent years been quite prepared to update the traditional practice in various ways. In the absence of any proper scientific studies of the question it is impossible to say whether the classical or the modernistic approach gives the better results, or whether there is no real difference between them. The practical details of the treatment are in any case often quite similar in the two versions, though there is a tendency for the traditionalists to use more needles per patient and to leave them in for longer. (For what it is worth, the ancient texts seem to imply that the most skilled acupuncturists use very few needles - ideally only one - so in this respect the modernists seem to be the more 'traditional'!) HOMOEOPATHY In the case of homoeopathy we again find at least two views of how it should be approached. There is a purist school of so- called 'classical' homoeopathy, and there is also a more pragmatic version which takes more notice of recent developments in orthodox medicine and tries to relate homoeopathic practice to these. Nearly all non-medically qualified homoeopaths are purists in this sense, but the position of medical homoeopaths is more complicated; there are wide variations from country to country and changes are occurring all the time. One important way in which homoeopathy differs from acupuncture and indeed from most other forms of alternative medicine is that it was invented or discovered by a doctor and at first was practised almost exclusively by doctors. (There were in fact some eminent early non-medical practitioners, such as Hahnemann's widow Melanie and Von Boenninghausen, a lawyer; but these were exceptions and they had to get special permission from the authorities to practise.) The story of homoeopathy begins with Samuel Christian Hahnemann (1755 - 1843). He was an orthodoxly qualified German doctor who became disillusioned, understandably, with the medicine of his day, and therefore abandoned medical practice for a number of years, working instead as a translator and chemist. In 1790 he carried out an experiment on himself which planted the seed of homoeopathy in his mind and ultimately was to change his life. The idea was suggested to him by a book he was translating from English, Cullen's Materia Medica. In this he found a description of the Peruvian bark cinchona, from which quinine is derived. He disagreed with Cullen's explanation of how cinchona acted, and decided to take some himself to see what happened. He experienced the symptoms of an attack of 'intermittent fever', and this eventually gave him the central idea of homoeopathy: to choose medicines on the basis of similarity between their effects and the symptoms of the disease. The medicines Hahnemann used at this time were almost all taken from the ordinary pharmacopoeia of his day. Most were herbal, although he also used a few minerals. Thus they can in a sense be called 'natural', an important consideration for modern homoeopaths although probably less so in Hahnemann's day. In 1821 Hahnemann was forced to leave Leipzig owing to the hostility of the apothecaries. He moved to Anhalt Kothen, a small principality some 36 miles away where the Duke was an ardent admirer of his system. Here he remained in virtual seclusion (for travel in those days was very arduous), cut off both from his followers and from contact with mainstream medicine. His patients were now nearly all sufferers from chronic disease, and this, together with his virtual isolation, led to changes in his ideas. While in Kothen he published a controversial theory of chronic disease, the miasm theory (see p. 000), together with a series of new and unfamiliar medicines for treating such disease according to his theory. And he propounded the 'dynamization' idea, which was to grip the public imagination almost to the exclusion of everything else. 'Dynamization' is the term Hahnemann applied to the process of trituration (for solids) or hard shaking (for liquids) which he used in preparing his medicines. As well as this, he also diluted them in successive steps, to levels that seemed improbable to his contemporary critics and even more so today, when according to modern molecular theory there should be none of the original substance left at all in many of the medicines and very little indeed in the rest. He explained the claim that these extraordinarily dilute substances nevertheless could be used as medicines by saying that the process of dynamization made them much more active than before. During his lifetime Hahnemann was a very contentious individual who managed to sow discord wherever he went, not least among his followers. He was unwilling to accept any deviation from his precepts, and as these changed quite considerably over the years adherence to them was not always easy. He disapproved violently of any attempt to compromise with orthodox medicine, an attitude which resulted in the premature closure of a homoeopathic hospital founded in Leipzig after his departure. Fierce disputes continued to be a feature of homoeopathy even after Hahnemann's death. To see why, we need to understand that there were two distinct sides to Hahnemann's thought. In some ways he was a scientist, carrying out pharmacological and clinical research. In other ways, however, he was prone to build speculative theories that were closer to metaphysics; in this he resembles Anton Mesmer. Thus, in later editions of his main theoretical work The Organon he included a considerable amount of speculation about vitalism that some of his disciples, especially in England, found unacceptable. He also became progressively more extreme in his teaching about potency. At Hahnemann's death his ideas had become widely diffused throughout Europe. They had also crossed the Atlantic to both Americas, and at some point they reached India, still the country where homoeopathy is most widely practised. In the late nineteenth century, however, it was the USA rather than India which was most deeply committed to homoeopathy. The new doctrine reached a peak of success in the decades 1865 - 85, when an astonishing number of homoeopathic hospitals and colleges were constructed. In 1900 there were 22 colleges, and before the First World War there were 56 purely homoeopathic general hospitals, some with up to 1400 beds, 13 mental asylums with up to 2000 beds, 9 children's hospitals, and 21 sanatoriums. Soon after this homoeopathy went into decline in America. The main reason for this was quarrelling among the homoeopaths themselves. They were divided into two factions. The more numerous was composed of doctors who did not distinguish sharply between homoeopathy and orthodox medicine and were prepared to compromise with orthodoxy. The other group, who regarded themselves as strict Hahnemannian purists, distanced themselves as much as possible from orthodox medicine and took Hahnemann's later ideas even further than Hahnemann himself had done. In particular they were extremists in the matter of potency, taking the dilution method to extraordinary lengths. For this purpose they invented various machines, since to make these ultra-high dilutions by hand would have taken far too long. This 'purist' group, the best known of whom was Constantine Hering, were strongly influenced by the teachings of the Swedish mystic Emanuel Swedenborg, which by this time had become established in America. The Swedenborgians found in homoeopathy just the medical system they were looking for, while the homoeopaths thought that Swedenborg's ideas complemented Hahnemann's perfectly and gave them a new philosophical profundity. They were particularly attracted by the Swedenborgian emphasis on the mental and spiritual characteristics of patients, and also by the idea that chronic disease has deep roots in the personality. The last, and probably the most influential, of these Swedenborgian homoeopaths was James Tyler Kent (1849 - 1916). He compiled a Repertory - a kind of large index of symptoms and medicines - which is very widely used today; he also wrote extensively on methods of prescribing and on the medicines themselves. In England, meanwhile, homoeopathy was pursuing quite a different course. The English homoeopaths, of whom the best known today are Robert Dudgeon and Richard Hughes, were enthusiastic about the new medical teaching but nevertheless were prepared to be critical. They rejected some of Hahnemann's more extreme ideas, and instead of ignoring orthodox medical knowledge they did their best to build bridges between it and homoeopathy. For example, they took account of the results of animal experiments, and in choosing medicines they took note of the pathological changes of disease as well as the symptoms. This could be called Hughesian homoeopathy. If the empirical school of British homoeopathy that existed in the late nineteenth century had continued it is possible that homoeopathy today would be much more accepted by orthodox medicine than it actually is. But change was on the way. In the early years of the twentieth century an English homoeopathic doctor, Margaret Tyler, went to America to study under Kent. She returned full of enthusiasm for Kent's ideas, and began to proselytize for them with considerable success. Other doctors took them up, notably Dr (later Sir) John Weir. Probably Tyler did not convert many of the old guard, but as they retired or died they were replaced by her sympathizers. As a result, British homoeopathy changed its character radically in the first two decades of the twentieth century and became predominantly Kentian. In this form it was taken up by a number of lay homoeopaths. As we have already seen, there had been non-medical homoeopaths right from the beginning, but they had been exceptional. In Britain, however, there were few or no legal restrictions on lay practice, and it flourished. In part this was because Tyler's writings were so distant from orthodox medicine that they were immediately accessible to non-medical readers. Margaret Tyler remained active in homoeopathy for many years and wrote a number of books on it. Her principle contribution was to establish the idea of constitution in homoeopathy, which is often what appeals to people today. Previously homoeopathy had been fairly firmly based on Hahnemann's pharmacological experiments. The idea was to find a medicine whose effects, as verified by experiments on healthy people, were as similar as possible to those from which the patient was suffering. For example, white arsenic causes severe diarrhoea, vomiting, and thirst for small quantities of water. These symptoms are similar to those of acute gastroenteritis, so white arsenic would be the similimum in such a case and could be used to treat a patient who showed these symptoms. Under Tyler and her associates this way of prescribing was not abandoned but it was complemented, and partly overshadowed, by a new theory that seems to have originated in America with Hering. This was that there are certain personality types, each of whom is supposed to have a suitable kind of medicine. For example, the 'white arsenic' patient is fearful, chilly, tidy and fussy; he dresses neatly, can't bear anything out of place, and is therefore known as the 'gold-topped cane' patient. The sulphur patient is in many ways the opposite: intolerant of heat, untidy, careless, given to abstract thought, he is called the 'ragged philosopher'. Or there is the Sepia patient (usually a woman); she is pictured as a sallow tired mother of a large family, with whom she is totally fed up. Tyler says that she longs to escape from the house, and feels exhausted. Her six-year-old son starts drumming with a spoon on a tin pot; she snatches the pot away and smacks her son, who starts to howl. The whole kitchen is in uproar, and she doesn't care. Obviously these constitutional indications are not directly derived from experimental testing of drugs - which homoeopaths call "proving". It is hardly likely that taking sulphur, say, would make someone untidy who was not so already. The idea of constitution must therefore come from homoeopaths' theorizing or observation, although there is unfortunately no way of verifying this from the homoeopathic literature. There are a few hints of this way of looking at medicines in Hahnemann's writings but nothing more than hints; mainly it seems to come from Hering and Kent but especially from Tyler. So-called classical homoeopathy today is really Kentian/Tyler homoeopathy and is certainly not identical with what Hahnemann taught and practised - a fact that is unknown to many modern enthusiasts. A consultation with a modern homoeopath who adheres to this "classical" system is thus likely to involve a great deal of questioning about the patient's moods, fears, reactions to weather, food likes and dislikes, and so on. These are deliberately not directly related to the main complaint that has brought the patient to the homoeopath, because for the purist this complaint, if not exactly irrelevant, is simply the end point of a deep-seated disorder affecting the patient's whole physical, mental and spiritual being. For homoeopaths of this persuasion the "pathological" (disease-based) prescribing of Hughes and his disciples is a very inferior method. Ostensibly for this reason, Hughes and his ideas were displaced from their former pre-eminence shortly after Hughes' death in 1902. I think it likely, however, that another and probably more important reason for Hughes's posthumous fall from favour was his enthusiasm for reconciling homoeopathy with the orthodox medicine of his day. The Kentians who came to dominate British homoeopathy throughout most of the twentieth century were isolationist and rather hostile to orthodox medicine, a trait they inherited from their mentor, Kent, himself. Anton Mesmer and hypnotherapy Many people think of Mesmerism and hypnosis as simply different names for the same thing. There is however rather more to it than that, and the story of Mesmerism is worth looking at in its own right, since it exemplifies many of the difficulties that attend the attempt to introduce an unconventional form of treatment into orthodox medical practice. There are also some curious and interesting resemblances between the careers of Mesmer and Hahnemann which do not generally seem to have been noticed. Franz Anton Mesmer (1734 - 1815) was almost an exact contemporary of Hahnemann (1755 - 1843). He grew up on the shores of Lake Constance, on the border between Germany and Switzerland, in a Swabian town called Iznang. His father was gamekeeper to the Bishop of Constance and Mesmer was brought up as a Catholic; indeed, as a youth he contemplated entering the priesthood, but he soon realized that he lacked a vocation. For a year he studied law, but in 1760 he became a medical student in Vienna, where he qualified MD and PhD in 1767 at the fairly advanced age of 32. Mesmer was thus, like Hahnemann, well grounded in the science of his day, and he showed no leaning towards occultism or mysticism. It is therefore somewhat ironic that his name should have become linked with these qualities. His early career after qualifying was, in fact, conventional enough. He married a rich aristocratic widow, ten years older than himself, and thanks to his wife's connections soon established a prosperous practice in Vienna, where he met and became friendly with the young Mozart and his father. Not until the 1770s did he begin to move in the direction that was later to bring him such renown and notoriety. A young girl called Franzl Oesterlin, a relative of Frau Mesmer, became Mesmer's patient. She was suffering from symptoms that would now be regarded as psychological, possibly associated with hyperventilation. In order to make herself more easily available for treatment she came to stay with the Mesmers, and as he studied her case Mesmer was led to formulate remarkable theory. Mesmer's doctoral thesis had been concerned with the influence of gravitation on human physiology. He had suggested that gravitation depends on a subtle universal fluid which he imagined to pervade the whole cosmos, including living organisms, and to set up 'tides' in the bloodstream and nerves of human beings. This thesis, which in later years he referred to as The Influence of the Planets on the Human Body, sounds as if it should be concerned with astrology, but Mesmer intended it to be fully scientific. Ideas of this kind were acceptable scientific currency in the eighteenth century, and indeed Mesmer had lifted whole sections of his theory from the writings of the respected English physician Richard Mead. Contemplating Franzl's symptoms, he made the 'obvious' connection. He now understood what was causing the ebb and flow of her attacks: nothing else than the gravitational tides he had described in his dissertation. How to use this discovery to effect a cure? Why, by magnetism. Magnets were already in use by at least some doctors, though admittedly this was a contentious subject; and of course magnets, with their polar attraction and repulsion, could be plausibly supposed to act in the same general way as gravitation. Mesmer's friend Maximilien Hell, professor of astronomy at the University, had a number of magnets made for him in the astronomy department, with different shapes according to the part of the body they were intended to treat. The effects were gratifying. As soon as the magnets were applied to Franzl she had an immediate strong reaction followed by a dramatic improvement, and after further experiments Mesmer convinced himself that he had succeeded in controlling the ebb and flow of the universal gravitational fluid. Almost immediately after this, Mesmer quarrelled with Hell about who should have credit for the discovery. Hell claimed that it was the magnets themselves that had effected the cure, but Mesmer insisted that their only role was to channel the cosmic flow through the patient. It was in fact unnecessary to use magnets, he discovered; objects made of cloth or wood worked just as well. The explanation, he concluded, was that he himself was touching them; he was an 'animal magnet' who acted on objects and people in an analogous way to a mineral magnet acting on metal. Mesmer now tried to persuade the medical Establishment in Vienna of the validity of his discovery. In this he was unsuccessful, but Franzl made a complete recovery and eventually married Mesmer's stepson. (Mozart, in a letter, records a meeting with this lady, now grown stout and the mother of three children.) Mesmer's fame increased, and so did his practice; in 1755 and 1776 he travelled in Swabia, Bavaria, Switzerland, and Hungary, treating the famous. He was less successful in the case of Maria Theresa Paradies, a girl suffering from psychologically caused blindness since the age of three who was nevertheless a professional pianist. She had been treated with the conventional drastic methods of the time - bleeding, purging, blistering - and also with some experimental techniques, including the application of a tight plaster helmet and painful electrotherapy. At first Mesmer was successful; Maria Theresa recovered her sight, at least temporarily. But the ophthalmologist who had failed to cure her was, not unnaturally, jealous of Mesmer, and claimed the cure was not genuine. Eventually, for reasons that are unclear, the patient's father reacted violently against Mesmer, finally appearing at his house, sword in hand and demanding that the treatment of his daughter be stopped. Partly, at any rate, the explanation for the fiasco is that as the girl's sight improved her piano-playing deteriorated; she ceased to be so much of a public curiosity and was in danger of losing a pension that she was in receipt of from the Empress. Perhaps, too, there were other causes connected with the Paradies' family life (child sexual abuse?) which may have been responsible for the girl's initial blindness. At any rate she relapsed; eventually she achieved a reasonably successful career as pianist and composer, but she never again recovered her sight. Mesmer, meanwhile, was the centre of a scandal. Many people suspected him - almost certainly unjustly - of having had improper relations with Maria Theresa, and the hostility of the Viennese doctors increased. In 1778 Mesmer, by now informally separated from his wife, left Vienna for Paris. Once established in Paris, Mesmer began a long series of feuds with the French medical Establishment. The Academy of Sciences, in spite of attending demonstrations, were unconvinced by the animal magnetism theory. Mesmer therefore approached the newly founded Royal Society of Medicine, which he hoped would be more amenable than the long-established Paris Faculty of Medicine. His initial demonstration at his suite in the Place Vend“me was not well received. In 1778, therefore, he moved out of Paris and set up a clinic at a nearby town, Cr‚teil, where he had more room to treat the large number of patients who flocked to him. Some received individual therapy, while the less seriously ill or the convalescent were treated in groups. For this purpose Mesmer invented the baquet, a large wooden tub containing bottles of magnetic metal, stone, glass and so forth. Mesmer had magnetized all these items himself, by touching or pointing at them. The baquet had iron rods projecting from it; the patients pressed these against the affected parts of their bodies, and they also held hands to allow the animal magnetism to flow through the group. Many grateful patients wrote testimonials to the efficacy of the treatment, but the Royal Society was unimpressed and refused to attend the demonstrations. However, Mesmer was more successful with the Paris Faculty of Medicine, a prominent member of which, Charles Deslon, became a convinced believer in animal magnetism. He had himself magnetized, served as Mesmer's assistant, and eventually established his own clinic. Having moved back again to Paris, Mesmer now accepted Deslon's suggestion that they should try to gain the endorsement of the Paris Faculty. Three prominent members of the Faculty agreed to watch Mesmer at work. They were shown a number of remarkable cures, but remained obstinately unconvinced. Mesmer now gave up hope of obtaining the Establishment's approval, and concentrated on his clinical work. It is important to notice that he distinguished between what we would now call psychological and physical disorders, and refused to treat the physical. His patients ranged from the rich and aristocratic to the poor; everyone received an equal amount of attention and those who could not afford to pay were treated free. One feature of Mesmer's methods which attracted a good deal of unfavourable comment was the 'Mesmeric crisis'. Some patients, especially those suffering from more serious symptoms, experienced nervous trembling, nausea, occasionally delirium or convulsions. Mesmer regarded these as an inevitable accompaniment of the process of normalization of the flow of animal magnetism, and he had special padded 'crisis rooms' in which patients could throw themselves about without hurting themselves, while Mesmer or his assistants gave them individual attention. The depth of the crisis naturally varied from case to case, but Mesmer insisted that some degree of crisis, no matter how slight or transient, would always be found if it was looked for carefully enough. Even more dramatic than the crisis, however, was the Mesmeric trance. Mesmer discovered this phenomenon only after he had been practising his method for some considerable time; the trance then became for him a method of inducing the crisis. Another of his followers, the Marquis de Puys‚gur, discovered that it was possible to communicate with people in trance, getting them to answer questions, remember long-forgotten childhood events, and so on. The Marquis came to believe that it was possible to produce cures without a crisis, but Mesmer, constrained by the demands of his theory, did not agree. It is generally held that Mesmer was practising hypnotherapy, but it is probably more accurate to say that he was a shamanistic healer whose methods certainly included hypnotherapy but were not identical with it. Mesmer's conduct during therapy sessions was highly impressive, being intended to augment the drama of the situation as much as possible. His clinic was meticulously furnished to maximize suggestion: the light was dim, everyone conversed in whispers, and music was used to alter the patients' mood according to what was required at each stage of the process. There were four baquets in the room, three for paying patients and the fourth for those being treated free. Mesmer, as Master of Ceremonies, was elaborately dressed and carried a wand, which he pointed at patients or used to touch or stroke them. The patients gasped, twitched, went into trance, or experienced convulsions or catalepsy. Mesmer's assistants ministered to the more severely afflicted and if necessary brought them into one of the padded crisis rooms. Although Mesmer made some influential converts, especially Deslon, he was eventually to break with almost all of them. He was autocratic and dictatorial (like Hahnemann) and would brook no opposition. A lawyer called Nicolas Bergasse became converted to Mesmerism and suggested to Mesmer the establishment of a private academy to propagate his ideas. The result was the grotesquely misnamed Societ‚ de l'Harmonie. The Society was secret. All the members had agreed to sign an undertaking that they would not pass on any part of Mesmer's teaching without his written permission, nor would they establish a clinic without such permission; they were permitted to treat only individual patients. It was this last condition that destroyed the Society within two years of its foundation in 1783. The Society combined the roles of institute, medical school, and clinic. Students learnt the theory of Mesmerism and how to apply it in practice to patients. Schools were set up in Paris and also in several other cities in France, and thousands of pupils attended the courses. Bergasse took on much of the administration and became correspondingly powerful within the organization. Meanwhile Mesmer's erstwhile assistant Deslon had set up on his own account, and in 1784 he was investigated by a royal commission. The committee was convinced by his cures but denied, once again, the reality of animal magnetism. Another commission, set up by the Faculty of Medicine, reached the same conclusion. Mesmer objected that it was he, rather than Deslon, who should have been investigated, but there was nothing he could do about it. Bergasse, Puys‚gur, and other disciples of Mesmer now began to make public the knowledge of animal magnetism. Mesmer was furious, and the Society dissolved amid scenes of rancour and confusion. In any case the Revolution was coming and Mesmerism began to be overtaken by politics; Bergasse was later to adapt the doctrine of animal magnetism to support his views on revolutionary politics. Mesmer kept aloof from politics. He travelled about in Europe for a number of years, though he was back in France from 1798 to 1802; he sued for his losses under the Revolution and was awarded enough to keep him in reasonable comfort for the rest of his life. He now recommenced his wanderings, and began to develop more outlandish ideas than he had entertained hitherto, starting to speculate on what we today would call paranormal phenomena and extrasensory perception. During the trance, he said, the mind comes into contact not only with other minds but also with the cosmos, and so in principle is capable of acquiring universal knowledge. In this way it is possible for seers and fortune- tellers to foretell the future. He published these ideas in a book in 1799, and as a result gained the reputation of an occultist. Mesmer died in Switzerland in 1815. He was in his eighty- first year; a gypsy in Paris had foretold long ago that he would die at this age, and he believed her, so he was prepared for the end when it came. In his own terms, Mesmer must be judged to have failed. His dominating ambition was to achieve scientific recognition for his theory of animal magnetism and this did not occur. His methods of treatment, however, were reinterpreted as suggestion and were rechristened hypnosis or hypnotherapy, and in this form they were taken up by, among others, Jean Martin Charcot, Pierre Janet, and Sigmund Freud (although Freud later abandoned hypnosis). Although a faint aura of the disreputable has clung to hypnosis, there has always been a minority of doctors and psychiatrists who have valued and practised it. There is still a Society of Medical and Dental Hypnosis in Britain. Like Mesmer himself, some people have been attracted by the idea that hypnosis facilitates telepathy and clairvoyance. Numerous books, some by doctors, appeared in the mid-nineteenth century describing remarkable cases of thought transmission and other marvels during trance. It is interesting, however, that Mesmer's name is not mentioned at all in some of these books; the aura of charlatanry could not be dissipated. Matters were not helped by the development of hypnosis as a stage entertainment. There was also the fear that hypnotists might be able to manipulate their subjects for their own purposes; Svengali might be fictional, but could there not be real-life Svengalis? Mesmer regarded his ideas as thoroughly scientific, although admittedly he did later flirt with the occult. In the nineteenth century hypnosis was part of the stock-in-trade of occultists such as Helena P. Blavatsky, the founder of Theosophy, and there is still a widespread belief that the hypnotic trance affords a way into hidden depths of the mind. And although the term animal magnetism is little used today, very similar ideas keep surfacing under other names: for example, Wilhelm Reich's "orgone energy". MESMER AND HAHNEMANN The sixth edition of Hahnemann's textbook THE ORGANON contains a number of approving references to the then topical subject of Mesmerism. Hahnemann apparently used Mesmeric techniques himself, and he made a connection in his mind between the 'vital force' which, he believed, brought about healing, and Mesmer's 'animal magnetism'. Subsequent generations of homoeopaths have made little of the connection, however, probably because of the reputation for charlatanry that later became attached to Mesmer's name. The similarities between Mesmer and Hahnemann, both in career and in character, are in fact striking. It is worth listing them. 1. They were almost exact contemporaries. 2. Both came from fairly humble backgrounds (Hahnemann was the son of a worker in the Meissen pottery trade.) Neither had very much to say about his childhood, which may have been because neither was particularly happy. 3. Both qualified, rather late in life, as orthodox physicians and both adopted heterodox ideas that brought them into conflict with the medical Establishments of their day and came to dominate their lives and thought completely. 4. Both spent a considerable time in Paris. 5. Both had lawyers as prominent followers. 6. Both started as scientists and then moved gradually towards more occult or metaphysical ideas. 7. Both were characterized by feelings of injustice and persecution. 8. Both were intolerant of any deviation on the part of their followers, with whom they became involved in acrimonious and destructive disputes, which led to the closure of establishments set up to propagate their ideas (Mesmer's Society of Harmony, the Homoeopathic Hospital in Leipzig). 9. Both insisted that cure must always be preceded by an aggravation or crisis, no matter how brief and slight. 10. There are close resemblances between Hahnemann's vital force and Mesmer's animal magnetism. It is significant that some American homoeopaths actually suggested the existence of a homoeopathic force, which they called Hahnemannism by analogy with galvanism. CONCLUSION It seems that there is an inevitable contradiction inherent in the attempt to get alternative medicine accepted "officially" as valid. It can be done if its practitioners are prepared to compromise with the "establishment", but in the process they to may have to give up some of their cherished ideas and theories. It is usually this, quite as much as the difficulty of providing hard evidence for the efficacy of the alternative system in question, that causes so much heart- searching and agonizing. There will probably always be some people who feel that the sacrifice is simply not worth while, and who prefer to remain aloof from mainstream medicine altogether. The converse of this, however, is also true: increasing contact with the alternative forms of medicine is likely to alter doctors' thinking in ways that are not easy to foresee in detail; indeed it is already beginning to do so. 4: IDENTIFYING FEATURES People who subscribe to the view that unorthodox medicine should be alternative rather than merely complementary nearly always base this opinion on a number of characteristics which they think distinguish the kind of medicine they favour. These apply to most forms of alternative medicine but especially to the medical and physical therapies (Groups A and B, Chapter 2, p.00). Alternative medicine, we could say, is supposed to be: 1. natural. 2. traditional. 3. holistic. 4. vitalistic. 5. supported by modern physics. 6. more truly scientific than orthodox medicine. 7. optimistic 8. ecological 9. anti-authoritarian 10. capable of dealing with the real causes of disease But what do these claims really amount to? ALTERNATIVE MEDICINE IS NATURAL This is probably the single most important claim made on behalf of alternative medicine; no form of therapy is complete without it. It stems from a nostalgic yearning to return to Nature, to our Source. In its extreme form, this is a quest for what Marghanita Laski called the Adamic state. The designers of travel advertisements and brochures draw on this longing when they try to seduce us with their specious images of blue skies, empty beaches, and laughing figures redolent of eternal youth. 'For ever wilt thou love, and she be fair!' All the same, Mr Squeers was right: Nature is a curious concept. How we think of it at any given moment depends a great deal on social and economic circumstances. In Victorian times, Nature (the capital N was almost invariable then) was thought of as an arena of battle: 'Nature red in tooth and claw.' This interpretation of Darwinism derived, not from Darwin himself, but from philosophers such as Herbert Spencer who based themselves on Darwin, and it reflects the competitive entrepreneurial spirit of Victorian England. Survival of the fittest could be seen to be part of the 'natural law'; a satisfying idea for those who happened to have reached, or been born into, a superior economic and social position. For us, the ecology-minded descendents of those Victorians, the natural world has become a cooperative effort rather than a battlefield. We know, of course, that animals eat one another and members of the same species fight one another for territory or mates, but they do so only within certain limits. Predator and prey are not deadly enemies; the lion wants to eat the individual antelope but it doesn't want to destroy the whole herd - if it did it would have nothing left to eat. Predator and prey depend on each other in a delicate symbiosis, so that their relationship is more like a partnership than a struggle for survival. As for battles between members of the same species, these seldom lead to death for the defeated individuals, and in any case the conflict results in greater health and fitness for the species as a whole. Today we are taught to think of nature as forming a vast ecosystem, which would persist indefinitely in harmony with itself were it not for us. We are the wild card, the unnatural joker in the pack, who has entered the ecosystem and disturbed it, perhaps irreversibly. The evidence of our meddling is continually brought home to us in television programmes, books, and newspaper articles. We are made to feel guilty because we are destroying our planet by pollution, by upsetting its temperature control mechanism with carbon dioxide, by deforestation. Alternative medicine sees our orthodox medical treatments as one aspect of the ecological catastrophe we are in the process of bringing about. Our medicine, it could be said, is flawed in the same way as our management of the planet is flawed, and for the same reason: because we have moved too far from our roots in nature. Just as we insensitively try to 'conquer nature' on the outer level, so too on the inner, physiological, level we try to bulldoze our way to health. Antibiotics, corticosteroids, antidepressants, and the rest of the conventional therapeutic armamentarium may 'work' in a sense, the alternative purists admit, but they are 'against nature' and so can only lead in the end to worse catastrophes than those they are designed to cure. Notice that word 'armamentarium'. As Susan Sontag has pointed out, a lot of the vocabulary we tend to use (the 'fight against cancer') implies a military model for treatment, in which disease is the enemy, to be conquered by the doctor; an idea that is unappealing for alternative medicine, which more often sees your symptoms as your body's attempt to heal itself, and therefore not to be suppressed as in 'allopathy'. 'Primitive' peoples who live or lived close to nature - the Australian aborigines, the North American Indians, the forest dwellers of the Amazon - are said to preserve valuable information about the uses of plants and to possess sophisticated rituals of healing and psychotherapy that we have arrogantly spurned or even tried to suppress. Our own pharmacology, in contrast, is seen as crude, dangerous, and, inevitably, 'unnatural'. Some forms of alternative medicine make less claim to be natural than others. Patients who ask for homoeopathy often explicitly say that they want it because it is natural, but naturalness was not a selling point for homoeopathy originally - the quality was not so highly prized in the early nineteenth century - and even today more emphasis is placed on the safety and effectiveness of homoeopathy, and its 'holistic' character, than on its naturalness. However, homoeopathy is supposed to stimulate the natural healing properties of the body, instead of suppressing them as orthodox treatment is held to do, and the starting point of practically all the traditional homoeopathic medicines is a natural vegetable, mineral, or animal extract; often the plant or animal is used whole. In this respect homoeopathy is rather similar to herbalism, in which the medicines are typically prepared from the whole plant. This is said to be natural, in contrast to the products of the modern pharmaceutical industry, which are isolates of the 'active principle'. Using the whole plant is said to prevent adverse effects, because the various components balance one another instead of acting unopposed, as in 'allopathy'. Even within orthodox medicine, the use of whole plant extracts died out only quite recently. As late as the 1960s, when I was a medical student, some of the older physicians were still using digitalis (foxglove) leaf tablets to treat heart failure, in preference to the active principle, digoxin. There is a deep-seated belief in alternative medicine circles that herbal medicines - and by extension, 'natural' methods of treatment in general - are safe and somehow intrinsically virtuous, whereas 'drugs' are nasty and even vaguely immoral; a belief that slides rather easily into sentimentality. "Clear your mind of cant, sir," as Dr Johnson used to say. The natural world abounds with toxins - the deathcap mushroom, snake venom, puffer fish toxin; and of course bacteria and viruses, are all natural too. Comfrey, which has been widely recommended as a cure for migraine, and indeed does seem to work for this purpose, has been suspected of causing liver damage. The idea that nature is inevitably benevolent is extraordinarily sentimental. Mother Nature is not only Mother Divine, taking care of her children; she is also Kali, dancing naked on the bodies of her victims and wearing a necklace of human skulls. She cares nothing for the survival of the individual, only for the species. The corollary of the view that natural = good is, inevitably, the corresponding equation: artificial = bad. I think it is this notion that underlies the belief, taken seriously by some people, that the Aids virus was manufactured deliberately by bacteriological warfare laboratories in the USA or the USSR (take your pick according to your political attitude) and then either escaped or was disseminated deliberately. The psychological basis for this belief seems to be the feeling that a benign nature would not have produced such a terrible plague; it must have been due to human malevolence. But even if it were true - even if Aids had really been produced artificially, by genetic engineering (a telling expression), would that make it 'unnatural'? An important question, surely. Can anything that happens, no matter how technological, really be outside nature? After all, we ourselves are part of nature, not separate from it. In fact, it's the delusion that we can escape from the natural consequences of our actions that has led to the seemingly disastrous situation we find ourselves in today. The physicists who made the first nuclear explosion depended after all, on the cooperation of the laws of nature. Usually, however, we do tend to think of ourselves as in some sense having lost contact with nature, and this is perceived as a Fall from Grace. There is a clear moral implication in this perception, which emerges in the kinds of things patients say. They announce: "I eat all the right things," with the unspoken implication that they deserve praise for this. And if, in spite of eating all the right foods, doing all the right things, and thinking all the right thoughts they nevertheless become ill, they feel aggrieved. It wasn't fair, they complain. When we set the word 'fair' down on paper we at once see the absurdity of applying it to nature; we don't, rationally and consciously, expect nature to be fair. But emotionally and unconsciously we do, thanks to an enormous amount of propaganda on its behalf in recent years in books, magazine articles, and on television. Part of the reason we expect this is probably the decline of formal religious belief. In other times people looked to God to hand out appropriate rewards and punishments, either in this life or the life to come. Now that many of us no longer believe in a future life or, except vaguely, a God, we transfer our longings for justice to a semi-personalized Nature. (The Victorians spoke of Providence in this way, and I remember, as a child, puzzling over the question whether Providence was or was not the same as God, and, if not, what the difference was.) "When people stop believing in God, they don't believe in nothing, they believe in anything." (G.K.Chesterton) The problem with casting Nature in the role of God is that she inherits the metaphysical uncertainties that used to attend Divinity. 'If God is all-powerful and all-good, why does He permit evil to exist in the world?' we used ask. Now it's Nature who has to answer this question. In fact, however, we don't expect quite so much from Nature as we used to expect from God, if only because most enthusiasts for purist alternative medicine are not much given to metaphysical speculation and don't ask the really awkward questions. Nature can get away with more than God used to do. ALTERNATIVE MEDICINE IS TRADITIONAL Nature and tradition are closely allied concepts in alternative medicine. The underlying assumption is that our hunter - gatherer ancestors lived happy lives in total harmony with nature, free from environmental poisons and pollutants, successfully treating such few illnesses as they might acquire with plants gathered from the forest. Those happy days are long gone, but we can, via our television screens, glimpse people still leading a version of this idyllic existence in what remains of the Amazon or African rain forests. Several overlapping myths seem to be present in this idea, or perhaps it is the same myth that has reappeared more than once in history in different guises. There is the myth of the Garden of Eden. There is the myth of Arcadia, the idyllic rural setting where every prospect pleases. And there is the nineteenth-century myth of Rousseau's Noble Savage, uncontaminated by civilization. The combination of these fantasies is extraordinarily powerful, and not necessarily wholly delusive. The forest dwellers do still exist, just, and there are important lessons that we could learn from them before it is too late. But they are not 'primitive'; their societies are complicated and sophisticated, even if not in the way that ours is, and it is patronizing of us to say otherwise. Probably the nearest we can get to the primitive origins of our species is to study the way of life of our closest living relatives, the chimpanzees. Thanks to Jane Goodall's work at Gombe we now have a much better idea about this, but the implications are not wholly reassuring. True, chimpanzees have the beginnings of a 'culture', and they also take 'plant medicines' when ill: evidence, if you like, that these things are 'natural'. But in that case, murder, infanticide, and warfare are also 'natural' since chimpanzees seem to indulge in these activities too. But we don't have to go so far back as that, you say. Are there not more recent societies or civilizations from whom we could learn: the Indians of North America, for example? We read moving statements by American Indian shamans and chiefs, lamenting the destructiveness of the white man. (It is remarkable, incidentally, how radically the popular image of the 'Redskin' has been transformed in the last twenty or thirty years, from tomahawk-wielding savage, fit only to be mowed down by the superior courage and technology of the white man, to sage guardian of truths we are in peril of losing for ever.) Indeed it is probable that a considerable number of herbal medicines were borrowed from the Indians by nineteenth-century American settlers. The idea of looking to the New World for traditional knowledge is a fairly new development, however. The favourite region in which to seek wisdom remains the East, as it has been since Roman times. Acupuncture has been with us for a long time, but there have been fresh imports recently: Japanese, Indian (Ayurvedic), and even Tibetan traditional medicines are beginning to arrive in the West. It is not every alternative therapy that can claim an antiquity as impressive as that of acupuncture or Ayurvedic medicine. Even so, practically all the therapies make at least some claim to have roots in tradition; certainly it is very difficult to think of any system that makes a virtue of being completely new and original. Those therapies that are not obviously ancient, such as osteopathy and chiropractic, homoeopathy, Anthroposophical medicine, and the Alexander technique, do the best they can by pointing to a Founding Father (or sometimes Founding Mother). This may seem like a trivial comment, since it is clear that if a system did not originate in the mists of antiquity or even prehistory, as did acupuncture, for example, there must have been someone who invented or discovered it in the first place; but the important thing is that this person almost invariably becomes invested by practitioners of the system with an aura of near- infallibility. As Jung (who is himself an illustration of the process) would say, this is an activation (or 'constellation') of the archetype of the Wise Old Man. Even if a therapy is relatively recent, there is often a tendency for its advocates to try to trace the underlying concepts as far back as possible, as if proving their antiquity would somehow validate them. Claims are often made that the treatment in question was anticipated by Hippocrates, always a favourite ultimate progenitor. This is true of homoeopathy, which seems to be exceptionally richly endowed with authority figures, starting, of course, with Hahnemann himself. ALTERNATIVE MEDICINE IS HOLISTIC This is another pretty well universal claim of alternative medical systems; indeed, the description of a treatment as natural and holistic could be said to identify it as alternative. But it can sometimes be difficult to ascribe any definite meaning to the term except as an indication of approval. What does being holistic actually amount to? Indeed, is it really much more than a card of identity, a label that people attach to themselves or their method to indicate their allegiance to a cause? One might expect that a truly holistic practitioner would be one who had a practical grasp of several methods of treatment, or was at least sufficiently familiar with a large range of alternative (and, ideally, orthodox) treatments to be able to advise patients about which would be most likely to help them. But this seldom seems to be the case; more often therapists seem to be firm adherents of one or two kinds of treatment, and indeed there seems to be a certain amount of suspicion of a more eclectic approach, people who use it being regarded as dabblers. Each therapy tends to have its own view of what holism means. For some it is a good deal more elaborate than for others. The Western manipulative methods, osteopathy and chiropractic, are probably the least concerned with constructing comprehensive theoretical frameworks. The oriental therapies, on the other hand, arrive equipped with ready-made and very detailed schemes. Homoeopathy, in this as in some other respects, is somewhere in the middle. Homoeopathy does have a tendency to take on philosophical or metaphysical characteristics. This has happened a number of times in the past, most notably in the USA in the late nineteenth century, when it became interwoven with Swedenborgianism. In Britain, homoeopathy has on the whole been more down-to-earth, and the claim that it is holistic is usually based not so much on philosophical ideas as on the fact that it takes the patient's personality and individual reactions into account. The main weakness of this claim is that the commonly used homoeopathic history-taking, although elaborate, is somewhat stereotyped, and usually ends in the selection of one of a fairly small group of medicines. (A number of computer programmes for selecting medicines have been introduced in the last few years, and it is hoped that these will improve the accuracy and scope of the process.) Another way in which alternative medicine is often said to be holistic is that it is not supposed to deal in disease categories; these are said to be a feature of conventional medicine, and derive from its insensitive lack of concern for the individual. 'There are no such thing as diseases, only sick people.' Taken to an extreme, this would mean that an alternative practitioner would have no interest at all in making a conventional diagnosis, and some practitioners do indeed adopt this viewpoint. Rejection of diagnostic labels is an ancient idea that surfaces a number of times in the history of alternative medicine. It was held, for example, by Paracelsus, that maverick among physicians and forerunner of many alternative practitioners down to our own day. Hahnemann held the same view, which he had probably arrived at independently. Modern non-medical practitioners also advocate it at times and it is easy to understand why: it exempts them from the need to bother about orthodox medicine. Even within orthodox medicine the concept of disease categories is challenged seriously from time to time, especially by psychiatrists. There are for example considerable differences in the ways that British and American psychiatrists diagnose schizophrenia. Indeed, it is in psychiatry that the conventional medical model seems most open to question, as Thomas Szaz has pointed out in The Myth of Mental Illness, and since alternative medicine has much in common with psychotherapy it is not surprising that we find alternative practitioners expressing reservations about the value of diagnosis. Probably the truth lies somewhere in the middle. It is undeniably often convenient, in fact pretty well unavoidable, to use disease categories. (Could you go through life without using the concept of the common cold?) Problems arise, however, if we adhere to them too rigidly, or fail to recognize that there can be many individual variations among people who have been affixed with the same disease label. But awareness of this truth is not confined to alternative medicine; it is characteristic of good conventional medicine too. The commonest problem with conventional diagnosis is not that diagnostic labels are used, but that they are used inappropriately, as a cover for ignorance. All of us (not just doctors) feel more secure if we think we have identified something and given it a name. Patients, too, feel this; they constantly ask: 'Is it arthritis?' (or ME, or allergy, or whatever is fashionable at the moment). Having a label does not necessarily help in treatment, but it gives a (usually spurious) sense of control. However, labels can also inhibit further thought and action, and this is my real objection to them. Many patients, for example, have pain in their neck radiating down into their arms or shoulders. On the basis of an x ray which has shown the kinds of changes that almost everyone acquires as they age they have been told that they have arthritis and nothing can be done about it. But this is doubly misleading. First, the x ray changes may have little or nothing to do with the symptoms patients experience; there are plenty of people with severely abnormal x ray findings and few or no symptoms, and conversely others who have a great deal of pain and hardly any x ray abnormalities. Very often neck pain arises from the muscles and other soft tissues rather than from the bones and joints. Secondly, quite a number of these people can be helped a good deal by physical methods: I use acupuncture for this, but manipulation or other forms of treatment (all of which, probably, act in much the same way) can work well too. To label such people as arthritic is both inaccurate and unhelpful, since it tends to paralyse further thought. This is one of the ways in which the use of excessively materialistic ways of thinking can be damaging. As Dr R.S. Macdonald, an osteopathic physician, has put it: Orthodox doctors are used to seeing such abnormalities as tight muscles, restricted joints, and tenderness, around areas like a fractured bone, inflamed joint, abscess, or cancer. Therefore, whenever these abnormalities are found, it is not surprising that the orthodox doctor presumes there is some pathological cause. In similar circumstances, the osteopath will always consider the possibility of pathology but, when no evidence for it can be found, the osteopath will diagnose only the dysfunction observed. [Natural Health Handbook, 128]. This is an important principle that ought to be applied much more widely in medicine, not just in osteopathy. Doctors are trained to look for pathology: that is, for definite abnormalities which can be detected by x rays, blood tests and so on, and they are taught to regard it as a failure if they miss such an abnormality. And this is how it should be; the doctor should make every effort to reach an accurate diagnosis if possible. But the concept of 'accurate diagnosis' needs to be expanded to include the idea that there are many medical problems which must, indeed, have a 'cause' in the widest sense of the word, but not necessarily a cause that can be detected by conventional tests. The abnormalities exist but they are subtle and sometimes transient. A good example is the muscle trigger point, or trigger zone. These are tender areas in muscles which hurt when pressed and can give rise to 'referred' pain and sometimes other symptoms in areas of the body some distance away. Trigger points in the back of the neck, for example, can give rise to headache often localized in the forehead or around the eyes, and this is often labelled incorrectly as 'sinus headaches'. No one knows what muscle trigger points are, though there are several theories. Nearly everyone has a few, which are usually latent, not causing any problems; but unaccustomed over- use of a muscle, psychological tension, and probably many other things can cause them to become active and give rise to symptoms. It is very easy for any doctor to convince himself that trigger points exist - he need only examine a few patients and look for them - so why are they not generally recognized? Because they are not taught in medical school. This in turn is presumably because they cannot, so far, be detected by laboratory or other tests; they are outside the scope of present-day medicine. Describing a patient as suffering from a muscle trigger point disorder is still attaching a label, making a diagnosis, even if an unconventional one. For that matter, it is attaching a label to say, as many homoeopaths do, that a patient is a 'sulphur type', an 'arsenicum type', or whatever. We cannot speak or think about anything without using categories. Instead of deluding ourselves that we can we ought to be more relaxed and undogmatic about the labels we do apply.