A Perfect Storm of Epistemology and Turf: The Debate About Unique Knowledge Within Naturopathic Medicine
David Schleich, PhD
The DOs sided with the MDs in Iowa this past winter to beat back our petition to the state legislature for licensing. American “osteopaths” have utterly diverged from their roots and traditions, and their history is such that with assimilation behind them they have become what they fought. Historically, osteopathic medicine was undoubtedly at one time focused on primary care and holistic health. However, the distinction between the MD and the DO professions has faded rapidly since the 1960s, at a time when the naturopathic profession was beginning again its long, slow climb toward professional formation (Gevitz, 1994).
Naturopathic medicine has many roots and branches, which stretch back into the healthcare landscapes of 12 decades, yearning for space, yearning for place. As more healthcare and higher education professionals across a variety of disciplines covet natural approaches to health promotion, inevitably they bump into the social construction of naturopathic medicine in North America, and the question arises “what is the unique knowledge of naturopathic medicine anyway?”
That same question, if applied to allopathic medicine, is perhaps decidedly easier to answer. Laurence Foss and his colleagues attribute biomedicine epistemologically as a subset of biology, locked in a paradigm that has no tolerance for “a correspondence between psychosocial variables and disease susceptibility” (Foss, 2002, p. 5). Foss pointed out as well that even recent findings in the “so-called sciences of complexity, whose systems display ‘holistic,’ self-organizing behavior” (2002, p. 6) have a difficult time attaching to orthodox allopathic medicine.
Scholars of the “literature of the professions” have been looking for reliable information about the essential characteristics of the “nonbiomedicine” heterodox medical systems for many decades, as they try not only to locate those systems in civil society but also to understand where the modalities and theoretical frameworks of such systems came from and why. There is also the recent reality of the co-opting of long-cherished naturopathic modalities by “integrated medicine” people in the MD, DO, DC, and even NP professions, among others, who sniff market share and assume that they can assimilate into their backpacks whatever is going. That MDs and DCs can “dry needle” with impunity is a case in point.
It is valuable, in this regard, to look again at the epistemological roots of naturopathic medicine, that is, to take a look at the origin, nature, methods, and limits of the knowledge base of the system of medicine we cherish. While these roots are examined briefly in chunks of naturopathic history and philosophy courses, they are not top of mind for the profession as it struggles for an entry point license in New York or licks its wounds in Iowa.
However, this very conversation is going on. For example, Richenda Power’s book A Question of Knowledge (2000) adds a surprising dimension to the growing, complex discussion around defining naturopathic medicine’s epistemological place in this confusing terrain of complementary and alternative medicine and integrative medicine. We simply must be confident about the nature and grounds of knowledge with reference to the limits and validity of that demarcated knowledge. It cannot be only the Foundations of Naturopathic Medicine (FNM) Project (http://www.foundationsproject.com) that does this work. Every naturopathic curriculum on the continent has this obligation.
In any case, Power’s work is actually a social scientific inquiry into knowledge itself, part of an emerging literature about the sociology of knowledge (Bourdieu, 1990; Cant & Sharma, 1996; Kuhn, 1970; Leslie, 1980; Power, 2000; Stacey, 1988, 1992; Woolgar, 1988; Yawney, 1991). One contribution of her work is that it provides a remarkable compendium of definitions associated with the “art” and “science” of “holistic medicine.” In this regard, Power found “few statements that contained direct claims for holistic medicine being an art” (2000, p. 128) at the same time as she discovered a much larger “representation” of material on the science of holistic medicine. She commented, “It was used as powerful symbolic capital in political struggles between groups of health workers” (Power, 2000, p. 129). Fascinating for us in the naturopathic educational field is the critical value of such a social scientific debate as that which Power summarizes, in the derivation of a deeper, theoretical framework of knowledge for the medicine we cherish. Power’s work is characterized by such statements as “There is knowledge other than the scientific; we need a new form of science and medicine. Instinctive common sense and experience are good enough; and Medicine is not scientific anyway” (2000, p. 162).
In an effort to define knowledge itself, a delightful question for the professional educator, Power chooses holistic medicine (in which catchment group naturopathic medicine is included) as one key example of a “body of knowledge in the process of construction” (2000, p. 24). She concluded that “knowledge is embodied but not individualized, is public and personal at the same time, and deeply political” (Power, 2000, p. 11). Power observed that, because holistic medicine as a body of knowledge was being formed and not clear in the minds of the general population and less clear in terms of having a place in the institutions and agencies of civil society, ideas about “medicine, science and people would be on display and thus would be available as data” (2000, p. 24). Using the word holism as a kind of barometer of the formation of a word within a system of knowledge, she triangulated patterns of use of the word by specific groups.
Bourdieu (1990) identified what Power was attempting. In his view. this is the “real task of the sociologist in describing the logic of the struggles over words” (Bourdieu, 1990, p. 55). Power tried to identify who “appeared to be ‘formally’ constructing holistic medicine, and who was left out” (2000, p. 29). A special burden of Power’s work here is that she reviewed abundant textbooks in psychological medicine, psychosomatic medicine, medical practice (specifically physician-patient relationships), and holistic medicine itself. She included newspapers, magazines, and journals in her review as well. She journeyed through texts emerging from the British Holistic Medical Association, the Research Council for Complementary Medicine, and turned to the ASLIB (a libraries directory) to amplify the search. In 1984, she discovered that, although the ASLIB did not use the terms holistic medicine, complementary medicine, or alternative medicine and although she took the trouble to study a list of library current holdings in the same year, which showed no major relevant pattern, she did discover that during the same period a majority of the dictionaries used in the health and medicine fields were indicating “an emergence of a body of knowledge and also thereafter of changing perceptions of holistic medicine” (Power, 2000, p. 32).
Power’s work eventually pointed out “a sudden emergence of the word ‘holistic’ as applied to medicine and health care” (2000, p. 127) She added that there was “evidence of a general conflation of the labels ‘alternative’, ‘complementary’ and ‘holistic’” by 1984 (Power, 2000, p. 127). Why this is even important is that part of our challenge in the second decade of the second century of our medicine, there is widespread misunderstanding of what naturopathic medicine actually is in order to distinguish itself from the dominant octopus of allopathic biomedicine.
We are not without beginnings in this work, however. Many of our own profession’s scholars have contributed to the long-emerging conversation about what the essential, codified knowledge of naturopathy or naturopathic medicine actually is. Cody (1985), for one, explains that the term naturopathy itself can be traced back to the teachings and concepts of Benedict Lust. Like osteopathy in the beginning, when the frontier physician Andrew Taylor Still established it as a powerful alternative to the allopathic medical thought of the 19th century, the energy of naturopathy emerged from its professional formation intentions, as well as from its “social movement” characteristics. In turn, both of these influences had to be grounded in an essential “epistemology of osteopathic theory” (Zuger, 1998). In this sense, Cody described naturopathy or nature cure as “both a way of life and a concept of healing employing various natural means of treating human infirmities and disease states” (Power, 2000, p. 17). Smith and Logan, 2 decades later, pointed out that naturopathic medicine was a “unique system of primary health care that is not limited to a single modality of healing and cannot be identified with any one therapeutic approach” (2002, p. 173). Their reported difficulty lay in distinguishing the essential “knowledge” of the medicine from other “systems,” which included parallel and intersecting information, principles, and practices.
In an editorial in The Naturopathic and Herald of Health, Benedict Lust in 1902 explained that naturopathy was “purposely a hybrid word” (p. 262). Alluding to the therapeutic practices of nature cure physicians, homeopaths, and other healthcare practitioners—such as Connaro (nutrition and fasting), Priessnitz (hydrotherapy), Woerishofen (the Kneipp cure), Kuhne (serotherapy), Macfadden (physical medicine), Willmans (mental science), and finally A. T. Still (osteopathy)—Lust proclaimed a “new medicine” whose scope and “essential knowledge” would encompass every “life-phase of the id, the embryo, the fetus, the birth, the babe, the child, the youth, the man, the lover, the husband, the father, the patriarch, the soul” (1902, p. 4). Initially, Lust had been especially interested in the hydrotherapy principles and practice of Sebastian Kneipp. However, Lust called his new and eclectic naturopathy the “medicine of the future” (1902, p. 78).
These descriptors, though, do not capture or express more than the barest beginnings of an epistemology of naturopathic medicine. Smith and Logan (2002) indicate that the actual term naturopathy came from a word coined by the German homeopath John Scheel. Dr Scheel, it is reported, formed the word from a combination of Latin and Greek to translate literally as “nature disease.” The term, then, is an actual misnomer but now widely describes an approach to natural medicine encompassing an eclectic group of therapies, which is all the more reason for a demarcated body of knowledge, defensible and dynamic, to protect its place in civil society. A further complicating factor, referenced by Smith and Logan, is that any undertaking that defines and demarcates “naturopathic knowledge” must take care to explain that the understanding of “naturopathic medicine” and “naturopathy” varies among many geographic locales and regulatory jurisdictions.
In 1902, Benedict Lust had a practice that focused principally on medical herbs, hydrotherapy, and exercise. He began to promote the concept and term naturopathy from a professional platform as a licensed osteopathic physician. To these therapies, he gradually added homeopathy and “manipulative therapies.” Noteworthy is that Lust quickly abandoned his earlier investment in a string of “Kneipp societies” in Manhattan, Brooklyn, Boston, Chicago, Cleveland, Denver, Cincinnati, Philadelphia, Columbus, Buffalo, Rochester, New Haven, Minneola (Long Island), New Mexico, San Francisco, and elsewhere (Wendel, 1951). The definition of naturopathic medicine and the knowledge informing its identity were moving targets from the outset.
While Bloomfield explained that “naturopathy for some people means all the forms of non-allopathic medicine which depend on ‘natural’ remedies and treatments” (1983, p. 116), Twaddle and Hessler insisted that “American naturopathy appears to be an heir of the Thomsonian, eclectic and homeopathic movements” (1987, p. 219). At the same time as Lust was promoting naturopathy, Andrew Taylor Still was promoting osteopathy and D. D. Palmer was establishing chiropractic aggressively all over America. As well, Henry Lindlahr, a German-born naturalized American, was establishing a sanitarium in 1903 in Elmhurst, Ill., along with the Lindlahr College of Natural Therapeutics, and contributing to an early unifying treatise on the essential epistemology of naturopathy.
Our medicine has continued to evolve for over 100 years, and conversations about its nature and impact ultimately and inevitably began to move across disciplines. These early filaments of a social definition of naturopathy have even begun emerging in a broader academic discussion about not only the nature of the medicine but also as part of an effort to define the essential knowledge within naturopathic medicine itself.
Bourdieu (1990) understood what Power was attempting. In his view, it was the “real task of the sociologist in describing the logic of the struggles over words” (Bourdieu, 1990, p. 55). Bourdieu explained that the search is to identify who “appeared to be ‘formally’ constructing holistic medicine, and who was left out” (1990, p. 29).
Power’s method, in any case, is worth a look. It is fascinating for those interested in exploring various definitions of “integrated or integrative medicine” since the allopaths are busy as ever scooping whatever they please, but without a consistent integrity or respect for those who have held the sacred space of what Foss called “medical ontology” (Foss, 2002, p. 5). Power’s work eventually pointed out “a sudden emergence of the word ‘holistic’ as applied to medicine and health care” (Power, 2000, p. 27). She warned us that there was already by 1984 frustrating “evidence of a general conflation of the labels ‘alternative’, ‘complementary’ and ‘holistic’” (Foss, 2002, p. 127).
Significantly, at about the same time, the U.S. naturopathic profession at Rippling River, Ore., itself was zeroing in on a definition that quickly enjoyed a wider circulation than previously. Today, the FNM Project is finally codifying the knowledge of a profession that is increasingly part of the fabric of modern life and knowledge. We need to be grateful for that work and keep it going somehow.
David Schleich, PhD is president and CEO of NCNM, former president of Truestar Health, and former CEO and president of CCNM, where he served from 1996 to 2003. Other previous posts have included appointments as vice pres-ident academic of Niagara College, and administrative and teaching positions at St. Lawrence College, Swinburne University (Australia) and the University of Alberta. His academic credentials have been earned from the University of Western Ontario (BA), the University of Alberta (MA), Queen’s University (BEd) and the University of Toronto (PhD)
Bloomfield, R. J. (1983). Naturopathy. In R. Bannerman, J. Burton, & C. Wen-Chieh (Eds.), Traditional medicine and health care coverage: A reader for health administrators and practitioners (pp. 116-123). Geneva: World Health Organization.
Bourdieu, P. (1990). In other words. Cambridge: Polity Press.
Cant, S., & Sharma, U. (Eds.). (1996). Complementary and alternative medicines: Knowledge in practice. London: Free Association Books.
Cody, G. (1985). History of naturopathic medicine. In J. E. Pizzorno & M. T. Murray (Eds.), Textbook of natural medicine. Seattle: John Bastyr College Publications.
Foss, L. (2002). The end of modern medicine. Albany: State University of New York Press.
Gevitz, N. (1994, April 1). “Parallel and distinctive”: The philosophic pathway for reform in osteopathic medical education. The Journal of the American Osteopathic Association, 94(4), 328-332.
Kuhn, T. (1970). The structure of scientific revolutions. Chicago: University of Chicago Press.
Leslie, C. (1980). Medical pluralism in world perspective. Social Science and Medicine,14b, 191-195.
Lust, B. (1902). Naturopathy vs nature cure. The Naturopathic and Herald of Health, 1(3), 262-263.
Power, R. (2000). A question of knowledge. London: Prentice Hall.
Smith, M. J., & Logan, A. C. (2002, Jan.). Naturopathy. Complementary and Alternative Medicine, 86(1), 173-184.
Stacey, M. (1988). The sociology of health and healing. London: Unwin Hyman.
Stacey, M. (1992). Regulating British medicine: The General Medical Council. Chichester: John Wiley.
Twaddle, A. C., & Hessler, R. (1987.) A sociology of health care. New York: Macmillan.
Wendel, P. (1951). Standardized naturopathy: The science and art of natural healing .Brooklyn, NY: Paul Wendel Inc.
Woolgar, S. (Ed.). (1988). Knowledge and reflexivity: New frontiers in the sociology of knowledge. London: Sage.
Yawney, C. (1991, March). Evaluating complementary medicine: The social construction of choice. Paper presented at the British Sociological Association Annual Conference at the University of Manchester, Manchester, England.
Zuger, A. (1998, Feb. 17). Scorned no more, osteopathy is on the rise. New York Times. Retrieved June 16, 2012, from http://www.nytimes.com/1998/02/17/science/scorned-no-more-osteopathy-is-on-the-rise.html?pagewanted=all&src=pm