Third European Congress on Systems Science

Alberto Ricciuti

A.I.R.S. (Associazione Italiana per la Ricerca sui Sistemi) Member

Medicina Naturale Scientific Editor

via Decembrio, 18 - 20137 Milano (Italia)

tel./fax: + 39 (2) 5454011

Résumé - Le recours de plus en plus fréquent à des méthodes de soin naturelles, plus respectueuses de l’unité de la personne, est considéré, par de nombreux auteurs, l’expression dans la médecine du changement de paradigme en cours dans la culture actuelle. Toutefois le passage entre le soin de la "maladie" au soin de la "personne" paraît souvent comme ayant seulement l’aspect d’un élargissement du champ de vision du médecin, qui continue de se voir lui-même comme l’observateur neutre d’une réalité extérieure. Le vrai changement de paradigme demande la prise de conscience de la part du médecin que, dans son rapport avec le patient, il n’administre pas seulement ce qu’il sait mais aussi et surtout ce qu’il est. A ce point le comportement éthique ne s’epuise plus avec la simple application de principes corrects, mais se rapproche plus d’un ensemble d’actions dictées par la compréhension de ce que peut être le bien pour le patient.

Summary - The growing tendency to have recourse to natural cure methods, with a greater respect of the person as a whole, is considered by many authors as the medical expression of the paradigm change of modern culture. Nevertheless the evolution from "illness" care to "person" care only seems to have the appearance of a widening of the doctor’s field of vision, which still sees himself as a neutral observer of an external reality. The true paradigm change requires the doctor to become fully conscious that, in his relation with the patient, he doesn’t only administer what he has but also and above all what he is. Therefore the ethic behaviour doesn’t merely sum up in the application of correct principles but gets closer to acting accordingly to can be the patient’s well-being.

The contemporary man’s dilemma - and maybe that of all ages - seems to take shape in the difficulty in finding the right balance between the necessity of self-assertion and the innate need to elevate himself to the universal.

The respective answers to these needs often wave between the dreariest individualism and the attractive seduction of some ideology. Both answers, if taken to the extreme, generate some kind of senses and soul narcosis which make one insensitive or indifferent to solidarity and justice, to right and freedom, to truth and beauty.

On the contrary, the right balance is never extreme. It can only be reached through wisdom, which, in a constant search for meaning, allows the anonymous individual to ascend to the level of "person" and lets the ingenue closure of ideologies to open up to dialogue and to the values beyond it.

Nowadays, such ascent and opening are deeply needed in medicine and Health: need for the doctor to fertilise his technical-scientific competence with renewed Ethos, need for the medicine to think over its epistemological foundations and to find out research and care methods more oriented to the person than to the illness.

The recourse to medical practices more opened to the biographic dimension of pain and not only to the impersonal biological dimension of the illness is greatly increasing. The body is no longer considered an agglomerate of single parts but a global unit emerging from a complex net of relations. Illness, or health, is less and less felt as a "condition" but a "process", i.e. no longer as a single damaged part of the "body machine" but as a complex existential event which often generated from a discordance in behaviours and relationship of the person with itself, with others, with the environment.

From medicine one no longer expects (except in some particular situations mostly connected to an emergency) some impersonal repair service but a global help in finding lifestyles and behaviours that will provide a general well-being.

This is unanimously pointed out by all studies and researches of social medicine published during recent years and such a phenomena progressively increases with the instruction degree of people, reaching its top at high school and university level.

To persist in considering this phenomena as a fashion or as a consequence of the plethora of young doctors looking for an occupation is naive and straying. Reasons, more complex, must be found into the historical and psycho-social dimension of today times: into the emergent bio-ecological culture, into the need of respect for the person peculiarity and his individual and social beliefs, into the slow rising of a culture of right and solidarity.

If we want the medicine to continue to help people, to effectively support them through their slow evolution path, a careful reflection upon these themes becomes an essential step, because it makes the doctor redefine the epistemological and methodological fundamentals of his professional praxis and to wonder upon the most authentic meaning of his role, upon his hopes and fears. If it is true that, in means of technical-scientific knowledge, the doctor administers the patient what he has, it is also true that on human and communication levels, he administers what he is. And an inappropriate intervention on these levels might be as devastating for the person as a technically incorrect intervention.

In an attempt to answer to these needs there has been, in recent years, a continuously growing recourse to different medical practices which belong to the wide world of Natural Medicine.

Among these different practices two main streams emerge: on one hand the persistence of behaviours radicalised on rigid doctrinal positions, which remain in strong conflict with the academic traditions of medicine, and which deliberately put themselves into the blind alley of the alternative medicine ; on the other hand more opened, ‘in between’ positions, which seek an interface with the actual scientific knowledge in the intent to widen their respective knowledge and to integrate different methodologies of diagnosis and care.

This second position, which tends to prevail, is undoubtedly the most fecund and the only which may allow the promotion and diffusion of a systemic approach to health problems.

Thus Natural Medicine must be seen in the strong meaning of a medicine which operates in respect of the person’s nature, without preconceived ideological closures and instrumental restrictions, and not in the weak and naive meaning of a medicine which only employs natural care instruments which we might therefore call naturalistic.

And by saying "person" I mean a rational being, with the capability to express sentences, to acknowledge the truth on good and evil, to interact more consistently with his environment, to effectively achieve high value aims. Thus, a "moral animal" in which medicine can recognise the significance of psycho-biological process which specify his uniqueness only trough a global approach, in his complexity of inseparable body, made of flesh and soul.

Facing such a large theme, I consider that getting entangled with vain and stale polemics about official medicine, alternative medicine, etc. is awkward and reductive. This is not the question. If it ever was before, it is not now.

What is now happening doesn’t come from a revision of scientific theories (historically, this has always happened immediately after), but from a new way of feeling and experimenting life which force science, consequently, to revise its own theories.

Admitting the ever more frequent recourse to natural methods, to doctors practising natural medicine in the definition I gave in the beginning (it is not the same thing...), is only meant, here, to wonder about the meaning of all this, in order to draw helpful indications for the future of medical praxis, on individual, social-economic and social-sanitary level.

If we orient our attention on great medical systems born in different social-cultural contexts, such as Chinese and Ayruvedic medicine or the "new born" homeopathy, looking more for what they have in common than what separate them, in the intent to understand why more and more people look up to them, I think we can point out three essential arguments:

1. The conception of man as an indivisible and not reproducible unity in his spiritual, mental, and physical aspects which constitute his nature of "person".

2. The "diversity" not as a chaotic ground noise which hinders medical and practice research but as a precious wealth to be used as information and resource, orientated to the change and to the re-harmonisation of the behaviours and life style of the person.

3. The aim of medical praxis is not recovery but the strengthening of self-organising and self-repair capacities of the human being, through stimulation, support and re-harmonisation of personal resources. Thus recovery does not belong to the sphere of medical praxis but to that of possible achievements.

Thus, the patient is asked to actively and consciously participate to the care process and to exert his responsibility in re-organising his new life style. Recovery might even be easier and more durable.

On these basis, the effectiveness and potential utility of medical intervention is never reduced, not even when the patient’s energy and hope of survival is reduced to a narrow gleam.

On these same basis, one can overcome the mortifying sentence "there is nothing else that can be done" that the doctor says to himself - even before than to the patient - in those situations in which the omnipotent aim of obtaining recovery is no longer achievable, and which turns away, often even physically, the doctor from his patient, one with a feeling of frustration and impotence, the other with a feeling of loneliness and abandonment.

The content of these three fundamental assessments can constitute the heart of an ambitious project of re-foundation of medical culture and the overcoming of limits, clear to everybody by now, of the actual bio-medical system.

At the contrary those same Medicines can get enormous benefit from dialoguing, without prejudice, with the technical-scientific knowledge and his great theoretical and practical potentialities.

I have always been convinced that the wisest path we can and should follow goes through an integration of these different methods of research and care, allowing the overcoming of mutual limits.

This could offer to the doctor a human and professional re-qualification, a clinical eye oriented to the totality of the person and a better capacity to achieve decisional strategies more sensitive to the environment ; for the patient a more satisfying relation on the communication level, more efficient on the diagnosis-therapy level and more attractive in promoting, if necessary, useful reflections on his lifestyle.

So, this theoretical and practical approach finds his definition in the concept of "therapeutics alliance", that well expresses the solidarity, trust and respect which qualify the relationship between doctor and patient and is the fundamental presupposition of each other’s responsibilities.

The latest research on social medicine shows that this process has already been initiated, pushed by an irreversible change of the health demand. Thus, it is dutiful to try to make it explicit through organised forms of thoughts and actions which permit to sustain and promote the passage towards what seems to emerge as the new social-cultural paradigm.

The doctor has always positioned himself - founding his role on this pretence - as a neutral external observer of the illness and the mechanisms that determine its evolution. The reasons behind this attitude transcend medicine itself and are to be found in the wider classical conception of the world and nature that started with the works of Newton, Descartes and Bacon and evolved in the last three centuries.

Yet the belief that natural phenomena can be observed neutral, as if they happened "out there", in an absolute space and time, ended with the revolutionary discoveries made by great physicists at the beginning of this century. Even only through observing a phenomenon the observer interacts with it and modifies it.

This is not the place to go through this complex though well known theory. On the other hand, though it might seem a bit daring to apply tout court these concepts to medicine, it is true that there seem to be strong connections on different levels. On the communication level, for example, doctor and patient interact and are both modified by that relationship.

But even amongst doctors who practise the so-called natural medicine, and who often claim direct cultural influence of that assertion and its practical implications, it is not always perfectly clear. We do talk about the patient as a person, about the importance of therapies that respect vital process, about an olistic vision, with care for the man and its relations. But the image that the doctor still has of its role is often that of the ‘old’ observer that tends never to question himself nor its objectifying look. Observer of a reality, undoubtedly more complex, but towards with he still keeps distance. The depositary of a knowledge, maybe richer and more articulate - in accordance to the modern complexity theories he often refers to - but which is, in many cases, administered to patients through new forms of ‘indoctrination’.

But is this the only change in medicine? Can we be sure that the arrival of new psycobioecological theories is sufficient for an evolution of medicine and Health not only on an individual level but on relational and social levels as well? I don’t think so.

In other words what I’m saying is that the man who addresses another man in his global existential dimension is still another man who casts himself in that story. We doctors are primarily using ourselves as an observing instrument, even while using technological prosthesis to amplify the perception capabilities of our sense-organs. It is to our being a ‘person’ that we need to turn our attention to, to educate ourselves to a new sensitivity, more perceptive to the human universe we establish a relationship with.

And when I talk about perception I mean much more than the bare data that our senses can point out. I’m talking about the capability to live the empathic experience that gives access to the understanding of the other ‘person’, that helps to formulate a clinical judgement centred on the patient and not only on the illness, that allows to freely and naturally modulate the expression of communication and the therapeutic strategies at the same time. I am talking about the clinical look centred on the person that the bare practice of scientific-technological knowledge seems to have shadowed.

I’m not talking about a new way of ‘practising’ medicine, but a new way of ‘being’ doctors: a way that needs us to listen not only to our being doctors but also to our being patients, thus reaching a greater consciousness and consistency with ourselves before confronting the patients, so to transmit them our hopes and not our fears. Because what the patient feels more intensely is the way we are, if what we are asserting is the frank expression of our consistency or if we are only reading some impersonal script. I believe that the change that’s undergoing in medicine cannot be limited to the recovery or re-elaboration of old or new theories that support alternating therapeutic approaches, but is destined to strengthen in a change of how the doctor ‘resounds’ in front of the patient’s life story.

I consider every attempt to grant the imprimatur of ‘natural’ only to doctors that follow certain prescription modalities, as some would wish, to be awkward and imperialist. It is an offence to personal freedom and a margination of natural medicine and of its anthropological vision, in a limited and short-sighted naturalistic sphere unable to get rid of its old paradigm.

The future of medicine will be determined by the consciousness and unconditional respect of the central role of the person and on behavioural consistency. The capability of balancing with due care and wisdom diagnostic interventions and therapeutic choices will therefore be its logical and natural consequence. To change the medicine, in practice, we have to change the doctor and the perception of his own role inside the relationship with the patient.

It would be a great mistake to consider these assertions as purely aesthetic. Measuring with new theories is only a part of the evolution path of the doctor, the part that deals with the intellectual knowledge of different points of view on life. But medicine is a practical activity, is giving body to what we are. Because, amongst the theories that intellectually support their work, men choose those that better adapt to their vision of life.

But putting into practice a new way of being always requires an internal discipline, i.e. a method of mental hygiene. It is, therefore, during his professional training that the future doctor should be initiated with method to that reflective and introspective practice which will allow him, by confronting his own doubts and fears, to develop empathic sensitivity and ethic behaviour. This will help to reach a greater ease in proportioning himself and his intervention in the relationship with the patient. The load of anxiety and responsibility sometimes connected to the alliance with the patient, and which is often responsible for the ‘flight’ into an excessive (and expensive) prescription of numerous diagnostic exams and useless, if not harmful, therapies, could therefore be greatly lightened.

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