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The Holistic Approach: How It Works

A Case History

The holistic (body-mind-spirit) approach to health, healing, and quality of life surpasses by far any of the several I've used in half a century of practicing medicine. The best way I know to give you some idea and feeling for what it is and how it works is with a case history. This is a remarkable story: Enjoy!

When I greeted Jane, my new patient, in the waiting room, I got the impression of severe tenseness and quiet desperation. It took me longer to notice her determination to do whatever it took to get her life back. I had no idea that we were about to form a remarkably effective therapeutic alliance to resolve a serious complex of health challenges.

Jane is in her 50's, married, and has one child. She works in a large research organization.

Once in the consulting room, I soon found out why I got the impression of tension and desperation. Jane had significant physical, emotional, and relationship challenges that were impacting her life at home and at work. Physically, she had fatigue, severe hot flashes, insomnia, total body pain, headaches, increased body fat, dry skin, brittle nails, and decreased cardiovascular endurance. Emotionally, she was depressed.

There were relationship issues at home and at work. At home, the tension was high between Jane and her husband. Communication was minimal. He had erectile dysfunction. When he delayed his return home from a business trip because of an injury, she suspected that there was a different reason. She felt angry with him because of his behavior toward her and their inability to communicate is a satisfying way.

At work she felt overwhelmed. Coworkers had found that they could ask Jane to do their work for them and she couldn't say no. She would agree to do it and then feel angry with herself for agreeing and angry with them for asking. She lived with anger at work and at home.

As I listened attentively to Jane as she told her story I noticed that her manner was tense and her movements were jerky. Her face was slightly puffy and her complexion had a cloudy quality. The lateral third of her eyebrows was missing. These signs suggested hypothyroidism. So did several of her symptoms including fatigue, depression, insomnia, dry skin and brittle nails. The severe hot flashes suggested progesterone and probably estrogen deficiency.

After hearing her out, I described to her the following strategy: improve her biochemical balance by beginning a basic nutritional supplement program and supplying the hormones she was evidently lacking. At the same time, we would begin to address her relationship issues at home and at work. She agreed to this strategy.

I began by asking her to

Biochem optimization starts here: Next, I prescribed a basic nutritional supplement program: Essential Nutrients (a high potency multivitamin-mineral supplement), optidose vitamin C (the maximum she can take without getting excessive gas or loose bowels), Super EPA (high-quality concentrated fish oil), and progesterone compounded in a transdermal cream.

At the end of the first consultation I felt that we had connected, formed a therapeutic alliance, and that she would make good progress.

First follow up, 4 weeks:
When she returned in a month for her first follow up visit, she actually had made good progress. All of her symptoms were 50% better except for total body pain, which was 80% better and headaches, which were 50% worse. She thought the worsening headaches were associated with increasing conflict and tension with her husband.

Her lab work was in. the important findings were

We were both pleased with her progress, which I thought was due mainly to the support and hope that she gained from our relationship and the nutritional support program with the Big Three and progesterone.

Interventions: I asked her to continue her present program, begin a natural thyroid hormone (NatureThroid) and vitamin D 3000 IU twice daily, with a re-test in six weeks, and take the Enneagram assessment. The Enneagram is an online personality assessment that provides amazingly useful clues about the very early life experiences that shaped the personality and created social conditioning that had survival value at the time but now constrains and handicaps the person, usually without her being aware of it. What is even more important, it gives equally useful clues about what practical action one can take now to uncoil that early conditioning and slip free of it. I expected the Enneagram to give clues about what action Jane could take at home and at work to resolve the relationship issues that were at least as important as her biochemical imbalances in causing her suffering and desperation.

Master the mind begins here. 2nd follow up, 3weeks: She reported further progress. All symptoms had improved except hot flashes, which were slightly worse. Her depression was almost gone. Total body pain was completely gone! Headaches were much improved and she noticed that they occurred when she and her husband were having conflict. She felt a decrease in the tension between them. The look of quiet desperation was beginning to give way to hopefulness about her future.

By now, we had her Enneagram scores. The Enneagram gives uncannily valuable clues about three things. First, what early social conditioning created the particular personality type. Second, how that social conditioning, which had survival value at the time, now limits and hinders the individual from being the best person he/she can be. Third and most important of all what practical action he/she can take now to uncoil the conditioning and get free of it.

Jane's Enneagram indicated that her primary personality type was Helper. The characteristic early family situation of people of this personality type is rejection by the father or father figure. This creates the basic fear of being without love because one is unworthy of love. Rejection by the father and the resulting basic fear give rise to a particular set of beliefs that one must put other's needs first, one must give in order to get, and one must earn love because it will not be given. There is also the belief that if one sacrifices now, love will come in the future. Since the unconscious motive for the Helper's helping is fear, the expectation of love coming in the future is usually frustrated. The Helper over time becomes increasingly angry, bitter, and begins to demand love from others, which of course drives others away. So the Helper is likely to create the very situation he/she fears the most.

Fortunately, it doesn't have to be that way. Different action produces different results. At that point I began to guide Jane toward some different actions. She needed to do some different actions at home and at work. I made a tactical decision to ask her to start at work since that would be easier than starting with her relationship with her husband. The husband/wife relationship is usually the most intense and difficult to change and I wanted Jane to have some successes in less challenging relationships before she took on the most difficult, and important, one.

Interventions: Continue all supplements and hormones.

Her assignment at work was, whenever someone asked her to do their work for them, instead of immediately agreeing as she was socially conditioned to do, she would stop and ask herself, "Should I say no?" I did not suggest that she actually say "No", just ask herself the question.

At home, I asked her to begin to make some observations. First, she was to observe and journal her behavior when she was in conflict with her husband. She was to notice and journal what she actually did. Second, she was to try taking 100% responsibility for the situation between them. Notice that I was not asking her to change her behavior toward him, just to increase her awareness of what was actually going on.

The guidance to take 100% responsibility always gets some interesting responses. About half of my patients are so socially conditioned to play the blame game that they immediately reject the guidance. The social conditioning says, "To err is human; to find someone to blame it on is genius." For those who try accepting 100% responsibility, the surprising result is an immediate increase in their feeling of personal power and belief in self. They are actually claiming their ability to respond to the situation (responsibility = the ability to respond) instead of reacting to it as they always did before, with predictably unsatisfactory results. Reacting is determined largely by social conditioning rather than the reality of the situation existing at the time, so the reactive behavior is always basically the same, inappropriate to the present situation, and consequently nothing changes for the better.. Insanity has been defined as continuing to do the same thing and expecting a different result.

Awareness evolution evident here; e.g. it does not destroy me when people are angry with me or disapprove of me. When I stand up for myself if feel warmth instead of loathing for myself. 3rd follow up, 2 weeks:
Everything improving except hot flashes, which were worse.

At work she was stopping to ask herself, "should I say no?" when people asked her to do some of their work for them. Soon, she was going beyond asking herself and sometimes actually saying "no" or "I have some of my own work to do now but I'll do yours later." Just as she feared, most people acted offended to one degree or another. She discovered, however, that their acting offended didn't kill her and, even more surprisingly, she began to feel warm inside because she was standing up for herself instead of loathing herself for agreeing to do what she knew wasn't right.

At home, tension was still high with husband and there were some angry exchanges.

Interventions:
Begin estriol (the anticancer estrogen) transdermal for hot flashes Continue to develop ability at work to discriminate when it is appropriate to help and act accordingly.
At home, observe her emotions in encounters with her husband. Journal her observations This had the potential for creating a breakthrough for the relationship because observing her emotions instead of reacting to them would evolve her awareness and, more importantly, break her emotion's power to control her behavior. Emotions unobserved exercise control of behavior; emotions observed lose their power to do so. This permits response instead of reaction, and the response, which is new behavior, reaches back and begins to uncoil early social conditioning. It also changes relationships because when behavior changes, relationships change.

Biochemical balance on the level of physical activity. 4th follow up, 2 weeks: All symptoms were improved except for excess body fat.

Tension with husband was decreasing. They were talking more and beginning to laugh together and to enjoy one another's company.

Relationships at work continued to improve.

Interventions:
Begin walking or swimming for 45 to 60 minutes four days per week Begin tai chi. At home and at work, practice receptivity: listen with every fiber of your being to what is being communicated. Then decide what is true and useful for you and act on it. Begin to observe your motives and actions as well as thoughts and emotions.

<5th follow up: 3 weeks:
Overall symptoms were 70 % improved. Life was going well at home and at work. I asked her what she thought were the most important factors in her excellent progress. Her response: practicing receptivity instead of resistance, clarity gained from observing and journaling her thoughts, emotions, motives, and actions, the nutritional supplements and hormones, and taking 100% responsibility for her situation and relationships.

Interventions:
Increase dose of estriol, since hot flashes were not improving as rapidly as her other symptoms.
I cautioned her to beware of the backlash that always follows a breakthrough.

Further evolution of awareness: know Jane better. Doing what makes her heart sing. 6th follow up: 3 weeks
Symptoms 80% improved.

She was now rapidly climbing four flights of stairs at work without giving out of breath. In fact, she was able to carry on conversations while climbing the stairs. She previously had to stop several times on the way up because she was short of breath.

She had rediscovered her love for gardening and landscaping and was taking a landscaping course. When there was an open house for participants and their friends, Jane's husband, daughter, and son-in-law asked to attend because Jane was "so full of life" that they wanted to see what she was enjoying so much. This filled Jane with warmth and joy.

I asked her what she thought would be most helpful to continue her splendid progress. Her response: "Know Jane better."
"That's exactly right," I responded.

Evolution of awareness: perhaps I can do for her what my mentor did for me. 7th follow up: 3 weeks
Symptoms 95% improved. She has launched a part-time landscaping business and finds delight in working with her customers to create beauty with plants and shrubs.

Taming and training the Princess.
At work, Jane had been dealing with a coworker, a woman of striking physical beauty, who used this asset to manipulate others to do her bidding. When Jane no longer acquiesced to the Princess' wishes, she was shocked, then angry. By this time, Jane had attained the personal power and skill to remain open and receptive to the Princess while continuing to say and do what Jane considered appropriate in each situation. When the tension between them was high, Jane remembered an older woman who had once been her mentor, helping Jane build her skill in doing her work. Jane then said to the princess, "I won't do your work for you but I will show you how to find the information you need to do it for yourself." Princess accepted the offer, and Jane became her mentor. The princess' regal outrage gradually evolved into respect and then, warmth. She expressed her appreciation to Jane for teaching her how to increase both her effectiveness in her job and her self esteem.

Jane was able to observe a similar progression with most of the other people in her department: first, anger when Jane no longer did their work for them; then respect, then in some cases, warmth. One coworker sometimes dropped by Jane's desk and, with a warm smile said, "I really like the new you!"

8th follow up: 3 weeks
By now, she has cleared all of her symptoms except excess body fat, which was disappearing steadily at a healthy rate. She was enjoying her relationships with her husband, daughter, and coworkers. Her landscaping business was flourishing. She looked 20 years younger. Her comment, with a big smile, "Life is good!"

Interventions:
We discussed the concept that harmony and new knowledge only come into being out of conflict skillfully done. For awareness and new knowledge to evolve there must be an ongoing cycle of conflict resolving into harmony. I wanted her to know this so that when the next conflict arises she is not be alarmed but can embrace it and use the process that had already worked for her to resolve the next conflict into harmony. In this way she will gain more knowledge and personal power and those around her will benefit just as her husband, daughter, and coworkers already have.

She is to continue her supplement and hormone program.

9th follow up: 5 weeks
She told me that this would be her last visit. Her husband had been given another overseas assignment for an indefinite period. This time, he asked her to accompany him. He said, "I want to come out and play with you. I used to want to do that and then for a while I didn't. Now, I want to come out and play with you again." This conversation and invitation made her heart sing.

We discussed how she could continue to get her supplements while overseas, how to get medical consultation there, and have a telephone consultation with me in three months.

I gave her an order for the lab work she would need before her departure.

Summary
Can you see

I am happy for Jane and honor her for giving us a brilliant example of what can be accomplished when one concurrently accesses the healing power of body, mind, and spirit. This is also an excellent example of the operation of the therapeutic alliance between patient and physician. To me, the functioning of this alliance, also known as intelligent cooperation, is the most heart warming and fulfilling part of the practice of medicine.