A HOLISTIC APPROACH TO STRESS MANAGEMENT

* Author’s Note: This passage was adopted from the book Managing Stress, Principles and Strategies for Health and Wellbeing, Jones & Bartlett Publishers, Sudbury, MA, 1999. Our purpose in presenting it here is to provide instructors with some additional insight to the direction of mind/body research and medicine and the future direction of this aspect of the human condition of which stress management is so great a part.

When the stress response was first recognized, much attention was placed on the physical aspects of the mechanisms involved with fight or flight, specifically the symptoms of stress. As this field of study expanded to explore the relationship between stress and disease, it began to overlap and to some extent, even merge with the fields of psychology, sociology, physics, and clinical medicine. What was once thought to be a physical response, and then referred to as a mind-body phenomenon, is now suggested to be a complex multifaceted or holistic phenomenon involving the mental, physical, emotional, and spiritual components of well-being. Looking at stress from these four different perspectives may explain why there are so many varied definitions of stress. Ironically, this new insight itself has produced some tension within the community of health care professionals, and here’s why.

Medical science is slowly experiencing a paradigm shift. A paradigm is a conceptual model to understand a common reality. A shift is a change in the perception of that reality. For the past two hundred years or more, the Western world has adopted a mechanistic model of reality, due in large part to the philosophical beliefs of Rene Descartes (the mind and body are separate entities) and the laws of physics created by Isaac Newton, which are believed to be inspired by the Cartesian Theory. The mechanistic paradigm compares the universe and all its components to a large mechanical clock where everything operates in a sequential form, largely by chance (or stated another way, no divine strategy). In this period of human knowledge in the Western culture, the mechanistic model (also called the reductionist model) seemed to logically explain nearly every phenomenon.

The field of medicine, strongly influenced by Newtonian physics, applied the mechanistic model to the human organism, comparing the body to a clock as well. The mentality of this applied paradigm, what Dr. Larry Dossey calls ERA I Medicine (for a greater explanation read Dossey’s books, Space, Time and Medicine, or Recovery of the Soul), focused on symptoms of dysfunction. Like watch repairmen, physicians were trained to fix or repair any parts that were broken. Drugs and surgery became the primary two tools forged in the discipline of clinical medicine. Prime examples of the fix or replace method include the prescription of penicillin and organ transplants, respectively.

To no surprise the application of this mechanistic model in medicine virtually stripped the responsibility of healing away from the patient and placed it completely into the hands of the attending physician(s). To be quite honest, there is no denying that many advances in clinical medicine have been nothing less than astonishing, such as heart and liver transplants and total hip replacements. Yet with these magnificent achievements there are significant limitations and side effects; medicine is aptly referred to as an art as well as a science. In this mechanistic model of reality, anything that cannot be "measured" or quantified has virtually been ignored. Moreover, anything that cannot be scientifically explained by cause and effect is dismissed as superstition and regarded as invalid. What this medical paradigm failed to include was the dimension of the human spirit, an immeasurable source of energy with a potential healing power all its own. This concept of the human spirit is considered so important by the World Health Organization (WHO) that it issued a statement saying, "The existing definition of health should include the spiritual aspect and that health care should be in the hands of those who are fully aware of and sympathetic to the spiritual dimension."

The Newtonian paradigm was viewed as the ultimate truth until recently, when a young physicist named Albert Einstein introduced his Theory of Relativity in 1905. In simple terms, Einstein said that all matter is energy, and furthermore, all matter is connected at the subatomic level. No single entity could be affected without all connecting parts similarly being affected. From Einstein’s view, the universe wasn’t a giant clock, but a living web. Breaking from Newtonian ideals, Albert Einstein supported an additional concept, called the "Unified Field Theory," suggesting that the universe is a living web of connected parts, giving rise to the ancient "whole systems theory" where everything connects together and the whole is greater than the sum of the parts.

Although today’s medical technology is incredibly sophisticated, physicians, for the most part, still view the human body as a clock with fixable or replaceable parts. In other words, the basic premise of modern medicine in the Western world has not changed in over 300 years. Furthermore, the mind and the body, so eloquently separated in theory by the philosophical perspective of Rene Descartes, are still treated separately, not as one living system. The idea of the yet to be understood complexities of the mind-body connection, which in some rare cases appear to make cancer tumors go into spontaneous remission, is as foreign a concept to most physicians today as the idea of a Sony Walkman would have been to the founding fathers of the United States two hundred years ago. But new discoveries in the field of medicine have not fit so nicely into the concept of a mechanical clock or reductionist theory. Instead, they mirror Einstein’s concept of an intricate network of connecting systems. As a result, standard concepts regarding health and disease are slowly beginning to give way to a more inclusive reality or paradigm. As an example, very recently medical researchers have learned that emotions can suppress the immune system, giving rise to the field of psychoneuroimmunology, a concept thought inconceivable and ludicrous only a decade ago. The "body as a clock" mentality no longer seems to answer all the questions posed in the framework of the mechanistic model. In fact, some issues like the placebo effect are being completely revisited.

Old paradigms are not abandoned until new conceptual models are created and established. Ironically some new paradigms are actually old concepts which are dusted off and reexamined. Such is the case with a very old, but newly discovered health paradigm, which by no coincidence strongly parallels Einstein’s basic theory. The wellness paradigm, a model conceived to understand human health, indicates that total wellness is the balance, integration, and harmony of the physical, intellectual, emotional and spiritual aspects of the human condition. These four components of total well-being are so closely connected and interwoven that at times, it is virtually impossible to separate and divide them. Although for the purpose of academia these areas are best understood separately, in reality they all act as one living interconnected system, just as Einstein hypothesized with the universe. At a deep level, many of us know the holistic theory to be intuitively correct, yet in moments of insecurity (or fear) we ignore this simple truth and instead give credence (and power) to a lesser concept of reality.

The word health is derived from the English word "hal," meaning to heal or to be made whole. Throughout the ages wholeness has been symbolized by a circle. The wellness philosophy states that the whole is greater than the sum of the parts. When applied to the practice of clinical medicine, this philosophy suggests that all aspects of the individual be equally treated and each considered as a part of the whole. Regrettably, conventional medical practice still treats the physical component (i.e., the symptoms of stress) with drugs and surgery, often disregarding how the body connects with the mental, emotional, and spiritual aspects of well-being. Some physicians refuse to acknowledge the similarities between stress and disease. On the other hand, non-traditional approaches, of which stress management is a part (specifically biofeedback, meditation, massage therapy, and mental imagery), are currently referred to as "alternative medicine" by the American Medical Association. Because the word "alternative" has a negative connotation to many practitioners in the field of holistic wellness, the words complementary and comprehensive medicine are now used to refer to additional healing modalities. Given this insight, it should be noted that healing and curing are two different concepts. Typically, the word curing means that a disease or illness is eradicated. While in some cases healing techniques may cure a person from disease or illness, the concept of healing really means to bring a sense of inner peace to one’s life, even in the face of death. From this vantage point one can see that a person may be healed and yet still be ill. In the age of high technology and instant gratification, expectations are often placed on the curing aspects (eradicating the symptomatic problems) rather than the essence of true healing. This in itself has caused tension in the allied health fields because many health care professionals trained in the mechanistic paradigm use both terms interchangeably. The tension doesn’t stop there. In 1993 a study published by David Eisenberg in the New England Journal of Medicine announced that over one-third of the American population seeks alternative methods of healing outside those accepted in the field of traditional medicine because they are unsatisfied with the western approach to health care. What makes this matter even more astounding is that these healing methods are not covered by insurance, meaning that people are paying out of their own pocket for these services. In the 1993 televised series entitled Healing and the Mind, creator and host Bill Moyers explained the trend this way, "There is a deep yearning for a human (whole) approach to medicine." Stress management techniques which attempt to deal with the causes as well as the symptoms of stress compliment this holistic approach.

COMPONENTS OF THE WELLNESS MODEL

If we were to take a closer look at the components of the wellness paradigm and the effects that stress has on them, we would see the following. Mental (intellectual) well-being is regarded as the ability to gather, process, recall and exchange (communicate) information. Exposure to stress tends to overload our mental circuits, thus decreasing the processing and recall abilities to make sound decisions. Physical well-being is described as the optimal functioning of the body’s major physiological systems (e.g. cardiovascular, digestive, reproductive etc.). From the observations documented in Selye’s research, the inability to return to homeostasis can prove fatal to various organ tissues and eventually the host organism. Emotional well-being is defined as the ability to feel and express the full range of human emotions and to control them, not be controlled by them. Anger and fear act as umbrella emotions which can collectively overload the emotional circuits resulting in mental paralysis, often leading to states of depression. Spiritual well-being is described as "the maturation of higher consciousness through strong nurturing relationships with both the Self and others, the development of a strong personal value system, and a meaningful purpose in life." Stress, in turn, can create a series of obstacles on the road to spiritual development, making the path to one’s higher self inaccessible. From a holistic perspective, to effectively deal with stress, all areas of the wellness paradigm must be equally addressed and nurtured; thus, the whole is greater than the sum of the parts.

Not long ago (and in some cases still today), many stress management programs were based on this mechanistic model, with the focus solely on the physical well-being. Upon the initial recognition of this association between stress and disease, courses designed to intervene in this process were created with an emphasis to use techniques to decrease the physical symptoms of stress. These classes consisted primarily of one or two relaxation techniques that were taught to help decrease the most obvious stress symptom: muscle tension. These techniques only addressed the symptoms (the physical component), but did nothing to relieve the causes of stress involving the mental, emotional, or spiritual components. As a result people often experienced a rebound effect with recurring symptoms. On a different front, coping skills (e.g. cognitive restructuring, time management and journal writing) were taught by psychologists in private therapy sessions and these coping strategies soon made their way into the public sector as well.

Through the advocacy of the wellness paradigm, attempts have been made to unite the practice of both relaxation skills and coping skills for a holistic approach to stress management. This implies viewing each person as more than just a physical body and dealing with the causes of stress as well as the physical symptoms. The primary focus regarding the application of the wellness model is based on the prevention of disease and illness and the enhancement of health. Furthermore, the underlying current of this philosophy is to place the responsibility of healing back into the hands of the individual. Successful stress management therapy programs have now begun to adopt this wellness philosophy and holistic approach, supporting the concept that, indeed, the whole is greater than the sum of the parts. A sound stress management program does not merely attempt to reduce (fix or repair) stress, but rather manage it correctly. This management process attempts to focus on all aspects of one’s well-being. This philosophy is implemented by attempting to resolve the causes and reduce/eliminate the symptoms of stress. It is imperative to remember that as an intervention modality, the wellness paradigm does not dismiss the use of medications or surgery. Rather, it strongly suggests that there be a collaborative integration of several therapeutic techniques to produce a more effective healing process. Equally important as a preventive measure, the use of coping skills and relaxation techniques are also advocated to maintain the essence of inner peace.

Stated simply, effective stress management includes the following:

1. A sound knowledge of the body’s reaction to perceived stress.
2. A sound knowledge of mental, physical, emotional, and spiritual factors associated with stress.
3. The utilization of several coping techniques to work through a resolution of the causes of stress
4. The regular practice of relaxation techniques to offer homeostatic balance to the body.
5. The periodic evaluation of effectiveness of your coping skills and relaxation techniques.

To give an accurate understanding of the stress phenomenon, it is important to see the human condition as one collective living system. Once this is understood it becomes easier to manage stress effectively. In the words of Hans Selye, "I cannot and should not be cured of my stress, but merely taught to enjoy it." The enjoyment comes in the ability to manage stress effectively.

Copyright © 1996-1999 Jones and Bartlett Publishers