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For what reasons have people sought Alternative medicine in the West since its inception in the late eighteenth century?

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Introduction-The term ‘Alternative medicine’ describes a broad domain of healing resources separate to those intrinsic to the politically dominant heath system of a particular society or culture in a given historical period.1 Alternative medicine has thrived since its inception in the late eighteenth century. This literature review was carried out with the aim of gaining insight into the reasons behind people seeking alternative medical help, despite the long-established presence of conventional medicine.

Methods- the JSTOR and Wellcome Library online databases were searched to obtain relevant articles. Access was gained via the University of Liverpool libraries.

Conclusion- There are several reasons why people have sought, and continue to seek, alternative medicine. These include harmful side-effects of conventional prescription pharmaceuticals, a lack of holistic patient assessment, and an impersonal approach to medical consultations.

Abstract
Objective: Alternative medicine has thrived since its inception in the late eighteenth century. This literature review was carried out with the aim of gaining insight into the reasons behind people seeking alternative medical help, despite the long-established presence of conventional medicine.
Methods: the JSTOR and Wellcome Library online databases were searched to obtain relevant articles. Access was gained via the University of Liverpool libraries.
Conclusion: There are several reasons why people have sought, and continue to seek, alternative medicine. These include harmful side-effects of conventional prescription pharmaceuticals, a lack of holistic patient assessment, and an impersonal approach to medical consultations.

Introduction
The term ‘Alternative medicine’ describes a broad domain of healing resources separate to those intrinsic to the politically dominant heath system of a particular society or culture in a given historical period.1 Since the late 1700s, the West has been exposed to various such movements, all of which claimed to be safer and more effective than conventional medicine. These emerged largely in the form of protests against controversial methods practiced by doctors at the time. Though Alternative methods of treatment existed before the 1800s, only at the turn of the century did there emerge distinct, comprehensive systems of care which rivalled the medical establishment. Such was this rivalry that by the end of the 1840s, the medical counterculture had taken roughly 10% of the healthcare market.2 By the end of the twentieth century there were more registered Alternative practitioners in the UK than General Practitioners, while in the US, more visits were made each year to providers of Alternative medicine (425 million) than to primary-care doctors (399 million).3 The aim of this literature review is not to justify Alternative medicine, but to explore the reasons for people seeking these methods.
Methods
Research began through the use of two trusted online academic databases: JSTOR, an extensive digital library containing over 2000 academic journals; and the Wellcome Library online catalogue, renowned for its vast collection of books and journals regarding the history of medicine. Two different search terms were used in order to maximise the range of articles retrieved. Table 1, below, details the number of results obtained with each search term, by each database.

The first fifty results obtained from each database were carefully assessed for their suitability for inclusion, based on title and abstract. Appropriate articles found within the Wellcome Library database were subsequently assessed for availability in the University of Liverpool’s online catalogue. Once access was gained, articles were read and an understanding of the current evidence base obtained. This enabled development of a final research question on which to base the literature review.

Discussion
A Natural Approach
Since its beginnings in the late 1700s, Alternative medicine has portrayed itself as offering a distinctive approach to medical treatment. Alternative practitioners were firm believers that nature was the most potent medicine of all, and that powerful synthetic drugs would often overwhelm rather than help the patient. They believed patients needed to be guided to a natural physiological and/or mental state, through non-invasive interventions. The practitioner did not cure, but rather aided the body’s own natural healing process. Somewhat ironically, this approach was drawn from the work of Hippocrates (c. 460 – c. 370 BC), famously described as ‘the father of modern medicine.’2 Arguably, Hippocrates could be more accurately considered the father of modern naturopathy. This is a branch of Alternative medicine based on a belief in ‘vitalism’, which suggests that ‘vital energy’ or ‘vital force’ guides bodily processes.
Hippocrates believed that health was restored by promoting equilibrium within the fluid essences (‘humours’) of the patient. He believed and taught that medicine could only aid the body’s own self-healing capacities, known as the ‘vis medicatrix naturae’. Great emphasis was placed on having a healthy diet and lifestyle, with drugs functioning in supporting healing rather than curing disease. This is an approach which until recently was considered to share a greater likeness with the practices of Alternative medicine. By merely facilitating nature, iatrogenic harm to the patient would be minimised and the rate of healing maximised.4
Most Alternative therapies were developed as formal health systems based on primitive practices and philosophies. Founded by New Hampshire farmer Samuel Thomson (9 February 1769 – 5 October 1843) in 1790, Thomsonianism was the first Alternative system to be developed in the US, consisting of a program of botanical healing which either gently evacuated or heated the body. Thomsonians believed that conventional medical treatment was often unnecessarily invasive and/or too harsh on the patient. The laxative Mercurous Chloride, for example, then known as ‘Calomel’ was the most frequently prescribed drug within conventional medical practice, with the possible exception of opium. Used to ‘cleanse’ the intestinal tract, it often produced severe side effects, such as ulceration of the mouth, loss of teeth, necrosis of the jawbone, and thick, excessive salivation. These side effects were, in the eyes of doctors, inevitable. In contrast, Thomsonian herbal remedies were gentle and natural, formulated and administered with the intention to support the body’s own natural and recuperative powers. In the words of Thomson, ‘nature ought to be aided in its cause, and treated as a friend; and not as an enemy, as is the practice of physicians’. His approach was to ‘learn the course pointed out by nature’, then to ‘administer those things best calculated to aid her in restoring health’. As a result, many patients did better in the hands of Thomsonians than conventional doctors.2
Inadequacies in conventional medicine, such as the use of drugs frequently causing more harm than good, inevitably led to exploration of alternatives. An additional example of this can be found in Homeopathy, an Alternative therapy founded by the German doctor Samuel Hahnemann (10 April 1755 – 2 July 1843) in 1796. Based on the principle of ‘like cures like’, the theory was that a substance causing symptoms of disease in a healthy person would cure similar symptoms in a sick individual. Hahnemann disagreed with the harshness and risk that characterised treatment of disease at the time. His system involved using very small doses as opposed to the powerful medicines used in conventional medicine.4 Whilst it could not, and still cannot, be proven to have any direct physiological benefit, Homeopathy patients were often seen to have better outcomes than those in the care of conventional doctors. This was likely a result of both allowing nature to take its course and avoiding subjecting patients to harmful conventional procedures.

A Holistic Approach
Despite being a part of Western Medicine since the time of Aristotle (384 – 322 BCE), anatomy-based pathology did not become a developing field until the late eighteenth century. Prior to this, knowledge of the body’s structure had very little relevance to the practice of conventional medicine. Understanding of disease and decision-making processes for the treatment and management of patients was based on humours and energies involving the body and mind. It was the development of anatomy and pathology during the Renaissance period that gave rise to scientifically-based medicine. Medical theory began to move away from the Hippocratic concept of ‘harmony’ towards ‘specificity’. Armed with new drugs as modern tools, doctors began abandoning the philosophy of self-healing. Each disease that arose could be treated with a specific, external cure.5 This new breakthrough was exciting and fashionable amongst doctors, to such an extent that it was to the detriment of patient care. If an Alternative therapy was inexplicable or contradicted contemporary medical understanding, it was rejected, regardless of any proven efficacy.6 In the 1780s for example, the only medicine able to successfully treat gout was a remedy containing Colchium, marketed by the French army officer Nicholas Husson, as ‘Eau Medicinale’. Although effective, it was rejected by the medical profession.3
As a consequence of scientific medicine, the idea that illness was unique to each individual was steadily lost. Instead grew the existence of a pro forma of pathologies, each producing a specific disease affecting all patients in the same way. Doctors began paying more attention to the similarities between patients than the differences. The patients’ subjective experiences were more irrelevant; overridden by the objective evidence of disease pathology. As diagnosis and treatment became increasingly dependent upon physical damage to organs, tissues and cells, doctors became less considerate of the patient as a whole. Hippocrates once said that ‘there are no diseases, only sick people.’ In a world where Medicine was becoming increasingly bureaucratic, the Hippocratic touch was being lost.6
In contrast, practitioners of Alternative medicine claimed superior relationships with their patients. Generosity with time and personal attention had been a core aspect, allowing the patient to feel comfortable divulging sensitive information and giving them time to fully describe all their problems. The notion of what became known in the 1930s as ‘psychosomatic medicine’, that the mind can affect the body therapeutically, had been an integral part of Alternative medical practice from its beginning.2 Practitioners built a rapport with the patient, taking time to get to know them. An ethos involving continuity of care allowed the practitioner-patient relationship to grow. By being attentive to patients’ needs and concerns and displaying non-judgemental empathy, practitioners cultivated a place of physical and emotional healing. Personal choice and patient autonomy made Alternative therapy patient-centred. In addition, a Homeopath would be thorough in exploring a patient’s every symptom, mental and physical, in order to prescribe the most appropriate medication. Whether the prescriptions were effective or not, patients often felt better after consultations.2
Thomson himself called for ‘the study of patients, not books – experience, not reading’. A likely explanation for the introduction of Alternative medicine was that the public perceived conventional medicine to be overly rationalistic, placing too much importance upon theory as opposed to trust in experience. Conventional medicine would hypothesise about the nature of the illness and deduce therapy from the result. Treatments worked because the theory said they should, and because most patients did in fact recover. However, Alternative practitioners would argue that the recuperation of patients under the care of doctors occurred in spite of their treatment, not because of it; their recovery due to nothing more than the placebo effect and the vis medicatrix.6
In the 1850s, Hydropathy, an alternative health system that involved the use of water for pain relief and treatment, underwent a popular health reform movement in America. It involved the addition of behaviours such as abstinence from alcohol and tobacco, vegetarianism, regular exercise, and fresh air, to the original doctrine of cold water baths. The result was ‘hygeio-therapy’, a method that ‘restores the sick to health by the means which preserve health in well persons’. It could be argued that the modern notion of holism stems from this health reform. Perhaps current understanding of the therapeutic and preventative effects of some of those behaviours makes it unsurprising that hydropathy was effective for many patients.2
Conclusion
The eighteenth century introduction of Alternative medicine into the Western world and its subsequent popularity raises the question: why? Why in a society with a pre-established medical system was there need for something different? Possible explanations are uncovered through analysis of past patient approaches and interaction to Alternative and conventional medicine. Alternative medicine came as a direct solution to patient dissatisfaction with conventional medicine, secondary to a combination of: side effects of pharmaceuticals, disregard for emotional, mental and spiritual aspects of health, and lack of cure. People needed something that conventional medicine was not delivering. Even in the 21st century, with the exceptional capabilities of modern medicine, the holistic, patient-centred focus of Alternative health systems ensures their heavy utilisation in the West. Acknowledging, appreciating and developing understanding of the attraction of Alternative medicine is hugely important for doctors of today. It will play a vital part in the satisfaction of patients’ needs in conjunction with the delivery of empirical, evidence-based medical care.

1. Zollman C, Richardson JD, Vickers A. ABC of complementary medicine [electronic book] edited by Catherine Zollman, Andrew Vickers, Janet Richardson: Oxford ; Wiley-Blackwell Pub./BMJ Books, 2008. 2nd ed., 2008. (ABC series).
2. Jonas WB, Levin JS, Berman B. Essentials of complementary and alternative medicine / editors, Wayne B. Jonas, Jeffrey S. Levin ; associate editors, Brian Berman … [et al.]: Philadelphia : Williams & Wilkins, 1999., 1999.
3. Porter R. Blood and guts : a short history of medicine / Roy Porter: London : Penguin, 2003., 2003.
4. Fulder S. The handbook of alternative and complementary medicine / Stephen Fulder: Oxford : Oxford University Press, 1996.
5. Don GB. Why Not Call Modern Medicine “Alternative”? Annals of the American Academy of Political and Social Science 2002;583:12-28.
6. Whorton JC. Nature cures [electronic book] : the history of alternative medicine in America / James C. Whorton: Oxford ; Oxford University Press, c2002., 2002.

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