Section 1: Why CAM Now?
This is the question social scientists frequently ask about a social phenomenon. Why at this particular point in time does a trend become pervasive? In the case of CAM, there are many answers. The rise of the consumer movement and the accompanying distrust of experts has often been cited (Haug and Lavin, 1983; Goldstein, 1999; Kronenfeld and Schneller, 1997). The influence of the womensâ health movement has also had an impact. Woman have expressed their dissatisfaction with aspects of conventional medical care which has lead to a search for alternative strategies (Boston Womenâs Health Collective 1984; Shorter, 1991). The holistic health movement along with a new and broader definition of health created a climate conducive to the use of CAM (Epp, 1986). The rise of the self-help movement in the 1970s was powerful in shifting, responsibility for health care from professionals to individuals and their support groups (Kelner, 1985). Today the Internet is empowering people by providing them with enormous amounts of information on health and illness, and also where to go for care (Clarke and Hoffman-Goetz, 1999). The chapters in this section reflect on the reasons for the popularity of CAM at the end of the 20th century.
Boston Womenâs Health Collective. 1984. The New Our Bodies, Our Selves. New York: Simon and Schuster.
Clarke, Juanne N., and Laurie Hoffman-Goetz. 1999. âInformation Technologies as a Source of Medical Information.â in Trends Conference. Ottawa.
Epp, Jake. 1986. Achieving Health for All: A Framework for Health Promotion. Ottawa: Ministry of National Health and Welfare.
Goldstein, Michael S. 1999. Alternative Health Care: Medicine, Miracle, or Mirage? Philadelphia: Temple University Press.
Haug, Marie R., and Bebe Lavin. 1983. Consumerism in Medicine: Challenging Physician Authority. Beverly Hills: Sage.
Kelner, Merrijoy. 1985. âCommunity Support Networks: Current Issues.â Canadian Journal of Public Health 76:69â70.
Kronenfield, Jennie.J and Schneller. 1997. âThe Growth of a Buyer Beware and Consumer Practitioners Model in Health Care: The Impact of Managed Care on Changing Models of the Doctor-Patient Relationships.â presented at the Annual Meetings of the American Sociological Association, August, Toronto, Canada.
Shorter, Edward. 1991. Womenâs Bodies: A Social History of Womenâs Encounter with Health, III Health, and Medicine. New Brunswick: Transaction Publishers.
The Culture of Fitness and the Growth of CAM
MICHAEL S. GOLDSTEIN
Throughout North America and Western Europe the promotion of health and fitness is a widespread and growing phenomenon. In the United States almost one third of adults own stationary exercise cycles (Darnay, 1998:589). Almost two thirds of the smokers in the nations which comprise the European Community have tried to stop at least once (Commission on the State of Health, 1996:32). In Canada the rate of participation in physical activity among adults rose from 21% to 37% between 1981 and 1995 (Active Living Canada, 1999). Although many, if not most, advocates and participants in these efforts to promote health and fitness may not view their activities as part of complementary and alternative medicine (CAM), there is nonetheless, an increasing connection between fitness and CAM. Each shares a set of crucial underlying values and assumptions as well as a skepticism toward conventional medicine, and an affinity with the growing commodification of health.
This paper will set out six important values shared by both advocates of CAM and those who regularly participate in activities to remain fit. Next, the chapter examines the increasing level of skepticism toward, and commodification of conventional medicine. Each of these trends acts synergistically to reinforce the affinities between CAM and fitness. I conclude that the growing emphasis being placed on fitness throughout Western societies is likely to be a major entry point to the world of CAM.
SHARED VALUES
An emphasis on fitness and use of CAM are conceptually compatible, since they share six basic assumptions about the individual, health and healing:
1) Health as Wellness, Not the Absence of Symptoms
The notion that an individualâs health is not synonymous with the mere absence of illness or symptoms is perhaps the most fundamental assumption within the world views of those who advocate CAM as well as health and fitness. From this perspective, âhealthâ is about maximizing oneâs potential, and is applicable to everyone, regardless of their physical condition. The belief is that despite the limits on a person, arising from genetics, symptoms, or ways of thinking, it is always possible to be healthier. A quality of striving, typified by the phrase âachieving high level wellnessâ, permeates both attempts to become more fit, and CAM approaches to chronic illness (Dunn, 1973; Goldstein, 1992; Chopra, 1989:236â7; Johnston, 1991).
Efforts to reach wellness are unique to each individual, and are derived from oneâs particular goals, needs, and status in life. Thus, in efforts to keep fit, as in the use of CAM, the meaning of health is different for everyone. Achieving health or wellness does not mean reaching an arbitrary, preset goal, Rather, it is an ongoing process, which demands active participation and effort. An overriding concern with striving to transcend whatever oneâs current situation (losing a few more pounds, refraining from smoking for another day, keeping oneâs tumor, asthma, or genital herpes in check, etc.) is a key point of convergence for CAM and for efforts to be fit.
2) Personal Responsibility for Health
Although the idea of being responsible for oneâs health is not a new one in western, and particularly, American society, it has received new vigor and prominence (if not omnipresence) within the worlds of both fitness and CAM (Reiser, 1985). It is a theme drawn upon by every major exponent or spokesperson in the world of fitness, and a key component of most approaches within CAM. This emphasis on personal responsibility comes in many different versions. Moderate or mainstream approaches, such as the classic statements by John Knowles, past President of the Rockefeller Foundation, simply emphasize that â99% of us are born healthyâ and that it is our own âmisbehaviorâ that renders us unfit or ill later in life (Knowles, 1977). More radical or far reaching versions go beyond the behavioural level, and stress the mental states, under oneâs own control, that are seen as essential to maintaining health, and even curing illness (Pelletier, 1979; Ferguson, 1987; Chopra, 1993). These mental states are said to operate in two ways: indirectly, by fostering the behavioral changes needed to get and stay healthy, and directly, by exerting an independent physiological impact throughout the body. While only a few of the better known exponents of CAM, such as Hay (1987) and Jampolsky (1989) go so far as to suggest that the individual is responsible for absolutely everything that happens to him or her, others like Deepak Chopra are not far behind.
For our purposes, the importance of this common emphasis on personal responsibility is that those who have been involved with fitness and health promotion are likely to be quite familiar with notions of personal responsibility that are strikingly similar to those within the world of CAM. Individuals who have succeeded in their efforts to become more fit are apt to be strongly committed to these beliefs. The fact that numerous research reports by mainstream scientists (especially in the field of psychoneuroimunology) have validated the view that the mind can produce chemical changes at the cellular level throughout the body, has given a strong boost to the importance of these beliefs for both CAM and health promotion.
3) The Interpenetration of Mind, Body and Spirit
A third major tenet common to both the worlds of CAM and fitness is the inextricable connection between these three dimensions of life; each of which can have a causal impact upon the others. Again, we find something that is not in any way a new belief, but rather a traditional belief given new vigour, as well as a broadened emphasis, by its importance in both CAM and fitness. What is of particular interest here is not only the idea that the mind and body have a potentially strong influence over each other. Rather, it is the inclusion of âspiritâ as a co-equal partner in the equation (Levin, 1996; Dossey, 1993). Most major approaches in CAM, such as Traditional Chinese Medicine (T.C.M.) and Ayurveda have religious origins, as well as an important spiritual dimension (Beinfeld and Korngold, 1991; Frawley, 1990). Many others, such as chiropractic, naturopathy, and homeopathy have strong religious roots which have become relatively neglected at the present time (Fuller, 1989; Kaptchuk, 1997). For these, and for many of the newer modes of CAM, the ill defined, non-denominational term âspiritualityâ has replaced religion. Still, for most of the CAM healing practices there is a crucial dimension of life that goes beyond both the body and the mind.
The spiritual component of a heightened concern with health and fitness may not be immediately apparent. Yet, history demonstrates that an emphasis on physical fitness has often been an important part of religious movements and revivals in both the U.S. and Europe (Whorton, 1982; Dubos, 1959). Today, numerous advocates of fitness have stressed its spiritual aspects. Spiritual or âpeakâ experiences are often cited as the outcome of intense physical exertion (running in a marathon, completing an AIDS Ride, climbing a mountain, etc), as well as the motivation for continuing efforts to become even more fit. Again, we find an important overlap in the basic beliefs of CAM and those promoting an interest in health and fitness.
4) Health as Harmony with Nature
In Mirage of Health, Rene Dubos (1959) described two competing Greek deities and their approaches to achieving health. Hygeia symbolized health through discovering and following the laws of nature, while Aescalapius represented health through the triumph of human intervention aimed at limiting the ravages of existing illnesses. While the image and ideology of Aescalapius have dominated conventional medicine in this century, it is Hygeia whose approach is the key to most approaches in CAM, as well as to the worlds of fitness and health promotion. Prevention of future illness and disability is the ultimate goal of both. In this quest each emphasizes the need, not to control ânatureâ, but to align ourselves more with ânatureâs lawsâ.
The roots of this view are similar both for CAM and health promotion. The early advocates of fitness in America, (Jefferson, Thoreau, Benjamin Rush, Thomas Paine, etc.) and the masters of TCM, Ayurveda, and many other modes of CAM did not distinguish between what nature taught about something purely physical, such as what to eat, and something social or political, such as how to behave with oneâs friends or family. It is all a seamless web of choices which flow from knowledge of natureâs (godâs) laws (Rosen, 1974). To see this seamless web in todayâs CAM practices, simply examine the catalog of choices at one of the thriving centers of CAM training, such as the Omega Institute, north of New York City, or any other place where advocates of CAM gather. The courses, symposia, and workshops typically aim to bring health, healing, work life, family life, and fitness all into closer harmony with nature. Or, conversely, read any of the popular books on running, aerobics, or dieting, and see how the author grounds both the motivation for engaging in the activity, as well as the successful outcome, in terms of coming closer to living ânaturallyâ.
A central image offered in both CAM and the fitness movement is the (re)creation of ânaturalnessâ in ourselves and the larger world. Eating natural foods, allowing natural healing processes to take place, accepting our natural emotions, and keeping our bodies in their natural state by avoiding drugs, alcohol and tobacco, are all part of this worldview.
5) Ambivalence Toward Science and Technology
For many fitness advocates the notion that people can maintain their unhealthy lifestyles, and then be âsavedâ by some technological breakthrough is problematic (Dubos, 1959; Illich, 1976; Gusfield, 1981). Similarly, exponents of CAM typically feel that a reliance on high tech medicine runs counter to the lessons that their particular school of therapy has to offer. Both groups agree that relying on a âtechnological fixâ, such as artificial sweeteners to replace sugar, will not only fail (the sweeteners themselves may cause ill health or disease), but that they epitomize a mind set opposed to all the other values central to the group. For example, an emphasis on scientific medicine frequently leads to a reliance on physicians, which runs counter to the idea of taking responsibility for oneâs health. The âwisdom of the...