Year Of The Whole Person
by Ilene Serlin
An article published in Psychotherapy Bulletin, official bulletin of Division 29 of the American Psychological Association,
(2005) Volume 40, Number 1.
A feature article in the June issue of the APA Monitor recently stated that the “public is hungry for mind/body alternative and complementary interventions (Dittman, 2004, p. 42).” In the same issue, another article quotes David Myers (2000) that “Compared with their grandparents, today's young adults have grown up with much more affluence, slightly less happiness and much greater risk of depression and assorted social pathology” and that “consumer culture has reached a fever pitch.” Finally, the January 2005 issue of the Monitor focused on the epidemic of obesity, showing the range and cost of this problem. What do alternative and complementary interventions, consumer culture and obesity have in common?
What they have in common is that they are aspects of a paradigm shift, a new holistic perspective on psychology that is needed to address symptoms of mind, body and spirit. Psychology has celebrated the “Decade of Behavior” and the “Year of Cognition:” it is time for a psychology of the “Whole Person.” Behavior and cognition have been polarized in the past, but the new paradigm of the Whole Person brings behavior and cognition together in a dialectical relationship through consciousness. A psychology of the Whole Person integrates behavior, cognition and consciousness, or body, mind and spirit. For example, while depression and obesity have biological dimensions, they are symptoms of a consumer culture of increasing speed, lack of connections and social support, and personal inner emptiness. The recent film “Super Size Me” shows the lack of real nourishment from a diet of McDonalds and consumer culture where “more” is bigger but not necessarily better. Cynthia Belar, APA's Executive Director for Education, called for an integrative psychology in the September 2000 issue of the Monitor:
I have spent years educating physicians and other health professionals that psychology had a scientific knowledge base and practice relevant to both 'mental' and 'physical' health…the biopsychosocial model cannot be segmented into its component parts without attention to interactive efforts… (p. 49).
The theme of the Whole Person is a centerpiece of APA's President-Elect, Ron Levant's, presidential initiative. It was also the title of a Presidential mini-convention that was co-sponsored by Division 32 (Humanistic) and Division 43 (Family) in 2001 on Healthy Families, Healthy Society and Healthy Workplace called “Healthy families: A dialogue between holistic and systemic-contextual approaches,” and was published as an article called “Year of the Whole Person” (Serlin, 2001, 2002). What is the approach of the Whole Person and why is this important for psychologists today?
The Whole Person approach is integrative, and considers the person in the context of his or her world. It seeks to understand the meaning of symptoms such as obesity, as well as its biological and behavioral causes. Learning whole person approaches is important for psychologists because the public and patients are already clamoring for integrative approaches and finding them in medicine, but not psychology. People are turning to healthcare practitioners to reduce stress through meditation, yoga, and acupuncture; psychologists can make a valuable contribution by contextualizing behavioral techniques in the framework of a therapeutic relationship and process. The recent popularity of the Bill Moyers' show on alternative healing and the revelation in the January 28, 1993 issue of The New England Journal of Medicine that over one-third of Americans utilize unconventional medicine signals a major shift in attitudes toward healing. The National Institutes of Health funded an Office of Alternative Medicine (OAM) to support research into alternative approaches, whose budget has been growing yearly. NIH issued a “Roadmap” with an emphasis on prevention and education. The Consortium of Academic Medical Centers for Integrative Medicine (CAMCIM), consists of 23 medical schools with programs in integrative medicine that have educational, research and clinical training. The work of Candace Pert has shown that the processing of emotions often affects physical illnesses and the ability to heal. Research on healthy humans as well in cancer and HIV-positive patients has shown significant increases in immune function or positive health outcomes with emotional expression (Pert, 1997). A holistic perspective on psychology and a holistic concept of the self is central to humanistic psychology, positive psychology, and wellness health psychology. Since the movement toward integrative healthcare in inevitable, it is time for psychology as a primary healthcare profession to bring its unique contribution to a multi-disciplinary approach. New approaches would also revive the morale and effectiveness of practitioners, and help provide new opportunities for practice. Integrative psychology thus addresses a three-fold crisis in healthcare: 1) the “completely disgruntled healthcare consumer”, 2) a “disenfranchised, disillusioned physician”, and 3) our “healthcare is a broken model” (Gazella, 2004, p. 86).
An integrative approach is urgent to address today's complex health issues. For example, one-third of California's 2 million teens are very overweight or risk becoming obese and are at risk for life-threatening illnesses by the time they reach 30. The highest rates were among Latino and African Americans. In addition, the death rate among young Americans due to cardiac arrest rose during the 1990's, especially among women and African Americans, and seems to be related to the epidemic of obesity (Haney, 2001). Since these lifestyle issues include too much junk food and video games, increased stress, and lack of role-modeling and social support, an educational campaign stressing healthy lifestyles would be beneficial.
In a study carried out by the US Department of Agriculture, over one-half of all American adults are considered overweight or obese, spending about $33 billion each year on diet books, diet pills and weight loss programs (Squires, 2001). Both taking and keeping weight off are psychological issues. These require understanding of motivation, stress factors, coping mechanisms, and social support. In fact, an encouraging study at UCSF suggests positive results from a non-medical approach to weight loss (PRNewswire, 2000), in which sustained weight loss resulted from training people in two basic internal skills of self-nurturing and limit setting. Non-medical interventions are also extremely relevant for regulating mood. The use of anti-depressants is at an all-time high for Americans. Studies have shown a relationship between changes in energy and anxiety levels and eating and exercise habits. The relationship is not a simple causal one, but a complex interactive one, in which mood affects behavior, and behavior affects mood. Using psychological interventions gives people more conscious control over their lives, and improves their self-esteem and sense of meaning. In an increasingly speeding world, we can no longer coast on data points (“knowledge”), but need wisdom to make constructive choices, and establish and maintain priorities.
The overuse of psychotropic medications among preschoolers is another problem where a Whole Person approach would be helpful. In response to an article in the Journal of the American Medical Association showing a dramatic increase in the use of psychotropic medications for preschoolers between 1991 and 1995, Levant advised First Lady Hillary Rodham Clinton that psychological and pharmacological interventions for children need equal attention. Finally, psychosocial support groups used to treat cancer show increased quality of life and survival time (Fawzy et al., 1993; Spiegel et al., 1989). Supportive-expressive group therapies are existentially based and aim to help patients live their lives more fully in the face of a life-threatening illness. A wellness model would focus on how to help healthy individuals cope with these extraordinary circumstances. Support groups can address questions of meaning, mortality and expression.
Roger Sperry, an eminent psychobiologist who died in 1994, described the paradigm shift from "scientific materialism" to a holistic, non-mechanistic, bidirectional model. Instead of prediction and control, this model provided "…a more realistic realm of knowledge and truth, consistent with science and empiric verification "(Sperry, 1991b, p. 255), and including an "ultimate moral basis" (Sperry, 1995, p. 9) of environmental and population sustainability. In Sperry's interactionist, nondualistic model of mental and physical states, causation is determined upward from physical states, as well as downward from mental states.
Consciousness, which brings together the physical and mental states, comprises the area of meaning, beliefs, and existential choice. An illness such as breast cancer, for example, involves the meaning of the breast for a woman, her attitude and spirituality, as well as her confrontation with death and mortality. Out of this confrontation with mortality can come a renewed will to live. Hardiness and optimism support coping patterns (Maddi & Hightower 1999). Stories of death and rebirth, descent into sadness and ascent into joy, and disconnection and reconnection are ancient myths common to all humankind. With the courage to create (May, 1975), our new narratives create a self that moves from deconstruction to reconstruction (Feinstein & Krippner, 1988; May, 1989; Sarbin, 1986; Gergen, 1991). Healing narratives are experienced as coherent and meaningful, and the use of narrative therapies has been gaining attention in family therapy (Epston, White & Murray, 1992; Howard, 1991; Omer & Alon, 1997; Polkinghorne, 1988; Rotenberg, 1987). The act of telling stories has always helped human beings deal with the threat of non-being, and sometimes the expressive act itself has a healing effect (Pennebaker, 1990). Not all expressive acts are verbal, however; a Whole Person psychotherapy would embrace diversity of technique and approaches that include non-verbal and multi-modal modalities like the expressive therapies and mindfulness meditation (Jon Kabat-Zinn, 1994). Bringing the body and community into therapy also serves diversity by re-balancing the dominance of a white, individualistic European male verbal psychological tradition. Whole Person goals include achieving a gender balance of emotional empathy, emotional self-awareness, assertiveness and instrumental problem-solving (Levant, 2001).
Ultimate questions about the nature and fate of human beings are religious or spiritual dimensions that need to be brought back in to a Whole Person psychology. Spirituality as a way of knowing adds to the diversity in psychology. One of the three major themes at APA's 1999 National Multicultural Conference and Summit was “spirituality as a basic dimension of the human condition” and it recommended that:
psychology must break away from being a unidimensional science, that it must recognize the multifaceted layers of existence, that spirituality and meaning in the life context are important, and that psychology must balance its reductionistic tendencies with the knowledge that the whole is greater than the sum of its parts. Understanding that people are cultural and spiritual beings is a necessary condition for a psychology of human existence (Sue, Bingham, Porche-Burke, Vasquez, 1999, p. 1065).
Further, a psychology that separates science from spirit is culturally narrow, and “may not be shared by three quarters of the world nor by the emerging culturally diverse groups in the United States” (Sue et al, p. 1065). Spiritually based rituals have been shown to be effective coping strategies for dealing with life stresses (Pargament, 1997) and serious trauma (Frankl, 1959). However, while a national survey showed that 92% of all American reported that “my religious faith is the most important influence in my life” (Bergin & Jensen, 1990, p. 5), most psychologists are unprepared to deal with these issues (Shafranske & Malony, 1990).
In conclusion, training psychologists in whole person therapies would not only help psychologists become more inclusive, therefore, but would revitalize our work. In the new paradigm of the whole person, psychologists would rediscover our modern yet ancient roles as healers of the psyche.