Monthly Archives: October 2012

Every Thought Leads to Infinity

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This is a little after the fact, but here is the abstract from a presentation I did at the International Society for Psychological and Social Approaches to Psychosis, New Zealand/Australia annual conference, August 2012 in Auckland, New Zealand.

Every Thought Leads to Infinity: Visionary Experience and Creative Illness in Carl G. Jung’s Red Book and Philip K. Dick’s Exegesis

Jung’s Red Book and Dick’s Exegesisare private journals that both men worked on for years during periods of visionary experience. The recent publications of these books illuminate Jung’s and Dick’s experiences as well as provide a key to understanding their later books that grew out of their inner work. For both Jung and Dick, their early interests and writings prefigured their later visionary experiences.

Jung’s early interests in spiritualism and archetypal symbols in mental illness later manifested in his own life as what he called his “confrontation with the unconscious.” Through great effort, he was able to use these experiences to fuel what he called the process of individuation, the journey of “becoming who one is.”

Dick’s work focused on the themes of “what is real,” and “what is human.” He commented that, at the time of his visionary experiences, it was as if he had become a character in one of his own novels in which the very fabric of reality was in question.  His later books explore spontaneous visionary experience through the lenses of mental illness, drugs, and spirituality.

Both men exhaustively researched the writing of philosophers, mystics, and scientists (as well as turning to objective analysis of their own writings) in an attempt to find some reference point for their own experiences. This presentation will look at the lives of CGJ and PKD and their journals, The Red Book and the Exegesis, through a structure of the childhood struggle to become who one is, a preoccupation phase in which their interests deepened, but also set the stage for a crisis phase of visionary experience, and then an occupation phase in which they integrated interests and crisis into path of occupation that continues to influence individuals and society.

What Do Holistic & Integrative Medicine Have to Do With the Quality Revolution in Healthcare?

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I recently went to the Asia Pacific Forum on Quality in Health Care, in Auckland. This event was put on by Ko Awatea and the Institute for Healthcare Improvement. What I found interesting was that in addition to issues around efficiency and evidence-based medicine, there was also a strong focus on patient and family involvement and collaborative care.

In some follow-up reading after the conference, I came across a short article by Swensen et al from the NEJM 362.5 (Feb 4, 2010) called “Cottage Industry to Postindustrial Care – The Revolution in Health Care Delivery.” This article argues that the concept of what  constitutes a “good doctor” is changing. Currently, to be a “good doctor” means “swimming upstream against the system, rather than relying confidently on it.” This reminds me of my writing on creating a holistic medical practice; the clinician relies on a standard of professionalism that is not always supported by the systems in which clinical work occurs. The article arrives at a contrast between the “good doctor” of the past and of the present.

“In the past, a stereotypical good doctor was independent and always available, had encyclopedic knowledge, and was a master of rescue care. Today, a good doctor must have a solid fund of knowledge and sound decision-making skills but also must be emotionally intelligent, a team player, able to obtain information from colleagues and technological sources, embrace quality improvement as well as public reporting, and reliably deliver evidence-based care, using scientifically informed guidelines in a personal, compassionate, patient-centered manner.”

The components of emotional intelligence, systems focus, collaborative care, compassion, and patient-centered approach are hallmarks of holistic and integrative philosophies.

I was just reading a continuing education article called, “Improving Quality of Psychiatric Care: Aligning Research, Policy, and Practice,” by Kelli Harding and Harold Pincus (Focus, Spring 2011, Vol. IX, No. 2). The authors state that in our current health care system in the US, the “problems are so widespread that trying harder within the current system is not enough.  System-wide change is needed.” The authors mention the Institute of Medicine’s 10 Rules for Patient/Consumer Expectations of Their Health Care (adapted below from To Err is Human:  Building a Safer, Health System, 2000). Again there is a contrast between the old and the new:

Old Rules New Rules
1. Care based on visits Continuous Healing Relationships
2. “Do no harm” Safety is a system property
3. Professional rules greater than System Cooperation and Collaboration between clinicians and institutions
4. Decisions based on training and experience EB decisions without variance
5. Professional autonomy drives variability Individualization, customized care
6. Professionals control care Patient as source of control, shared decisions
7. Decisions based on training, experience Shared knowledge, free flow of information
8. Clinicians react to events Anticipation of needs
9. Secrecy is necessary Transparency in system performance
10. Cost reduction Value or continuous decrease in waste

Again, we can see that the focus of holistic and integrative medicine on individualized, patient-centered care, collaboration, preventative medicine, low-cost lifestyle modifications vs. high cost pharmaceutical interventions, and on the therapeutic value of a positive therapeutic relationship, all appear to have a prominent place in the new health care revolution, which the authors call a “paradigm shift.”

One area of creative tension between the new quality health care revolution and the holistic & integrative medicine revolution is the variable to time. We know that there is an association between shorter visits and malpractice claims, (Wendy Levinson et al., “Physician-Patient Communication: The Relationship With Malpractice Claims Among Primary Care Physicians and Surgeons.” JAMA, Vol 277, No. 7 (Feb 19, 1997):  553-559). We also know that it takes longer to support behavioral and lifestyle change than it does to write a prescription. We also know that time spent on preventative medicine saves time later as well as money, which is a quality issue. It may be that the quality revolution may make time for clinicians to spend more time with patients in certain circumstances in order to provide less expensive, safer, higher quality care. This is a long-term savings and is more efficient in the long-run, but in the short run it will cost more in clinician time spent with patients.

Creating a health care system that is quality-based, efficient, safe, and cost-effective is a challenging task and countries all around the world are struggling with this problem. It will be very interesting to see how the current health care revolution in quality, in the US, plays out and whether principles of holistic, integrative, and preventative medicine find a prominent place or whether efficiency and evidence-based pharmacological interventions take a more prominent place. During the last time of health care revolution, the Clinton plan in the 1980s, I was a medical student and had a chance to take an elective in health care policy and law. That revolution largely left the doctors out of the loop. Competition was supposed to solve the problem. Ten years later I was working at a multi-specialty group that went to a “eat what you kill” reimbursement policy. I understood the concept, but I couldn’t believe I was hearing this language used by the people in health care systems.

As a student, I remember reading that competition in health care is only cost-effective if there is a population of around 200,000. There then followed a map of the US showing all the regions with less than that population and I realized that system of reform would not work. This time around, it seems that many doctors are embracing the revolution and are more involved in the process of change. At least the language of compassion, collaboration, and continuous healing relationships has at least a linguistic place in the current revolution.