The ancient Greek goddess Hygieia represented the concept of maintaining health, i.e. prevention of disease, and her sister Panakeia the knowledge of remedies, i.e. treatment of disease. Dr Richards highlights how these two concepts relate to the different models of medicine today, and advocates alternative modalities such as chiropractic care.
What is a paradigm shift? The word paradigm stems from an ancient Greek word meaning pattern. Shift has been defined as a change in position, direction, makeup or circumstances.
PARADIGMS IN HEALTH CARE
Different and competing schools of thought, paradigms, conceptual frameworks and models in approaches to health and disease have existed throughout recorded history. Among the most relevant to this article are models that developed in ancient Greece, as they have continued to have an immense influence on the way our society approaches matters of health and disease.
In pre-Hellenic times, the most prominent of the healing deities was Hygieia. Patriarchal trends in religion and society then led to goddesses being positioned as relatives of a more powerful male god. Accordingly, Hygieia became a daughter of the main healing god Asclepius, representing the concept that those who lived wisely would maintain their health, i.e. prevention of disease. Her sister was Panakeia, who represented the knowledge of remedies, i.e. treatment of disease.
These ancient concepts developed into two schools of health care in two different Greek city states, Kos and Knidus.
The search for a panacea, colloquially but accurately put as a pill for every ill and a potion for every emotion, has become a major aim of biomedical science and practice.
THE KOAN MODEL
Kos is an island off the coast of what is now Turkey, and the writings of the Koan teachers, known as the Hippocratic Corpus, offer insight into the attitudes on which this model was based.
- Emphasis was on the patient, rather than the disease.
- Physical observation and examination, including understanding the patient’s way of life, behaviour and emotional state, was of great importance. The practitioner had to understand the individual’s constitution and how health was related to food, drink, climate, social institutions, religion and government. This might be seen as a precursor of today’s bio-psychosocial approach.
- Diagnosis – the ceremonial naming of the disease – was of little importance. Understanding the history of the condition was important.
- Disease was seen as a natural process, rather than the result of punishment from the gods or possession or invasion of the body by external supernatural or other agents.
- Disease should be seen as punishment only in that it might result from transgression from natural life habits. Such behaviour was out of balance and did not support the life force that kept the individual alive and healthy.
- Reliance on nature, which involves a life force with strong health-maintaining and healing capabilities. The task of the practitioner was to work in harmony with these natural forces, removing impediments to recovery and adjusting conditions so that the patient could reach a harmonious balance and health.
- A conservative approach, based on what today is called watchful waiting, rather than active intervention.
- Relatively few drugs were used.
- Patients should have a responsibility for their own health. The concept that prayer is good, but while calling on the gods one must oneself lend a hand, was attributed to Hippocrates.
Strengths of this paradigm might include the following:
- The very essence of this approach, based on minimal intervention, should mean that it would produce little iatrogenesis (relating to illness caused by medical examination or treatment).
- It should involve relatively low cost, as it is based on self-care. In our modern context, it has minimal requirement for expensive technologies, medical and surgical treatments and drugs.
- It offers large scope for disease prevention and health promotion.
Weaknesses might include the following:
- It might not be what is needed in some cases. That is, the ability of life force might not be enough to keep the person alive and to return them to health. Indeed, Asclepiades saw this approach as little more than a meditation upon death.
- People who are ill or in pain often are fearful and do not think rationally. Most health care practitioners are very familiar with the demanding, irrational patient who just wants something done ‘to fix it’.
A simple example would be the case of a person with a fever. Rather than seeing the raised temperature as part of the body’s normal adaptation or response to particular conditions, and monitoring and taking supportive measures, such as rest or chiropractic adjustment if indicated, until that process is complete, many would take a drug to counteract the fever symptom and lower the body temperature to what is considered normal in a healthy person. This is the basic approach of allopathic, modern biomedicine.
THE KNIDAN MODEL
Information on the Knidan model is more difficult to come by, but it differed from the Koan, and had the following bases:
- Focus was on the disease, not the patient.
- Elaborate diagnosis was based on symptoms.
- Diseases were believed to be entities situated in organs or body parts.
- Such diseases were categorised according to their effects in terms of symptoms.
- Accordingly, treatment was directed against the invading disease rather than assisting the patient.
- Drugs were used more widely.
Palmer described the Knidan model as follows:
‘[Man’s] whole object was to find an antidote, a specific for each and every ailment which could and would drive out the intruder, as though the disorder was a creature of intelligence.’
A strength of this model might be that such more aggressive or invasive interventions could be needed in some patients in some conditions, i.e. those that threaten the patient’s health or life beyond the ability of the life force to deal with.
Weaknesses might be:
- Interference with the health-promoting activities of the life force.
- A heightened risk of iatrogenesis.
- Higher costs based on a more complex approach.
Those familiar with the chiropractic paradigm, as an example of a complementary therapy/modality, can easily see that it is based on the Koan model, and the biomedical model of allopathic medicine and surgery has its conceptual foundations in the Knidan.
Modern Western medicine, as described by Peters and Chance, has been practised by a professional elite who have until recently approached disease from a mechanistic point of view, reducing problems to molecular phenomena in order to find a mechanism responsible for them, then counteracting them with drugs that influence the organic process involved. In this paradigm, the patient is seen as the passive, helpless victim of an invasive force that must be hunted down, attacked and destroyed by the physician-rescuer. The patient’s role is one of following instructions and putting his life in the hands of the physician, who assumes full responsibility for diagnosing the malady and effecting a cure.
They quote Capra as follows:
‘The public image of the human organism – enforced by the content of television programs, and especially by advertising – is that of a machine, which is prone to constant failure unless supervised by doctors and treated with medication. The notion of the organism’s inherent healing power and tendency to stay healthy is not communicated, and trust in one’s own organism is not promoted. Nor is the relation between health and living habits emphasized; we are encouraged to assume that doctors can fix anything, irrespective of our lifestyles.’
CONCLUSION
Perhaps new models of care might be found not in the new, but in the old – in recognising and utilising the beauty and wisdom of Hygieia/Cinderella and the natural power, safety, functionality and economy of the Koan model.
This article is based on two papers published by Dr Richards in:
- The Chiropractic Journal of Australia 2008; (38):135-37.
- The Chiropractic Journal of Australia 2013; (43):21-8.
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