One of the things I especially appreciate about the book is Dacher’s gentle, reassuring voice. His desire to share both his personal wisdom and the wisdom of the ages with us seems to come from a place of genuine care and concern for others, rather than from a sense that his opinions are particularly special or important. In fact, he doesn’t take credit at all for either the integral theoretical framework put forth or for the set of contemplative practices he introduces and describes. Although Dacher is indeed sharing with us a vision of optimal health and human flourishing based in ancient wisdom teachings, he does so in an especially accessible and compelling manner, framing his perspective in terms that make perfect sense in the context of modern healthcare. It’s clear that Dacher strongly believes that a stable sense of profound well-being — regardless of the presence or absence of physical disability or disease — is available to everyone, given the requisite level of commitment. As Dacher states:

As we lay the foundation for a life of human flourishing these are the two well-informed acts of faith we will take — a faith in the vision of human flourishing and a faith in the path that takes us there. [...] The experiment [...] is to test out this vision and roadmap and see for yourself if it will indeed unfold this future for you.

Dacher sums up the integral framework as follows:

The word “integral” means unitary or one. It refers to a far-reaching health and well-being that addresses all of the important aspects of our lives. There are four components of an integral health. They correspond to the four central aspects of our life. The first two are highly personal — our physical and mental well-being. The second two relate to our interaction with others — our interpersonal relationships and our relationship to the larger culture and planetary community. [...] A concern for each of these [interconnected] aspects of life is essential if we are to resist and recover from disease, optimize well-being and reach towards our full human potential.

Dacher’s perspective is distinct from both conventional and CAM (complimentary and alternative) approaches to health in that he focuses on precisely that which has been most ignored in modern healthcare — inner development. From Dacher’s point of view, the process of inner development:

…ultimately relies on a sophisticated series of methodologies whose aim is to understand the nature of the mind, release its habitual and dysfunctional patterns and enable the unfolding of the qualities of human flourishing.

Throughout the book, Dacher introduces us to and coaches us through a series of contemplative practices designed to facilitate a full flowering of inner development, including mindful breathing and loving-kindness meditations, both of which can be practiced as guided meditations using the audio recordings that come with the book (in CD format). Dacher also shows us how to take an inventory of the daily habits and behaviors that either support or undermine the process of inner development. He gives us suggestions on how to apply mindfulness practice to routines in our daily lives. He instructs us on the art of mindful listening, on how to turn afflictive emotions and other experiences of adversity into opportunities for growth, and how to transform our work lives so as to bring optimal health and healing to ourselves and those around us.

Dacher especially shines in his lucid examination of how our habitual tendencies to get entangled with the various aspects of automatic mental activity keep us from realizing the full promise of health and happiness in life. The main practices presented in Aware, Awake, Alive are designed specifically to help us break free of these tendencies that cloud our minds, so that we can at first glimpse and then over time establish stable contact with a depth of clear, peaceful awareness. It is this experience of our deepest, most authentic nature that, according to Dacher and many of the world’s wisdom traditions, forms the basis for a life of wellness and enduring happiness.

Reading this book has inspired me to work through my own integral health program (which includes several of the core practices Dacher describes) with renewed vigor and commitment. Dacher’s vision is powerful and compelling. The path he lays out is promising and time-tested. His voice is humble, trust-worthy, and compassionate. His work is brave, important, and a gift to us all.

The word “integral” means unitary or one. It refers to a far-reaching health and well-being that addresses all of the important aspects of our lives. There are four components of an integral health. They correspond to the four central aspects of our life. The first two are highly personal — our physical and mental well-being. The second two relate to our interaction with others — our interpersonal relationships and our relationship to the larger culture and planetary community. [...] A concern for each of these [interconnected] aspects of life is essential if we are to resist and recover from disease, optimize well-being and reach towards our full human potential.

Dacher points out that conventional medical science does indeed acknowledge the fact — supported by both research and common sense — that multiple factors impact our health. I can’t tell you how many times I’ve heard folks who embrace some vision of holistic health crow on about how modern medicine is completely ignorant of the well-established connections between physical, psychological and cultural aspects of health and illness. One need only talk to the medical professionals in one’s local area to be disabused of this simplistic notion. Certainly in my experience at least, the vast majority of healthcare professionals are quite aware of the complexities involved in maintaining health and treating illness. The problem, as Dacher describes it, is not the lack of information supporting a multidimensional view of health, but rather “that our singular focus on biology keeps us from implementing this knowledge.”

The main point that Dacher stresses again and again in the book, and the main thing that distinguishes an integral approach to health from both conventional and CAM approaches, is that inner development is both the basis for and the driving force toward the attainment of integral health. Most CAM approaches promote alternative remedies, treatments and therapies, which is fine as far as it diversifies and optimizes the toolkit that healthcare practitioners have at their disposal. However, what characterizes a truly integral approach is:

the turn inward and reliance on our inner capacities, rather than on remedies and therapies. The reliance is on ourselves rather than on practitioners. So [the important distinction is] between a variation on biological medicine, which merely increases our medical tool kit, and an authentic vision of integral health that results from inner development.

This vision of an integral health resulting from a focus on inner development is precisely what is described in detail in both Aware, Alive, Awake and in Dacher’s previous book, Integral Health. I highly recommend both of these books. Perhaps some day soon I’ll actually finish reading Aware, Alive, Awake in its entirety so that I can write a proper review!

I’ve read many, many books about mindfulness and meditation practices, but Dacher has a way of framing and explaining things that I find to be particularly lucid and helpful. Here’s how he explains the process of becoming entangled with mental activity:

As soon as we are enmeshed in mental activity we further elaborate it by superimposing upon it old perspectives and stories stored in memory. In this way we turn simple, unadorned, and brief mental movements into complex mental events which are largely imaginary, and more old than new. What was once a momentary neurological blip appears to assume a life of its own.

I like how Dacher uses the term “mental movement” to talk generally about all aspects of automatic mental activity (thoughts, feelings, mental images, and sensory impressions). This concept fits very nicely with the general theory of Somatics that Thomas Hanna has articulated in the context of his work in neuromuscular re-education (I’ve been long interested in how somatics, psychology, and spirituality can be integrated in a single model of personal transformation). Dacher goes on to explain how enmeshment in mental activity continues to hijack our attention and cloud our minds:

Once we elaborate a mental movement we then add feelings and emotions [...]. That leads to a proliferation of further mental activity which includes fear, anxiety, anger, desire, aversion, and so on. Then, we act out this personalized and imaginary story in the outer world through our speech and actions. A small mental blip, which would naturally come and go, becomes our life, and the life that is actually happening in the moment is lost.

Dacher offers several perspectives and practices that help us to undermine this habit of mental entanglement, and more generally he articulates a vision of optimal health and human flourishing that, while based in ancient wisdom teachings, is also framed in terms that make perfect sense in the context of modern healthcare. For whatever reason, I find Dacher’s vision to be particularly powerful and compelling as I continue to engage with various integral health practices. I’ll dive into all this in much more detail once I finish the book!

My answer: As I use the term, “integral” refers to any approach that brings together multiple perspectives in an effort to address the multiple dimensions of human life. In this sense, the term “integral” is basically interchangeable with “integrative” and “holistic.” As a matter of personal preference, I like the term “integral.” I graduated from the California Institute of Integral Studies, which is grounded in the Integral Psychology of founder Haridas Chaudhuri, and I’m also a big fan of Ken Wilber’s “four quadrant” integral theory.

In general, however, the terms integral, integrative, holistic, mind/body, and wellness are all meant to convey “whole person” approaches to health and healing, as opposed to the disease-focused system associated with conventional medicine.

Keeping in mind that most, if not all, healthcare practitioners—whether in conventional settings or integrative health centers—would claim to be treating the “whole person,” I agree with the following distinctions Dr. Elliott Dacher makes between conventional, complimentary and alternative, integrative, and integral approaches:

[Article featured on Davi Nikent.org]

The evolution of medicine in modern times has been from allopathic or conventional, to alternative and complementary, to integrative and now to integral.

These can be defined as:

Conventional: The traditional approaches of medical science.
Alternative and Complementary: Healing approaches outside of the mainstream of western medical science.
Integrative: The merging of conventional, alternative and complementary approaches under a single “umbrella” of care.

Each of the preceding approaches, as they are currently and predominantly practiced in western culture, primarily focus on the biological or physical aspects of healing, emphasizing the role of professionals and their specialties, remedies and therapies in the treatment of physical disturbances. It is the recognition that these approaches have not addressed the whole person and therefore limit what can be achieved in health and healing that has driven the development of an integral approach.

Integral: The expansion of the health and healing process to address the entire range of the human experience: biological, psychospiritual, relational and cultural. All are seen to contribute to the disease process and to health and healing. The expansion of consciousness, the inner aspect of healing, rather than the outer “medical tool kit” is a central aspect of the integral approach. The aim of integral medicine is broader than all preceding approaches to health and healing. The aim is to gain freedom from suffering and to experience the flourishing of the full potential of our humanity – the natural arising of an inner peace, wholeness, love, compassion and joy – that can sustain itself throughout the life cycle irrespective of the presence or absence of disease. This can only be achieved with an integral approach to healing that considers all aspects of the human condition.

From the Practitioner’s Perspective:

As a conventional practitioner I would approach the individual from the perspective of the physical symptom and disease, limiting my diagnosis and treatment options to those of western science. As an alternative and complementary practitioner I would approach the physical symptom and disease from the perspective of my particular training (acupuncture, chiropractic, nutritional, etc.) and formulate a diagnostic and treatment plan in relationship to my specialty. An integrative care approach combines conventional and alternative approaches to offer a broader spectrum of choices when treating the individual’s symptoms or disease. As an Integral practitioner I would approach the patient first looking at their entire life circumstance – biological, psychosocial, relational and cultural – focusing on the whole person rather than the disease, symptom, or my particular specialty, my diagnosis would include concerns in each of these areas of life and my healing plan would cover the broad range of needs and possible approaches necessary to move towards a larger health of the whole person. Because as an integral practitioner my vision is broader so also is that which can be achieved, a human flourishing vs. a physical healing. As an integral healer I must be in a transformative process myself as the driving force for a larger healing is not merely biological knowledge but an understanding and growth into a larger consciousness. An expanding consciousness is a key ingredient of an integral process.

Elliott Dacher, MD
March 2005