The program below is introduced as a “Special series discussing the problems of survival and freedom in America”. Mike Wallace begins by saying that his aim in talking with Fromm is to “try to measure the impact of our free society on us as individuals. Whether we’re as happy as we like to think we are, or as free to think and to feel.” Imagine Bill O’Reilly or Brian Williams or Katie Couric devoting an entire program to such questions! These kinds of questions are incredibly important, yet conspicuously absent from public discourse. In terms of Integral Health, it is simply impossible to understand individual health and happiness without understanding the way our individual lives are shaped by societal forces.

During the discussion, Fromm talks about the “marketing orientation” of the American citizenry of the 1950s: “Our main way of relating ourselves to others is like things relate themselves to things on the market. We want to exchange our own personality – or as one says sometimes, our ‘personality package’ – for something.” Fromm (I’m paraphrasing here) goes on to describe modern social relationships as shallow, with real intimacy being hidden by a superficial friendliness. He suggests that the average American is only genuinely concerned with private affairs, never losing sleep about the pressing societal problems which threaten our very existence. He says the average person prefers to leave such things to specialists in the government, talking about problems shown on the news with friends and coworkers, but with no more sense of urgency than one would talk about a car that needs repair. Fromm asserts that, despite our apparent preoccupation with it, true love remains a relatively rare phenomenon. He laments that it is all too common that the most important things we talk about on Sundays are the very things that we pay relatively little attention to in our everyday lives. Again, he’s talking about life in the 1950s, but it’s easy to be struck with how little things have changed, at least in many respects. Like when he says: “I think our danger is that we talk one thing, and we feel and act another thing. I mean, we talk about equality, about happiness, about freedom – and about the spiritual values of religion, and about God – and in our daily life, we act on principles which are different, and partly contradictory.”

Speaking of the “religious renaissance” he was seeing back then, Fromm describes it as “the greatest danger that true religious experience has ever been confronted with.” He goes on to say that man today, being concerned with production and consumption as ends in themselves, has very little energy and time to devote himself to the true religious experience, which Fromm defines (in response to Wallace) as “the capacity to feel deep love and oneness with others and nature.” Wallace also asks Fromm to define “happiness” and “democracy”. Regarding happiness, Fromm offers: “People today seem to define happiness as the experience of unlimited consumption. Happiness should be something which results from the creative, genuine, intense relatedness – awareness, responsiveness, to everything in life – to man, to nature.” Regarding democracy he says: “Democracy once meant an organizational society and a state, in which the individual citizen is – feels – responsible, and acts responsibly, and participates in decision-making. I think what democracy means today, in reality, is to a large extent, manipulated consent – not forced consent, manipulated consent -and manipulated more and more with the help of Madison Avenue.” Fromm adds, “We have a mass man, a mass bureaucracy, a manipulation of everyone to act smoothly but with an illusion that he follows his own decisions and opinions.”

Fromm gives Wallace–and the people watching this ABC News Special–a lot to chew on. Again, I think many of Fromm’s concerns and observations are just as relevant today as they were fifty years ago. Without further ado:

Addiction is a chronic relapsing brain disease. Brain imaging shows that addiction severely alters brain areas critical to decision-making, learning and memory, and behavior control, which may help to explain the compulsive and destructive behaviors of addiction.

Ah yes, the brain. The three pound hunk of tofu that is the ultimate source of all problems and all answers. (Deep, prolonged sigh.) Of course it’s true that any human behavior or experience can be understood in terms of neurobiology and brain states, and it’s also pretty clear that this understanding is valuable and worth pursuing. But it simply doesn’t follow—in theory or in practice—that therefore dysfunctional behaviors and experiences are neurobiological diseases. In our everyday lives, we take for granted that human life is complicated and plays out on many levels. And long before “neuroplasticity” became a buzz word, we already knew that what we do, how we use our attention, and how we relate to one another affects the quality of our lives (and the structure and function of our bodies/brains).

I worked on a chemical dependency unit in a psychiatric hospital for several years, and I’m fairly certain that most of the professional staff would accept information provided by NIDA (and most everything on the HBO site) uncritically, as I’m sure it fits seamlessly with what they learned in graduate school. But young people tend to question everything, and the patients I worked with were anywhere from 12 to 18 years old. Part of my job was to lead educational discussion groups with these kids several times a week. I also accompanied them to Alcoholics Anonymous and Narcotics Anonymous meetings several times a week. These kids constantly questioned staff members about all the contradictions they perceived between AA’s philosophy, the treatment center’s information packets, and their own life experiences. For the most part, the contradictions the kids brought up were crushed by the weight of authority, not cleared up by reasoned argument and explanation. I was quite often in the awkward position of covering for and/or attempting to recast the many misconceptions served up daily and repeatedly to patients, some of whom were desperate for accurate information. The kids (who were almost all cigarette smokers) would inevitably point out things like: “Nicotine is super addictive, right? Well, I personally know several people who quit smoking on their own, without any treatment centers or twelve step groups. So, why is everybody here telling me I can’t stop getting high on my own, that I’m powerless over the ‘disease of addiction’?”

As Stanton Peele (one of the few clear-thinking “leading experts” on addiction I’ve come across) has been pointing out for decades, addiction is and has always been politically and socially defined as much as it has been scientifically defined. Peele covers this ground thoroughly in his recent article The Fluid Concept of Smoking Addiction:

The neurobiological model of addiction is static. It is built on the difficulty – often stated as the near impossibility – of quitting or moderation. The model does not attempt to explain how (or, more accurately, why) people cease addictions – even though such cessation is more typical than not with every type drug. The neurobiological model really has nothing to say about why smokers quit (as a majority do), for example due to the pleading of a spouse or a child. In the terms of the model, cessation is unexpected, unexplained, unpredictable, and simply falls beyond its purview or boundaries.

I used an Integral Health framework to help my patients make sense of their substance abuse problems. In practice, our entire staff operated under the integral premise, i.e. that we must address every conceivable dimension of the patient’s life if we hope to make the most effective impact. Some patients, especially those who were heavy opiate users, were given (non-narcotic) drugs to deal with their withdrawal symptoms. Other than that, there was little about the treatment program that had anything to do with directly impacting brain chemistry. We helped patients become more aware of their thought patterns. We taught them healthy coping strategies to deal with the challenging situations and emotions that would inevitably continue to crop up in their lives. We brought their families in for counseling sessions. We contacted teachers, probation officers, judges—anyone who would be working with these kids once they were discharged back into their respective communities—and developed detailed aftercare plans. We covered all the bases, because we knew that substance abuse problems both develop and are potentially resolved in a multidimensional, bio-psycho-sociocultural context. Surely, most thoughtful people (including the folks at NIDA) know this to be true, and yet the “leading experts” continue to present their oversimplified, disingenuous “brain disease” model to the public (complete with brain scan images that often signify very little, and the obligatory lip-service footnote containing the term “biopsychosocial”). I confess, I’m not entirely sure why this is the case. I suspect it has something to do with how government and academic institutions secure their funds. The more influence the pharmaceutical industry has on research and policy processes, the more traction the brain disease model seems to get. And, of course, the public eats up (literally, in the case of pills) easy answers and quick-fix remedies that require as little life-style change and psychological work as possible.

So, although it may seem reasonable to rely on the opinions of leading experts in a given field, this doesn’t always hold true when it comes to the field of mental health. Integral and integrative understandings of addiction and other problems do exist, but they haven’t yet had the appeal and/or financial backing required to capture the imagination of either the leading experts or the general public.

On the bright side, I’m sure all this will change once I click the “Publish” button and everyone on the internet reads this blog post!

In an integral health model, moving toward optimal health is not possible without acknowledging, engaging with, and addressing all dimensions of our lives, including the dimension of social systems and institutions. And as long as corporate profit is the highest organizing principle of our health care institutions, our conceptions of health and well-being will be distorted accordingly, leading to interventions that can often cause more harm than good.

ORGASM INC., a new film by Liz Canner, “is a powerful look inside the medical industry and the marketing campaigns that are literally and figuratively reshaping our everyday lives around health, illness, desire — and that ultimate moment: orgasm.” Check out the trailer:

Orgasm Inc. Official Trailer from Astrea Media on Vimeo.

So I’m making a concerted effort to be more constructive in my rantings and ravings instead of merely tearing into whatever pushes my buttons. I don’t want throw out the babies with the bath water, so to speak, because there’s usually some truth to be found in most perspectives. That’s the whole point of an integral approach to health, to weave together what’s useful so that problems can be approached more effectively.

The challenge though, is to figure out exactly which perspectives are appropriate or useful in what specific contexts, to articulate how various partial truths fit together into a comprehensive plan of action. I’m hoping to rise to that challenge in the coming weeks by diving deeper into this integral inquiry through engaging others’ perspectives, reflecting on my experiences, and writing about whatever struggles and insights come along the way.

I’ll sign off for today with what I think is the most interesting part of Menand’s piece, where he ventures into this integral territory with some provocative reflections:

Mental disorders sit at the intersection of three distinct fields. They are biological conditions, since they correspond to changes in the body. They are also psychological conditions, since they are experienced cognitively and emotionally—they are part of our conscious life. And they have moral significance, since they involve us in matters such as personal agency and responsibility, social norms and values, and character, and these all vary as cultures vary.

Many people today are infatuated with the biological determinants of things. They find compelling the idea that moods, tastes, preferences, and behaviors can be explained by genes, or by natural selection, or by brain amines (even though these explanations are almost always circular: if we do x, it must be because we have been selected to do x). People like to be able to say, I’m just an organism, and my depression is just a chemical thing, so, of the three ways of considering my condition, I choose the biological. People do say this. The question to ask them is, Who is the “I” that is making this choice? Is that your biology talking, too?

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