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Editors: Marilyn Schlitz & Tina Hyman

Contributions by: Larry Dossey, Roger Walsh, Michael Murphy, Ivan Illich, Eugene Taylor, Lawrence LeShan, Caroline Myss, Rachel Naomi Remen, Arthur Deikman, Deepak Chopra, Stanley Krippner, Kenneth Pelletier, Bernie Siegel, Candace Pert, Joan Borysenko, Jon Kabat-Zinn, Jack Kornfield, Dean Ornish, Fred Luskin, George Leonard, Richard Tarnas, William Braud, Rupert Sheldrake, Elisabeth Targ, Dean Radin, Stanislav Grof, Kenneth Ring, Willis Harman, Charles Tart, Elizabeth Sahtouris, Thomas Berry, Christian de Quincey, David Ray Griffin, Theodore Roszak, Brian Swimme, Ralph Metzner, Duane Elgin, Erwin Laszlo, Angeles Arrien....

Foreword (page 1)
By Ken Wilber

      It always struck me as interesting that a major tenet in the Hippocratic Oath, an oath that in various forms has been taken by many physicians around the world for almost 2,000 years, is simply, "Do no harm to your patients." The positive injunctions are few; but that negative injunction jumps right out at you. Why would it even be necessary to ask a future physician to promise something like that? It is as if Hippocrates understood that, of all the power a physician has, much of it enormously positive and beneficial, one item needs most to be checked: the almost unprecedented capacity to harm a person, legally.

      In several versions of the Hippocratic Oath, it is clear that Hippocrates (long thought to be Hippocrates the Great but revealed by recent scholarship to have been a member of a Pythagorean circle, which does the opposite of diminish his reputation) also understands, particularly when it comes to medicine, that there are two ways to do harm: sins of commission and sins of omission. A physician can harm a patient with what he knows; but even more so, with what he doesn't.

      The aim of integral medicine can be stated simply as the desire to lessen the harm done by both of those sins, and therefore much more effectively set the stage for the extraordinary miracle that, 2000 years later, none of us yet understand: healing.

      Stated more positively, the aim of integral medicine is to utilize as complete and as comprehensive an approach as possible in treating any illness—while, of course, remaining fully cognizant of the pragmatic realities of time constraints, insurance limitations, and office practicalities. The integral medicine that is rapidly developing today has moved significantly beyond early attempts in this area, variously known as "holistic," "allopathic," "alternative," and "complementary." Although some of the components of those pioneering efforts are retained, integral medicine is being launched from a platform much wider in its reach, more grounded in empirical research, and more effectively related to comprehensive models of human psychology and consciousness. But it is helpful to remember that an integral medicine differs in significant ways from both conventional and complementary medicine, while attempting to include the enduring and effective elements of each.

      What would such an integral medicine look like? And how can it effectively be applied given the economic and pragmatic constraints of today's world? The following chapters are attempts to address exactly such questions. Before we outline some of their ground-breaking conclusions, let's set the stage by looking at some of the traditional problems and dilemmas faced by most medical and health-care professionals.

      Everybody knows the first dilemma, because for years it was drummed into medical students: "Don't get emotionally involved with your patients." At the time, that was certainly not a cruel and uncaring injunction to treat people like objects; it was a genuine and sincere attempt to bring a dispassionate and scientific approach to healing illness. Becoming emotionally involved with a patient not only clouded the physician's judgment, it constantly drained the physician and accordingly seemed to harm the patient.

      And yet, beginning in earnest a decade or two ago, there was an explosion of hard empirical research showing that positively enlisting various emotional factors—on the part of the heath-care practitioner as well as the patient—had a profoundly affirmative effect on the treatment, in many cases not only reducing recovery time but medical costs as well. Nor was this a case of "needy" patients doing better if somebody held their hands. Controlled studies consistently showed that, if certain emotional and affective elements are engaged in the healing process, positive effects tend to be seen across all types of patients. Put bluntly, not becoming emotionally involved in some ways could not only increase medical costs but significantly harm the patient. What's a poor doctor to do?

      Medical schools across the country began eyeing this research warily. The whole thing had too much of a "New-Age" ring to it for most conventional medical practitioners. Trying to introduce these "subjective" factors was the opposite of what modern medicine ought to be doing. Nonetheless, virtually all medical schools were forced to confront this issue when research showed that patients were fleeing orthodox medicine and spending some 2 billion dollars annually on types of healthcare that did not ignore these subjective factors. Over two-thirds of medical schools now have courses in complementary medicine, although the relationship between the two approaches remains as uneasy (and even cynical) as it ever was. Part of integral medicine is an attempt to find a framework that can allow both of those approaches—conventional and complementary—to exist in a framework that embarrasses neither.

     A second common dilemma faced by medical practitioners is the very difficult problem that has become popularly known as the "Cartesian dualism," or the mind-body problem, and which, for all its high-flying philosophical accoutrements, simply means this: right now you mostly likely feel that you have some sort of consciousness and free will, and yet physical science proceeds as if reality is a closed materialistic system. Even if philosophically you are a materialist, you have to constantly translate every experience you have into materialistic terms, because that is simply not how your experience arrives. Physicalism, in other words, violates the grain of how the world naturally presents itself (not to mention the fact that the majority of philosophers in the area simply do not believe that consciousness can be reduced to eliminative materialism). And yet, as a conventional physician, you are more-or-less forced to treat a patient as if the patient were essentially a biophysical or material system—medications for this, surgery for that, radiation for this, one physical intervention after another physical intervention. Your patients, when it comes to medicine, are physical machines, and yet in your own awareness you do not feel that you are a physical machine—and neither do your patients. The "Cartesian" problem in the conventional practice of medicine is simply that you are basically forced to treat a patient as if he or she were a physical machine, when both of you know otherwise.

      A third common dilemma faced by conventional medicine is that of compliance. It is now estimated that in many cases a majority of treatment failures are due to lack of patient compliance with the prescribed medical intervention (from taking pills to following recommended diet). Patient compliance has always fallen into the rather nebulous area of "subjective psychology"—exactly the area ruled out by the biophysical model of medicine. Once again, the very core practices of biophysical medicine are rendered ineffective precisely by those factors deemed not central to the model.

      A forth dilemma faced by health-care practitioners is rarely spoken about, but it is a topic always lurking in the hushed background: just where do you locate illness? And where do you locate the causes of any illness? It is simply impossible to draw a boundary around any disease entity, let alone its causes. Arteriosclerotic heart disease has many contributing factors, including diet, with primary culprits including trans-fatty acids, now thought to directly contribute to thousands of deaths annually but are nonetheless widespread ingredients in virtually every packaged food product in this country. Or take the number of hormone-like synthetic chemicals, now numbering in the tens of thousands, around 10% of which are known carcinogens. Can any person be healthy if the biosphere is sick? From this uncomfortable perspective, it appears that as a physician, when you treat any patient, you are being asked to fix one small link in a thoroughly diseased chain of events.

      Psychiatrists face this painful dilemma all the time. A teenager comes to the office for treatment of anxiety neurosis; it soon becomes obvious that it is not so much the teenager who is sick as his family, with an abusive father and alcoholic mother. Where is the illness "located?" Not to mention the fact that this teenager has to pass through metal detectors every day in school in order to make sure that he is not carrying an Uzi machine gun. And so what's the poor psychiatrist to do? Medicate the kid, of course.

      This dilemma is simply that, just as in some mysterious way everything is connected to everything else, so all illness is somehow deeply embedded in networks, systems, and chains of pathology, with any individual patient being something like a canary in the proverbial mine shaft, picking up the systemic illness a bit earlier than others and having the good sense to drop dead first.

      Whether or not any particular health-care practitioner explicitly thinks of illness as being part of larger (and possibly diseased) systems in the world, there is usually the gnawing sense that one's efforts at health care are not much different from being a surgeon in a MASH unit during a war: you patch them up and send them right back out on the battlefield to catch the next bullet. The intrinsic insanity of the situation—this impossible Catch-22 job—seems to be felt to some degree by all sensitive health-care professionals.

      Related to that difficult issue of how to define or even locate "illness" is the converse and equally impossible dilemma: what do we mean by "health"? Once it is understood that a human being is not simply an assemblage of physical parts, but contains emotional, mental, and spiritual dimensions that cannot be reduced without remainder to material processes, then what exactly does "health" mean in such a multidimensional being? How many levels of being—physical, emotional, mental, spiritual—should a doctor treat? Can I be healthy if I am spiritually malnourished? If a Nazi's blood tests come back completely normal, is that person healthy?

      "Well, as a physician, that is not, and cannot be, my primary concern." But that is the same agonizing dilemma, isn't it? By saying that those areas are not the concern of physicians, we are by default pledging allegiance to the old materialist version of medicine, thus forcing ourselves to treat a person according to a model that both the doctor and the patients know is hooey. And there is the painful dilemma: as a health-care professional, you might indeed have to specialize in one particular area and ignore and compartmentalize all others; but as a human being, you simply cannot do so and retain any sort of basic sanity or decency. The more effective you are as a conventional physician, the less a human being you often find yourself becoming.

      Integral medicine is designed, in part, to help with those dilemmas, not so much as they effect the patient or client, but as they effect the physician and health-care practitioner. Integral medicine is also, of course, a way to more effectively and efficiently help patients; but it is, first and foremost, a way to help the health-care professional handle all of those pressing problems and painful dilemmas.

      This is one of the defining ways that sets integral medicine apart from both conventional medicine and alternative medicine. It is sometimes said that conventional medicine treats the illness and alternative medicine treats the person. That's fine, and I personally believe both of those are very important. But integral medicine goes one step further: it treats the illness, the person, and the physician.

      Here it is useful to make a distinction between what might be called "an integral approach" and an "integrally informed approach." As we will see, both of these play an important role in integral medicine, although the former applies more to the patient, and the latter, to the health-care professional. While an integral approach can more effectively help the patient, an integrally informed approach can more effectively help the healer.

     All of the dilemmas mentioned above are variations on a common theme: the nature of a human being and his or her relation to a larger scheme of things. Although it might seem at this point that we are taking an unnecessary detour through philosophy, psychology, metaphysics, or some other alarmingly irrelevant field, the whole point about any truly integral approach is that it touches bases with as many important areas of research as possible before returning very quickly to the specific issues and applications of a given practice, in this case, medicine. Fortunately, the results of this particular detour can be summarized fairly simply and succinctly, with its direct relevance to medicine quickly established.

      An integral approach means, in a sense, the "view from 50,000 feet." It is a panoramic look at the modes of inquiry (or the tools of knowledge acquisition) that human beings use, and have used, for decades and sometimes centuries. An integral approach is based on one basic idea: no human mind can be 100% wrong. Or, we might say, nobody is smart enough to be wrong all the time. And that means, when it comes to deciding which approaches, methodologies, epistemologies, or ways or knowing are "correct," the answer can only be, "All of them." That is, all of the numerous practices or paradigms of human inquiry—including physics, chemistry, hermeneutics, collaborative inquiry, meditation, neuroscience, vision quest, phenomenology, structuralism, subtle energy research, systems theory, shamanic voyaging, chaos theory, developmental psychology—all of those modes of inquiry have an important piece of the overall puzzle of a total existence that includes, among other many things, health and illness, doctors and patients, sickness and healing.

      So an integral approach does not start by asking, for example, "Which of those methodologies are right and which are wrong?," but instead asks, "What kind of a universe is it that allows all of those practices to arise in the first place?" Since no mind can produce 100% error, this inescapably means that all of those approaches have at least some partial truths to offer an integral conference, and the only really interesting question is, what type of framework can we devise that finds a place for the important if partial truths of all of those methodologies?

     If we found such an integral framework, isn't it likely that it would have a direct impact on the practice of medicine and the difficult dilemmas faced by medical practitioners who, in effect, are presently forced to be less-than-integral in their medical practice?—while nevertheless feeling the strain and inner turmoil of wishing to be as whole and as integral as they can as human beings? And wishing to bring that integrity to an integrally informed practice of medicine? Is it really necessary that the more I become a doctor, the less I become a human? Or is there some way to practice medicine that surrenders not one ounce of the rigorously scientific, empirical, and clinical dimensions that will always be a cornerstone of any modern scientific system of health care, but also makes room, in a coherent fashion, for all of those other dimensions of being-in-the-world, dimensions that, if ignored or repressed, not only subtract from one's humanity but from being a truly effective physician?

     To show what is involved, here is an example of how an integral approach has been used in psychology; the example is directly relevant because it is in the dimensions of psychology and consciousness that an integral approach has much to offer conventional medicine.

     There are at least a dozen major schools of psychology, East and West, ancient and modern. There are the more "external" and "objective" approaches to consciousness, such as neuroscience, cognitive science, chaos and complexity theory, behaviorism, and neuropharmacology. There are the more "interior" or "subjective" approaches, such as depth psychology, meditation, guided imagery, and phenomenology. There are the "social" approaches that emphasize the relational nature of consciousness, including family therapy, systems theory, and social psychology. And there are the avant garde approaches, including subtle energy research, metanormal and paranormal capacities, and transpersonal states and stages of consciousness.

     When I first began studying psychology and consciousness, it was still common practice to pick one (or at most two) of those schools, decide that those were basically the correct approaches, and then spend the rest of one's professional life vigorously attacking the other ten schools. But as integral perspectives began to have an effect on the field, the central question in psychology and consciousness studies changed from, "Which of those 12 schools is the best or most accurate approach?," to "Why is it that all 12 of those schools exist in the first place?"

     Nobody is smart enough to be wrong all the time. The implication was clear: if we are ever to have anything resembling a comprehensive, inclusive, integral view of psychology and consciousness, there is one and only one thing that we know for sure: it will include all 12 of those schools. Hundreds of thousands of decent men and women around the world are already practicing neuroscience, or psychiatric pharmacology, or meditation, or subtle energy research, or transpersonal psychology, or contemplation, or chaos and complexity theories. For the most part, they are responsible, sincere, and concerned men and women of integrity, and they honestly believe that the practice of their chosen field is making a positive and helpful contribution to humanity. And you know what? I believe them. And I hope you do, too. It is not a matter of whether they can do that, or should do that, or are mistaken to be doing that. It is simply the case that they are already doing that, and are doing so in knowledge communities that have passed their knowledge forward for decades or even centuries, all of them contributing in invaluable ways to the sum total of understanding of what it means to be a human in the world.

     So the really interesting question in psychology and consciousness studies soon becomes, "What theoretical framework can account for the important if partial truths of all 12 of those schools?" And then, "Once we have some sort of integral and nonexclusionary theory, how can that integral theory be put into integral practice?"

     In psychology and consciousness studies, here is one result of such an integral approach. If you put all 12 of those important schools of psychology on the table; if you assume that they all have an important piece of the overall puzzle; if you then ask, "What must the nature of the human psyche be in order that all of those approaches are focusing on some important aspect of it?," one of the conclusions that you reach is that the human psyche must contain various dimensions or domains in order for the above methodologies to exist in the first place.

     The type of integral psychology that I am most familiar with condenses all of those "necessities" down into five of the most important dimensions or components of the psyche, which are called quadrants, levels, lines, states, and types. A few of the following chapters present a general outline of this version of integral psychology, so here I can be mercifully brief—but the point, in any event, is that if we have a more integral psychology, we might very well be getting closer to what it means to be an integral physician.

     "Quadrants" is merely shorthand for first-, second-, and third-person perspectives. All major human languages have first-, second-, and third-person pronouns ( first-person: I, we; second person: you, all of you; third person: him, her, them, they, it, its). The simplest and least derogatory explanation for that is: those pronouns represent real and enduring dimensions of experience and reality, dimensions that language itself has therefore adapted to and included during evolution. The first-person dimensions of being-in-the-world include, among other things, the interior "I," self-identity, art and aesthetic expression, meditation, depth psychology, guided imagery, introspection, contemplative prayer, normal and altered states of consciousness, and interior phenomenology. The second-person dimensions of being-in-the-world involve, among other things, the ways that a "you" and an "I" can come together and form a "we" (which is why "you" and "we" are sometimes treated together as second person), and thus second-person dimensions include culture, hermeneutics, mutual understanding, morality (or how we treat each other with regard), intersubjectivity in all its dimensions, and communication itself. The third-person dimensions of being-in-the-world include the more "objective" approaches to reality, which do not use "I-language" or "we-language" but rather "it-language"—namely, the more scientific approaches that focus on those third-person dimensions of being-in-the-world—approaches that include physics, chemistry, neuroscience, pharmacology, and so on. These "it" approaches are sometimes subdivided into individual and systems approaches, giving us the sciences that focus on an individual or its subcomponents (the more "atomistic" versions of science, including physics, molecular biology, etc.) and those that focus on the collective (such as the numerous forms of systems theory, ecology, and complexity theory). These two approaches are often summarized as "it" (singular) and "its" (plural, collective, systems).

     So the quadrants (I, we, it, and its) are just a simple way to keep track of the four major dimensions of being-in-the-world that are not only embedded in all major languages—and are therefore already present and fully operating in both you and your patients—but dimensions of reality that have been intensely investigated by literally hundreds of major paradigms, practices, methodologies, and modes of inquiry. These dimensions of being-in-the-world are most simply summarized as self (I), culture (we), and nature (it). Or art, morals, and science. Or the beautiful, the good, and the true. Or simply I, we, and it. And the interesting point is that, as far as we can tell, none of those dimensions can be reduced without remainder to the others (which is why, as a scientist, you might try to focus exclusively on the "it" dimension of reality, but as human being, you cannot do so without rupturing the fabric of experience).