So many therapists are striking at the pattern of disease, instead of supporting the pattern of health. One of the things that you as Rolfers must always emphasize is that you are not practitioners curing disease; you are practitioners invoking health. Invocation is possible by an understanding of what the pattern is, the structural pattern of health. As you bring a man’s structure to conform to that pattern of health, you achieve health. You invoke health.

Dr. Ida P. Rolf

Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.

Constitution of the World Health Organization (WHO)

Health care – a set of actions by a person or persons to maintain or improve the health of a patient/customer. Healthcare – a system, industry, or field that facilitates the logistics and delivery of health care for patients/consumers.

Deane Waldman, M.D., M.B.A.

Years ago, when I first began my career as a healthcare professional, I was working as a medical technologist at a small hospital in the Dallas-Fort Worth area. I was responsible for performing laboratory testing as well as collecting blood specimens from patients by phlebotomy. I had the naïve belief that all people who worked in healthcare were doing so because they wanted to help people regain their health. Needless to say, I think it took about six months for my ‘eyes to be opened’, and I realized the fallacy of my belief.

One encounter with a patient has stood out among my memories from that job, and I believe it illustrates what is lacking in much of what passes for healthcare in this country. One day, around 4:00 pm, I was sent to obtain a blood specimen on a middle-aged female patient. The test to be performed was a two-hour postprandial glucose level to check if the patient’s blood sugar had ‘spiked’ after eating lunch (this test is a good way to gauge if a diabetic’s insulin or oral medication is controlling the glucose level in the blood over time, by preventing marked fluctuations after eating). Much to my surprise, when I walked into the patient’s room, she was sitting up in bed, eating a candy bar! I thought to myself, “Well, so much for the test results! This won’t be able to measure anything that her doctor wants to know.”

I introduced myself and explained the purpose of my visit. She made a totally unsolicited comment that she was in the hospital because her blood sugar was “messed up” again. She just wanted her doctor to fix whatever was wrong so that she could keep eating her candy! At that point, I couldn’t decide whether I was more frustrated with this patient, because she seemed to have no clue as to the long-term consequences of uncontrolled diabetes, or her doctor, who was obviously enabling the patient to continue behaviors that were injurious to her health. I remember thinking afterwards that there must be a better way. From that day on I began to ‘look outside the box’ that is traditional medicine, and search for alternatives that might be better able to support people in staying healthy, rather than simply treating disease. Eventually, I found out about Rolfing® Structural Integration.

Everyday, we speak to our clients about the benefits of Rolfing SI and how it has changed not just our physical bodies, but also how we view ourselves and the world around us. Each of us has stories about people being transformed by structural integration, and we are grateful at being able to continue the legacy of Dr. Rolf into the future. As we continue to contribute toward establishing integration and wholeness in the lives of our clients, we should also consider the possibility of doing the same in our chosen field of endeavor, the realm of healthcare.

Integrative Medicine – More Than the Sum of Its Parts

The term integrative medicine is often used to refer to “blending the best of conventional (allopathic) and complementary and alternative medicine (CAM)” (Bell et al. 2002). Combining the two systems seems like a good idea, one that seems to promise an improved package of medical care for the consumer (Bell et al. 2002). The challenges to achieving this are a number of complex practical and conceptual issues within the field of medicine. Bell et al. (2002) suggest that by adopting a worldview from complex systems theory, in which the whole equals more than the sum of its parts, a new perspective for medicine and healthcare research emerges. Does this concept sound familiar, Rolfers?

Within the field of mainstream medicine, if you were to present this idea to most practitioners, the assumption implicit in ‘merging’ mainstream and CAM approaches is that the politically dominant ‘larger unit’ (conventional medicine in the Western world) carries the values, culture, and conceptual framework into which it expects the ‘smaller unit’ (i.e., CAM) to assimilate (Bell et al. 2002). It assumes that “each CAM intervention, once tested and proven effective, can be incorporated into conventional care as now practiced” (Bell et al. 2002).

Unfortunately, much of the conventional practice of physicians, especially for the treatment of patients with chronic diseases, focuses on a specific disease process, rather than on healing the individual person (Bell et al. 2002). Dissatisfaction with how physicians provide conventional care and rely on pharmaceutical medicine continues to grow among consumers and physicians alike (Bell et al. 2002). Integrative medicine emphasizes the goals of wellness and healing of the whole person, with the patient and the integrative practitioner as partners in developing and implementing a comprehensive treatment plan. Healing is believed to originate within the patient rather than from the physician (Bell et al. 2002). The philosophy of integrative medicine is compatible with the WHO definition of health that equates health with well-being (Bell et al. 2002). Again, I ask, does this sound familiar?

The problems that the systems of CAM that emphasize healing the person as a whole (e.g., traditional Chinese medicine, Ayurvedic medicine, and classic homeopathy) encounter with Western science are that 1) no commonly used, scientific methods are easily applied to them for study; 2) there are no obvious ways to incorporate them into conventional practice; and 3) there is no Western conceptual framework into which they fit (Bell et al. 2002). Because of this, clinicians and researchers often break off parts of these CAM systems from their original context and fit these smaller pieces into the dominant model of conventional care and medical research (Bell et al. 2002). As an example, acupuncture has been studied for its efficacy with various Western disorders, but traditionally, Chinese medicine uses a program of diet, botanicals, acupuncture, qi gong, acupressure and environmental interventions to address systemic disturbance patterns in a given patient. In acupuncture-only research, the effect sizes are often modest, and it is reasonable to hypothesize that the effect sizes of the full treatment program would be more clinically significant if studied as used in practice (Bell et al. 2002).

Western thought has a predisposition toward pragmatism. Conventional medicine supports the belief that only outcome results that are persuasive enough will constitute acceptable evidence and will only support one health policy over another when justified by those results. Worldviews and the values placed on different health outcomes are closely related. The values that underlie medical care shape the scientific questions that researchers ask, the health outcomes they measure, and their interpretation of the results.

In contrast to conventional medicine, many different systems of CAM share the belief that a given disease may manifest at the spiritual level as well as on the physical plane. Integrative medicine proposes that the origins of disease are multifactorial more than hierarchical, and include genetic, physical, emotional, psychological, and spiritual issues (Bell et al. 2002). An integrative medicine approach seeks to discern multiple perceived origins of a disease process and addresses them all. Integrative medicine assumes that the individual has the potential for healing at the spiritual level, even when physical healing does not take place.

Conventional medicine, on the other hand, has confined itself largely to the belief that the physical manifestations are the disease and the primary domain for medical intervention. Differences between the views of conventional medicine, various CAM systems, and integrative medicine on the nature of disease can lead to divergent treatment plans and even to different goals for healing.

Identifying and Weighing Health Outcomes

There is limited data to support the healingoriented integrative medical approach as having an advantage over other medical worldviews. The classic view of the quality of healthcare can generally be divided into three components: 1) structure (providers’ competency, equipment, etc.); 2) process (what was done? how well?); and 3) outcome (the results of the intervention).

Structure

Clinical research generally sets randomized controlled trials as the gold standard. It is possible to establish strong causality through enhancing internal validity, but it does not allow for generalizability, which is especially challenging with CAM and integrative medicine research where practices are so diverse and practitioner competency is far from being well defined.

Process

Problems arise from two sources of potential biases and limitations: 1) who would do the final evaluation? – complementary and alternative medicine practitioners who are not stakeholders but who are well skilled in the scientific method are hard to find; and 2) the criteria and measures used (i.e., allopathic or alternative). These two practical problems of integrative research are especially challenging partially because conventional and CAM providers often speak ‘different languages’ and value different outcomes.

Outcome

Should the primary goal of a physician be solely to eliminate disease, or should it also be to optimize well-being? According to Arnold S. Relman, M.D., “Medicine cannot be expected to make unhappy people happy, or frightened people calm” (Relman and Weil 1999). Is it a proper role for a physician to assist a patient toward growing in inner peace and spiritual wellbeing, in addition to subduing the disease process in the body? What outcomes matter to the individual patient, and what differential weight do other stakeholders such as physicians, third-party payers, or hospital administrators place on the outcomes that the patient desires? Who chooses the outcome goals in the end, and how do researchers measure success? Implicit in the worldview of integrative medicine, consistent with the patientcentered approach to healthcare, is the belief that the patient is the most important stakeholder and that the rest of the system must give higher priority to the patient’s needs and values than it does now within conventional care (Bell et al. 2002).

Conclusions and Implications

Integrative medicine is a system of care that considers health (or disease) as an emergent property of the person in an environmental context, conceptualized as an intact, indivisible dynamic system. Integrative medicine is a complex dynamic, higherorder system of systems, conventional and CAM (Bell et al. 2002).

In the twenty-five years since Engel published his seminal article on the biopsychosocial model for medicine, a few theoreticians have tried to point out the relevance of dynamic systems theory, chaos theory, and complexity theory for conventional medicine, psychology, and CAM. However, medicine as a field has not yet incorporated these ideas on a wide scale. It is the challenge of health outcomes research to prove or disprove the relevance of this integrative, systemic worldview to the field of medicine and to test the feasibility of its emergence as a practical and desirable way to provide clinical care (Bell et al. 2002).

Where Do We Go from Here?

Rolfers pride themselves on constantly challenging the norm, whether in society or within themselves. We must act as responsible members of a healing profession to adapt to societal trends and take up the role of being prime movers, rather than reactionaries to changes in healthcare. To do so will require moving out of our individual ‘comfort zones’ and being willing to assimilate into more conventional realms so as to increase our input, and thereby facilitate change in a more integrative process-driven way. Dr. Rolf challenged the established norms of her time, and we can do no less than to tackle established resistance and assist the apparent transformative process currently going on in medicine.

We can give money to fund the efforts of the Rolf Institute® Research Committee and stay informed. We can reach out to other healthcare practitioners in our communities, whether by beginning to dialogue as colleagues, by making referrals, or engaging in a more formal way by seeking to combine our practices with healthcare facilities. Each one of us has particular gifts that will help increase awareness within the communities in which we live. I am currently involved with the Blue Zones Project®, which is helping transform communities across the US into areas where the healthy choice is the easy choice, and people live longer with a higher quality of life.1

Healthcare has changed dramatically since I first began my professional career (Affordable Care Act, anyone?), and I am excited to see what the next ten years will bring. I believe in what Rolfing SI can bring into the lives of individuals, and I plan on devoting any future efforts toward impacting the population of my community as well. Dr. Rolf once said that presenting the concept of Rolfing SI required “compound essence of time . . . to really understand a Rolfer’s function in the community, you need to understand people’s difficulties and why they are resisting the ideas of Rolfing [SI]” (Feitis 1978). I truly believe the time has come for us to seize the opportunity and act, as the resistance against integrative medicine is shifting in a favorable way.

Linda Loggins is a medical technologist certified by the American Society of Clinical Pathology (ASCP) and a Board Certified Structural Integrator. She graduated from the Rolf Institute in 1993, became a Certified Advanced Rolfer in 2002, and completed her Rolf Movement certification in 2006. She graduated with a master’s degree in public health in 2014. She walked the Komen Breast Cancer three-day sixty-mile walk for the third time this year. She especially enjoys being a grandmother to a wonderful two-and-a-half-year-old boy named Trevor.

Endnote

1. Research gathered by Dan Buettner for National Geographic identified longevity hotspots around the world (Blue Zones) where people lived longer with an excellent quality of life. Nine principles or practices, the Power 9, were common to some or all of the communities. Healthways, Inc. is a company that adopts towns or cities as Blue Zones Projects in order to facilitate the communities adopting healthier lifestyles by transforming the environment in which people live.

Bibliography

Bell, I.R., O. Caspi, G.E.R. Schwartz, K.L. Grant, T.W. Gaudet, D. Rychener, V. Maizes, and A. Weil 2002. “Integrative Medicine and Systemic Outcomes Research.” Archives of Internal Medicine 162(2):133-140. Feitis, R. (Ed.) 1978. Ida Rolf Talks About Rolfing and Physical Reality. New York, NY: Harper & Row. Relman, A.S. and A. Weil. “Is Integrative medicine the medicine of the future?” A debate presented at the University of Arizona; April 9, 1999; Tucson, AZ.

In Memoriam Structural Integration:

The Journal of the Rolf Institute® notes the passing of the following member of our community: Evelyn Lehner, Certified Rolfer™