PEER GYNT'S ONION by ANTHONY CAMPBELL Posted to Wiretap 10/13/94. (C) Copyright 1994 Anthony Campbell This text is COPYRIGHTED, but freely distributable. COPYRIGHT NOTICE This book is copyright. I am distributing it electronically as an experiment. Permission is granted to make and distribute verbatim copies of this book provided the copyright notice and this permission notice are preserved on all copies. Comments, questions etc. should be sent to the author at acampbell@achc.demon.co.uk. Anthony Campbell Consultant Physician, Royal London Homoeopathic Hospital, London, UK. --------------------------------------------------------------------- PEER GYNT'S ONION An Alternative Alternative Medicine Book Anthony Campbell [Peer Gynt addresses the onion] I'm going to peel you now, my good Peer! You won't escape either by begging or howling. [Takes an onion and pulls off layer after layer.] ... What an enormous number of sheaths! Isn't the kernel soon coming to light? I'm blessed if it is! To the innermost centre, It's nothing but sheaths - each smaller and smaller - Nature is witty! [Henrik Ibsen, PEER GYNT, Act V, Sc.5] (C) Anthony Campbell 1992, 1994 For Marie-Christine CONTENTS ________________ INTRODUCTION 1. THE CHANGING FACE OF MEDICINE 2. WHAT IS ALTERNATIVE MEDICINE? 3. COMPLEMENTARY OR ALTERNATIVE? 4. IDENTIFYING FEATURES 5. ALTERNATIVE CAUSES OF DISEASE 6. IS IT SAFE AND DOES IT WORK? 7. PLACEBOS AND PSYCHOTHERAPY 8. THE NEW AGE 9. TRYING TO MAKE SENSE OF IT ALL INTRODUCTION Like Peer Gynt's onion, alternative medicine has many layers: practical, sociological, philosophical, even mystical. In this book I have sought to peel my own version of it, discovering in the process a variety of opinions both in others and in myself. And if in the end I find, like Peer, no centre to my onion, no one fixed viewpoint I can confidently label as right to the exclusion of all the rest, perhaps that is no bad thing; the world seems over-supplied just now with people convinced of their own rightness. I have been practising a combination of unorthodox and orthodox medicine for nearly twenty years, and this seemed a good time to put down the conclusions I have arrived at up to now, although without claiming that they are final (the only final conclusions should be those we hold when we die). Their merit, such as it is, comes from the fact that I am not a journalist or other armchair critic but a labourer at the coal face. (Not that I have anything against journalists; indeed, I was a medical journalist myself for a number of years.) Patients quite often ask me how an orthodoxly trained doctor like me came to practise homoeopathy and acupuncture. I think they often expect to hear about a 'road to Damascus' conversion experience, but really it wasn't at all like that. It happened more or less by chance, as these things so often do. As a medical student in the late 1950s I learnt nothing whatever about any form of alternative medicine. I can only remember homoeopathy, for example, being mentioned on one occasion, and I assumed, without thinking about it very much, that homoeopathy had probably ceased to exist as a medical system in the nineteenth century. As for acupuncture, I knew, of course, that it was still practised in China, and at some time in the 1960s I happened to read a letter in the British Medical Journal from a doctor who described with amusement his experience of being treated with acupuncture for a sprained ankle in France. This was pretty much the total of my knowledge of alternative medicine until the 1970s. At that time I was working for a journal called ABSTRACTS OF WORLD MEDICINE, which was published by the British Medical Association. Sometimes as I walked about the streets in the neighbourhood of BMA House I would chance to pass by a building that bore the legend "Royal London Homoeopathic Hospital". I used to wonder about this a little; I supposed that the name was probably a quaint survival from the nineteenth century, but it seemed unlikely that homoeopathy was still practised there today. I found out my error thanks to some friends who were ardent homoeopathic patients. They told me that homoeopathy, far from being extinct, was still alive and flourishing and was practised by doctors as well as by people without a formal medical training; the homoeopathic hospital I had noticed was in fact the foremost institution for the study and practice of medical homoeopathy in Britain and perhaps the world. By this time I had for various reasons (including the demise of the journal for which I worked) left medical journalism and returned to clinical medicine. I had just obtained the membership of the Royal College of Physicians, which is the essential higher qualification needed by anyone who wants to become a consultant in medicine in the National Health Service, and I was looking for a new career direction. Owing in part, perhaps, to a certain contrariness of character, I was also interested in exploring unorthodox medicine. What attracted me most was acupuncture, but I did not know of any way to take this interest further, while homoeopathy was evidently a practical possibility. I therefore made enquiries at the hospital. As it happened, British homoeopathy was in crisis at that time. A short while previously a British Airways Trident had crashed just after taking off from Heathrow, killing all aboard. Among the passengers were several of the most prominent homoeopathic doctors of the day, who had been on their way to an international congress in Belgium. There was accordingly an urgent need to find new recruits for homoeopathy in Britain and to secure the future staffing of the Royal London Homoeopathic Hospital, and I was one of the doctors who eventually filled this gap. The Hospital is within the National Health Service, and sees a large number of patients annually (over 20,000 consultations in a year). It offers not only homoeopathy and orthodox medicine (all the doctors who work there are qualifed in both areas) but also a range of other complementary therapies, including acupuncture, osteopathy, and autogenic training. Some patients are admitted for more intensive treatment or for investigation, but the majority are outpatients. Most have long-term disease; we see few acute problems, partly owing to the length of our waiting lists. In the time that I have been at the hospital public attitudes, and doctors' attitudes, have changed considerably. I have noticed this in connection with the acupuncture courses for doctors which I hold. Ten years or so ago I had to spend a certain amount of time on courses answering questions from doctors who were sceptical. Nowadays this very seldom happens; they nearly all assume unquestioningly that acupuncture works and simply want to get on with learning it. As might be expected, however, the enormous outpouring of popular interest in alternative medicine has not gone unchallenged. There has been a reaction. Books and articles criticizing various aspects of alternative medicine have begun to appear, and the British Medical Association carried out an investigation whose findings were largely unfavourable to unorthodox treatments. However, the mistake of the 'anti' lobby is usually to pick off the easy, obvious targets without really going into the subject in any depth. Of course there is a large element of nonsense in alternative medicine, and it is tempting, and sometimes legitimate, to make fun of it. But some of the treatment that is included under the rubric 'alternative' does actually work, and has been shown to do so in proper scientific studies, so it is wrong to dismiss the whole lot as mumbo-jumbo. Reading some of these books, I seem to hear the despairing gurgles of some quite presentable babies as they disappear down the plug hole. Moreover, the critics of alternative medicine usually fail to see that, even if a lot of what they attack so vehemently is foolish and misguided, there must be a reason why it has become so popular. There must be something wrong with orthodox medicine, there must be a need that it is not responding to. It can be difficult and uncomfortable for people trained in Western mainstream medicine to come to terms with unorthodox practices. I have noticed, for example, that many of the doctors who come on my acupuncture courses seem quite happy to use the technique for treating painful disorders of muscles and joints, but relatively few go on to apply it to the treatment of other things like allergies, gynaecological problems, or colitis, to mention just a few which often respond well. Yet treating these disorders is no more difficult than treating muscles and joints; in fact, in some ways it is easier. What prevents them is probably a psychological block; they can just about imagine that acupuncture might work for a painful back, but they cannot see any reason why it should work for, say, ulcerative colitis. For that matter, nor can I; but it certainly appears to. At the other extreme a few doctors switch allegiance almost completely after they qualify and become, in effect, alternative practitioners, using almost no conventional treatment at all. However, these are very much the exception, and the vast majority continue to use the two approaches together. In so doing they attract the scorn of many non- medical therapists, who regard them as dabblers. However, I am quite unrepentant about mixing methods in this way. I am thoroughly convinced of the value of sustaining creative tensions within oneself. It is no doubt more comfortable to be a whole-hearted believer or a whole-hearted disbeliever in anything, but either of these attitudes tends to cut one off from many possibilities. I am reluctant to do this; I like to keep my options open. This book should be seen as an exploration of the (I hope creative) tension that results from trying to keep both the orthodox and the alternative perspectives in view simultaneously. 1: THE CHANGING FACE OF MEDICINE To begin with, a thought experiment, which will help you to define your own attitude to the ideas I want to examine in this book. Suppose that an old friend whom you have not seen for several years telephones you unexpectedly and says she would like to talk to you. When you meet, she tells you that she is seriously ill and has not long to live. She has no close relatives, so she wants to leave her considerable fortune to a medical charity of some kind. She has two ideas, and finds it difficult to choose between them. The first idea is to leave the money to buy a scanner for her local hospital, where she has been well treated. She knows that there is a need for such a machine in the district, and it would undoubtedly benefit many patients. The other idea is more unorthodox. She has received a lot of help from a practitioner of alternative medicine, who is keen to set up an institute for the study and practice of various kinds of therapy. This person has plenty of enthusiasm and many plans and your friend is convinced of the value of what he is trying to do. Although your friend is well off, her legacy would not be enough to fund both of these projects fully. She wants your advice about what she should do. How do you advise her? 1. She should leave all her money to fund the scanner. 2. She should leave it all to fund the institute for alternative medicine. 3. She should divide it between them in the hope that the balance will be made up from elsewhere. If so, what proportion would you suggest she ought to leave to each? (Give your reasons.) It is a fairly safe prediction that this imaginary situation has at least made you pause for a moment to wonder about your attitude to alternative medicine. Fifteen or twenty years ago, unless you happened to belong to the then tiny band of stalwart supporters of homoeopathy and other unconventional forms of therapy, you probably would not have hesitated for a moment in dismissing it all as quackery. As we know, things are very different today. Recently I was in the Casualty Department of my local general hospital. The notice board contained advertisements for local services of various kinds; nothing very remarkable in that, except that included among them were a group of local osteopaths and a hypnotherapist. Only a very short time ago such a thing would have been inconceivable. Indeed, it is not very long since an orthodox doctor would have been liable to erasure from the Register if he 'associated' with an alternative practitioner. Things are certainly changing fast. Nowadays we hear more and more about osteopathy, homoeopathy, acupuncture and other kinds of unconventional treatment. Once they were a minority interest, pursued by just a few cranks. Now they are constantly in the news, on television, in articles in popular magazines. But there is a correspondingly large amount of confusion in the minds of both patients and doctors. What are these things? Do some of them work? All of them? None of them? Is it all a media hype? And it is difficult to find definite answers to questions such as these. There are so many different alternative treatments available, and the number seems to grow all the time. It is not even clear what we should call the phenomenon. Once it was 'fringe medicine', then 'alternative medicine', and now often 'complementary medicine'. (The progressive change reflects the increasing respectability of the thing in question.) Nor can one easily define alternative medicine. At one time it would have been safe to say that it was any kind of treatment that is not taught to medical students or practised in National Health Service Hospitals, but that definition is no longer valid; many hospitals now use acupuncture, and other forms of alternative treatment, such as osteopathy or reflexology, can be found in some. So far no form of alternative medicine is officially part of an orthodox medical course in this country, but a number of medical schools have included occasional lectures on homoeopathy or acupuncture, and a University Chair of alternative medicine is now about to be established. At a postgraduate level these subjects are already well accepted; many doctors have attended courses in them. So why are these forms of 'rejected knowledge' suddenly so acceptable? An important part of their appeal must surely be that they provide answers to questions that orthodox medicine fails to address or answers unsatisfactorily. Sometimes these questions and answers are quite down-to-earth and practical (What can I do to relieve my migraine? Take feverfew), but sometimes they are psychological or spiritual (Why have I got cancer? Because you failed to resolve your deepest psychological and emotional problems). Philosophical ideas are seldom far from the surface in alternative medicine. Partly, too, it is simply a question of time and attention. When patients visit their family doctor they usually expect a prescription, certainly, but they also want (but probably seldom really expect) something less tangible: to be listened to, to be given sympathy and reassurance, and especially to be allowed time to talk about themselves. This tends not to happen in consultations under the National Health Service, simply because there are too many patients. But in any case doctors are not always well equipped to provide this kind of service. Their education does not necessarily prepare them to cope with the social and emotional problems they encounter, especially in general practice. A modern medical training is largely concerned with the diagnosis and treatment of identifiable physical disease, and even the psychiatry that a medical student learns is likely to be based on physical models. Orthodox medicine has fallen into difficulties that in large part have been created by its own successes. The roots of this lie in the late nineteenth century, when medical scientists such as Pasteur, Koch, and Virchow were making discoveries that, for the first time, gave doctors an insight into the way the body works and what happens to it in disease. This was a most exciting time for young medical men, as we can see in George Eliot's portrait of Lydgate in Middlemarch. And the excitement continued into the twentieth century, with the discovery of insulin and other hormones, vitamins, and the sulphonamides and penicillin. Later, effective treatment was introduced for tuberculosis, and vaccination against poliomyelitis more or less eliminated this disease from the rich countries. Smallpox was finally eliminated world-wide, the first (and so far the only) time that a major infective disease has succumbed to the advance of science. In Britain, the setting up of the National Health Service made all these medical advances freely available to the whole population. Aneurin Bevan, who introduced the scheme, apparently believed that it would eventually result in many fewer people going to their doctor. Possibly this thought was suggested to him by his Socialist ideals; it sounds a little like the withering away of the State which was supposed to occur in Communism, and it proved as delusive. Instead of diminishing, the numbers of patients coming for treatment increased steadily, as people came to think of health as their right. Gradually, however, medical optimism began to receive set-backs. Perhaps the first major disappointment was the discovery that cortisone, which at first had been greeted enthusiastically as the scientific answer to arthritis, proved to have serious unwanted effects. Since then the same story, with variations, has been repeated again and again, most notably in the thalidomide disaster in 1962. A certain degree of naive optimism about medicine does still exist, especially in the popular press, which continues to trumpet the arrival of new miracle cures for various ailments, as it has done for many years; and we feel aggrieved if we learn from our doctor that there is still no effective treatment for many people suffering from quite common diseases - asthma, for example, or migraine. A lot of these patients can be helped to a greater or lesser extent, of course, but they cannot be cured, and a sizable minority still cannot be helped at all. Along with our expectations of modern medicine, however, many of us have also grown suspicious of it. There have been too many cases in which people have been harmed or even killed by treatment, and some of us therefore reject scientific medicine - 'drugs' - partially or even wholly. There is a paradox here - modern medicine is perceived as both good and bad - and there is another paradox in the way we think about doctors. The old paternalistic image of the doctor as a benign bespectacled figure in a white coat dispensing wisdom as well as medicines still persists in many people's subconscious, but it is beginning to coexist uneasily with another image, that of the coldly dispassionate scientist, who is more interested in research or diagnosis than in actually treating patients. Nevertheless, surveys continue to show that people rate doctors very highly in terms of trustworthiness. And the persistence of the avuncular image leads us to bring to the doctor many problems that in other times might have seemed more appropriate for a clergyman to deal with - unhappiness, loneliness, guilt. Many people become deeply emotionally dependent on doctors because, in a secular age, they have no one else to turn to. Doctor-dependency is quite a new phenomenon, and so is the degree of respect commonly accorded to doctors and medicine today. In former times doctors were often considered as little better than tradesmen. (Within living memory physicians were excluded from the Turf Club at York because they sent in bills.) As for surgeons, their original associations were, we remember, not with the consulting room or the operating theatre but with the barber's shop. Nous avons chang‚ tout cela. But doctors today find it difficult to live up to their reputation; most of them know they do not have all the answers, and, increasingly, so do their patients. A large part of the appeal of alternative medicine stems from patients' rejection of the god that has failed them. "Much of today's revolt against orthodox medicine is not so much kicking the habit completely as seeking an alternative guru, a drug that is more satisfying... Faced with life's problems, more and more people become doctor-dependent or medicine-dependent." (Roy Porter, Senior Lecturer in the History of Medicine at the Wellcome Institute, writing in The Listener in 1985). But there is an additional reason for the rejection of orthodox medicine by many people today. This has to do with the popular image of the doctor as a scientist - a picture of themselves which many doctors share. Modern medicine, in keeping with the rest of our lives, becomes ever more dominated by technology. This makes it more expensive, but also widens the range of problems it can tackle. In one way this is perceived as good, but it can also appear soulless and impersonal. And it is easy to understand this idea. There is undoubtedly something intimidating - terrifying to some people - about a large modern hospital; it is not hard to imagine oneself being swallowed up in it for ever more, like a Kafka protagonist (hero does not seem quite the word here), or like Russell Hoban's Kleinzeit. (Not that there is much new about this. The hospitals of former times were also perceived as frightening, though for different reasons; admission to hospital was often regarded as little better than a death sentence, which in view of the lack of sterility, anaesthetics, and effective treatment of almost any kind it often was.) Why is this image of the doctor as scientist so off- putting for many of us? Partly because we fear - with some justification - that care for the individual patient may sometimes conflict with the demands of research, and it may not always be the interests of the patient that come out ahead. But it goes deeper than that. When I was a boy in the 1940s I had a series of books called the Wonder Books. There was, I remember, The Wonder Book of Why and What, The Wonder Book of How and Why, and various others whose titles I have forgotten. The general theme (still based on pre-war euphoria) was the conquest of the natural world by human science and technology. If I had those books today they would seem impossibly dated, and not only because the information they contained has long been superseded by later discoveries. An even more significant change has been the abandonment of our triumphalist convictions about the very notion of 'conquering nature'. Our self-praise is more muted than it used to be; we are a good deal less sure of ourselves. At the same time as we have begun seriously to question the attitude to nature that almost everyone took for granted in my youth (along with a pride in, and conviction of, the durability of the British Empire), there has been a subtle but important shift in the kind of thought and sensibility that many of us value. One way of representing this shift is to construct a table containing opposed pairs of ideas, which could conveniently be labelled 'head' and 'heart'. If you prefer a more up-to-date way of saying the same thing, they could also be called left-hemisphere and right-hemisphere thinking. HEAD HEART left brain right brain reductionism holism tough-minded tender-minded rational intuitive scientific artistic materialistic spiritual mechanism vitalism astronomy astrology chemistry alchemy artificial natural yang yin male female complementary alternative The psychologist and philosopher William James identified a quite similar polarity when he divided people up into two groups, which he called tough-minded and tender-minded. TOUGH-MINDED TENDER-MINDED empiricist rationalistic sensationalistic intellectualistic materialistic idealistic pessimistic optimistic irreligious religious fatalistic free-willist pluralistic monistic sceptical dogmatic For the last several hundred years, Western thought has been dominated by left-column attitudes, but now there seems to be a movement towards the right column, at least at a popular level. For many people - certainly for nearly all who are involved in alternative medicine - the left-hand column represents BAD and the right-hand column GOOD. I have arranged the columns in this way because the right side of the brain, which controls mainly the left side of the body, is supposed to be artistic, creative, and so on, therefore 'good', while the left side of the brain, controlling mainly the right side of the body, is analytical and language-dominated, and therefore, if not actually 'bad', at least not entirely approved of. (It would be possible to tease this distinction out further. For example, left-handedness, because of its association - sometimes - with a dominant right hemisphere, has a certain aura of virtue and value in alternative circles. Again, there are political overtones in the idea of the right hemisphere as somehow occupying the place of a repressed, non-vocal, minority vis … vis the dominant left hemisphere.) You may have noticed something odd about the first table. I have listed 'alternative' and 'complementary' as polar opposites, yet a little earlier I used these terms more or less interchangeably. In fact, the difference between them is, in a way, what this book is about. 'Complementary' implies a fairly amicable relationship between orthodox and unorthodox medicine. The recently founded Research Council for Complementary Medicine includes both orthodox and unorthodox practitioners among its trustees. 'Alternative', on the other hand, implies a rejection of the conventional approach and the substitution of something different. For the most part, my focus in this book is on the philosophical and emotional rejection of conventional medicine, which is why I have generally used the term 'alternative'. I realize that many people practising various forms of unconventional medicine would claim that their methods are complementary, not alternative, and that they have no hostility to orthodox medicine. I fully accept this, and in so far as anyone does maintain this position, what I say about alternative medicine may not be applicable to him or her. However, there are undoubtedly many others who are hostile to conventional medicine at least to some degree, and it is their attitude that I have in mind in much of what follows. Believers in alternative medicine tend to act in one of two ways. Either they try to build bridges between the orthodox and the unconventional methods as much as they can, or they think of them as mutually antagonistic and not only do not build bridges but often devote a good deal of energy to trying to blow up those that may already exist. When one listens to some of the more radical advocates of alternative medicine one often gets the feeling that they are saying medicine is too important to be left to the doctors. And doctors who use alternative medicine themselves often seem to be regarded as the worst of the lot; it is as if they have committed a kind of trahison des clercs in reverse. Hahnemann spoke contemptuously of 'half-homoeopaths', meaning doctors who used orthodox medicine together with homoeopathy; nearly 200 years later this practice attracts the same scorn from the ultra- committed. Inglis and West, for example, are dismissive of most doctors who claim to practise alternative medicine: 'Medical qualifications do not in themselves make anybody a better therapist than somebody who has not done the standard medical training. Rather the reverse, in fact, as the standard training is only too likely to condition medical students into accepting ideas and attitudes inimical to the practice of natural medicine' [295] It is clear what they have in mind; in terms of the table on p.000, the standard medical training is supposed to condition you to think in the left-hand column (assuming, that is, that you were not initially selected for medical school precisely because you thought like that, which you probably were). What comments like that of Inglis and West tell us is that there are important differences between the underlying assumptions of nearly all non-medical alternative practitioners on the one hand and most, though certainly not all, medically qualified ones on the other. (But I must emphasize once more that I am, inevitably, generalizing, and exceptions on both sides can always be found.) A remarkably clear statement of the alternative position appeared quite recently in The Homoeopath [1990, 10, 110 - 113]. Its author, Dr Denis MacEoin, is an academic who is not professionally involved in homoeopathy; however, he feels strongly on the subject, as he indicated in his response to a talk given by a senior homoeopathic doctor at a seminar on the relations between medical and non-medical homoeopaths. Most of the audience, one gathers, approved of the sentiments expressed; not so Dr MacEoin. He is entirely hostile to any attempt to integrate the two brands of homoeopathy. Orthodox doctors, and this often includes those with a smattering of homoeopathic training, are not competent to lay down the parameters for the management of a homoeopathic case. It is axiomatic that homoeopathy represents, in the broadest sense, a philosophical and clinical contradiction of allopathy and a system of medicine in its own right. MacEoin correctly identifies the dilemma that has always faced homoeopathy. Either it tries to go it alone, and risks isolation, or it tries to integrate itself with orthodox medicine, in which case it risks being taken over. MacEoin has no doubt that independence is the right course, and he believes that this will eventually lead to a situation in which homoeopathy will become 'a distinctive, broadly-based medical system capable in the fullness of time of usurping the current role of allopathy...'. There must, he insists, be no compromise on essentials: 'to seek for anything less than freedom to pursue the goal of raising homoeopathy to the status of a primary system of medical treatment to which surgery and drug treatment will be complementary would be to betray the vision of generations of homoeopaths and the hopes of thousands of patients like myself.' There is evidently an almost unbridgeable gulf between alternative views of this kind and the more moderate 'complementary' version of unorthodox medicine. I shall look at this in more detail in Chapter 3. First, however, we need to try to establish what it is we are talking about. 2: WHAT IS ALTERNATIVE MEDICINE? About the only way one can define alternative medicine is negatively, by saying that it is all those forms of treatment that are not taught in conventional medical schools. It would be impossible to list all the different kinds of alternative medicine, partly because new ones keep appearing, and partly because in some cases it is a matter of opinion whether or not a particular method is 'medical' at all. Homoeopathy and osteopathy, for example, obviously do qualify as therapies, but what about yoga, 'sacred Native American exercises', and 'techniques for releasing Karmic patterns that may be inhibiting your growth and well-being', all of which were on offer at a recent exhibition of alternative medicine and complementary therapies in London? It is hard to classify these as treatments, but they are certainly intended to be methods of improving your physical and mental well-being. But methods of treatment as such were on offer at the exhibition too, of course. They included reflexology, therapeutic massage, kinesiology, Feldenkrais, the Alexander technique, Touch for Health, biofeedback. Aroma therapy, shiatsu, and polarity therapy, as well as other methods, some of which I had not heard of previously. Prevention was not forgotten either: there were lectures about the technological dangers that surround us. 'An academic teacher and scientist' looked at 'how computers, microwave ovens, electronic watches, and geopathic stress can make you ill and what you can do about them,' and another lecturer gave a timely warning about 'how the misuse of Kundalini energy can cause mental, physical, and emotional problems.' There was a good range of alternative treatments on offer at this exhibition, but even so only a fairly small proportion of those that exist were represented. A survey carried out in New Zealand found that among 270 people advertising some kind of alternative medicine a total of 94 distinct therapies were mentioned and 81 practitioner qualifications were listed. We need some kind of scheme to make sense of this plethora of treatments, to fit them into categories of some kind. But it is not easy. In their book THE ALTERNATIVE HEALTH GUIDE, Brian Inglis and Ruth West use four main groups, with subdivisions. Their main groups are Physical Therapies, Psychological Therapies, Paranormal Therapies, and Paranormal Diagnosis. But, as they point out, the boundaries between the various therapies are tending to break down, which makes categorization difficult. Even so, their scheme contains some curious illogicalities: it is not obvious, for instance, why Iridology, which purports to be a scientific method of diagnosing disease, should be classed as paranormal, or why art therapy and music therapy should be included as Physical Therapies instead of as Psychological Therapies. My task, fortunately, is easier than theirs, since I am not trying to survey the whole field of alternative medicine but only to pick out certain items to look at in more detail. For my purpose it will be sufficient to use the following scheme. A. Medical therapies: that is, therapies which use pharmacopoeias of some kind (herbalism, homoeopathy). Anti-allergy treatments such as dietary manipulation and clinical ecology (Chapter 5) form a sub-group. B. Physical therapies: osteopathy, chiropractic, acupuncture; also polarity therapy, metamorphic technique, and Rolfing, which have additional psychotherapeutic aspects. C. Psychological therapies: psychotherapy, hypnotherapy, biofeedback, the humanistic psychotherapies, autogenic training, meditation, Silva Mind Control, psychosynthesis. D. Miscellaneous, including so-called paranormal therapies (spiritual healing, radionics and radiaesthesia, 'psychic surgery'.) I include this category for the sake of completeness, but I don't want to say very much about it. E. Diagnostic methods (Kirlian photography, Iridology, astrological medicine). Many of the categories overlap to some extent. Although I have included psychological therapies as one of the categories in its own right, there is an element of psychology in all the treatments, as of course there is in orthodox medicine too; but in some of them it is much more prominent than in others. On the other hand, there are some therapies that are mainly intended to produce psychological effects but which use physical methods such as massage and posture to do so. There is another way of classifying alternative treatments which is more contentious. This is to divide them into those that are semi-respectable from the point of view of orthodox medicine and those that are not. Obviously this cannot be a rigid distinction, if only because the tolerance of individual doctors for the unorthodox varies from doctor to doctor. However, it is fair to say that homoeopathy, acupuncture, manipulative medicine (a deliberately vague term to include both osteopathy and chiropractic), and hypnotherapy are semi-respectable, in the sense that there are appreciable numbers of orthodox doctors who have studied these methods and use them at least part of the time, whereas the remainder of the therapies are used hardly at all by doctors, although even here there are a few exceptions (some doctors, for example, use radionics and radiaesthesia). A third classification has been used by some people. This has three main categories: (1) well-established treatments (acupuncture, osteopathy, homoeopathy, naturopathy, herbal medicine, hypnotherapy); (2) 'core' treatments, used by a wide range of alternative 'specialists' as an adjunct to their own methods (advice, diet, vitamins, relaxation, stress management, massage, exercise); (3) fringe treatments and diagnostic methods (colour therapy, music therapy, radionics, aromatic oils, gem therapy, biofeedback, iridology, Kirlian aura diagnosis, hair analysis). Although the vast majority of alternative practitioners lack conventional medical qualifications, some alternative techniques are used by doctors. In Britain there are very few legal restrictions on the techniques that a doctor can use, even within the National Health Service. Provided the doctor is either a principle in general practice or a consultant, he is remarkably free to do what he thinks best for his patient. If he wants to attend a course in homoeopathy or acupuncture, for example, he can do so, even if it is given by people without orthodox medical qualifications, and he can use the techniques he learns to treat his patients, provided they agree. Under the new provisions of the National Health Service general practitioners can employ alternative practitioners to work under their supervision in their practices. Non-medical practice is also very free in Britain. A few diseases, such as venereal infections, may only be treated by doctors, but otherwise anybody may call himself or herself a therapist of any kind, with or without having received any kind of training. The situation is different in many other countries, where often it is only doctors who are allowed to treat patients. One tends to think that interest in alternative therapy on the part of doctors is quite new. But this is due to our historical parochialism. The Scottish surgeon James Braid used hypnosis in the 1840s to relieve pain during surgery. He coined the term hypnosis to dissociate the phenomenon from Mesmerism and he tried to get the method generally accepted, but shortly afterwards anaesthetics were introduced and hypnotism was abandoned. However, a French country doctor named A.A.Li‚bault took up hypnotism as a method of relieving symptoms by suggestion, and later it was used in Paris at the SalpetriŠre hospital by the celebrated neurologist Charcot. Hypnotism is still used today by some doctors in Britain and elsewhere, and it has now largely completed the journey from quackery to orthodoxy. There has been a Society of Medical and Dental Hypnosis in this country for many years. Acupuncture has likewise been known in the West for a surprisingly long time; as early as the seventeenth century, in fact, although it only became widely known in the nineteenth. At that time it was practised quite extensively in France and in England, where the Leeds Infirmary became a major acupuncture centre in the 1840s. Shortly afterwards, however, it fell into disuse, and only revived after President Nixon's visit to China in 1972. Today the British Medical Acupuncture Society has over 1200 members and the number is constantly rising. The position of homoeopathy is more curious. For a variety of reasons it has attracted more hostility from orthodox doctors than either acupuncture or hypnotherapy, yet there has always been a small but resolute body of medically qualified homoeopathic doctors. When the National Health Service was set up after the war the homoeopathic hospitals were included, perhaps because there were influential people who habitually received homoeopathic treatment, and later the Faculty of Homoeopathy, the official teaching body for medical homoeopathy in Britain, was incorporated by Act of Parliament. This gives homoeopathy a greater degree of official recognition than it enjoys in any other country except, perhaps, India, yet British medical students learn nothing whatever about the subject and indeed are (or were until very recently) not likely even to have heard of it except in the dismissive phrase 'a homoeopathic dose', meaning an absurdly small dose. In the next chapter I return to some of these issues and look at them in a little more detail. 3: COMPLEMENTARY OR ALTERNATIVE? In her recent book on alternative medicine, Rosalind Coward made an important point. The alternative health movement has given voice to a fundamental philosophical opposition to past ways of viewing health... For many, the notion of being alternative is considerably more than just doing it differently from orthodox medicine. It is also a symbolic activity. It is a profound expression of a new consciousness which individuals have about health and the body. [THE WHOLE TRUTH, 11] This is exactly right. Another way of putting the same thing would be to use William James's term "over-belief". For many