Holistic care is, in fact, most important when it's hardest to do -- when there is a lot that needs fixing. I suppose there may be a holistic way to suture the finger of a healthy, young person lacerated while dicing zucchini, but I doubt it would matter much. It does, however, matter a great deal in complex cases of chronic illness, attendant despair, social isolation, and hopelessness. And at such times, it's really hard!
Here's an illustration, based on any number of patients we've treated over the years. Consider a woman of roughly 70, who comes to the clinic ostensibly to get dietary advice because she wants to lose weight. She is, indeed, obese -- with a body mass index of 32. She has high blood pressure and type 2 diabetes, and is on medication for these. Her husband passed away 4 years ago, and she lives alone. She is lonely, tends toward sadness, and is always tired. She sleeps poorly.
She eats in part because she is often hungry, in part to get gratification she doesn't get from other sources. She does not exercise because she has arthritis that makes even walking painful. Her arthritis has worsened as her weight has gone up, putting more strain on already taxed hips and knees. Medication for her joint pains irritates her stomach, and worsens her hypertension. There's more, but you get the idea.
If you can descend one degenerating spiral at a time, you can reverse engineer the process -- and ascend the same way! In my view, that is what holistic care -- in its practical details -- needs to be; both when practiced by a health care professional, and in the context of self-care- when practiced for you, by you.
For the hypothetical case in question, and innumerable real people like her, reversing a descent begins with one well prioritized move in the other direction.
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-- David L. Katz, MD, MPH
