Finding the correct meaning of “holistic”

March 18, 2009


Following this news story I heard on Radio 4 about other words which people would like to ban. “Holistic” was one of them. Below is an outline of my own thoughts on this.

“Holistic” is a term that has, in the past decade or so, been horrendously maltreated. As an Occupational Therapist I trained for three years in order to provide holistic treatment for the patients, clients or service users with whom I work. But what does “holistic” actually mean? And why is it now used in a way for which it was never intended.

A dictionary definition of “holism” is “Med. the treating of the whole person including mental and social factors rather than just the symptoms of the disease”. [1] This has traditionally been the realm of the Occupational Therapist. The models which I use to structure my practice in mental health take in an individual’s person, environment and occupation (P-E-O model) [2] and their volition, habituation and performance capacity (MOHO) [3]. Let me explain further.

The P-E-O model states that an individual is a complex amalgam of who they are, their environment – social, physical, temporal –and their occupation (the things that they do). The Occupational Therapist therefore needs to look at each of these areas of the individual’s life in order to establish how best to carry out an intervention.

MOHO considers an individual’s motivation, their readiness to interact with their physical, social and temporal with a consistent pattern of behaviour (habituation) and their ability to carry out these occupations.

Both of these models (and, indeed, all of the other models of Occupational Therapy which I have not listed here) consider the individual as a whole person, rather than focus solely on their particular problem. The individual is not “the broken leg in bed 3” but “Mrs Jones in bed 3 who has a fractured femur”. This is the meaning of holistic in Occupational Therapy practice and it is essential in order to understand the needs of the individual and provide the individualised treatment that they need.

“Holistic” has, unfortunately, been hijacked, mainly by complementary therapies and wooster nutritionists. It now appears to be applied to anything that is ethereal, woolly and unscientific. Occupational Therapists need to reclaim “holistic” and ensure that its true meaning is restored, otherwise there is a real danger that Occupational Therapy will end up being bracketed with Reiki, Hot Stone Therapy and the like.

[1] Reader’s Digest Oxford Complete Wordfinder (1993), 712.

[2] Law M, Cooper B, Strong S, Stewart D, Rigby P, Letts L (1996) The person-environment-occupation model: a transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63, 9-23

[3] Kielhofner G (2002) Model of Human Occupation. 3rd ed. Baltimore: Lippincott Williams and Wilkins.

Crap reporting, legitimate research

October 3, 2008


Asbo kids have ‘mental illness’
Just another bland example of flaky overhyped unreferenced speculative reductionist comedy reporting.

Spotted on the bad science mini blog. The reporting is dire – no references to published literature, no interviews with any of the “researchers” mentioned. Just some stock footage of young people drinking, riding bicycles, walking and being arrested.

The sad thing is that this excuse for journalism refers to a paper published in Biological Psychiatry 2008, 64, 599-606 which was also covered by the BBC news website.

To precis: Cortisol is the hormone produced when we (humans) are stressed. This enables us to stay calm and deal with stressful situations. Adolescent males with conduct disorder (CD) were shown in this study to have no increase in cortisol from their normal levels when placed in a stressful situation.

The researchers acknowledge the limitations of their study (potential poor adherence to the regime, retrospective accounts) and the numbers of participants was relatively small (CD=70-42 early onset, 28 adolescent onset, control=95).

The ITN reporter, rather than reporting the facts (physiological markers may affect behaviour but do not necessarily cause it (Hodgins in the BBC news article)) has chosen to sensationalise it and misreport it as a mainly psychological problem. Whether this is wilful or merely negligent is unknown. But it once again reminds us all that there is a real need for health and science correspondents who have an actual understanding of their subject.

Edit at 1500 03/10/2008
Also blogged by jdc. Many thanks jdc!

George Carlo and mobile telephone masts

September 19, 2008

[BPSDB]First blog post. Will probably get better as I do more. Bit nervous. Here goes…

According to the Stourbridge News, Dr George Carlo is a leading American scientist and an advisor to the US government who is an ‘expert’ in electro sensitivity (example of his work here). He has been telling the good people of the West Midlands that they are at risk from the 18 masts on a former water tower in Kingswinford.
Carlo is not unknown to the bad science crowd. In June 2007, Dr. Ben Goldacre wrote this column which advises to to treat Carlo with caution. Carlo has told Kingswinford’s residents that they “are in danger”, which would appear to be a serious piece of scaremongering.
Commenter J Elliott of Bristol has spoken out in favour of Carlo and questions Mike Dolan’s (executive director, Mobile Operator’s Association) assertions re: the WHO. I can only assume that he missed this, which states on page 16:

There are individuals that report a wide range of symptoms that they attribute to
electromagnetic fields or being close to electrical equipment. To date, experimental and
epidemiological studies have failed to provide clear support for a causal relationship
between electromagnetic fields and complaints. The reported symptoms are generally
non-specific and no consistent set of symptoms has been identified.

With thanks to the Little Black Duck for link to original story and megachicken for the links to the follow up and the example of Carlo’s work.