Becoming whole

As a third-year undergraduate working on my final dissertation, part of my research was to ask a group of about 40 primary school children to 'draw a picture of yourself'. Each child was given a sheet of A4 paper. Curiously, although there was plenty of space, a quarter of them drew just their head.

I had deliberately avoiding the instruction, 'draw a portrait of your-self', which might suggest just a head and shoulders view. How would you approach this task?  

I doubt that any of us consciously consider ourselves de-capitated from our Bodies. Yet in the 17th century, the establishment in the UK of both the Royal Society and the College of Physicians deemed a separation of head and body necessary. The main reason for this was to satisfy the Church. The Church took the head (soul/psyche), while the body was given over to physical examinations of various types, otherwise prohibited on religious grounds.  

This unnatural division became famous through the writing of Rene Descartes, and has been known ever since as the Cartesian duality. And although William James, Wilhelm Wundt and others later re-claimed the mind as 'consciousness', thus creating the birth of 'psychology', the body/mind split has continued. The mechanistic world view of Newton transferred itself to medicine and Western reductionism followed, so that the body is now perceived as a collection of parts, with body and mind conventionally treated separately from each other within a far from unified model. 

Prior to this shift, however, a more whole-person perception was standard. The medieval population, for example, saw no such separation, and nor do most Eastern or holistic health traditions. And now an urge for unity has begun to re-assert itself in the West.

Changing attitudes

The first stirrings of whole person unity in psychology dawned with William Penfield in the mid-1950's, who noted that discrete brain areas were directly associated with specific body parts and functions. The 1970's and 1980's saw a resurgence of complementary health practices, coinciding with the growth of the ecology movement and greater awareness of our 'inter-connected' nature.  

As a holistic practitioner this was a rewarding time to build a professional practice. GPs would happily refer their (often chronic fatigue or other 'idiopathic') cases to us and, if we needed extra diagnostic information for our own clients, we would reciprocate. Things looked positive for the future, with new inroads being made in re-joining the head to the body in psychology. For example, in Descartes Error, Damasio (1994) argued that emotional responses are not 'separate' from our physically-based impulses; while Candace Pert's (1998) discovery that our 'mind' is spread throughout our body clearly upholds this view. 

Since then it has been further recognised that we have a 'second brain', located in our stomach (Gershon, 2003), which sends many more messages to our 'first brain' than it receives from there. Most recently, body-based therapies such as Tai Chi (Wayne & Fuerst, 2013), Yoga, and massage (Van der Kolk, 2014; Rothschild, 2010) have become recognised for their role in treating trauma, while aspects of dyslexia can often be ameliorated by inhibiting primitive reflexes (Goddard, 2002). In addition, the growing field of psychoneuroimmunology is increasingly demonstrating the intimate relationship between our mental states and health outcomes (Maté, 2019). In the past psychiatrists would frequently scoff at the idea that nutrition might play a role in mental health. Similarly, we now understand the impact on the brain from a dysregulated microbiome (Cryan, 2018).

The last 20 years, then, has shown an increasing shift towards 'Integrative Medicine' (Kligler & Lee, 2004) and in psychology itself the relatively newly formed field of neuro-somatic psychotherapy perceives a mutual pathway between the body and mind, with physical illness often 'somatised' from mental states, and vice versa (NCIP, 2023). In fact, over the past 40 years there has been a growing realisation that mental health is 'not all in the mind' – as Richard Mackarness (1976) pointed out in his famous book on food allergies and mental health. 

A new model for health care

It is now becoming clear that our body and brain work together as one unified organism. This is nurtured and defended by an incredibly complex and intelligent immune system, which has evolved from year dot to keep us alive within our environment.

We are also a whole person (body and mind), living within a family and/or social setting, which is itself a sub-set of a wider culture, with its own beliefs and values. Each of us is also subject to a global physical and political environment, which impacts (positively or negatively) on us, collectively and individually. 

As such, a new model of health is needed; one which reflects this reality. Many psychotherapists are familiar with George Engel's bio-psychosocial model from 1977, which perceives an individual within their social setting. Figure 1, above, shows this model, updated to include these wider spheres of influence, as proposed by Bronfenbrenner (1979), to give an ecological/interactive paradigm in which health is created from our lived experiences, within multiple spheres of life, interacting with our whole body/mind nature.

How is this relevant to Psychologists?

While it is certainly true that we can help our clients a great deal by enabling them to understand and/or heal their thought patterns, I argue that we are handicapping ourselves if we ignore the further good that adopting a 'whole person' perspective can contribute. 

There are three main benefits to this. Firstly, if we can help people identify and change the factors in their life spheres that are impacting on their mental health we are more likely to produce a deeper and longer-lasting recovery, with a lower likelihood of relapse. Secondly, this in turn could lead to reducing the client's overall time in clinical treatment, so that more clients can benefit from the service. Thirdly, it is far more cost-effective to prevent than treat those in mental crisis. A report by the Tony Blair Institute for Global Change (TBIGC, 2023) argues that the current centralised NHS model, which is almost entirely focused on treating 'sickness' rather than on wider objectives, is not only harming people's health but hampering the economy.

A widening of our approach would entail placing self-care much higher in the equation. For example, instead of one long stream of CBT/CFT or counselling, these consultations would become interspersed with additional, compatible disciplines, with the psychologist retaining the central thread of treatment. The difference in overall cost would therefore be negligible. But, even if a 'whole person' care package initially increased cost per capita, the long-term benefit of generationally reduced chronic mental illness, while also encouraging self-care, would ultimately reduce costs while increasing the overall mind/body health of citizens, and therefore our shared wider world, through increased happiness, productivity and the functionality of society generally.

Figure 2, below, illustrates some of the modalities found beneficial in mental/cognitive health, and which integrate well with psychological approaches.

More information, including current research support for each of the complementary areas shown above, can be found via the major professional organisation websites for each discipline.  

The Division of Clinical Psychology's Faculty of Holistic Psychology

With the current crisis in mental health care it is becoming essential that we adopt a new approach. The old model, with the head separated from the body, has arguably contributed to the unsustainable state of the NHS today. It may surprise many, however, that we can benefit hugely from revisiting the past for possible solutions to this situation by integrating sympathetic modalities from other fields of health practice with our own mentally-based therapies. 

In 2004 around 100 psychologists and practitioners of nutrition, EMDR, osteopathy, exercise and others met to establish the Division of Clinical Psychology, Faculty of Holistic Psychology. The brain child of BPS clinical psychologist Nigel Mills, a committee of mixed practitioners was formed, including an equal number of counselling and clinical psychologists. The Faculty now comprises around 280 members, a growing number of whom have arrived recently, as if in answer to an unspoken clarion call from society for a better approach following Covid-19.  

The explosion of complementary (non-drug-based) health practices of the 1980's means that there now exists a wide variety of expertise in these fields, with an established body of research to support it. Practitioners in a variety of BPS divisions, including clinical, counselling, health, education and more, can all become more 'whole'. 

Service provision

What does all this mean here and now? Well, that depends on where one is working. For those working outside of the NHS it is not at all difficult to construct an individualised 'bespoke', whole-person treatment plan in consultation with each client. For example, in addition to CBT, someone living with a difficult partner or work situation could be encouraged to adopt assertiveness skills (through free YouTube videos); use Vitamin B complex (to aid nerve health) and/or massage/ osteopathy (to relieve accumulated neck tension), alongside contact information for free legal, or other, advice and support agencies. Similarly, some mental health states can be assisted by dietary changes, and there are many free or cheap Kindle/audio-books, and other online advice sites for these and which are entirely complementary to psychotherapies.

However, many of these services are no longer available on the NHS (e.g. nutritional advice and supplementation) due to cuts in favour of additional pharmaceutical treatments. In addition, as founder Faculty member Stuart Whomsley explains, current systems for mental health care within the NHS focus on pathways, often linked to diagnosis. This can mean that an aspect which falls outside of the main care-route for the pathway is likely to go unaddressed. A person can only be on one pathway. Connections are missed.  

In addition, current data capture programmes appear largely designed for completing tasks and then auditing. The person can get lost in this. It is hard for clinicians to find a holistic overview. Stuart suggests that 'what we need is a clinician-led, bottom up system design in which information is intuitive to find, with a cover overview to guide the practitioner to where they want to go. In addition, although it is genuine progress for nurses to take an increased role within GP surgeries, the triage system has further broken the individual's personal relationship with the family GP which, in the past, ensured some form of continuity of care.' 

Given all of this, at present the concept of adding value to create a whole person approach on the NHS appears a Utopian dream. But with an estimated NHS drugs bill of £17.2 billion per annum (at November 2020) to cover the multiple prescriptions required for a health service based on 'separate parts', a whole person approach could greatly assist in reducing both the burden of ill-health, as well as the cost to the NHS. 

Whole health hubs

Despite our current mental health crisis there are rays of hope. It is now theoretically possible (at least) for GPs to prescribe exercise, dietary alterations, and even time in nature as non-drug based additions. Each has an evidence base, so can legitimately be approved by NICE. Our profession could also be empowered to integrate these, and other non-medical interventions, as part of a mental health care package. On a wider scale we need community 'whole health' hubs where this type of assistance can be provided, either as preventative care or integrated within an individualised health plan.

In the meantime, it could surely profit us all to discover as much as possible about those modalities that are complementary to our work. We can no longer behave as if our clients' heads are detached from their bodies, or exist in isolation from their life-sphere. As the physicist Fritjof Capra, author of A Systems View of Life (2016), remarked: "The fragmented view of reality not only is an obstacle for understanding the mind, but also a characteristic aspect of mental illness… The Cartesian split between mind and body and… the conceptual separation of individuals from their environment, appear to be symptoms of a collective mental illness shared by most of Western culture, as they are indeed often perceived by other cultures" (Capra, 1983, p.406). 

- Jennifer Poole PhD, Nemeton Ecological Research Unit, Hampshire. [email protected]

References

Bronfenbrenner, U. (1979). The ecology of human development. Harvard, MA: Harvard       University Press.

Capra, F. (1983). The turning point. London: Flamingo.

Capra, F. (2016). A systems view of life. Cambridge, UK: Cambridge University Press.

Cryan, J. (2018). More than a gut feeling.  The Psychologist.   

Damasio, A. (1994). Descartes' error: Emotion, reason and the human brain. Vintage:        London.

Gershon, M. (1998). The second brain. Harper: New York.

Goddard, S. (2002). Reflexes, learning and behaviour. Fern Ridge: Oregon, US.

Kligler, B., and R. A. Lee (2004). Integrative medicine: Principles for practice. New York: McGraw Hill.

Mackarness, R. (1976). Not all in the mind. Pan: London

Maté, G. (2019). When the body says no. London: Vermillion.

NCIP (2023).  National Council of Integrative Psychotherapists.

Pert, C. (1998). Molecules of emotion. Simon & Schuster, London.

Rothschild, B. (2010).Eight keys to safe trauma recovery. Norton. New York.

TBIGC (2023). Fit for the future.    

Van der Kolk, B. (2014). The body keeps the score. Viking Penguin: New York

Wayne, P., and M. Fuerst. (2013). The Harvard Medical School Guide to Tai Chi. Shambala: Boston, US.