By Jessica J Witmer, MA, Ms.Ed., LMHCA
What is Complementary & Alternative Medicine (CAM)?
Complementary and alternative medicine, otherwise known as CAM, is any medical and healthcare system, practice, and/or product that is not presently considered to be part of conventional medicine [1]. Conservative estimates suggest that at least 50% of people in the US, and more worldwide, use various CAM interventions as a part of their healthcare [2].
What is Integrative Healthcare?
Convention western medicine is considered to be highly effective for emergency medicine, but less effective or curative for the treatment of chronic illnesses or symptoms. Increasingly, healthcare consumers are aware that western, allopathic healthcare is not the only form of treatment available to them, and are investigating other healthcare approaches for symptom-relief [3], particularly for issues that are chronic.
When healthcare consumers choose to forgo allopathic treatment in favor of other treatment modalities, they are said to be using “alternative healthcare”. When people choose to utilize allopathic treatment in addition to other treatment modalities, they are considered to be using “complementary” or “integrative healthcare”.
Why Integrative Care for Mental Health?
Evidence suggests that some patients withhold their use of CAM modalities from their medical providers because they believe that their prescriber will be unsupportive or undereducated about the benefits of CAM [4]. When patients hesitate to disclose the use of CAM to prescribers, they can experience adverse effects on overall treatment, including delays in treatment, poor outcomes, and safety issues [5].
Bridging the Gap
While licensed mental health counselors (LMHCs) are not licensed to practice medicine, to prescribe pharmaceutical medications, or to offer medical advice, these healthcare providers can play an important role in integrative healthcare. Integrative mental health counselors have qualifications, such as licensure and/or certifications, training, and experience in assisting clients in exploring the variety of treatment modalities that are available to them for their mental healthcare.
These providers help bridge the gap by providing a place for consumers to explore over-the-counter and/or self-directed use of CAM, and also by providing them with referrals to licensed and/or certified CAM-informed medication prescribers, such as psychiatrists or psychiatric nurse practitioners, who are knowledgeable about potential supplemental/herbal/drug interactions.
Integrative mental health counselors can also refer their clients to other practitioners who are proficient in treatment modalities that can form a comprehensive and holistic treatment plan. When the treatment plan integrates modalities available, both allopathic and alternative, the best results can be achieved, sometimes even eliminating the need for medications with potentially risky side effects.
Complementary and Alternative Treatment Modalities
In our increasingly medically diverse world, people have a variety of treatment modalities available to them. The modalities listed below are some of the most widely used and effective forms of CAMs that are available for healthcare consumers. As can be seen via this list, there are numerous systems of medicine available for healthcare, many of which are highly effective in treating the whole person.
Functional medicine: a systems biology–based approach that focuses on identifying and addressing the root cause of disease [6]
Naturopathic medicine: emphasizes prevention, treatment, and optimal health through the use of therapeutic methods and substances that encourage individuals’ inherent self-healing process [7]
Culinary medicine: helps people reach good personal medical decisions about accessing and eating high-quality meals that help prevent and treat disease and restore well-being and often focuses on optimal assimilation of necessary nutrients [8]
Herbal medicine: the ancient art and science of using plants to support health and wellness [9]
Environmental medicine: the comprehensive, cost-effective, proactive cause-oriented, patient-centered and preventive strategic approach to medical care dedicated to the evaluation, management, and prevention of the adverse consequences resulting from environmentally triggered illnesses [10]
Chiropractic medicine: emphasizes the body’s ability to heal itself and often involves manual therapy, spinal manipulation, and nutritional and/or dietary counseling [11]
Homeopathy: utilizes the principle “like cures like” and utilizes extremely diluted substances to invigorate the body’s natural healing response [12]
Ayurvedic traditional medicine: the ancient Indian healthcare system that relies on a natural and holistic approach to physical and mental health [13]
Traditional Chinese medicine: understands the body as an integrated whole and seeks to restore and maintain harmony throughout the body through the use of herbs, acupuncture, and other interventions [14]
Indigenous/traditional medicine: the knowledge, skills, and practises based on the theories, beliefs, and experiences indigenous to different cultures used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness [15]
Energy medicine: uses an energetic or informational interaction with a biological system to bring back homeostasis in the organism [16]
Bodywork: body-based approaches to treatment that emphasize manipulation and realignment of the body's structure in order to improve its function as well as the client's mental outlook [17]
Somatic psychotherapies & mindbody medicine: recognizes the continuity and the deep connections that all psycho-corporal processes contribute, in equal fashion, to the organization of the whole person [18]
Spirituality / Shamanic medicine: works within a holistic framework to address the spiritual side of illness in a complementary relationship with the nonspiritual treatment of illness and injury, sometimes utilizing rituals, psychotropic herbs, medical marijuana, etc. [19]
German new medicine: understands physiological symptoms, commonly understood as diseases, as “special biological programs” that are initiated by the brain/body as an emergency adaptation response designed to assist an individual through a conflict or time of stress [20]
Mindbody Connection
In one groundbreaking study, the Adverse Childhood Events study (ACES), it was discovered that there is a strong correlation between childhood stressors such as abuse, neglect, or even divorce, and chronic illnesses later in adulthood [21]. One weakness of the current, mainstream medical model is that many conventionally-trained physicians are not adequately trained in assessing for ACEs and/or recognizing the effects that ACEs have on physical health [22].
Thankfully, that is changing as healthcare practitioners from a variety of disciplines are increasingly becoming aware of the complex relationship between traumatic experience and chronic illness. Many integrative healthcare approaches seek to understand the bidirectional impact of physical and mental wellbeing, or what is sometimes known as the “mindbody connection”. Mounting evidence suggests that mindbody approaches such as biofeedback, relaxation therapy, hypnosis, guided imagery, and psychoeducational approaches are effective treatment interventions for a variety of conditions, from arthritis to headaches and chronic pain [23].
Controversy
There is an occasional friction between proponents of CAM and allopathic medicine schools of thought, usually centering around the concept of “evidenced-based medicine”. Exclusive supporters of allopathic medicine sometimes display concern about the lack of evidence to support the use of CAM modalities, while CAM practitioners display concern about the lack of funding for the research of CAM modalities, and/or financial or philosophical conflicts of interest of the pharmaceutical/medical industry [24].
From an economic perspective, there is little incentive to prevent dis-ease, or treat it naturally, when large profits are gathered from the treatment of symptoms. The lack of financial incentive to invest in CAM-oriented healthcare infrastructures puts CAMS practitioners at an economic disadvantage; unfortunately, this makes CAM approaches financially out of reach for many people.
The Ethics of CAMs
When it comes ethical considerations, it is important to note that healthcare providers are faced with a sometimes contradictory obligation: one the one hand, to protect people from potentially harmful practices, and on the other hands to protect peoples’ right to autonomy and to choose their own healthcare approach. Healthcare providers have an obligation to protect clients and patients from potentially harmful interventions; yet, in order to determine which interventions are helpful or harmful, studies must be performed.
Central to the controversy, and sometimes rigorous debate, between conventional, western approaches and CAM approaches is the “uniqueness of the individual”. Evidence-based practices, which are typically based on statistical information, can improve the likelihood of successful outcomes for the majority of people; however, it doesn’t necessarily follow that a given intervention is the best choice for a particular individual. Even if evidence suggests that a particular healthcare option is the best choice for 7 out of 10 people, there is still the question of what is best for the remaining three individuals. As one healthcare provider and researcher stated, “No matter how large the study and how detailed the subgroup analysis, we will never have data detailed enough to provide with absolute certainty the answer for our one unique patient” [25]. The appeal of CAM healthcare choices, for many people, is the attention to the uniqueness of the individual that is central to many CAM systems, such as homeopathy or TMC, but is sometimes lacking in more conventional healthcare orientations.
Furthermore, in a postcolonial and culturally diverse world, there is an increasing awareness that individuals from across cultures have a human right to practice healthcare that is consistent with their ancestral traditions, whether that be eastern, herbal, shamanic, and so on [26]. For example, native and indigenous peoples have the right to their traditional ancestral medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals, and minerals. Indigenous individuals also have the right to access, without any discrimination, to all social and health services [27].
Mental health counselors are obligated to follow the ethical guidelines of the American Counseling Association, which are formulated out of the following eight values:
“autonomy, or fostering the right to control the direction of one’s life;
nonmaleficence, or avoiding actions that cause harm;
beneficence, or working for the good of the individual and society by promoting mental health and well-being;
justice, or treating individuals equitably and fostering fairness and equality;
fidelity, or honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in professional relationships; and
veracity, or dealing truthfully with individuals with whom counselors come into professional contact” [28]
By providing their clients with access to integrative, holistic methods of symptom relief, integrative mental health counselors are taking seriously the ACA’s guidance by following the principles of nonmaleficence (do no harm), beneficence (do good), and autonomy (respect client’s freedom to choose).
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