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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
     [e-mail].


     Anthony Campbell
     Consultant Physician, Royal London Homoeopathic Hospital,
     London, UK.


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                        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 changé 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 à 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.Liébault
        took up hypnotism as a method of relieving symptoms by suggestion,
        and later it was used in Paris at the Salpetrière 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
        alternative medicine enthusiasts the over-beliefs are far from
        being incidental additions to practical methods of treatment; one
        could almost say that the practical therapies emerge from the
        philosophical presuppositions than the other way round.
             All the same, an important qualification is needed here.
        There are certain "major" forms of alternative medicine -
        acupuncture, homoeopathy, osteopathy and hypnotherapy - that are
        practised by quite large numbers of doctors as well as non-
        medical practitioners. The British Medical Acupuncture Society,
        for example, has over a thousand members at present and the
        number is rising all the time. A few doctors who take up
        alternative medicine become "renegades" and abandon conventional
        medicine altogether, but this is exceptional; most remain more or
        less orthodox but modify their practice by adding one or more of
        the alternative therapies, which they generally practise part-
        time.
             These "major" alternative therapies therefore tend to exist
        in two forms. To use the terminology of politics and religion -
        not wholly inappropriately - one could speak of moderates and
        extremists. The problem here, however, is that opinions about
        these things are not sharply polarized but lie along a spectrum;
        it would be an over-simplification to represent all medical
        practitioners of alternative medicine as moderates and all non-
        medical practitioners as extremists.
             In the case of osteopathy, in fact, the distinction is not
        very relevant. The osteopaths have decided, for better or worse,
        to cast their lot with "the medical establishment", and it seems
        likely that within a few years osteopathy will be as "orthodox"
        and uncontentious as, say, physiotherapy. But some of the early
        osteopaths' theories and beliefs will have been jettisoned along
        the way.
             The distinction is however very relevant for acupuncture,
        homoeopathy, and hypnotherapy, and I should like to bring this
        out by looking briefly at the way these two forms of medicine
        have developed.

        ACUPUNCTURE
             In traditional Chinese medicine acupuncture has an elaborate
        theoretical basis. The most basic idea is yin-yang polarity,
        which underlies every phenomenon in nature. There is also said to
        be a universal subtle fluid or energy called chi which is
        responsible for the processes of life. Chi flows through the body
        in the blood vessels and also in special channels, usually
        misleadingly called meridians in English. The so-called meridians
        connect the various internal organs (liver, spleen, kidney and so
        on). Disease is held to result from imbalances in the flow of chi
        and hence in the proportions of yin and yang, and the task of the
        acupuncturist is supposed to be to restore the balance by
        judiciously adjusting the flow. This is essentially a hydraulic
        concept, and the acupuncturist is pictured as a kind of engineer.
             The theory of acupuncture is elaborate and complicated. It
        is said to be very ancient and may indeed be so, although most of
        the texts on which the modern practice is based are mediaeval. It
        is certainly very complicated, and it employs concepts and
        terminology that are exotic and strange for Westerners.
             This seems to be a considerable part of its appeal for
        Western enthusiasts, especially for those (the majority) who are
        not medically qualified. To learn it, you must put aside your
        Western concepts of pathology, physiology, and even anatomy; such
        a willing suspension of disbelief is obviously easier if you have
        not acquired them in the first place to any great extent.
        Moreover, acupuncture is part of Eastern wisdom, hence profound,
        and in studying it you distance yourself decisively from dull,
        mechanistic, materialistic Western science.
             In part the notion that acupuncture is vaguely mystical is
        illusory, for the ancient Chinese were remarkably pragmatic and
        mechanistic thinkers themselves, and there is nothing mystical
        about their view of acupuncture. Many Western enthusiasts for
        acupuncture, however, do think of it as an esoteric, mystical
        branch of knowledge. This is merely one example of the difficulty
        of making cross-cultural leaps of this kind.
             But there is another view of acupuncture. In the last
        fifteen year or so there has grown up a different version, which
        might be called modern or non-traditional. This is based, not on
        the ancient Chinese theory of chi, yin and yang, 'meridians' and
        so on, but on modern Western concepts of anatomy and physiology.
        It ignores the Chinese system of pulse diagnosis and assumes that
        the effects of acupuncture  -  many of which, obviously, it
        accepts as real  -  are produced via the nervous system as
        generally understood by modern science. And it assumes that there
        must be changes in blood flow in various organs, alterations in
        hormone levels, and other physiological effects to account for
        the effects.
             I originally learned acupuncture from a Western doctor who
        had written a number of books on the subject; these we were
        required to read before attending the course, which lasted a
        week, from Monday to Friday. When we arrived on the course we
        were told by our tutor that he no longer accepted the Chinese
        theories which his own books were about, though he still thought
        it was important to have a grasp of the traditional ideas so as
        to understand the subject. He said he had come to this
        iconoclastic position as a result of his own experience, which
        showed that you got the same kind of results even if you didn't
        practise according to the classic Chinese principles. I admired
        his honesty in reversing his thinking in this way.
             Nearly all non-medical acupuncturists in the West base their
        practice on the traditional system, though sometimes in a
        somewhat modified form. (I think it is in fact questionable how
        far it is possible for a Westerner to adopt traditional Chinese
        ideas and make them thoroughly his own, at least without learning
        to read Chinese and spending a considerable time in China.) In
        China itself, it seems, things are changing.
             According to Nathan Sivin, a sinologist who has studied the
        question at first hand, modern Chinese doctors do not use or
        understand the ancient system. They are unable to read the
        classical literature, which has to be translated into modern
        Chinese. Although acupuncture is still used, the diagnostic
        methods are modern. Patients, likewise, are no longer familiar
        with the yin - yang and five-element concepts. Sivin concludes
        regretfully that there can be no return to traditional Chinese
        medicine in its original form. (American Journal of Acupuncture
        1990, vol. 18, 325, 341).
             The majority of Western doctors who take up acupuncture use
        the non-traditional version, although this is not universally
        true; adherents of both views can be found in the British Medical
        Acupuncture Society, whose members are all medically or dentally
        qualified. For a Western doctor, the non-traditional version has
        several advantages. There is no need to try to come to terms with
        obscure medical concepts, which are likely to seem
        incomprehensible or incredible, or both, to someone with a modern
        scientific training. Moreover, since the 'new' version is based
        on the orthodox medical ideas that the doctor is already familiar
        with, he or she can absorb the basic skills in quite a short time
        and start to practise them without a long delay.
             The traditionalists, not surprisingly, look on all this with
        horror. They say that doctors are looking on acupuncture simply
        as a medical technique, and neglecting the real treasures that
        the 'proper' version contains. They speak disparagingly of
        doctors who attend one or two weekend courses in acupuncture and
        then start to treat their patients. In reply, doctors point out
        that all their conventional medical knowledge is relevant to
        modern acupuncture and therefore they have in effect been
        studying for years.
             Who is right? There is no doubt that doctors can learn the
        basics of practical acupuncture in a short time, and by applying
        these principles in the light of their knowledge of medicine they
        get good results in many disorders. Naturally it takes time and
        experience to become thoroughly skilled in the techniques, but
        the contention of the modernists is that techniques is what they
        are; the ancient theory is irrelevant. And clearly if someone is
        not convinced that the traditional Chinese ideas are valid, he or
        she has little motive to spend years learning them.
             The traditionalists, of course, claim that acupuncture done
        according to the ancient theories gives better results. The
        modernists claim the contrary, and moreover point out that the
        Chinese themselves have in recent years been quite prepared to
        update the traditional practice in various ways. In the absence
        of any proper scientific studies of the question it is impossible
        to say whether the classical or the modernistic approach gives
        the better results, or whether there is no real difference
        between them. The practical details of the treatment are in any
        case often quite similar in the two versions, though there is a
        tendency for the traditionalists to use more needles per patient
        and to leave them in for longer. (For what it is worth, the
        ancient texts seem to imply that the most skilled acupuncturists
        use very few needles  -  ideally only one  -  so in this respect
        the modernists seem to be the more 'traditional'!)

        HOMOEOPATHY
             In the case of homoeopathy we again find at least two views
        of how it should be approached. There is a purist school of so-
        called 'classical' homoeopathy, and there is also a more
        pragmatic version which takes more notice of recent developments
        in orthodox medicine and tries to relate homoeopathic practice to
        these. Nearly all non-medically qualified homoeopaths are purists
        in this sense, but the position of medical homoeopaths is more
        complicated; there are wide variations from country to country
        and changes are occurring all the time.
             One important way in which homoeopathy differs from
        acupuncture and indeed from most other forms of alternative
        medicine is that it was invented or discovered by a doctor and at
        first was practised almost exclusively by doctors. (There were in
        fact some eminent early non-medical practitioners, such as
        Hahnemann's widow Melanie and Von Boenninghausen, a lawyer; but
        these were exceptions and they had to get special permission from
        the authorities to practise.)
             The story of homoeopathy begins with Samuel Christian
        Hahnemann (1755 - 1843). He was an orthodoxly qualified German
        doctor who became disillusioned, understandably, with the
        medicine of his day, and therefore abandoned medical practice for
        a number of years, working instead as a translator and chemist.
        In 1790 he carried out an experiment on himself which planted the
        seed of homoeopathy in his mind and ultimately was to change his
        life. The idea was suggested to him by a book he was translating
        from English, Cullen's Materia Medica. In this he found a
        description of the Peruvian bark cinchona, from which quinine is
        derived. He disagreed with Cullen's explanation of how cinchona
        acted, and decided to take some himself to see what happened. He
        experienced the symptoms of an attack of 'intermittent fever',
        and this eventually gave him the central idea of homoeopathy: to
        choose medicines on the basis of similarity between their effects
        and the symptoms of the disease.
             The medicines Hahnemann used at this time were almost all
        taken from the ordinary pharmacopoeia of his day. Most were
        herbal, although he also used a few minerals. Thus they can in a
        sense be called 'natural', an important consideration for modern
        homoeopaths although probably less so in Hahnemann's day.
             In 1821 Hahnemann was forced to leave Leipzig owing to the
        hostility of the apothecaries. He moved to Anhalt Kothen, a small
        principality some 36 miles away where the Duke was an ardent
        admirer of his system. Here he remained in virtual seclusion (for
        travel in those days was very arduous), cut off both from his
        followers and from contact with mainstream medicine. His patients
        were now nearly all sufferers from chronic disease, and this,
        together with his virtual isolation, led to changes in his ideas.
             While in Kothen he published a controversial theory of
        chronic disease, the miasm theory (see p. 000), together with a
        series of new and unfamiliar medicines for treating such disease
        according to his theory. And he propounded the 'dynamization'
        idea, which was to grip the public imagination almost to the
        exclusion of everything else.
             'Dynamization' is the term Hahnemann applied to the process
        of trituration (for solids) or hard shaking (for liquids) which
        he used in preparing his medicines. As well as this, he also
        diluted them in successive steps, to levels that seemed
        improbable to his contemporary critics and even more so today,
        when according to modern molecular theory there should be none of
        the original substance left at all in many of the medicines and
        very little indeed in the rest. He explained the claim that these
        extraordinarily dilute substances nevertheless could be used as
        medicines by saying that the process of dynamization made them
        much more active than before.
             During his lifetime Hahnemann was a very contentious
        individual who managed to sow discord wherever he went, not least
        among his followers. He was unwilling to accept any deviation
        from his precepts, and as these changed quite considerably over
        the years adherence to them was not always easy. He disapproved
        violently of any attempt to compromise with orthodox medicine, an
        attitude which resulted in the premature closure of a
        homoeopathic hospital founded in Leipzig after his departure.
             Fierce disputes continued to be a feature of homoeopathy
        even after Hahnemann's death. To see why, we need to understand
        that there were two distinct sides to Hahnemann's thought. In
        some ways he was a scientist, carrying out pharmacological and
        clinical research. In other ways, however, he was prone to build
        speculative theories that were closer to metaphysics; in this he
        resembles Anton Mesmer. Thus, in later editions of his main
        theoretical work The Organon he included a considerable amount of
        speculation about vitalism that some of his disciples, especially
        in England, found unacceptable. He also became progressively more
        extreme in his teaching about potency.
             At Hahnemann's death his ideas had become widely diffused
        throughout Europe. They had also crossed the Atlantic to both
        Americas, and at some point they reached India, still the country
        where homoeopathy is most widely practised.
             In the late nineteenth century, however, it was the USA
        rather than India which was most deeply committed to homoeopathy.
        The new doctrine reached a peak of success in the decades 1865 -
        85, when an astonishing number of homoeopathic hospitals and
        colleges were constructed. In 1900 there were 22 colleges, and
        before the First World War there were 56 purely homoeopathic
        general hospitals, some with up to 1400 beds, 13 mental asylums
        with up to 2000 beds, 9 children's hospitals, and 21 sanatoriums.
             Soon after this homoeopathy went into decline in America.
        The main reason for this was quarrelling among the homoeopaths
        themselves. They were divided into two factions. The more
        numerous was composed of doctors who did not distinguish sharply
        between homoeopathy and orthodox medicine and were prepared to
        compromise with orthodoxy. The other group, who regarded
        themselves as strict Hahnemannian purists, distanced themselves
        as much as possible from orthodox medicine and took Hahnemann's
        later ideas even further than Hahnemann himself had done. In
        particular they were extremists in the matter of potency, taking
        the dilution method to extraordinary lengths. For this purpose
        they invented various machines, since to make these ultra-high
        dilutions by hand would have taken far too long.
             This 'purist' group, the best known of whom was Constantine
        Hering, were strongly influenced by the teachings of the Swedish
        mystic Emanuel Swedenborg, which by this time had become
        established in America. The Swedenborgians found in homoeopathy
        just the medical system they were looking for, while the
        homoeopaths thought that Swedenborg's ideas complemented
        Hahnemann's perfectly and gave them a new philosophical
        profundity. They were particularly attracted by the Swedenborgian
        emphasis on the mental and spiritual characteristics of patients,
        and also by the idea that chronic disease has deep roots in the
        personality.
             The last, and probably the most influential, of these
        Swedenborgian homoeopaths was James Tyler Kent (1849 - 1916). He
        compiled a Repertory  -  a kind of large index of symptoms and
        medicines  -  which is very widely used today; he also wrote
        extensively on methods of prescribing and on the medicines
        themselves.
             In England, meanwhile, homoeopathy was pursuing quite a
        different course. The English homoeopaths, of whom the best known
        today are Robert Dudgeon and Richard Hughes, were enthusiastic
        about the new medical teaching but nevertheless were prepared to
        be critical. They rejected some of Hahnemann's more extreme
        ideas, and instead of ignoring orthodox medical knowledge they
        did their best to build bridges between it and homoeopathy. For
        example, they took account of the results of animal experiments,
        and in choosing medicines they took note of the pathological
        changes of disease as well as the symptoms. This could be called
        Hughesian homoeopathy.
             If the empirical school of British homoeopathy that existed
        in the late nineteenth century had continued it is possible that
        homoeopathy today would be much more accepted by orthodox
        medicine than it actually is. But change was on the way.
             In the early years of the twentieth century an English
        homoeopathic doctor, Margaret Tyler, went to America to study
        under Kent. She returned full of enthusiasm for Kent's ideas, and
        began to proselytize for them with considerable success. Other
        doctors took them up, notably Dr (later Sir) John Weir. Probably
        Tyler did not convert many of the old guard, but as they retired
        or died they were replaced by her sympathizers. As a result,
        British homoeopathy changed its character radically in the first
        two decades of the twentieth century and became predominantly
        Kentian.
             In this form it was taken up by a number of lay homoeopaths.
        As we have already seen, there had been non-medical homoeopaths
        right from the beginning, but they had been exceptional. In
        Britain, however, there were few or no legal restrictions on lay
        practice, and it flourished. In part this was because Tyler's
        writings were so distant from orthodox medicine that they were
        immediately accessible to non-medical readers.
             Margaret Tyler remained active in homoeopathy for many years
        and wrote a number of books on it. Her principle contribution was
        to establish the idea of constitution in homoeopathy, which is
        often what appeals to people today.
             Previously homoeopathy had been fairly firmly based on
        Hahnemann's pharmacological experiments. The idea was to find a
        medicine whose effects, as verified by experiments on healthy
        people, were as similar as possible to those from which the
        patient was suffering. For example, white arsenic causes severe
        diarrhoea, vomiting, and thirst for small quantities of water.
        These symptoms are similar to those of acute gastroenteritis, so
        white arsenic would be the similimum in such a case and could be
        used to treat a patient who showed these symptoms.
             Under Tyler and her associates this way of prescribing was
        not abandoned but it was complemented, and partly overshadowed,
        by a new theory that seems to have originated in America with
        Hering. This was that there are certain personality types, each
        of whom is supposed to have a suitable kind of medicine. For
        example, the 'white arsenic' patient is fearful, chilly, tidy and
        fussy; he dresses neatly, can't bear anything out of place, and
        is therefore known as the 'gold-topped cane' patient. The sulphur
        patient is in many ways the opposite: intolerant of heat, untidy,
        careless, given to abstract thought, he is called the 'ragged
        philosopher'. Or there is the Sepia patient (usually a woman);
        she is pictured as a sallow tired mother of a large family, with
        whom she is totally fed up. Tyler says that she longs to escape
        from the house, and feels exhausted. Her six-year-old son starts
        drumming with a spoon on a tin pot; she snatches the pot away and
        smacks her son, who starts to howl. The whole kitchen is in
        uproar, and she doesn't care.
             Obviously these constitutional indications are not directly
        derived from experimental testing of drugs - which homoeopaths
        call "proving". It is hardly likely that taking sulphur, say,
        would make someone untidy who was not so already. The idea of
        constitution must therefore come from homoeopaths' theorizing or
        observation, although there is unfortunately no way of verifying
        this from the homoeopathic literature. There are a few hints of
        this way of looking at medicines in Hahnemann's writings but
        nothing more than hints; mainly it seems to come from Hering and
        Kent but especially from Tyler. So-called classical homoeopathy
        today is really Kentian/Tyler homoeopathy and is certainly not
        identical with what Hahnemann taught and practised - a fact that
        is unknown to many modern enthusiasts.
             A consultation with a modern homoeopath who adheres to this
        "classical" system is thus likely to involve a great deal of
        questioning about the patient's moods, fears, reactions to
        weather, food likes and dislikes, and so on. These are
        deliberately not directly related to the main complaint that has
        brought the patient to the homoeopath, because for the purist
        this complaint, if not exactly irrelevant, is simply the end
        point of a deep-seated disorder affecting the patient's whole
        physical, mental and spiritual being.
             For homoeopaths of this persuasion the "pathological"
        (disease-based) prescribing of Hughes and his disciples is a very
        inferior method. Ostensibly for this reason, Hughes and his ideas
        were displaced from their former pre-eminence shortly after
        Hughes' death in 1902. I think it likely, however, that another
        and probably more important reason for Hughes's posthumous fall
        from favour was his enthusiasm for reconciling homoeopathy with
        the orthodox medicine of his day. The Kentians who came to
        dominate British homoeopathy throughout most of the twentieth
        century were isolationist and rather hostile to orthodox
        medicine, a trait they inherited from their mentor, Kent,
        himself.

        Anton Mesmer and hypnotherapy
             Many people think of Mesmerism and hypnosis as simply
        different names for the same thing. There is however rather more
        to it than that, and the story of Mesmerism is worth looking at
        in its own right, since it exemplifies many of the difficulties
        that attend the attempt to introduce an unconventional form of
        treatment into orthodox medical practice. There are also some
        curious and interesting resemblances between the careers of
        Mesmer and Hahnemann which do not generally seem to have been
        noticed.
             Franz Anton Mesmer (1734 - 1815) was almost an exact
        contemporary of Hahnemann (1755 - 1843). He grew up on the shores
        of Lake Constance, on the border between Germany and Switzerland,
        in a Swabian town called Iznang. His father was gamekeeper to the
        Bishop of Constance and Mesmer was brought up as a Catholic;
        indeed, as a youth he contemplated entering the priesthood, but
        he soon realized that he lacked a vocation. For a year he studied
        law, but in 1760 he became a medical student in Vienna, where he
        qualified MD and PhD in 1767 at the fairly advanced age of 32.
             Mesmer was thus, like Hahnemann, well grounded in the
        science of his day, and he showed no leaning towards occultism or
        mysticism. It is therefore somewhat ironic that his name should
        have become linked with these qualities.
             His early career after qualifying was, in fact, conventional
        enough. He married a rich aristocratic widow, ten years older
        than himself, and thanks to his wife's connections soon
        established a prosperous practice in Vienna, where he met and
        became friendly with the young Mozart and his father. Not until
        the 1770s did he begin to move in the direction that was later to
        bring him such renown and notoriety.
             A young girl called Franzl Oesterlin, a relative of Frau
        Mesmer, became Mesmer's patient. She was suffering from symptoms
        that would now be regarded as psychological, possibly associated
        with hyperventilation. In order to make herself more easily
        available for treatment she came to stay with the Mesmers, and as
        he studied her case Mesmer was led to formulate remarkable
        theory.
             Mesmer's doctoral thesis had been concerned with the
        influence of gravitation on human physiology. He had suggested
        that gravitation depends on a subtle universal fluid which he
        imagined to pervade the whole cosmos, including living organisms,
        and to set up 'tides' in the bloodstream and nerves of human
        beings. This thesis, which in later years he referred to as The
        Influence of the Planets on the Human Body, sounds as if it
        should be concerned with astrology, but Mesmer intended it to be
        fully scientific. Ideas of this kind were acceptable scientific
        currency in the eighteenth century, and indeed Mesmer had lifted
        whole sections of his theory from the writings of the respected
        English physician Richard Mead.
             Contemplating Franzl's symptoms, he made the 'obvious'
        connection. He now understood what was causing the ebb and flow
        of her attacks: nothing else than the gravitational tides he had
        described in his dissertation.
             How to use this discovery to effect a cure? Why, by
        magnetism. Magnets were already in use by at least some doctors,
        though admittedly this was a contentious subject; and of course
        magnets, with their polar attraction and repulsion, could be
        plausibly supposed to act in the same general way as gravitation.
             Mesmer's friend Maximilien Hell, professor of astronomy at
        the University, had a number of magnets made for him in the
        astronomy department, with different shapes according to the part
        of the body they were intended to treat. The effects were
        gratifying. As soon as the magnets were applied to Franzl she had
        an immediate strong reaction followed by a dramatic improvement,
        and after further experiments Mesmer convinced himself that he
        had succeeded in controlling the ebb and flow of the universal
        gravitational fluid.
             Almost immediately after this, Mesmer quarrelled with Hell
        about who should have credit for the discovery. Hell claimed that
        it was the magnets themselves that had effected the cure, but
        Mesmer insisted that their only role was to channel the cosmic
        flow through the patient. It was in fact unnecessary to use
        magnets, he discovered; objects made of cloth or wood worked just
        as well. The explanation, he concluded, was that he himself was
        touching them; he was an 'animal magnet' who acted on objects and
        people in an analogous way to a mineral magnet acting on metal.
             Mesmer now tried to persuade the medical Establishment in
        Vienna of the validity of his discovery. In this he was
        unsuccessful, but Franzl made a complete recovery and eventually
        married Mesmer's stepson. (Mozart, in a letter, records a meeting
        with this lady, now grown stout and the mother of three
        children.) Mesmer's fame increased, and so did his practice; in
        1755 and 1776 he travelled in Swabia, Bavaria, Switzerland, and
        Hungary, treating the famous.
             He was less successful in the case of Maria Theresa
        Paradies, a girl suffering from psychologically caused blindness
        since the age of three who was nevertheless a professional
        pianist. She had been treated with the conventional drastic
        methods of the time  -  bleeding, purging, blistering  -  and
        also with some experimental techniques, including the application
        of a tight plaster helmet and painful electrotherapy.
             At first Mesmer was successful; Maria Theresa recovered her
        sight, at least temporarily. But the ophthalmologist who had
        failed to cure her was, not unnaturally, jealous of Mesmer, and
        claimed the cure was not genuine. Eventually, for reasons that
        are unclear, the patient's father reacted violently against
        Mesmer, finally appearing at his house, sword in hand and
        demanding that the treatment of his daughter be stopped.
             Partly, at any rate, the explanation for the fiasco is that
        as the girl's sight improved her piano-playing deteriorated; she
        ceased to be so much of a public curiosity and was in danger of
        losing a pension that she was in receipt of from the Empress.
        Perhaps, too, there were other causes connected with the
        Paradies' family life (child sexual abuse?) which may have been
        responsible for the girl's initial blindness. At any rate she
        relapsed; eventually she achieved a reasonably successful career
        as pianist and composer, but she never again recovered her sight.
             Mesmer, meanwhile, was the centre of a scandal. Many people
        suspected him  -  almost certainly unjustly  -  of having had
        improper relations with Maria Theresa, and the hostility of the
        Viennese doctors increased. In 1778 Mesmer, by now informally
        separated from his wife, left Vienna for Paris.
             Once established in Paris, Mesmer began a long series of
        feuds with the French medical Establishment. The Academy of
        Sciences, in spite of attending demonstrations, were unconvinced
        by the animal magnetism theory. Mesmer therefore approached the
        newly founded Royal Society of Medicine, which he hoped would be
        more amenable than the long-established Paris Faculty of
        Medicine.
             His initial demonstration at his suite in the Place Vendôme
        was not well received. In 1778, therefore, he moved out of Paris
        and set up a clinic at a nearby town, Créteil, where he had more
        room to treat the large number of patients who flocked to him.
        Some received individual therapy, while the less seriously ill or
        the convalescent were treated in groups. For this purpose Mesmer
        invented the baquet, a large wooden tub containing bottles of
        magnetic metal, stone, glass and so forth. Mesmer had magnetized
        all these items himself, by touching or pointing at them. The
        baquet had iron rods projecting from it; the patients pressed
        these against the affected parts of their bodies, and they also
        held hands to allow the animal magnetism to flow through the
        group.
             Many grateful patients wrote testimonials to the efficacy of
        the treatment, but the Royal Society was unimpressed and refused
        to attend the demonstrations. However, Mesmer was more successful
        with the Paris Faculty of Medicine, a prominent member of which,
        Charles Deslon, became a convinced believer in animal magnetism.
        He had himself magnetized, served as Mesmer's assistant, and
        eventually established his own clinic.
             Having moved back again to Paris, Mesmer now accepted
        Deslon's suggestion that they should try to gain the endorsement
        of the Paris Faculty. Three prominent members of the Faculty
        agreed to watch Mesmer at work. They were shown a number of
        remarkable cures, but remained obstinately unconvinced.
             Mesmer now gave up hope of obtaining the Establishment's
        approval, and concentrated on his clinical work. It is important
        to notice that he distinguished between what we would now call
        psychological and physical disorders, and refused to treat the
        physical. His patients ranged from the rich and aristocratic to
        the poor; everyone received an equal amount of attention and
        those who could not afford to pay were treated free.
             One feature of Mesmer's methods which attracted a good deal
        of unfavourable comment was the 'Mesmeric crisis'. Some patients,
        especially those suffering from more serious symptoms,
        experienced nervous trembling, nausea, occasionally delirium or
        convulsions. Mesmer regarded these as an inevitable accompaniment
        of the process of normalization of the flow of animal magnetism,
        and he had special padded 'crisis rooms' in which patients could
        throw themselves about without hurting themselves, while Mesmer
        or his assistants gave them individual attention. The depth of
        the crisis naturally varied from case to case, but Mesmer
        insisted that some degree of crisis, no matter how slight or
        transient, would always be found if it was looked for carefully
        enough.
             Even more dramatic than the crisis, however, was the
        Mesmeric trance. Mesmer discovered this phenomenon only after he
        had been practising his method for some considerable time; the
        trance then became for him a method of inducing the crisis.
        Another of his followers, the Marquis de Puységur, discovered
        that it was possible to communicate with people in trance,
        getting them to answer questions, remember long-forgotten
        childhood events, and so on. The Marquis came to believe that it
        was possible to produce cures without a crisis, but Mesmer,
        constrained by the demands of his theory, did not agree.
             It is generally held that Mesmer was practising
        hypnotherapy, but it is probably more accurate to say that he was
        a shamanistic healer whose methods certainly included
        hypnotherapy but were not identical with it. Mesmer's conduct
        during therapy sessions was highly impressive, being intended to
        augment the drama of the situation as much as possible. His
        clinic was meticulously furnished to maximize suggestion: the
        light was dim, everyone conversed in whispers, and music was used
        to alter the patients' mood according to what was required at
        each stage of the process. There were four baquets in the room,
        three for paying patients and the fourth for those being treated
        free. Mesmer, as Master of Ceremonies, was elaborately dressed
        and carried a wand, which he pointed at patients or used to touch
        or stroke them. The patients gasped, twitched, went into trance,
        or experienced convulsions or catalepsy. Mesmer's assistants
        ministered to the more severely afflicted and if necessary
        brought them into one of the padded crisis rooms.
             Although Mesmer made some influential converts, especially
        Deslon, he was eventually to break with almost all of them. He
        was autocratic and dictatorial (like Hahnemann) and would brook
        no opposition. A lawyer called Nicolas Bergasse became converted
        to Mesmerism and suggested to Mesmer the establishment of a
        private academy to propagate his ideas. The result was the
        grotesquely misnamed Societé de l'Harmonie.
             The Society was secret. All the members had agreed to sign
        an undertaking that they would not pass on any part of Mesmer's
        teaching without his written permission, nor would they establish
        a clinic without such permission; they were permitted to treat
        only individual patients. It was this last condition that
        destroyed the Society within two years of its foundation in 1783.
             The Society combined the roles of institute, medical school,
        and clinic. Students learnt the theory of Mesmerism and how to
        apply it in practice to patients. Schools were set up in Paris
        and also in several other cities in France, and thousands of
        pupils attended the courses. Bergasse took on much of the
        administration and became correspondingly powerful within the
        organization.
             Meanwhile Mesmer's erstwhile assistant Deslon had set up on
        his own account, and in 1784 he was investigated by a royal
        commission. The committee was convinced by his cures but denied,
        once again, the reality of animal magnetism. Another commission,
        set up by the Faculty of Medicine, reached the same conclusion.
        Mesmer objected that it was he, rather than Deslon, who should
        have been investigated, but there was nothing he could do about
        it.
             Bergasse, Puységur, and other disciples of Mesmer now began
        to make public the knowledge of animal magnetism. Mesmer was
        furious, and the Society dissolved amid scenes of rancour and
        confusion. In any case the Revolution was coming and Mesmerism
        began to be overtaken by politics; Bergasse was later to adapt
        the doctrine of animal magnetism to support his views on
        revolutionary politics.
             Mesmer kept aloof from politics. He travelled about in
        Europe for a number of years, though he was back in France from
        1798 to 1802; he sued for his losses under the Revolution and was
        awarded enough to keep him in reasonable comfort for the rest of
        his life.
             He now recommenced his wanderings, and began to develop more
        outlandish ideas than he had entertained hitherto, starting to
        speculate on what we today would call paranormal phenomena and
        extrasensory perception. During the trance, he said, the mind
        comes into contact not only with other minds but also with the
        cosmos, and so in principle is capable of acquiring universal
        knowledge. In this way it is possible for seers and fortune-
        tellers to foretell the future. He published these ideas in a
        book in 1799, and as a result gained the reputation of an
        occultist.
             Mesmer died in Switzerland in 1815. He was in his eighty-
        first year; a gypsy in Paris had foretold long ago that he would
        die at this age, and he believed her, so he was prepared for the
        end when it came.
             In his own terms, Mesmer must be judged to have failed. His
        dominating ambition was to achieve scientific recognition for his
        theory of animal magnetism and this did not occur. His methods of
        treatment, however, were reinterpreted as suggestion and were
        rechristened hypnosis or hypnotherapy, and in this form they were
        taken up by, among others, Jean Martin Charcot, Pierre Janet, and
        Sigmund Freud (although Freud later abandoned hypnosis). Although
        a faint aura of the disreputable has clung to hypnosis, there has
        always been a minority of doctors and psychiatrists who have
        valued and practised it. There is still a Society of Medical and
        Dental Hypnosis in Britain.
             Like Mesmer himself, some people have been attracted by the
        idea that hypnosis facilitates telepathy and clairvoyance.
        Numerous books, some by doctors, appeared in the mid-nineteenth
        century describing remarkable cases of thought transmission and
        other marvels during trance. It is interesting, however, that
        Mesmer's name is not mentioned at all in some of these books; the
        aura of charlatanry could not be dissipated. Matters were not
        helped by the development of hypnosis as a stage entertainment.
        There was also the fear that hypnotists might be able to
        manipulate their subjects for their own purposes; Svengali might
        be fictional, but could there not be real-life Svengalis?
             Mesmer regarded his ideas as thoroughly scientific, although
        admittedly he did later flirt with the occult. In the nineteenth
        century hypnosis was part of the stock-in-trade of occultists
        such as Helena P. Blavatsky, the founder of Theosophy, and there
        is still a widespread belief that the hypnotic trance affords a
        way into hidden depths of the mind. And although the term animal
        magnetism is little used today, very similar ideas keep surfacing
        under other names: for example, Wilhelm Reich's "orgone energy".

        MESMER AND HAHNEMANN
             The sixth edition of Hahnemann's textbook THE ORGANON
        contains a number of approving references to the then topical
        subject of Mesmerism. Hahnemann apparently used Mesmeric
        techniques himself, and he made a connection in his mind between
        the 'vital force' which, he believed, brought about healing, and
        Mesmer's 'animal magnetism'. Subsequent generations of
        homoeopaths have made little of the connection, however, probably
        because of the reputation for charlatanry that later became
        attached to Mesmer's name.
             The similarities between Mesmer and Hahnemann, both in
        career and in character, are in fact striking. It is worth
        listing them.

             1.   They were almost exact contemporaries.

             2.   Both came from fairly humble backgrounds (Hahnemann was
                  the son of a worker in the Meissen pottery trade.)
                  Neither had very much to say about his childhood, which
                  may have been because neither was particularly happy.

             3.   Both qualified, rather late in life, as orthodox
                  physicians and both adopted heterodox ideas that brought
                  them into conflict with the medical Establishments of
                  their day and came to dominate their lives and thought
                  completely.

             4.   Both spent a considerable time in Paris.

             5.   Both had lawyers as prominent followers.

             6.   Both started as scientists and then moved gradually
                  towards more occult or metaphysical ideas.

             7.   Both were characterized by feelings of injustice and
                  persecution.

             8.   Both were intolerant of any deviation on the part of
                  their followers, with whom they became involved in
                  acrimonious and destructive disputes, which led to the
                  closure of establishments set up to propagate their
                  ideas (Mesmer's Society of Harmony, the Homoeopathic
                  Hospital in Leipzig).

             9.   Both insisted that cure must always be preceded by an
                  aggravation or crisis, no matter how brief and slight.

             10.  There are close resemblances between Hahnemann's vital
                  force and Mesmer's animal magnetism. It is significant
                  that some American homoeopaths actually suggested the
                  existence of a homoeopathic force, which they called
                  Hahnemannism by analogy with galvanism.

        CONCLUSION
              It seems that there is an inevitable contradiction
        inherent in the attempt to get alternative medicine accepted
        "officially" as valid. It can be done if its practitioners are
        prepared to compromise with the "establishment", but in the
        process they  to may have to give up some of their cherished
        ideas and theories. It is usually this, quite as much as the
        difficulty of providing hard evidence for the efficacy of the
        alternative system in question, that causes so much heart-
        searching and agonizing. There will probably always be some
        people who feel that the sacrifice is simply not worth while,
        and who prefer to remain aloof from mainstream medicine
        altogether.
          The converse of this, however, is also true: increasing
        contact with the alternative forms of medicine is likely to
        alter doctors' thinking in ways that are not easy to foresee
        in detail; indeed it is already beginning to do so.








                        4: IDENTIFYING FEATURES

          People who subscribe to the view that unorthodox medicine
        should be alternative rather than merely complementary nearly
        always base this opinion on a number of characteristics which
        they think distinguish the kind of medicine they favour. These
        apply to most forms of alternative medicine but especially to
        the medical and physical therapies (Groups A and B, Chapter 2,
        p.00).
          Alternative medicine, we could say, is supposed to be:
             1.   natural.
             2.   traditional.
             3.   holistic.
             4.   vitalistic.
             5.   supported by modern physics.
             6.   more truly scientific than orthodox medicine.
             7.   optimistic
             8.   ecological
             9.   anti-authoritarian
             10.  capable of dealing with the real causes of disease


        But what do these claims really amount to?

        ALTERNATIVE MEDICINE IS NATURAL
             This is probably the single most important claim made on
        behalf of alternative medicine; no form of therapy is complete
        without it. It stems from a nostalgic yearning to return to
        Nature, to our Source. In its extreme form, this is a quest for
        what Marghanita Laski called the Adamic state. The designers of
        travel advertisements and brochures draw on this longing when
        they try to seduce us with their specious images of blue skies,
        empty beaches, and laughing figures redolent of eternal youth.

             'For ever wilt thou love, and she be fair!'

             All the same, Mr Squeers was right: Nature is a curious
        concept. How we think of it at any given moment depends a great
        deal on social and economic circumstances. In Victorian times,
        Nature (the capital N was almost invariable then) was thought of
        as an arena of battle: 'Nature red in tooth and claw.' This
        interpretation of Darwinism derived, not from Darwin himself, but
        from philosophers such as Herbert Spencer who based themselves on
        Darwin, and it reflects the competitive entrepreneurial spirit of
        Victorian England. Survival of the fittest could be seen to be
        part of the 'natural law'; a satisfying idea for those who
        happened to have reached, or been born into, a superior economic
        and social position.
             For us, the ecology-minded descendents of those Victorians,
        the natural world has become a cooperative effort rather than a
        battlefield. We know, of course, that animals eat one another and
        members of the same species fight one another for territory or
        mates, but they do so only within certain limits. Predator and
        prey are not deadly enemies; the lion wants to eat the individual
        antelope but it doesn't want to destroy the whole herd  -  if it
        did it would have nothing left to eat. Predator and prey depend
        on each other in a delicate symbiosis, so that their relationship
        is more like a partnership than a struggle for survival. As for
        battles between members of the same species, these seldom lead to
        death for the defeated individuals, and in any case the conflict
        results in greater health and fitness for the species as a whole.
             Today we are taught to think of nature as forming a vast
        ecosystem, which would persist indefinitely in harmony with
        itself were it not for us. We are the wild card, the unnatural
        joker in the pack, who has entered the ecosystem and disturbed
        it, perhaps irreversibly. The evidence of our meddling is
        continually brought home to us in television programmes, books,
        and newspaper articles. We are made to feel guilty because we are
        destroying our planet by pollution, by upsetting its temperature
        control mechanism with carbon dioxide, by deforestation.
             Alternative medicine sees our orthodox medical treatments as
        one aspect of the ecological catastrophe we are in the process of
        bringing about. Our medicine, it could be said, is flawed in the
        same way as our management of the planet is flawed, and for the
        same reason: because we have moved too far from our roots in
        nature. Just as we insensitively try to 'conquer nature' on the
        outer level, so too on the inner, physiological, level we try to
        bulldoze our way to health.
             Antibiotics, corticosteroids, antidepressants, and the rest
        of the conventional therapeutic armamentarium may 'work' in a
        sense, the alternative purists admit, but they are 'against
        nature' and so can only lead in the end to worse catastrophes
        than those they are designed to cure.

             Notice that word 'armamentarium'. As Susan Sontag has
        pointed out, a lot of the vocabulary we tend to use (the 'fight
        against cancer') implies a military model for treatment, in which
        disease is the enemy, to be conquered by the doctor; an idea that
        is unappealing for alternative medicine, which more often sees
        your symptoms as your body's attempt to heal itself, and
        therefore not to be suppressed as in 'allopathy'.
             'Primitive' peoples who live or lived close to nature  -
        the Australian aborigines, the North American Indians, the forest
        dwellers of the Amazon  -   are said to preserve valuable
        information about the uses of plants and to possess sophisticated
        rituals of healing and psychotherapy that we have arrogantly
        spurned or even tried to suppress. Our own pharmacology, in
        contrast, is seen as crude, dangerous, and, inevitably,
        'unnatural'.
             Some forms of alternative medicine make less claim to be
        natural than others. Patients who ask for homoeopathy often
        explicitly say that they want it because it is natural, but
        naturalness was not a selling point for homoeopathy originally  -
        the quality was not so highly prized in the early nineteenth
        century  -  and even today more emphasis is placed on the safety
        and effectiveness of homoeopathy, and its 'holistic' character,
        than on its naturalness.
             However, homoeopathy is supposed to stimulate the natural
        healing properties of the body, instead of suppressing them as
        orthodox treatment is held to do, and the starting point of
        practically all the traditional homoeopathic medicines is a
        natural vegetable, mineral, or animal extract; often the plant or
        animal is used whole. In this respect homoeopathy is rather
        similar to herbalism, in which the medicines are typically
        prepared from the whole plant. This is said to be natural, in
        contrast to the products of the modern pharmaceutical industry,
        which are isolates of the 'active principle'. Using the whole
        plant is said to prevent adverse effects, because the various
        components balance one another instead of acting unopposed, as in
        'allopathy'.
             Even within orthodox medicine, the use of whole plant
        extracts died out only quite recently. As late as the 1960s, when
        I was a medical student, some of the older physicians were still
        using digitalis (foxglove) leaf tablets to treat heart failure,
        in preference to the active principle, digoxin.

             There is a deep-seated belief in alternative medicine
        circles that herbal medicines  -  and by extension, 'natural'
        methods of treatment in general  -  are safe and somehow
        intrinsically virtuous, whereas 'drugs' are nasty and even
        vaguely immoral; a belief that slides rather easily into
        sentimentality. "Clear your mind of cant, sir," as Dr Johnson
        used to say.
             The natural world abounds with toxins  -  the deathcap
        mushroom, snake venom, puffer fish toxin; and of course bacteria
        and viruses, are all natural too. Comfrey, which has been widely
        recommended as a cure for migraine, and indeed does seem to work
        for this purpose, has been suspected of causing liver damage. The
        idea that nature is inevitably benevolent is extraordinarily
        sentimental. Mother Nature is not only Mother Divine, taking care
        of her children; she is also Kali, dancing naked on the bodies of
        her victims and wearing a necklace of human skulls. She cares
        nothing for the survival of the individual, only for the species.
             The corollary of the view that natural = good is,
        inevitably, the corresponding equation: artificial = bad. I think
        it is this notion that underlies the belief, taken seriously by
        some people, that the Aids virus was manufactured deliberately by
        bacteriological warfare laboratories in the USA or the USSR (take
        your pick according to your political attitude) and then either
        escaped or was disseminated deliberately. The psychological basis
        for this belief seems to be the feeling that a benign nature
        would not have produced such a terrible plague; it must have been
        due to human malevolence.
             But even if it were true  -  even if Aids had really been
        produced artificially, by genetic engineering (a telling
        expression), would that make it 'unnatural'?
             An important question, surely. Can anything that happens, no
        matter how technological, really be outside nature? After all, we
        ourselves are part of nature, not separate from it. In fact, it's
        the delusion that we can escape from the natural consequences of
        our actions that has led to the seemingly disastrous situation we
        find ourselves in today. The physicists who made the first
        nuclear explosion depended after all, on the cooperation of the
        laws of nature.
             Usually, however, we do tend to think of ourselves as in
        some sense having lost contact with nature, and this is perceived
        as a Fall from Grace. There is a clear moral implication in this
        perception, which emerges in the kinds of things patients say.
        They announce: "I eat all the right things," with the unspoken
        implication that they deserve praise for this. And if, in spite
        of eating all the right foods, doing all the right things, and
        thinking all the right thoughts they nevertheless become ill,
        they feel aggrieved. It wasn't fair, they complain.

             When we set the word 'fair' down on paper we at once see the
        absurdity of applying it to nature; we don't, rationally and
        consciously, expect nature to be fair. But emotionally and
        unconsciously we do, thanks to an enormous amount of propaganda
        on its behalf in recent years in books, magazine articles, and on
        television.
             Part of the reason we expect this is probably the decline of
        formal religious belief. In other times people looked to God to
        hand out appropriate rewards and punishments, either in this life
        or the life to come. Now that many of us no longer believe in a
        future life or, except vaguely, a God, we transfer our longings
        for justice to a semi-personalized Nature. (The Victorians spoke
        of Providence in this way, and I remember, as a child, puzzling
        over the question whether Providence was or was not the same as
        God, and, if not, what the difference was.)
             "When people stop believing in God, they don't believe in
        nothing, they believe in anything." (G.K.Chesterton)
             The problem with casting Nature in the role of God is that
        she inherits the metaphysical uncertainties that used to attend
        Divinity. 'If God is all-powerful and all-good, why does He
        permit evil to exist in the world?' we used ask. Now it's Nature
        who has to answer this question.
             In fact, however, we don't expect quite so much from Nature
        as we used to expect from God, if only because most enthusiasts
        for purist alternative medicine are not much given to
        metaphysical speculation and don't ask the really awkward
        questions. Nature can get away with more than God used to do.

        ALTERNATIVE MEDICINE IS TRADITIONAL
             Nature and tradition are closely allied concepts in
        alternative medicine. The underlying assumption is that our
        hunter - gatherer ancestors lived happy lives in total harmony
        with nature, free from environmental poisons and pollutants,
        successfully treating such few illnesses as they might acquire
        with plants gathered from the forest. Those happy days are long
        gone, but we can, via our television screens, glimpse people
        still leading a version of this idyllic existence in what remains
        of the Amazon or African rain forests.
             Several overlapping myths seem to be present in this idea,
        or perhaps it is the same myth that has reappeared more than once
        in history in different guises. There is the myth of the Garden
        of Eden. There is the myth of Arcadia, the idyllic rural setting
        where every prospect pleases. And there is the nineteenth-century
        myth of Rousseau's Noble Savage, uncontaminated by civilization.
        The combination of these fantasies is extraordinarily powerful,
        and not necessarily wholly delusive. The forest dwellers do still
        exist, just, and there are important lessons that we could learn
        from them before it is too late. But they are not 'primitive';
        their societies are complicated and sophisticated, even if not in
        the way that ours is, and it is patronizing of us to say
        otherwise.

             Probably the nearest we can get to the primitive origins of
        our species is to study the way of life of our closest living
        relatives, the chimpanzees. Thanks to Jane Goodall's work at
        Gombe we now have a much better idea about this, but the
        implications are not wholly reassuring. True, chimpanzees have
        the beginnings of a 'culture', and they also take 'plant
        medicines' when ill: evidence, if you like, that these things are
        'natural'. But in that case, murder, infanticide, and warfare are
        also 'natural' since chimpanzees seem to indulge in these
        activities too.
             But we don't have to go so far back as that, you say. Are
        there not more recent societies or civilizations from whom we
        could learn: the Indians of North America, for example? We read
        moving statements by American Indian shamans and chiefs,
        lamenting the destructiveness of the white man. (It is
        remarkable, incidentally, how radically the popular image of the
        'Redskin' has been transformed in the last twenty or thirty
        years, from tomahawk-wielding savage, fit only to be mowed down
        by the superior courage and technology of the white man, to sage
        guardian of truths we are in peril of losing for ever.) Indeed it
        is probable that a considerable number of herbal medicines were
        borrowed from the Indians by nineteenth-century American
        settlers.
             The idea of looking to the New World for traditional
        knowledge is a fairly new development, however. The favourite
        region in which to seek wisdom remains the East, as it has been
        since Roman times. Acupuncture has been with us for a long time,
        but there have been fresh imports recently: Japanese, Indian
        (Ayurvedic), and even Tibetan traditional medicines are beginning
        to arrive in the West.
             It is not every alternative therapy that can claim an
        antiquity as impressive as that of acupuncture or Ayurvedic
        medicine. Even so, practically all the therapies make at least
        some claim to have roots in tradition; certainly it is very
        difficult to think of any system that makes a virtue of being
        completely new and original. Those therapies that are not
        obviously ancient, such as osteopathy and chiropractic,
        homoeopathy, Anthroposophical medicine, and the Alexander
        technique, do the best they can by pointing to a Founding Father
        (or sometimes Founding Mother).
             This may seem like a trivial comment, since it is clear that
        if a system did not originate in the mists of antiquity or even
        prehistory, as did acupuncture, for example, there must have been
        someone who invented or discovered it in the first place; but the
        important thing is that this person almost invariably becomes
        invested by practitioners of the system with an aura of near-
        infallibility. As Jung (who is himself an illustration of the
        process) would say, this is an activation (or 'constellation') of
        the archetype of the Wise Old Man.
             Even if a therapy is relatively recent, there is often a
        tendency for its advocates to try to trace the underlying
        concepts as far back as possible, as if proving their antiquity
        would somehow validate them. Claims are often made that the
        treatment in question was anticipated by Hippocrates, always a
        favourite ultimate progenitor. This is true of homoeopathy, which
        seems to be exceptionally richly endowed with authority figures,
        starting, of course, with Hahnemann himself.


        ALTERNATIVE MEDICINE IS HOLISTIC
             This is another pretty well universal claim of alternative
        medical systems; indeed, the description of a treatment as
        natural and holistic could be said to identify it as alternative.
        But it can sometimes be difficult to ascribe any definite meaning
        to the term except as an indication of approval. What does being
        holistic actually amount to? Indeed, is it really much more than
        a card of identity, a label that people attach to themselves or
        their method to indicate their allegiance to a cause?
             One might expect that a truly holistic practitioner would be
        one who had a practical grasp of several methods of treatment, or
        was at least sufficiently familiar with a large range of
        alternative (and, ideally, orthodox) treatments to be able to
        advise patients about which would be most likely to help them.
        But this seldom seems to be the case; more often therapists seem
        to be firm adherents of one or two kinds of treatment, and indeed
        there seems to be a certain amount of suspicion of a more
        eclectic approach, people who use it being regarded as dabblers.
             Each therapy tends to have its own view of what holism
        means. For some it is a good deal more elaborate than for others.
        The Western manipulative methods, osteopathy and chiropractic,
        are probably the least concerned with constructing comprehensive
        theoretical frameworks. The oriental therapies, on the other
        hand, arrive equipped with ready-made and very detailed schemes.
        Homoeopathy, in this as in some other respects, is somewhere in
        the middle.

             Homoeopathy does have a tendency to take on philosophical or
        metaphysical characteristics. This has happened a number of times
        in the past, most notably in the USA in the late nineteenth
        century, when it became interwoven with Swedenborgianism. In
        Britain, homoeopathy has on the whole been more down-to-earth,
        and the claim that it is holistic is usually based not so much on
        philosophical ideas as on the fact that it takes the patient's
        personality and individual reactions into account. The main
        weakness of this claim is that the commonly used homoeopathic
        history-taking, although elaborate, is somewhat stereotyped, and
        usually ends in the selection of one of a fairly small group of
        medicines. (A number of computer programmes for selecting
        medicines have been introduced in the last few years, and it is
        hoped that these will improve the accuracy and scope of the
        process.)
             Another way in which alternative medicine is often said to
        be holistic is that it is not supposed to deal in disease
        categories; these are said to be a feature of conventional
        medicine, and derive from its insensitive lack of concern for the
        individual. 'There are no such thing as diseases, only sick
        people.' Taken to an extreme, this would mean that an alternative
        practitioner would have no interest at all in making a
        conventional diagnosis, and some practitioners do indeed adopt
        this viewpoint.
             Rejection of diagnostic labels is an ancient idea that
        surfaces a number of times in the history of alternative
        medicine. It was held, for example, by Paracelsus, that maverick
        among physicians and forerunner of many alternative practitioners
        down to our own day. Hahnemann held the same view, which he had
        probably arrived at independently. Modern non-medical
        practitioners also advocate it at times and it is easy to
        understand why: it exempts them from the need to bother about
        orthodox medicine.
             Even within orthodox medicine the concept of disease
        categories is challenged seriously from time to time, especially
        by psychiatrists. There are for example considerable differences
        in the ways that British and American psychiatrists diagnose
        schizophrenia. Indeed, it is in psychiatry that the conventional
        medical model seems most open to question, as Thomas Szaz has
        pointed out in The Myth of Mental Illness, and since alternative
        medicine has much in common with psychotherapy it is not
        surprising that we find alternative practitioners expressing
        reservations about the value of diagnosis.
             Probably the truth lies somewhere in the middle. It is
        undeniably often convenient, in fact pretty well unavoidable, to
        use disease categories.  (Could you go through life without using
        the concept of the common cold?) Problems arise, however, if we
        adhere to them too rigidly, or fail to recognize that there can
        be many individual variations among people who have been affixed
        with the same disease label. But awareness of this truth is not
        confined to alternative medicine; it is characteristic of good
        conventional medicine too.

             The commonest problem with conventional diagnosis is not
        that diagnostic labels are used, but that they are used
        inappropriately, as a cover for ignorance. All of us (not just
        doctors) feel more secure if we think we have identified
        something and given it a name. Patients, too, feel this; they
        constantly ask: 'Is it arthritis?' (or ME, or allergy, or
        whatever is fashionable at the moment). Having a label does not
        necessarily help in treatment, but it gives a (usually spurious)
        sense of control.
             However, labels can also inhibit further thought and action,
        and this is my real objection to them. Many patients, for
        example, have pain in their neck radiating down into their arms
        or shoulders. On the basis of an x ray which has shown the kinds
        of changes that almost everyone acquires as they age they have
        been told that they have arthritis and nothing can be done about
        it. But this is doubly misleading.
             First, the x ray changes may have little or nothing to do
        with the symptoms patients experience; there are plenty of people
        with severely abnormal x ray findings and few or no symptoms, and
        conversely others who have a great deal of pain and hardly any x
        ray abnormalities. Very often  neck pain arises from the muscles
        and other soft tissues rather than from the bones and joints.
             Secondly, quite a number of these people can be helped a
        good deal by physical methods: I use acupuncture for this, but
        manipulation or other forms of treatment (all of which, probably,
        act in much the same way) can work well too. To label such people
        as arthritic is both inaccurate and unhelpful, since it tends to
        paralyse further thought.
             This is one of the ways in which the use of excessively
        materialistic ways of thinking can be damaging. As Dr R.S.
        Macdonald, an osteopathic physician, has put it:

                  Orthodox doctors are used to seeing such
                  abnormalities as tight muscles, restricted joints,
                  and tenderness, around areas like a fractured bone,
                  inflamed joint, abscess, or cancer. Therefore,
                  whenever these abnormalities are found, it is not
                  surprising that the orthodox doctor presumes there
                  is some pathological cause. In similar
                  circumstances, the osteopath will always consider
                  the possibility of pathology but, when no evidence
                  for it can be found, the osteopath will diagnose
                  only the dysfunction observed. [Natural Health
                  Handbook, 128].


             This is an important principle that ought to be applied much
        more widely in medicine, not just in osteopathy. Doctors are
        trained to look for pathology: that is, for definite
        abnormalities which can be detected by x rays, blood tests and so
        on, and they are taught to regard it as a failure if they miss
        such an abnormality. And this is how it should be; the doctor
        should make every effort to reach an accurate diagnosis if
        possible. But the concept of 'accurate diagnosis' needs to be
        expanded to include the idea that there are many medical problems
        which must, indeed, have a 'cause' in the widest sense of the
        word, but not necessarily a cause that can be detected by
        conventional tests. The abnormalities exist but they are subtle
        and sometimes transient.
             A good example is the muscle trigger point, or trigger zone.
        These are tender areas in muscles which hurt when pressed and can
        give rise to 'referred' pain and sometimes other symptoms in
        areas of the body some distance away. Trigger points in the back
        of the neck, for example, can give rise to headache often
        localized in the forehead or around the eyes, and this is often
        labelled incorrectly as 'sinus headaches'.
             No one knows what muscle trigger points are, though there
        are several theories. Nearly everyone has a few, which are
        usually latent, not causing any problems; but unaccustomed over-
        use of a muscle, psychological tension, and probably many other
        things can cause them to become active and give rise to symptoms.
        It is very easy for any doctor to convince himself that trigger
        points exist  -  he need only examine a few patients and look for
        them  -  so why are they not generally recognized? Because they
        are not taught in medical school. This in turn is presumably
        because they cannot, so far, be detected by laboratory or other
        tests; they are outside the scope of present-day medicine.
             Describing a patient as suffering from a muscle trigger
        point disorder is still attaching a label, making a diagnosis,
        even if an unconventional one. For that matter, it is attaching a
        label to say, as many homoeopaths do, that a patient is a
        'sulphur type', an 'arsenicum type', or whatever. We cannot speak
        or think about anything without using categories. Instead of
        deluding ourselves that we can we ought to be more relaxed and
        undogmatic about the labels we do apply.
             As a rule, the label 'holistic' is used so loosely as to be
        nearly meaningless. It is almost invariably attached to any kind
        of alternative medicine you care to think of, but often all it
        seems to mean is that the practitioner is applying the principles
        of his own particular form of therapy. These are different,
        certainly, from those of orthodox science, but they are often
        just as rigid, just as stereotyped, in their own way.

             The real problem is that we as a society have no definite
        agreement about what constitutes a human being. The dominant
        scientific model is a mechanistic and materialistic one, in which
        human beings are thought of as flesh and blood computers
        transported about in bodies. To this view the alternative
        medicine movement opposes its body, mind, spirit model, but this
        is simply a set of words and is so vague as to be able to
        accommodate pretty well any theory you want to think up.
             It seems preferable to avoid both these models. If holism
        means anything in this context, it should indicate an ability on
        the part of the practitioner to assess the patient's needs in
        relation to a wide range of possible therapies, some orthodox,
        some alternative, without necessarily distinguishing rigidly
        among them. It should also include the ability to know when it is
        more appropriate not to give any treatment at all. Holistic
        treatment in this sense is undogmatic, not tied rigidly to any
        view of human nature, able to select from a wide range of
        therapeutic possibilities.

        ALTERNATIVE MEDICINE IS VITALISTIC
             The debate between vitalists and mechanists is an ancient
        one, indeed it goes back to the dawn of philosophy. Until
        relatively recently the vitalists appeared to be winning, which
        is hardly surprising. After all, living creatures are 'obviously'
        different from non-living matter, and it seems a matter of mere
        common sense to classify the world into two broad categories,
        living and non-living. We can then subdivide the living in
        various ways: plants and animals, fish, birds, beasts, and so on.
        But the gulf between living and non-living systems is apparently
        the widest of all and is fundamental, underlying all the others.
             In earlier times it was generally held that there is some
        kind of subtle substance or force that is responsible for life.
        In the case of animals and human beings, at least, this principle
        of life was often identified with the breath, doubtless because
        we only stop breathing when we are dead. This might be conceived
        of in a fairly literal way, so that the soul was thought of as
        escaping from the dying body in the last breath. In Greek, pneuma
        refers both to breath and to spirit, and the same idea is found
        in the Sanskrit prana; yogic breathing exercises are called
        pranayama, but prana is also the universal breath of life. We
        tend to interpret such statements poetically or figuratively, but
        for the ancients they were literal equivalents.

             The corresponding Chinese concept is chi. In keeping with
        the rather materialistic character of much Chinese thought, chi
        is supposed to have a number of specific functions in the body,
        which are worked out in considerable detail, and it circulates in
        well-defined channels, the so-called meridians. But an
        individual's chi is not self-contained in the way that Western
        science thinks of each person's blood volume as an isolated
        entity; rather, chi is constantly flowing in and out of the body,
        which is therefore in communication with cosmic chi. The actual
        nature of chi is difficult to specify in Western terms; it is
        neither energy nor matter but has characteristics of both of
        these, and so lies on the border between them.
             Even in ancient times, however, in India and elsewhere there
        were materialists who did not accept that there is anything like
        a soul in living creatures. This minority view gradually gained
        increasing acceptance in Western thought after the Middle Ages,
        as the mechanistic outlook came to predominate; William Blake's
        hostility to Newton reflects an awareness of the coming change in
        our perception of the world. Descartes took matters further by
        claiming that animals were automata, though for religious reasons
        he stopped short of applying the same idea to human beings.
             Ideas that were surprisingly similar to those of ancient
        China and India continued to be current in Western medicine until
        as late as the nineteenth century. Vitalism was taught in France
        at the respected University of Montpellier, where it was held
        that the vital force had its seat in the brain, whence it
        travelled via the nerves (thought of as hollow) to reach the
        different parts of the body.
             But major changes were on the way. Hitherto it had been
        supposed that there is something uniquely special about the
        chemical processes that occur in living creatures, a belief that
        is enshrined in the name 'organic chemistry'. Then a chemist
        synthesized urea. This may not seem a world-shaking event, but in
        fact it was, because hitherto urea had been thought to be
        produced only by animals. And urea was only the first of numerous
        other organic compounds to yield to chemical synthesis, until it
        was finally realized that organic chemistry was simply the
        chemistry of carbon.
             The reason that carbon is so special and is capable of being
        the essential building block of life is that it has four
        valencies or 'hooks' by which it can link up to other atoms,
        including other carbon atoms, to make long chains or rings; but
        otherwise there is nothing mysterious or 'living' about it.
        Vitalism was not immediately discredited by this discovery. But
        it was now definitely on the defensive, and as time went by it
        began to look less and less convincing. The last major
        philosopher to base his thinking on vitalism was Henri Bergson.
        In modern science vitalism is no longer discussed at all; it has
        gone the way of the phlogiston theory as an explanation of
        combustion and of the cosmic ether as a conductor of
        electromagnetism in space.

             It is doubtful how far such thinking has penetrated the
        thinking of non-scientists even today, however, and this may help
        to explain some of the popularity of alternative medicine, which
        is firmly vitalistic in outlook. Hahnemann, after an initial
        hostility to vitalism, adopted it as a principle of homoeopathy;
        healing, he said, depended on the operation of the vital force or
        dynamis, and so did the process of 'dynamization' which he used
        to make his medicines. Homoeopathic medicines, as conceived of by
        Hahnemann, could thought of as the vital force caught in a
        bottle. Pragmatic British homoeopaths, such as Richard Hughes and
        Robert Dudgeon, rejected both vitalism and dynamization.
             The concept of vital force is closely intertwined with that
        of energy; indeed, the two are often almost synonymous. 'Energy'
        is a precise term in physics, but in alternative medicine it is
        used far more loosely, and generally amounts to a little more
        than a metaphor. In spite of or because of this vagueness, energy
        is a near-universal item of conceptual currency for people in
        alternative medicine circles. There is much talk of healing
        energies and of energy centres in the body (these usually derive
        from the chakras of yogic physiology), and patients sometimes
        talk of feeling that their energy is blocked.
             This borrowing of 'energy' from physics (together with
        certain related terms, such as 'vibration') is symptomatic of a
        curious symbiosis that exists between alternative medicine and
        physics.

        ALTERNATIVE MEDICINE IS SUPPORTED BY MODERN PHYSICS
             Mainstream physics and cosmology today are so strange, so
        contrary to common sense expectations, that it is hardly
        surprising if those of us who are not physicists begin to get the
        impression that almost anything goes  -  that there is hardly any
        conceivable possibility that is too strange not to have at least
        the chance of being true; we remember J.B.S. Haldane's celebrated
        remark that reality is not only queerer than we suppose, it is
        queerer than we can suppose.
             Numerous books by physicists have appeared, popularizing
        quantum physics and cosmology. What is more, some physicists have
        espoused the kinds of thinking that appeal to people interested
        in alternative medicine and the paranormal. The connection
        between physics and the occult is hardly new, for no less a
        scientist than Isaac Newton spent many years working on practical
        alchemy, but more physicists seem to be willing to look at such
        matters today. To name just a few, Wolfgang Pauli collaborated
        with Jung in formulating a theory of psychologically meaningful
        coincidences, Henry Margenau has written a good deal about the
        paranormal, and  Fritjhof Capra has written best-sellers about
        the apparent similarities between mystical and scientific world
        views and about New Age thinking, including alternative medicine.

             And if some physicists have expressed interest in unorthodox
        ideas such as alternative medicine, alternative practitioners
        have not been slow to return the compliment. There have been
        attempts by homoeopaths to construct physical theories to explain
        the apparently paradoxical claim that medicines which are so
        dilute that none of the original substance is left can
        nevertheless have a beneficial effect. These theories have
        usually been based on somewhat esoteric physics concerning the
        properties of water. Other alternative medicine enthusiasts have
        written at length about electromagnetic fields that are supposed
        to surround living organisms, including trees as well as human
        beings.
             Sometimes speculations of this kind remain at a fairly
        theoretical level, being designed to provide scientific support
        for pre-existing systems of ideas derived from other sources, but
        often they merge insensibly with practical techniques of
        diagnosis and treatment. These techniques can rely simply on the
        operator's hands, but more often they use apparatus, which may be
        as simple as a pendulum or as complicated as an electrical
        machine costing hundreds or even thousands of pounds.
             The starting point of much of this is radionics and
        radiaesthesia. A number of lay practitioners of various
        therapies, and some doctors also, use a pendulum to diagnose
        allergies and other problems and to decide which medicine to
        prescribe. This can go to extreme lengths; it is somewhat
        alarming to see an otherwise intelligent person who is so
        convinced of the validity of these methods that before she eats
        or drinks anything she has to test it with her pendulum to see
        whether it is suitable for her.
             Numerous machines have been manufactured to do the same sort
        of thing in a more complicated way. In some, the patient merely
        holds a metal contact to connect her to the machine, while the
        therapist adjusts the settings to obtain a reading. This may
        indicate the homoeopathic or other medicine that is required or
        may give an indication of what sort of acupuncture treatment
        should be given. More elaborate and expensive machines take
        readings from the whole of the patient's body as she lies on a
        special couch. As a variant on this, machines exist that
        purportedly make homoeopathic medicines by radionic means without
        the need to go through the steps of manufacture traditionally
        used.

             There are other diagnostic methods allegedly based on
        physics. One of these is Kirlian photography, which is sometimes
        claimed to produce a picture of the human aura. It does this by
        placing the object (usually a human hand) in a strong electrical
        field and photographing the consequence emission of electrons.
             In spite of the apparent technological sophistication of
        some of the devices used, there is almost no independent
        objective evidence that any of them produce any meaningful
        information at all. Most of the machines now in use appear to
        depend heavily on self-deception. There has, however, been one
        curious apparent exception to this generalization, in the
        investigations carried out many years ago by Dr William Boyd, a
        homoeopathic doctor in Glasgow.
             Boyd was a careful scientist, who made a number of
        pioneering studies of homoeopathy between the wars. One series of
        these concerned a machine he invented called the Emanometer, with
        which he claimed he was able to detect an 'energy' of some kind,
        which he thought was similar, though not necessarily identical,
        to radio waves (radio was at the time a fairly new invention,
        still, literally, very much 'in the air'). He was apparently able
        to detect various abnormalities in patients, sometimes before
        they themselves were aware that anything was wrong, and he could
        also distinguish various homoeopathic medicines from one another.
        In 1924 a committee under an eminent physician, the future Lord
        Horder, investigated the Emanometer; later the committee was
        joined by E.J. Dingwall, research officer of the Society for
        Psychical Research and an authority on fraud.
             The committee concluded that Boyd was certainly able to
        detect something with the Emanometer, but they had no idea what
        it was or what it meant. They were also careful to say that there
        was as yet no good evidence that the Emanometer could be used in
        diagnosis or treatment  -  a cautious attitude that Boyd himself
        fully shared.
             The Emanometer was difficult to use in practice, and after
        Boyd died work on it was abandoned. It is impossible now to say
        whether some form of 'energy' was detected in the experiments or
        whether there was, after all, some subtle error in the set-up
        which no one noticed (that Boyd produced his results in good
        faith seems beyond doubt). This unsatisfactory result is rather
        similar to the uncertainty that afflicts scientific research into
        the paranormal, which often seems to be on the verge of yielding
        definite proof but somehow always fails to do so at the last
        moment. The resemblance may not be accidental; it is conceivable
        that, if paranormal abilities do exist, these are what Boyd
        possessed.
             All this work was carried out a considerable time ago, and
        is remote from the main direction of research in homoeopathy
        today. I will return to this later, but for the moment I want to
        look at the question of science and alternative medicine from a
        different angle.

        Alternative medicine is the only truly scientific form of
        medicine.
             This claim keeps being made, especially by the more
        philosophically-minded non-medical homoeopaths. Harris L.
        Coulter, for example, writes that:

                  The principal difference [between homoeopathy and
                  allopathy] is that homoeopathy is a precisely structured
                  doctrine. Even though most of its ideas find their
                  parallel in allopathy, it differs from the latter in
                  that the homoeopathic ideas are mutually consistent and
                  coherent... Allopathy, in contrast, lacks a precisely
                  defined and delineated set of ideas. It accepts
                  concepts, principles, and procedures from any number of
                  sources, with the result that the various parts of
                  allopathic doctrine are at times inconsistent, and even
                  incompatible, with one another... [Homoeopathic Science
                  and Modern Medicine, 93 - 94]

             This is a fascinating passage, for it beautifully
        encapsulates the difference between a scientific and a dogmatic
        approach, although not quite in the way Coulter intends.
             Everything depends on what we understand by the scientific
        method. Coulter evidently believes in the Baconian model, which
        is based on the principle of induction. According to this model,
        what we have to do is to keep accumulating facts until at last we
        discern the theory that fits them; the more facts we can find to
        support the theory the better.
             There is a fallacy in the idea of induction, which was
        pointed out long ago by David Hume and has continued to perplex
        philosophers ever since. It would take too long to discuss it in
        detail here, but we can get at the essence of the matter by
        considering the question of apotropaic magic.
             For many traditional societies, an eclipse of the sun or
        moon was, understandably, an awe-inspiring and alarming event.
        Often it was thought that a dragon was eating the sun or moon; in
        order to frighten it away the people would beat drums and perform
        magical rites. Fortunately these always worked. The success of
        the method proved, naturally, that it was the right one, and no
        one would be rash enough to try the experiment of doing nothing
        to see what happened.

             In this case, clearly, the theory was fully confirmed by the
        facts. It was nevertheless mistaken. The extraordinary scientific
        advances that have occurred in the last three hundred years or so
        have come about because this way of confirming theories gave way
        to another approach, which might be called the iconoclastic
        method.
             The iconoclastic method consists, essentially, not in
        looking for facts that support our theory, but in trying to find
        facts that contradict it. To put the matter less paradoxically,
        we ask what things the theory predicts should happen or should
        not happen, and then see if they do (or don't). The critical word
        here is 'predicts'; a genuine scientific theory has to be ready
        to risk its reputation by making predictions which, if falsified,
        disprove the theory or at least demand that it be modified.
             On this view of science (which I have, of course, taken from
        Karl Popper, currently regarded as the foremost modern
        philosopher of science), any theory which is truly scientific has
        to have a provisional character. There are no absolute truths in
        science. We can never know for sure whether any scientific theory
        is really true; all we can say is that it has not been found
        wanting so far. No matter how many facts you find to support your
        pet idea, this will still not make it into a law of nature. In
        fact, there are no natural 'laws' in this sense; all are in the
        last resort provisional and open to challenge. And this sometimes
        happens in practice: for example, Newton's gravitational law, for
        so long regarded as the ultimate example of an immutable
        scientific principle, has in our own day had to be modified in
        the light of Einstein's Special Theory of Relativity.
             The reason I have laboured this question is that the modern
        view of science stands Coulter's argument on its head. He may
        well be right in claiming that homoeopathy is a 'precisely
        structured doctrine', based on 'mutually consistent and coherent'
        ideas (although it would be possible to argue that they are not
        quite so consistent and coherent as he says they are), but in so
        far as it is so based, it is not scientific. The more you make
        homoeopathy or any other set of ideas immune to challenge and
        criticism the less truly scientific they become.
             Conversely, of course, the more you try to make homoeopathy
        scientific by carrying out clinical trials and subjecting its
        basic concepts to the kind of criticism that other scientific
        theories have to withstand, the less of a 'doctrine' it will be.
        This is the dilemma that confronts all would-be homoeopathic
        purists who want to represent themselves as scientific. Similar
        difficulties are faced by purist supporters of other kinds of
        alternative treatment. It may indeed be possible to make some of
        these methods more scientific, but there will be a price to pay
        in terms of the 'purity' of the system.


         ALTERNATIVE MEDICINE IS OPTIMISTIC
             If there is one feature of alternative medicine which, more
        than any other, distinguishes it from orthodox medicine, it is
        the extent of its optimism. From an advertisement for a
        homoeopathic clinic:

                        Most certainly, the alarming rise in all killer
                diseases, such as asthma, epilepsy, and heart-related
                chronic disorders, claim hundreds of thousands of
                precious lives each year. Yet there is hope, for at
                ..... we are helping all types of people suffering from
                a vast array of chronic life-threatening diseases,
                termed incurable by conventional medicine...

             This a particularly naive example of the genre, no doubt,
        and the implied claim of a universal panacea is certainly
        unusually blatant. But the confidence that alternative medicine
        has a cure for practically everything that orthodox medicine
        can't help is not unusual.

                  Anything that the body can regenerate, homoeopathy can
                  encourage happening. Uterine fibroids can dissolve,
                  brittle nails can go away. All kinds of viral problems
                  can abate. Aids. Obesity. Anything that the body can
                  throw off, we have mechanisms against. The idea is just
                  to stimulate the body and get those mechanisms working.
                  [Quoted by Coward, 47-48, from Homoeopathy Today, 1986]

             Although some non-medical alternative practitioners are
        commendably cautious about what kinds of problems they will take
        on, others are not; and the result is that many patients acquire
        quite unrealistic expectations of what can be achieved. It is
        quite common, for example, to find patients whose blood pressure
        is dangerous raised, to a point at which they are at considerably
        increased risk of a stroke, asking for alternative treatment in
        place of conventional medicines, or patients with troublesome
        gallstones who expect them to be 'made to dissolve'
        homoeopathically. Sometimes it can be quite difficult to convince
        such people that what they are asking for cannot be done.

             I sometimes get the impression that one reason for the
        existence of this over-optimism among patients is their belief in
        a conspiracy theory. Conventional doctors are seen as
        deliberately blackening the reputation of alternative medicine
        out of a misplaced sense of professional pride. But this is by no
        means the whole of the story.
             There is a deeply held belief in alternative medicine that
        the body has its own wisdom and, left to itself, will heal
        itself. Indeed, our 'natural' state is said to be health; disease
        is unnatural. In a sense, disease (often rendered as dis-ease, to
        emphasize the point) is almost an irrelevance, a distraction from
        the real business of staying healthy.
             In this respect, as in some others, there is an increasing
        amount of common ground between orthodox and alternative
        medicine. The government  -  responding, no doubt, to popular
        pressure  -  is placing more emphasis now on the prevention of
        disease; general practitioners are being encouraged, in fact
        almost compelled, to practise 'preventative medicine', to such an
        extent that we read of doctors who strike patients off their
        lists because they refuse to attend for 'health checks'. Many
        doctors are sceptical, probably rightly, about the value of much
        of this screening, but it is difficult for them to resist the
        demand.

        ALTERNATIVE MEDICINE IS ECOLOGICAL
             Interest in alternative medicine often shades off
        imperceptibly into wider concerns, for example with the state of
        the environment. The word 'ecology', which ten or fifteen years
        ago would probably have been unknown to many people, now turns up
        all over the place, and we are all being reminded constantly of
        our responsibility for the condition of the world. Although I
        have no figures to prove it, most of the people who feel strongly
        about environmental matters would probably also be sympathetic to
        alternative medicine, and the reverse is likely to be true as
        well. Probably the equation is not always fully worked out
        consciously, but there is a sense in which avoiding causing
        pollution in the world can be related to not taking harmful
        'drugs' into our inner environment, while a concern for
        preserving the balance in nature outwardly can be correlated with
        allowing the body to heal itself instead of disturbing its
        equilibrium as conventional medicine is said to do. (I return to
        the 'public health' implications of alternative medicine in
        Chapter 12.)


        ALTERNATIVE MEDICINE IS ANTI-AUTHORITARIAN
             The expression 'doctor's orders', which used to be heard a
        lot forty or fifty years ago, may not have disappeared
        completely, but it is certainly much less common today. The
        notion of the doctor as the expert who must be deferred to is
        becoming unfashionable, and instead we are encouraged to take
        responsibility for our own health, and to view the doctor as a
        co-worker in the enterprise rather than an authority figure.
             In some ways this change is more apparent than real. People
        may say they want to have more responsibility for their health,
        but when it really matters they are often quite happy to leave
        decisions to the doctor. Partly this is because the complexity of
        modern medicine means that patients can't easily assimilate
        information when they are given it, but partly, also, it is
        because people who are seriously ill don't necessarily want all
        the information which, in health, they might have thought they
        would.
             A personal account written by a doctor a few years ago
        illustrates this. He was a retired physician who had to go into
        hospital for a major operation. As he was a colleague, the
        surgeon started to explain all the technical details of the
        treatment he proposed to carry out, but the physician did not
        want to know, and simply asked the surgeon to get on with things
        as he thought best and spare him the details. If this is how a
        medical patient felt, many who are not medically qualified would
        surely react in the same way.
             But some people do want to know what is being done to them
        and some want to be actively involved in their treatment. In
        theory, alternative medicine is supposed to encourage patient
        participation, but there often seems to be a tendency for the
        alternative therapist to take on the role of the expert which the
        doctor is supposed to have abandoned. And patients usually go
        along with this, which is hardly surprising; for unless you
        regard a therapist as an expert in his field, what is the point
        of asking his opinion?
             A recent survey of complementary practitioners in the
        Midlands, which was carried out by Ursula M. Sharma of the Centre
        for Medical Social Anthropology at the University of Keele
        investigated this question among others. Dr Sharma found that
        although the therapists she interviewed generally believed in
        treating the patient as an individual and expected her to be an
        active partner in treatment, they were also pulled in the other
        direction by their wish to be more 'professional' and to lay
        claim to genuine forms of specialized knowledge. As Dr Sharma
        remarks, 'The practice of non-orthodox medicine abounds in
        contradictions, some internal and others imposed from outside.'
        [Complementary Medical Research, 1991, 5, 12 - 16]
             The Founding Fathers and Mothers of alternative medical
        systems are often, indeed nearly always, strongly authoritarian.
        Hahnemann, for example, would tolerate no deviation on the part
        of his disciples. He referred contemptuously to those who
        combined homoeopathy with allopathy as "half-homoeopaths". When
        one of his closest disciples, called Gross, who had had the
        misfortune to lose a child, remarked that the experience had
        taught him that homoeopathy was not the answer to everything,
        Hahnemann was furious and never fully restored him to favour. And
        when a Homoeopathic Hospital was established in Leipzig
        Hahnemann, by now living at Kothen, took exception to the Medical
        Director on the grounds that he was not sufficiently committed to
        homoeopathy and had him replaced; unfortunately the new Director
        soon left and his successor, who bore the appropriate name of
        Fickel, took the job with the undeclared aim of discrediting
        homoeopathy, and the ensuing debacle led to the closure of the
        hospital.
             We have already noted the similarities between Hahnemann and
        Mesmer (p.000); Mesmer, like Hahnemann (and Kent) was an extreme
        authoritarian. (The same, incidentally, is true of Freud; and
        psychoanalysis has many of the features characteristic of an
        alternative medical system.)
             The trend towards authoritarianism in alternative medicine
        persists undiminished today. It is not difficult to think of
        practitioners who have built up considerable followings of
        patients and pupils who accept their gurus' ideas unquestioningly
        and proselytize for them enthusiastically.

         Alternative medicine deals with causes
             Many patients say: "I don't just want to take a drug to
        suppress my symptoms, I want to find the cause." This idea is
        very prevalent in alternative medicine; we constantly see claims
        that conventional medicine merely deals with the manifestations
        of disease instead of eradicating it at the root.
             On the face of it this is rather strange, for if you asked
        most orthodox doctors what they think of alternative medicine
        their main criticism of it would be that it is merely a placebo
        which may help on a symptomatic level but does not tackle the
        causes of disease. We are therefore confronted with the curious
        paradox that both sets of practitioners believe that they are
        treating the causes of disease while their opponents are merely
        offering palliatives.
             The explanation is that the two groups have different ideas
        about what counts as a cause. Medical students are sometimes
        taught a little mnemonic for the possible causes of disease:
        Tumour, Trauma, Toxin, Degenerative, Deficiency. This scheme does
        not cover all the recognized possibilities and is old-fashioned
        in certain ways, but it does help to prevent one forgetting the
        major causes.
             Tumour and trauma are fairly self-explanatory. Toxin
        includes not only poisons of various kinds but also two very
        large subdivisions, bacterial and viral infection. Degenerative
        includes the inevitable accompaniments of aging and also the
        'autoimmune' disorders, such as rheumatoid and certain other
        kinds of arthritis. Deficiency includes food, mineral, and
        vitamin deficiencies and also internal failures of glandular
        secretion such as thyroid deficiency and sugar diabetes.
             To these groups of causes we must add one large and
        important category, Unknown. Very gradually, diseases move out of
        the Unknown into one of the other groups. There is also movement
        among the (more or less) Known groups, so that, for example,
        Alzheimer's disease, which twenty or thirty years ago was thought
        of as more or less an inevitable accompaniment of aging, and
        therefore Degenerative, is increasingly suspected of being a
        Toxic disease, in some way related to aluminium accumulation in
        the brain. Parkinson's disease, which similarly used to be
        classed as Degenerative, is likewise now thought to be perhaps
        caused by an environmental toxin or possibly by a dietary
        deficiency of some kind.
             There is another way of thinking about causation of disease,
        which is to look at what happens pathologically. A good deal of
        the space in medical textbooks is concerned with this aspect.
             In the second half of the nineteenth century it came to be
        recognized that the organs and tissues are made up of cells, and
        techniques were developed by Virchow, Ramon y Cajal, and others
        to allow these microscopic structures to be investigated in
        health and disease. In this way it came to be seen that disease
        processes could be understood at the cellular level. At much the
        same time, other workers were exploring the chemical constitution
        of the body, and finding that alterations in what came to be
        called biochemistry underlay many manifestations of disease.

             In our own day these trends have been taken much further. We
        no longer are confined merely to studying cells; now it is
        possible to analyse the molecular processes that occur inside the
        cells. As well as chemistry, we have a whole new science,
        immunology, with its own concepts and vocabulary. Viruses, which
        previously were too small to be analysed, can now be taken to
        pieces to allow their method of working to be understood. It is
        even becoming possible to replace individual faulty genes with
        good ones.
             And it is not just at the microscopic level that so much has
        been achieved; now it is possible literally to see into the
        living body without damaging it. Until quite recently almost the
        only tool available for doing this was the X ray. This merely
        provided pictures of 'shadows from shadowland', as the actor
        representing a radiologist in an American film once absurdly
        expressed it. Now radiology is simply one part of the much
        grander subject of 'medical imaging'. There are ultrasound echo
        techniques, which can be used to show the working of the heart or
        the condition of the fetus before birth. We have computer-
        assisted tomography, magnetic resonance imagery, and positron
        emission tomography, all of which are capable of giving the most
        astonishing three-dimensional pictures of the interior of the
        body. And it is possible to insert fibre-optic devices into all
        kinds of body cavities to allow the surgeon to see what is going
        on there.
             It is hardly surprising that, with all this in mind, modern
        doctors feel that they are able to say a good deal about the
        causes of disease. For alternative medicine, however, much of
        this is beside the point. No matter how much you understand about
        the mechanisms of disease, the argument goes, you still are not
        really dealing with The Cause. Bacteria and viruses may be
        proximately responsible for disease (that much is generally
        admitted by even the most radical enthusiasts for alternative
        medicine), but these organisms couldn't gain a purchase on us if
        we were not already weakened by other things. Alternative
        medicine makes a great virtue out of the fact that it
        distinguishes between the 'seed' and the 'soil'.
             It is only by understanding what alternative medicine means
        by 'causes' that we can explain the otherwise puzzling paradox
        that, according to alternative medicine,  we are supposed to be
        naturally healthy, yet we continue to suffer from disease.









                    5: ALTERNATIVE CAUSES OF DISEASE

        It's worth looking at this concept of causation in alternative
        medicine in a little more detail. The main causes of disease
        according to alternative medicine are:

             1. diet
             2. stress
             3. faulty ways of thinking and feeling
             4. allergy
             5. orthodox medicine (allopathy)
             6. miasms

        The role of diet.
             Since the natural is generally equated with health and
        virtue, it logically follows that living unnaturally is likely to
        be harmful. There are of course many respects in which our
        present way of life can be seen to be unnatural. Pollution in all
        its forms is widely regarded as a cause of disease. There is not
        much we can do individually about environmental pollution, but we
        can limit the amount of pollution we ingest by not eating things
        that will harm us.
             Diet, in fact, is a central cause of disease for nearly all
        alternative practitioners, and this idea has taken firm root in
        the population as a whole; about half the patients who come to
        see me raise the question at some stage, and nearly all are
        interested in discussing what they eat.
             This is hardly surprising, for orthodox medicine, too,
        attaches a lot of importance to a healthy diet in the prevention
        of coronary heart disease. Alternative and orthodox medicine
        agree on the desirability of reducing animal fats, sugar, and
        salt, and increasing the intake of vitamins and minerals; but for
        alternative medicine this is just the beginning. Diets exist to
        help control eczema, sinusitis, arthritis, colitis, multiple
        sclerosis  -  almost any disease or symptom you like to think of,
        in fact. Hardly any of these diets is based on proper scientific
        assessments, and many seem to have been composed at the whim of
        the author; few have any discernible scientific basis. But this
        is not why people follow them.
             And follow them they do, in considerable numbers and often
        with extraordinary tenacity, sometimes in spite of the
        unpalatability of the diet, its practical inconvenience, and even
        its manifest nutritional inadequacy. It is difficult to
        understand why this should be so, but possibly it is partly
        because we feel that changing our diet is something that lies
        wholly within our own control; it is something we can do.
             But it is not only that. Food and cooking customs have
        stronger emotional and cultural roots than almost any other human
        activity, perhaps stronger even than sex. We mostly acquire our
        eating habits literally at our mother's knee, and many of us
        never change them much for the rest of our lives. The
        anthropologist Claude Lévi-Strauss sees the cooking of food as a
        central theme in the development of human culture. Because
        cooking can be thought of as a form of technological processing,
        the back-to-nature movement prefers to eat raw food as much as
        possible  -  vegetarian, naturally, because vegetarianism, though
        not obligatory for a healthy diet, is preferable for a number of
        reasons, moral, aesthetic, and nutritional. If people must eat
        meat, they should eat white meat such as chicken rather than red
        meat, and fish is better than chicken. Partly, no doubt, this is
        because even orthodox medical authorities say that too much red
        meat is undesirable, but Coward may be right [141-143] in
        believing that red meat, because it contains blood, is thought of
        as 'too strong'.

             Coward also remarks on what she calls 'magical foods' such
        as ginseng and royal jelly, to which I would add vitamins, which
        are sometimes taken in such large doses ('megavitamins') that
        they cease to be a mere supplement and become a food in their own
        right.
             Many people invest much time, energy, and money in their
        diet, because they regard errors in this matter as a potent cause
        of ill-health. 'You are what you eat,' the saying runs, and this
        has been taken profoundly to heart by alternative medicine
        enthusiasts. My objection is not that diet is unimportant, for I
        am sure it does matter a great deal, but many alternative
        therapists have no idea of the standards of evidence, the quality
        of the research, that would be needed to establish the facts and
        to sort out the real from the imaginary.

        STRESS
             This rivals incorrect diet as a putative cause of illness
        and many of the same criticisms apply. It is almost invariably
        held that we are more subject to stress than previous
        generations, although the reasons for saying this are not spelled
        out in any detail and the statement often seems to betray a lack
        of historical awareness. There seem to have been plenty of causes
        for 'stress' in earlier times. A hundred years or so ago, for
        example, you could routinely expect to lose several of your
        children in infancy, and giving birth to the children in the
        first place was a risky undertaking for a woman. Throughout most
        of history, if you had to undergo an operation it would be
        without anaesthesia. These, one would think, were ample causes
        for worry and stress, quite apart from noisy or otherwise
        objectionable neighbours, poverty, bad housing, and all the
        thousand and one causes of unhappiness that people have always
        had to endure.
             Stress is not always regarded as bad for you; a great deal
        depends on how much there is, and of what kind, and on how you
        respond. What one person would call stress, another might call
        challenge.
             The problem is that 'stress' is never clearly defined. Often
        it seems to amount merely to any experience you don't wish to
        have, which is so wide as to be almost meaningless. And why is
        stress so bad for you, anyway?
             The usual explanation is that repeated exposure to
        challenging situations stimulates us to produce a primitive
        'fight or flight' reaction. Our blood pressure rises, our heart
        rate increases, the blood flow to our muscles increases while
        that to our intestines decreases: in short, we are prepared for
        action. But as a rule, in a modern urban society, no physical
        action is needed. If we are cut up by another driver while in our
        car, or if we are reprimanded by our boss at work, we can't
        resort to physical violence, much though we might like to. The
        result is that the aggression is internalized; our blood pressure
        remains up for a long time, we may develop a gastric or duodenal
        ulcer, and so on.
             It is a persuasive theory, and may even be true. But it is
        difficult to prove, and possibly is misleading. The medical
        writer Richard Asher once played a trick on his readers to
        illustrate this point. He quoted a description from a medical
        text written in 1871, in which the eminent author explained how
        the stress of modern life was causing people to suffer from
        peptic ulcers. It all sounds rather convincing, and, reading it,
        one is mildly amused, and rather impressed, to find that someone
        was saying this kind of thing as early as that. If that's what
        life was like in 1871, you think, how much worse must things be
        today. Then Asher pulls the carpet from under our feet. He admits
        to having practised a deception; the article he was quoting
        wasn't really about duodenal ulcer at all, it was about general
        paresis - syphilitic dementia, the true cause of which was
        unknown when the article was written. So much for the stress
        theory in this case.
             (In fact, even the hitherto accepted wisdom that duodenal
        ulcers are due to stress may have to be revised. Modern research
        suggests that ulcers may be caused by infection with a bacterium
        called Helicobacter pylori.)
             Anyone who practises medicine is bound to see patients who
        have been through appalling experiences, some of whom (though by
        no means all) then suffer various physical and mental disorders
        which it is very difficult to avoid linking with the stress that
        they have undoubtedly suffered. At the other end of the scale,
        people come with symptoms they attribute to stress, but the
        experiences they relate seem to be nothing more than the ordinary
        troubles inseparable from living. In these latter cases it is
        questionable whether the concept of stress really has any useful
        contribution to make.
             Stress, like diet, is invoked too easily by many alternative
        therapists as an explanation for patients' symptoms. It is
        essential not to be simplistic about it; during the Second World
        War, we are told, the incidence of anxiety neurosis and similar
        relatively minor psychiatric disorders fell considerably,
        presumably because people had more important things to worry
        about than their own symptoms.
             And yet it would be going too far to dismiss stress as a
        cause for disease. Very many of the symptoms that patients
        complain of are transparently related to painful psychological
        experiences that they are undergoing: financial worry, family
        problems, housing difficulties. Either these things cause the
        symptoms directly or they make existing fairly trivial symptoms
        appear intolerable.
             Naturally there are wide individual variations in
        susceptibility to stress and the kinds of effects it produces.
        Perhaps as a result of behaviour patterns learnt in childhood,
        some people seem to be incapable of recognizing mental suffering
        for what it is and so they express their unhappiness in a
        physical way, as stomach pain, chest pain, nausea and so on. This
        is the phenomenon the Americans call somatization, and most
        doctors groan inwardly when they recognise it in a patient. Other
        people seem actively to seek and increase stress, almost as if it
        were a drug; this is the so-called Type A personality, who is
        supposed to be vulnerable to coronary heart disease. Such people
        are described as ambitious, perfectionist, and governed by time,
        unable to delegate, constantly driving themselves to try to
        achieve more and finally cracking under the strain. Lately there
        seems to have been less emphasis on this aspect of heart disease,
        and the question whether there is a particular kind of individual
        who is especially liable to it still is not decided.
             There have been many claims that modifying people's
        reactions to stress and teaching them to relax can reduce their
        blood pressure and hence their liability to strokes and heart
        attacks. Falls in blood pressure with meditation have indeed been
        demonstrated fairly convincingly, but whether the hoped-for
        reduction in disease will follow is still uncertain. Some studies
        seem to show that there is such an effect, but the numbers of
        patients involved have been small. A recent study reported in THE
        BRITISH MEDICAL JOURNAL (10 April 1993), which used larger
        numbers, puts this in doubt.
             Patients with mildly raised blood pressure were recruited
        for the study and were taught to take their own blood pressures
        over a 12-week period. They were then randomly allocated either
        to a stress management programme (passive relaxation, meditation,
        and the use of relaxation in daily life) or to a programme of
        simple stretching exercises that would not be expected to reduce
        blood pressure. The effects of these two programmes were assessed
        by subjecting the patients to a mildly stressful interview
        designed to elicit Type A behaviour. Ninety-six patients were
        studied; 48 were allocated to stress management and 48 to gentle
        exercise.
             Neither stress management nor gentle exercise had any
        detectable effect on the patients' blood pressure. This is in
        contrast to previous studies that have shown an effect, so why
        the difference? The researchers think the answer is that they
        allowed a long (12-week) "run-in" period for the patients to get
        used to recording their own blood pressures. It is known that if
        patients have their blood pressure measured repeatedly it often
        tends to fall progressively towards normal, and these researchers
        think that this effect was not allowed for sufficiently in
        previous studies.
             Notice that this research does not necessarily prove that
        stress reduction has no effect in reducing the incidence of heart
        attacks over a period of several years. At least one study
        suggests that it does, but if so it probably works in other ways
        than simply by reducing blood pressure. All of which goes to show
        how difficult it is to get definitive answers to questions of
        this kind.

        Faulty habits of thinking and feeling
             Attempts have been made to try to link personality patterns
        with susceptibility to cancer. These apparently show that the
        chances of surviving cancer are better for some kinds of people
        than for others; patients who simply accept the diagnosis
        fatalistically seem to do worse than those who 'fight' the
        disease energetically, and also (which is perhaps more
        surprising) worse than those who deny that they are ill at all.
        The validity of these conclusions has been questioned, however,
        and even if they are correct one could still interpret them
        differently. It is possible that patients who simply accept the
        diagnosis without resistance do so because they already know, at
        some subconscious level, that they won't recover.
             It is also been claimed that it is possible to detect which
        kinds of people are most at risk of cancer many years before they
        actually acquire the disease. Cancer patients are supposed to be
        self-sacrificing individuals who for much of their lives have
        done what other people wanted rather than what they themselves
        wanted. They are therefore repressed and suppressed, full of
        unacknowledged anger.
             The studies I refer to have been made by orthodox
        researchers, some of whom are eminent, so it is not surprising
        that they have been welcomed by many alternative practitioners,
        who have adopted them unquestioningly, even though they are by no
        means full accepted as valid within orthodox medicine. Rather
        similar pen portraits have been drawn of the kinds of people most
        liable to suffer from other serious chronic diseases such as
        rheumatoid arthritis and multiple sclerosis.
             I must admit to finding this linking of personality with
        disease one of the least attractive ideas in alternative
        medicine. Firstly, it may not be true; the evidence is still
        unclear, and if the history of medicine in general, and
        psychiatry in particular, is anything to go by it is likely to
        remain so for some time. Secondly, as Susan Sontag writes in
        ILLNESS AS METAPHOR, although these portraits are presented
        sympathetically the kind of personality depicted is not the one
        most valued in the twentieth century. We may pity such people but
        we regard them as social failures.


                  Miss Beal and Miss Buss
                  Cupid's darts do not feel.
                  How different from us,
                  Miss Buss and Miss Beal.

             And, because they are different, we are enabled to feel
        comfortably superior to them. We are not repressed and
        frustrated, so we are not at risk of getting cancer.
             It is bad enough to know you have got cancer (or cancer has
        got you) without having to feel that it is happened because you
        are psychologically and emotionally inadequate. Even if it is
        true, but especially if it is not true.


        Allergy in alternative medicine
             Allergy: a difficult word, because it is used so widely and
        loosely, sometimes even figuratively ('I am allergic to him').
             In orthodox medicine, 'allergy' has a fairly precise
        meaning. It refers to a particular type of antigen - antibody
        reaction. The commonest form of this is hayfever, in which the
        antigen is pollen; antibodies of a particular kind (IgE) are
        present on the linings of the nose and elsewhere and react with
        the pollen to give the familiar symptoms of sneezing, running
        nose, and itching eyes. But although alternative medicine
        certainly recognizes hayfever as allergic, when alternative
        medicine practitioners speak of allergies it is usually food they
        have in mind.
             Orthodox medicine also recognizes the existence of food
        allergies. Some people have an immediate reaction to food which
        is usually easy to spot. Their lips swell, their mouth and tongue
        tingle, and blister-like swellings develop inside the cheeks;
        there may also be asthma and nettle rash. All these symptoms
        develop within ten minutes of eating the offending food and are
        certainly due to allergy. About 60 per cent of children with
        eczema develop symptoms in their skin and elsewhere in response
        to certain foods; many different foods are responsible in such
        cases, but eggs, citrus fruit, wheat, and milk are among the
        commonest offenders.
             There are also reactions caused by food that are not due to
        allergy but are produced in other ways. In a certain number of
        patients with migraine the attacks are brought on by food,
        especially chocolate, cheese, and red wine, though this is less
        common than many people think. Some patients have enzyme
        deficiencies that interfere with digestion and can cause
        intolerance to certain foods; for example, 80 per cent of
        Africans and Asians lack the enzyme needed to digest milk sugar.
        If they drink milk they experience bloating and diarrhoea. Some
        patients with the irritable bowel syndrome react adversely to
        certain foods, but this is not a true allergy; the bloating and
        discomfort experienced by such patients is probably due to the
        action of bacteria in the intestine, which ferment the food and
        produce gas and acid.
             Skin tests for allergy, though fairly satisfactory for hay
        fever, don't work well for food allergy, and there are no really
        satisfactory laboratory tests either. The RAST
        (radioallergoabsorbent test) is only moderately helpful, and
        optimistic attempts to detect food allergies by mixing samples of
        the patient's blood with various foods (cytotoxic testing), by
        hair analysis, or 'iridology' are hopeless. There is no
        satisfactory method of confirming the diagnosis except to get the
        patient to take a strictly controlled diet (elemental diet) for
        two to four weeks and see whether the symptoms improve, but this
        is not something to do lightly; it is easy to mistake a
        psychological improvement due to suggestion for an improvement
        due to the diet, and diets of this degree of severity are not
        safe to maintain for any length of time and are not safe at all
        for children.

             It is of course the suggestion factor that bedevils the
        whole question of food allergy. Thanks to an enormous amount of
        publicity, many people, including many alternative practitioners,
        are firmly convinced that their miseries are caused by food,
        especially the dreaded 'E numbers'. Some unfortunates have
        dedicated their lives to this idea and have become victims of the
        so-called 'total allergy syndrome'. They are said to be 'allergic
        to the twentieth century'. Some have lost their families, their
        jobs, and their money in consequence and a few have committed
        suicide. Such extremes are luckily rare, but many patients are
        victims of this delusion in a less catastrophic form. We are told
        on dubious evidence that food sensitivity is a common cause of
        headache, insomnia, tinnitus, palpitations, breathlessness, ankle
        swelling, abdominal bloating, and fatigue; in children it is
        supposed to cause hyperactivity, bed-wetting, and poor school
        performance.
             The delusive nature of much of the food allergy idea has
        emerged clearly from several recent studies. In a recent survey
        in Buckinghamshire, in which over 18,000 people took part, over
        4,000 claimed to have adverse reactions of kind or another to
        foods, food additives, or aspirin. Reactions to food additives
        were reported by 7.4 per cent of the responders, but when they
        were tested objectively only three people were found to be
        affected.
             Another investigation was carried out in Manchester a few
        years ago. Twenty-two patients attending an allergy clinic for
        suspected food intolerance were assessed by a psychiatrist, after
        which they were tested for food intolerance with exclusion diets
        and by being given the suspected foods 'double-blind'; that is,
        with neither the patient nor the tester knowing whether they were
        receiving the food or a placebo.
             Only four of the patients had definite evidence of food
        intolerance and all four were psychologically normal. Of the 18
        in whom food intolerance was not confirmed, only one was found to
        be normal psychiatrically; ten of the remainder were depressed,
        and the others were thought to suffer from other kinds of
        psychiatric disorder. The group in whom food allergy was not
        confirmed was then compared with another group of patients who
        did not complain of food allergy but who had been referred to a
        general psychiatric clinic. The two groups turned out to be
        exactly the same in respect of their symptoms and psychiatric
        abnormalities.

             However, there was one significant way in which they
        differed: social class. The psychiatrically abnormal group whose
        members believed that they were allergic to food was composed
        predominantly of professional people.
             In the United States, and to some extent in Britain and
        other countries too, interest in the question of food allergies
        has led to the development of a form of treatment often called
        clinical ecology. Extracts of what are thought to be the
        offending foods are injected into or under the skin; if the
        patient is indeed sensitive to the food, the relevant symptom
        (wheezing, headache, or tinnitus, for example) occurs within a
        few minutes. The clinical ecologist can then stop the reaction by
        giving a different, 'neutralizing', dose of the same substance.
             Clinical ecology is practised both by doctors and by
        therapists who are not medically qualified. It has attracted a
        great deal of criticism from within mainstream medicine, but
        until recently there was little objective evidence available to
        help one to make up one's mind. A short while ago, however, a
        study was carried out at the University of California which sheds
        a lot of light on the subject.
             Several experienced clinical ecologists took part. They
        selected a total of 18 patients who they believed were
        undoubtedly sensitive to foods, on the basis of repeated
        injections with a variety of food extracts. The patients had
        known what they were receiving on these occasions; none of them
        had reacted when given control injections of what they knew to be
        just the diluent, without the food extract.
             In the study they were retested with the same substances in
        the same office, with the same technician giving the injections
        as before; the only difference was that now they did not know
        when they were receiving the active injection and when they were
        receiving the control. The technician and the observer who was
        assessing the result were also ignorant of what was being
        injected on each occasion.
             The results were clear-cut. Various symptoms were indeed
        produced by the injections, but the patients correctly identified
        only 16 out of 60 active injections (27 per cent) as having
        provoked symptoms. They also thought that 44 out of 180 control
        injections (24 per cent) were active. There was no difference in
        the symptoms produced by active and control injections.

             Seven patients who had produced symptoms were given
        neutralizing injections. In most of these cases, as it later
        turned out, the initial injection which had produced the symptoms
        had been a control one; but the neutralizing injections relieved
        these symptoms just as effectively as they did the 'real'
        symptoms provoked by active injections.
             The conclusion of this study seems to be inescapable:
        although (or because) these clinical ecologists genuinely
        believed in the technique they were using, on the basis of their
        experience, the effects they were seeing were due to suggestion
        and not to the substances they were injecting.
             The moral of this, as pointed out by Dr Anne Ferguson in a
        leading article on the subject in the same issue of the New
        England Journal of Medicine [1990,323:429-33; 476-478] is that
        'Self-deception affects doctors as well as patients, and through
        kindness and enthusiasm many of us may be doing a great
        disservice to ill persons anxiously seeking a non-psychiatric
        diagnosis. If we apply the wrong label with conviction, and then
        treat the symptoms with suggestion and placebo, relief is likely
        to be transient, and psychopathology will probably emerge.'

             As a footnote to this story, it is worth mentioning a recent
        study of another alternative diagnostic technique, Iridology
        (Chapter 2, p.00). It depends on the theory that diseases can be
        diagnosed from the appearance of the iris (the coloured part of
        the eye), which is divided into segments like a clock face; if a
        segment is flecked or coloured unusually it is supposed to point
        to a disorder of a particular organ.
             Iridology is used not only by clinical ecologists but also
        by osteopaths, acupuncturists, herbalists, homoeopaths and
        others. Often they inspect the iris simply with the help of a
        torch and a magnifying glass, but professional iridologists have
        special equipment with which to photograph the iris and make
        slides which can be projected on a screen.
             The method has obvious attractions. It appears to be
        scientific; after all, orthodox doctors pay a great deal of
        attention to the appearance of the back of the eye (the fundus),
        so why not the iris? It is also safe and painless, and its
        practitioners claim that it can provide information that is not
        otherwise available, not only about past health but even about
        what is to come. 'The beauty of the iris diagnosis is that it
        reveals tendencies that may not yet have begun to express
        themselves as actual symptoms. This makes it possible to plan our
        lifestyle, including appropriate treatment, according to our
        natural strengths and weaknesses, likes and dislikes.' [quoted by
        Inglis and West, 279].

             Unfortunately, however, it seems that it does not work. In a
        careful study [BMJ (1988) 297, 1578 - 81], a Dutch researcher,
        Paul Knipschild, tested the ability of experienced iridologists
        to diagnose the presence or absence of chronic cholecystitis. All
        the iridologists agreed that his study design was fair, and they
        were confident of their ability to make the diagnosis.
             However, the outcome was no better than chance. In spite of
        analysing the results with a variety of sophisticated statistical
        methods in an attempt to detect some pattern that was not
        immediately obvious, Knispschild was forced to conclude that the
        iridologists had completely failed the test. When shown these
        results they were puzzled and couldn't explain them.
             In an interesting sequel to this study Knipschild went on to
        investigate the effects that research of this kind has on
        doctors' belief systems. Three weeks before his paper on
        iridology appeared in the British Medical Journal he sent a
        questionnaire to 200 doctors, including some who had written
        articles in journals of alternative medicine, asking them whether
        they believed in iridology as a useful diagnostic aid for certain
        diseases. Later, he sent them copies of his paper and asked them
        to say whether their opinion had changed.
             Knipschild obtained replies from 78 doctors. Fifteen who did
        not believe in iridology before reading the report continued not
        to believe in it afterwards. Most were initially uncertain, and
        two-thirds of these became disbelievers as a result of the
        report. However, four who were strong believers initially
        continued to believe in it afterwards. [BMJ, 299, 491-2. 1989].
        It would be interesting to know what effects reading this report
        would have on non-medical practitioners' attitudes.

        THE CANDIDA THEORY AND ME
             This is an example of how ideas gleaned from orthodox
        medicine can be combined with long-standing alternative beliefs
        to produce a theory of disease that can be applied to almost any
        set of symptoms.
             Candida albicans is a fungus that gives rise to thrush, a
        superficial infection of moist surfaces such as the vagina and,
        in babies, the mouth. It is in fact often present in the vagina
        without causing symptoms, but sometimes, for unknown reasons, it
        gives rise to discharge and itching; some women seem to be
        particularly susceptible to it. It is also found in the lower
        part of the bowel, where again it usually causes no problems.

             As a rule it is a nuisance rather than a threat to life, but
        in people whose immune system is damaged, perhaps by drugs given
        to suppress tumours, candida may spread inside the body,
        affecting many internal organs and leading eventually to death.
             This much is well recognized in orthodox medicine. In
        alternative medicine, however, there has grown up a wide-spread
        belief that there is another set of symptoms due to candida
        overgrowth in the intestines. These include almost anything you
        like to name: fatigue, headache, listlessness, spots before the
        eyes, abdominal bloating, looseness of the bowels... the list
        goes on and on. It is, in fact rather reminiscent of Hahnemann's
        list of symptoms due to the psora 'miasm' (see p.000), and there
        is another indirect link with Hahnemann's ideas as well.
             Hahnemann believed that orthodox treatment was responsible
        for many of the ills suffered by his patients. This idea comes
        into the candida story too, for the reason for the overgrowth of
        candida is supposed to be the use of antibiotics. A recognized
        unwanted effect of some antibiotics (the so-called broad-spectrum
        group) is that they tend to alter the proportions of the bacteria
        that normally live in the lower part of the intestines, and in
        rare cases this can have serious or even fatal consequences. The
        candida theory builds on this fact; if you have had a course of
        antibiotics in the past, especially a long one or a repeated
        series of courses, this is said to make you vulnerable to
        candida.
             The trouble with the candida theory, as with most theories
        of this kind, is that it is very hard to assess objectively.
        Candida certainly does exist in the gut, but it is difficult to
        say at what point it becomes abnormal in quantity. It is still
        more difficult to explain how candida could give rise to the
        remarkable range of symptoms that it is blamed for. But this
        comprehensiveness is of course just what recommends it to many
        patients and alternative therapists.
             The Candida theory has, not surprisingly, been proposed as a
        main cause for what has come to be the very model of an
        'alternative disease', myalgic encephalomyelitis (ME). The
        Myalgic Encephalomyelitis Association estimates that there are
        currently 150,000 sufferers in Britain.
             The first description of what may or may not have been the
        same disorder was given in the 1950s, following an outbreak of a
        mysterious disease at the Royal Free Hospital in London; it was
        therefore called Royal Free Disease. The term Postviral Fatigue
        Syndrome has also been applied to more or less the same clinical
        picture. This confusion about what to call the condition reflects
        the considerable uncertainty that exists about ME.

             None of the names that have been suggested is satisfactory.
        "Myalgic encephalomyelitis" means inflammation of the brain and
        spinal cord accompanied by aching muscles, but neither of these
        is necessarily present in ME. "Postviral Fatigue Syndrome" is
        likewise unsatisfactory, since the condition is not necessarily
        preceded by an identifiable viral infection. 'Chronic Fatigue
        Syndrome' would be a suitably non-committal expression, conveying
        our ignorance of its cause, or causes, but ME seems to be the
        name that has established itself. (It is also been called 'yuppie
        flu', probably reflecting a tendency for it to afflict people in
        the professional classes; a feature that recalls food allergy.)
             A typical way for ME to begin is with a sore throat, running
        nose, and enlarged nodes ("glands") in the neck. This is of
        course what most people would describe as "flu". In addition,
        there may be diarrhoea and vomiting, or sometimes giddiness and a
        fast pulse rate. Some patients at this stage suffer from
        headaches, blurring of vision, and double vision. However, the
        worst complaint is usually severe muscular weakness, together
        with a feeling of intense physical and mental misery.
             As time passes the physical and mental debility persist,
        though they may vary in intensity from day to day or even within
        the same day. Some patients are so badly affected that they have
        to stay in bed all the time, and if they do get up they may find
        that the smallest household task is too much for them; going to
        work is out of the question. The muscles may be tender to the
        touch.
             Memory is often affected. The ability to concentrate is
        impaired or lost, and patients may be more emotional than normal,
        being liable to outbursts of tears or anger at things that would
        normally seem trivial. Sleep patterns may be disrupted.
             Other symptoms include cold hands and feet, extreme
        sensitivity to changes in temperature and weather, bouts of
        sweating, and palpitations. The patient may have to pass urine
        more frequently than normal.
             As the months go by, these symptoms may diminish in
        intensity although without going away completely; the patient can
        go back to work, but finds that he is exhausted at the end of the
        day and has no energy for anything else. This may persist for
        months or even years. A few more severely affected patients do
        not recover even to this limited extent, and have to spend most
        of their time in bed.

             There is no agreement about what causes ME. At one extreme
        some doctors regard it as a wholly psychological disorder, while
        others are convinced that it is due to a preceding viral
        infection. It is also been thought to be due to hyperventilation.
        This is an interesting disorder, thought to be fairly widespread,
        in which people tend to breathe just a little too deeply for long
        periods. As a result the chemical balance of the blood is
        altered, with a shift towards the alkaline pole, and numerous
        symptoms such as tingling, palpitations, and anxiety can result.
        Hyperventilation is almost certainly part of the picture in a
        number of cases of ME but the two disorders are probably not
        identical.
             ME is probably not a new disease. It is very similar to
        'neurasthenia,' which was first described in 1867 by an American
        neurologist, George Beard. The symptoms he gives are almost
        identical with those of ME; he attributed it to an organic cause
        (depletion of the stored nutriment of nerve cells). It chiefly
        affected the middle classes, like ME, and the treatment he
        advocated (complete rest) was again similar to that now advised
        for ME.
             Chronic fatigue without a diagnosis of ME is extremely
        common. In the USA a survey in 1988 found that chronic fatigue
        was a major problem for 24 per cent of all adults attending
        primary care centres, and in this country the findings are
        similar; a community survey in 1987 showed that 25 per cent of
        women and 20 per cent of men 'always feel tired'.
             There is no way of diagnosing ME by means of laboratory
        tests. The commonly used tests give normal results as a rule,
        although thyroid function may be at the lower end of the normal
        scale and certain enzymes in the blood may be a little raised. A
        test for infection with a particular group of viruses
        (enteroviruses) has recently been developed at St Mary's
        Hospital, Paddington, and gives positive results in a number of
        patients with ME. Many patients think that this a specific test
        for ME, but in fact all it shows is whether or not a patient has
        at some time been infected with the virus in question; it cannot
        show that this virus is the cause of the present symptoms. For
        the moment, therefore, ME is a purely clinical diagnosis. Tests
        may be used to eliminate other possible causes of the patient's
        symptoms, but once this has been done ME can be said to be the
        diagnosis if the symptoms correspond with the description of the
        condition.
             Patients often ask: 'Is it ME, doctor?' The answer is that
        if you have the symptoms, you have ME by definition, because ME
        is, at present, simply a collection of symptoms. What underlies
        the question, however, is a request for reassurance that it is
        not 'all in the mind'; patients who believe that they have ME
        usually resist any suggestion that they might be depressed. But
        in fact there are many resemblances between ME and depression.

             Depressed patients typically do complain of severe tiredness
        after even minimal effort. (Manic patients, in contrast, have
        boundless energy.) In fact, loss of energy is a common way for
        depression to appear, and depression often comes on suddenly,
        just as ME does. Both depression and ME are twice as common in
        women as men, and rare in children. When patients suffering from
        chronic fatigue are assessed psychiatrically in standard ways,
        between 50 and 80 per cent fulfil the criteria for diagnosis of a
        psychiatric disorder.
             Mental as well as physical fatigue is common in ME, but in
        neuromuscular disorders such as myasthenia gravis there is little
        mental fatigue.
             Patients' resistance to the idea that their ME symptoms may
        be due to depression is understandable, but if we accept the view
        that depression itself is an organic disorder, due to some
        impairment of brain function, much of the ground for argument
        disappears. A diagnosis of depression says nothing about the
        cause of the depression; it may come on after a viral infection,
        and conversely depressed people may be more liable to viral
        infections through an effect on their immune systems. But a
        diagnosis of depression carries a certain undesirable connotation
        for many people, hence their reluctance to accept it.
             At present treatment of ME is inevitably unsatisfactory, in
        view of the uncertainty about what causes it or even whether it
        exists. This frustrates many doctors and can breed resentment in
        the patients, who feel that no one has adequately recognized the
        serious nature of their condition.
             Almost every form of alternative medicine has been tried for
        ME. Candida overgrowth, as I have said, is a popular theory about
        its cause, and therapists who believe in this, and who are also
        doctors, may give patients courses of antifungal drugs. Non-
        medical practitioners often try a dietary approach to reduce
        candida. Undue sensitivity to carbohydrates (reactive
        hypoglycaemia) and allergies to foods are also popular as
        explanations. Some patients do seem to improve if refined
        carbohydrates are eliminated from their diet, and others can be
        helped by elimination diets to try to find the offending item or
        items, but both of these measures, especially elimination diets,
        are difficult to put into practice and should never be undertaken
        lightly or without skilled supervision. As always, the role of
        suggestion is hard to exclude.
             Homoeopathy helps some patients, and so does acupuncture,
        but neither of these can offer a sure cure.

             It seems likely that ME is not just one thing. There are
        some patients in whom it is the result of a persisting viral
        infection, but these are a probably a minority. In most cases
        psychological factors appear to be playing a large part, but it
        could certainly be objected that these are the result of the
        disease rather than its cause, and this is usually hard to
        disprove. Perhaps in the end it is a meaningless question.
             As a rule the best plan of treatment is to encourage
        patients to find out how much activity they can sustain without
        making themselves worse. "Overdoing things" can easily bring on a
        relapse and is to be avoided, but on the other hand complete
        inactivity is also undesirable, partly because it is likely to
        increase the patient's depression and partly because the muscles,
        if not used, will deteriorate further and become still weaker,
        and this weakness due to disuse will then be superimposed on that
        due to the illness. A gradual increase in activity as the
        condition begins to improve is the thing to aim at.
             What happens instead in too many cases is that the
        unfortunate patient goes from therapist to therapist, seeking a
        cure and never finding it, trying endless methods, swallowing
        innumerable medicines, vitamins and minerals; some people take
        thirty or more medications daily. To persuade such patients to
        give up the quest is nearly hopeless.

        Orthodox medicine (allopathy)
             Running through much of alternative medicine like the wire
        thread in a banknote is the notion that orthodox medicine is bad
        for you. Like many of these ideas, this one goes back to
        Hahnemann, who believed in it strongly. Indeed, it was so
        entrenched in homoeopathy in the early days that when The London
        Homoeopathic Hospital was founded in the nineteenth century the
        rule was laid down that no 'allopathic' medicine was to be kept
        in the pharmacy, and even the use of homoeopathic medicines in an
        undiluted form was discouraged. (However, it appears that on
        Hahnemann's death a bottle of Bryonia tincture [the undiluted
        plant extract] was found in his medicine set.)
             Certain kinds of orthodox drugs are held to be particularly
        harmful; these include corticosteroids and antibiotics. There is
        of course a good deal of support for this idea in orthodox
        medicine itself. Every drug has potential undesirable effects and
        some have a great deal of them. Every prescription is a balancing
        act; the doctor has to weigh up the possible benefits of his
        medicine against the possible dangers. But alternative
        practitioners seldom base their criticisms on detailed lists of
        the unwanted effects of drugs, and their objection is as much
        emotional as rational.

             It sometimes happens that patients are advised by their
        alternative practitioner to stop their orthodox treatment; they
        may be told that they cannot have alternative treatment until
        they have done this. The results of this can be unpleasant or
        even catastrophic. If the orthodox medication is doing no good,
        as may be the case, no harm will result, of course, but it may be
        affording a lot of symptomatic relief, for example by dulling
        pain or suppressing a rash, and stopping it will then make the
        patient much worse. In some cases stopping a medicine could have
        serious or even fatal consequences.
             The evidence that orthodox medicines really do interfere
        with the action of homoeopathic medicines or acupuncture is
        flimsy, being based mainly on prejudice or hearsay. On principle
        it is always a good thing to reduce medication if this can be
        done safely, since many patients, especially the elderly, are
        over-medicated;  but the important word is 'safely'.
             Belief in the adverse effects of allopathic drugs,
        especially antibiotics, has given rise to the idea, held by some
        alternative practitioners, that the cause of Aids is not the HIV
        virus, which is supposed to be merely a harmless 'passenger'. The
        alternative theory has it that Aids is really a form of
        'suppressed syphilis' (a miasm, in fact), which has taken on this
        aggressive form because people's immune systems have been
        weakened by antibiotics. The appeal of this theory seems to be
        mainly that it provides yet another reason to condemn the use of
        antibiotics.

        THE MIASM THEORY.
             This discussion of the causes of disease according to
        alternative medicine would not be complete without mention of the
        miasm theory proposed by Hahnemann, which is still taken
        seriously by some homoeopaths, especially in South America.
        Although its main relevance is to homoeopathy, somewhat similar
        ideas crop up from time to time in other contexts too.
             In outline, Hahnemann postulated that the vast majority of
        chronic disease is due one of three pollutions or 'miasms'. These
        are supposed to operate very much like infections; two are
        venereal (syphilis and sycosis), while the third, called psora,
        which is much the most important, is non-venereal and extremely
        widespread; so widespread, indeed, that the only person not to
        have been infected appears to have been Hahnemann himself.
             Psora enters via the skin, where it gives rise to an itchy
        rash, which may however be localized and transient and so not be
        noticed. Nevertheless it becomes generalized throughout the body
        immediately, and lies in wait, possibly for many years, until at
        some later stage it bursts forth in a terrifying explosion of
        manifestations of chronic disease.
             In his book on chronic disease Hahnemann devotes over thirty
        pages to the chronic results of infection with this Hydra-headed
        monster. He names almost every ill known to man, so that it is
        almost impossible to think of any disease or symptom (he does not
        distinguish clearly between these) that would not be due to
        psora. As a result, the psora theory becomes so universally
        explanatory as to be practically useless; by explaining
        everything it explains nothing.
             This has not prevented numbers of later homoeopaths from
        trying to adapt the theory to fit subsequent discoveries. Psora
        has been equated at various times with, among other things,
        chronic infection, autoimmune disease, viral disease, and
        hereditary disease. The most dramatic development was in
        nineteenth century America, where psora acquired a strongly
        moralistic flavour and was regarded as a moral as well as a
        physical contagion.
             Moreover, it was now held to be passed on from generation to
        generation. In the words of James Tyler Kent, one of the best
        known American homoeopaths of the late 19th century: 'The human
        race walking the face of the earth is little better than a moral
        leper. Such is the state of the human mind at the present day. To
        put it another way, everyone is psoric... A new contagion comes
        with every child.' As critics remarked, psora took on many of the
        characteristics of Original Sin.
             This perhaps rather unlikely development was due to the
        influence of the ideas of the Swedish philosopher and mystic
        Emanuel Swedenborg, which profoundly affected the course of
        homoeopathy in America and, later, in England as well. (Many of
        the more extreme features of modern homoeopathy are due to
        Swedenborgianism, a fact that has not always been given the
        attention it deserves. See Appendix I.)
             We seldom read quite such blatant equations of disease with
        morality today, but the implication that healthy living is
        virtuous living often lies just below the surface. The expression
        'I try to eat the right things' is heard very frequently, and
        there is usually the unspoken implication that the patient has
        earned merit by this.




                     6: IS IT SAFE AND DOES IT WORK?-

             Why have doctors usually been so resistant to these
        'unorthodox' forms of treatment? There does not seem to have been
        any one reason for their hostility, and it probably varied from
        therapy to therapy. It certainly was not on the grounds of
        safety, for in many cases the unorthodox treatment was a lot
        safer than the orthodox treatment of the day. Homoeopathy, for
        example, was at least harmless, if nothing else, whereas the
        orthodox doctors in the early nineteenth century were happily
        giving their patients enormous doses of highly toxic substances
        such as mercurous chloride and extracting large quantities of
        their blood, sometimes to the point of literally bleeding them to
        death. (To be fair, we must also remember that the patients
        demanded this treatment and felt aggrieved if they did not get
        it.)
             It seems likely that some of the hostility felt by the
        orthodox was simply the customary human dislike of anything
        unfamiliar, coupled with financial interest; the new homoeopathic
        treatment tended to attract patients. But naturally the orthodox
        tried to rationalize their objections in various ways.
             In our own time the usual reason given for rejecting
        alternative treatment is that it has not been tested
        scientifically. 'Carry out proper clinical trials,' orthodox
        doctors say, 'and we'll listen to you; until then, don't waste
        our time.'
             The background to this is the change that came over orthodox
        medicine just after the Second World War. Up to then medicine had
        been largely 'anecdotal' (a term applied today in a derogatory
        sense); doctors published accounts of their experiences but did
        not make a serious attempt to validate them objectively. Now it
        has become increasingly recognized that it is very easy to fool
        oneself. There is a natural human tendency to remember one's
        successes and forget one's failures, so that in retrospect one's
        results are surrounded by a comforting rosy glow.
             A closely allied source of error arises from the almost
        universal belief that if someone recovers after receiving a
        particular treatment it must be because of that treatment. The
        history of medicine affords many curious instances of this. For
        example, in the FOUR BOOKS OF THAT LEARNED AND RENOWNED DOCTOR
        LAZARUS RIVERIUS, published in 1678, we read of the remarkable
        cures effected by 'Powder of Woolfs Guts': one case concerned a
        woman suffering from abdominal pain, and another was a woman with
        a 'Hysterical Epilepsie'. A cancer of the upper lip was cured by
        Oyntment of Green Frogs. To make this, 'Take Green Frogs that
        live among trees, or in pure waters, and put them in an Earthen
        Pot full of small holes in the bottom, and fill their mouths with
        butter, cover the Pot close, and daub the juncture with clay, and
        set over it another empty pot which must be set in the ground up
        to the brim; then make a fire around fit for distillation, and
        gather the Oyl that drops into the pot in the ground, and mix the
        powder of frogs into a Liniment.' [The Lancet, (1990) Burton,
        J.L., 'Herbal remedies  -  an alternative.' 336, 1565 - 66]
             'Oyl of scorpions' was regarded by Dr Riverius as an
        'ordinary remedy'; applied externally, it could be useful in
        treating cough and fever. This recalls rat oil, still apparently
        much in demand in the monasteries of Mount Athos, where it is
        used as an external application in all kinds of disorders. To
        make it, you catch a baby rat, immerse it in a bottle of olive
        oil, and expose it to the sun. Gradually it dissolves in the oil,
        which can then be used medicinally: rubbed on the head for
        headache, instilled in the ear for earache and so forth. [De
        Loverdo, C. (1956), J'ai ete moine au Mont Athos. La Colombe,
        Paris.]
             All these remedies have been found to 'work'. Nevertheless,
        the unprejudiced observer is left with the feeling that there is
        something rather improbable about them, and it was in an
        endeavour to weed out the modern equivalents of Oyntment of Green
        Frogs that doctors began, after the Second World War, to carry
        out 'clinical trials'. The practical details of these vary, but
        the general principle is quite simple. It is to make a
        comparison. One can, for example, compare two different
        treatments with each other, or one can compare the effect of
        giving a particular treatment with that of not giving it.
             Two things to notice about this idea. Firstly, clinical
        trials nearly always compare groups of patients, and the results
        are analysed statistically by means of mathematical techniques
        that are often complex. They therefore don't tell you much about
        the reactions of individual patients, a failing that bothers many
        advocates of alternative medicine.
             Secondly, clinical trials usually include the use of a
        'placebo control', which in the case of a medicine is a tablet or
        capsule that is supposed to be indistinguishable from the
        'active' substance. This is to try to eliminate the effects of
        suggestion. If the doctor knows what the different patient groups
        are taking but the patients don't the trial is said to be 'single
        blind', but whenever possible the doctor is kept in ignorance as
        well, in which case the trial is 'double blind'.
             Alternative practitioners, especially those who were not
        medically qualified, were at first not very interested in the
        idea of carrying out clinical trials. Moreover, they tended to
        object to the methods used in these trials, saying that treating
        patients as groups, with standardized treatments, was contrary to
        the spirit of alternative medicine, which regarded everyone as an
        individual. And even those practitioners who were willing to
        participate in trials generally lacked the necessary resources
        and expertise.
             Some clinical trials were carried out by doctors practising
        alternative medicine, however, mainly in homoeopathy. Probably
        the earliest of these was the mustard gas experiments during the
        war, in which homoeopathy was shown to be effective in preventing
        the effects of skin burns with the gas. Placebo controls were
        used in this study. There was then a long gap until the late
        1970s, when a group of homoeopathic doctors in Glasgow carried
        out trials of homoeopathy in the treatment of rheumatoid
        arthritis. Since then further studies of the homoeopathic
        treatment of other disorders, notably hay fever, have appeared,
        and some of these have been published in well-known medical
        journals such as The Lancet. There have also been trials of
        homoeopathic medicines in veterinary practice.
             In France, as well as in other countries on the continent of
        Europe, there have been many elaborate scientific laboratory
        studies of homoeopathic medicines. It is therefore no longer
        correct to say that there is no scientific evidence for the
        efficacy of any alternative medicine; for some kinds, at least,
        there is quite a lot. (I will return to this question later.)
             Another development in the 1980s was the setting up of the
        Research Council for Complementary Medicine. This is a group
        consisting of both doctors and non-medical practitioners; its
        main task is to foster research in all kinds of alternative
        therapy. It gives advice to would-be researchers, helps them to
        design their projects, and tries to obtain funding for these
        schemes from Government and other sources.
             This all sounds very optimistic. But difficulties still
        exist, and most of these stem from a deep division in attitude
        which often separates doctors, including those sympathetic to
        alternative medicine, from non-medical practitioners. Ardent
        supporters of alternative medicine often do not acknowledge the
        need to offer objective evidence for their claims even today.
        Inglis and West provide an illustration of this, for in their
        book THE ALTERNATIVE HEALTH GUIDE neither 'placebo' nor
        'suggestion' are mentioned in the index.

        Reservations of orthodox doctors.
             An anxiety often voiced by orthodox doctors is that those
        alternative practitioners who lack an orthodox medical training
        may fail to realize when their patients are seriously ill and
        need ordinary medical attention. Alternative practitioners say
        that this worry is exaggerated, although many of them would like
        to have some training in diagnosis if it were available. They
        also suspect that doctors are tempted to use the danger of missed
        diagnosis as a weapon against the alternative competition.
             There is no doubt that diagnoses are missed by alternative
        practitioners. They are also missed by orthodox doctors, of
        course, but at least one can say that they should not be.
        Alternative practitioners, on the other hand, are not expected to
        make pathological diagnoses. The important, but at present
        unanswerable, question is how frequently these disasters occur.
             I doubt in fact whether missed diagnoses by alternative
        practitioners are all that common, though there are no
        statistics. Still, the possibility is alarming, and instances of
        it certainly do occur. It is particularly worrying in the case of
        acupuncture, because this sometimes relieves pain effectively
        even though there is a serious cause for it. In a study reported
        a few years ago from the National Hospital for Nervous Diseases
        it was found that acupuncture was capable of temporarily
        relieving headache due to brain tumours. It certainly is possible
        to imagine that this kind of treatment might lull both patient
        and therapist into a false sense of security, and the risk
        probably is not confined to brain tumours; disease in other parts
        of the body might be similarly masked.

             It is sometimes said that non-medical practitioners should
        receive at least a brief training in diagnosis, so that they
        could detect problems that needed referral to a doctor. It sounds
        like a good idea, but given that an orthodox doctor has six
        years' training and even after that is not regarded as safe to
        practise unsupervised until he has had a further period of post-
        graduate supervision, it seems unlikely that much could be
        achieved for non-medical trainees in a few weeks or even months.
             A much worse problem that I have occasionally encountered
        is, in a way, the reverse of this. There are a few alternative
        practitioners who use various unorthodox diagnostic methods, on
        the basis of which they claim to detect that the people who
        consult them are at risk of developing serious diseases such as
        cancer, multiple sclerosis, or even Huntington's chorea, one of
        the most unpleasant disorders it is possible to suffer from.
        There is no reason whatever to believe that these prognoses means
        anything at all, but it can place any unfortunate recipient in
        the most horrible dilemma. Some of the people who have been given
        such a diagnosis (the son of a personal friend, in one instance)
        have not believed my reassurance and have continued to worry,
        eventually embarking on a long and costly regimen of treatment to
        prevent the onset of a non-existent disease.
             Out-and-out charlatanry of this kind is fortunately rare.
        But even when practised in good faith, some treatments, such as
        acupuncture, are potentially dangerous. They may nevertheless be
        used by people who have no anatomical knowledge or training
        whatever. There certainly is a good case to be made out for
        requiring anyone who practises these techniques to have undergone
        at least a minimum period of instruction, but a proposal of this
        kind raises the whole question of accreditation and this will not
        be easy to resolve.
             Leaving aside the thorny question of safety, I pass on to
        look at some of the evidence regarding efficacy.

        THE QUESTION OF EFFICACY.
             You may remember the epithets used by the authors of 1066
        AND ALL THAT to describe the two sides in the Civil War. The
        Republicans were Right but Repulsive, the Royalists were Wrong
        but Wromantic. Not so long ago a sympathetic but uncommitted
        observer of the medical scene might have been tempted to
        categorize orthodox and alternative treatments in more or less
        these terms. On the one hand there was mainstream medicine, with
        its surgery and its drugs, able to cure or relieve many disorders
        but doing so in an impersonal, soulless, mechanistic way, and on
        the other hand there was alternative medicine of various kinds,
        caring for individuals but able to offer nothing more than
        placebo therapy.
             Today the difference between the two is no longer so clear-
        cut, because for some forms of alternative treatment, at least,
        there is a certain amount of scientific evidence to show that
        they work. In the case of the alternative physical therapies
        (osteopathy, chiropractic, acupuncture), for example, a fair
        amount of research has been carried out. Admittedly the quality
        of some of this work is rather variable. Two recent reviews of
        acupuncture, one of which listed 32 papers and the other 40,
        found serious shortcomings in most of them. Making allowances for
        this, however, it appears that there is good evidence that
        acupuncture can relieve quite a number of kinds of pain, at least
        temporarily, although treatment may need to be repeated at
        intervals.
             At one time there was a great deal of interest among
        acupuncturists in the naturally occurring substances known as
        opioids. These are found in many tissues, but particularly in the
        brain, where some of them are apparently involved in the
        mechanism that underlies pain perception. At first it was thought
        that the discovery of these substances explained the relief of
        pain by acupuncture, but this now looks unlikely. There are
        probably two separate processes at work here.
             When an acupuncture needle is inserted there is a short (90
        minute) diminution in sensitivity to pain; this effect is
        produced by the release of substances within the nervous system.
        The use of acupuncture as an alternative to anaesthesia in
        surgery depends on this, although acupuncture is now little used
        for surgery even in China.
             The other effect is a local reduction in pain, lasting for
        several days or even longer, in an area of the body which was
        previously painful. This is the effect which comes into play when
        acupuncture is used as a treatment for disease, but unfortunately
        very little is known about how it occurs. Partly this ignorance
        exists because we also know very little about the mechanisms of
        pain itself in many chronic disorders.
             It seems quite likely that acupuncture and manipulation work
        in rather similar ways. Certainly a good many of the disorders
        that respond to acupuncture will also respond to manipulation and
        vice versa.
             One way in which acupuncture and other physical treatments
        differ from medical treatments like homoeopathy is that they are
        less amenable to placebo-controlled trials of the kind that
        orthodox doctors expect. It is certainly possible to needle
        patients in the 'wrong' places and to compare the effects of this
        with needling them in the 'right' places, but for several reasons
        this is not a satisfactory comparison, especially when it is non-
        traditional acupuncture that is under consideration. (The
        acupuncturist inevitably knows whether or not he is needling the
        'correct' point and so may unconsciously influence the outcome,
        the sensations excited at the two sites may well be different,
        the depth of needle insertion at the 'real' and 'placebo' points
        is often different, and so on. Moreover, it seems fairly certain
        that there is some response to inserting a needle no matter where
        it is done, so the question is whether one can improve on this
        'baseline' effect by specific means.)
             Practitioners of both herbal medicine and homoeopathy are
        under pressure to justify their treatments through clinical
        research, and both have encountered difficulties in carrying it
        out. There is, however, one outstanding difference between the
        two methods: herbalism is not faced with the difficulty of
        proving that very highly diluted substances can have a measurable
        pharmacological effect. If anything, in fact, it suffers from the
        opposite problem: because it uses extracts of the whole plant,
        often containing a large number of substances some of which may
        not yet even be chemically identified, there can be a question
        about the safety of some of the medicines as well as about their
        efficacy.
             As Simon Mills, himself a herbalist and Co-director of the
        Centre for Complementary Health Studies at the University of
        Exeter, has pointed out, although herbal medicines have been used
        as far back as historical records go and no doubt long before
        that, interest on the part of herbalists in research is quite
        recent, partly because there has hitherto been little
        organization to encourage this kind of work. Mills himself is
        emphatic that research is needed: 'if what you say is so valuable
        and powerful then it should be able to stand up for itself in any
        forum.' [Complementary Medical Research, 1991, 5, 29 - 35] As he
        also acknowledges, however, research in herbalism faces special
        problems: one, which I have already mentioned, is the complexity
        of the substances used, and another is the belief that herbs are
        usually supposed to act on the body differently from orthodox
        medicines.
             Like homoeopaths, herbalists set much store by contact with
        the patient; they see their work as 'healing', not just
        prescribing a medicine. In spite of all this, Mills insists,
        research in herbal medicine is possible, even by conventional
        double-blind comparisons in some cases, but in general he favours
        the use of different trial designs to take account of the special
        characteristics of herbal prescribing. Laboratory research, and
        even animal research if conducted without causing harm or
        suffering to the animals, also have a place, he believes.

             A most comprehensive review of clinical trials in
        homoeopathy was carried out recently by three researchers at the
        University of Limburg, in Holland; one of the three was Paul
        Knipschild, the professor of epidemiology, whose work on
        iridology I have referred to elsewhere. [Kleijnen, J.,
        Knipschild, P., ter Riet, G. (1991). British Medical Journal,
        302, 316 - 23]
             This review looked at 107 controlled trials in 96 reports
        published throughout the world. Most of the trials were found to
        be poor in quality, but there were many exceptions. As a whole,
        of 105 trials in which it was possible to make some kind of
        assessment of the results, 81 had a positive outcome and 24 a
        negative one. Positive results were obtained with all kinds of
        homoeopathy, whether 'classical' or 'modern'. (The authors
        rightly comment on the 'innumerable ways' in which Hahnemann's
        principles have been applied in practice.)
             The reviewers were surprised by the large amount of positive
        evidence they found. 'Based on this evidence we would be ready to
        accept that homoeopathy can be efficacious, if only the mechanism
        of action were more plausible... The evidence presented in this
        review would probably be sufficient for establishing homoeopathy
        as a regular treatment for certain indications.' Although there
        were shortcomings, these were no worse than those found in
        comparable studies of conventional therapy. The authors conclude
        that there is a great need for further research, in the form of
        'a few well-performed controlled trials in humans with large
        numbers of participants under rigorous double blind conditions.'
             The mechanism of action is indeed the crucial issue; if this
        were not such a problem homoeopathy would have been generally
        accepted long ago. It is difficult for the unprejudiced observer
        not to feel that there must be something odd about a treatment
        that consists in nothing more than throwing a few drops of
        medicine into a cattle drinking-trough, especially when the
        medicine itself, on ordinary chemical analysis, would be shown to
        contain nothing but water. For most scientifically trained people
        this strains credulity to breaking point or beyond it.

        SCIENTIFIC CONTROVERSY: THE BENVENISTE AFFAIR.
             The extraordinary passions that this question can raise were
        dramatically illustrated a few years ago by the feud between
        Jacques Benveniste, a highly respected researcher in immunology,
        and the journal NATURE. On 30th June 1988, the journal published
        an article by Benveniste and his colleagues at the Unit for
        Immunopharmacology and Allergy of INSERM at Clamart, in the
        outskirts of Paris. The article appeared to provide support for
        homoeopathy.

             When a certain type of human white blood cell, the
        polymorphonuclear basophil, is exposed to antibodies against IgE
        (the protein concerned in allergic reactions), certain changes
        occur. Histamine (the chemical that causes many of the clinical
        symptoms of allergy) is released from the cell, and the cell
        itself changes its appearance.
             What Benveniste and his team claimed was that these changes
        could occur even though the liquid containing the anti-IgE
        antibodies was diluted to fantastically high levels (1 x 10-120);
        that is, far beyond the point at which any molecules of the
        starting substance could be expected to be present. As Benveniste
        put it, perhaps rather over-dramatically, in an interview in LE
        MONDE, it is as if one shook a car key in the Seine at the level
        of the Pont Neuf in Paris and then collected a few drops of water
        at Le Havre that would start that very car and not another.
             Benveniste also found that in order to produce these effects
        it was not enough just to carry out a plain dilution; vigorous
        shaking, of the kind used in making homoeopathic medicines, was
        required. Another interesting finding was that there were
        successive peaks and troughs in the effect as the dilution
        process was continued. (This feature has appeared repeatedly in
        homoeopathic research as far back as the early 1900s, and
        presumably must mean something; it suggests a kind of 'resonance'
        phenomenon.)
             As an established scientist with a sound reputation,
        Benveniste was under no illusion about the storm of controversy
        that his paper was likely to provoke. However, he can hardly have
        been prepared for the scandal that broke over his head soon after
        his paper appeared. The editor of NATURE, John Maddox, had
        accompanied publication of the paper with an editorial expressing
        considerable reservations: 'Benveniste's observations are
        startling not merely because they point to a novel phenomenon,
        but because they strike at the roots of two centuries of
        observation and rationalization of physical phenomena. The
        principle of restraint which NATURE applies in its editorial is
        simply that, when an unexpected observation requires that a
        substantial part of our intellectual heritage should be thrown
        away, it is prudent to ask more carefully than usual whether the
        observation may be incorrect.'

             Benveniste was in full agreement that his results ought to
        corroborated by other scientists - indeed, this had already
        happened at five other institutions. (However, in a later
        television discussion he also made the valid point that there was
        no need to be quite so apocalyptic as Maddox had been in saying
        that two centuries of science would have to be thrown away.
        Benveniste's results, if correct, were certainly very interesting
        and important, but they were not quite as world-shaking as that.
        They were, he thought, in principle capable of being explained by
        the electromagnetic properties of water.)
             On 28th July NATURE published what was in effect a
        recantation of its initial decision to endorse Benveniste's paper
        at least to the extent of agreeing to publish it. An
        investigative team, composed of John Maddox, the editor, James
        Randi, a professional magician and debunker of claims for the
        paranormal, and Walter W. Stewart, a specialist in errors and
        inconsistencies in the scientific literature and scientific
        fraud, had spent five days at Benveniste's Unit at Clamart.
             Their report, entitled '"High dilution" experiments a
        delusion', was dismissive of his results. It concluded that 'the
        care with which the experiments reported have been carried out
        did not match the extraordinary character of the claims made in
        the interpretation; the phenomena described are not reproducible,
        but there has been no serious investigation of the reason; the
        data lack errors of the magnitude that would be expected and
        which are unavoidable; no serious attempt has been made to
        eliminate systematic errors, including observer bias; the climate
        of the laboratory is inimical to an objective evaluation of the
        exceptional data.' In other words, Benveniste, in the view of the
        investigative team, had been guilty of extreme gullibility and
        self-deception.
             Benveniste, understandably, reacted with great anger  -  not
        to the fact that an inquiry had been conducted, for he had been
        quite willing for this to be done  -  but to the way in which it
        had been conducted and to the implication that his team's honesty
        or scientific competence were dubious. 'The only way definitively
        to establish conflicting results,' he said, 'is to reproduce
        them. It may be that we are all wrong in good faith. This is no
        crime, but science.'
             Several things occur to me about this sorry tale. One is
        that it seems extraordinary that a scientific journal like NATURE
        did not conduct its investigations before publishing Benveniste's
        paper rather than afterwards. Another is that the composition of
        the team, which did not include anyone competent to assess
        Benveniste's work scientifically, must surely indicate the kind
        of conclusion it was expected to reach. (Like the Latin num, it
        expected the answer 'no'.) A third is that surely it was naive of
        Benveniste not to anticipate this outcome when he was informed of
        the composition of the team; it was then that he should have
        objected.
             Probably most people who knew little or nothing about the
        subject before the occurrence of the NATURE controversy gained
        the impression that Benveniste's research was unique in modern
        times. This is very far from the case; a great deal of laboratory
        work has been carried out, and is still continuing, in a number
        of countries. France and Germany have been particularly prominent
        in this, but centres elsewhere (in Italy, Israel, and Canada, for
        example) have also contributed. A few years ago an international
        society known as GIRI was established thanks to the efforts of
        Professor Madeleine Bastide, of the University of Montpellier in
        France, in order to coordinate and encourage this work. I was one
        of the founding members of this group in 1987, and since then we
        have seen it grow and develop rapidly. Researchers who are
        members of GIRI have published their results in various
        mainstream journals, but for some reason this work has so far not
        given rise to anything like the furore that greeted the NATURE
        publication.
             One would like to believe that questions about the reality
        of the high dilution effect and its possible mechanism of action
        would soon be settled by further scientific studies.
        Unfortunately this appears rather unlikely. What leads me to this
        rather depressing conclusion is the fate that seems to have
        befallen another recent scientific controversy that has excited
        even fiercer argument: the cold fusion affair.
             On 23rd March 1989, less than a year after the Benveniste
        furore, Stanley Pons and Martin Fleischmann, two chemists working
        at the University of Utah, announced to the world that they had
        achieved nuclear fusion  -  the process that powers the Sun  -
        not in a huge apparatus costing many millions of dollars and
        operating at thousands of degrees centigrade, but in a test tube
        of water, at a cost of about 100 dollars, at room temperature.
             This claim, if correct, would make the alchemist's hope of
        making gold look trivial in comparison. Cold fusion would provide
        the world with limitless supplies of energy, without causing
        pollution or radiation. (It might also provide dictators of small
        countries with an easy way of making nuclear weapons, but that is
        another story.)
             It sounded too good to be true; but was it? Pons and
        Fleischmann chose to announce their discovery, not in the normal
        scientific way by publication in a journal (such as NATURE), but
        directly to the press. Few details emerged at first, although it
        appeared that their technique depended on passing an electric
        current through heavy water (water containing deuterium, a heavy
        isotope of hydrogen) between palladium electrodes. This process,
        they said, produced a huge amount of heat, which could not have
        come from any electrochemical reaction but must be due to the
        fusion of deuterium nuclei.
             Immediately governments and scientists throughout the world
        began to try to reproduce the phenomenon. Meanwhile the State of
        Utah voted five million dollars for further research into cold
        fusion and a National Cold Fusion Institute was established in
        Salt Lake City.
             Many scientists were sceptical, however, and bitter
        controversy ensued, with claims and counterclaims; there were
        allegations of fraud and of suppression of scientific evidence.
        The scientific paper that Pons and Fleischmann eventually
        published did not answer all the questions people were asking,
        and scientists who tried to reach them by telephone were
        generally unsuccessful. Most mainstream scientists, having failed
        to confirm the existence of cold fusion, gave up and returned to
        their regular work.
             This side of the story has been presented recently by Frank
        Close, a nuclear physicist, writing in NEW SCIENTIST (19th
        January 1991). However, the same issue of the magazine contains
        another article, by John Bockris, who is a distinguished
        professor of chemistry at Texas A & M University. Unlike Close,
        Bockris believes that Pons and Fleischmann had discovered
        something important. 'There is already enough evidence... to
        dismiss the widely held view that the original claims had no
        value. [A remarkable use of double negatives to express a
        contentious idea with the maximum of scientific caution!] It
        seems now established that nuclear particles are, under some
        circumstances, produced in bursts at electrodes in the cold. As
        to the heat, there is no proof that it originates in a nuclear
        process, though when it coincides with nuclear emissions it is
        difficult to think that it does not.'
             This conclusion is not based merely on an examination of the
        claims of Pons and Fleischmann. Confirmation has been reported at
        a number of centres, including Bockris's own laboratories. It
        seems, therefore, that the matter still is not finally settled.
             There are distinct similarities between this extraordinary
        affair and the Benveniste controversy. Like the high dilution
        effect, cold fusion poses a challenge to accepted ideas of what
        is and is not possible according to established scientific
        principles. In both cases there has been what NEW SCIENTIST
        rightly calls a lack of mutual respect between scientists working
        in different disciplines. 'The chemists failed to consult nuclear
        physicists before making their claims, treating the nuclear
        evidence for fusion with extraordinary carelessness. Physicists
        adopted a dismissive, arrogant attitude to those some described
        as "mere chemists", without appraising the possible significance
        of the electrochemistry behind the reaction. The sneers that have
        accompanied claims and counterclaims in both camps are a poignant
        reminder of the fragmented specialism and tunnel vision that dogs
        much research today.'

             In spite of the enormous importance that cold fusion, if it
        exists, would have for the world, there is still no agreement
        about whether it is a mare's nest or not. Millions of dollars
        have already been devoted to research, it has attracted some of
        the best scientific minds in the world, and still we don't know
        what to believe. If this is the case with cold fusion, what
        likelihood is there that early clarification will be forthcoming
        in the question of high dilution, whose potential importance is
        comparatively so minor?
             There is a widespread belief that scientists are objective
        observers, who weigh up the evidence for and against hypotheses
        dispassionately and then come to conclusions that are based on
        facts and facts alone. Even a limited personal acquaintance with
        real live scientists, however, or an exploration of the history
        of scientific ideas, will show that this idea does not correspond
        very closely with what is found in practice. One may have
        reservations about some of the arguments put forward by Thomas
        Kuhn in THE STRUCTURE OF SCIENTIFIC REVOLUTIONS, but it is
        difficult not to agree that there is a fair amount of truth his
        central thesis, which is that scientists, on the whole, don't
        change their minds; changes in science occur as old men die off
        and are replaced by younger ones with different outlooks. There
        is, Kuhn seems to imply, a considerable element of fashion in
        science, although Kuhn prefers to speak, more formally, of
        paradigm shifts.
             If Kuhn's view of how science develops is even approximately
        right, it is still more true of medicine.  Medicine is based on
        science but can never be wholly scientific, for much the same
        reason that politics cannot be scientific: medicine and politics
        both deal with people, and people's behaviour cannot be analysed
        with the rigour demanded by science. Doctors, whether they like
        it or not, are constantly having to make up their minds about
        diagnosis, prognosis, and treatment on the basis of inadequate
        evidence. The results of investigations in individual cases, no
        matter how sophisticated, are often inconclusive; it is notorious
        that when postmortems to establish the cause of death are carried
        out (this happens much less frequently now than twenty or thirty
        years ago) there are liable to be some red faces among the
        doctors looking on, even at the most renowned medical centres.
             It is probably because of this inevitable degree of
        uncertainty in medicine that doctors who come on training courses
        to learn acupuncture or homoeopathy often seem less interested
        than might be expected in research in these subjects. It may well
        be that we are currently experiencing a paradigm shift in
        medicine, as younger doctors, especially younger general
        practitioners (hospital doctors seem more resistant),
        increasingly accept the validity of using alternative methods
        such as homoeopathy, acupuncture, and manipulation. (As I write
        this, membership of the British Medical Acupuncture Society,
        which was founded only a few years ago, has passed the 1,000 mark
        and is still rising fast.) Not long ago the British Medical
        Association set up a working party to study alternative medicine.
        Its conclusions, as might have been predicted, were largely
        negative and hostile; but, as also might have been predicted, the
        BMA is already beginning to look like King Canute and there are
        signs that it will shortly modify its stance.











                     7: PLACEBOS AND PSYCHOTHERAPY

             Whenever a television programme about alternative medicine
        is broadcast the result is a sudden, sometimes overwhelming,
        influx of would-be patients at the homoeopathic hospitals. By no
        means all of these people, unfortunately, are suitable for
        treatment, and this can create difficult problems.
             Many alternative practitioners might say that there are no
        patients who are unsuitable for treatment. And in a way this is
        true, at least as regards medical treatments such as homoeopathy.
        (Acupuncture is rather different, for even in ancient China it
        was never regarded as the only or even the main form of
        treatment; many more texts deal with herbal medicine than with
        acupuncture.) However, suitability for treatment is one thing and
        prospects for success are another.
             Here, for example, is a list of some of the kinds of
        problems brought to the hospital in a month: spondylosis,
        trigeminal neuralgia, rheumatoid arthritis, motor neurone
        disease, osteoarthritis, migraine, irritable bowel syndrome,
        hypertension, frozen shoulder, Parkinson's disease, intermittent
        claudication, sinusitis, peripheral neuritis, peptic ulcer,
        depression, tinnitus, rhinitis, epilepsy, unstable bladder,
        rosacea, eczema, psoriasis, otitis externa, asthma, multiple
        sclerosis, ulcerative colitis, piles, carpal tunnel syndrome,
        recurrent urticaria, psychosexual problems... and, of course,
        undiagnosed aches and pains and other obscure symptoms that no
        one has managed to explain. How many of these are suitable for
        alternative, or complementary, treatment?

             Homoeopathic prescribing is based mainly on the symptoms
        that patients describe, and in theory at least takes little or no
        account of the orthodox medical diagnosis. It should therefore in
        principle be possible to match a patient's symptoms to those of
        some homoeopathic medicine or other and so find something to
        prescribe. And so it is, as a rule; but unfortunately this does
        not necessarily produce an improvement. Of course, it may do so,
        and every experienced homoeopathic prescriber can point to
        instances in which a seemingly hopeless illness has improved
        dramatically following a homoeopathic prescription. But what
        about the cases where it does not?
             For the dyed-in-the wool enthusiast there is no real problem
        here. He has immersed himself completely in a belief system, and
        can always explain failures away in one way or another. If the
        treatment has not worked in any individual case it must be
        because it has not been applied properly. This was Hahnemann's
        position.
             Those who are less firmly committed to a principle have to
        find another approach. There are several groups of patients for
        whom this may be necessary.
             Some people who come are suffering from serious, perhaps
        fatal, diseases: not cancer, necessarily, though that is probably
        what comes first to mind; there are plenty of other equally
        unpleasant possibilities.
             There are other patients with long-standing disorders that
        are not fatal but for which there is no effective orthodox
        treatment (tinnitus, Parkinson's disease). Or perhaps there is
        reasonably effective orthodox treatment (asthma, high blood
        pressure) but the patient wants a total cure, a complete freedom
        from the need to take any kind of medication.
             And then there are those who arrive saying: "Doctor, you're
        my last hope." Many of these 'last hopers' have complex
        psychological problems, which they insist are physical, and which
        have taken them from specialist to specialist over months or
        years. Commonly they arrive accompanied by a long-suffering,
        over-solicitous spouse, who interjects remarks into what is
        clearly by now a well-rehearsed descriptive routine. In extreme
        cases such people may become therapeutic black holes, insatiably
        sucking in therapists, investigations, and treatments. Like black
        holes they can be destructive and dangerous; it is not uncommon
        to find that they have already become involved in sagas of
        complaint or even litigation against former 'last hopes'.
             Any doctor will see a number of such patients like this in
        the course of a year. Orthodox critics of alternative medicine
        tend to think that the whole clientele of alternative
        practitioners is made up of such patients, but fortunately that
        is not the case; however, it is true that patients of this kind
        tend to gravitate towards alternative medicine.
             To say that none of the patients in these 'difficult'
        categories can be helped by alternative, or complementary,
        methods would be too sweepingly pessimistic. Some can; there are
        many surprises. And even if nothing can be done, at least it is
        possible to offer a little kindness and attention. Inevitably,
        however, any doctor who is self-critical about what he is doing
        is bound to recognize that in many of these cases any treatment
        he gives is likely to have a placebo effect only.

             For the critic of alternative medicine, of course, it is all
        placebo. The clinical trials I discussed earlier have been
        conducted to try to defuse this criticism, but there is another
        way of responding to it which is favoured by some of the younger
        and more self-confident medical practitioners of complementary
        medicine. Instead of desperately trying to prove that none of
        their cures are due to placebo, they want to turn the tables on
        their critics by invoking what they have called an 'enhanced
        placebo effect'. I find this an interesting concept, and up to a
        point a persuasive one.

        THE ENHANCED PLACEBO RESPONSE.
             The  placebo effect is a great deal more important and more
        interesting than many people realize. It is generally said that,
        in clinical research, one should expect a response to placebo in
        about 30 per cent of the patients. Such responses are believed to
        be fairly brief  -  about six weeks as a rule. However, it seems
        that if you attempt to increase the placebo effect as much as
        possible, by using the strongest possible suggestion, the
        response rate can be much greater  -  as high as 80 per cent in
        some studies. Richard Asher reports an experiment he carried out
        in which more than 90 per cent of the group got some relief of
        pain from a dummy pill and more than 50 per cent had complete
        relief.
             The duration of relief from placebo may also be much greater
        than is usually believed: several months in some studies. There
        are other surprises in store as well. 'Organic' symptoms respond
        to placebo just as well as psychological ones, perhaps even
        better. Most doctors tend to assume, rather patronizingly, that
        placebo responders are likely to be somewhat inadequate,
        uncritical, 'suggestible', individuals. But not so. There seems
        to be nothing that distinguishes the placebo responder from you
        and me. In fact, there probably is no such person as a 'placebo
        responder' at all, for if you repeat your study later with the
        same group of subjects, you find that the people who show a
        response to placebo the second time round are not necessarily the
        same as those who responded the first time.

             Perhaps the most surprising thing of all is that even belief
        in the placebo may not be necessary. In one study in America the
        patients were told that they were being given sugar pills,
        without any medication, which would have no effect on their
        illness at all. In spite of this, quite a number of them had a
        good response to the 'treatment'. Admittedly, this is only one
        study, which has not been repeated; but it prompts some
        interesting reflections.
             Not long ago a study of the effectiveness of suggestion in
        general practice was carried out in Southampton. Patients
        suffering from not very serious illnesses that would be expected
        to clear up spontaneously in a few days were interviewed in one
        of two ways. For one group the doctor was non-committal and
        simply asked the patient to return in a few days to report
        progress; in the other group the patients were told firmly that
        they would soon be better and there was nothing to worry about.
        It was found that those who were given reassurance about their
        condition recovered, on average, significantly faster than those
        who were treated neutrally.
             To use positive suggestion in this way is surely legitimate
        and acceptable. But is it right to go considerably further?
             It is often said, with some justification, that the methods
        of alternative medicine are such as to maximize the effects of
        suggestion. For the most part alternative medicine is private
        medicine, and there is some evidence that patients who pay for
        their treatment fare better than those who don't. The patients
        get individual attention from the therapist, with whom they are
        able to build up a personal relationship. The techniques used are
        often impressive, nearly always involving elaborate diagnostic
        rituals which are sometimes supplemented by impressive-looking
        pieces of apparatus. Above all, the patient (often) and the
        therapist (nearly always) believe strongly in the efficacy of the
        therapy being used.

             Advocates of the enhanced placebo response hold that it is
        right to seek to increase the placebo element deliberately as
        much as possible  -  and probably give it a different name, so as
        to avoid the adverse association that 'placebo' carries with it.
        In this way, they say, one augments whatever direct benefit may
        be produced by the therapy itself in its own right. And they see
        this as perfectly legitimate; after all, the aim is to help the
        patient, and if suggestion can play a part in this, why not?
             I can certainly see the logic of this argument, but there
        are two aspects of it that bother me. The first is that, if you
        deliberately set out to convey more belief and confidence than
        you feel, you are deceiving the patient and, possibly, yourself.
        There may well be occasions when this is justifiable, but to make
        it into a general rule seems to be a rather dubious policy. For
        some therapists, in fact, it may be psychologically difficult or
        impossible.
             Probably the most dramatic example of the use of therapeutic
        suggestion on a large scale in the history of Western medicine is
        that of Anton Mesmer.  Mesmer used every device imaginable to
        maximize suggestion and produce his cures. But he did not himself
        think that his cures were merely the result of suggestion; on the
        contrary, he believed strongly in his theory of 'animal
        magnetism' as the explanation. Indeed, much of his life's work
        was devoted to trying to get this idea accepted by the orthodox
        medical authorities of his day.
             The moral of this is that you are unlikely to have much
        success with your enhanced placebo effect unless you believe
        strongly in your treatment yourself. Of course there are examples
        to the contrary  -  charlatans who have successfully duped the
        public without having any belief in what they were doing  -  but
        they are the exception rather than the rule.
             A second difficulty with the enhanced placebo idea is that
        it is condescending and 'paternalistic', in the pejorative sense
        of the word. It puts the therapist, by implication, on a
        different level from the patient. This is, or should be, contrary
        to the spirit of complementary medicine, which usually claims to
        think of patient and therapist as involved in a joint venture
        together.
             My own feeling is that whenever possible it is best for the
        doctor or therapist to tell the patient the truth as he sees it.
        I certainly accept that there will be many cases in which this is
        impracticable or undesirable. 'Humankind cannot bear very much
        reality.' However, not to be truthful in cases where it is
        possible to be so is somewhat condescending.
             Certainly it is always right to be as optimistic as possible
        in every case. After all, none of us knows the future, and we all
        see instances in which even the most hopeless-seeming problem
        turns out very well. Nevertheless it is right to be as honest
        with patients as circumstances allow, and to give them, in
        general, a frank account at the outset of what one expects that
        treatment can, and cannot, achieve for them.

             There is another aspect of the placebo response that needs
        to be kept in mind. Neutral treatments such as inert tablets can
        do harm as well as good. (This is sometimes called the 'nocebo'
        effect.) A remarkable example of this occurred in the course of a
        modern homoeopathic 'proving' carried out a few years ago in the
        north of England.
             A proving is an experiment made to ascertain the effects of
        a homoeopathic medicine on healthy people, according to the
        principle enunciated by Hahnemann. In this case the medicine in
        question was one commonly used in homoeopathy, called Pulsatilla.
        It was given in the '3x potency', which meant that there was a
        certain amount of the medicine present in the tablets, although
        not very much. (This was the lowest dilution which could be used
        without giving the game away by differences in appearance and
        taste between medicine and placebo.)
             The study was carried out on volunteers in the north-west of
        England; most were members of a large philosophical society. It
        was planned to last for three months, with the volunteers taking
        one tablet twice daily and recording their symptoms in a diary.
        During the first month all the 'provers' received a dummy tablet;
        they did not know this, although the doctor who was conducting
        the trial did. In the second month half the provers received
        Pulsatilla and half dummy tablets, and in the third month those
        who had received Pulsatilla previously now received the dummy
        tablet and vice versa. In the second and third months neither the
        doctor nor the provers knew which group was receiving Pulsatilla,
        and indeed at this time the provers did not even know that it was
        Pulsatilla that had been chosen for the trial.
             The results were very interesting. Thirty of the 52
        participants returned their diary sheets filled in to some
        extent, although only 18 completed the whole three months. When
        the diaries were analysed no evidence emerged to show that
        Pulsatilla had produced any more symptoms than the dummy tablet.
        What was very striking, however, was the fact that much the
        largest number of symptoms occurred during the first month; that
        is, at the time when all the volunteers were taking dummy
        tablets. The incidence of symptoms declined progressively over
        the whole three-month period, regardless of whether the
        participants were taking Pulsatilla or dummy tablets. Several of
        the provers experienced such severe symptoms while taking the
        dummy tablets that they had to withdraw from the trial.

             This experiment does not necessarily show that Pulsatilla is
        incapable of causing any symptoms, but it does indicate that, at
        least in these circumstances, any symptoms it did provoke were
        completely swamped by those due to self-suggestion. It also
        confirms the remarkable efficacy of self-suggestion as a cause of
        severe symptoms.
             Many years ago I had an experience which reflects this. A
        patient holding an academic appointment came to see me at the
        hospital. I had the impression that she might easily produce
        symptoms through self-suggestion, so I cautiously gave her an
        inert sugar tablet to start with. Sure enough, a few days later I
        received an outraged letter from her, demanding to know what this
        highly dangerous substance was which I had given her; she said it
        had caused an acute psychotic reaction and her professor was very
        worried about her. I wrote back saying that I was sorry to hear
        this but did not think there was any way that the tablet could
        have caused her symptoms, since it was only milk sugar. No
        further correspondence ensued between us.
             Many homoeopaths believe, following Hahnemann's dictum, that
        homoeopathic medicines frequently give rise to 'aggravations';
        that is, to temporary worsening of the patient's symptoms. One of
        the best-known of the nineteenth-century English homoeopaths,
        Robert Dudgeon, was sceptical about this, saying that
        aggravations are much rarer than Hahnemann supposed, and I
        entirely agree with this. If you tell patients firmly that there
        will be no adverse effects from their medicine you hardly ever
        see 'aggravations'. If, on the other hand, you tell patients that
        aggravations are likely you will certainly see plenty.

        Alternative medicine as psychotherapy.
             Although I have reservations about the idea of the enhanced
        placebo, I certainly do accept that much of what any alternative
        therapist does is, in the broadest sense of the word,
        psychotherapy.
             Many practitioners of alternative medicine resist the notion
        that psychotherapy plays any part in what they practise. Up to a
        point this is understandable, since the notion that alternative
        medicine is partly psychotherapy can too easily be used by
        critics as an excuse to dismiss the whole thing; but as there is
        now a fair amount of evidence to show that at least some of the
        alternative therapies do have effects over and above what is
        attributable to psychological factors there is no real need to be
        so defensive.

             In everyday clinical practice, as opposed to the rather
        artificial setting of a scientific clinical trial, the
        alternative therapist is constantly dealing with psychological
        problems, either on their own or as part of a more comprehensive
        clinical picture. Whether he likes it or not, therefore, and
        whether he calls it that or not, a great deal of his work is
        psychotherapy. Very many patients suffer from symptoms that are
        due wholly or partly to psychological factors. One example of
        this among scores of others remains in my memory.
             A middle-aged woman was thought to be suffering from
        multiple sclerosis. Her symptoms were typical of this disease,
        although there was always a little residue of doubt about the
        diagnosis, partly because she had had a test by a neurologist
        which had not confirmed it. (This test, known as the visual
        evoked response, is not conclusive proof either way, but a
        negative outcome does make the diagnosis less likely.) After some
        time it emerged that there was a definite psychological factor in
        this patient's case; she was unhappily married, and although she
        was separated from her husband he still used to beat her on
        occasion.
             Some years went by, during which she continued to attend the
        hospital without any great change in her condition. Then she
        divorced her husband and made a second marriage, which was happy.
        As soon as she did this all the symptoms of her multiple
        sclerosis disappeared.
             Less clear-cut examples of psychologically caused illness
        are extremely common. This, of course, is fully recognized by
        orthodox medicine, and almost every doctor in clinical practice
        -  every general practitioner, certainly  -  sees numerous
        examples. In some cases it is possible to put a formal
        psychiatric label on the patients in question but often it is
        not.
             Although orthodox doctors vary in their attitudes much more
        than most alternative therapists would allow, it is fair to say,
        as a generalization, that they tend to look for a pharmacological
        solution for mild or moderately severe psychological symptoms. In
        a busy general practice there simply is no time to practise very
        much psychotherapy even if the doctor's interests lie in that
        direction, and although psychotherapy is available in National
        Health Service psychiatric hospitals there are far more patients
        than these units can cope with. In consequence, doctors often
        take what seems the easiest way out, which is to prescribe a so-
        called minor tranquillizer or a 'sleeping tablet'. Although this
        practice has been discouraged in recent years there still are
        many thousands of patients who have become dependent on these
        drugs.

             Alternative therapists, naturally, are critical of the
        orthodox approach to psychological problems, and not simply
        because it relies predominantly on drugs. They object to the
        whole series of assumptions on which this treatment is based.
             We touch here on what is probably the core of the difference
        between the alternative and orthodox approaches. The assumption
        that underlies much of mainstream psychiatry today is that
        psychiatry should, ideally, be reducible to neurology. Admittedly
        we are not at that stage yet, and perhaps never will be, but many
        psychiatrists write and talk as if this is what they believe;
        sometimes it is explicitly stated. Much modern theorizing about
        depression, mania, and schizophrenia, for example, proceeds on
        the assumption that an explanation in terms of brain chemistry or
        structure will eventually be found. Biochemical hypotheses are
        put forward to account for the ways in which the drugs used to
        treat these mental disorders are supposed to work. The resulting
        picture is of the human being as a mechanism  -  enormously
        complicated, it is true, but a mechanism none the less.
             The model that is assumed in much of this discussion is that
        of the computer. Mostly it is the hardware  -  the nerve cells or
        the chemical composition of the fluids in which they live  -
        that is supposed to be at fault; and even when more
        'psychological' factors are admitted to be part of the equation
        they often seem to be thought of as faults in the programme, the
        software.
             The view of the alternative therapists, I need hardly say,
        is diametrically opposed to these ideas in almost every respect.
        The central claim of pretty well all the various alternative
        therapies is that they reject the materialistic outlook. We quite
        often find it stated that human beings are composed of body,
        mind, and spirit. Alternative treatments are supposed to act on
        all these levels simultaneously, whereas orthodox medicine, in
        contrast, only recognizes the first level, the physical, and even
        then its outlook is thought to be pretty blinkered. This is
        partly true of even the more physical forms of treatment, but it
        becomes increasingly evident as we move towards the more overtly
        psychotherapeutic end of the spectrum (Chapter 2, p.00).

             If you ask for a clearer statement of what is meant by mind
        and spirit in this context and how they differ from each other
        you are unlikely to get a definite answer, except in the case of
        those few systems, such as Anthroposophical medicine, which are
        explicitly based on an elaborate philosophical theory. This is
        hardly surprising, since few alternative therapists, after all,
        are philosophers, but it does result in a certain haziness of
        thought and language. Nevertheless the concept of a 'spiritual
        dimension' underlies a great deal of the discussion of
        alternative medicine. In a recent review of some aspects of
        complementary medicine, Lorraine Nanke and David Canter quote an
        earlier finding that 'nearly half of the holistic practitioners
        replied that religious and spiritual experiences were important
        in shaping their views about health, illness and healing, in
        contrast to 13 per cent of family practitioners.' [Complementary
        Medical Research, 1991, 5, 1 - 6]
             It is of course perfectly true that many, perhaps most,
        patients who seek alternative treatment have no definite
        theoretical stance on the question. Nevertheless many forms of
        alternative medicine do have these 'spiritual' aspects if one
        looks for them. This emerges most clearly in the case of
        homoeopathy.
             Samuel Hahnemann, the founder of homoeopathy, was not a
        mystic, but in his later years he did incorporate certain ideas
        into homoeopathy (especially the potency theory and the notion of
        the vital force) that verged on the metaphysical, and were so
        regarded by his contemporaries. In the second half of the
        nineteenth century a number of North American homoeopaths,
        including some of the most respected and influential among them,
        became ardent disciples of the seventeenth century philosopher
        and mystic Emanuel Swedenborg. Swedenborg's teachings, which
        derived from his accounts of contacts with spirits, gave a new
        and distinct character to American homoeopathy, and in the early
        twentieth century these ideas crossed the Atlantic to Britain,
        where they took root strongly and largely transformed the native
        school of homeopathy. (I have related this story in my book THE
        TWO FACES OF HOMOEOPATHY.)
             Homoeopathy is certainly not unique among alternative
        medical systems in possessing this semi-mystical element.
        Anthroposophical medicine, for example, was invented in the early
        twentieth century by the Austrian philosopher and mystic Rudolf
        Steiner, and incorporates numerous mystical ideas derived in part
        from Paracelsus and Goethe. (Anthroposophical medicine has
        something in common with homoeopathy but uses different medicines
        prescribed in different ways.) Traditional Chinese acupuncture,
        although not a mystical form of treatment in China itself, often
        seems to appeal to Westerners sympathetic to ideas of that kind.
             Then there is a large number of alternative psychotherapies
        that possess a 'spiritual' dimension. Some, such as Silva Mind
        Control, are frankly concerned with the attempt to enhance
        people's paranormal abilities. Others make use of astrology or of
        memories supposed to be derived from previous lives. Nor is it
        only the 'far out' therapies that show these characteristics.
        Even Freud, who was in many ways the perfect example of a 'left-
        column' thinker, toyed with the paranormal, and his pupil Jung
        was still more receptive to these ideas.
             At the furthest edge, so to speak, alternative therapies
        shade imperceptibly into other things such as meditation, methods
        of self-development, paranormal healing and forms of prayer. At
        this point alternative medicine begins to blend with New Age
        thought. Although not everyone who uses alternative medicine is
        necessarily much concerned with ideas of a New Age, many are, and
        the converse is certainly true; there can hardly be anyone who
        believes in New Age concepts who is not also firmly committed to
        alternative medicine, as either a patient or a practitioner. In a
        recent television programme on the New Age at least half the
        members of the invited audience who spoke identified themselves
        as therapists of one kind or another.
             In appearance, the New Age movement originated with the
        hippie movement in the 1960s, but it can be traced much further
        back than that; William James describes what is essentially the
        same phenomenon at the end of the nineteenth century in America,
        while Norman Cohn has given us a brilliant analysis of similar
        ways of thinking in the millenarian movements of the Middle Ages.
        There is indeed something strongly archetypal about it, so that
        it keeps on cropping up again and again in history.
             It was, for example, particularly evident among the American
        homoeopaths in the nineteenth century. They believed that
        homoeopathy would eradicate the deeply rooted 'miasms' that were
        poisoning human existence and were being transmitted from one
        generation to the next; and this happy development, they
        supposed, would not merely eliminate chronic disease but would
        bring about a complete transformation in social conditions.
        Similar ideas are still held today by some influential lay
        homoeopaths.







        8: THE NEW AGE

             To discuss in detail all the causes for the rise of New Age
        thought would take me too far from my theme. Several obvious ones
        present themselves. War, famine, pollution, over-population, and
        disease seem to crowd in upon us more and more as the twentieth
        century draws to its close, and one would have to be stoical
        indeed not to feel at least apprehensive about the future.
             Then there is the dissatisfaction with science that I noted
        at the beginning of this book. Even as recently as fifty years
        ago, science seemed to most people to be benevolent; far fewer of
        us would assert that so confidently today. There is a feeling
        abroad that we have been too hubristic, too clever for our own
        good, and are beginning to reap the consequences.
             In addition to these causes for anxiety a growing number of
        people, especially among those sympathetic to alternative
        medicine, are taking seriously ideas that would thirty or forty
        years ago have seemed like the rankest superstition. The
        prophecies of Nostradamus are wheeled out and apparent
        fulfilments of them are discerned. Biblical fundamentalists,
        especially in America, see prophecies of doom in various parts of
        Scripture: in the Apocalypse (Book of Revelation) ascribed to St
        John, naturally, but also in a number of books of the Old
        Testament. Astrology, though often declared dead, refuses to die;
        and astrologers are convinced that the end of the second
        millennium, coinciding as it does with the transition from the
        Age of Pisces to the Age of Aquarius, must be accompanied by
        dramatic changes in human fortunes.
             So much is more or less self-evident. But why the close
        connection with alternative therapy?

             So far we have been looking at alternative medicine almost
        entirely as something that affects just the individual. It does,
        however, also have what might be called its public health
        persona. For rather in the way that conventional medicine can be
        thought of as linked with social measures to improve people's
        lives (better housing, clean water, healthier food), alternative
        medicine could be thought of as being concerned with the
        spiritual as well as the material health of society and the
        planet itself. And rather as on the individual level  our
        symptoms are said to be a sign that the body is seeking to heal
        itself and are thus in some sense to be welcomed, so too on the
        planetary level all is going to be well. Yes, we are in for a
        period of tremendous turmoil and upheaval, but at the end of our
        journey through the valley of despair we can expect to emerge
        into the broad sunny uplands of a new Eden.
             The close connection between New Age thinking and
        alternative medicine is well exemplified by Transcendental
        Meditation (TM). This technique was brought to the West in the
        1950s by an Indian teacher, the Maharishi Mahesh Yogi. The
        special features of TM, according to its founder, were that it
        was easy to learn and did not require any commitment to strange
        dress or postures or the adoption of a new way of life. It was
        simply a technique, and could be learned by anyone without the
        need to take on a belief system. At the same time  -  and this
        was part of its appeal for many people  -  it did stem from an
        ancient Indian tradition; it had an authentic background.
             Maharishi was said to have been the closest disciple of a
        renowned Indian teacher, Swami Brahmananda Saraswati, the
        Shankaracharya of Jyotir Math in the foothills of the Himalayas.
        (Shankaracharya is a title; four maths, or monastic seats of
        learning, were founded in different parts of India, probably
        about 800 AD, by the original Shankaracharya, the most renowned
        philosopher of the Advaita Vedanta school of Indian philosophy.)
             It was from his master that Maharishi obtained the system of
        meditation he later taught. After his master's death in 1953
        Maharishi remained for some time in seclusion but then begun to
        teach; at first only in India, but later in countries throughout
        the world, including the USA and Britain.
             Initially his success was reasonable but not dramatic. In
        1967, however, TM was taken up by the Beatles, and this certainly
        brought it decisively to public attention. Maharishi was
        interviewed on television by Malcolm Muggeridge and David Frost,
        and articles appeared in almost every newspaper and in numerous
        magazines. The Beatles went to India with Maharishi, and although
        their involvement with TM was fairly short-lived the impetus they
        gave to his movement was great enough to keep it in the public
        eye long after their departure.


        TRANSCENDENTAL MEDITATION AS A MEANS TO HEALTH
             Transcendental meditation (TM) is at bottom a spiritual
        technique, but it has always been described as having many
        beneficial effects not only on psychological functioning but also
        on physical and mental health. Among the benefits listed in a
        current TM brochure we find:

                   -  Increased mental clarity, alertness and creativity.
                   -  Increased self-esteem, well-being, and vitality.
                   -  Reductions in stress, anxiety and depression.
                   -  Improved immunity and resistance to disease.
                   -  Improved sleep patterns.
                   -  Better relationships at home and work.

             The basis for these effects is the state of deep rest
        provided by TM. 'During TM, the mind experiences its quietest,
        most settled state, while alertness is fully maintained: a state
        best described as "restful alertness" or "pure consciousness".
        Research has shown that TM gives rise to a unique state of deep
        rest, accompanied by a high degree of integration in brain
        functioning. This profound state of rest allows the body to throw
        off deeply rooted stresses that are not removed by ordinary
        relaxation or sleep.' [TM brochure]
             These claims are supported by a large number of scientific
        studies  -  more than 350, we are told. In one of these, a group
        of more than 2,000 TM practitioners followed up for five years
        was found to need only half the number of doctors' visits and
        hospital admissions recorded for a comparable control group;
        heart disease and nervous system disorders were particularly
        infrequent, and so were tumours.
             TM is said to help in a wide range of physical illnesses,
        including asthma, hypertension, angina, multiple sclerosis, and
        ME. It also has an important part to play in prevention: it
        reduces all the major risk factors for heart disease, increases
        resistance to stress and 'promotes positive health habits'. A
        three-year survey of psychiatric hospital admissions in Sweden
        showed that there was much less need for psychiatric care among
        people practising TM.

             One of the chief attractions of TM has always been the ease
        with which it is learnt and practised. It is described as 'a
        simple, natural and effortless technique practised for 15 - 20
        minutes each morning and evening, sitting comfortably with eyes
        closed. This technique can be easily learned by anyone,
        regardless of age, educational background, culture or religious
        belief, and requires no change of life-style or diet.'
             While this is perfectly true, it is also the case that TM is
        not just a technique. Like its founder, it is rooted in the
        Indian tradition, and has an elaborate philosophical basis.
        However, it is quite possible to meditate for years without
        troubling oneself about this aspect.
             In 1985 Maharishi set up a centre in New Delhi to study
        Ayurveda, the ancient traditional form of Indian medicine. This
        led to the development of 'Maharishi Ayurveda', which is
        Maharishi's version of the ancient system, incorporating TM.
             The basis of Maharishi Ayurveda is said to be the
        establishment of balance within a person's mind and body, which
        will then relieve stress and tension. TM is the main technique
        for achieving this, but now it is supplemented by a variety of
        means, including diet, exercises, breathing methods, and herbal
        preparations. Claims are made for the alleviation of many
        diseases, including Aids, and there is even a report that this
        treatment can reverse some of the effects of normal ageing.
             Public health is not neglected either. It has long been a TM
        claim that there are beneficial effects on society at large  -
        the 'Maharishi effect'  -  including decreases in the incidence
        of diseases, hospital admissions, suicides, accidents, crime, and
        even reductions in national and international conflicts. Once
        again, these claims are supported by numerous sociological
        studies.
             I first came into contact with TM shortly before the Beatles
        arrived on the scene, and I used the technique for many years. I
        thought then, and I still think, that it is a Good Thing. Whether
        or not all the claims made for it can be substantiated is another
        question and I have no first-hand experience of the recent
        Ayurvedic aspect. But that the practice of TM does reduce one's
        vulnerability to stress I have no doubt. The main effect seems to
        be that after a year or two of meditation strong outside stimuli,
        whether pleasant or unpleasant, tend to 'damp out' more quickly
        than before; they push one off balance less than they used to do.
        This may seem a fairly modest claim, but I think it is a genuine
        and valuable effect which is not the result of suggestion.
             In the late 1960s and early 1970s I attended a number of the
        large international TM gatherings, or 'courses', as they were
        known, which were held in various parts of the world. Numerous
        young Americans used to attend these courses, and most of them
        had absorbed the hippie values of the Sixties, which seemed to
        blend easily with TM.
             There was a good deal of talk of 'negativity' and
        'positivity'. To have serious doubts about TM would certainly be
        'negative', but it was also 'negative' to think or talk much
        about illness, death, war, famine, over-population, or any of the
        other individual or collective threats we might feel exposed to.
        Instead we were supposed to concentrate on the beneficial effects
        of TM. If the meditation were only practised widely enough all
        these problems would be solved. There was no need to go into the
        details of how this would come about, but everything would be
        taken care of automatically, thanks to the increased creativity
        of meditators on the one hand and the beneficial effects of TM on
        society at large on the other.
             Maharishi himself appeared to believe this, at least in
        public. He gave talks to large audiences in which he announced
        the arrival of a Golden Age of Enlightenment  -  literally
        golden, for all the literature of the TM movement was now
        embellished by having the titles picked out in gold lettering. In
        private, too, he was generally up-beat, although he continued to
        emphasize the need to hurry to get people to start meditating in
        order to counteract the harmful stresses of modern life, which he
        blamed for such things as civil disorder and war.
             This insistence on positivity and optimism, and on the
        dawning of an Age of Enlightenment, fitted in very well with the
        ideas of the alternative health movement, which was just
        beginning to take off at the end of the 1970s.
             The problem which quite a few of us found with all this
        hyperbole was that it overstated what was actually quite a good
        case to be made out for TM. Meditation done in the TM way really
        did help many people to cope with the effects of psychological
        tension and there were few serious adverse effects. Severely
        disturbed individuals could certainly react badly to TM, but the
        initial screening procedure was reasonably successful in
        detecting such vulnerable people, who were regarded as unsuitable
        for TM. (Some of them could however be given a different, less
        far-reaching, practice to help them.)
             The main weakness of TM  was the fact that it was
        stereotyped. This is a relative criticism only, for if you are
        going to offer a form of meditation to many thousands or even,
        ideally, millions of people, which is what Maharishi intended, it
        clearly has to be done in a standarized manner. But this did
        inevitably mean that meditators who came across difficulties of
        various kinds had no easy way of resolving them within the TM
        framework. Some people, for example, experienced personal
        disasters of various kinds which they had been led to believe
        should not have happened to them. (Not that it was ever stated
        that meditators should not expect to have accidents or become
        ill, but the implication that such things ought to become less
        likely was there.) Others were sufferers from mild or moderate
        anxiety, depression, or other psychological symptoms which were
        not severe enough to exclude them from TM but were nevertheless
        distressing.
             Meditators who encountered problems of this kind naturally
        tended to approach their teacher of meditation or one of the
        other meditation guides specially trained to monitor the progress
        of TM, but all these people were supposed to confine themselves
        to the meditation itself, not to offer advice on meditators'
        lifestyles or to diagnose their physical and mental ills. This
        was a perfectly reasonable rule, given that few of the meditation
        teachers or their assistants were professionally qualified to
        give advice of that kind. Nevertheless there were inevitably a
        considerable number of meditators who had need of something of
        the sort in addition to the meditation itself.
             Another kind of difficulty arose when people reported
        strange, sometimes very powerful, experiences during meditation.
        The policy was to play these down and not to attach much
        importance to them, which again was sensible, given the large
        numbers of meditators. But not everyone found this satisfactory;
        some wanted to know what the experiences meant, and these people
        required individual attention; it wasn't enough to give them
        stock answers.
             In the end I found the grandiose claims increasingly being
        made on behalf of TM impossible to go along with. This tended to
        induce a mood of disillusionment; Louis Macneice's line often ran
        through my mind: "It's no go the yogi man, it's no go Blavatsky."
        Yet it was necessary to remember that TM did, in a sense, appear
        to work; it was not all a waste of time, and I still felt I had
        gained a great deal from it, if not perhaps as much as I had been
        promised. Which brings us back to the theme I hinted at in the
        Introduction: the difficulty of keeping a balance between
        credulousness and cynicism.
             TM is not without parallels; there have been a number of
        rather similar movements over the last 20 years, but I have
        singled out TM partly because of my first-hand experience of it
        but also because it includes pretty well all the components of
        the New Age: the quest for individual spirituality, alternative
        medicine, and the promise of collective transformation leading to
        the dawning of an Age of Enlightenment. It exemplifies rather
        well both the attractions and the drawbacks that characterize New
        Age movements in general.






                    9: TRYING TO MAKE SENSE OF IT ALL

             At the beginning of this book I posited an imaginary
        situation to help you to define your own attitude to alternative
        medicine. From what followed it should be apparent that I don't
        myself believe that there is any one 'right' answer to questions
        about the value or otherwise of these therapies. Much depends on
        your initial assumptions and the belief system you bring with
        you, as well as on the exact nature of the therapy being
        considered. A few general conclusions do, however, seem possible.
             Clinical research provides a fair amount of evidence to show
        that the better-established therapies (acupuncture, manipulation,
        homoeopathy, hypnotherapy) do work part of the time and for
        certain kinds of disorders. Indeed, all those I have mentioned
        have already made a greater or lesser amount of progress from the
        'fringe' towards medical respectability, and in so doing have
        begun to lose something of their alternative character. Whether
        you find this a matter for rejoicing or regret is a matter of
        individual reaction.
             We have also seen, however, that part of the appeal of
        alternative medicine for many people is precisely that it is
        perceived as being anti-mechanistic, non-reductionist - that is,
        a right-brain phenomenon. This version of therapy is inevitably
        more or less at odds with the prevailing medical orthodoxy, which
        is mechanistic, reductionist, left-brain. Here your choice of
        attitude is largely determined by where on the left-brain/right-
        brain spectrum you happen to find yourself. (You probably can't
        do much to alter your positioning on this spectrum; it seems to
        be determined largely by factors outside your control.) What
        follows, therefore, is determined by my own position (somewhere
        in the middle, I think, but more towards the left in respect of
        many topics). In reading what I write you should make appropriate
        allowances, but don't overdo these because I have done my best to
        allow for my own biases and to be as fair to both views as I can.

        A FRANKLY PERSONAL APPRAISAL
             The principal failing of the philosophical alternative
        medicine enthusiasts, it seems to me, is their facile over-
        optimism. From some popular books about alternative medicine you
        would infer that there is almost nothing that can't be cured. And
        quite a number of patients do indeed draw just this conclusion,
        and are bitterly disappointed by the outcome. As for the
        therapists, they sometimes seem to believe that, if their
        treatment fails to cure a patient, this must be because they
        haven't yet found the right combination of medicines, acupuncture
        points or whatever that would do the trick; they are usually
        strongly resistant to the idea that their treatment might simply
        not provide the answer in every case.
             Of all the uncomfortable facts that need to be faced, the
        starkest and most uncomfortable of all is of course death. It is
        often said, with a fair amount of justification, that
        conventional medicine is inadequate when it comes to coping with
        the dying. Hence the hospice movement. This inadequacy is
        probably at least in part due to the difficulty that doctors,
        like other people, experience in coming to terms with their own
        mortality. But what about the alternative movements? Do they do
        any better? It hardly seems likely. Few of them, after all, have
        much to do with the dying; most patients these days die in
        hospital.
             The difficulty that many doctors experience in confronting
        the fact of death is not wholly their fault. Patients, too, often
        collaborate in the conspiracy of denial. We seldom talk much to
        our patients about death; perhaps we should do so more. But there
        is a strong cultural resistance against it; as many people have
        noted, death has become the ultimate unmentionable. Patients are
        usually quite happy to discuss intimate details of their sex
        lives, but they are nearly always much more reticent about death.
        And naturally doctors, too, experience the same reluctance. 'For
        those who live neither with religious consolations about death
        nor with a sense of death (or anything else) as natural, death is
        the obscene mystery, the ultimate affront, the thing that cannot
        be controlled. It can only be denied.' (Susan Sontag, ILLNESS AS
        METAPHOR, p. 55.)
             Denial is certainly the rule, although one can sometimes
        discern a different note. The middle-aged and elderly may voice
        their anxieties indirectly, often making a little joke of it, as
        we tend to do when we are afraid of something: 'it's anno domini,
        I suppose,' or, more sombrely, 'don't grow old, Doctor, it's a
        mistake, I can tell you.'
             Denial can take very odd forms indeed. Now we are offered
        the prospect of technological immortality. Certain entrepreneurs
        invite us to pay them huge sums of money for the privilege of
        being frozen in liquid nitrogen (head down to preserve the brain
        in case the refrigeration fails temporarily), in sure and certain
        hope of resurrection when at some future time it has been
        discovered (a) how to revive us and (b) how to cure whatever it
        was we died of. For people who cannot afford to have their whole
        body frozen there is a cut-price alternative which consists in
        freezing just the head.
             There is an interesting resemblance here to the Egyptian
        practice of embalming the dead in order to ensure their
        immortality. Like our modern 'cryonics', embalming was a very
        costly affair; only a small minority of the population could
        afford the full treatment, although, as in our case, a cheaper
        alternative version was also available. The modern transformation
        of a 'spiritual' conception of immortality, as held by the
        Egyptians and other peoples of the ancient world, into a
        materialistic and technological one is surely very significant.
             What is astonishing about the whole cryonics idea is not so
        much the implausibility of the 'science' involved as the
        extraordinary and probably unwarranted optimism it implies about
        the future stability of our sophisticated technological
        civilization. There is also a remarkable degree of egotism in the
        assumption that a future society would actually want to revive
        large numbers of unknown people.
             It is certainly not for the doctor to try to make patients
        confront things they don't wish to confront. We all have the
        right to our reticence and our escapes from reality. On the other
        hand, probably no therapist can achieve very much for many of his
        patients unless he has at least begun come to terms in one way or
        another with his own mortality.

                  No choice is uninfluenced by the way in which the
                  personality regards its destiny, and the body its
                  death. In the last analysis, it is our conception
                  of death which decides our answers to all the
                  questions that life puts to us. [Dag Hammerskjold,
                  United Nations Secretary General: 1966 Markings,
                  tr. W.H.Auden and Leif Sjoberg, Faber and Faber,
                  p.136]

             This coming to terms with mortality may have been an easier
        task in more religious ages; certainly the Victorians had no
        false shame about discussing death. When I was a boy in a Roman
        Catholic school we were frequently exhorted to remember, on going
        to bed, the Four Last things: Death, Judgement, Hell and Heaven.
        It is, or at least was, one of the great strengths of Catholicism
        that it did not shrink from acknowledging the reality of death.
        Our headmaster used to boast that, when he attended the annual
        Headmasters' Conference and was asked what he thought he was
        preparing his pupils for, he used to reply: "For death." That
        reply would probably be considered morbid today; I have no idea
        if his modern successor would say the same thing.
             Of all the great world religions it is, I think, Buddhism
        that faces the fact of death with the greatest degree of honesty.
        In the Theravada Buddhist tradition, for example, the monks and
        nuns regularly chant: "I have not gone beyond sickness, I have
        not gone beyond aging, I have not gone beyond death." Morbid? No:
        wholly admirable.
             The onset of a serious or fatal illness is one way in which
        our inevitable mortality may be brought home to us. The slow
        breakdown of our physical or mental faculties is another. Like
        Peer Gynt, we find ourselves gradually peeling away the layers
        that went to make up our physical and mental selves, until at
        last we reach the end and nothing is left at all. It can seem
        like a bad cosmic joke: "Nature is witty."
             Of course, I am deliberately putting the matter in its
        starkest terms. In many instances a certain amount of compromise
        is possible. Useful treatments, conventional or alternative, do
        after all exist for many diseases, and some at least of the
        disabilities of aging can be mitigated in various ways. There is
        also a lot we can do to help ourselves, especially by prevention:
        we can avoid tobacco and excessive amounts of alcohol, we can
        take exercise and prevent putting on weight by eating sensibly,
        we can keep our minds active. Not to do these things is doubtless
        foolish.
             But we ought also to recognize that we may do all this and
        still become ill, and our illness may be of a kind that no
        presently available treatment can help. We ought also to
        recognize that there can be no guarantees of immunity from the
        attrition of time. Sometimes patients say: 'Why should this have
        happened to me?' To which there can be only one honest, if
        brutal, answer: 'Why not you?'
             The implied message of technology and of the Welfare State
        is that pain and suffering should not be part of life and we have
        a right to be relieved from them. It is not a message that would
        have made much sense to earlier generations, who seem to have
        accepted these things as inevitable. And alternative medicine,
        although it rejects technology as such, generally colludes in
        fostering the delusion that we should be perpetually healthy.
        There is therefore nothing surprising if many patients with
        incurable disorders believe that a cure must exist somewhere. But
        for many such people there will be nothing but an incessant
        progression from one specialist to another, from one form of
        alternative therapy to another.
             It is never right to deny a patient hope. At the same time,
        however, it is equally wrong to buoy people up with false
        promises. A fine balance is to be struck.

        ALTERNATIVE MEDICINE AND THE SPIRITUAL DIMENSION
             We saw a little earlier (p.000) that nearly half of a group
        of alternative practitioners who were questioned said that
        religious and spiritual experiences played an important part in
        forming their clinical practice, whereas only 13 per cent of
        orthodox general practitioners thought in this way. This is
        surely a most important difference. It points to the fact that
        many alternative practitioners don't hesitate to assume the role
        of guide, guru, shaman or what you will. In other words, they are
        not content to confine their activity to giving fairly mundane
        advice about diet, exercise, and the avoidance of stress, but
        believe that they can communicate to their patients a wider
        vision of human nature and its relation to spiritual forces.
             In this respect the alternative practitioners are reverting
        to an older view of the place of the healer. In many traditional
        societies, healing and religion were closely connected; in fact,
        healer and priest were often one. The shaman was a man or woman
        who had undergone certain initiations, often of a very exacting
        kind, that enabled him or her to communicate with the spiritual
        world and to mediate between that world and ours. Practices of
        this kind were not confined to so-called 'primitive' peoples such
        as the tribes of Central Asia or the North American Indians; they
        persisted in one form or another into Classical times and even
        later.
             The use of dreams as an aid to diagnosis, for example, was
        widespread in antiquity, and patients would visit well-known
        shrines in order to sleep there and have dreams which would be
        interpreted by the resident priest, who would then prescribe the
        necessary treatment. And even the medicine of the ancient world
        (for example, that corpus of knowledge ascribed to Hippocrates)
        preserves a good deal of its religious origins.
             Gradually, however, conventional doctors abandoned this
        connection with religion and the spiritual. We find little
        evidence of it, for example, in Galen's writings, and by the time
        we reach the rational eighteenth century the physicians of the
        day are eager to distance themselves as much as possible from any
        such cultic connections. In our own time this separation has
        become pretty well complete. For example, the phrase 'a good
        bedside manner', which some thirty or forty years ago could still
        be applied to a physician as a term of praise, today has
        connotations of the slightly bogus if not of outright
        charlatanry; it is taken to imply the use of positive suggestion
        beyond the limit of reputable practice. Modern doctors insist on
        their scientific credentials and on objectivity.
             Alternative practitioners are seldom sufficiently detached
        from the prevailing climate of opinion to ignore science totally,
        but they reinterpret it in their own terms. And this is an
        important part of the appeal of the alternative therapies for
        many people. Even the most way-out practices usually have at
        least a veneer of science, but they are also perceived as
        partaking of the spiritual dimension. Hence their practitioners
        and their patients can claim the best of both worlds.
             The wish to link the spiritual and the mundane in this way
        is surely valid in principle. Given that many patients do come to
        therapists (of all kinds) with problems that are not amenable to
        treatment in the ordinary sense of the word, there really is no
        choice. Either the therapist has to do the best that he or she
        can, or the patient must be sent elsewhere. But to whom? To a
        psychiatrist? Sometimes that is the right solution, but not very
        often. To a priest? Yes, sometimes; but not many patients these
        days want an overtly religious solution, and in any case, many
        clerics, at least in the West, appear to be quite as much at sea
        about what they believe as the rest of the population -
        sometimes, one suspects, even more so.
             The therapist must often, therefore, fall back on his or her
        own inner resources. This presupposes that he or she has some
        kind of metaphysical framework to rely on, or has at least given
        the matter sufficient reflection and attention to have something
        to offer. A conventional medical education today clearly does not
        supply anything of the kind. The strength of many alternative
        practitioners is that they have found some kind of Answer that at
        least satisfies themselves and may appeal to other people as
        well. Admittedly some of these Answers may well appear bizarre to
        many uncommitted outsiders, but there are likely to be some who
        will find them to be what they have been looking for.
             Probably the person who has understood this need most
        clearly in modern times was C.G.Jung. His form of psychotherapy,
        which he called analytical psychology, is professedly scientific;
        he himself always insisted that he was a scientist and based his
        ideas on practical observation. But however this may be, there is
        no denying the fact that Jung's ideas and methods have many of
        the features of alternative psychotherapy, especially the use of
        dreams as the gateway to the unconscious.
             As is well known, Jung paid an enormous amount of attention
        to religion. Indeed, he is on record as saying that all those
        middle-aged patients with whom he worked who achieved a
        substantial degree of self-integration (which he called
        individuation) did so because they succeeded in resolving a
        religious dilemma, in the widest sense of the term.
             But although Jungian analysis might be described as
        alternative psychotherapy, at least in the sense that it is not
        fully accepted as valid by mainstream psychiatry, it emphatically
        could not be accused of sentimentality or refusal to face facts.
        Many of Jung's own patients were middle-aged, and this is still
        true of many people who undergo Jungian analysis today. (The term
        'midlife crisis' originates with Jung.) A Jungian analysis is
        therefore very likely to lead, at some stage, to an encounter
        with the idea of death, and facing this and other unwelcome
        thoughts is a central part of the process of 'individuation'.

             What follows from all this is the perhaps rather
        uncomfortable conclusion that the only therapists who can help
        people to encounter the deep problems - incurable illness,
        awareness of death - are likely to be those who have at least
        begun to resolve these questions for themselves. It probably
        doesn't matter so much exactly how they have done so, although
        certain paths are intrinsically more promising than others; but
        what does matter is the personal qualities of the woman or the
        man who is conducting the therapy.
             I should not wish to imply that this is necessarily a matter
        of arriving at a formal set of metaphysical or religious beliefs.
        Indeed, it may be that what some people need is the ability to
        transcend belief systems that have become too constricting. This
        often seems to be true of patients whose suffering stems in part
        from the fact that they are perceiving their life situation too
        exclusively from one narrow point of view.
             Yet still we are not at the core of the matter. Maybe it is
        really the word 'therapy' that we keep stumbling over, for it
        implies that there is something 'wrong' that needs to be 'fixed'
        by the expert. But perhaps we should do better to stop thinking
        so much in terms of health versus disease.
             Many patients come to alternative therapists with a request
        for a 'natural' form of treatment. As we have seen (p.000), the
        word begs many important questions. But even beyond this, perhaps
        the whole idea of 'treatment' - the implied model on which it is
        based - is inappropriate for some people. Perhaps some of us need
        to abandon the notion of an expert therapist 'treating' a
        'patient' and instead to think more in terms of a dialogue
        between two people caught in the same situation.
             A dialogue of this kind naturally demands a fair degree of
        maturity in both participants, and it is by no means what is
        needed in every case. But there are times when the so-called
        therapist will be best advised, not to prescribe a medicine,
        whether natural or not; not to stick needles into the 'patient';
        indeed, not do anything at all, even to give advice about life
        style or anything else, but simply to listen and to reflect back
        the situation to the sufferer without making a judgement or a
        recommendation about what to do or not to do. The result of this
        can be an increased willingness to accept things as they are, and
        to recognize that ill health, aging and death lie in wait for all
        of us in one form or another.
             If we can do this, without making up metaphysical theories
        to account for our situation and without trying to explain it
        away, there may be a way forward. It isn't an easy one, for it
        requires the development of an ability to tolerate physical and
        mental discomfort and uncertainty. Our minds dislike uncertainty
        and much prefer the apparent security of fixed views. But we have
        it on good authority that it is by facing uncertainty that
        ultimate freedom from suffering can be attained. Speaking of his
        own experience on the way, the Buddha said: "If I stood still, I
        sank; if I struggled, I was carried away. Thus by neither
        standing still nor struggling, I crossed the flood."








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