Global Advances Toward a Whole Systems Approach

Editorial When a patient with symptoms presents to a physician or other healthcare professional, the skillful practitioner notices not only where the patient is compromised but also how the patient is healthy. From ancient times through the present, this way of seeing individual patients as whole beings, as having both strengths and challenges, has been the hallmark of professional practice. And now is the time to advance patient care through a focus on whole systems approaches. As scientists, clinicians, and leaders, we are most constructive and productive when we are self-aware. Increasing use of the term whole systems invites us to think more deeply about what this new term may mean for our own practices. So we invite our readers to reflect on our individual and collective understanding. For example, what is meant by “whole?” Should the patient be seen as an individual? As a member of a family? And should the patient and family be seen as members of a community? Which community or communities? When asking such questions, we realize that “whole” is a value judgment. In her book Kitchen Table Wisdom, Rachel Naomi Remen quoted the Talmud: “We do not see things as they are, we see things as we are.”1 So “whole” can be in the eye of the beholder. The same may be said of systems. We talk of organ systems, of family systems, of ecosystems. What is meant by “systems”? By definition, these are human creations that bring order to apparent chaos, simplicity to complexity. Our challenge as human beings is that to understand anything intellectually, we must simplify, and, in doing so, we must create boundaries. However, true systems rarely have real boundaries. The web of interconnections is far too extensive. So any boundaries we choose must be seen as social constructs that reflect value judgments. This emphasis on harmonious interconnections within the body, with the diet, with the soil, with seasons, and with the family, community, and universe is easily seen in culturally and geographically based whole systems healing traditions from the East, such as Ayur veda and traditional Chinese medicine, but also those from the West, such as anthroposophic medicine. These whole systems approaches reflect values and boundaries that challenge contemporary healthcare’s majority culture. Recognizing this, one might say that we collectively have much to learn from the world’s many healing traditions. So we need to ask ourselves: do we subscribe to any boundaries and value judgments that may get in the way? In fact, what are the value judgments that may make a “whole systems approach” to health and healing so enticing? Do we mean a preference for inclusion rather than exclusion, for holism rather than reductionism? Perhaps yes, but, almost certainly the growing interest in whole systems at this time in history comes from our newly acquired understanding that the challenges of infectious epidemics, chronic illness, drug addiction, and successful aging go far beyond what our current healthcare “systems” can address. As first articulated by Donella Meadows, “The right boundary for thinking about a problem rarely coincides with the boundary of an academic discipline, or with a political boundary.”2 As we write this (August 11, 2014), the World Health Organization (WHO) has proclaimed the West African Ebola virus epidemic to be of great global concern: