July 27-28, 2024 in Andalusia, Alabama  –  “Energetics, Somatics and Sensory Experiencing” with Thomas, Mel and jim mcdonald now enrolling!

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The Dance of the Realms:

Exploring the Interplay of Health, Disease, and Illness

In the Five Realms model, we recognize that health, disease, and illness are not static, isolated states, but rather dynamic, interconnected aspects of the human experience. The realms are in constant interplay, each influencing and being influenced by the others in a complex dance. Fully understanding the dance of the realms takes extensive training in the bodies of knowledge of each realm, but I I hope the following illustrations are helpful for understanding the models versatility and complex interactions.

When we envision the Five Realms as a series of nested circles, with the Realm of Eco-Sociocultural-Political Context as the outermost circle, the Realm of Experience within that, and the Realms of Health, Maladaptations, and Disease nestled inside the circle of Experience, we can begin to see the interactions between the realms in a new light.

In this model, the Realm of Context acts as a container, holding and shaping all the other realms within it. The conditions, resources, and constraints of our ecological, social, cultural, and political environments form the boundary conditions within which our experiences of health and illness unfold. The outer circle of Context exerts a constant pressure on the inner circles, shaping their form and movement.

The Realm of Experience, then, becomes the mediating layer between the external world of Context and the internal world of Health, Maladaptations, and Disease. Our subjective experiences – our perceptions, beliefs, emotions, and meanings – act as a kind of permeable membrane, selectively filtering and interpreting the influences of the outer realm of Context.

Through the lens of our Experience, we make sense of the world around us and navigate the challenges and opportunities of our lives. This process of meaning-making and story-telling shapes our inner landscape of health and illness, influencing how we perceive and respond to the movements of the Realms of Health, Maladaptations, and Disease.

Within the circle of Experience, we find the dynamic interplay of Health, Maladaptations, and Disease. These three realms are in constant motion, each one vying for dominance within the limited space of the inner circle. When the Realm of Health expands, it pushes against the boundaries of Maladaptations and Disease, keeping them in check and imparting a sense of vitality and health upon the Realm of Experience.

However, when the Realms of Maladaptations or Disease begin to grow, they can encroach upon the space of Health, compressing it and making it more difficult for the body to maintain its natural state of resilience. The expansion of Maladaptations or Disease can be triggered by a variety of factors, including the pressures of the outer realm of Context, the challenges of difficult Experiences, or the diminishing of the Realm of Health.

As these inner realms shift and move, they send ripples outward, influencing the Realm of Experience that surrounds them. The expansion of Disease, for example, can color our subjective experience of the world, tinting it with shades of suffering, limitation, and distress. The contraction of Health can lead to a sense of disconnection, despair, or loss of meaning, an experience we call Illness.

And yet, the Realm of Experience is not merely a passive recipient of these influences but can also exert its own force on the inner realms. By consciously working with our experiences – by exploring new perspectives, finding sources of support, and cultivating resilience – we can begin to reshape the landscape of our inner world, creating more space for Health to grow.

This process of transformation can also ripple outward, influencing the Realm of Context that surrounds us. As we begin to shift our inner experiences and cultivate greater well-being, we may find ourselves naturally drawn to different environments, relationships, and resources that support our ongoing growth and healing. We may begin to advocate for changes in our social, cultural, and political systems, working to create a Context that is more conducive to collective health and experience of vitality.

In this way, the interactions between the realms can be seen as a dynamic, multi-directional flow, with influences moving from the outer realm of Context inward to the inner realms of Health, Maladaptations, and Disease, and vice versa. The Realm of Experience acts as a critical interface, mediating and shaping these flows of influence.

By understanding the interplay of the realms and having a wide range of tools at our disposal, we can create personalized, holistic interventional plans that meet each individual’s unique needs. This is the art of navigating the dance of the realms – being attentive to the interplay of the Realm of Context and the Realm of Experience while balancing the shifting dynamics of health, maladaptations and disease, and responding to this complex dance with creativity, flexibility, and compassion.

Applying the Five Realms Model in Clinical Practice: A Case Study

Step 1: Understanding the Illness Experience

The herbalist begins by creating a safe, non-judgmental space for Sarah to share her story. They ask open-ended questions, inviting Sarah to verbalize and unpack her experiences: “What has it been like for you to navigate these digestive issues and fatigue?” “How does that feel in your body?” Through active listening and empathetic reflection, the herbalist validates Sarah’s experiences and helps her identify her personal goals and priorities for interventions.

During this conversation, the herbalist also engages in gentle motivational interviewing, exploring Sarah’s readiness for change and providing conversational on-the-spot education about the body’s stress response and its impact on digestion and overall well-being. This collaborative process helps to clarify Sarah’s goals and priorities, and lays the foundation for a truly patient-centered approach to care.

Step 2: Assessing the Realm of Health

Next, the herbalist works with Sarah to explore her current health practices and sources of vitality. They discuss not only Sarah’s diet, sleep patterns, movement habits, and stress management techniques, but also the activities and relationships that bring her joy and a sense of connection to others and the natural world.

Sarah shares that while her busy schedule often leaves her feeling depleted, she finds renewal in her weekly hikes with friends and her daily practice of journaling. The herbalist reflects back these strengths and resources, and together they brainstorm ways to build upon these foundations of health. This co-creative process empowers Sarah to take an active role in her own healing journey.

Step 3: Identifying Maladaptations

Building upon their understanding of Sarah’s illness experience and health practices, the herbalist next explores any maladaptations or imbalances that may be contributing to her symptoms. They note the impact of chronic distress on Sarah’s digestive function and energy levels, and identify patterns of reduced adaptive capacity, regular sympathetic excess and probable HPA-axis dysregulation.

The herbalist also returns to discussing Sarah’s relationship with food and body, noting a history of restrictive dieting and negative self-talk. Together, they explore the ways in which these maladaptive patterns may be perpetuating Sarah’s digestive issues and fatigue, and discuss strategies for cultivating a more balanced, compassionate approach to self-care.

Step 4: Investigating Disease Processes

With a deeper understanding of Sarah’s unique experience and the underlying maladaptations at play, the herbalist then assesses for any specific disease processes that may be contributing to her symptoms, or that constitute a red flag or urgent need for referal. They review Sarah’s medical history and order relevant laboratory tests to make sure conditions such as SIBO, celiac disease, and inflammatory bowel disease have been ruled out.

The herbalist also explores any medications or supplements Sarah is currently taking, and considers potential drug-herb interactions or nutrient depletions. This comprehensive assessment helps to ensure that Sarah’s treatment plan is safe, effective, and tailored to her individual needs.

Step 5: Considering the Sociocultural Context

Finally, the herbalist explores the broader sociocultural factors that may be influencing Sarah’s health and access to care. They discuss the demands of Sarah’s job, her financial constraints, and her cultural background and beliefs about health and healing.

The herbalist also assesses Sarah’s social support networks and community resources, identifying potential allies and obstacles in her healing journey. Together, they brainstorm strategies for navigating these challenges and leveraging her strengths and resources for optimal health and well-being.

Therapeutic Plan:

Based on this comprehensive assessment across the five realms, the herbalist collaborates with Sarah to develop a holistic treatment plan that honors her unique goals, preferences, and circumstances. This plan includes:

  1. Illness Experience: Regular check-ins and supportive counseling to validate Sarah’s experiences, celebrate her progress, and address any challenges or concerns that arise. A daily plant-centered ritual is recommended where Sarah makes a cup of linden tea, and does a short body scan and a 60-second breathing exercise before mindfully sipping her tea.
  2. Health Building: 1-3oz of dark chocolate daily is recommended to boost vitality, joy, calories, magnesium, copper and iron; along with personalized recommendations for enhancing her existing health practices (e.g., more restorative movement, a regular bedtime routine).
  3. Addressing Maladaptations: A tincture of milky oats (nervine tonic) and motherwort (anxiolytic bitter) to soothe the nervous system and stimulate the digestive system, along with referrals to a low cost mindfulness-based stress reduction program.
  4. Managing Disease: With the cooperation of Sarah’s primary care a trial of enteric-coated peppermint oil is started to address SIBO, along with dietary modifications to support gut health and reduce inflammation.
  5. Sociocultural Context: Connection to a local women’s health collective for affordable herbal education and community support, along with advocacy for workplace policies that prioritize employee well-being.

As Sarah begins to implement this collaborative treatment plan, she experiences not only a reduction in her physical symptoms, but also a renewed sense of agency, resilience, and vitality. The herbalist continues to offer guidance and support, adapting the plan as needed to reflect Sarah’s evolving needs and goals.

This case study illustrates the power of the Five Realms model as a framework for holistic, patient-centered care. By starting with the illness experience and co-creating interventions that honor the full complexity of the individual, herbalists can facilitate deep and lasting change that goes beyond the mere resolution of symptoms. This approach recognizes the innate wisdom and resilience of the human body and spirit, and empowers individuals to take an active role in their own health and well-being.

As we conclude this introductory exploration, let us consider the implications of adopting the Five Realms model in herbal education and practice.

Next in this series: Part 8 – Conclusion and Invitation

 

 The botanical illustrations used in this post were created by Annie SewDev.