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

Listen to this blog post via Thomas’ AI voice clone! While it’s Thomas’ voice, the cadence and enunciation might differ slightly from how he normally speaks. We hope that you enjoy the convenience of listening!

 

Introduction

In this introductory exploration of my philosophy of herbal medicine, I introduce the Five Realms model – a holistic framework for understanding the complex, multidimensional nature of health and healing. This model recognizes that the human experience of well-being and illness is shaped by the dynamic interplay of biological, psychological, social, and cultural factors. By attending to the realms of Health, Maladaptations, Disease, Experience, and Eco-Sociocultural Political Context, the Five Realms model offers a nuanced and integrative approach to conceptualizing the diverse influences on health outcomes.

Throughout this piece, I will delve into each of these realms in depth, drawing upon insights from fields such as biomedicine, psychology, anthropology, and philosophy. I will situate the practice of herbal medicine within this multidimensional landscape, highlighting its potential to support healing and transformation across the spectrum of human experience. Case studies will illustrate how this model can be applied in the real-world context of clinical practice.

Throughout this exploration, my aim is to contribute to a larger conversation about the role of philosophy in shaping medical knowledge and practice. By engaging critically with the historical and contemporary perspectives on health and healing, and by proposing an integrative framework for understanding the multidimensional nature of human well-being, I hope to stimulate further dialogue and inquiry into the foundations and future directions of herbal medicine as a healing art and science.

Ultimately, the Five Realms model challenges us to embrace a systems-level perspective on health and healing – one that transcends the reductionism of the biomedical paradigm and honors the profound complexity of the human condition. By adopting this expansive and integrative lens, we as herbal practitioners can more effectively understand and address the root causes of suffering, and support our clients in their journeys towards wholeness and well-being.

In the following sections, I invite you to join me in exploring an introduction to the Five Realms. Together, we will examine the philosophical foundations and scientific bases of each realm, and consider their implications for the art and science of herbal medicine. Through this journey, my hope is that we will arrive at a richer, more nuanced understanding of what it means to heal and be healed – and of the vital role that herbal medicine can play in facilitating this transformative process.

Why Philosophy?

Every one of us, as individuals and as practitioners, is steered by an intricate system of unconscious beliefs and values that shape our decision-making processes and worldview. In everyday language, “philosophy” is often deployed to describe this system of guiding principles, encompassing beliefs about reality, moral and ethical values, and our approach to acquiring knowledge.

An implicit philosophy, operating beneath the level of conscious awareness, can subtly and yet significantly influence a practitioner’s perception of evidence. This can lead to confirmation bias, where evidence supporting existing beliefs is favored, while contradicting evidence is dismissed or undervalued. Such biases can cement a rigid framework that resists change, even when confronted with compelling new evidence or perspectives.

On the other hand, making a philosophy explicit provides an opportunity to scrutinize these underlying beliefs and the way they shape interpretation of evidence. It offers an avenue to identify what kind of information could potentially challenge these beliefs and to actively seek out such information. This introspective process encourages intellectual flexibility, openness to new evidence, and a readiness to adapt and evolve one’s philosophy in light of new understanding.

Implicit philosophies may also contribute to a dogmatic adherence to certain practices or systems of medicine that may not stand the test of rigorous empirical scrutiny. Over time, the lack of willingness to adapt or evolve these systems in response to emerging evidence can lead to their eventual downfall. We’ve seen this in medical history, where systems that were inflexible in their philosophy were overtaken by those that adapted and evolved in response to new discoveries and understanding. The explicit articulation of a medical philosophy allows for flexibility and adaptability in light of new evidence, thus promoting progress and growth in practice.

Modern herbal medicine, as a field, doesn’t operate under a single defined philosophy. Modern herbal philosophy is a mosaic of diverse traditional medical system philosophies, consciously or unconsciously amalgamated by individual practitioners, often with elements of contemporary biomedical science woven in. This amalgamation, while reflecting the diversity and richness of the field, can also drive variability and inconsistency in the expectations of what herbal medicine can and can’t do.

By outlining my philosophy of practice, I aim to provide a flexible framework and language that facilitates a deeper understanding of the diverse ways in which herbal medicine can impact people. This philosophy of herbal medicine will attempt to answer fundamental questions about medicine, health, disease, and the role of herbalism and herbalists – questions such as “What is the goal of medicine?” “What is health?” “What is disease?” “What do herbalists do” and “Do herbs work?” The answers to these questions will provide insights into the complex and multifaceted nature of herbal practice, while also offering a structured approach for navigating this complexity.

My hope is that this framework will help to clarify the scope and potential of herbal medicine, while also providing a foundation for more effective communication and decision-making within the field. By establishing a shared language and understanding of the key principles and practices of herbal medicine, we can foster greater consistency in the expectations and outcomes of herbal practice, while still allowing for the flexibility and adaptability necessary to meet the unique needs of individual clients.

My aim in articulating this philosophy is not to suggest a rigid standardization of the field of herbal medicine, but rather to provide a guiding framework that supports a more nuanced understanding of its diverse applications and limitations. By fostering a clearer understanding of what herbal medicine can and cannot do, I hope to enhance the ethical integrity of my teachings and practice, and to address common misconceptions about the scope and efficacy of herbal therapies.

Furthermore, this philosophy seeks to navigate the complex relationship between herbal medicine and biomedicine, finding common ground through critical thinking, evidence-informed practice, and a patient-centered approach. By acknowledging both the unique contributions and the limitations of each paradigm, we can work towards a more integrated and holistic understanding of health and healing.

Origins of the 5 Realms Model

My philosophy of herbal medicine evolved out of two decades of clinical herbal practice, emerging from the daily realities of caring for embodied individuals. With this practical focus, my intent is to delve into the philosophical underpinnings that influence my clinical practice, encompassing a broad spectrum of considerations from the conceptualization of health and disease to the intricacies of clinical application. These reflections are rooted in my experiential comprehension and portrayal of clinical realities, adopting an eclectic philosophical stance.

At the heart of my approach is a marriage of modern phenomenology and empirical principles. Phenomenology, as a philosophical movement, is concerned with the direct investigation and description of phenomena as consciously experienced, without theories about their causal explanation. This emphasis on the lived, subjective experience of illness and health aligns closely with the goals of herbal medicine, which seeks to understand and address the unique experience and needs of each individual. The work of philosophers such as Maurice Merleau-Ponty and Hans-Georg Gadamer has been particularly influential in shaping my understanding of the embodied nature of illness and the role of interpretation and meaning-making in the healing process. Merleau-Ponty’s concept of the “lived body” – the body as subjectively experienced, rather than as an objective, physiological entity – resonates strongly with the holistic orientation of herbal medicine. Similarly, Gadamer’s hermeneutic philosophy, with its emphasis on the dialogical nature of understanding and the importance of historical and cultural context, helps inform my approach to the therapeutic relationship and the co-creation of healing narratives.

At the same time, my approach is grounded in a commitment to empirical principles and the scientific method. While honoring the subjective experience of the individual, I also recognize the importance of objective data and evidence-based practice. This empirical orientation is essential for ensuring the safety and efficacy of herbal interventions, and for advancing the scientific understanding of medicinal plants.

However, my empiricism is tempered by a nuanced perspective on vitalism, informed by the work of philosopher and physician Georges Canguilhem. Canguilhem challenged the mechanistic reductionism of modern biomedicine, arguing for a more dynamic and holistic understanding of life and health. He saw the living organism not as a passive machine, but as an active, self-organizing system that is constantly adapting to its environment. For Canguilhem, health is not merely the absence of disease, but the ability of the organism to adapt to the challenges of its milieu. Disease, in turn, represents a failure of this adaptive capacity – a “stumble” in the “creative adaptations” of life. This perspective resonates deeply with the vitalist orientation of many traditional healing systems, which see health as a dynamic balance between the individual and their environment.

At the same time, Canguilhem rejected the more simplistic versions of vitalism, which posited the existence of a non-material “vital force” separate from the physical body. Instead, he advocated for a “critical vitalism” that recognized the irreducible complexity of living systems, while still grounding this understanding in empirical science.

This nuanced perspective on vitalism informs my own approach to herbal medicine, which seeks to honor the innate wisdom and resilience of the living body, while also recognizing the importance of empirical evidence and scientific rigor. It is a perspective that acknowledges the profound complexity and dynamism inherent in human existence, and that sees health as an active, creative process of adaptation and self-organization.

Alongside Canguilhem’s critical vitalism, the concepts of salutogenesis and allostasis have also been influential in shaping the Five Realms model. Salutogenesis, developed by medical sociologist Aaron Antonovsky, shifts the focus from the causes of disease to the factors that support health and well-being. This health-promoting perspective is central to the Five Realms approach, which seeks to understand and nurture the innate resilience and healing capacity of the individual.

Allostasis, a concept from physiology, describes the body’s ability to maintain stability through change. This dynamic, adaptive view of health aligns with Canguilhem’s critical vitalism and underlies the Five Realms model’s emphasis on supporting the body’s self-regulating and self-healing capacities.

A key motivation behind the development of the Five Realms model was to address the limitations of the mainstream, reductionistic biomedically-derived understanding of health and disease. This reductionism has not only limited the mainstream understanding of health and disease but has also constrained the conversation around the therapeutic potential of herbs. By focusing narrowly on disease categories and measurable physiological parameters, the biomedical paradigm often misses the broader, more holistic ways in which herbs can support health and well-being.

In contrast, the Five Realms model provides a framework for a more nuanced and expansive understanding of the therapeutic actions of herbs. By considering the impact of herbs on the realms of physiology, lived experience, ecological and social context, and beyond, the model allows for a richer appreciation of the diverse ways in which plants can influence health and healing. Moreover, by grounding this understanding in a holistic, non-reductionistic view of the human organism, the Five Realms model opens up space for more meaningful and empowering conversations with clients and students about their health journeys.

Rather than claiming this blend of philosophical ideas as entirely new or unique, I see them as contributing to a practical understanding of the fundamental nature of reality and being. The person seeking care is the central focus of my approach, making their subjective experience an appropriate starting point. But this central focus is not fixed; it shifts and flows, making room for objective assessments of disease processes and re-emerging in the consideration of vitality, resilience, and the social and cultural context of health. This model’s strength lies in its adaptability, treating the realms as fluid entities that often merge, especially in the liminal spaces where the rigid science of medicine transitions into its more artful practice.

The following eclectic model I present is, I hope, helpful to the students and practitioners of herbal medicine, and also a conversation starter for other systems of medicine in search of a guiding philosophy.

The Five Realms – A Visual Overview

The Five Realms are centered around a few core premises about the nature of health, disease, and illness.  As you read about each individual realm it’s helpful to have a basic understanding of the other realms.

Health isn’t binary. It’s not something you have or don’t have. It’s not either/or. There’s often a state/space/transition between health and disease.

The state between is probably easiest defined as Maladaptations, which I think of as environmental adaptations that worsen long-term health.

Health isn’t a static state. It’s dynamic, waxing and waning under the influence of many forces, some within our control, some not.

Health is strongly influenced by eco-sociocultural-political forces – these provide the context for how we define health and our access to health necessary essentials.

Thus, we might visualize the eco-sociocultural-political context as another interdependent Realm.

Or we might better visually understand it as the container that holds the Realms.

Lastly, the Realm of Experience mediates the external world of Context and the internal world of Health, Maladaptations, and Disease.

Most importantly, when visualizing the 5 Realms, attempt to refrain from making them linear and static. They are in a constant dynamic dance with each other. I invite you to shift focus regularly and rearrange the Realms as a practice of conceptual fluidity.

No matter how you visualize the Five Realms, it’s helpful to keep in mind that the mental constructs we create to make overwhelming complexity easier to understand are just that – mental constructs. At the end of the day, we are all complex embodied beings in constant dynamic dialogue with our environment, just trying to make sense of life and our role in it.

Next in this series: Part 2 – The Realm of Health

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