Relational Healthcare and the Re-Emergence of Wholeness-Based Medicine by Dr. Brian Plante, N.D.
- Abstract
- Western healthcare currently faces a crisis of worldview and delivery. Naturopathic medicine and Relatefulness both advance a wholeness-first paradigm, which addresses critical needs at the root-cause level of human suffering and disease. The synthesis of naturopathic medicine and Relatefulness practice (i.e., Relational Healthcare) represents a novel solution to the increasing fragmentation within the Western healthcare system and doctor-patient relationship. The return to health depends on remembering wholeness, and the wisdom and tools of naturopathic medicine support this best when they are coupled with the radical co-presencing of Relatefulness. As a clinical approach, this synthesis addresses patients’ need to see and know themselves, feel deeply connected to their doctor, and understand the homeodynamic processes of their bodies and how to work with them.
- Author info
- Brian Plante, N.D. (licensed naturopathic physician), on track for Relatefulness facilitation certification
- Originality
- I confirm that this work is original and has not previously been published elsewhere
- Conflicts of interest
- Dr. Plante is a licensed naturopathic physician at the Amen Clinics in Orange County, CA, and is the founder of Relational Healthcare LLC
- References
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Relational Healthcare and the Re-Emergence of Wholeness-Based Medicine
by Dr. Brian Plante, N.D.
Introduction: The Western Healthcare Experience
You walk into a doctor’s office, sick, looking for answers. Most of us living in the Western world know the experience well; you’re handed a clipboard of intake forms, asked to wait nervously in a stiff, fluorescently-lit waiting room. A medical assistant brusquely calls your name. You are ushered down a hallway into a sterile exam room, where you eagerly await your moment with your doctor.
Predictably late, the doctor comes in hurriedly, repeating the same questions you answered both on your intake forms and verbally to the medical assistant, barely making eye contact as they nod and chart the encounter on an electronic health record device. Perhaps a brief physical exam, referral for additional testing, and a new prescription or two. All in about 15 minutes or less.
Patients I’ve spoken to often describe these experiences as unsatisfying, underwhelming, or outright traumatic. My primary care doctor doesn’t listen to me, I hear frequently. They told me it was all in my head, and referred me to a psychiatrist. I’m still looking for answers.
On the doctors’ end, it’s often not much better. Rushed visits, 20-25 patients per day, lab orders, prior authorizations, prescription refills, charting patient visits on weekends, holidays, and during continuing medical education conferences. Many doctors say they went into healthcare because they wanted to help people get well. This is not what I signed up for, they say, on the edge of burnout. Not to mention the severe stress of medical school, residency, and fellowship.
Naturopathic physicians are spared some of this. Our schooling emphasizes prevention, identifying and treating the root causes of disease, treating the whole person, and doctor as teacher. We are steeped in both evidence-based medicine and traditional systems of healing that see human beings as inseparable from nature and each other.
Trained as a holistic primary care physician, I saw everything from diabetes to depression, cancer to cardiovascular disease. My residency specialized further in complex, chronic illness, including Lyme disease, POTS, fibromyalgia, chronic fatigue syndrome, and the earliest cases of long COVID. We ordered blood tests, imaging, gut microbiome tests, urine toxin tests, and took the time to listen to our patients. A physician of both past and future, I thought I was ready.
A Growing Need in Healthcare
There was something missing, however. Despite our philosophy and heritage, modern naturopathic doctors are often still burdened by similar stressors as our conventional colleagues. The administrative load is extensive, our testing and treatment plans are complex, and patients come to us desperately seeking answers that conventional specialists haven’t been able to provide. There is so much need, and seemingly not enough of us to address it. Joined by a growing force of fed-up conventional MDs and DOs, the emerging fields of functional medicine and integrative medicine are asking similar questions.
What is really making us sick?
Is it our food, environmental toxins, artificial environments with increasing screen use, poor sleep, stress, or mineral deficiencies?
What can we change about our lifestyles, while navigating a culture that seems to continue demanding more of us?
What is truly needed to be well?
What many people are not consciously aware of is that what they want most deeply is an embodied remembering of their wholeness. They want to know themselves, understand their bodies, and vividly re-discover how they fit into the larger fabric of our world.
Functional and Integrative Medicine: Improvements, but Incomplete
Functional and integrative medicine is a response to the limiting reductionist paradigm in conventional medicine. It posits that disease begins at the level of function (or, more appropriately, cellular dysfunction), before structural changes can be observed at the organ level. Conventional imaging or lab testing may fail to show dysfunctional changes before they become obvious and severe. Minor disruptions in function can point to much deeper imbalances within the human body, and these can be supported through individualized nutrition, hormone balance and optimization, gut microbiome balancing, detoxification support, immune support, and addressing chronic bacterial, viral, or parasitic infections.
The goal of functional and integrative medicine is to treat each human being as a unique individual who may have imbalances in one or more of these domains, which are contributing to or causing the patient's symptoms. Correcting these imbalances is believed to bring the body back into a state of balance and organized cellular and organ function, resulting in improved health, quality of life, longevity, and long-term disease risk reduction.
A bias that can occur in a functional and integrative medicine approach is to overfocus on manufacturing health through supplementation and clinical intervention, leading to an ongoing pattern of trying to fix oneself – to optimize one's body endlessly. This is a slippery slope that can cause someone to experience ongoing fragmentation within themselves rather than an embodied, fluid, felt sense of their wholeness.
American culture capitalizes on this by advocating for new cutting-edge wellness trends and therapies that promise longevity, symptom eradication, and age reversal. While some of these therapies may help, the paradigm underlying them keeps many people stuck – dissatisfied, impatient, frustrated, and unable to be with themselves as they are.
Naturopathic Medicine: A Brief History
Naturopathic medicine is a contemporary medical approach that synthesizes the best of conventional Western medicine with evidence-informed natural medicine. It utilizes conventional lab testing and imaging, specialty functional tests including but not limited to comprehensive stool analyses, urine toxin tests, and saliva hormone tests, and employs any of the following treatments based on the root-cause needs of each individual patient: therapeutic nutrition, exercise, lifestyle, specific nutrient or herbal supplements, homeopathy, bodywork, light, sound, and frequency therapies, injection therapies, and individualized prescription medications when needed.
Naturopathic medicine was born from a lineage of Western traditional healing based in the European (primarily German) practice of “Nature Cure” – a combination of nature-based therapeutics that emphasized physical activity, nutrition, clean air, sunlight, and clean water (aka, “hygienics”). Nature Cure included the application of hot and cold water, known as hydrotherapy, and the use of homeopathic medicines, along with hygienics, to facilitate healing by way of the body’s innate processes.
In the late 1800s and early 20th century, these modalities were popularized due to their ability to restore health in cases of chronic disease caused by modern urban environments, when conventional doctors at the time were unable to achieve such results. Patients would often leave the cities they lived in and travel to nature-based retreat centers where they would invest several months or even years in dedicated healing lifestyle practices such as these. Many found that they could reverse chronic diseases that their conventional doctors believed were incurable and terminal.
Due to the standardization of medical education following the Flexner Report in 1910, funding for medical education was directed away from nature-based therapies and toward the development of pharmaceutical and surgical approaches to medicine, causing the natural health profession to lose scientific credibility and merit.
Nevertheless, the naturopathic medical profession persisted as an ‘alternative’ medicine. It advanced by bridging Nature Cure therapeutics with herbal medicines, specific nutrients like vitamins and minerals, chiropractic manipulation, and other forms of bodywork and massage. Contemporary naturopathic physicians are also trained to understand and prescribe pharmaceutical medications when necessary, which is often appropriate as part of a whole-person treatment plan, especially for genetic conditions or short-term stabilization of severe disease states.
The underlying assumptions and clinical philosophy guiding naturopathic practice advocate for ‘the healing power of nature’ – the idea that when the conditions are right, health is the natural state of being. Health, therefore, in most cases does not need to be manufactured de novo through external intervention. Rather, the causes of disease must be identified and addressed, and obstacles to health must be removed. When the obstacles are removed and the healing power – the vital force of the patient – is gently stimulated, a return to health is the inevitable result.
In modern biochemistry and physiology terms, we would say that the body has self-regulating mechanisms of homeostasis and homeodynamics that, when allowed to run their course, will keep the body healthy. When obstructed, the body will make its best attempt to maintain survival, and this is the process that creates disease.
The goal of the naturopathic physician is to identify and remove obstacles to health, whenever possible to work with rather than against the healing power of nature and the patient's own vital force, to educate the patient in what is necessary for health, to treat the whole person, and to emphasize prevention.
Naturopathic Medicine and Relatefulness: Towards A Synthesis
These principles distinguish the naturopathic medical approach from functional and integrative medicine, although the tools used may overlap. Naturopathic medicine functions under a wholeness paradigm, though the modern naturopathic physician may struggle at times to uphold it within our culture, with selective economic pressures and prevailing wellness trends.
Naturopathic medicine follows a wholeness paradigm because it looks to nature as the guide. Although at times random and chaotic, natural systems tend toward homeodynamic coherence. Ecosystems that cannot return to coherence after allostatic stress usually decay – food chains get disrupted, biomes are altered, and the environment cannot sustain itself.
When allowed to operate without substantial external disruption, these systems are self-regulating. The human body functions according to the same mechanistic processes. It cannot be divorced from its natural environment, and when it is, disease is the result (which, paradoxically, is the body’s best attempt to return to health).
Relatefulness, with its emphasis on innate wholeness and its deep trust in the solidity and coherence of the human person in relationship, no matter what arises, is deeply compatible with a naturopathic clinical philosophy. Relatefulness is also complementary to naturopathic medicine's clinical tools. Together, they promote and protect wholeness – not just as an idea, but as an embodied, lived, remembered reality. The combination of naturopathic medicine and Relatefulness represents a necessary and critical emergence in supporting the health of the whole human person at a time when we need it most.
Due to the cumulative impacts of environmental toxicants, synthetic environments with artificial lighting, unnatural electromagnetic fields, and polluted air, sleep and circadian rhythm disruptions, and persistent activation of stress physiology, we need whole-person approaches to health now more than ever. Nature Cure therapeutics that worked 100 years ago are no longer sufficient to restore health due to the ubiquitousness of these insults. Our vital force is weakened.
The emerging paradigm of healthcare requires all tools – from lifestyle, diet, and foundations for health, nutritional and herbal supplementation, to advanced clinical interventions such as medications and surgery – alongside psychological and relational practices that support wholeness. To regulate our physiology, live in harmony with nature’s homeodynamic processes, and know ourselves as whole human beings, we need naturopathic medicine, and we need Relatefulness.
Relatefulness and the Processes of Healing
Relatefulness supports a person’s rediscovery of wholeness by centering awareness-in-connection. This differs from a doctor-patient or psychotherapist-client relationship because the relationship is bi-directional (and multi-directional when practicing in a group). In a therapeutic relationship, despite two human beings being present, the doctor or therapist generally does not share their experience as it is unfolding. Yet bi-directional and multi-directional relational practices encourage a person to develop greater awareness and greater capacity for true-to-life relationships, where exploration, creativity, play, co-discovery, and co-experimentation are included as part of co-presencing. This shifts the aim away from therapeutic insight or change being the primary goal. Nevertheless, this practice’s way of being does often result in change.
Many of my patients find that Relatefulness provides a mode of seeing and being that they are not getting anywhere else in their integrative healthcare treatment. In other words, their other treatments are all interventional and change-oriented. This is not a bad thing; intervention and change are often needed to facilitate a return to health and interrupt dysfunction. But overemphasizing these at the expense of radical awareness and ‘being-with’ often unconsciously keeps people in never-ending cycles of trying to fix themselves and obtain wholeness as some kind of object or destination, rather than the embodied knowledge of wholeness as a starting point.
In my clinical experience, the shift from deficiency toward wholeness as the backdrop dramatically changes measurable clinical outcomes: patients get better faster, behavioral change is less difficult, and their bodies are more receptive and less reactive to interventional support, whether that is nutritional supplementation or structural bodywork such as massage.
I refer to this as “the yin and yang of healing.” The yin aspect of healing is the acceptance, surrender, non-doing, receptive, and bottom-up (emergent) processing style, while the yang aspect is the directive, interventional, and targeted approach to treatment. A comprehensive treatment plan and health-promoting lifestyle requires elements of both.
Although there may be yang ‘moves’ within Relatefulness, the overall practice tends toward yin – much like meditation and other mindful practices such as yoga or tai chi. For many Americans, rest and other solitary, yin health practices are difficult to consistently incorporate (I have such a hard time resting is a phrase I hear from my patients often).
By centering awareness in bi-directional and multi-directional containers, the yin aspects of health can often be re-integrated more fluidly and directly because of the attentional infrastructure that human-to-human relationship provides. Relatefulness can serve as a developmental catalyst that balances the yin and yang of self-integration and healing. As the late humanistic psychologist, Carl Rogers, famously said, “The curious paradox is that when I accept myself just as I am, then I can change.” (in On Becoming a Person: A Therapist's View of Psychotherapy).
Relational Healthcare: Clinical Applications
Relatefulness also supports the doctor-patient relationship. In my practice, I employ a variety of Relateful tools with my patients as part of their medical assessment and delivery of lab results and treatment. Contexting becomes an important aspect of setting expectations around the visit, so that we know how we are relationally orienting. Impact statements become invaluable when it comes to understanding a patient's goals, how they are feeling in response to reviewing lab or imaging findings, how their suggested course of treatment is landing for them, and how we might make it more collaborative. For example:
What is it like for you to hear these results?
How is it for you, in this moment, as we're talking about this?
It sounds like this is really important to you; hearing you say that, here is what it brings up in me…
I’m imagining you’re feeling overwhelmed (or hopeful) with all this new information. Is that true?
Here’s some of what you can expect as we work together…
Contexting is one of the most powerful skills for being an embodied physician. Continually naming what I see as potential choices – for what we talk about, how we continue to explore a line of questioning or a suggested treatment strategy – is so indispensible because it keeps the interaction fluid and relational without losing the structure necessary to achieve our clinical goals, i.e., to identify and treat the causes of disease. By re-contexting, I am leading both myself and the patient back to the present moment, orienting to Why are we talking about this? What is our intention? And how is that for you?
Structuring my visits in a way that allows sufficient time to truly be present with each other and include Relateful elements provides a missing experience that many people have never had with their doctor before. While the goal of Relateful practice outside of medicine does not necessitate that a person feels seen, heard, or understood, in a healthcare setting that is the priority. I am more able to offer this as a whole human being when I, the physician, have done and continue to do Relatefulness practice. I am able to be here for my patients while also being here for and with myself, and when relevant, I can choose to share how that is impacting me in ways that invite the relationship into a deeper sense of allyship and co-creation.
This pairs exceptionally well with a naturopathic medical approach. Naturopathic medicine not only prioritizes nature-based therapies, diet, lifestyle, and medications when appropriate, but, like Relatefulness, stands on a foundation of assumed wholeness and assumed intelligence – of the body, the person, and the natural world that is inseparable from us. To bring relational practices into this deep medical holism provides not only the framing, co-presencing, and specific guideposts for how to relate more fully, but it supports patients’ rediscovery of wholeness in their bodies, relationships, and lives.