What is Naturopathic Medicine?
Gary Piscopo, ND, LAc and Eric Yarnell, ND, RH
Modern naturopathic medicine is a progressive medical system that integrates the best elements of traditional and conventional treatment modalities and focuses them around a central goal: supporting the inherent self-healing processes of the human person. While the profession formally called “naturopathic medicine” has existed for just over 100 years, its historical roots stretch back to the dawn of human existence.
It should be clearly noted that naturopathic medicine is not simply an empirical system of therapeutics based on the use of natural agents. Though it diverges significantly from the conventional medical model in some of its conceptual elements, the naturopathic medical model can explain empirical facts as they occur in nature, generate hypotheses that are experimentally testable, and offers an explanatory strategy rooted in basic biophysical sciences that gives rise to an integrated medical world view.
A Brief History of Naturopathic Medicine
In 1901, Benedict Lust, ND organized a national convention and chaired a committee that endorsed the use of massage, herbs, homeopathy, spinal manipulation, and other types of natural healing. In 1902, he evolved the term “naturopathy” from the phrase “Nature Cure”, a expression coined by Dr. John H. Scheel in 1895. Lust founded the first school of naturopathic medicine in North America and helped to widely propagate the profession and its philosophy. Licensing laws giving naturopathic physicians the right to practice were passed in several states, including California (1907), Washington (1919), Connecticut (1923), Hawaii (1925), Oregon (1927), and Arizona (1935).
Eventually there were several naturopathic schools across the country, but conventional (allopathic) medicine was also in ascent and was effectively taking over the medical landscape. By the 1930’s, a number of factors conspired to bring about the decline of the natural health movement. These included the death of Benedict Lust, the public infatuation with technology and “wonder drugs”, internecine conflicts between various branches of natural health, and the rising political power of the American Medical Association. Perhaps the most significant factor in the creation of conventional medicine, however, was the role played by the Rockefeller and Carnegie cartels.
At the turn of the twentieth century in the United States, the profession that would later become allopathic medicine was in disarray and in serious need of reform. Abraham Flexner, who was on staff at the Carnegie Foundation for the Advancement of Teaching, was commissioned to do a major study on the state of medical schools in the United States and Canada. Published in 1910, the Flexner Report had a tremendous impact on the field of medicine. While it undoubtedly introduced needed reform by eliminating many suboptimal programs and pioneering the beginning of organizational standards, the Flexner Report also became the foundation for a form of medicine defined by technological and pharmacological interests.
Recognizing the potential to dominate a field with a tremendous profit potential, “philanthropic” contributions from the Rockefeller and Carnegie organizations were funneled into allopathic medicine in the wake of the Flexner Report. Those medical schools that conformed to the emerging corporate view advanced by these organizations (a view that included intensive education and research devoted to the propagation of pharmacological and technological products) were showered with millions of dollars in funding. Those that did not, including naturopathic institutions, disappeared from the medical landscape.
The modern resurgence of naturopathic medicine can be traced in part to the founding of the National College of Naturopathic Medicine in Portland, OR in 1956. This was the first of the current brand of naturopathic medical schools offering four-year, science-based naturopathic medical training. It was ultimately followed by several others (see table 1). Many regions of North American currently license naturopathic physicians (see table 2).
Table 1. Naturopathic Medical Campuses
| Accredited Programs | Location | Date Founded |
|---|---|---|
| National College of Naturopathic Medicine | Portland, OR | 1956 |
| Canadian College of Naturopathic Medicine | Toronto, ON | 1978 |
| Bastyr University | Seattle, WA | 1978 |
| Southwest College of Naturopathic Medicine | Tempe, AZ | 1992 |
| University of Bridgeport College of Naturopathic Medicine | Bridgeport, CT | 1997 |
| Boucher Institute of Naturopathic Medicine | Vancouver, BC | 1999 |
| National University of Health Sciences | Lombard, IL | 2007 |
Table 2. North American Jurisdictions that License Naturopathic Physicians
| State/Province/Country | Notes |
|---|---|
| Alaska | |
| Alberta | |
| Arizona | |
| British Columbia | |
| California | |
| Connecticut | |
| District of Columbia | |
| Florida | Not currently issuing new licenses |
| Hawaii | |
| Idaho | |
| Kansas | Registration only |
| Maine | |
| Manitoba | |
| Minnesota | Limited right to practice under general statute |
| Montana | |
| New Hampshire | |
| Nova Scotia | |
| Ontario | |
| Oregon | |
| Puerto Rico | |
| Saskatchewan | |
| Utah | |
| US Virgin Islands | |
| Vermont | |
| Washington |
Naturopathic medicine today is vibrant and growing. There are active licensing efforts in many states and a growing number of naturopathic medical schools. The National Center for Complementary and Alternative Medicine (NCCAM) has funded a research agenda to further study naturopathic medicine, as well as several naturopathic research fellowships and a number of individual projects. See the “For More Information” section at the end to find out more about what is happening with naturopathic medicine today.
“Traditional Naturopaths” vs “Naturopathic Physicians”
In 1919, the Naturopathic Society of America that was created by Benedict Lust was reorganized as the American Naturopathic Association (ANA). This organization splintered after his death, resulting in the an Eastern ANA, who favored a more traditional approach to naturopathy and the Western ANA, who favored a more progressive approach. Unhappily, this division in the field of naturopathy remains today, a division that has created a great deal of confusion for the general public.
Adherents to the philosophy of the Eastern ANA, who call themselves “traditional naturopaths,” “true naturopaths,” or “naturopathic counselors” ascribe to the view that naturopathy is not a medical practice. Therefore, they typically avoid procedures common to medical care, such as diagnosing and treating disease, prescribing pharmaceuticals, and performing invasive procedures. Practitioners of naturopathic medicine, who refer to themselves as “naturopathic physicians” or “doctors of naturopathic medicine (ND)” believe that the founders of naturopathy intended for it to be a system of medicine, one that should grow and evolve. They therefore include diagnosing and treating disease, prescribing limited pharmaceutical agents when necessary, and performing a limited number of invasive procedures in their practice. While naturopathy is eclectic enough to support both these views, it is clear that Lust, who held degrees in osteopathy and medicine, did conceive of naturopathy as a system of medicine and not simply an empirical art.
Most non-medical naturopathic practitioners obtain their degrees from correspondence or distance learning programs. In the worse cases, a doctorate in naturopathy can be obtained from a diploma mill (i.e. schools that grant a degree for a fee, but require no course work and offer no classes). Unfortunately, there is currently no consistent terminology that would distinguish naturopathic practitioners who earned a degree from a correspondence school from those who earned a degree from an accredited naturopathic medical school.
Because the field of naturopathy is so diverse, there is debate on whether every element within it comprises “medicine” and if a correspondence school degree may not be sufficient for some elements, such as instruction in basic nutrition. To be fair, many correspondence school naturopaths are content to do what may be called “naturopathic coaching” and do not practice medicine as it is currently conceived in the health care delivery system. Others, however, have taken advantage of the system and abuses do exist.
For the health consumer unaware of the divisions within the field of naturopathy, the lack of an easy method to identify correspondence school practitioners makes it difficult to make an informed decision and to set appropriate expectations. In addition, individuals with only a correspondence school or diploma mill degree (i.e. do not have degrees in nursing, conventional medicine, chiropractic, etc. that some of these individuals have) are problematic in several ways. First, since there are no system-wide standards for naturopathic correspondence school education, it is difficult to assess the quality and skill of their graduates. Second, these individuals do not study medical diagnosis, do not study basic sciences (anatomy, physiology, pathology, etc.) to any but the most superficial extent (if at all), and do not undergo practical training in a supervised clinical setting. This introduces several deficits into a health care interaction, one of which is an inadequate ability to recognize serious disease. Third, correspondence school naturopaths are poorly prepared to do any but the most basic kind of counseling or lifestyle intervention, given the lack of sustained clinical supervision or professional patient management training. Finally, having little exposure to the terminology, methods, and organization of the current health care delivery system, the ability of correspondence school naturopaths to function as an advocate when their patients interact with the conventional medical system is typically minimal.
A critical public health issue that non-medical naturopaths and naturopathic physicians disagree on is the issue of licensure. Correspondence-schooled naturopaths oppose any licensure that would limit any part of their practices, which includes licensure of naturopathic physicians and dietitians. They argue that licensure limits health freedom and is a thinly veiled effort to monopolize the fields of nutrition and naturopathy. Sadly, in support of this view, organizations created by some correspondence-schooled naturopaths have orchestrated a campaign of factual distortions, innuendoes, name-calling, half-truths, and legal attacks.
Naturopathic physicians hold that licensure is necessary because it creates an infrastructure of accountability designed to protect the general public by maintaining professional standards. Its purpose is not to establish a monopoly but to define the practice of naturopathic medicine both legally and ethically. This creates a set of appropriate expectations so that an environment of trust can develop with both the general public and other medical practitioners. To this end, naturopathic physicians have made great strides in maintaining its own medical schools, its own accreditation system (recognized by the appropriate government bodies), its own licensing exam, and its own licensing laws and agencies. For the interested reader, both sides of this debate can be easily accessed on the Internet.
Philosophy of Naturopathic Medicine
The rise of rational medicine is usually attributed to the insights of the Greeks. In an attempt to achieve the ideal harmony between man and environment, the Greek culture began a systematic investigation of nature that initiated medicine’s evolution out of the realm of the supernatural. Illness was reframed as the product of natural rather than magical forces. As such, the potential for medical therapy based on rational analysis was developed.
The parameters of this therapy, however, remains a keenly debated issue within the field of medicine. To give one example, there is the issue of the proper focus of medical therapeutics. Opinion has classically oscillated between two divergent poles represented by the Greek mythos of Hygeia and Asclepias. Followers of the Hygeian persuasion viewed health as a natural balance between the individual and their environment. It logically followed that the physician should recognize, appreciate, and work within the dictates of natural law where possible. Interventions, therefore, tended to be indirect and prevention-oriented. This approach forms the basis not only of the principles of hygiene, but the principles of the ecologically-based medical perspective that informs naturopathic medicine.
From the Asclepian viewpoint, however, nature was seen as erratic and unreliable. This gives rise to the view of physicians as having a special status that allowed them to dominate and control the chaotic nature of the human body. It was the responsibility of the physician to actively intervene in disease processes in order to restore a state of health. Direct, “heroic” intervention was thus regarded as the proper focus of medical therapeutics, a view that forms the basis of conventional medicine’s therapeutic credo.
To offer an informal introduction, the health care outlook of naturopathic medicine ascribes to an ecological orientation based on Hippocratic principles. Whereas conventional medicine’s mechanistic orientation is defined by the classical medical design, naturopathic medicine’s ecological outlook is defined by an information-systems medical (infomedical) design. Within this design, “subjective” elements such as spiritual, emotional, psychological, and sociocultural factors can be recast as informationally-active processes that directly impact the physiological systems of the body. Therefore, the importance of adaptive and informational parameters in both health and disease is central to this perspective (see Figure 1).
Figure 1
| Naturopathic Model | Conventional Medical Model | |
|---|---|---|
| Design | Postmodern | Classical |
| Orientation | Ecological/Hygeian. | Mechanistic/Asclepian. |
| Whole System Explanatory strategy | Discrete Components Explanatory strategy | |
| Philosophical Level | Cybernetic circularity. Holism. Monism. Indeterminism. | Mechanistic materialism. Reductionism. Dualism. Determinism. |
| Intra-organizational approach | Engineering approach | |
| Empirical Level | Mutalistic, self-organizing. General systems strategy. Nonlinear causality. | Uni-directional, atomic. Reductionistic. Linear causality. |
| Disease | Adaptive response to unnatural toxic conditions. Imbalance of homeostatic cycles. Process and information oriented | Deviation from somatic norms.< Physical etiologic agents. Structurally oriented |
| Health | Balance of ecological processes. Multilevel ability to adapt to systemic challenge. | Absence of somatic deviation. |
| Patient | Biopsychosocial system. Mind and Body integrated. Modeled as dissipative structure. | Biological organism. Mind and Body separated. Modeled as machine. |
| Therapy | Focus on strengthening self-healing processes first. Increases adaptability. | Focus on cure and physical intervention first. Increases function. |
An increasingly important goal of contemporary medical investigation is understanding how the activity of the human system influences the individual’s health and susceptibility to disease. The general systems strategy inherent in the naturopathic model allows for a number of advantages in this regard over the reductionistic strategy of the conventional medical model. First, the general systems strategy allows for the re-integration of behavioral and psychosocial data that is arbitrarily ignored within the conventional medical model.
Second, the systems perspective serves as an organizational guide, allowing naturopathic clinicians to target their interventions to the appropriate level of the human hierarchy. Such an approach affords the possibility of the greatest efficacy at the lowest cost with the lowest level of side effects for procedures within naturopathy’s treatment range.
Finally, because it is an integrated conceptual outline based on findings from biological, psychosocial, and cognitive disciplines, the general systems strategy avoids the fragmentation found in conventional medicine. Instead it generates a common framework that can accommodate the preventive, curative, and rehabilitative aspects of total patient care. In cases that lie outside naturopathy’s therapeutic sphere, this framework provides a communication interface with which to confer with other health professionals. The outcome is more effective referrals and better patient management.
According to the naturopathic model, the human person is a biopsychosocial whole who is intimately connected to the environment. This dynamic is thought to be mediated by a series of cyclic, cybernetic processes. Therefore, rhythmic phenomena such as the temporal organization of the human system play a significant role in naturopathic therapeutics.
Using a naturalistic rather than a mechanistic metaphor, naturopathic medicine models the mind-body not as a machine but as in intelligent, self-organizing entity. Structurally, this entity is conceptualized as forming a totality comprised of several hierarchically-arranged levels of organization. Within this totality are innate self-healing (also called autopoietic) processes which make up the vis medicatrix naturae, an important concept that can be translated as the healing power of nature or the body’s inherent ability to heal itself. The processes of the vis medicatrix naturae are conceived as being cyclic, nonlinear, and open. Assisting the vis medicatrix naturae is the cornerstone of the naturopathic approach, philosophically and clinically.
Because the individual is modeled as a series of interactive levels, disease is not viewed as a discrete entity. Rather, it is seen as a hierarchical process manifesting as a pattern of disruptions. As these disruptions can occur on a variety of levels, naturopathic medicine recognizes both physical (matter/energy) and informational (data/meaning) type interventions.
Similarly, health is seen as a multilevel processes that incorporates emotional, spiritual, sociocultural, psychological, and physiological aspects. The result is the integrated capacity of the system to adaptively adjust to a wide array of environmental challenges. The term “adaptive” is a quality-of-life concept that refers to the ability of the organism to maintain a viable steady-state in a given milieu. The milieu itself is defined by a variety of environmental, physiological, and personal values. Naturopathic medicine’s diagnostic and therapeutic modalities are designed to identify, restore, stabilize and /or increase the level of adaptivity available to a given individual.
The therapeutic outlook of naturopathic medicine follows logically from this conceptual framework. As opposed to the physicalistic, engineering methodology of conventional medicine, naturopathy offers a synergistic, information-oriented treatment approach. The focus of this approach is the strengthening of the individual’s autopoietic resources. For this reason it is felt that treatment, to the extent appropriate, should be “natural”. That is, it should reflect the fact that the human system is genetically adapted to specific material and informational inputs. Looking to respect this biological heritage, natural therapeutics confines itself to evoking a therapeutic response through low-level invasive, life-style intensive treatment methods. To this end, naturopathy attempts to create a healing milieu by providing both physiologically and informationally-active therapeutic measures. The ultimate aim of the approach is to assist the human system in reaching its maximum level of stability, adaptability, and health.
Principles of Naturopathic Medicine
Some of the basic principles of naturopathic medicine are discussed below. These do not fully cover all aspects of the naturopathic healthcare model, but they provide a very good basic introduction.
The Healing Power of Nature: In terms of the ancient debate concerning the proper focus of medical therapeutics, naturopathic physicians generally ascribe to the view that the human organism has a unique capacity to heal itself and that such healing is only aided, not accomplished, by a physician. The incredible biomolecular complexity of the numerous cyclic, cybernetic processes of the organism is believed to account for this capacity, as exemplified by the recent advances in psychoneuroimmunology. Since the nonlinear, autopoietic dynamic that defines this self-healing ability of the human body has yet to be fully articulated, it is simply referred to in naturopathic medicine as the vis medicatrix naturae–the healing power of nature.
First Do No Harm: Naturopathic physicians, when given a choice of nearly equally effective agents, will generally choose the one that is safest. A more exact translation of this Hippocratic concept would be that sometimes harmful therapies are needed but they should be reserved for the last resort and, if at all possible, avoided. This principle does not mean harmful therapies should never be used.
Doctor as Teacher: One of a naturopathic physician’s primary roles is to educate the patient. This means that, to the extent possible and appropriate, information sharing with the patient should take place so that they are able to make informed decisions about their health care. Since the creation of a healthy lifestyle often rests on the choices and decisions the patient makes, this principle also implies that the patient has a responsibility to assist in the restoration of their own health. Another way to think about this that the “healing power of nature” can be constrained if significant obstacles are not addressed or if the patient is ignorant of their own self-healing processes. One of the naturopathic physician’s key tasks as a teacher is to empower the patient to appreciate and accept this responsibility.
Prevention and Wellness: Whenever possible, naturopathic physicians work to prevent illness rather than waiting until invasive treatment is required. Naturopathic physicians also strive to maintain wellness in all aspects rather than simply helping to prevent and treat illness. This principle implies that naturopathic medicine acknowledges the social and cultural antecedents of disease, since economic, cultural, and political factors can play as much of a role in determining one’s health as the better established mental, emotional and physical causes of illness.
Treat the Cause: Naturopathic physicians typically strive to determine the underlying causes of illness and to address these to the extent that it is feasible. While this is not always possible, this guiding principle is one that often overlooked in conventional medicine, and helps to define naturopathic medicine both in the field of research and in general patient care. Naturopathic physicians also work to relieve suffering and palliate disease. Sometimes this may be all that as possible if the causes of illness cannot be identified in an individual patient, though the cause can often be treated while suffering is simultaneously alleviated. The naturopathic healthcare model holds, however, that it is imperative to avoid suppressing symptoms in most cases without addressing the cause of the dysfunction. It is believed that if this clinical guideline is not observed, the potential for even greater pathology may ultimately be created.
Treat the Whole Person: Naturopathic physicians focus on taking into account the totality of the human individual they are working with in the course of patient care. Even a relatively minor physical ailment affecting one organ system may actually be a clue to larger pathology. The mind, body, and environment form a ecological whole that requires them to be considered together in the process of assessing health and disease.
For More Information
The American Association of Naturopathic Physicians (Washington, DC) is the national professional association of licensed naturopathic physicians. Their website at www.naturopathic.org provides a wealth of information about naturopathic medicine and maintains a referral list of licensed naturopathic physicians across North America. The Canadian Naturopathic Association performs the same function in Canada.
Most naturopathic medical schools maintain websites that contain a great deal of information about naturopathic medicine. Seven of these are:
- Bastyr University www.bastyr.edu
- Boucher Institute of Naturopathic Medicine www.binm.org
- Canadian College of Naturopathic Medicine www.ccnm.edu
- National College of Naturopathic Medicine www.ncnm.edu
- National University of Health Scienceswww.nuhs.edu
- Southwest College of Naturopathic Medicine www.scnm.edu
- University of Bridgeport www.bridgeport.edu/naturopathy