Holism

In medicine, holism is the claim that disease, health, and healing cannot be adequately understood by studying the body’s smallest parts in isolation. A holist insists that something is lost when a physician reduces a sick person to a malfunctioning organ, a disordered gene, or an abnormal lab value — that the patient’s life circumstances, relationships, psychological state, and social position are not background noise but part of what makes them sick and part of what will make them well. The concept operates at several levels simultaneously: as a theory of what disease is, as a guide to how medicine should be practiced, and as a critique of the biomedical model that has dominated Western medicine since the late nineteenth century.

What Holism Opposes

Holism defines itself against reductionism — specifically, against what Stegenga calls the biomedical model, the position that diseases should be understood and treated at the level of microphysiological parts and processes. (Stegenga, 2018) The dispute between holists and reductionists is not a single argument but several running in parallel. Stegenga identifies three dimensions: an ontological disagreement about whether higher-level properties (a person’s stress, their social class, their sense of meaning) can be reduced to lower-level ones (neurotransmitter concentrations, cortisol levels); a methodological disagreement about how to research disease; and an epistemological disagreement about what counts as an explanation of illness. (Stegenga, 2018)

The three dimensions do not always move together. A physician might accept ontological reductionism — believing that all disease processes are ultimately biochemical — while insisting on methodological holism, because the biochemical details are too complex to be clinically useful and a broader view of the patient produces better outcomes.

Holism About Disease

The holist’s strongest case begins with the observation that organisms are not the sealed, self-contained units that the biomedical model implies. Ludwik Fleck, writing in 1935, argued that the classical immunological picture of a bounded organism invaded by hostile agents was inherited from ancient myths about disease-causing demons, not derived from experimental evidence. Organisms are better understood as “harmonious life units” in which symbiotic bacteria play essential roles; what we call disease is less an invasion than a complicated revolution within this complex. (Fleck, 1935)

Arthur Kleinman extended this critique from the biological to the experiential level. He distinguished between illness — the lived human experience of symptoms and suffering — and disease — the practitioner’s technical recasting of that experience into biomedical categories. (Kleinman, 1988) When the biomedical model recasts illness as disease, something essential to the patient’s experience is stripped away: cultural meanings, social context, and personal significance are not legitimated as subjects for clinical concern and receive no intervention. (Kleinman, 1988) Kleinman proposed the biopsychosocial model as a dialectical alternative, construing disease as the embodiment of a symbolic network linking body, self, and society. (Kleinman, 1988)

Montgomery, approaching the question from clinical epistemology, observed that medicine strives for causal simplicity because the ethics of practice — the need to intervene in the patient’s illness — works to reduce cause in every case to the simplest manifestation possible. (Montgomery, 2006) But human biology resists this simplification. Illness exists on cellular, organic, organismic, personal, familial, and cultural levels simultaneously, making it what David Morris called “biocultural.” (Montgomery, 2006) The discovery of bacteria in the late nineteenth century hijacked disease causality, promoting expectations of a linear “magic bullet” cause for every disease and displacing earlier views of illness as a lapse from a physiological norm. (Montgomery, 2006)

The Organism as Whole

The most rigorous neurobiological case for holism in the first half of the twentieth century came from Kurt Goldstein’s The Organism (1939). Goldstein’s starting point was methodological: rather than ascending from experiments on simple organisms toward a theory of the human, he began with the human being as the primary datum and worked outward. (Goldstein, Kurt, 1939) He built this inversion on three postulates: record all phenomena without preference for those that fit existing theory; describe observable phenomena thoroughly before submitting them to theoretical reduction; and accept no concept that has been derived only from artificially isolated situations, because such concepts will not transfer to the whole organism without distortion. (Goldstein, Kurt, 1939)

From this foundation Goldstein extracted what he called a general law of organismic life: any change in one locality of the organism is always accompanied by simultaneous changes elsewhere. (Goldstein, Kurt, 1939) The corollary is that the properties of a stimulus cannot explain its effects; what determines the effect is the functional significance that stimulus holds for the whole organism at that moment. (Goldstein, Kurt, 1939) Every reaction, on this account, is a Gestalt-reaction of the whole, with figure and ground continuously reorganizing. There are no genuinely isolated processes except those produced artificially in the laboratory, and laboratory isolation is precisely what distorts the findings that reductionist physiology then generalizes. (Goldstein, Kurt, 1939)

Goldstein pressed this argument against localization theory directly. Transplantation experiments showed that performances are relatively independent of specific anatomical localities: correct innervation appears almost immediately after transplantation, which is inexplicable on the assumption that function is fixed in place. (Goldstein, Kurt, 1939) The significance of anatomical structures is real, but what any given region does depends entirely on its participation in the functioning of the whole organism at that time; no region carries its function as a fixed local property. (Goldstein, Kurt, 1939) The clearest expression of organismic unity, Goldstein argued, is the fact that only one performance is possible at any given moment. This is not an empirical generalization assembled from observations of reflexes; it is a direct expression of what it means for there to be one organism rather than a collection of semi-independent mechanisms. (Goldstein, Kurt, 1939)

Goldstein acknowledged that biological knowledge built on these principles would always be inherently incomplete. Understanding an organism requires starting with phenomenological descriptions of how the organism presents itself, then expanding to encompass the organism as a whole, a task that cannot be finished because new situations always reveal new aspects of the whole. (Goldstein, Kurt, 1939) This productive incompleteness is not a failure of the method; it is a feature of genuine contact with living reality as opposed to with the simplified preparations that isolationist methods use as their objects.

Holism About Intervention

If disease is shaped by social and economic conditions, then interventions should address those conditions rather than confining themselves to pharmacological “magic bullets.” Thomas McKeown’s argument that the major decline in tuberculosis mortality began long before antibiotics — driven instead by improved nutrition from greater socioeconomic equality — became the foundational case for interventional holism. (Stegenga, 2018) Michael Marmot’s Whitehall Study reinforced it by demonstrating that socioeconomic status causally influenced health outcomes even among British civil servants who were not poor. (Stegenga, 2018)

Stegenga frames the McKeown thesis as the claim that population health improvements came primarily from socioeconomic changes rather than reductionist medical interventions — that social and economic interventions deserve priority over pharmaceutical ones. (Stegenga, 2018) Stegenga contrasts this with disease-centered medicine, in which a patient is simply a vessel containing a disease entity that the physician must identify and eliminate. Patient-centered medicine, by contrast, treats the whole patient as the focus, engaging the patient as a partner in understanding their entire life situation. (Stegenga, 2018)

The Whole Person

The most philosophically developed version of medical holism comes from Eric Cassell’s work on suffering. Cassell argued that suffering occurs when a person perceives an impending destruction of their integrity as a person, and that it continues until the threat of disintegration has passed or the integrity of the person can be restored. (Cassell, 1991) This formulation makes suffering irreducible to bodily pain — patients can have severe pain without suffering (when the source is known and controllable) and can suffer without pain (when the meaning of their symptoms is dire).

Cassell proposed a topology of the person as the foundation for clinical care: persons have personality, character, a lived past, a family, a cultural background, roles, associations, a political existence, an unconscious life, a body, a believed-in future, and a transcendent dimension. (Cassell, 1991) The Cartesian mind-body split, he argued, had given medicine too narrow a conception of its domain, effectively excluding the person from medical concern and making suffering either “unreal” (because subjective) or identified exclusively with bodily pain. (Cassell, 1991) Even in the best clinical settings, patients suffer from their treatment as well as their disease, because medicine’s primary concern with the body and physical disease leaves the suffering person unaddressed. (Cassell, 1991)

Cassell’s most radical claim was that the “whole” in holistic medicine is not merely a whole patient but the irreducible unit of patient-plus-doctor — the healing relationship itself, not the individual. (Cassell, 1991) Yet this healing relationship was being undermined by the same technological specialization that Gadamer diagnosed: as hospital medicine fragmented care among subspecialists, the patient was left “essentially alone at critical junctures,” and the therapeutic power of the relationship went unused. (Cassell, 1991)

The Loss of Wholeness

Hans-Georg Gadamer, writing from a hermeneutical tradition, argued that specialization in modern research had moved so far from orientation toward the whole that even researchers needed the same kind of general orientation as lay persons when they looked beyond their narrow domain. (Gadamer, 1996) Mental health, in Gadamer’s account, was not the possession of specific measurable capacities but an equilibrium of the whole person — “a condition of the person as a whole being who is not simply a bundle of capacities.” Such equilibrium concerned the totality of a person’s relation to the world. (Gadamer, 1996)

Clinical and behavioral science research, Kleinman observed, possessed no category to describe suffering — no routine way of recording what he called “the most thickly human dimension” of patients’ and families’ experiences of illness. Symptom scales and survey questionnaires quantified functional impairment but were silent about the existential dimension. The image of patients that emerged from such research was “scientifically replicable but ontologically invalid.” (Kleinman, 1988)

Three Forms of Holism

Stegenga distinguishes three forms of holism that are often conflated. Values holism is the requirement that physicians take into account the patient’s values and preferences when formulating a treatment plan. Contextual holism is the requirement that physicians consider the broader context of a patient’s life when making a diagnosis. Metaphysical holism is the deeper philosophical claim that the complexity of normal and pathological physiology cannot be reduced to microphysical processes. (Stegenga, 2018) The first two are largely uncontroversial in contemporary medicine, at least in principle. The third remains genuinely disputed.

Goethean Wholeness

A distinct lineage of holism, separate from the Smuts–Engel–biopsychosocial line, runs from Goethe’s plant studies through the late twentieth-century revival of Goethean science. Its central distinction, articulated most precisely by the physicist and philosopher Henri Bortoft, is between two ways of conceiving the whole — only one of which Bortoft regards as authentic. Bortoft’s encounter with Goethe was not accidental: his interest grew directly from working under David Bohm in the 1960s on the problem of wholeness in quantum theory, giving his later Goethean philosophy roots in cutting-edge physics rather than in literary Romanticism.(Bortoft, Henri, 1996)

A counterfeit whole is the whole imagined as a thing standing behind or above the parts: either as a sum to which the parts add up, or as a “superpart” — a kind of false transcendental — that controls the lesser parts and dictates their behavior. (Bortoft, Henri, 1996) An authentic whole, by contrast, is the whole that is present in each part. The hologram is Bortoft’s primary illustration: the entire image is wholly present in each fragment of the plate, so that any piece reconstructs the whole image, only with reduced sharpness. (Bortoft, Henri, 1996) Authentic wholes are encountered not by stepping back to get an overview but by going further into the parts, since the whole is reflected in them. (Bortoft, Henri, 1996) The hermeneutic circle, named by Friedrich Ast in the eighteenth century, names the same structure in textual interpretation: the meaning of the whole is needed to read the parts, and the parts are the only path to the whole. (Bortoft, Henri, 1996)

Bortoft connects this analysis to Goethe’s plant morphology directly. In The Metamorphosis of Plants (1790) the leaf functions as an authentic whole in this sense: it is not a generalization abstracted from the cotyledons, stem leaves, sepals, and petals, but is present in each of them as a transformation. (Goethe, Johann Wolfgang von (Miller ed./trans.), 1790/2009) This organic unity, as Bortoft reads Goethe, turns ordinary perception inside-out: it holds differences within unity rather than flattening them into uniformity, and it refuses to treat the organism as a mere aggregation of separable parts. (Bortoft, Henri, 1996) Goethe’s “delicate empiricism” trains the perceiver to see the whole in the part rather than infer it from a collection of parts. The same intuition shapes his proto-ecological reading of organism-environment interdependence — published, as Miller notes, seventy-five years before Haeckel coined the word “ecology” — and his fractal account of plant identity, in which side branches are “separate small plants placed on the parent in the same way that the parent is attached to the earth.” (Goethe, Johann Wolfgang von (Miller ed./trans.), 1790/2009) (Goethe, Johann Wolfgang von (Miller ed./trans.), 1790/2009)

The diagnostic relevance for medical holism is direct. Bortoft argues that ordinary “spectator awareness” cannot grasp the whole because such awareness is occupied with things, and the whole is not a thing among things; the whole appears to such awareness as nothing, and so is missed entirely. (Bortoft, Henri, 1996) Medical holism, on Bortoft’s reading, slides into counterfeit-whole thinking whenever “the whole patient” is conceived as a sum of body, mind, social context, and spirit — a checklist of systems to be totaled, with the patient hovering somewhere behind them as an aggregating principle. The authentic alternative, modeled on Goethean cognition, would treat the whole patient as something present in each clinical observation rather than as a thing arrived at by adding observations together. The biologist Wolfgang Schad’s Man and Mammals applies this approach to zoology: every detail of an animal is read as a reflection of its basic organization, so that the animal “explains itself” rather than being explained by an external classificatory scheme. (Bortoft, Henri, 1996)

Bortoft proposes that this Goethean mode of science stands alongside mainstream science as complementary rather than competing: where mainstream science discloses the causal order of nature, Goethean science discloses its wholeness — both can be true, in incommensurable registers, and neither is more fundamental than the other. (Bortoft, Henri, 1996) (Bortoft, Henri, 1996) Vegetative reproduction supplies a visible natural example of multiplicity-in-unity: a fuchsia divided into many cuttings yields organically One plant — “all the potatoes of one variety in the world are one plant,” in John Seymour’s phrase Bortoft cites. (Bortoft, Henri, 1996) The same logical structure, Bortoft suggests, characterizes any authentic clinical whole.

Therapeutic Ecology

The philosophical argument from Goethean wholeness reaches its most concrete clinical expression in what David Hoffmann, writing in Medical Herbalism (2003), calls therapeutic ecology: the idea that the healing individual is enmeshed in a web of therapies that exist in relation to each other and to the wider world, rather than standing alone against a discrete disease entity. For Hoffmann, phytotherapy is not simply one treatment modality among others; it is the expression of humanity’s shared ecological and evolutionary heritage with plants. (Hoffmann, David, 2003) The practitioner who uses whole plants to treat whole people is, on this account, enacting a relationship that long precedes the institutions of medicine.

Hoffmann proposes that this ecological frame reshapes the structure of the healing encounter. Where biomedical practice places a physician against a disease, the therapeutic ecology model places the individual at the center of four concentric branches (medicine, bodywork, psychology, and spiritual technique), all existing in relation to each other and to the wider environment. (Hoffmann, David, 2003) Self-healing is not primarily a physiological event but a relational one, dependent on the quality of the whole ecological system in which the person is embedded.

The coevolutionary claim extends this further. Orthodox pharmacology tends to frame the secondary metabolites of plants (the alkaloids, phenolics, and terpenes that give medicinal herbs their effects) as chemical defenses, products of a Darwinian competition in which plants arm themselves against insects, fungi, and herbivores. Hoffmann argues that this framing is the antithesis of the vitalist herbalist worldview: most herbalists and naturopaths see the relationship between plants and human beings not as “an uneasy balance of chemical power” but as coevolutionary mutualism, a long-standing reciprocity rather than a running arms race. (Hoffmann, David, 2003) The distinction is not merely rhetorical. It determines what question the phytotherapist asks about a remedy: not “what toxic constituent must we isolate and dose carefully?” but “what is the character of this plant’s relationship with the human body?”

The meadowsweet case illustrates the stakes. Meadowsweet (Filipendula ulmaria) contains salicylates, the class of compounds behind aspirin, which are known to cause gastric irritation. Yet clinical tradition and observation confirm that meadowsweet can reduce gastric inflammation. Hoffmann draws the holist conclusion directly: salicylates do not account for the herb’s full activity, and some counteracting constituent must be present in the whole plant that the isolated compound lacks. “The whole is more than the sum of the parts.” (Hoffmann, David, 2003) This is not a metaphysical assertion made in advance of the evidence; it is an inference from a clinical discrepancy that isolationist pharmacology cannot explain.

Hoffmann presses this into explicitly ecological territory when he compares the environmental costs of conventional drug manufacture with those of herbal production. Industrial synthesis of a drug like cimetidine generates chemical waste and depends on energy-intensive processes; sustainably produced marshmallow (Althaea officinalis) supports small-scale agriculture and soil health. “Herbalism,” Hoffmann writes, “is part of a dawning awareness in humanity that Earth and its inhabitants do not exist solely for our use.” (Hoffmann, David, 2003) On this reading, the choice of a medicinal plant is not only a clinical decision but an ecological one, a position for which there is no counterpart in the biomedical model as conventionally understood.

The Western philosophical framework adequate to hold all of this together remains, Hoffmann acknowledged in 2003, still unwritten. He could identify what it would need to accomplish (using the biomedical model as an anatomical map without adopting its reductionist commitments), but could not yet point to the definitive text. (Hoffmann, David, 2003) This is honest rather than evasive. Bortoft could describe the logic of authentic wholes; Hoffmann could describe what treating with them looked like at the bedside; whether those two accounts amount to a single coherent philosophy of medicine is a question the field has continued to work through.

Holism and Alternative Medicine

Defenders of complementary and alternative medicine frequently invoke holism to justify their practices, claiming to treat the “whole person” rather than isolated symptoms. Stegenga observes that this appeal is ambiguous: the “whole person” in such formulations typically comprises body, mind, and spirit, but what spirit adds to the clinical picture — and whether it is a meaningful medical category — is left unclear. (Stegenga, 2018)

Charles Wolfe’s analysis of eighteenth-century vital materialism complicates the picture further. The Montpellier vitalists insisted on the irreducible materiality of the living systems they studied — they were interested in living bodies and organisms, not vital principles or entelechies. (Wolfe, Charles T., 2010-2015) Yet vital materialism was not a wholesale holism: it retained a reductionist dimension in its approach to body-soul relations, treating the soul’s properties as explicable through the material organization of the body while refusing to treat matter as merely inert. (Wolfe, Charles T., 2010-2015) The history of the holism-reductionism debate suggests that the two positions have never been as cleanly opposed as their advocates assume.

The term “holism” was coined in 1926 by the South African philosopher and statesman Jan Christiaan Smuts in his Holism and Evolution. Smuts defined it as an interpretation of living organisms as systems whose functioning is more complex than the sum of their individual parts: “The synthesis of parts into a whole changes those parts so that they no longer function as they would in isolation.” (Whorton, 2002) Despite this coinage, the word did not find its way into everyday medical discourse until the 1970s, when critics of conventional medicine adopted it as a slogan for their dissatisfaction with the biomedical model’s narrow focus on organs and pathogens rather than the patient as a whole person. (Whorton, 2002)

The Hippocratic Corpus contained proto-holist elements in its conception of disease as an agonistic drama requiring attention to the whole patient. The Epidemics formulated the collaborative triad of medicine — “the disease, the patient, the physician” — inverting the hierarchy so that the patient is the primary agent in fighting illness with the physician as servant of the art. (Jouanna, 1999) The foundational therapeutic formula — “opposites are cures for opposites” — required understanding the patient’s total constitutional balance, not merely a local lesion. (Jouanna, 1999) Fourth-century physicians elevated dietetics to the same level as surgery and pharmacology, placing it above them on the grounds that dietetic medicine addressed the whole person’s way of life, not merely an isolated disease. (Nutton, 2023) Phenomenological philosophy of medicine has provided the most philosophically rigorous contemporary case for holism. Havi Carel argues that illness is a complete transformation of one’s life whose impact cannot be adequately described as merely physical or mental dysfunction — understanding it requires viewing personhood as embodied, situated, and enactive, which is a fundamentally holist ontology. (Carel, 2016) The gap between objective disease markers and subjective illness experience is clinically important: the degree of correlation is so poor in some domains that the biomedical model’s reductionist assumptions become actively misleading. (Carel, 2016) S. Kay Toombs reinforces this from a Husserlian direction: the Western biomedical model identifies illness with pathoanatomical or pathophysiological fact, such that patients whose complaints do not correlate with demonstrated findings are dismissed as not really ill — a structural consequence of reductionist assumptions. (Toombs, 1992) Illness, Toombs argues, is fundamentally experienced as the disruption of lived body rather than dysfunction of biological body, and therapeutic goals that focus exclusively on objective pathophysiology are structurally incomplete. (Toombs, 1992) Carel has proposed a “phenomenological toolkit” — structured first-person accounts of illness experience — as a practical holist intervention designed to make the lived dimension of illness legible to clinicians. (Carel, 2016)

The Holistic Health Explosion (1970s–1990s)

The practical force of holism as a medical position emerged less from philosophy seminars than from a popular collapse of confidence in conventional medicine during the 1970s. Ivan Illich’s Medical Nemesis (1975) crystallized the critique with its opening declaration that “a crisis of confidence in modern medicine is upon us.” Illich accused the medical establishment of a “presumptuous expertise” that required every form of human suffering to be pressed into its narrow biomechanical construct of disease, and charged that medicine had itself become “a major threat to health” through the epidemic of doctor-induced, or iatrogenic, illness. (Whorton, 2002) The thalidomide tragedy of the 1960s had already imprinted pharmaceutical danger on public awareness; Illich turned this anxiety into a structural argument. (Whorton, 2002)

Into this atmosphere, acupuncture arrived. In July 1971, New York Times journalist James Reston traveled to China, underwent surgery for appendicitis, and had his postoperative pain relieved within an hour by an acupuncturist. His front-page account in the Times introduced a form of traditional Chinese medicine to millions of Americans who had never encountered it, and triggered a surge of public and medical interest in therapeutic systems that operated on principles entirely outside the biomedical model. (Whorton, 2002) Acupuncture became the visible symbol of what holistic medicine claimed to offer: attention to the patient’s whole energetic and constitutional situation, not merely the presenting lesion.

Henry Lindlahr’s Philosophy of Natural Therapeutics (1918) offered one of the early-twentieth-century vitalist tradition’s most explicit formulations of medical holism. Lindlahr described the human being as a three-dimensional entity — body, mind, and spirit — and argued that genuine healing must address all three dimensions: physical treatment (hydrotherapy, diet, fasting, exercise, spinal manipulation) addresses the physical body; mental treatment (auto-suggestion, cultivation of positive attitudes) addresses the mind; and spiritual treatment (faith, alignment with natural law, connection to the source of vital force) addresses the spirit (Lindlahr, Henry, 1918). No single modality, in his account, was sufficient, and health was the harmonious integration of all three. The formula anticipates the biopsychosocial model’s tripartite structure while grounding it in a vitalist rather than a biochemical framework.

Lindlahr also used zone therapy — a pressure-based somatic system — to argue for the kind of organismic interconnectedness that Goldstein’s neurological holism would later formalize: pressing specific points on the fingers could suspend or moderate pain in distant parts of the body, demonstrating that “you cannot injure one part of it without affecting its entire mechanism” (Lindlahr, Henry, 1918). The inference Lindlahr drew was conservative-sounding by holistic standards — it was primarily an argument against unnecessary surgery — but the underlying claim about systemic interdependence was the same claim that Goldstein would make from electrophysiology and Bortoft from Goethean morphology: that the organism functions as a whole and that local interventions have systemic consequences that isolationist thinking cannot anticipate.

Federal recognition followed, however awkwardly. In 1991, Senator Tom Harkin of Iowa pressed Congress to establish an Office of Alternative Medicine within the National Institutes of Health — the first time the federal research apparatus had been directed toward evaluating therapies that conventional medicine had treated as beneath investigation. (Whorton, 2002) NIH’s director at the time resigned partly because the appropriation “implied legitimacy for alternative medicine” in ways that felt to him like a political rather than a scientific decision. (Whorton, 2002) The office nonetheless survived and grew rapidly: by 2001 its annual appropriation had reached eighty-nine million dollars, forty-five times its original budget. In 1998 Congress upgraded it to the National Center for Complementary and Alternative Medicine, giving it greater autonomy within NIH. (Whorton, 2002)

The direction of travel was captured by the career of Andrew Weil, a Harvard-trained physician whose bestselling books on optimal health reached audiences that academic medicine rarely touched. In 1996 Weil established a Program in Integrative Medicine within the Department of Medicine at the University of Arizona — a two-year fellowship for MDs trained in internal medicine or family practice, designed to “combine the best ideas and practices of conventional and alternative medicine into cost-effective treatments” without embracing alternative practices uncritically. (Whorton, 2002) The word “integrative” signaled that the holistic impulse was no longer positioned against conventional medicine but offered as a supplement to it. Historian James Whorton, surveying this trajectory in 2002, borrowed a term coined by the early nineteenth-century reformer John Bovee Dods — “curapathy” — to describe the emerging synthesis: a moment when the boundary between alternative and conventional medicine might dissolve into something that could be called, simply, health care. (Whorton, 2002)

See Also

• Reductionism
• Vitalism
• Mechanism
• Social Determinants of Health
• Placebo Effect
• Suffering
• Clinical Judgment
• Medicalization
• Vis Medicatrix Naturae

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Holism and Alternative Medicine