{A Systems Theory Approach To An Expanded Medical Model was written by Elliott Dacher M.D.}

As practitioners, we approach our patients and their problems within the framework of a conceptual model that organizes and defines the questions we ask, the information we seek, the diagnostic and therapeutic options, and ultimately the outcome of our interventions. Because we are so accustomed and conditioned to think and act within a specific framework, we rarely if ever consider the fundamental conceptual principles underlying our practice even though these principles can assume a powerful, although often unseen, authority over our professional lives.
The dominant medical model of Western culture, the biomedical model, is based on three underlying, yet untested, assumptions and principles: (1) objectivism, the idea that accurate knowledge can be exclusively achieved through an impersonal assessment of sensory based information; (2) determinism, the idea that causation is exclusively characterized by an upward and linear mechanistic linkage; and (3) positivism, the idea that knowledge exclusively accumulates through the accretion of data from the positive results of sensory based experimentation. This model has served us well, but with the progressive urbanization of life accompanied by the industrial and technologic revolutions humankind has seen the development of new and very different adversities, which have resulted in the emergence of a uniquely new category of modern day ailments, particularly stress related diseases, acute and chronic that are directly linked to personal attitudes and lifestyle. As a result, the limitations of a medical model that cannot effectively incorporate psychological, psychosocial, or spiritual factors-factors that are at the source of these ailments-has become increasingly evident.

The emerging public interest in health promotion, self-care, alternative healing practices, and mind/body medicine is a response to the limitations of the biomedical model and challenges future health practitioners to develop a more comprehensive understanding and approach to the care of individuals (Eisenberg et al., 1993). Ideally, such an approach would maintain the scientific rigor and discipline that has so successfully served the biomedical model while at the same time expand the vision and reach of modern medicine. New approaches to clinical care must be developed in a manner that can be easily integrated into clinical training and effectively assist the future practitioner in meaningfully expanding his or her capacity to respond to the changing needs and demands of a diverse population of clients.

The comprehensive model proposed here incorporates and integrates the principles and practices of the biomedical model with the new and emerging initiatives noted above. It does so by presupposing that there are multiple maps and explanatory models for perceived reality. Each map is considered valid in itself, yet when considered together they provide a closer approximation to reality than is possible when each is taken alone. As complex beings living in a complex ecology, we can appropriately and simultaneously be considered as instinctual beings whose systems are amenable to repair, interactive units whose major component systems are the mind and body, and spiritual beings who emerge from and ultimately rejoin the timeless flow of nature. The model I am proposing will consider each of these aspects of our being-instinctual, mind/ body, and spiritual-their relationship to each other, and the manner in which each can be integrated into a comprehensive approach to health.

This approach will be based on new set of assumptions and principles which incorporate, yet expand upon, those of the biomedical model. The first principle, dynamism, reflects the view that the human experience is at all times in an active and vital relationship with its environment, continuously exchanging nutrients and information and adapting to new and different circumstances. Unlike a machine that cannot change itself once it is set in motion, humans can repair their own tissues, regenerate new tissue, and through will adapt to varying external conditions by altering their actions. The second principle, holism, is the term that we use to designate the viewpoint that human life is a natural, self-organized, unfolding process that consists of constituent elements bound together from the very beginning as a unitary interactive whole. If an embryo is homogenized into a soup that contains all of its initial ingredients (DNA, RNA, and so forth) it is not possible to reconstitute a living embryo from these isolated parts. The memory and pattern of the whole precedes the development of the parts and is disrupted when the intact living process is altered. The final principle, purposefulness, intentionality and goal directed activity, can be found at every level of the human experience: The automatic mechanisms of homeostasis are directed towards maintaining a precise physiologic balance; the in-born psychic instincts, the Jungian archetypes, outline the patterns, intentions, and directions of psychologic development which sustain a continuity and stability of the human experience; and consciousness appears to follow the universal quest to expand itself sufficiently to understand and re-unite with the ground of its being. Together, these three principles extend our understanding of the human condition and recognize the full range of healing capacities built into the human mind and body.

Elliott S. Dacher is a pioneer in the emerging medicine of the future. His knowledge and practical approaches to the field of health and healing have evolved from his extensive experience as a practicing internist participating in over 50,000 medical visits and his ongoing independent research and study.