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The College of Naturopathic Doctors of Alberta (CNDA) asked me to lecture at their June 2018 conference and dictated my topic would be "Back to Basics." This sounded easy enough when first suggested, nearly a year before, as in theory I wouldn't have to read and learn new information. I could just stick with basic stuff that we already all know. It would be preaching to the choir, I thought, a piece of cake, as they say. Yet preparing this lecture turned out to be more challenging than I thought it would be and likely more controversial than I really want it to be. Mind you, I do not shy away from controversial ideas, curmudgeon that I am, but even I worry that colleagues may stop talking to me.
To speak about basic naturopathy, it was apparent that I needed a clear definition of what naturopathy is. To point my audience backwards in the direction of basic naturopathy necessitates accurately defining what naturopathy is. As I began to think about this and plan the lecture in my mind, it became apparent that the definitions we rely on are inadequate, not just for my purpose but for a range of other things such as legislation, public relations, and education.
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A good definition describes the meaning of a word so that it expresses the essential nature of the thing; a good definition gives a clear outline of the subject in question, marking its border so it stands out and is distinguishable from other similar things. A definition defines; it draws a line around the thing.
My usual first step to understanding the meaning of a term is usually to look at the root words it derives from. So "naturo," is probably from the Latin word natura, to which the Greek suffix "-pathy" is tagged on. The suffix "-pathy" derives from pathos, meaning "suffering or disease." The same suffix is used in loads of terms such as myopathy (muscle disease), neuropathy (nerve disease), or even sympathy (suffering together).1
Thus, naturopathy might have two possible meanings. First it might mean, "nature-disease" or "suffering nature." If so, then climate change or drought might be examples of naturopathy. Or perhaps naturopathy could mean "suffering caused by nature," perhaps an example would be frostbite. My lecture audience is, after all, going to be Canadians. The roots of the word "naturopathy" seem insufficient to define naturopathic medicine.
Many websites tell us that Dr. John Scheel patented the term "naturopathy" in 1895, and that Lust purchased the rights from him. My search through the patent records has so far failed to locate this patent. I had hoped Scheel might have described what he meant by the term in his patent application.
The definition of naturopathy that is often quoted in the legislative arena to carve out a scope of practice is originally from the federal Dictionary of Occupational Titles published in 1931:
Doctor, Naturopathic (medical services) 079.101-014 A Naturopathic physician, diagnoses, treats and cares for patients, using a system of practice which bases treatment of physiological functions and abnormal conditions on natural laws governing the human body: utilizes physiological, psychological and mechanical methods, such as air, water, light, heat, earth, phototherapy, food and herb therapy, psychotherapy, electrotherapy, physiotherapy, minor and orificial surgery, mechano-therapy, natural processed foods and herbs and nature's remedies. Excludes major surgery, therapeutic use of x-ray and radium and use of drugs, except those assimilable substances containing elements or compounds which are components of body tissues and are physiologically compatible to body processes for maintenance and life.2*
During the process of winning licensure, naturopathic medicine was defined by the individual state licensing statutes, but these definitions were legal scope-of-practice definitions, often conflicting with each other, reflecting different standards of practice in different places; they just told us the limits of what we could do legally, not what we were doing. In 1965, the US Department of Labor's Dictionary of Occupational Titles became the formal and widespread definition because it was federal and superseded state definitions. The definition was controversial as it primarily reflected a nature cure perspective:
Diagnoses, treats and cares for patients using a system of practice that bases treatment of physiological function and abnormal conditions on natural laws governing the human body. Utilizes physiological, psychological and mechanical methods such as air, water, light, heat, earth, phytotherapy, food and herbs therapy, psychotherapy, electrotherapy, physiotherapy, minor and orificial therapy, mechanotherapy, naturopathic corrections and manipulations, and natural methods or modalities together with natural medicines, natural processed food and herbs and natural remedies. Excludes major surgery, therapeutic use of x-ray and radium, and the use of drugs, except those assimilable substances containing elements or compounds which are components of body tissues and physiologically compatible to body processes for the maintenance of life.
We rarely use this definition when describing who we are and what we do in public. I cannot name any "natural laws governing the human body" aside from gravity.
The current definition the American Association of Naturopathic Physicians (AANP) uses is as follows:
Naturopathic medicine is a distinct primary health care profession, emphasizing prevention, treatment, and optimal health through the use of therapeutic methods and substances that encourage individuals' inherent self-healing process. The practice of naturopathic medicine includes modern and traditional, scientific, and empirical methods.3
This implies a single self-healing process shared by all individuals. That feels rather vague to this reader. So does the word distinct. A good definition should distinguish between primary health care professions and tell us how naturopathic medicine is distinct.
The Canadian Association of Naturopathic Doctors (CAND) definition reads as follows:
Naturopathic medicine is a distinct primary health care system that blends modern scientific knowledge with traditional and natural forms of medicine. The naturopathic philosophy is to stimulate the healing power of the body and treat the underlying cause of disease. Symptoms of disease are seen as warning signals of improper functioning of the body, and unfavourable lifestyle habits. Naturopathic medicine emphasizes disease as a process rather than as an entity.
Process? Entity? I admit I don't think I've ever thought about this. I'll have to ask those Canadians about this. That lecture in Calgary I am committed to giving is only a few weeks off as I write this.
Benedict Lust's 1905 definition also attempted to distinguish the profession by claiming it is distinct but then claims ownership of osteopathy and chiropractic under the heading naturopathy:
Naturopathy is a distinct school of healing, employing the beneficent agency of Nature's forces of water, air, sunlight, earth power, electricity, magnetism, exercise, rest, proper diet, various kinds of mechanical treatment such as massage, Osteopathy and chiropractic, and mental and moral science."4
If you want to read more of these definitions, the white paper Iva Lloyd, ND, wrote for the World Naturopathic Federation lists over a dozen different definitions of naturopathy.5
We don't pay much attention to these definitions anymore as our profession backed away from striving for a clear definition of naturopathy about 30 years back and instead substitutes a list of principles that supposedly underlie naturopathic medicine. Here is the short version copied from Bastyr University's website, though most naturopathic doctors know them by heart:
- The Healing Power of Nature (Vis Medicatrix Naturae): Naturopathic medicine recognizes the body's inherent ability to heal itself...
- Identify and Treat the Causes (Tolle Causam) ...
- First Do No Harm (Primum Non Nocere) ...
- Doctor as Teacher (Docere) ...
- Treat the Whole Person…
How did we come to these principles? The credit goes to Drs. Pam Snider and Jared Zeff. Actually, some of the credit for this switch in focus from definition to principles should be shared with Roger Fisher and William Ury. These two guys wrote a book called Getting to Yes that was published in 1981.
For those of you too young to remember, there was an optimistic period in the 1980s when conflicts were considered resolvable by a "getting to yes" idea, promoted in that book. The premise was that when negotiating, rather than focusing on points of disagreement, instead to focus on common goals or points of agreement.7 This simple idea changed the dynamics of many an argument and gave us hope that other conflicts could be resolved. (I recall one of our lobbyists forcing me to read it before taking the Colorado ND Association on as a client.) These 'getting to yes' tactics were so popular that one did not need to have read the book to ask, "Let's find what we can agree on to move forward and each get what we need instead of arguing."
This is in essence what the AANP did in the late 1980s.8 Jared Zeff described the challenges back then:
In 1985 or so, when the AANP began, we knew we needed to accomplish 5 things to reestablish our profession. We needed a national professional organization, we needed our schools accredited, we needed a national standard/national licensing examination, we needed a peer-reviewed journal, and we needed a useful definition for legal, educational, and other purposes. The extant definition was the US Department of Labor, Dictionary of Occupational titles definition, which was strictly a modality-based definition: "Naturopaths treat the sick with diet, earth, air, water, etc." This was not useful to us legislatively, and we would tend to argue about whether it should include or exclude this or that. I was given the job of developing a useful definition, along with Pamela [Snider].
We were to lead an open session at the Alderbrook Convention in 1986, our second AANP conference, to begin the process of developing the definition. We knew what would happen and had a secret plan to implement. We had a room full of naturopaths: older, younger, men, women, students, US and Canadians. Any time this had been done in the past, the argument broke out about what should be included. And that is how this meeting began, with arguments about modalities. After a while of the arguments, I posed a question; 'Is there anything about which we do agree?' I knew the answer in advance. It was that we all agreed that there was a philosophy that underlay the medicine. Once the room acknowledged that we agreed that there was a naturopathic philosophy, then we proposed that we determine what that was. What were the tenets of that philosophy? Certainly, Vis Medicatrix Naturae, Do No Harm, and what else? … the process we went through to answer that question, … took three years, and resulted in the definition we now use. We built into the process a review every 5 years to make sure we did not leave something out, etc. It has gone through 2 reviews since the initial unanimous adoption, and has not yet been changed.
…The first time there was a proposal for the consideration of 3 new tenets to add to the 6-tenet definition. They were: Least Force, Ease Suffering, and one other that escapes me. These were written, proposed to the House [of Delegates, AANP], debated, and defeated.9
Dr. Pam Snider remembers a similar process: "The Committee wrote the first draft and presented it at Alderbrook. There was an open mike, more revising over the weekend, the first draft was published for the profession to comment on, and Jonathan Wright had also solicited a lot of input from old and new docs, students etc. in a booklet he pulled it all together in and sent to me and Jared. A 1988 bound report to AANP has a lot of input reported in it…this went on for 3 more years."10
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