ESEARCH and royals, patients
R and politicians, counsellors and
clinicians – all have recently taken
a considerable interest in complementary
and alternative medicine (CAM). Fringe, ADRIAN FURNHAM on the role of psychology in
unconventional, unorthodox, natural and
folk medicine have come in from the cold, understanding the dramatic rise of alternative therapies.
and CAM is now big business under this
new label (Ernst & Furnham, 2000). CAM social causes to be specified in the q Therapy: Conventional medicine often
seems to be favourably perceived by many aetiology of illness. The third model has claims to destroy, demolish or suppress
general practitioners (Easthope et al., been labelled holistic and does not the forces that make people ill, while
2000). Indeed the rise of CAM has led to distinguish between soma, psyche and alternative therapies often aim to
a House of Lords inquiry into six aspects social. It stresses total therapy and holds strengthen the vitalising, health-
of CAM: evidence, information, research, up the idea of a natural way of living. promoting forces. CAM therapies
training, regulation and risk, and NHS The wide scope of CAM makes it seem particularly hostile to chemical
provision (Ernst, 2000). difficult to pigeonhole within one of these therapies and surgery.
In recent years the increasing public models, or to identify what unites CAM in q Patient: In much conventional medicine
interest in CAM (see box opposite) has the face of the considerable diversity of the patient is the passive recipient of
been reflected in academic books (e.g. theories, philosophies and therapies. Yet external solutions – in CAM the patient
Abbot et al., 1996; Vincent & Furnham, there are common themes within the is an active participant in regaining
1999) and journal articles (e.g. the ‘theme philosophies of CAM. Aakster (1986) health.
issue’ of the Journal of the American believes that they differ from orthodox
Medical Association, 1998, 280, No.18). medicine in five ways: One way of classifying the many different
So what answers has this research q Health: Whereas conventional medicine CAM therapies is by ‘emphasis’ (structural,
provided? Why is CAM so popular? sees health as an absence of disease, biochemical, energetic and mind-spirit) and
Does it actually work? And what role alternative medicine frequently by their methods of care and treatment
can psychology play in understanding mentions a balance of opposing forces (Turner, 1998). Using factor analysis, I set
the phenomenon? (both external and internal). out to see how 589 members of the public
q Disease: The conventional medicinal classified 39 different types of CAM,
Unity and diversity in CAM interpretation sees disease as a specific, depending on whether they had heard of it,
Aakster (1986) described three main locally defined deviation in organ or knew how it works, whether they had tried
models of medical thinking. The tissue structure. CAM practitioners it, and whether they believed it works or
pharmaceutical model is a demonstrable stress wide signs, such as body not (Furnham, 2000). A pattern emerged
deviation of function or structure that can language indicating disruptive forces with art therapies (e.g. music, dance), talk
be diagnosed by careful observation. The and restorative processes. therapies (i.e. counselling), and ‘foreign
causes of disease are mainly germ-like, and q Diagnosis: Regular medicine stresses techniques’ (e.g. Reiki, Shiatsu) all
the application of therapeutic technology is morphological classification based on classified distinctly. The ‘big six’ therapies
all-important. The integrational model location and aetiology, while alternative – acupuncture, chiropractic, homoeopathy,
resulted from technicians attempting to interpretations often consider problems medical herbalism, naturopathy (a belief in
‘reintegrate’ the body. This approach is not of functionality (e.g. in dressing or the healing power of nature) and
afraid of allowing for psychological and feeding oneself) as diagnostically useful. osteopathy – are often grouped together by
lay people, presumably because they see
them as most established and regulated –
despite the fact the they are based on very
WEBLINKS different methods and philosophies.
Research Council for Complementary Medicine: www.rccm.org.uk In fact it is this diversity in the field of
National Center for Complementary and Alternative Medicine: www.nccam.nih.gov CAM that can lead to problems in
Institute for Complementary Medicine: www.icmedicine.co.uk regulation. While there have been calls to
Complementary Medical Association: www.the-cma.org.uk find regulatory bodies to oversee all CAM
House of Lords Science and Technology Report: www.parliament.the-stationery-office.co.uk/ practices, this has proved very difficult
pa/ld199900/ldselect/ldsctech/123/12301.htm because of the theoretical, historical and
political differences between the various
The Psychologist Vol 15 No 5 May 2002
CAM specialities. Given this lack of an THE RISE AND RISE OF CAM
official regulatory body, scientific research
into the effectiveness of CAM becomes USA UK
even more crucial. q In 1993, 34 per cent of the population visited q Around 25 per cent of the British population
Fortunately, the popular interest in a CAM therapist, more than visited primary have used some form of CAM.
CAM has indeed been matched by a care physicians. Expenditure was estimated at q Around 80 per cent of the public who use it
relatively sudden and dramatic increase in $13.7 billion a year (Eisenberg et al., 1993). are satisfied with CAM therapies compared
research on the two central questions in q By 1998, 47.3 per cent of all Americans were with 60 per cent with ‘orthodox medicine’.
this area: do CAM therapies actually work, estimated to visit a CAM practitioner. annual q Around 65 per cent of British hospital doctors
and why do people choose them? visits rose from 427 million in 1990 to 629 believe that CAM has a place in mainstream
million in 1997 (Eisenberg et al., 1998). medicine.
Does it work? France q About 93 per cent of GPs have suggested
Is there good evidence from double-blind, q Use of homoeopathy (the most popular CAM) a referral to CAM (Ernst & Kaptchuk, 1996).
placebo-controlled, randomised studies that rose from 16 per cent of the population in q Nearly 67 per cent of local health authorities
a particular therapy ‘cures illness’ as it says 1982 to 29 per cent in 1987, and to 36 per in the UK are purchasing at least one form of
it does? Properly designed and executed cent in 1992 (Fisher & Ward, 1994). CAM (White & Ernst, 2000).
studies are complex and very expensive, The Netherlands q Individuals spend £1.6 million per annum on
and similar to the research effort to q In 1981, 6.4 per cent visited a CAM therapist – CAM therapies, the NHS about £40 million;
determine the efficacy of psychotherapy. rising to 15.7 per cent in 1990 (Fisher & Ward, and £500 million is spent on CAM products
Indeed, it is the extensive research into the 1994). (Ernst & Furnham, 2000).
placebo effect that makes psychological
input particularly valuable (Vincent &
Furnham, 1997). efficiency, the central question must be question is how the brand offers something
The answer to the question is either why patients choose (at their own expense) quite different that no other product service
very little or no good evidence is available to visit a CAM practitioner. What do they offers. This raises the question – as yet to
for the therapeutic success of most CAM, get from the treatment? Why do they be answered – of what makes an individual
possibly with the exception of herbalism persist? This is where there have been brand loyal to a therapy, a therapist or
(Vincent & Furnham, 1999). This is many psychological studies (Furnham & indeed a place of treatment.
because there has not been a concerted Kirkcaldy, 1996; Vincent & Furnham,
scientific research effort to investigate the 1999) concerning the often mixed motives People want a cure without side-
claims of many of the specialities of CAM that patients have in shopping for health effects or pain This may in fact
until recently. However, as more treatments. Results from various studies distinguish different CAM therapies,
sophisticated meta-analyses are published it (reported by Vincent & Furnham, 1997) offering a very strong, unique selling point
does seem to be the case that there is clear, show several key factors. for homoeopathy over either herbalism or
incontrovertible evidence for small but acupuncture, because of the scare stories
robust positive effects of specific CAM People shop for health They want to about poisoning in the former and pain and
treatments (e.g. Ernst & Pittler, 1998). use all possible (and affordable) options in infection in the latter. It is for instance the
health care. People are not ‘brand loyal’ to ‘gentleness’ of homoeopathy and its
Why choose it? orthodox medicine or any particular dilutions that may be particularly attractive
If the evidence is limited and equivocal, therapy. They experiment, and CAM is to to people.
and indeed often points to lack of many just another product or service. The
CAM is seen as a ‘last hope’ for
chronic illnesses Many sufferers of
chronic painful conditions or addictions
have tried many other cures, and turn to
CAM as a last hope. Some treatments
have a powerful psychological component
particularly those associated with touch
(i.e. massage, reflexology). Equally the
emphasis may need to move from cure
to effective management of such chronic
conditions, just as it does in clinical
Disappointment with the traditional
orthodox consultation GPs all too
often have little time, may seem
patronising, or may not fully examine the
patient or touch them. Further, patients are
often not asked the full set of questions
they expect to answer for a ‘full’ diagnosis.
In short, they are not treated like a modern
May 2002 The Psychologist Vol 15 No 5
adult consumer. There is a strong departure associated with gait, balance, body odour,
point for many CAM practitioners who and so on. The implication is that the
have much longer consultations, and diagnostic interview may need to include
appreciate patients’ need to talk or be questions about all aspects of the person’s
examined. The question is how the life, not only their physical symptoms.
traditional or average CAM consultation is
different from both traditional orthodox Is there a CAM ‘type’?
consultation and that of other (competitor) Comparisons of users and non-users of
CAM therapies. It is possible to compare CAM have shown evidence of different
and contrast across a number of variables beliefs about health and disease in general
(history-taking approach, language used, (Vincent & Furnham, 1997). There is some
patient role, decision-making process, evidence that frequent CAM users are more
bedside manner) to show how different health conscious and believe more strongly
they are, which may account for the that people can influence their own state of
popularity of CAM. health, both by lifestyle and through
maintaining a psychological equilibrium.
People want an emphasis on Users of CAM appear to have less faith in
‘wellness’, not ‘illness’ Because many ‘provider control’ – the ability of medicine
people want to learn more about self-care, (specifically orthodox doctors) to resolve
fitness (wellness and preventive measures) balanced, natural and preventive, fitting problems of ill health. Some studies of
orthodox medicine may be seen as a in with the particular zeitgeist. cancer patients using CAM have found that
narrow, restorative, disease- (complaint-) they were more likely than those not using
oriented approach that aims to destroy, Many people believe in the ‘holistic’ CAM to believe cancer was preventable
demolish or suppress illness-inducing message It seems obvious to most that through diet, stress reduction and
forces through such things as chemical lifestyle, personal relationships and work environmental changes and to believe that
therapies and surgery. What many people operate all together and simultaneously patients should take an active role in their
want is an emphasis on natural restorative have an impact on health. Equally they own health (Cassileth, 1988).
processes. The emphasis is quite different believe that there are many and manifold Many CAM users seem to be
– illness vs. wellness. Psychologists have signs of wellness and illness from sympathetic with green issues, ideas and
long recognised this as a valid and useful digestion, sleep patterns and body understanding. These include
approach. CAM is often seen as restorative, appearance to more subtle nonverbal signs environmentalism, anti-materialism and
a belief in ‘one world’. Pro-CAM beliefs
may also include issues around inequality,
References alienation, and social exclusion. CAM
Aakster, C. (1986). Concepts in Ernst, E. (2000).The British House of Complementary Therapies in
patients also seem to be interested in
alternative medicine. Social Science Lords enquiry into Medicine, 8, 82–87. general consumer affair issues and may
and Medicine, 22, 265–273. complementary and alternative Furnham,A. & Lovett, J. (2001). even belong to bodies that attempt to lobby
Abbot, N.,White,A. & Ernst, E. (1996). medicine. Focus on Alternative and Predicting the use of in favour of a certain position. They appear
Complementary medicine. Complementary Medicine, 5, 3–5. complementary medicine:A test
to be sensitive to consumer rights, bad
Nature, 381, 361. Ernst, E. & Furnham,A. (2000). BMWs of the theory of reasoned action
Bergin,A. & Garfield, S. (1994). and complementary/alternative and planned behaviour. Journal of practice and poor treatment. CAM patients
Handbook of psychotherapy and medicine. Focus on Alternative and Applied Social Psychology, 31, appear to be particularly interested in the
behaviour change. Chichester: Complementary Therapies, 5, 2588–2620. ‘life of the mind’. They certainly believe
Wiley. 253–254. Furnham,A. & Lovett, J. (in press).The the maxim of ‘a healthy mind and a healthy
Cassileth, B. (1988). Unorthodox Ernst, E. & Kaptchuk,T. (1996). perceived efficacy and risks of
cancer medicine. Cancer Complementary medicine – The complementary and conventional
body’. CAM patients are, because of their
Investigation, 4, 591–598. case for dialogue. Journal of the medicine: a vignette study. Journal own medical condition, likely to be very
Easthope, G.,Tranter, B. & Gill, G. Royal College of London, 30, of Applied Biobehavioural Research. empathic to the plight of others, and hostile
(2000). General practitioners’ 410–412. Turner, R. (1998).A proposal for to the ‘uncaring’ attitude of certain
attitudes toward complementary Ernst, E. & Pittler, M. (1998).The classifying complementary
specialists (e.g. surgeons). However,
therapies. Social Science and effectiveness of acupuncture in therapies. Complementary
Medicine, 51, 1555–1561. treating acute dental pain:A Therapies in Medicine, 6, 141–143. despite these suggested differences in
Eisenberg, D., Kessler, R., Foster, C., systematic review. British Dental Vincent, C. & Furnham,A. (1997). beliefs and values, there is little to support
Noriock, F., Calkins, D. & Journal, 184, 443–447. Complementary medicine: A the widely held view that those who use
Delbance,T. (1993). Fisher, P. & Ward,A. (1994). research perspective. Chichester: CAM are especially gullible or naive, or
Unconventional medicine in the Complementary medicine in Wiley.
United States: Prevalence, costs Europe. British Medical Journal, Vincent, C. & Furnham,A. (1999).
have unusual (neurotic) personalities or
and patterns of use. New England 309, 107–111. Complementary medicine: State bizarre values or belief systems.
Journal of Medicine, 328, 246–252. Furnham,A. & Kirkcaldy, B. (1996).The of the evidence. Journal of the In terms of demography, those who use
Eisenberg, D., Davis, R., Ettner, S., health beliefs and behaviours of Royal Society of Medicine, 92, CAM are more likely to be women, aged
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30–40, middle rather than working class,
M. et al. (1998).Trends in medicine clients. British Journal of White,A. & Ernst, E. (2000). Economic
alternative medicine use in the Clinical Psychology, 35, 49–61. analysis of complementary educated above average levels, and to live
national survey. Journal of the Furnham,A. (2000). How the public medicine:A systematic review. in urban rather than rural areas. Their
American Medical Association, 11, classify complementary medicine: Complementary Therapies in medical history is more likely to feature
1569–1575. A factor analytic study. Medicine, 8, 111–118. chronic problems than acute, often non-
specific or with a heavy psychological (i.e.
The Psychologist Vol 15 No 5 May 2002
non physical) component. Many patients including the explanations that they psychotherapy – with all the associated
have a ‘thick file’ in the sense that their provide, merits good research. Social problems of unregulated practitioners of
interest in health issues has led them to psychological expertise in questionnaire very dubious practices.
seek out various remedies from many design and analysis, as well as discourse Psychological theories may also be
different sources. analysis, can be (and indeed has been) applied to, and tested in, the CAM context.
However, despite some differences in very useful in trying to understand patient Thus Furnham and Lovett (2001) showed
beliefs, it is dangerous and foolhardy to motives and satisfactions. Research the theories of reasoned action and the
talk about the ‘typical’ user. CAM rejoices psychologists interested in experimental theory of planned behaviour could be
in differences and individuality and the design and meta-analysis may assist in used successfully to investigate factors
uniqueness of people’s lives. evaluating the quality of the experimental underlying intentions and actual use of
evidence, as well as assist CAM homoeopathy over a one-month period.
The role of psychology in CAM practitioners and less experienced research Similarly, Furnham and Lovett (in press)
research design studies so as to reduce artefacts and demonstrated how attribution theory could
Psychological research can substantially confounds. Recent studies on efficacy understand patient perceptions of risk.
help medical and sociological research into research into psychotherapy, perhaps even There are many other psychological
CAM through both methodological and harder to evaluate than CAM therapies, has theories and models in the health and
theoretical contributions. helped psychologists address some of the medical psychology literature (e.g. the
Psychologists’ expertise in evaluative issues concerned with evaluating the health beliefs model) that may go a long
research and methodology, their ingredients of therapeutic efficacy (Bergin way to answering some of the fundamental
understanding of placebo effects and their & Garfield, 1994). questions in this comparatively new,
emphasis on evidence-based methodology From a theoretical perspective multidisciplinary area of research.
means that they are ideally suited to join psychology may be particularly useful in Psychology and CAM may have a healthy
multidisciplinary research teams interested helping understand patient pathways to and fruitful relationship for many years to
in CAM. More sophisticated, longitudinal CAM; the knowledge, attitudes and beliefs come.
research is needed to explore differences of patients as well as the dynamics of the
in orthodox medicine and CAM patients. GP and CAM consultation. Indeed this s Adrian Furnham is Professor of
Further, key elements in the CAM knowledge may prevent the growth of CAP Psychology at University College London.
consultation that make them popular, – complementary and alternative E-mail: email@example.com.
May 2002 The Psychologist Vol 15 No 5