Silent voices: Women, complementary medicine, and the co-optation of change

Characteristics, Opportunities, and Challenges of Osteopathy Based on the Perceptions of Osteopaths in Austria: Qualitative Interview Study

BACKGROUND

There are no uniform regulations for the osteopathic profession in Europe. It is subject to country-specific regulations defining who shall be allowed to practice osteopathy and which qualification shall be required. In recent years, legal regulations have been established in several European countries for the profession of osteopathy; however, these are also still pending for Austria. Currently, physiotherapists and physicians with osteopathic training are practicing osteopathy in Austria.

OBJECTIVE

This study aims to examine the characteristics, challenges, and opportunities of osteopaths in Austria.

METHODS

Guideline-based interviews with osteopaths (N=10) were conducted. The different research questions were examined using a qualitative content analysis.

RESULTS

The study provided a differentiated insight into the professional situation of osteopaths in Austria. The most important result was that all interviewees unanimously supported a legal regulation of their profession. However, owing to their different professional self-image-on the one hand, individuals working on a structural basis, and, on the other hand, individuals working on a cranial or biodynamic basis-they were able to imagine a uniform professional regulation only to a limited extent. Additional topics for the interviewed osteopaths in Austria were the quality assurance of training and the urgent need for scientific research. Furthermore, the study also dealt with the influence of the COVID-19 pandemic on daily practice and on education and training in osteopathy.

CONCLUSIONS

This study is a pioneering study with regard to systematic basic research on osteopathy in Austria. The obtained results and the newly acquired research questions not only have the potential to serve as a basis for further studies but also provide insight into the working and professional situation of osteopaths in Austria for universities, schools, professional associations, politics, and-last but not least-all interested parties.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/15399.

The salutogenic gaze: Theorising the practitioner role in complementary and alternative medicine consultations

Research on why people use complementary and alternative medicine (CAM) shows clients value the CAM consultation, where they feel listened to and empowered to control their own health. Such 'empowerment' through CAM use is often theorised as reflecting wider neoliberal imperatives of self-responsibility. CAM users' perspectives are well studied, but there has been little sociological analysis of interactions within the CAM consultation. Specifically, it is unclear how user empowerment/self-knowledge relates to the CAM practitioner's power and expert knowledge. We address this using audio-recorded consultations and interviews with CAM practitioners to explore knowledge use in client-practitioner interactions and its meaning for practitioners. Based on our analysis and drawing on Foucault (1973), The Birth of the Clinic: an archaeology of medical perception and Antonovsky (1979), Health, Stress and Coping, we theorise the operation of power/knowledge in the CAM practitioner-client dyad by introducing the concept of the 'salutogenic gaze'. This gaze operates in the CAM consultation with disciplining and productive effects that are oriented towards health promotion. Practitioners listen to and value clients' stories, but their gaze also incorporates surveillance and normalisation, aided by technologies that may or may not be shared with clients. Because the salutogenic gaze is ultimately transferred from practitioner to client, it empowers CAM users while simultaneously reinforcing the practitioner's power as a health expert.

Bodily intimacy and ritual healing in women'stantric retreats

Alternative health care and holistic spiritual practices have become increasingly popular in many Western countries, especially among women, who often claim them to be deeply transformative. This paper presents an ethnographic study of women's tantric retreats in Northwest Europe that aimed to help women reconnect with their vital sexual energy, rediscover the sacredness of their female bodies, and possibly heal from damaging and even traumatic experiences regarding their femininity and sexuality. It draws on Turner's influential view on ritual as a liminal space in order to account for the transformative potential of these workshops. Specifically, it applies Hinton and Kirmayer's flexibility hypothesis, which suggests that healing rituals shift people's mode of being-in-the-world, including their cognitive, emotional, and physical state or stance, towards openness to new ways of being. First, it highlights different ontological domains where shifts took place, notably somatic state, self-image and relationality. Subsequently, it identifies the main modalities that were used for enabling transformation: the embodiment of the metaphor of the goddess/the divine as present in each woman and the use of intimate, loving touch and meditative awareness. The process of transformation and healing elucidated in this way engaged the physical, emotional and cognitive levels as interacting dimensions, relying foremost on the activation of a vital energy that both gave participants a deep sense of self and connected beyond the self.

Medical Pluralism, Mainstream Marginality or Subaltern Therapeutics? Globalisation and the Integration of ‘Asian’ Medicines and Biomedicine in the UK

Medical Pluralism refers to the coexistence of differing medical traditions and practices grounded in divergent epistemological positions and based on distinctive worldviews. From the 1970s, a globalised health market, underpinned by new consumer and practitioner interest, spawned the importation of ‘non-Western’ therapeutics to the UK. Since then, these various modalities have coexisted alongside, and sometimes within, biomedical clinics. Sociologists have charted the emergence of this ‘new’ medical pluralism in the UK, to establish how complementary and alternative medicines have fared in both the private and public health sectors and to consider explanations for the attraction of these modalities. The current positioning of complementary and alternative medicines can be described as one of ‘mainstream marginality’ ( Cant 2009 , The New Sociology of the Health Service, London: Routledge): popular with users, but garnering little statutory support. Much sociological analysis has explained this marginal positioning of non-orthodox medicine by recourse to theories of professionalisation and has shown how biomedicine has been able, with the support of the state, to subordinate, co-opt and limit its competitors. Whilst insightful, this work has largely neglected to situate medical pluralism in its historical, global and colonial contexts. By drawing on post-colonial thinking, the paper suggests how we might differently theorise and research the appropriation, alteration and reimagining of ‘Asian’ therapeutic knowledges in the UK.

Integrative Health for Women

Integrative Medicine is a model of health care that combines both conventional and unconventional therapies that serve the whole person and focus on prevention and whole health. Women are the highest utilizers of health care and Integrative Medicine for a variety of reasons. Integrative Medicine represents a more "female energy" in the field of medicine, which is needed even more today as health care moves toward value-based care and out of high-cost and high-harm care. Integrative Medicine can be incorporated into medical practice and into health workers' lives for wellness.

Undoing gender? The case of complementary and alternative medicine

Despite a rich body of sociological research that examines the relationship between gender and health, scholars have paid little attention to the case of complementary and alternative medicine (CAM). One recent study (Sointu 2011) posits that men and women who use CAM challenge traditional ascriptions of femininity and masculinity through the exploration of self-care and emotions, respectively. Drawing on 25 in-depth interviews with middle-class Americans who use CAM, this article instead finds that men and women interpret their CAM use in ways that reproduce traditional gendered identities. Men frame their CAM use in terms of science and rationality, while simultaneously distancing themselves from feminine-coded components of CAM, such as emotions. Women seek CAM for problems such as abusive relationships, low self-esteem, and body image concerns, and frame their CAM use as a quest for self-reinvention that largely reflects and reproduces conventional femininity. Further, the reproduction of gendered identities is shaped by the participants' embrace of neoliberal tenets, such as the cultivation of personal control. This article contributes to ongoing theoretical debates about the doing, redoing and undoing of gender, as well as the literature on health and gender.

A qualitative study on the term CAM: is there a need to reinvent the wheel?

Background

As complementary and alternative medicine (CAM) has developed extensively, uncertainty about the appropriateness of the terms CAM and other CAM-related terms has grown both in the research and practice communities. Various terms and definitions have been proposed over the last three decades, highlighting how little agreement exits in the field. Contextual use of current terms and their respective definitions needs to be discussed and addressed.

Methods

Relying upon the results of a large international Delphi survey on the adequacy of the term CAM, a focus group of 13 international experts in the field of CAM was held. A forum was also set up for 28 international experts to discuss and refine proposed definitions of both CAM and integrative healthcare (IHC) terms. Audio recordings of the meeting and forum discussion threads were analyzed using interpretive description.

Results

Multiple terms to describe the therapies, products, and disciplines often referred to as CAM, were considered. Even though participants generally agreed there is a lack of optimal definitions for popular CAM-related umbrella terms and that all terms that have so far been introduced are to some extent problematic, CAM and IHC remained the most popular and accepted terms by far. The names of the specific disciplines were also deemed adequate in certain contexts. Focus group participants clarified the context in which those three terms are appropriate. Existing and emergent definitions of both CAM and integrative healthcare terms were discussed.

Conclusions

CAM and other related terms could be used more effectively, provided they are used in the proper context. It appears difficult for the time being to reach a consensus on the definition of the term CAM due to the uncertainty of the positioning of CAM in the contemporary healthcare systems. While umbrella terms such as CAM and IHC are useful in the context of research, policy making and education, relevant stakeholders should limit the use of those terms.

Providing therapies to the opposite sex: views of complementary therapists working in clinical and private practice settings

AIM

The study explored the experiences of working with the opposite sex as a therapists in a cancer care centre (CCC).

METHODOLOGY

Therapists (n = 17) participated in three focus groups. Audiotapes were transcribed verbatim and analysed.

RESULTS

Themes and sub-themes were identified; these related to maintaining safety, the relevance of location to how safe therapists felt when working with men, the therapeutic relationship, safety precautions and being vigilant.

LIMITATIONS

The participants were from one cancer care centre in the North West of England. Only two males participated.

CONCLUSION

This exploratory study identified that the majority of the participants in this study had concerns about safety related to the gender or sex of their patient or client. This was more of an issue in private practice with concerns centred on inappropriate sexual responses from male clients. This has implications for training and safety in establishing and maintaining a practice.

Complementary medicine in the primary care setting: Results of a survey of gender and cultural patterns in Israel

OBJECTIVE

The purpose of this study was to examine the use of complementary and alternative medicine (CAM) in a primary care practice in Israel to determine prevalence and patterns of use.

METHODS

Trained research assistants invited all patients attending the administrative, medical, pharmaceutical, or nursing services of 7 clinics in urban and rural areas of northern Israel over a 16-month period, from April 1, 2005, through August 1, 2006, to complete a 13-item written questionnaire about CAM use and beliefs about CAM safety and efficacy. CAM was defined as therapies often referred to as alternative, complementary, natural, or folk/traditional medicine, and which are not usually offered as part of the medical treatment in the clinic, including herbal medicine, Chinese medicine (including acupuncture), homeopathy, folk and traditional remedies, dietary/nutritional therapy (including nutritional supplements), chiropractic, movement/manual healing therapies (including massage, reflexology, yoga, and Alexander and Feldenkrais techniques), mind-body techniques (including meditation, guided imagery, and relaxation), energy and healing therapies, and other naturopathic therapies. The Pearson chi(2) test and multivariate logistic regression were used to assess univariate associations with the odds ratios of CAM use among Arab and Jewish women. A t test was performed to determine whether there were any differences in the continuous variables between the 2 groups.

RESULTS

Of 3972 consecutive patients who received the questionnaire, 3447 responded; 2139 respondents (62%) were women. Of the female respondents, 2121 reported their religion (1238 respondents [58%] self-identified as being Arab, and 883 [41.6%] as being Jewish). Compared with men, more women used CAM during the previous year (46.4% vs 39.4%; P < 0.001). Women were more likely to use CAM and to be interested in receiving CAM at primary care clinics. Arab women reported less CAM use than Jewish women but were more interested in experiencing CAM, had a higher degree of confidence in CAM efficacy and safety, and more frequently supported the integration of CAM practitioners in primary care clinics.

CONCLUSIONS

In this study, women visiting primary care clinics in northern Israel used CAM more often than men did. Arab women reported less use of CAM than did Jewish women but also reported greater confidence in CAM efficacy and safety.