Personal values and medical preferences: postmaterialism, spirituality, and the use of complementary medicine.

BACKGROUND: The use of complementary medicine is increasing in the countries of the West. To find out the reason for this, research concentrated on the patients' demands for these methods, on their dissatisfaction with conventional medicine, and on their health conceptions. Quantitative research into the influence of attitudes and convictions in a broader sense on the use of complementary medicine are lacking, but would be of interest. QUESTIONS: This article aims to throw light on the specific question of whether materialistic or postmaterialistic values and spiritual preferences correlate with the use of unconventional medical methods. METHOD: Within the framework of the Swiss National Research Programme 34: 'Complementary Medicine', 3,077 and 2,276 Swiss residents were interviewed by telephone in 1995 and 1996, respectively, about their use of the medical system as well as about their attitudes towards materialism and spirituality. RESULTS: Hypotheses were confirmed: Attitudes and convictions influence the use of complementary medicine. Postmaterialists and interviewees who tended to agree with neoreligious statements used complementary medicine significantly more frequently than materialists and interviewees who tended to disagree with neoreligiosity or who tended towards traditional Christian values. CONCLUSIONS: Further research should concentrate on the interaction of different attitudes and convictions in order to learn more about the background of the growing trend towards complementary medicine. Another important conclusion is that the so-called health market is not simply subject to supply and demand, and cannot be regulated by marketing means alone.

[Spiritual healing at a public psychiatric institution]. / Geistig-energetisches Heilen an einem öffentlichen psychiatrischen Dienst.

INTRODUCTION: Complementary medicine has an increasing importance also in Switzerland, above all for somatic diseases. The spreading of these methods in psychiatry and psychotherapy is a far slower process. The psychiatric outpatient service of the Swiss region Baselland offered, besides conventional psychotherapy and several different complementary methods, the possibility of spiritual healing and evaluated it by scientific means. QUESTIONS: Is a cooperation between a spiritual healer and a public institution feasible? What are the results of the treatment? How ist the perception of the treatment by the patients? Is further research promising? METHOD: Patients with diverse and mostly long-term diseases willing to receive spiritual healing had, in addition to a conventional psychotherapy, been treated by a healer working in our facilities. Before and after the healing sequence as well as at the follow-up after 6 months the patients have been questioned by means of semistructured interviews to give their impression of the treatment and its results. The respective psychotherapists and the healer herself had to give their assessment of the treatment and its results as well. RESULTS: The analysis of the data of the first 20 patients resulted in 9 persons stating a better well-being, one a deterioration and 8 broke off the treatment prematurely in unchanged health condition. The majority of patients very much appreciated the treatment in terms of ease and relaxation, only one patient reacted with anxiety and interrupted the first treatment. At the follow-up after 6 months there has been no change to the initial results. Two persons could not be reached for the post-evaluation. DISCUSSION: Cooperation of a healer and a public psychiatric institution proved to be feasible and fruitful. For almost half of the patients, the treatment has been a remedy highly appreciated and only one patient has reacted negatively. Therefore it seems justifiable to further offer this type of treatment and to evaluate it. To back up this estimation further, also controlled research studies should be carried out with e.g. more homogeneous patient groups or with different healers.

[Complementary and conventional medicine: prejudices against and demands placed on natural care and conventional doctors]. / Komplementär- und Schulmedizin: Vorurteile sowie Ansprüche an die Natur- bzw. die Hausärztin.

QUESTION: In Switzerland some 40% of the population use complementary healing methods, whereby 28% also make use of the services of alternative therapists. Are different demands made upon these alternative therapists in terms of their time, the respective perception of authority, understanding and trust, from those made upon conventional medical practitioners? METHOD: Within the framework of the Swiss National Research Programme 34: Complementary Medicine, qualitative interviews were initially conducted with 38 patients of natural-care doctors or traditionally-oriented family doctors. In a second stage, 3077 Swiss residents were interviewed by telephone in a longitudinal survey in 1995 and 2276 in 1996. RESULTS: The demand for doctors with partnership qualities decreases in favour of doctors more inclined to be directive, particularly in complementary medicine users in poor health. It took courage for about half of all those questioned to express an opinion at variance with that of their doctors. Both natural-care doctors and academically-trained family doctors clearly allocate sufficient time for consultation. Higher expectations were placed upon general practitioners in terms of accessibility, while natural-care doctors tended to be providers of advice in difficult situations. The level of compliance in terms of medication regime adherence is higher in the case of natural-care doctors. While users and non-users of complementary medicine alike expressed the expected attitudes and prejudices towards the other medical system, once again certain attitudes expressed by complementary medicine users depended upon their particular state of health. Natural-care doctors enjoy a relatively high legitimacy. DISCUSSION: The demands placed in terms of communication skills are high for both conventional and alternative medical practitioners, and call for a situation-sensitive approach to changing patient needs. General practitioners must accept that their traditional performance is as appreciated as ever but that in certain situations there are more significant explanation patterns concerning health and illness for patients than conventional medicine can offer. The (poor) level of compliance in the case of conventional medication should also be viewed in terms of the cost factor. In general, questions raised during consultations concerning medication should be seen as significant, as both users and non-users of complementary medicine pay close critical attention to them.

[Motivation for the choice of complementary and mainstream medicine. Patients' behavior in a pluralistic medical system]. / Beweggründe für die Wahl von Komplementär- und Schulmedizin. Patientenverhalten in einem pluralistischen Medizinsystem.

The reasons for choosing between various therapeutic possibilities depend in part on rational and in part on emotional factors. This project dealt with the systematic verification of some decision factors most of which were known already. The project was divided in a qualitative and a quantitative part. The qualitative segment was based on semistructured interviews with patients of general practitioners or of naturopaths. This procedure is often used in ethnological research. It identified and evaluated the main motives for the individual choices of therapies by the patients. The quantitative part of the study was carried out by a procedure often used in social sciences, namely by strictly structured telephone interviews of several thousand policyholders of the health insurance fund Helvetia. The aim of this part of the study was to verify the findings of the qualitative study and to investigate the possible significance of additional sociological factors for the choice between different therapies. The conclusions drawn from the abundance of data show that a widespread use of complementary medicine is a reality. Both parts of the project came to the same conclusions. The patients use complementary medicine in a very pragmatic way, be it alternately, be it in parallel but not necessarily in addition to mainstream medicine. The behavior of the patients is very complex, depends on many factors, and can neither be predicted nor easily influenced, not even by an additional free insurance for complementary medicine which was offered to one of the subgroups of the study (in conjunction with J. Sommer's project 'A Randomized Experiment Studying the Effect of Including Complementary Medicine in the Mandatory Benefit Package of Health Insurance Funds in Switzerland'). The interpretation of the telephone interviews concerning the significance of some of the registered sociological factors turned out to be difficult. The project aimed primarily at illustrating the use of complementary medicine and at characterizing its users.

[Accommodations for psychiatric patients. An empirical study of the Basel area canton]. / Wohnraum für psychisch Leidende. Eine empirische Untersuchung im Kanton Basel-Landschaft.

The psychiatric services of the Swiss region of Basel-Landschaft observed an increasing deterioration and shortage of accommodation offers for mentally ill persons. At the same time, it grew temporarily more and more difficult to let single rooms in flat-sharing communities. Therefore a psychiatric services research project aimed at evaluating the wishes and needs of specialists in the housing sphere, and of about 600 in- and outpatients, as well as for their caregivers. The results showed, similar to other studies, on the one hand patients' predominant wish to live independently, whereas on the other hand there was a great difference between the views of patients and their caregivers. The latter view this aspiration for independence rather skeptically. The striking disagreement between patients and caregivers may be fruitful for the therapeutic process; however, this applies only if both partners are aware of this fact.

[Conventional or complementary medicine: what criteria for choosing do patients use?]. / Schulmedizin oder Komplementärmedizin: Nach welchen Kriterien entscheiden sich die Patientinnen und Patienten?

Only a few studies have investigated in depth the motives behind the choice of conventional or complementary medicine. While some studies document failures or general mistrust of conventional medicine as the main reasons for turning to complementary medicine, others conclude that the decision to try alternative medicine is not necessarily due to disappointment with conventional medicine but rather an endeavour to do everything possible for one's own health. Patients regard complementary medicine indeed as a complement. Longer-lasting consultation and a better doctor-patient relationship are occasionally mentioned as favourable aspects of complementary medicine. Other motives are a critical attitude to modern civilization and the growing symbolic value of health. The choice may be related to the nature of the disease. Depending on the patient population involved, complementary medicine is used for either more difficult or simpler cases. As a general rule it is the chronic problems that are dealt with by complementary medicine. Users of complementary medicine cannot be regarded as a homogeneous group. Nevertheless, one Swiss study concludes that users of complementary medicine tend to be female, with higher education, from the upper middle class and aged between 30 and 50. They have postmaterialistic value priorities, holistic interpretative models of health and disease, and want to share in decision-making on treatment questions. Approaches and contexts of individual studies differ and the study populations of individual investigations are sometimes questionable. This means that some results are to be treated with caution. The literature under review rarely refers to cultural and social aspects as possible factors, and processes are likewise rarely investigated. Only one study presents behaviour in sickness as a social process which reveals how people perceive, interpret and respond to health problems. In conclusion, the sociological theories and findings involved in the entire question area are briefly outlined.