When Dr. John Travis started his "Wellness Resource Center" in Mill Valley, Calif., in 1975, he figured "it would never fly. It was too weird. Even the name wouldn't catch on."
By 1980, he said recently, with mixed satisfaction and regret, "you didn't have to spell wellness on the telephone anymore."
Satisfaction, because the name he coined had become as much a part of the culture as jogging.
Regret, because, Travis said to a small group of "wellness" physicians recently, it had pretty much lost its original meaning.
"What's happened," he said, "is that the health education people and the fitness people and some elements of the holistic movement have co-opted the concept of 'wellness,' but with a much narrower definition."
Travis was training at Johns Hopkins Medical Center in 1972 when the concept first came to his attention.
He was one of a growing number of medical students who, confronted by increasingly high-tech, mass-production hospital medicine, were becoming increasingly disillusioned, depressed and confused by their chosen profession. A system that appeared to fall short of the ideals of healing that drew them to medicine in the first place began to stir rebellion -- a Sam Shem, for example, who vented his reaction to the system in the cult-classic "House of God," and then went on to become a psychoanalyst, novelist and playwright. Or a John Travis, who helped invent a new kind of medicine, or, as he would prefer, a new kind of health. What immediately appealed to him about the wellness idea was that it was a concept that "put together spiritual, mental and physical well-being."
It was neither a response to an illness nor even just a way to prevent illness, but a new healthy, or well state of being, involving body, mind and soul. It was something new, although it had its roots in ancient healing methods. It was, he believed, a genuine paradigm shift -- a so-called sea change, away from Rene Descartes' philosophy which had effectively separated the concepts of mind, body and spirit and scattered their care over the past 300 years to the clergy, the doctors and, eventually, the psychiatrists.
Wellness, the precursor of the so-called holistic movement, would consider all aspects of the human being as related, each essential to the other, and only in the balance of the three in relation to an individual's environment would a state of wellness exist.
Today, however, in its narrower, popular definition, "it is usually just a physical meaning, often confused with preventive medicine and health education -- you know, learning how to culture your throat or check your lymph nodes and that sort of stuff, which is really not wellness at all."
For example, he said, "fitness is only about one twelfth of wellness, and so is nutrition. And unless you deal with the psychological and spiritual elements, you run into the same problems health education did in the 1970s -- putting out information to people who already know they should stop smoking or lose weight or stop drinking. And they already felt bad about it, and felt even worse as people plucked their guilt strings and faded off into the woodwork.
"What is important," said Travis, "is that we look at the reasons people smoke, abuse themselves with things like alcohol, and then provide them with the basic human needs that those high-risk behaviors are attempts to substitute for."
Dr. James S. Gordon, a psychiatrist who practices and teaches holistic medicine at the Georgetown University Medical Center, has spent years studying and writing about "alternative" medicine. "We are," he says, "still groping for the proper scientific language to encompass the holistic approach," but he is convinced that its integration with the western medical model is becoming more and more accepted. At Georgetown, Gordon teaches an elective course on "the integral approach to psychiatry and psychosomatic medicine," and finds "a growing awareness among medical students who are already beginning to look at alternative ways."
Today John Travis runs "Wellness Associates" in Mill Valley, Calif., where, he wrote recently, the orientation is not "towards healing conditions of illness. In contrast, the primary orientation of wellness is on increasing conditions of wellness."
Travis and a half a dozen colleagues from all parts of the country meet together on a more or less regular basis to discuss the state and the growth of the wellness concept. Dr. Elliot Dacher, who began his own practice in the most traditional of modes, is one of them, and at a recent session, moderated an informal appraisal of the movement. It is widely misunderstood and misinterpreted and the name may be attached to almost anything, from fitness courses and food faddism to a host of mostly non-medically trained practitioners Travis has referred to as "flaky," even though he eschews the old model of medicine almost completely.
Dacher, on the other hand, although not a psychiatrist as Gordon is, practices similarly, incorporating modern medical technology into an approach that is a little hand holding, a little empathy, a little direction and a lot of one-on-one doctor-patient time. Through his "Wellness Center" in Reston, he helps his patients form support groups to which they can specifically relate and recently has begun a series of retreats. To cut costs, because health insurance reimbursements tend to be for procedures, rather than time, Dacher has no receptionist, draws blood himself and performs many of his own tests.
Because he could not devote the kind of time he felt was necessary for the kind of practice he wanted, Dacher gave up a position with a major health maintenance organization where, as he puts it, "I was in a situation where I was very powerful, very honored. I gave up a six-figure salary and lifetime tenure without knowing what I was going to do."
Some of his colleagues, he said, "thought I was crazy, but there were others who admitted that in a way they were really envious."
Gordon practices and teaches "what we used to call the art of medicine. By virtue of it being an art, it becomes imaginative. You're not stuck with any specific techniques."
He urges his students to "listen to their intuitions, make themselves available to their patients intellectually, emotionally and personally."
For Dacher, the break with the "clinical distance" he was taught in medical school has almost mystical elements.
"Medicine's enormous investment in technology and science -- the whole process of what has happened in medicine in the past 30 or 40 years -- has caused physicians, as well as the rest of society, to lose their touch with that part of themselves that goes out and heals from a different place. The sense of being present with patients, and the acknowledgment and recognition and caring that goes with that, brings back a specialness, almost a sacredness."
Gordon is not a member of the informal "wellness" support group, although one of his recent books, "Mind, Body and Health," coedited with Drs. Dennis Jaffe and David Bresler, includes a chapter on wellness by John Travis.
Gordon puts the relationship with patients this way: "Each moment you see someone, that person is in a different kind of situation, and your approach has to match the situation rather than matching the diagnosis. You may see six people with the same condition, but prescribe six different things, based on the individual person, where they are, what that treatment can teach them about themselves. One of the fundamental things I do in my practice is find out what can be learned from an illness and how can the illness be used as a springboard for a richer life, a greater awareness, rather than simply regarding it as a disaster or an enemy."
Gordon does not accept patients until he is certain they understand that under his guidance, they "will take a good look at themselves, make some changes in their lives, try new approaches which may involve being a very active participant."
"Medicine," he says, "should be fun. I have more energy when I have been with a patient. There is no burn-out from intimate meetings with people. I serve as a catalyst, and catalysts don't lose power by working." Books
"Mind, Body and Health," by James S. Gordon, MD, Dennis T. Jaffe, PhD, and David E. Bresler, PhD; Human Sciences Press.
"The Healing Partnership" ($4.95) and New Directions in Medicine ($15.95), by Drs. Raymond F. Rosenthal and James S. Gordon, both published by Aurora Associates, Suite 400, 1015 18th St. NW, Washington, D.C. 20031.