Fourteen patients and a doctor sat in the circle.
They sat easily and talked and laughed and exchanged ideas about how to keep well.
Keeping well. They repeated this almost magic word several times. They talked of attitudes, exercise, relaxation and the right food. Of taking control of your life, taking responsibility for your own health, feeling less tense. Feeling well.
This was the Wellness Group, which meets one night a week at the Kaiser-Georgetown Health Plan's Reston Center, 30 miles from the heart of Washington.
A new and growing wellness movement is challenging medicine.
The movement goes by several names -- "wellness," "holistic medicine," "wholistic medicine" -- but all speak of considering and caring for the whole person, not just treating Disease A with Pill X.
All embrace or overlap several other growing movements in and outside traditional medicine: Self-care (learning to be your own doctor sometimes), patient education, prevention, fitness and exercise.
All are part of what could be called a new life-style medicine, which teaches us that what we do and don't eat, smoke, drink and do has more to do with our health than all the things doctors can do. All these forces seek to go beyond today's jogging and exercise to offer a whole way of life, one that includes exercise but also declares a large degree of independence from doctors, disease and helpless depression.
The movement, like hot tubs and group sex, has found its fastest -- and some of its strangest -- growth in California.
But today, Dr. James Gordon, a Washington psychiatrist who headed a study of "alternate" services for President Carter's Commission on Mental Health, reports: "Holistic medicine and wellness centers are happening all over the country. About 100 places" from Maine to Texas and in almost every state and the District of Columbia "are practicing all or part of these new ideas."
Holistic medicine and wellness, proponents say in lofty words, treat patients "humanistically" as "mental and emotional beings," and seek "optimal attunement of body, mind, emotions and spirit" in "a health-oriented ecology and life style." One observer sensibly sums this up as "concern for the whole person, not just the part that hurts."
The new movements often use alternative treatments ranging from meditation to acupuncture to ayurvedism (India's herbal medicine). The doctors and others who do and teach these things range from the skilled and responsible to knocks, quacks and money-chasers.
But all these trends represent a revolt against the prevalent medical model, the usual "disease model" of treatment: I get sick, I got to the doctor, he gives me a cure.
Wellness, all its advocates say, is far more than an absence of illness. It is a sense of health and control even in the face of illness and adversity. i
Dr. Elliot Dacher (prounced "Dosher") is medical director of the Kaiser-Georgetown Reston center. He is 36, well-trained and well-certified, and he fully uses orthodox medicine.
"But as a doctor," he said, "I was doing a lot of things to a lot of patients, but they kept coming back. I slowly became convinced I wasn't doing them any favor. I was just making them dependent on drugs and on me, rather than helping them really get better.
"So I began to explore their lives with them. And my own life. And my family's. What were we doing to keep well? To relax? To eat right?"
He began telling his patients: "I can't get you well. Everything it takes to get well is already inside each person. It's all there for free, and it can't be purchased. It can only be found in ourselves."
He also began to explain: "You can be well if you're ill. All of us have known people who had serious illnesses, but maximized their potential. Within whatever limits they had, they went on.
"There are also people who are not ill at all who are not very well. You can see it on people's faces at a bus stop."
"The most important factor pushing us in new directions," said Dr. James Gordon, "may be the incredible cost of health care today. And the consumer movement, the civil rights movement, the women's movement, the old people -- Gray Power.
"And the fact that so many people are dissatisfied with the present approach."
The new movement was probably born out of the alternative health services of the 1960s, the free clinics, drop-in centers and crisis centers that gave care, shelter and counseling to the disaffected young of that decade.
These young found conventional services "threatening, damaging or unresponsive," Gordon said, and they found common ground with many activist health workers who also "believed that, given time, space and encouragement, ordinary people could help themselves."
Too, many health professionals and their patients "were becoming dissatisfied with the 'best care,"' especially that given people who complain of feeling poorly, yet have no physical pathology. A social innovator named Sidney Garfield sympathetically named them "the worried well." Many doctors use the term derisively.
By the early 1970s, however, many the often inadequate free clinics to create the physically and emotinally oriented services that would become holistic centers.
"There was, and is, no single model," Gordon reports. A Lutheran minister, Granger Westberg, started a Wholistic Health Center in a Springfield, Ohio, church basement. It has led to a network of clinics in the East and Midwest, combining traditional medicine with mental and spiritual couseling.
The Wholistic Health and Nutrition Institute in Mill Valley, Calif., tries to substitute stress reduction, often via biofeedback, relaxation and exercise, for reliance on drugs.
At the Pain and Health Rehabilitation Center in LaCrosse. Wis., Dr. Norman Shealy, a neurosurgeon who largely abandoned drugs and surgery, tries to substitute diet, fitness, biofeedback, electrical pain relief and other techniques.
The Helping Hand Clinci of St. Paul, Minn., teaches its patients selfcare. The Swedish Wellness Center of Englewood, Colo., was founded by two hospitals whose boards were considering expansion. Instead, they founded this joint clinic to try to keep patients out of the hospital.
Most of these centes meld orthodox medicine with biofeedback, family thereby, stress control, meditation, nutritional therapy and, in Gordon's phrase, "other healing traditions."
"I'd say holistic medicine at its best includes everything useful conventional medicine offers, plus other things," Gordon sums up. "If somebody gets hit by a truck, you're not going to tell him to sit there and meditate."
"I still work with many patients one to one," said Dacher in Reston. "Two years ago we also started our willness group.
"We started with learning sessions in three areas: Stress and how fitness.
Later, the group sort of took itself over."
It is 7:30 p.m. on a Tuesday. Dacher wears his usual garb, unpressed pants and an open sport shirt.
The wellness group tickles in. Eight women, six men, suburbanites, fresh or unfresh from their jobs and their car pools. Worn jeans, open shirts, only a few smart outfits or crisp button-downs. These are the citizens of Tense City, trying to make sense of their health and their lives, rather than succumbing to neuroses and coronaries.
A slim, wiry woman, 35ish, in jeans and a checked shirt, opens the weekly forum. Her youngest child "has been waking me up again. He woke up 10 times the other night. I was a zombie.
"I really needed to relax, so I tried self-hypnosis. I counted backwards to 10, and I was just saying, "This isn't working.' That's the last I remember. For 20 minutes, 'cause I'd set the alarm. Then I got up and went to work.
"It was really very relaxing. I've also used the meditation." In addition to teaching self-hypnosis -- in reality, deep relaxation -- Dacher urges his patients to meditate in a simple way, no semi-religious hocus-pocus, for 20 minutes twice daily. "I've been meditating at least once a day," this woman said.
A government official with thick glasses tells of doing his meditation "to calm down -- just closing my eyes seems to help."
The four, far from mysterious, components in such meditation, said Dr. Herbert Benson of Harvard, are sitting quietly, closing one's eyes, repeating a simple word or phrase and closing out other thoughts.
A cheerful, mildly stout woman in a flowery shirt tells how "our diet has completely changed." Dacher and the group put great store in abandoning junk and factory food and too many sweets, in favor of fresh, unprocessed fruits, vegetables, nuts, seeds, yogurt, whole-grain bread and chemical-free poultry and meats.
The woman also speaks of the group's "caring and sharing." This night's 14 men and women -- some nights there are 20 -- are obviously a kind of surrogate family for these American wanderers.
The best physicians have always been holistic practitioners, considering and treating the whole of their patients' lives.
A mayo Clinic doctor wrote 40 years ago: "Four out of five times I'd find out what was wrong sooner if I started by examining the patient's home life, his job and his bank account instead of his heart, his digestive system and his kidneys."
Today many physicians -- as many testify -- no longer take the time to pay attention to their patients' whole lives. Their complex scientific training, Gordon says, has "deemphasized the importance of things we knew 100 years ago, like the physician sometimes touching the patient."
Dr. William R. Barclay, editor of the Journal of the American Medial Association, has written that "medical care is first of all caring, and this component of medicine seems to be missing from much of what we do today."
Many doctors are consciously adding some of the "new" yet old methods in simple but practical ways.
Dr. Michael Newman, a young specialist in internal medicine on Washington's 19th Street NW "medical row," says many "caring doctors" are doing a far better job than innovators who ignore tradition to try unproved fads.
In a pamphlet of their own writing, he and his associate. Dr. Devra Marcus, tell their patients, "Your health is our concern but your responsibility . . . Our job is to help you be aware of how your life style affects your health." And: "Not every symptom requires medication."
"We find patients are just as happy if you really give them imformation," Newman said. "They don't really say, 'Dr. Soandso would give me a pill.'"
Dr. Samuel Bessman of the University of Southern California is a more severe critic of the new movements. He attacks the moneymaking "high priests" of new, unscientific "cults" who discourage patients from seeing doctors when sick.
All the new movements, all experts agree, badly need study to separate the useful among them from the merely silly or commercial. Prevention, now an official new policy of federal health agencies, needs to be developed and tested not out of sentiment buy as rigorously as vaccination.
No one, say the doctors who still must care for the sick, should begin to act as though the sick are sinners who are to blame for their illnesses.
Still, Gordon says: "We're overdue for some change."
As the months go by, some drop out of the Reston Medical Center's Wellness Group and some enter.
A man of 60 is about to have surgery. Dacher suggests that he begin trying another new technique: "visualization" or "suggestive imagery," that is, intensely imagining desired bodily responses or mental attitudes or even inter-personal situations.
"You can do a lot about your own recovery," Dacher said. "By resting beforehand. By eating right. And by visualizing the kind of recovery you want."
Another man said, "I'm taking fewer pills for my blood pressure, and I'm still on my low-fat diet. I'm under 200 pounds -- I haven't been there in years. But the really great thing, what I've gotten out of this, is awareness -- of food, of my feelings, of myself. I feel more in control."
When other patients too, tell of being "better able to cope," Dacher tells the group:
"Clearly, all of you are feeling better in one way or another. Some of you have forgotten your abdominal complaints. Some have fewer pains. And you've taken responsibility for who and what you are.
"It's a long process. It'll go on for a lifetime. But these are incredible changes in two or three or six months. Doctors don't usually see that in their practices."
The wellness movement may have been born in part out of the self-fascination of the "me" generation. But, given true expertise and a reasonable use of traditional medicine, it can become a more mature road to health.