9. Communication with the whole person
CHAPTER OBJECTIVES
• Demonstrate understanding of the concept of and components of the whole person
• Synthesise all aspects of the whole person in order to achieve effective communication with the ‘other’
• Consider and develop strategies to overcome the difficulties associated with assisting the whole person
• List the various meanings of the concept of holistic care
• Understand the importance of holistic communication
• List some characteristics of holistic communication.
Defining the whole person
The concept of the whole person is important to many health professions. Those professions require inclusion, understanding and care for the whole person. There is detailed discussion about the components of the whole person in Chapters 7–8 of this book. In summary, there are five basic aspects of the whole person (Brill & Levine 2005). Four of these aspects are the physical, cognitive, emotional/psychological and spiritual functioning of the person. The physical functioning is the most obvious and includes the body of the person, the functioning of their internal organs and their external body parts. While there is some debate about the components of the mind, cognitive functioning definitely includes thoughts and memory processes. Some believe that emotional or psychological functioning is part of the mind, others believe it originates in the heart while others believe it originates in the liver. Regardless of origin, psychological and emotional functioning is an aspect of every person and a component of the dynamic system of the whole person. Spiritual functioning refers to that aspect of the person that gives meaning to self, life and the universe. It involves moral values and relating to the world at a spiritual level. Whole people exist in a social context and thus, while the person may consist of the four above-mentioned aspects, past and present social experiences create the fifth aspect of the whole person – the social aspect. The social aspect influences and often determines responses in the other four aspects. These five components of the person interrelate to exist as a dynamic whole. It is impossible to separate the individual aspects from the whole because they are mutually dependent on each other and mutually affect each other.
GROUP ACTIVITY
• Do the five aspects of the whole person ever operate separately? Explain.
• List ways in which each aspect may affect the functioning of the person.
• Consider how the health professional might recognise the influence of each aspect of the whole person.
While it is possible to focus upon one aspect of the whole person, dividing the whole into parts for analysis can be problematic (Dossey et al 2003, Harms 2007, Reed & Sanderson 1999) because each aspect exists in an intricate and sometimes delicate relationship with the other parts. Analysis of one aspect is often useful and transformative. Such analysis, however, should always consider the effects of the other aspects.
There are times during life when one particular aspect may dominate the dynamic system of the whole individual. The demands of life at that time or the particular choices made by the individual result in the person giving greater priority to a particular aspect of their whole more often than the other aspects. For example, the physical aspect of an elite athlete may dominate their focus and functioning because of the requirement for physical training. A student is required to use the cognitive aspect regularly and thus the cognitive aspect may prescribe their focus and functioning. A grieving person may experience extreme emotional stress and thus the psychological aspect of a grieving person may dominate their functioning. A person who chooses to be a monk or nun usually makes choices based upon the spiritual aspect. The need for social acceptance during adolescence may mean that the social aspect of the adolescent drives/dominates their existence at that stage in life.
REFLECTION
• Consider the five aspects of the person. Do you agree that these aspects create the whole person? Do you feel there are any more internal aspects of the person? If so, ensure your answers do not belong in one of the other five aspects.
• Consider times in your life when one of the aspects may have dominated your functioning (e.g. when playing competitive sport or when studying). Were the other aspects dormant at that time? How did the focus affect your overall functioning? Did other aspects become less predictable or more sensitive? How did you manage this? What facilitated a sense of wellbeing despite the focus upon one aspect?
Holistic care
The principle of holism always considers the person to be a whole, regardless of the specific demands upon that person at a particular time. The concept of holism is not a new idea for many health professions (Brill & Levine 2005, Dossey et al 2005, Milliken & Honeycutt 2004, Reed & Sanderson 1999, White 2006); in fact, a variety of health professions have developed because of a holistic philosophy of care (Punwar & Peloquin 2000). There are various ways of understanding holistic care. It can mean inclusive care that accommodates diverse cultural and spiritual systems (Taylor 2000), in particular the medicine of traditional indigenous healers and the traditional interventions of eastern cultures. Holistic care can also mean complementary and alternative medicine (CAM; Dossey et al 2003) as opposed to traditional medical care. A holistic concept of healthcare is the basis of CAM (Milliken & Honeycutt 2004) and thus some consider holistic care as synonymous with CAM. Some health professions perceive holistic care as the consideration of the whole person – every aspect of the unique individual – using a variety of interventions depending on the needs of the individual. In these professions, holistic care means avoidance of focusing upon one aspect of the individual over another aspect. It requires recognition that healthcare is more than a focus upon the physical needs of the individual (White 2006). Holistic care fulfils more than the immediate needs relevant to the particular health profession; it recognises there are many causes contributing to those needs. It recognises that the immediate needs may arise from more than the physical aspect of the person, even though the need initially may appear to be physical. Holistic care understands there is more than one way to fulfil a need and to achieve healing. It considers the less obvious and often forgotten aspects of the cultural, psychological, social and spiritual functioning of the individual.
REFLECTION
• Consider the aspect of the person to which you feel most comfortable relating. Why?
GROUP ACTIVITY
• Have each group member explain which aspect of a person they would feel most comfortable addressing in their health profession.
• As a group decide which aspect of the person is the easiest to relate to or address. Discuss why.
• As a group decide which aspect is the most difficult to address. Discuss why. Suggest strategies that might assist in overcoming this difficulty.
Holistic care does not merely treat symptoms but also searches for causes, understanding there are often multiple causes that arise from and relate to every aspect of the whole person. Mutual respect is the foundation of holistic care and it assumes equality (see Chs 2& 12) within the therapeutic relationship. Mutual respect seeks involvement from the person seeking assistance in the collaborative goal-setting and decision-making associated with their care and future (Dossey et al 2005). In holistic care, the responsibility for change and healing lies within the person. The role of the health professional is to facilitate and empower the person to achieve their set goals (Milliken & Honeycutt 2004).
Unless specifically taught to provide holistic care, a developing health professional may require experience to provide holistic care consistently (Liu et al 2000). It is possible for a health professional who practises within a particular specialty area to provide holistic care, despite a focus upon their specialty area. Regardless of the situation, it is possible to consider the whole person while practising as a health professional. Holistic care is fundamental in achieving family/person-centred practice in any healthcare service and thus should be an aim of every health professional.
Holistic care includes consideration of context
To provide holistic care it is important that health professionals consider the interrelating aspects of the whole person regardless of the presence of an obviously dominating aspect at any one time. It is also important to consider that individuals with whom health professionals communicate develop within diverse and multiple contexts. Recognition of these contexts is essential when communicating (Harms 2007, Milliken & Honeycutt 2004, Purtilo & Haddad 2002, White 2006; see Chs 6& 7). Some consider these contexts to be physical, financial, cultural and social (family or kinship groups, friends, colleagues or acquaintances), while others consider them to also include a spiritual element (Colbert 2003, Taylor 2000). Regardless of their composition, these contexts provide experiences that promote positive or negative responses within the cognitive, spiritual and psychological functioning of the individual. Such responses ultimately affect the physical and social aspects of the individual (Colbert 2003, Golman 2006) and, therefore, all of these contexts require the attention of health professionals.
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