Health Psychology. Michael Murray
Systematic reviews show inconsistent evidence on the efficacy of herbal medicine in treating various conditions. While some reviews did not have substantial evidence to support the use of herbal supplements during pregnancy (Dante et al., 2013) or to treat depression (Butler and Pilkington, 2013), others showed support for treatment of tic disorders (Kim et al., 2014), gout (Li et al., 2013) and irritable bowel disease (Ng et al., 2013). A systematic review by Li et al. (2014) showed how the use of herbal medicine can help to improve the quality of life among chronic heart failure patients. However, reviews that showed substantial findings also raised concerns regarding small sample sizes, high clinical heterogeneity, and poor methodological quality in some trials. We return here to a refrain from other chapters concerned with the evidence base for treatments: more large-scale randomized controlled trials (RCTs) are required to provide robust evidence on the efficacy of herbal medicine. At present, there is limited support for a few specific treatments but the evidence is inconclusive for many of the most popular herbal remedies.
Homeopathy
Homeopathy is a form of CAM which involves the use of highly diluted substances to trigger the body’s natural healing system. It is based on the Latin principle similia similibus curentur, which means ‘let like be cured by like’. This means that a substance that can cause symptoms when taken in large doses can also be used to treat the same symptoms when taken in smaller doses. Its origins can be traced back to the work of the German physician Samuel Hahnemann (1755–1843). During his time, medical treatments often relied on harsh procedures such as blood-letting, purging and the use of poisons. Hahnemann refused to use these techniques and experimented on himself and other healthy volunteers. He recorded the physiological effects of toxic materials such as mercury, arsenic and belladonna and then collated reports of ‘cured symptoms’ based on homeopathic prescriptions of these substances. See also the discussion of placebos in Chapter 2.
Homeopathic medicine is particularly popular in Europe and in India. In the UK there are currently four homeopathic hospitals, in London, Bristol, Liverpool and Glasgow. It is much more widely used on the European continent, especially in France and Germany. Homeopathy has been used for a variety of health conditions, including asthma, ear infections, hay fever, allergies, dermatitis, arthritis and high blood pressure, and for mental health conditions such as depression, stress and anxiety. However, systematic reviews on the effectiveness of homeopathy showed inconclusive results and trials are of poor quality (Ernst, 2012; Peckham et al., 2013; Saha et al., 2013). Posadzki et al. (2012) have also commented on the potential harm of homeopathy to patients in direct and indirect ways.
Aromatherapy
Aromatherapy involves the use of essential oils from plant extracts for therapeutic purposes. This practice dates back to ancient Egyptian, Chinese and Indian traditions. French chemist and scholar René-Maurice Gattefossé (1881–1950) is considered to be the father of modern aromatherapy. He discovered the healing properties of lavender when he accidentally burned his hand while working in his laboratory. He continued to experiment on essential oils, including thyme, lemon and clove, and used these with First World War soldiers as antiseptics. In recent years, aromatherapy is being used for stress and pain relief, headaches, and digestive and menstrual problems. The essential oils can be massaged into the skin, added to warm bath water, blended into lotions or creams, or inhaled through a diffuser, vaporizer or candles. Consumers can buy oils at pharmacies or health shops or attend an aromatherapy session with a trained therapist. However, as with other CAMs, systematic reviews on the efficacy of aromatherapy have produced inconclusive results (Hur et al., 2012; Lee et al., 2012).
Perspectives on CAM
Debates around the efficacy of CAM have polarized researchers. The most basic explanation for the popular appeal of CAM is the placebo effect. The generous time, warm glow of personal attention and friendly conversation received by each individual patient with many CAM practitioners compares favourably to the brief and business-like encounters of mainstream medicine. This aspect seems particularly true in the case of cancer. For example, one Australian study found that ‘CAM use appeared to be associated with high patient acceptance and satisfaction which was not related to either cancer diagnosis or prognosis’ (Wilkinson and Stevens, 2014: 139). Another positive factor in favour of CAM is that patients ‘find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life’ (Astin, 1998: 1548). Arguably, the specific treatment effects per se are of marginal relevance. In light of the inconclusive evidence base, Segar (2012) outlined two main discussions around this topic. First, there were concerns regarding evidence-based medicine and whether CAM can be assessed appropriately using the currently available methods, which are based on positivist, biomedical approaches that may be incongruent with the underlying principles of CAM. Second, there were questions about whether CAM should be advocated considering that its effect may be no different from a placebo. While some commentators are concerned that CAM is pseudo-scientific, MacArtney and Wahlberg (2014: 114) argued that ‘this form of problematization can be described as a flight from social science’ and could negatively represent CAM users as ‘duped, ignorant, irrational or immoral’. While there is insufficient evidence from RCTs to support the efficacy of CAM, findings from qualitative research suggest that the use of CAM can promote feelings of control, empowerment and agency (Sointu, 2013).
In the UK, the Department of Health provides clinical guidelines for health care professionals on CAM. A systematic review by Lorenc et al. (2014) showed that a total of 60 guidelines have been produced in relation to CAM therapies. About 44% were inconclusive, mostly due to insufficient empirical evidence, while there was almost an equal proportion of guidelines either recommending or advising against CAM (19%). The World Health Organization launched a Strategy on Traditional Medicine (2014–2023) to support the development of policies and action plans to strengthen the role of CAM to improve health, well-being and people-centred health care, and to promote quality and safety of CAM through regulation and better training and skills development of practitioners. The strategy aims to build a knowledge base around CAM, regulate products, therapies and practitioners, and integrate CAM into national health care systems.
Changing Cultures and Health
In a world of rapid change and interpenetration of cultural groups and belief systems and an increasingly globalized society, health psychologists need to recognize the complexity and diversity of dynamic and interlocking systems rather than assume that our health belief systems are fixed (MacLachlan, 2000).
BOX 6.1 The false stereotype of the ‘Drunken Aboriginal’
Traditionally, Aboriginal people consumed weak alcohol made from various plants. Their problems with alcohol began with the colonial invasions of the eighteenth century. Contrary to all popular stereotypes, surveys find that roughly similar proportions of Aboriginal people drink alcohol to the European colonial population. The media distort the facts and reinforce stereotyping.
Evidence shows that the lifetime risk of alcohol consumption for Australian Aboriginal and Torres Strait Islanders is similar to that of the non-indigenous population for both males and females. Similar proportions of Aboriginal and Torres Strait Islander people and non-indigenous people of the same age and sex exceed lifetime risk guidelines, apart from women aged 55-plus where Aboriginal and Torres Strait Islanders are significantly less likely than non-indigenous women to exceed lifetime risk guidelines (7% compared to 10%) (Australian Bureau of Statistics, 2014).
So where did the false stereotyping come from? One answer lies in early colonial art. A lithograph was created by Augustus Earle (1793–1838) and printed by C. Hullmandel, London, in 1830. A group of bedraggled indigenous Australians are sitting in a Sydney street. They wear ragged remnants of European clothing or simply material wraps. Empty ‘grog’ bottles are scattered on the ground. Behind them there is a two-storey hotel with a kangaroo sign and another sign on the side of the building says ‘George Street’. Fashionably dressed British