Book Review

Healing Powers: Alternative Medicine, Spiritual Communities, and the State

N Engl J Med 1993; 328:216-217January 21, 1993

Article

Healing Powers: Alternative Medicine, Spiritual Communities, and the State
By Fred M. Frohock. 340 pp. Chicago, University of Chicago Press, 1992. $29.95. ISBN: 0-226-26584-6

Most people value the goal of personal health highly. Considerable differences of opinion and belief exist, however, about how best to preserve and promote one's own physical and mental well-being. Usually, there is no problem when “alternative” approaches are used to supplement conventional, accepted medical therapies (for example, praying for a successful surgical outcome). When therapeutic strategies predicated on spiritual beliefs are employed exclusively, however, as a substitute for conventional medicine, fundamental moral and public-policy questions about the relation between society and individual choice emerge. This intersection of state authority and personal faith, within a context of illness and medical possibilities, is the subject explored in this book.

Frohock, a political scientist who has taught bioethics, suggests potential resolutions to the legal and political dilemmas that arise in a liberal society, in which unconventional outlooks on reality may jeopardize the public interest in maximizing health and life. He inquires whether the state should properly embody a particular morality, answering in large part that, in a classically liberal political system, the answer should be in the negative. Instead, he suggests that the state function as an umpire, working hard to maintain tolerance and neutrality among competing accounts of health, disease, and healing and to protect individual rights against external interference.

Frohock finds the tension between state authority and individual faith most compelling in instances of parents making decisions for children and clinicians and courts assessing the decision-making capacity or competence of adult patients. Regarding the latter, he asks whether it is ever possible to disprove fairly and convincingly a patient's concept of reality. What appears crazy to some may, according to the author, be mainstream convention for others.

Frohock makes his points through a blend of narrative storytelling (partially based on interviews and partially fictional) and more didactic text. The case studies are fascinating and flow easily and enjoyably. The commentary is rather academic in places, wandering off at times on fairly dense philosophical tangents, but it contains a storehouse of valuable information about the historical, philosophical, and psychological bases of alternative approaches to healing. Good descriptions are supplied of the most prominent religious sects (such as Christian Scientists and Pentecostalists) and secular movements (such as Alcoholics Anonymous) resting on faith and spirit that depart from conventional medical views. In addition, the author provides a useful discussion of the development of what, at least at this time, the majority considers standard medicine. Extensive endnotes and references substantiate the author's scholarship on this project.

The primary audience for this book will be an intelligent public. Many physicians will find it enlightening, though, particularly for the insights it offers for better understanding of and conversing and negotiating with the substantial number of patients who are adherents of alternative healing methods.

Marshall B. Kapp, J.D., M.P.H.
Wright State University School of Medicine, Dayton, OH 45401-0927