February 2004

Developing the lifetime wellness practice

by Dr. Donald Epstein

In order to establish a lifetime wellness practice one must first define wellness, be able to understand its attributes, speak its language, know its experience, measure its outcomes, and have clinical systems that can produce the benefits desired.

The practitioner cannot simply add wellness care to a therapeutic or prevention model and truly expect an individual to have the cultural or clinical foundation for transitioning into wellness care.

Often, dogmatic philosophical and practice management methods help establish office environments that may be inconsistent with the wellness practice.

When short term palliative, or therapeutic goals are at odds with long‑term goals, it is highly unlikely the patient will be retained through the transition to wellness care.

A lifetime wellness practice is developed and nurtured, not from fear, but from the stream of hope of humanity. In the wellness practice, while we share our philosophy with our patients, we neither try to convince them or change their minds. Instead, we open our hearts and help theirs to open, discovering the common concerns and hopes of both the individuals and the global community we co‑habit.

The Epstein Wellness model states that wellness and illness exist on a continuum, which serves as a context for the human experience. It is this context that provides a cognitive, non‑cognitive, and autonomic backdrop through which the adaptive process is expressed.

In this context, wellness departs from the biomedical model that equates wellness to lack of disease, or at best a preventative issue. In the Epstein model, wellness is neither disease mitigation nor a preventative strategy. Extensive research utilizing patients' self‑reported wellness, in both biomedical and social science arenas, strongly suggests that wellness is a health belief of the individual, influenced by the individual's depth of self‑perception, self‑realization and connectedness of the body‑mind consciousness.

The functioning of the frontal lobe of the cerebral cortex is central to these more integrated cultural, emotional and somatic relationships. Under stress, this highest evolved of neural structures is compromised, as are the individual's options for wellness.

Therefore, in the wellness practice, we seek evidence of enhanced cortical participation. This is assessed in relationship to cognitive awareness of one's spinal structures and one's adaptive strategies.

Both wellness and illness are private, personal and subjective. Planned "canned" communications are best replaced with acknowledgement of the uniqueness of the individual during his or her healing journey.

Patients seek out health care or wellness practitioners motivated by concerns. These concerns may be about their physical health but also may be about the inner journey, sometimes more than about the external or circumstantial experience of symptoms. The wellness practitioner needs to allow for a verbalization of the concern, without judging it, or projecting therapeutic intent to this concern.

With increased wellness there is a growing discernment between the concern (an expression of the illness behavior) and the symptom or circumstance. With greater movement towards the wellness spectrum there is increasing loss of personal identification with a symptom or circumstance.

An individual's experience of the journey between illness and wellness is also dependant upon the current stage of consciousness expressed. This is true for the patient entering an office and offering symptoms or concerns for discussion, as it is true of the practitioner listening to these concerns or symptoms and communicating and taking action based upon the conversation.

A new patient seeking symptom relief alone is likely to be operating from a fairly low, fear‑based, pain‑oriented defensive consciousness level. His or her emotional and conceptual definitions/understanding of wellness and illness come from those levels. As the patient continues in care, if wellness and somatic awareness develop, then the objectives, concerns and chosen action of the patient will undergo developmental growth. The wellness practitioner needs to be sensitive to the range of possibilities and provide the room for growth, speaking with each individual in a language dependant upon the apparent level of consciousness, development and expression.

When the motivation for treatment is fear of loss due to the furtherance of advancement of a condition, it has little or nothing to do with the subjective, and internal experience of the person having the condition. A practice based upon this model, even a subluxation based one, rarely transitions to a true wellness practice. There is a particular culture that the patient has been indoctrinated into, and which the chiropractor has utilized relative to his or her "turf" condition of subluxation.

The concept of illness and wellness exist on a continuum as part of the social science paradigm. The perceptions, attitudes, choices, and behaviors an individual expresses are dependant upon the backdrop of where the person is on this continuum between wellness and illness.

I am suggesting that there are somatic anchors to stressful events which is worn or expressed as defense posture. The inability to fully experience and digest an event, or circumstance is associated with characteristic spinal structural adaptations. This is the etiology I propose for the vertebral subluxation. The subluxation is a symptom of a conflict between one's experience of life and the optimum structure of the body.

Illness is associated with a more rigid, less flexible spine, utilizing autonomic sensory motor strategies inconsistent with change, growth, wide range of perception, emotion and adaptive responses. To the degree that we are able to participate with ourselves, our spine, and our awareness of our body, we are able to participate with the world.

Wider range of motion appears in relationship to a wider range of emotion and available adaptive energy and repertoire of responses.

It is through the shift from stress physiology and its attending defense posture through which our higher brain function can engage, and we can reassess our lives, experience greater connection to the transcendent source of awareness, and to one another. I suggest that the vertebral subluxation is evidence that there are adaptive challenges impeding one's movement between illness and wellness. Increasing wellness is associated with the experiencing a wider circle of participation of the self in the world.

The wellness practice must embrace approaches that allow for movement from "unconscious automatic" structural‑sensory motor behaviors, toward more awakened, higher brain participation with the body.

With such a brain‑body connection, experience of benevolent emotions such as love, compassion, and gratitude can emerge. By promoting a greater participation with this range of the human experience to a greater segment of the population, we can change the world one spine at a time.

(The Epstein model of wellness supports the Network Spinal Analysis [NSA] practice, and is an evidence‑based model. It is now part of the course at Life University, and published in the recent issue of JVSR. A two‑part article on the evidence‑based model of wellness and NSA will be published in the April and subsequent issues of the Journal of Alternative and Complimentary Medicine. These models also form the basis of a new post graduate certificate in Wellness Education and Outcomes Assessment which will be offered through Florida Atlantic University. To hear Dr. Epstein, or to find out more about wellness, chiropractic, and NSA, go to www.innateintelligence.com)