Complementary and alternative medicine play vital roles in improving health outcomes, alleviating symptoms, and sometimes resolving conditions entirely. As practitioners committed to this field, we acknowledge the value of these modalities. However, a concerning trend arises when some CAM providers propagate the notion that natural approaches are superior, while allopathic medicine should be vehemently avoided. Patients often turn to alternative medicine due to chronic conditions or positive past experiences, yet dissatisfaction with mainstream medical care isn’t a reliable predictor.1 This binary, good-versus-bad dynamic prompts us to question where medical advice ends and coercive control begins.
The effects of this belief system are evident in some patients who walk into our clinics — the patient who is crying because she took antibiotics for a UTI that was causing bleeding, the patient who dies because they refuse medical care, the patient whose cancer turns into stage IV because they avoid getting diagnosed and treating it. As health care providers, we must recognize that patients trust us due to conditioning, not solely because we’ve earned it. This power dynamic, though necessary, can be easily abused.
What Is Coercive Control?
Coercive control, also known as mind control, thought reform, undue influence, or colloquially referred to as a “cult,” is a growing and concerning phenomenon, especially in the United States. These detrimental dynamics can manifest in various settings, from one-on-one relationships to small groups, larger communities, and even entire industries. They transcend boundaries, affecting intimate relationships, religious groups and businesses alike.
In essence, coercive control is pervasive, underscoring the importance for health care practitioners to be keenly aware of this issue, and to actively educate both patients and colleagues about the potential for abuse inherent in such relationships.
At its core, coercive control involves exerting influence over individuals to the extent that they lose autonomy over their thoughts, behaviors and actions. In essence, their authentic identity or cognitive autonomy is seized, and they begin to operate according to the belief system imposed by the controlling figure, often to their own detriment.
There are many models to help describe the issue of coercive control - Robert J Lifton’s 8 Criteria of Thought Reform, Margaret Singer’s 6 Conditions for Thought Reform and Dr. Steven Hassan’s B.I.T.E. Model and Influence Continuum.2-3 These models help us understand how coercive control is exerted and where it might show up; and also emphasize that the destructiveness of a group or belief system isn’t a binary – it’s a gradient.
The Influence Continuum
As you attend to patients in the clinic, providing advice on lifestyle changes and treatment options, it’s crucial to bear the influence continuum in mind. Stay mindful of how your words may impact patients, recognizing that unintentional influence could limit their control over thoughts, behaviors and choices.
Specifically, the Influence Continuum for Leaders helps us gauge where we may fall on this continuum and how that may be affecting our patients.
Common Coercive Control Mechanisms in Alternative Medicine
Mystical Manipulation: This is typically seen as a fabricated mystical experience. In spiritual groups, it may involve performing miracle healings or psychic readings. In alternative medicine, our own remarkable cases are part of this phenomenon. While these cases are authentic, stories about them can create the impression that all treatments yield similar outcomes.
Embracing or perpetuating this belief without emphasizing the rarity of such results can manipulate patients’ expectations, influencing their medical choices and potentially steering them toward alternative medicine over a more balanced approach.
Black-and-White Thinking – All-or-Nothing Mentality: Avoid statements like, “All sugar ruins your health,” “All GMOs are bad,” or “Chemotherapy won’t help.” Black-and-white thinking in dietary advice can contribute to disordered eating and the emergence of orthorexia patients.
When providing guidance, be cautious of promoting an all-or-nothing approach. If a suggestion reflects a personal belief, disclose it to the patient. Embracing all-or-nothing thinking is detrimental and can result in poorer patient outcomes.
Demand for Purity: Similar to black-and-white thinking, the “demand for purity” refers to the belief that our body is a pure temple, favoring natural medicine over allopathic alternatives. Allopathic medicine is valid, and patients should have the freedom to choose their preferred care. When practitioners convey these beliefs, patients may absorb them more readily due to the authority position. Be mindful of how you communicate personal beliefs, avoiding all-or-nothing thinking in your interactions with patients.
Milieu Control: This involves controlling information dissemination and various aspects of the patient’s environment, behavior, physicality, and thinking. In the clinic, this subtle influence connects to an all-or-nothing approach in lifestyle recommendations.
Consider how your suggestions may impact the patient’s behavior and environment. While patients seek guidance for lifestyle changes, ensure your delivery doesn’t imply that it’s the only way to achieve their goals. Reflect on whether you’re providing information aligned with your beliefs or encouraging them to explore diverse perspectives.
Limiting Access to Outside World: Similar to traditional coercive control, restricting access to the outside world isn’t confined to closed compounds; it extends to how we guide people in seeking information. Reflect on whether you exclusively provide information aligned with your beliefs and if you can accurately discern legitimate research.
Consider if you have preferences for specific sources and whether you discourage patients from seeking information externally. Be mindful of influencing patients to explore diverse information sources that may or may not align with your beliefs.
High Exit Costs: What if patients diverge from your advice or seek alternative treatments you disagree with? Some practitioners resort to scolding patients for choices like taking antibiotics or visiting urgent care. The fear induced by not meeting expectations can be more significant than anticipated.
Be cautious of employing shame, fear, or manipulation for patient compliance, as this may lead to information withholding and a fear of being dismissed as a patient with nowhere else to turn.
Practical Relevance
As practitioners, our goal is to strike a balance in how we communicate and guide patients toward their health journey. Recognizing that individuals may not follow our methods precisely, we must be conscious of the potential for subtle and overt abuse in the clinic. Empower patients, rather than molding them into our ideals.
I encourage embracing the gray area of care: offering advice while remaining mindful of its impact, and keeping the door open for diverse possibilities and approaches beyond our expertise or belief systems.
References
Over my almost 30 years in clinical practice, I have used Chai Hu Long Gu Mu Li Tang extensively for a wide array of clinical presentations ranging from chronic headaches to anxiety, insomnia, and prescription drug withdrawal symptoms if these situations fit the appropriate patterns – all with extremely positive clinical outcomes.
There’s no doubt that many of your patients visit your practice because they are in pain. And there’s certainly no doubt that curcumin from turmeric (Curcuma longa) can be incredibly effective in stopping that pain, whether due to chronic conditions like arthritis or acute pain from intensive workouts. But your patients may also benefit from curcumin for other reasons.
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Low back pain is defined as pain the posterior superior iliac spine (PSIS), and it can be acute or chronic, localized or radiating. It is a common ailment for adults in the United States, with a lifetime prevalence as high as 65-80%. Whether or not an MRI is available to provide definitive knowledge of a structural issue, acupuncture can be an effective treatment for low back pain.
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