DEBATE DEBATE

There are three main types of world views: holistic, fragmentary, and fractal (Almeida Jr., 1994; Almeida Jr., in press). The ecosystem approach is by definition holistic, because it takes abiotic, biotic, and cultural factors into account, along with a flow of matter and energy across space and time. Accordingly, the concept of holistic health (or, for that matter, ecosystem health) involves all the patient's mental and family circumstances (social, economic, etc.) rather than just the physical and biological aspects of disease.

There is no doubt that Waltner-Toews' ecosystem approach to health deals with the subject as a whole rather than merely examining it in a fragmentary way. But what about mind in his model? The lack of this dimension is, in my opinion, the central weakness of his otherwise intelligent, instructive, and useful paper.

It seems to me that the author fails to take the reality of mind into account (at least in an explicit way) in keeping with the scientific tradition of not dealing with elusive categories. This is a regrettable mistake. For example, what can be said of hard epidemiological data on high blood pressure caused by hidden emotions (Mann, 1999)? Or eye movement desensitization and reprocessing (EMDR) as a powerful psychological procedure, developed mainly by Shapiro (1995) as a therapy for overcoming anxiety, stress, and trauma?.

The fact is that the role of mind-body interaction in health and disease is so well recognized today (Benson & Marg, 1996) that it must be incorporated into any health-disease model, especially a holistic one.

In addition to the above general remark, I wish to propose some questions to the author:

1) How does the ecosystem approach to health relate to (1) gene therapy, (2) transgenics, and (3) cloning?.

2) "Many tropical diseases are thus not only diseases related to climate and environment, but are diseases of poverty." In making this conflictive affirmation, it seems that Waltner-Toews does not really believe in tropical diseases as diseases of poverty.

3) How does the author fully explain Dubos' formidable "mirage of health" concept (Dubos, 1959) in light of the proposed ecosystem approach to health, particularly with respect to emerging diseases?

4) Waltner-Toews' ecosystem model of health is part of an overall view of sustainable development. It would be interesting to know the author's opinion of an international effort towards that end.

ALMEIDA Jr., J. M. G., 1994. Desenvolvimento ecologicamente auto-sustentável: Conceitos, princípios e implicações. Humanidades, 38:284-299.

ALMEIDA Jr., J. M. G. Holística: Por Uma Visão Estratégica de Desenvolvimento Ecologicamente Auto-Sustentável. (in press)

BENSON, H. & STARK, M., 1996. Timeless Healing. New York: Scribner.

DUBOS, R., 1959. Mirage of Health. New York: Harper.

MANN, S. J., 1999. The Hidden Cause of High Blood Pressure - Changing the Myths. London: Thorsons.

SHAPIRO, F., 1995. Eye Movement Desensitization and Reprocessing - Basic Principles, Protocols, and Procedures. New York: Guilford.