Re-Learnings of a Naturopath Practitioner

I never expected my understanding of health and illness to evolve as profoundly as it has over the past four months —to include a deeper awareness of my location, my clients locations, and the broader world around me. 

Coming into post-graduate psychology studies, I anticipated that my background as a clinical naturopath for women with reproductive disorders such as endometriosis and pre-menstrual dysphoric disorder (PMDD) had already provided a comprehensive understanding of health and illness. After all, two of the seven principles that underlie the practice of naturopathy include Docere (Doctor as teacher) and Tolle Totum (Treat the whole person), which highlight the importance of considering the physical, mental, emotional, genetic, social, and political aspects of each client (Snider, 2019). However, this learning experience has become a journey of rediscovery for me, prompting me to re-evaluate my practice as a naturopath now, my practice as a psychologist in the future, and my worldview altogether. The insights from my course (175.739) have been pivotal, leading me to re-solidify my understanding of the crucial role of the holistic context in which health and illness exist. I now see that a critical health psychology perspective, along with a commitment to patient-centered care (PCC), is essential to truly support, guide and holistically care for the well-being of women with reproductive concerns. 

The “coconut tree” of health and illness:  

Recently, Kamala Harris (a U.S. politician) famously quoted:

“You think you just fell out of a coconut tree?! You exist in the context of all in which you live and what came before you,”

This quote spread across the internet as a viral meme, but ironically, the analogy reflects my newfound understanding of health and illnesses: We can only understand health and illness from our social, historical and political environment.  

Throughout this course, I was initially struck by the extent to which social constructionism shapes our perceptions and understanding of health and illness in the modern world. I've learned that our perception of health is always embedded within social, cultural, and historical contexts and have defined what is considered "normal" or "abnormal" (Olafsdottir, 2013). What particularly stood out to me was the historical medicalization of women's health concerns that subsequently created a host of issues for women. For example, premenstrual syndrome (PMS) was classified as a diagnosable disorder in the DSM until its fifth edition, reflecting a hysteria discourse that still trends today of pathologizing women’s natural experiences (McVean, 2017). Another striking example is that the complete anatomical depiction of the clitoris only appeared in medical textbooks as recently as 2005 (Gross, 2020). This historical tendency neglects the true needs of women and skewed health statistics, creating an impression that women have a greater "need for fixing," while much medical research remains solely focused on male bodies (Lyons & Kerry, 2006; Conrad & Leiter, 2004). The result is an androcentric system in which female bodies are often misunderstood and dismissed, leaving significant gaps in our knowledge of what is truly "normal" for women’s health.  

In my newfound re-understanding of women with conditions such as endometriosis, I've realized that the social construction of illness has created significant barriers to legitimizing their experiences, which has led to harmful outcomes. For instance, diagnostic delays for endometriosis still average 8-10 years, a delay that reflects the broader tendency to dismiss or minimize women’s pain (Boylan et al., 2022). 

Power, Domination, Doom and Gloom

Another realization for me was realizing the significant role of power (or lack of power) involved in the construction of women's illness. The issues in healthcare that women face associated with medicalization (being dismissed, stigmatized, misunderstood, minimized, over-medicalized) are all systems of power which are determined by the historical, political and social context of the time (Conrad and Leiter, 2004; Ussher, 2010).  

In my naturopathic practice working with women facing reproductive health challenges, I see firsthand how this social construction of illness impacts their lived experiences. Society’s limited understanding of conditions like endometriosis often frames them as “just a bad period” or a “normal part of being a woman.”. Jones (2015) describes how these reductive interpretations can foster a cycle of silence and stigma, discouraging women from seeking help and perpetuating the idea that their pain is somehow less legitimate. This disconnects between patients’ lived experiences and society’s narrow definitions of “normal” health can significantly affect well-being, confidence, and self-worth, as women internalize these dismissive views. 

Women are NOT their conditions... Legitimize us! 

Further, I've become acutely reminded that women who suffer from endometriosis are, in fact, exactly that. They suffer with a condition, but they are not the condition. However, in the current bio-medical model of healthcare that practices mind-body dualism, and individualism, women continually place the patient AS their condition. 

There also remains the need to be diagnosed with a previously recognized disorder to be legitimized and to gain access to treatment and care in the first place (Thomas, 2021). The ‘gatekeeping' process of the bio-medical model of healthcare confines, reduces and locates the individual women (and other marginalized groups) as the source of her problems, which delegitimizes their experience, pain and their being.  

To re-legitemize women's experiences, a shift away from the biomedical system is, therefore, necessary (LaFrance & McKenzie-Mohr, 2013). In learning about what influences women's access to healthcare, I have come to realise that many women have had to conform to the ‘sick role’ (Jutel & Buetow, 2007), regardless of how they might experience or express their concerns, to gain any support. In practice, I've heard countless stories of women who feel the need to lie about their symptoms and experiences to gain access to pain medicines. 

As a private naturopath, I’ve had the privilege of working with women who can afford private healthcare and have the socio-economic status and privilege to access complementary and alternative medicine (CAM). Reflecting on this, I now see how this access mirrors Western culture’s fixation on health and the pursuit of “being healthy,” which often implies achieving an idealized standard shaped by societal norms. This mindset reinforces the notion that "to be healthy is to be perfect in the eyes of the social system to which I belong," when in reality, well-being encompasses far more than these narrow definitions. 

My work with this specific group of clients has also shaped my constructed understanding of health and illness. Many of my clients are Pakeha, from Western cultural backgrounds, and have already had negative healthcare experiences within conventional systems. This context often means they possess a heightened awareness of their own body’s signals and signs as a result of feeling unheard or dismissed by standard medical practices. Through these experiences, I’ve come to recognize that different cultural backgrounds bring entirely different ways of perceiving health, and these influence how clients describe their symptoms to me, a Westernized Pakeha woman. 

These cultural variations have shown me how different health perspectives impact clients’ ability to access care, often marginalizing those who do not fit into the traditional Western interpretive lens of health and illness. As Upsdell et al. (2023) discuss, individuals who interpret and respond to symptoms in non-Western ways can face significant barriers in conventional healthcare systems. This realization has led me to reflect on the importance of using culturally sensitive language in my practice, allowing all women to express their concerns authentically. Adopting a social constructionist approach enables me to be more inclusive and attentive to the diverse ways women experience and communicate their health. 

Patient-Centered Care: the only effective model.  

Through this course, I’ve come to see even more clearly that the traditional paternalistic model of healthcare is ineffective, especially for women with endometriosis and other reproductive health concerns. Although my background in CAM practice already highlighted the limitations of this model, this course solidified the need for a true power balance between the “doctor” and the “patient” in treating reproductive issues. The submissive patient role is no longer acceptable; instead, an informed-commitment model is essential to balance power, validate experiences, and allow women and other marginalized groups to become equal participants in their own care. 

Since completing this course, I’ve had transformative experiences in practice when actively working to equalize the power dynamic between myself (the "doctor") and the client. In a recent session, I invited a client to co-create their dietary plan by asking, “What goal would you like to set for yourself?” while offering suggestions based on my evidence-based knowledge. I felt a shift as the client became an engaged participant in their journey, and I let go of the anxiety of needing to have a definitive “answer” for them. This collaborative approach led to the client setting a realistic daily step goal, as part of managing PCOS symptoms, which not only relieved the pressure on both sides but created a meaningful and empowering healthcare experience. 

My own history has also reinforced these lessons. I’ve experienced medical neglect firsthand, having been told that nothing could be done about my menstrual pain and that it was something I just had to “deal with.” This dismissal left me feeling disempowered, helpless, and, of course, still in pain. Imagining the impact if someone had involved me in discussing lifestyle factors that might influence my pain and empowered me to create my own management plan—it would have been transformative. 

I’m constantly in awe of the evolution of my perspective and understanding of health and illness, even after being immersed in CAM sphere. Since this course, I’ve re-realized that to understand health and illness and to provide truly effective care, we must understand people just as much as the conditions they experience. This calls into question the effectiveness of care in the strictly biomedical model and underscores the importance of a shift toward patient-centered care (PCC), collaborative goal-setting, and an informed-commitment approach. PCC offers a personalized, integrative model of care that empowers women, restoring a sense of agency that history has often denied them (Coulter & Oldham, 2016). Through PCC, I’m reminded that listening is sometimes as powerful as any treatment. By fully acknowledging my patients’ experiences, I can provide care that not only addresses physical symptoms but also fosters trust and empowers them on their healing journeys. 

Perhaps the silver lining in the history of women’s oppression in modern medicine is the development of the PCC model. Women in New Zealand need PCC because they come from diverse cultural backgrounds, perspectives, and lived experiences. To be a healthcare practitioner for all women, we must view health through everyone's social, economic, political, and historical context. 

- Tayla Wiehahn

References:

Boylan, A.-M., Weckesser, A., & Dixon, S. (2022, March 23). People with endometriosis and PCOS wait years for a diagnosis – attitudes to women’s pain may be to blame. The Conversation; The Conversation. https://theconversation.com/people-with-endometriosis-and-pcos-wait-years-for-a-diagnosis-attitudes-to-womens-pain-may-be-to-blame-179500 

Conrad, P., & Leiter, V. (2004). Medicalization, markets and consumers. Journal of Health and Social Behavior, 45, 158–176 

Coulter, A., & Oldham, J. (2016). Person-centred care: what is it and how do we get there?. Future Hospital Journal, 3(2), 114–116. https://doi.org/10.7861/futurehosp.3-2-114 

Gross, R. (2020). The Clitoris, Uncovered: An Intimate History. Retrieved from: https://www.scientificamerican.com/article/the-clitoris-uncovered-an-intimate-history/ 

Jones C. E. (2015) Wandering wombs and “female troubles”: The hysterical origins, symptoms, and treatments of endometriosis. Women’s Studies 44(8): 1083–1113 

Jutel, A. (2022). Diagnosis: A social and political phenomenon. K. Chamberlain & L. A. C. (Eds.), Routledge International Handbook of Critical Issues in Health and Illness (pp. 71–81). Taylor & Francis Group. 

Jutel, A., & Buetow, S. (2007). A picture of health: Unmasking the role of appearance in health. Perspectives in Biology and Medicine, 50(3), 421–434 

K. Chamberlain & L. A. C. (Eds.), Routledge International Handbook of Critical Issues in Health and Illness (pp. 71–81). Taylor & Francis Group 

Lafrance, M. N., & McKenzie-Mohr, S. (2013). The DSM and its lure of legitimacy. Feminism & Psychology, 23(1), 119–140 

Lyons, A.C., & Kerry. (2006). Health psychology: A critical introduction. Cambridge University Press. 

McVean, A. (2017, July 31). The history of hysteria. Office for Science and Society; McGill University. https://www.mcgill.ca/oss/article/history-quackery/history-hysteria 

Olafsdottir, S. (2013). Social construction and health. In W. C. Cockerham (Ed.), Medical Sociology on the Move: New Directions in Theory (pp. 41–59). Springer. https://doi.org/https://doi.org/10.1007/978-94-007 

Snider, P., & Zeff, J. (2019). Unifying Principles of Naturopathic Medicine Origins and Definitions. Integrative medicine (Encinitas, Calif.), 18(4), 36–39. 

Tewhaiti-Smith, J., Semprini, A., Bush, D., Anderson, A., Eathorne, A., Johnson, N., Girling, J., East, M., Marriott, J., & Armour, M. (2022). An Aotearoa New Zealand survey of the impact and diagnostic delay for endometriosis and chronic pelvic pain. Scientific reports, 12(1), 4425. https://doi-org.ezproxy.massey.ac.nz/10.1038/s41598-022-08464-x 

Thomas, F. (2021). Medicalisation. Routledge International Handbook of Critical Issues in Health and Illness (pp. 23–34). Routledge