In late September, the Academy of Integrative Health and Medicine (AIHM) sent out a notice to its list to celebrate the 80th birthday of perhaps its most honored male elder, Bill Manahan, MD. Manahan’s story dates back to a founding membership meeting of a predecessor to the AIHM, the American Holistic Medical Association (AHMA), 40 years ago. One of Manahan’s most powerful areas of impact is an AIHM priority: sewing interprofessional respect. He’s worked to pry open the MD guild – which proved necessary even in the MDs’ “holistic” form. Manahan has been a mentor to countless practitioners and other functionaries in the holistic health and integrative medicine movement, including me. I thought his birthday was a good excuse to re-connect and explore a couple pieces of his rich history in the field – specifically the inter-professional work and the remarkable Minnesota group he has managed for 40 years.
Manahan’s work includes visionary promotion of integrative team care. He converted this passion into founding of the Minnesota Holistic Medicine group, the most influential and long-standing regional gathering in the field. At this site, he is celebrated for these contributions:
Manahan is Assistant Professor Emeritus with the Department of Family Medicine and Community Health at the University of Minnesota Medical School. He is Past-President of the American Holistic Medical Association and author of the book, Eat for Health. He founded The Wellness Center of Minnesota in 1982, one of the first physician-led integrative medicine centers in the country. In1994, Bill co-founded Open Door Health Center in Mankato, MN, a clinic for the underserved and uninsured. The clinic [formerly served] over 5,000 people each year with over 15,000 yearly visits. He served, for many years, on the clinical faculty of Mayo Medical School in Rochester. During that time, Bill had over 80 Mayo medical students spend two to six weeks with him in his office. Bill helped pioneer two integrative medicine programs for medical students from North America. These programs are designed to educate and encourage medical students to become leaders in integrative medicine. The programs are known as the Leadership and Education Program for Students in Integrative Medicine (LEAPS into IM) and the Humanistic Elective in Activism and Reflective Transformation and Integrative Medicine (HEART-IM). Both of these programs are supported by the American Medical Student Association (AMSA).
Manahan also served on the founding Integrator editorial board and has been available multiple times for his perspectives on key issues. (See short list of come of his Integrator contributions at the bottom of this interview.) For you who want to hear his voice, check this 2018 podcast.
Integrator: I thought of calling you when AIHM sent out the notice celebrating your 80th birthday. Congratulations! I’ve had in my mind all these years that you were there at the founding of the AHMA.
Manahan: No, I didn’t know about it when Norm Shealy, MD and Gladys McGarey, MD and Evarts Loomis, MD [pictured, L to R] and others founded it in 1978. They met in La Cross, Wisconsin, about a 3 hour car ride from where we lived, in Mankato, Minnesota. I learned about it through my wife then, Diane. She was a nurse and she got something in the mail about a new holistic nurses group with Norm’s wife, who was a nurse, and Barbie Dossey, RN, PhD. She wanted to go. We went to the second meeting, also in LaCross, in 1979.
Integrator: What was it like?
Manahan: For me it was like how someone must feel what they find Jesus! I was thinking, ‘oh, these guys think like I do!’ It was everything I wanted and much more. We went back the next year for the first member meeting and I’ve pretty much been going ever since.
Integrator: Ah, so I had right that you were a founding member. You say you had a surprise at that meeting regarding membership requirements. It ended up becoming something of a mission for you – that took 20 years.
Manahan: In the meeting I raised the question of why would we want to limit membership to just MDs and DOs. Norm said that it was MDs that needed it the most. The idea of opening membership more broadly to others who were holistic was voted down. But afterward Jim Gordon, MD – he was the only one who voted with me – came and asked me to come on the Board.
Integrator: Go Jim! I know that exclusion aggravated a lot of folks, including my naturopathic doctor spouse and many in the naturopathic profession with which I was working in the 1980s. What, are you the only holistic doctors? That’s a great piece of history – you and Jim there.
Manahan: It’s greater how long it took to actually get the change! It took 20 more years! We had a meeting every 4 months. I kept bringing it up.
Integrator: What was the resistance?
Manahan: I think it was two things. The first is that everyone else we were thinking about – chiropractors, acupuncturists, others – were already more holistic. Like Norm said – we had our own work to do. The other, if I go to my dark side, I can see that part of it was us being egotistic and isolationist.
Integrator: Honestly, I kind of get it politically and culturally. It’s hard enough for many medical doctors – especially in that time – to open their thinking among their own kind. How much hard to have to do it among “lesser” professions that in this are were more advanced. The view from outside we pretty much all about the dark side, as I recall!
Manahan: I kept pushing for it when I became president, from 1988-1990. I kept bringing it up. It took me the whole first year and most of the second [of my 2 year term] for the Board to agree. Then since it was a bylaw change, we had to put it to the whole membership. It went down 3 to 1! That was a real lesson in leadership to me. I was a general who forgot to bring the troops along. It wasn’t until much later, 2007 or 2008, that it was finally changed. I kind of gave up on it. I realize now that some of us just see the world earlier – that we need all practitioners working together.
Integrator: You fundamental interprofessional respect and belief in the importance of team care distinguished you early. It was a big part of what drew me to you.
Manahan: Every MS should be partners with NDs and DCs or DOs in their practice. MDs don’t know how to do slow medicine. They do “fast medicine” as [MD and author] Victoria Sweet calls it. We should let the MDs do what they do well, the fast medicine – and then link to the alternatives to deal with the chronic diseases out in the community. The system is so broken. I went in for a 10 minute dermatology appointment. Guess what the charges were?
Integrator: Well those quick freezing of face spots can wrack up a bill quickly.
Manahan: $1300! This is totally immoral. It’s totally immoral to charge $1300 for 10 minutes. It’s a metaphor for the whole system. It’s amazing – the system is so broken.
Integrator: Do you see signs of healing?
Manahan: I think functional medicine is helping some of the MDs bridge some of the gap, to help them go upstream to treat the causes. [Acupuncturist] Jennifer Blair grabbed me by the collar once and said TCM has been going upstream for 200 years. That’s true with Ayurveda, and naturopaths. Basically, MDs are not trained to do it.
Integrator: I think there are some re-training MDs – functional and integrative and lifestyle – who are clearly working their way toward slow medicine. Any other positive signs?
Manahan: Well, definitely what is going on at the VA [Veterans Administration]. That whole health program is exciting. I’ve been very pleased with the VA, and who they have drawn into leadership. I’d also say that another positive sign is definitely what we have seen and been able to do with our group here in Minnesota – Minnesota Holistic Medicine. It’s going stronger than ever over 30 years in.
Integrator: I’ve always found it remarkable that you keep running and managing that group.
Manahan: It’s going strong. We started in 1989. My wife, Diane, suggested I do it since I was so excited going to every meeting of the AHMA every 4 months. I was just so filled up by my tribe at those meetings – it was a high point of every quarter. Then we’d go back to our regular life and it would be like air going out of a balloon. When Diane suggested it, I didn’t think we had enough to start anything. But with a few people I knew, and nurses and others who Diane knew, we started with 15-20 or so. Now we have close to 1000 on the list. We still meet quarterly – though we’ve called it off the COVID. We usually have 100 or so show up.
Integrator: What’s the professional mix?
Manahan: It’s about 250 MDs and DOs, 150 nurses, and then 600 others from many fields. The meetings tend to break down into similar percentages. It’s basically a time to first, get to know each other, second, to learn from each other, and third, to then begin to refer to each other.
Integrator: Do you have any tips on how to stimulate interprofessional respect and team care? It’s my sense that while we have a lot of lip service to it in the integrative space, it is often less realized than we project.
Manahan: I don’t have any tricks. I’d say the first is just getting to know one another, and second, you just have to hear the other talk about how they approach and care for a patient. It took a few years for some of the chiropractors to join, because MD’s had not been kind to DC’s over the years. One of our Saturday morning programs that was really appreciated by everyone who attended was having six holistic dentists discuss “Controversies in Dentistry.” They talked about root canals, fluoride, implants, and things like. Who do you think was most interested? The MDs and RNs! I realized that many of us do not know much about the dental field.
Manahan: The first thing I see is it doing nationally what Minnesota Holistic Medicine has done. MDs and DOs expecially don’t know how to refer to anyone but MDs and DOs. By learning together at our Saturday morning meetings, we will learn to do a better job of cross-referral, I suspect.
Manahan: I’d like to see allopathic medicine focus more on what they do well. I’d like to see NDs, DCs, PTs, acupuncturists, definitely energy medicine – all working together with MDs. There are a certain percentage of people with depression, for instance, who need SSRIs, maybe one in 5. Others need something else. We need to have practitioners working together so people can get what they need.
Two Additional Notes
1. Manahan Integrator sampler: Manahan was part of the founding Integrator Editorial Board – a group of colleagues who lent the credit of their names to the Integrator idea when I was beginning in 2006. In the early years, the Integrator regularly featured forums on different topic that were especially notable for their interprofessional nature. Bill was a regular participant – offering whole columns from time to time. Here is a selection of what came up by putting “Manahan” in the search function at www.theintegratorblog.com.
2. Manahan on Charles Eisenstein’s “The Coronation” In late March, when COVID-19 first began to make itself known to us, author and philosopher Charles Eisenstein produced a stimulating thought-piece, The Coronation, that went viral. I called for comments and Manahan sent one, that I haven’t yet published. This summary reflection from Manahan is another look into the present perspective of one of the early influencers of this movement.
April 28, 2020
To try to summarize this article by Charles Eisenstein seems similar to me as if trying to summarize the Bible. His article is so filled with ideas, knowledge, and wisdom, that I will do the author a grave injustice trying to say it in fewer words. But I will try!
Covid demonstrates the power of our collective will. How do we truly awaken to the power? This pandemic makes our habit of how we live visible to us. It can help us break the addictive hold on all of us that our lives are normal. Do we really need all these jobs, air travel, vacations, and conferences?
Are we really ready to live in a world of decreased civil liberties, hugs, public life, freedom to assemble, etc.? Have we maybe gone too far with our war on death? We tend to forget that each year in the world there are five million deaths from hunger, one million from suicide, 70,000 from drug overdose, and millions more from gun deaths and diseases of life-style such as Type 2 Diabetes, obesity, lung cancer, and hypertension.
We tend to like problems that succumb to domination and control such as fighting the Nazis in Germany. But, when the cause is intimate to ourselves such as homelessness, addictions, and inequality, we find there is nothing to war against.
The question maybe not asked enough is if the measures instituted against the virus will ultimately cause more suffering and death than they prevent. Will death by loneliness be classified as such? Will death by decreased immunity be recognized?
Eisenstein suggests that maybe this pandemic will force us to embrace the holistic paradigms and practices that have been waiting in the margins. Maybe this pandemic will help us move towards a new system of health and healthcare built around an increased advocacy for the emotional d spiritual dimensions of health. Maybe this pandemic will help us begin to understand the power of attitudes and beliefs regarding illness and healing; to understand the power of a movement that embraces herbs, meditation, prayer, yoga, Qigong, organic food, and other holistic modalities that are proven to boost immunity.
We, as a collective world, have stood helpless in the face of an ever-sickening society. We have the symptoms of civilization malaise, but we have not been willing to change the systems and patterns that caused them. Maybe Covid has gifted us a reset. We can become a more compassionate society by transforming our basic narrative of separation. To be alone is a primal fear, and modern society has rendered us more and more alone.
Covid is the emergence of the unconscious into consciousness; the crystallization of chaos into order; the transcendence of compulsion into choice. It is possible that Covid will bring order to the kingdom and build an intentional society on the love already shining through the cracks in the world of separation.