Guest Blog: David Tusek, MD - An Integral Path to Medicine (The mysteries of salutogenesis)
April 25, 2009 02:43

An Integral Path to Medicine
(The mysteries of salutogenesis)

David Tusek, MD
Longmont, CO

  1.  Theory:  working to further develop the AQAL framework for health,  healing, medicine
  2. Practice:  working to define a practical approach to implement integral methodologies into the practice and delivery of healthcare
  3. Architecture:  building an environment/campus/network that can facilitate the delivery of healthcare by housing a collaborative community of integrally informed practitioners


Theory:   The mapmaker

It is an inestimable gift of the integral approach to have provided us with a “one-pager” to make sense of our world:  a map in which we can see how seemingly disparate elements and phenomena in our universe fit together.  This not only provides us with a view from 30,000 ft, but also allows the origin of a common language which is big enough & inclusive enough to contain, describe, and communicate the wonders of this panoramic vista.

This map acts as a portal to communication or inter-communication between cultures, paradigms, structures, as well as amongst individuals. 

In this spirit, a very important and urgent goal for integral medicine (and medicine in general) is to flesh out the AQAL crosshairs.

Most doctors now acknowledge that, at least some of the time, acupuncture seems to work better than placebo.  But how can this fact fit into our understanding of how the body works.  On what level, or on what basis, exactly, does it work?   And since we can no longer deny that it works, how do we incorporate it into our worldview?

There are myriad other phenomena, practices, and modalities that have underpinnings that are baffling from a modern scientific perspective.  But gradually research in the fields of the noetic sciences is cross-pollinating with data from studies of subtle energy phenomena, biophotons, and even high-resolution functional brain imaging technologies and is beginning to shed light on how and why their effects seem to be so powerful, non-random, and more effective than placebo.

So, one of the pressing goals of AQAL theory in the realm of medicine is to further enhance and color-in the integral map as it particularly relates to this field.  


Practice: Implementation for the real world

Health is nothing more than thriving despite the inevitable fact that
            a.)  you are dying every day, and
            b.)  the world is a place where horrible, painful, things occur on an ongoing basis.

(Note:  This does NOT preclude Thriving!)

With an integral perspective we can begin to enter the realm of customizing healthcare modalities, interventions, and practices based upon the needs of the individual patient.
For example, we begin to ask how various STAGES of various LINES affect how a patient will respond to a disease, and how to optimize his/her therapy and healing.

First, however it is important to clarify several points.

a.) The difference between health and healing
b.) The difference between chronic and acute illness
c.) The impact of “lifestyle” (in the most compreshensive sense of the word) on health
d.) The successes and failures of lifestyle modification
e.)  The difference between recovery (restorative) and healing (evolutionary)

Health is about harmony.   It is a state of relative balance and symmetry and equilibrium.  In its ideal form, there is no scarcity of the necessary elements required to thrive, nor is there an overabundance  (no deficiencies, but also no toxicities).  The organism enjoys an overall condition of balance [appropriate for its particular developmental stage(s)] within and among all of the 4 quadrants.  (A translational steady-state)

Healing, on the other hand, implies change--often radical--which is necessary due to a particular (usually unpleasant & unwelcome) stimulus.  As the organism responds to an ailment (be it infectious, musculoskeletal, hematologic, psycho-emotional, etc...) it is called to transform in some manner.  The skin layers of a wound re-organize into a scar, for example, on the simplest level.  This scar may heal quickly and fully, or it can be marked by pain, keloid formation, infection, or even dehiscence.  All 4 quadrants are involved in the ultimate outcome of the scar.  But regardless of the final result, that area of the skin will never be the same.  The ultimate change in the tissue is not just related to the severity of initial damage, but also to the overall AQAL mileu during the healing process.

Of course, there is good healing and bad healing.  In some cases the individual/organism becomes “stronger” or better adapted as a result of the healing experience  (for example one might develop antibodies against a virus which is much less likely to re-infect that person in the future).  In other cases the healing process is poor, interrupted, regressive, or marked by complications (which may even be fatal).  Again, the overall status of balance within the 4 quadrants is of critical relevance here.

In any case, since the process of healing from an ailment, generally speaking, involves change, disease can be regarded as a fulcrum for the lever of change (or transformation).   The real mission of medicine is to harness this potential to transform which is inherently present in the face of disease.  Often the greater the severity of the ailment, the greater this “potential” becomes.  The true goal of the healer is to help to unlock, and not squander this often enormous “potential”

Rather than thinking of healing as a return to homeostasis, as for example a rubberband that is stretched will return to its original start position when the tension is removed, true healing involves a process of evolution.

This evolutionary process, when it occurs, may manifest in any of the quadrants independently, but in an ideal medical model, with optimal treatment/therapy, it would incorporate/integrate/engage all of them.

For instance in Q1,  a sufferer may, through the healing process, progress along the emotional line to a place of greater emotional resilience; and/or along the spiritual line to a place of greater peace.  (These may coincide with simultaneous advancement within Q2, such as by healing/rehabilitation/physical therapy leading to a stronger muscle or joint, or less inflamed liver than prior to the injury--but not necessarily.)  In Q3/4 a given family or community (or, over time, even a culture) could use the insight of one or more sufferers of a given condition or syndrome to collectively improve the healthfulness of their local environments, access to various salutory resources, or the amelioration of healthcare delivery policies in general.

(However, it bears noting that we go through an process of growth, maturation, and decline, and that eventually the physical body will deteriorate.  This law in no way applies to the inner (consciousness) dimensions of the organism.  Indeed, as the physical body approaches death, the soul and spirit within may blossom with profound radiant awareness.)

Acute illness and injury is most amenable to cookbook medicine.  Typically, the goal of treating acute ailments is “recovery” rather than any deep connotation of healing. I.e., a return to the prior level of function.   While recovery remains intimately dependent upon the AQAL balance, generally speaking, the modalities and therapies for acute conditions are straightforward and well-defined.    (Although I would submit that acute illness usually arise in the context of preventable and thus modifiable lifestyle factors).

In contrast, chronic illness, which has--by an enormous margin--the greatest impact upon the health (particularly amongst the citizens of Western countries) is anything but straightforward.  The manifestation, development, and course of chronic disease is fundamentally entrenched in the lifestyle of the individual.  And “lifestyle” can be broadly defined as the overall quality of balance of the 4 quadrants (again, relative to the particulars of the levels, lines, and states within them).

Lifestyle modification--in the most encompassing sense--(which can be either  “transformational” OR “translational”) then forms the basis of any intervention that may be prescribed to prevent or treat chronic conditions.  Therefore, as physicians, we should be expert at dealing with these issues!  Right?   Unfortunately nothing can be further from the truth.   Any marginally effective approach that assists people with lifestyle change must incorporate a view that is multidisciplinary in scope. 

Ideally it would be helpful to know some of the following:

Quadrant I (UL): 

  1. motivation / readiness for change-   where does the particular individual lie on the spectrum between, “I definitely cannot or will not change my behavior” to, “I am very willing, able, and eager to change my behavior?
  2. personality type-   what are the levers and fulcrums that motivate a particular individual?  (Myers-Briggs, FiveFactorModel, Enneagram)
  3. cognitive ability-  how sophisticated is this individual and what is the best level at which to communicate ideas with him/her?  (IQ, Folstein MMS exam)
  4. moral level-  are there any hidden agendas that would be helpful or crucial to understand when working with this particular individual?
  5. psycho-emotional axis-  what are some of the potential shadow elements that may impact behavior and behavior change?  (repressions, denials, past traumas, etc.) Eg. In E. Tolle’s terminology, what is the source and the manifestation of the “pain body”.
  6. sprituality-  what is the degree of a sense of meaningfulness and purposefulness in the person’s life?  (directly related to stress-tolerance, coping mechanisms, etc)

Quadrant II (UR):

  1.  nutrigenomic background-  what biological forces are at play which determine the particular individual’s optimal dietary needs? (which can vary greatly)  
  2. Status of endogenous inflammation-  (hsCRP, TNF markers, etc.)
  3. Blood type-  what particular RBC antigens play a role in the given person’s health?
  4. Genetic background-  what predispositions has this individual inherited?
  5. Direct toxin exposure-  what history does this individual have of specific, self-directed consumption of harmful substances (drugs, alcohol, smoking, poor diet).   See Q3 a.
  6. Nutritional deficiencies-  is there a history of inadequate intake of necessary nutrients?
  7. Access and exposure to regular physical exercise
  8. Somatic typology


  1. Prana/Chi flow status-  what is the status in terms of these energies? (blockages, excesses, deficiencies)
  2. Dosha-  what physical type/category does this patient fall into? (Kappa, Vata, Pitta)  And how can this inform the diagnostic workup and therapeautic prescription?
  3. Biophotonic phenomena
  4. Vibrational phenomena and subtle energies NOS-

Quadrant III (LR):

  1. Access to needs-   Does the individual have adequate access to basic needs?  (food/shelter/safety/”adequate” social environment, etc)
  2. Healthcare policy-  Access to basic healthcare?
  3. Educational system-  Does the individual have access to adequate education?
  4. Social network- Does the individual have a social network of relatives/friends?
  5. Access to recreational activities/nature-  sun! mountains! fresh air! starry skies!---inspiring landscapes (macro)  plants birds insects (micro)
  6. Geopathic effects- Any chronic exposure to enviromental toxins, noxious fumes, chemicals, pollutants, molds, allergens, radiation, etc. ?


  1. The energy of space-  what is the influence of the patient’s surroundings upon the individual (not only in the utilitarian sense, but also in a direct sub-conscious energetic level)?   Architecture?  (Feng-shui, Dousing)
  2. The energy of other beings-  interactions with other people and animals can have direct impact upon our own energetic states.  What is the history of these factors in the patient’s social circle?

Quadrant IV (LL):

  1.  Cultural notions of “disease”-  these can turn a relatively minor “illness” into a profoundly grave “sickness”.  How do these notions inform the experience of the particular patient?
  2.  Collective neuroses/psychoses-  What is the broad cultural background in this area?(how is one’s health impacted if they grow up among Nazis?  Exposed to extreme sadomasochistic violence in pathologically tolerant contexts?)
  3. History of socio-culturo-familial trauma/abuse/neglect  -vs-  support/caring/love
  4. The intentions of the healer-  How will the diagnostic workup and therapeautic plan selected by this particular healthcare provider work for this particular patient, given all of the above???


Of course this is but a brief smattering of possible entries.  But even just grasping a partial list, what an armementarium would we wield ( ! ) as healthcare professionals if we had:

  1. a quick way to inventory this data in our patient encounters
  2. knowledge of how to interpret it in the context of their health
  3. understanding of how to harness these insights in an effective manner
  4. understanding of how to “meet each individual patient where they are at” and     convey helpful information in an effective manner.


Where we are now:

A.) 4 Quadrant snapshot--while far from complete, the intake form that we use at our office is a quick way to obtain a multi-quadrant assessment of where (in which “arena” of their life) they are thriving, and where they are struggling and need particular attention.

Furthermore, we have developed and are refining a similar brief, questionnaire-based assessment of:

B.) Readiness for change-- to improve the most pressing areas requiring lifestyle modification.  Typically this is initially based upon evaluation the “5 pillars of health” and the  “3 diets”.

5 pillars:

  1. plentiful purified filtered water
  2. individualized diet
  3. regular exercise (all 3 types: strength, cardio, & stretch)
  4. deep restful rejuvenating sleep
  5. formal approach to stress reduction and relaxation

3 diets:

  1. 1. physical diet:  optimal nutrition for your specific body
  2. 2. psycho-emotional diet:  media, social activities
  3. 3. spiritual diet:  contemplative/meditative activities

C.)  Personality type-- to identify particular personality traits which bear significance in terms of style and approach to behavior change.  We are incorporating numerous models including Myers-Briggs, FFM, Enneagram data, Robert Kegan & Lisa Lahey’s work, Roberta Wennik’s work, etc.   This allows us to identify the multiple (but reproducible) personality traits in a quick & efficient manner, and modify our therapeutic goals, plans, and prescriptions accordingly.

  1. Nutrigenomic diet-- since nutrition is absolutely fundamental and foundational in health, and because we are continually gaining more data that suggests that optimal dietary needs vary widely between individuals, and because various food sensitivities and subtle intolerances are so common, we have developed an efficient, multimodal technique of nutritional analysis. 

    We take into account numerous aggregate variables and nutritional models in order to derive a comprehensive individualized dietary assessment.  Some of these include (Dosha type, blood type, serologic inflammatory marker levels, metabolic typing (based upon oxidizing rates), acid/base assessment (based upon Robert Young’s work). 


David Tusek practices family and emergency medicine with an integral approach in Broomfield, CO and can be reached at



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