Holistic Health

Smuts and the coining of holism

The word holism was coined by Jan Smuts (1870-1950), a South African statesman and botanist, in his book Holism and Evolution, published in 1926. A chapter by the philosopher William Sweet says Smuts wrote the roughly 350-page book in about eight months after losing the 1924 South African election. In an encyclopaedia entry of 1929, quoted by Sweet, Smuts described holism as the theory that makes the existence of wholes a fundamental feature of the world, treating natural objects as wholes and not merely as assemblages of parts.

Sweet judges that the book did not have lasting scholarly impact but introduced a new term into popular discourse. The historian Bruno Hamnell reports that it was widely and mostly favourably reviewed, although some reviewers criticised Smuts's vague definitions.

From interwar term to medical vocabulary

Hamnell's survey of the academic literature finds that, once the word reached medicine, its meaning quickly detached from Smuts while continuing to stand for similar principles: a rejection of materialism, mechanism and mind-body dualism in favour of a view of the person as a whole that takes social and environmental factors into account. He lists early medical uses in the British Medical Journal in 1936 and 1940 and a Journal of the American Medical Association editorial headed Holistic Medicine in 1948.

The holistic health movement of the 1970s

According to Hamnell, a British Medical Journal reviewer wrote in 1976 that holistic medicine now held the floor, and the New York Times first used the phrase holistic health in 1978, reporting on a conference that introduced indigenous and alternative approaches including yoga and acupressure. He describes the idea gaining traction in Californian New Age circles and the counterculture, and says holistic health centres and a holistic health movement had emerged by 1980, followed in the 1980s by specialist journals and by British and American holistic medical associations.

In a 1981 survey, the philosophers Loretta Kopelman and John Moskop characterised the movement by five shared assumptions: a positive view of health as well-being, individual responsibility for health, the importance of health education, control of social and environmental determinants of health, and low-technology natural therapeutic techniques. They also proposed that advocates differ in whether they are committed to scientific method.

Wider definitions of health

Two other documents are often read alongside this history. The Constitution of the World Health Organization, adopted on 22 July 1946 and in force from 7 April 1948, defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. In 1977 the psychiatrist George Engel argued in Science that the dominant biomedical model left no room for the social, psychological and behavioural dimensions of illness and proposed a biopsychosocial model. The sources reviewed do not say that either text founded the holistic health movement.

Holism, holistic and holistic health

Hamnell describes holism as a term charged with multiple meanings and says that, in medicine, holistic perspectives have been linked to alternative approaches, New Age spirituality and pseudoscience. He reports that holistic health, once it appeared in the late 1970s, was often used interchangeably with alternative medicine and sometimes with healing. Related labels in his account include holistic medicine and the German Ganzheitsmedizin, which he gives as the German equivalent of holistic medicine.

An integrated review in a nursing journal, which extracted data from 58 articles, found that holistic describes whole person care, often acknowledging body, mind and spirit, and that holistic nursing defines a disciplinary practice specialty. That finding comes from nursing literature and should not be assumed to describe every professional group that uses the word.

Complementary, alternative and integrative

The United States National Center for Complementary and Integrative Health uses complementary for approaches used together with conventional medicine and alternative for those used in place of it. It describes integrative health as bringing conventional and complementary approaches together in a coordinated way, with an emphasis on treating the whole person. Those labels describe how approaches relate to conventional care, whereas holistic is a broader label for an outlook, so the terms overlap without being equivalent. Integrative medicine is covered on its own page.

The nursing review found considerable overlap between holistic nursing and integrative nursing, both being associated with complementary and alternative modalities and with similar philosophical underpinnings, while the relationship of integrative nursing to integrative health care was unclear from definitions alone.

Partner terms and counter-terms

Hamnell identifies interdependence, organicism, process, Gestalt and synthesis as partner-terms of holism, and materialism, mechanism, reductionism, specialisation and analysis as its counter-terms. He also observes that holism has carried varying political and spiritual associations over time, from links with totalitarianism in the interwar era to environmentalism and New Age spirituality since the 1970s, which helps explain why the word attracts both support and criticism.

A concept and not a single technique

Holistic health is not one technique with a standard session, practitioner role or dose. In the account of Kopelman and Moskop, the movement is characterised by shared assumptions, among them individual responsibility for health, health education and the use of low-technology natural therapeutic techniques, and not by a fixed procedure. The sources reviewed do not describe a standard intake, session sequence or schedule for holistic health as a whole.

Holistic nursing is described in the nursing literature as a disciplinary practice specialty that delivers whole person care. A nurse or other clinician who works this way may or may not use complementary approaches, and the sources reviewed do not set out what a consultation involves.

How the label appears in studied interventions

Researchers apply the word holistic to quite different interventions. A 2025 trial in China described a holistic nursing intervention based on Harmonious Nursing Theory for people in the stroke recovery period, compared with routine nursing. A 2025 German trial described a holistic diagnostic service in which employees with limited work ability attended a two-day assessment at a rehabilitation centre, followed by consultations at the workplace. These are separate programmes with different components, and the shared adjective does not make them versions of one practice.

Aims described by advocates

Hamnell says that Smuts saw holism as a way of reconciling science and religion, whereas proponents of holistic medicine have mainly sought to broaden medical practice by drawing on history and on non-Western cultures. He adds that doctors and nurses have also promoted holistic approaches in order to renew healthcare, rejecting mind-body dualism and emphasising factors such as lifestyle and spiritual health.

These are statements about intentions and orientation. The sources reviewed do not attach holistic health as a whole to a specific condition, population or outcome, so no condition-specific claim is recorded here.

Wellbeing and public health programmes

In a qualitative evaluation of a public health programme in North West England, stakeholders understood wellbeing as more than health and more than happiness, concerned with functioning, sense of purpose and flourishing, and regarded it as an essentially holistic concept. The study interviewed 52 stakeholders and 90 community members and reports perceptions, not health outcomes.

Marketing use

Hamnell notes that holism is now a common term in branding and marketing, often in relation to health or the environment. A reader meeting the word on a product or service should therefore not assume that it signals any particular method, qualification or evidence base.

What has and has not been studied

Holistic health as a general approach has no defined dose, schedule or comparator, so it cannot be tested as a single intervention. A PubMed search using the Holistic Health subject heading restricted to randomised trials and systematic reviews returned 124 records. Those opened were studies of specific interventions or tools that carry the word holistic in their titles, and none was a review of holistic health as a whole. This search was not exhaustive and other databases were not searched.

Researchers who study whole systems of complementary and alternative medicine have noted limitations in applying biomedical cause-and-effect assumptions and conventional efficacy designs to such systems, and have worked with complexity scientists on other approaches. That discussion concerns research design and does not report effects of any treatment.

Two trials that use the label

The Chinese trial allocated 166 people in stroke recovery, 83 per group, by random number table to routine nursing or holistic nursing based on Harmonious Nursing Theory. Its abstract reports lower self-rated anxiety and depression, higher hope scores and higher satisfaction in the holistic group. The abstract does not state blinding, follow-up length or trial registration, and the outcomes were self-reported, so the findings are limited to this setting and design.

In the German trial, 61 employees were analysed, 32 in the intervention group, with the control group assessed six months later. The difference in work ability score at six months was 1.15 points (95% confidence interval -0.05 to 2.35, p=0.061), which the authors called clinically important but not statistically significant, and sick leave was 4.00 weeks shorter (-7.49 to -0.51). The sample was small, and the result applies to this service and population.

Holistic concepts in a reductionist programme

The North West England evaluation reports a perceived dissonance between the holistic concept of wellbeing and a programme designed in reductionist ways that required monitoring against discrete outcomes. The authors raise concern about how wellbeing can be realised without compromising the concept. This is a finding about measurement and programme design, not about whether holistic approaches improve health.

Scientific and conceptual criticism

Hamnell reports that holistic approaches faced criticism from the late 1970s for lacking scientific evidence, and that one book of the period was criticised in the New England Journal of Medicine and the Southern Medical Journal for irrationalism, mysticism and spiritualism. Some doctors defended the approach and argued for testing holistic treatments before dismissing them, while critics argued for dismissal because they had not been tested. In his assessment, the association with New Age ideas and pseudoscience continues to give holistic medicine a poor reputation.

Kopelman and Moskop offered criticisms of each of the five tenets they identified. Only the abstract of their 1981 article was available for this draft, so the content of those criticisms is not summarised here.

Vagueness and political readings

Early reviewers of Holism and Evolution criticised Smuts's loose definitions, and Hamnell notes that the term was associated with totalitarianism in the interwar era. Sweet discusses allegations that Smuts's holism was racist and finds that the critics he examines point to no text in Smuts's account of holism that supports a direct link between the theory and racial hierarchy. Historians therefore disagree about the political meaning of the word, and the modern health usage has largely separated from Smuts's own theory.

Care boundaries

Because holistic is a broad label, any safety question depends on the specific practices involved. Hamnell notes that holistic health has often been used interchangeably with alternative medicine, which the NCCIH distinguishes from complementary use by whether it replaces conventional care. A 2018 retrospective study of United States cancer registry data defined complementary medicine as unproven treatment given by non-medical personnel alongside conventional treatment, and found higher refusal of conventional therapy in that group. Five-year survival was lower (82.2% against 86.6%), but once treatment delay or refusal was accounted for the association with survival was no longer significant, which suggests that refusal, not the added approach, drove the difference.

That study did not examine holistic health as such, was observational and has the limits its authors describe, including under-ascertainment of use. Taken with the other sources, it supports a general care boundary: a whole-person approach is not a reason to delay or replace necessary medical assessment or treatment.

Training and oversight

The sources reviewed identify no single training standard or regulatory framework for holistic health as a whole, and requirements differ by country and by profession. The nursing literature treats holistic nursing as a disciplinary specialty, and Hamnell records that holistic medical associations and journals appeared in the 1980s. Standards for any named practitioner or programme would need to be checked for that practitioner and jurisdiction.