Innovations in Medicine Take Us Back to the Future

The Center for Integrated Health and Healing

by Suzanne Comer Bell
Smoky Mountain Living  Spring 2006

Part 1 of 2 parts

In an earlier day, the medical crisis in the mountains revolved around the availability of basic health care. Doctors and medicine were in short supply, and a midwife was usually the only resource for the traumas of childbirth, pneumonia, or farm injuries. During the nineteenth and twentieth centuries, wealthy lowlanders discovered the mountains were a cool escape from sweltering heat and mosquito-borne malaria.

Jump to the twenty-first century, and we find a dizzying array of options for health and healing. The Western traditions of surgery, prescription drugs, and over-the-counter remedies have been entrenched for decades. Now alternative therapies, treatments, and supplements grab for our attention. People have begun to question the reaches of conventional medicine, but it’s opened the gates for a flood of health options, some ancient and others newly conceived. Where does one turn for help among the myriad choices?

You get a cold, worrisome test results, or just the blues—most people still want a doctor they can trust. These days, the need for a primary physician to serve as an umbrella over various specialists and therapies is greater than ever before. “Fix me, Doc” is still a common plea, but the answers might be less familiar, and might, instead, be a series of questions posed back to the patient and going much deeper than “Where does it hurt?” Doctors such as Charles Lefler, M.D., and James Nourse, Ph.D., L.Ac., of the Center for Integrated Health and Healing (CIHH) in Brevard, N.C., encourage patients to answer, “How are you relating to others? What does this trouble mean to you? Are you taking responsibility for your life?”

Lefler has assembled a center of practitioners whose specialties range from nutrition, reflexology, and psychotherapy, to acupuncture, massage, and Reiki. As the spokes around the hub of traditional internal medicine, these highly trained, gifted practitioners seek to heal each patient in mind, body, spirit, and environment. They are conscious of the need to stay in close touch with the mountains, their own personal environment, the seasons, even the changes in the fog, mist, and blue sky throughout a single day.

Walk with me into CIHH’s waiting area, a quiet, nicely appointed room with a pleasant selection of health and travel magazines, warm wood tables, and antique upholstered chairs (I’m guessing a grandmother’s legacy). Intentionally absent are the sterile, clinical atmosphere or a blast of entertainment doodads, TVs, and coffee to numb us from the pain. Instead, modest amenities welcome patients into a living room–like setting. A brass tree rooted in stone holds one corner of the room, while the open arrangement of seats invites conversation, relationship.

The room also invites an internal conversation. “How did I get here, after all?”

That Good Ol’ Mountain Feeling
For most of us, the experience of coming to the mountains is transformative. At our first approach, we inhale the fresh spicy air and walk into the enveloping greenness of life. Ahhhhh. We settle in to a cozy cabin perched on a ledge and drink in the views for miles. As life dishes out to us delicious new possibilities, our souls cry out, “This is home!” more than anywhere else on earth.

Then … something changes . . . the end of a favorite season, a sudden longing for family left behind, or symptoms of disease. As heavy rains set in for days, the dampness triggers allergies, not to mention depression and loneliness. And, so, you find yourself looking for help to restore your love affair with abundant health in the Smoky Mountains. Where do you turn, as the ring of mountains suddenly seem like steep sides of a blue bowl closing in? At the thought of trying to explain your feelings to someone, you begin to feel a flash of panic.

The practitioners of CIHH understand intensely this up and down journey toward health, and they offer patients multidimensional paths of healing that lead to wholeness. They’ve not only earned high-level medical licenses but hear stories like this one over and over from patients. More important, they’ve lived the story of loss and rediscovery themselves. By integrating their own experiences, the healing mountain metaphor, and years of training and experience in their fields, they are able to help others find a true, individual path of healing, one that integrates conventional medicine and thoughtful, nurturing attention to the mind, body, spirit, and environment that each of us lives in.

“We’re the Blues Brothers,” deadpans Dr. James Nourse, clinical psychologist and acupuncturist who works in the center’s office three days a week.

Dr. Charles Lefler, internist and founder of CIHH, concurs. “Yes, the blues are real,” says Lefler, refocusing after he has just announced there’s a blues accordionist playing downtown in Brevard tonight. “We all have our own blues story. But the question is [to patients], ‘Why? Help me understand what you see in this.’ Healing is frequently about someone hearing and understanding your blues.”

“That’s what we do here, something that nobody else is willing to do,” Nourse continues. “Rather than say, ‘Ok, you’re not getting enough light, so, of course you’re depressed, here take this medicine. No. [We ask,] ‘What does this mean to you?’”

“Are you willing to look at your life?” Lefler asks patients. “That’s the thrust of one of the things I do in a physical exam. I want to find out where people are. Is it just, ‘Give me a pill’? Or, ‘Don’t give me a pill.’ Is there something in between? ‘Am I responsible for who I am?’

“What is spirituality in your life?” Lefler asks patients. “What does your spirituality say about how you relate to the environment, the rest of the world?’”

Looking out the window, we’re immediately reminded the “rest of the world” is, in one sense, the Smoky Mountains, where the change of seasons brings opportunity for personal growth. The changes in light, moisture, and temperature in a single day can invite change in one’s own life. The practitioners themselves welcome the chance to learn from the beauty around them, even on a morning’s drive to work.

“I live in Hendersonville and three days a week commute to my CIHH office in Brevard,” Nourse said. “I choose to come down Crab Creek Road, because of the mountain views it affords. The pastures, farmland, the vista of the ancient mountains in all their changing climates, makes the opening of my day a meditation.  It influences everything else that happens as the day goes on. Ancient people, such as the Cherokee, understood this principle well. The mountain, the sky, the mist, the rain, they all speak to us and want to be in a relationship with us. When I allow myself each morning to be in relationship with this beauty, I begin the day healed and thus I'm better able to be a healer.”

Hints of natural beauty are placed throughout the center. In the exam area is a wooden bench; above it hangs a poem about the healing gifts of a mother cat, written by a patient. One room for “touch therapies” is designed in soothing, textured surfaces, soft light, and music. (Imagine an examination table transformed into a chenille-draped bed with fluffy pillows.)

In the waiting area, Lefler says, the elegant sculpture of tree and stone quietly offers two ancient symbols of life and strength. The “living room” is relational, says Lefler. “It brings patients in thinking, ‘What am I going to tell my friends today?’ It’s totally different from what modern medicine is selling. Modern medicine is selling widgets. I don’t want to be a widget doctor.”

Upstairs, where we’re having this heady conversation—interrupted with bursts of laughter at how many times an intelligent trio can get off the subject—is the heart of the practice, the kitchen. It’s also Maggie Crow’s counseling room, where she encourages patients to introduce new foods into their diet, to promote growth, balance, and repair. Her emphasis is on nourishment to the body, beginning with locally grown foods eaten in their original state.

As a registered nurse, Maggie finds working with Dr. Lefler a unique experience, she said. “His relaxed, hands-on approach, his energetic curiosity, and his ability to draw deeply upon his wealth of conventional and complementary experience makes being a part of his team educational, fun, and inspiring.”

Medicine for the Whole Person
What is the source of this intriguing center where the physical space is quietly inviting, and the people who serve patients are genuinely interested in your life?

“The Center had its origins in the work of Dr. Paul Tournier,” said Lefler, who began expanding his private practice in 2002. Tournier was a general practitioner in the twentieth century from Geneva, Switzerland, whose writings Lefler first read as an undergraduate at the University of North Carolina–Chapel Hill. According to Lefler, “In his book To Understand Each Other [1967], Tournier states: ‘He who loves understands and he who understands loves. One who feels understood feels loved and one who feels loved feels sure of being understood.’”

The inspiration from Tournier cut across the grain of contemporary Western medicine. “The medicine taught at medical and psychological schools considered the sick person in an objective way, whereas Dr. Tournier, dissatisfied with this view, had a vision of the mystery of persons, which cannot be revealed by objective methods of science” (introduction, Tournier, Medecine de la Personne).

Even before he entered medical school, Lefler knew his interests were in a new direction. “When I was interviewed for [acceptance in] the University of North Carolina Medical School,” Lefler said, “the Chairman of the Department of Medicine asked me what I thought about the future of medicine. I said I felt that we probably had most of what we needed on Earth for health as well as for treatments for illness if we could just become more knowledgeable. He felt the future of medicine was prospective in creating new technical methods of diagnosis and creating new therapies (not discovering more natural cures).”

Tournier’s “medicine of the whole person” reflected Lefler’s own intuition toward a natural, holistic approach to healing. Lefler believes he must listen with “an open heart, mind and spirit to the story of patient,” he said. “To understand the ‘blues’ is to hear more than the words. One must be aware of the color and the rhythm, what the ‘singer’ perceives as wrong and what they think would make life right.”

Then came another revelation—and the willingness to learn from it. The simple act of listening—really listening—offered to chance to gain more understanding and become knowledgeable of therapies that would complement conventional, or allopathic, medicine. “As I listened to my patients and sought to understand them,” Lefler said, “I was introduced to new ideas, ideas that were not presented to me in medical school.” He developed the idea for the Center for Integrated Health and Healing as he grew with his patients and wanted to “help them to re-discover their life and vitality.”

“Several years ago a patient asked me about bio-identical hormones,” Lefler said. “I knew virtually nothing about them at that juncture but quickly read the writings of John Lee, M.D. [author of What Your Doctor May Not Tell You about Menopause and related books], and also found a gynecologist who was familiar with this approach. Soon I had a working knowledge of this area and could answer the growing number of patients who were very interested in this approach if I could help them.” Now Lefler is one of only a few physicians in Brevard who are open to treating hormone imbalances with natural alternatives.

In 1999, Lefler invited James Nourse, a Jungian-based clinical psychologist, to join the practice. Then came Maggie Crow, a nourishment-wellness counselor. Today, the center also includes specialists in reflexology, massage, acupuncture, yoga, stress management, Reiki, and a newly conceived therapy called “Art Enablement.”

“When you’re around him you sense he is what he is, as he appears, very kind and so curious, so curious,” Crow says of Lefler’s work with his staff and patients. “There’s no hierarchy here. It’s a partnership with patients.”

Dr. Nourse has experienced Lefler’s thorough, open-minded approach both as a patient and the center’s clinical psychologist. “What endears me to Charles,” Nourse said, “is that he is comfortable in his own skin. He knows who he is, and, because of that, he doesn't have to convert anybody to his way of thinking in order to gain self-assurance. He believes strongly in the spiritual aspect of health and disease, but seeks to evoke a person's own spirituality to serve healing, rather than impose his own formula. He's my personal physician and I had a direct experience of this.”

Actually, such a radical integration of Western and Eastern, ancient and modern, ideas of medicine wasn’t that simple. Lefler says CIHH grew out of years of conversation among many practitioners in the Brevard area who were eager to learn more about Complementary and Alternative Medicine [CAM]. In the 1990s, with a group of other dedicated practitioners, Lefler established the Foundation for Integrated Healing. “The Foundation allowed me to dramatically grow my knowledge of [CAM therapies] in our area and [learn] how people could use both the medicine that I had been trained in as well as the alternative methods that they felt drawn to.”

The foundation’s purpose, Lefler said, is to complement CIHH in providing services to patients and the community. “The Foundation is meant to help people utilize the services available at the Center that they might not otherwise afford,” he explained. “It also has a strong educational mission.” Lefler is currently seeking grants in the creative arts to facilitate his newest idea, healing through creativity, or Art Enablement. As a nonprofit, the foundation can use tax-deductible donations to help patients receive therapies that aren’t covered by insurance.

Lefler is also seeking new patients, but there’s a requirement to get in. No, not some fancy precertification or referral, but simply a patient’s willingness to reevaluate his or her nutrition, exercise, and lifestyle. “Nutrition is so important,” Lefler stresses. “To enter my practice requires a nutritional-wellness consultation, which causes people to think, ‘Do I really want to take responsibility for my health starting with paying out of pocket?’ This aims to introduce the idea of responsibility . . . not just what [patients] eat but how they structure their lives and exercise.”

Can You Hear Me Now?
On a recent afternoon, a new patient returns to the waiting room from her nutrition consultation with Maggie Crow. The woman, about 60 years old, immediately pulls out her cell phone and calls her daughter.

“This nutritionist is wonderful!” she says. “She told me about anti-inflammatory foods. She said that Aspertame and other sweeteners are chemicals. Only green tea is left.”

Silence. She has to quit drinking black tea, coffee, and soft drinks. Ouch.

“Hello, are you still there? No bread, either. Starches are bad; they cause inflammation, aggravate the pain.”

Silence.

“You know, you should quit smoking, you should quit going to all your doctors and come to Dr. Lefler.”

Silence.

“Are you still there? Dr. Lefler is wonderful—so thorough. He won’t even see me without my seeing a nutritionist first.”

In a few minutes, the nurse opens the door and calls her in for her complete exam.

“Take me to the slaughter!” the woman dramatizes, and nurse Anita doesn’t miss a beat: “They’re coming to take me away!” she sings, a clear note that laughter is one of the key medicines at the Center for Integrated Health and Healing.

It is this kind of willingness to change that reveals good health is not that far away. As close, perhaps, as the choices to eat well, exercise, and breathe in the beauty of the Smoky Mountains.

Coming in the summer issue:
In the second part of this article, you’ll enter an exam room with Dr. Lefler and learn how he perceives a patient’s multilevel stresses that lead to ill health. Then you’ll get inside the mind of psychologist-acupuncturist James Nourse, experience the healing touch of reflexologist Judith Nourse through an unforgettable foot treatment, and discover how art meets science in Art Enablement, a cutting-edge therapy that allows patients to fully integrate their healing through creativity. But what holds all these fascinating therapies—and the Center itself—together? It’s more simple than you think, just as premium health is often right at our fingertips. If we’re willing . . .

© 2008 Suzanne Comer Bell