Artigo. A Body-Mind-Spirit Model in Health

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A Body-Mind-Spirit Model in
Health
a b
Cecilia Chan PhD, RSW, PhD, RSW , Petula Sik
b c
Ying Ho & Esther Chow MSW, RSW
a
Faculty of Social Sciences , University of Hong
Kong , Pokfulam Road, Hong Kong
b
Department of Social Work and Social
Administration , University of Hong Kong , Pokfulam
Road, Hong Kong
c
Department of Applied Social Studies , City
University of Hong Kong , Tat Chee Avenue,
Kowloon, Hong Kong
Published online: 17 Oct 2008.
To cite this article: Cecilia Chan PhD, RSW, PhD, RSW , Petula Sik Ying Ho & Esther
Chow MSW, RSW (2002) A Body-Mind-Spirit Model in Health, Social Work in Health
Care, 34:3-4, 261-282, DOI: 10.1300/J010v34n03_02
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A Body-Mind-Spirit Model in Health:
An Eastern Approach
Cecilia Chan, PhD, RSW
Petula Sik Ying Ho, PhD, RSW
Esther Chow, MSW, RSW
SUMMARY. Under the division of labor of Western medicine, the med-

ical physician treats the body of patients, the social worker attends to
their emotions and social relations, while the pastoral counselor provides
spiritual guidance. Body, mind, cognition, emotion and spirituality are
seen as discrete entities. In striking contrast, Eastern philosophies of
Buddhism, Taoism and traditional Chinese medicine adopt a holistic
conceptualization of an individual and his or her environment. In this
view, health is perceived as a harmonious equilibrium that exists be-
tween the interplay of ‘yin’ and ‘yang’: the five internal elements (metal,
wood, water, fire and earth), the six environmental conditions (dry, wet,
hot, cold, wind and flame), other external sources of harm (physical in-
Cecilia Chan is Dean, Faculty of Social Sciences, Professor, Department of Social

Work and Social Administration, University of Hong Kong, Pokfulam Road, Hong
Kong (E-mail: cecichan@hku.hk). Petula Sik Ying Ho is Assistant Professor, Depart-
ment of Social Work and Social Administration, University of Hong Kong, Pokfulam
Road, Hong Kong. Esther Chow is Associate Professor, Department of Applied Social
Studies, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong.
Address correspondence to: Dr. Cecilia Chan.
Initial version of this paper was presented at the Second International Conference on
Social Work in Health and Mental Health, January 12-15, 1998, Melbourne, Australia.
[Haworth co-indexing entry note]: “A Body-Mind-Spirit Model in Health: An Eastern Approach.” Chan,
Cecilia, Petula Sik Ying Ho, and Esther Chow. Co-published simultaneously in Social Work in Health Care
(The Haworth Social Work Practice Press, an imprint of The Haworth Press, Inc.) Vol. 34, No. 3/4, 2001, pp.
261-282; and: Social Work Health and Mental Health: Practice, Research and Programs (ed: Alun C. Jackson,
and Steven P. Segal) The Haworth Social Work Practice Press, an imprint of The Haworth Press, Inc., 2002,
pp. 261-282. Single or multiple copies of this article are available for a fee from The Haworth Docu-
ment Delivery Service [1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. (EST). E-mail address:
getinfo@haworthpressinc.com].
 2001 by The Haworth Press, Inc. All rights reserved. 261

262 SOCIAL WORK HEALTH AND MENTAL HEALTH
jury, insect bites, poison, overeat and overwork), and the seven emotions
(joy, sorrow, anger, worry, panic, anxiety and fear). The authors have
adopted a body-mind-spirit integrated model of intervention to promote

the health of their Chinese clients. Indeed, research results on these
body-mind-spirit groups for cancer patients, bereaved wives and di-
vorced women have shown very positive intervention outcomes. There
are significant improvements in their physical health, mental health,
sense of control and social support. [Article copies available for a fee from
The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address:
<getinfo@haworthpressinc.com> Website: <http://www.HaworthPress.com> © 2001
by The Haworth Press, Inc. All rights reserved.]
KEYWORDS. Body-mind-spirit, Eastern responses
LOOKING TO THE EAST FOR SOLUTIONS
In response to the over-specialization of the health care profession

and the failure of Western medicine to provide satisfactory cures (Tay-
lor, 1979), there is a growing interest in how the Eastern philosophies of
Buddhism, Taoism, Confucianism, energy work, body-mind connec-
tion and traditional medicine can shed new light on patients’ physical
and mental health (English-Lueck, 1990; Hansen, 1992; Legge, 1964;
Leung, 1988; Needham, 1970; Pachuta, 1989; Tsuei, 1992; Yang, 1995,
1995a). Western medicine fixes its gaze on isolated symptoms rather
than on the patient himself. Its practitioners, therefore, tend to pay more
attention to external sources of the disease at the expense of the internal
dynamics of the patient’s body. Under such circumstances, it may be illu-
minating to explore the Eastern philosophy of health and healing, which
treats patients in the totality of their body-mind-emotion-spirit-environ-
ment (Chan, 1997a; Chan et al., 1998; Lei, 1988; Pachuta, 1989; People’s
Medical Publishing House, 1984).
The purpose of this paper is to bring to the attention of the clinical so-
cial workers the Eastern body-mind-spirit approach in health and heal-
ing (Lei, 1988; Yang, 1995, 1995a). Health and well-being, in the
traditional Chinese medicine paradigm, result from the achievement
and maintenance of a state of harmonious balance of Life Energy1 (Qi)
between the internal integrated whole of the person and the external en-
vironment, the nature and the universe (Pachuta, 1989; Reid, 1989;
Vercammen, 1996; Yang, 1995). Traditional Chinese medical practitio-
Chan, Ho, and Chow 263
ners are trained to appreciate the dynamic interaction between the inter-
nal and external systems of a patient, his/her individual uniqueness,
inter-relations and reactions, and the circular effect within the overall
unified wholeness (Tsuei, 1992; Yin et al., 1994). By observing, listen-
ing, smelling, pulse reading, as well as inquiring about the patient’s
family relation, work and emotions, traditional Chinese medical practi-
tioners are able to make a comprehensive, in-depth diagnosis (Yin et al.,
1994). Treatment typically consists in a prescription for herbal soups,
recommendation for physical and therapeutic exercises, and some sug-
gestions on how to improve the patient’s family relations–the so-called
mind-body-family wholeness treatment (Koo, 1982, 1989, 1989a;
Sheikh & Sheikh, 1989; Topley, 1978). This may sound esoteric to the
practitioners of Western medicine. But the fact is alternative approaches
to healing, such as qi-gong,2 tai-jiquan,3 yoga,4 nutrition, aromatherapy,5
herbal medicine,6 acupuncture,7 acupressure,8 moxibustion,9 massage
and temple healing are now being practiced widely by patients and their
family members around the world (Chan, 1997; Harold, 1994; Lee, 1978,
1984; Ng, 1995; Sheikh & Sheikh, 1989; Yang, 1995).
Dualistic Western philosophy splits the spiritual and physical realms
into two hostile and mutually exclusive spheres and attaches greater
value to the former (Reid, 1989). Under the influence of the Western
medical model, health care professionals in Hong Kong, including so-
cial workers in most health care settings, tend to see themselves as the
caretakers of their patients’ physical health. The psychosocial and spiri-
tual needs of patients are often neglected (Chan et al., 1996a, 1996b;
Chan, 1997; Chang & Chan, 1994). Growing up in a predominantly
Chinese society, social workers in Hong Kong are aware of the wide
adoption of traditional Chinese medical practices as complementary
methods to healing. However, as professionals, they have little to con-
tribute in this area, because they are not familiar with the analytical
framework concerning an individual’s total well-being within the con-
text of the balance of the five elements,10 the attainment of yin-yang
equilibrium, and its associated interventions (Lei, 1988).
In this article, we introduce several useful concepts in traditional
Chinese medicine and discuss how they can be applied in clinical social
work interventions with patients and their family members in Hong
Kong (Chan, 1997, 1997a, 1997b). By working with patients suffer-
ing from cancer, stroke, Systemic Lupus Erythematosis (SLE),
Rheumatoid Arthritis (RA), diabetes, bereaved wives and post-di-
vorced single mothers in groups (Chan et al., 1996b, 1998; Lee, 1995;
Man, 1996; Wan, 1996), we have developed a model of an individual’s
body-mind-spirit total well-being. This intervention, which focuses on

the total well-being of the client’s body, emotions and spirituality (Chan
et al., 1998), aims at empowering the client at a personal level. (For de-
tails of the body-mind-spirit intervention, please read Appendix 1 and 2.)
Pre and post intervention research results show significant improvement
among patients who participated in treatment and self-help groups. They
score higher on both physical health and communication with profession-
als, and develop a sense of control of their illness and emotional well be-
ing (Chan et al., 1996b, 1998; Chow, 1995; Man, 1996; Wan, 1996).
TRADITIONAL CHINESE MEDICINE
Traditional Chinese Medicine originates from the Taoist philosophy

on one’s harmony with the universe (Reid, 1989). Under this philoso-
phy, an individual’s health and personal needs vary according to the
weather and environmental conditions. One can attain physical, mental
and spiritual health only when one is able to strike an inner balance and
harmony between the Yin, the passive or feminine force and the Yang,
the active or male force (Koo, 1982; Reid, 1989).
Health is thus seen as a harmonious equilibrium between the ‘yin’( and
‘yang,’ (the five elements (earth, wood, water, metal, and fire), the inter-
nal environment (dry, wet, hot, cold, wind and flame), the other external
conditions (physical harm, insects bites, poison, overeat and overwork)
and the seven emotions (joy, sorrow, anger, worry, panic, anxiety and
fear) (Yin et al., 1994). This represents a holistic approach similar to the
ecological and systems approaches practiced in the field of social work. It
highlights an important difference between Western and Eastern
typology: While Western typology divides the body, the mind, cognition,
emotions and behavior into discrete entities, Eastern typology regards the
physical and spiritual as indivisible yet two distinctly different aspects of
the same reality, with the body serving as the root for the blossom of the
mind (Reid, 1989). One’s physical, emotional and spiritual well-being
are taken as an integrated whole, underlying a systemic and cybernetic
conception of the equilibrium of human existence.
THE BODY-MIND CONNECTION

Given this holistic body-mind-spirit conception of health and
well-being, one can easily understand how one’s emotional states affect
one’s physical well-being and vice-versa (Borysenko & Rothstein,

1987; Chan, 1995). For example, the degree of physical and psychi-
atric morbidity of bereaved persons is found to be higher than that of

the normal population (Kararn, 1994; Parkes, 1986; Stroebe &
Stroebe, 1993). Our research provides further evidence of this
body-mind connection. One-third of the members in our groups of
divorced women are seeing psychiatrists for their emotional and
physiological problems, such as anxiety attacks, anger, suicidal ten-
dencies, depression and insomnia (Chan et al., 1998). Two-thirds of
cancer patients of our groups are suffering from depression and/or
anxiety attacks (Chan et al., 1996a). Indeed, the New Age body-mind
conception links somatic complaints to emotional deficits (Tsang,
1992), providing a basis for the development of interventions with
an integrated perspective.
In Western philosophy, patients are taught to fight their illness
(Simonton et al., 1978; Siegel, 1986). They refuse to accept chronic
illness, misfortune, loss and death. The treatment philosophy and
strategy is to confront and attack (Kaplan et al., 1993). Western medi-
cine combats the disease, tries to kill the bacteria, and radically cuts
out defective bodily parts. Like a ruin in a battlefield, the patients are
left to heal on their own. In contrast, Eastern philosophy regards dis-
ease as symptomatic of the patient’s bodily dysfunction and inner dis-
harmony. The treatment therefore focuses on strengthening the
patient’s entire bodily system and restoring his or her inner balance,
instead of tackling only the physical manifestations of the illness (Yin
et al., 1994). Since one’s organs, emotions, the environment (diet,
weather, color, taste, and sound) and spirits (values, life philosophy,
and beliefs) are all connected to one another, an equilibrium between
these elements is the key to one’s health and well-being. Prescriptions
thus vary according to the climate and the patient’s mood, emotions,
physical strength and social relationships (Yin et al., 1994). Training
and prescription for the patient’s total well-being under such a cyber-
netic framework should be useful to social workers, especially to
those working with clients in the process of healing. Table 1 shows the
symbiotic interaction among body parts, emotions and the mind
within the classification system of the five elements, which will be
useful in the diagnosis and treatment of the patient’s psycho-social
problems related to physical illness (Reid, 1989; Tsuei, 1992;
Vercammen, 1996; Yin et al., 1994).
TABLE 1. Categorization of the Body and the Mind Under the Symbiotic Inter-
action of the System of Five Elements
Category Five Elements

Wood Fire Earth Metal Water
Emotions Anger Joy Worry Sorrow Fear
Expression Yell, Laugh, Sing, Cry, Moan,
Grasp Grieve Nag Cough Tense
Body (Yin, Liver, Heart, Spleen, Lung, Kidney,
Yang) Gall Bladder Small Stomach Large Urinary
Organs Intestine Intestine Bladder
Tissue Tendons Vessels Muscle Skin Bone
Sense Eye Tongue Mouth Nose Ear
Organs
Organs Heart Spleen Lung Kidney Liver
Being (fire) (earth) (metal) (water) (wood)
Supported
Affecting Spleen Lung Kidney Liver Heart
Organs (earth) (metal) (water) (wood) (fire)
Mind/ Benevolence Faith Politeness Justice Intelligence
Spirituality Soul Mind Idea Spiritedness Will
Humanity Authenticity Reason Wisdom Faith
(Source: Tsuei, 1992, p.90; Yin et al., 1994, p. 20)
EMOTIONS AND PHYSICAL WELL-BEING
It is obvious that one’s physical functioning is linked to one’s emo-

tional expression and sense of well-being (see Table 1). An individual’s
internal systems of liver, heart, spleen, lungs, and kidney (the Chinese
internal systems are different from the organs referred to in Western
anatomy) will have a bearing on his or her mood and emotion (sorrow,
fear, anger, joy and worry). For example, if a person has a hot liver, it is
likely that he or she would be hot tempered and ‘liverish.’ If a person
has weak lungs, he or she is likely to be depressive and sorrowful.
Nancy (34/F, social worker) developed Tuberculosis (TB) in Jan-

uary 1998. Two years ago, her mother had developed pancreas
cancer, and Nancy took care of her mother at home during the ter-
minal stages of her cancer. When her mother died in November
1997, Nancy was exhausted and depressed. Two months later, she
developed TB. Her sorrow weakened her lungs and immune sys-
tem. Not until she turned to therapy did Nancy realize that her ill-
ness was a manifestation of the grief she felt for the loss of her
mother.
“I AM SICK AND TIRED OF BEING SICK AND TIRED.”
Physical illness and discomfort can be annoying, irritating, depress-

ing and anxiety provoking. They can seriously affect a patient’s emo-
tion, weaken their immune system and create a whole range of
imbalances inside the body (Zhang & Guo, 1991). The sicker they feel,
the more depressed they become. It is easy for individual to get into a vi-
cious cycle of worsening physical and mental health. According to tra-
ditional Chinese medicine, these are all the consequences of an
imbalance or a disharmony that exists between the interrelationships
and dynamics interaction amongst the various sub-systems and five
main elements (Tsuei, 1992; Yin et al., 1994). The key to successful
healing therefore lies in identifying the deficient elements and strength-
ening them through health education and mood control.
For the Chinese, a healthy person is someone who can always keep
his or her emotions under control, take time to cultivate the mind artisti-
cally and behave moderately. The book, Shen Chien, states, ‘in order to
nourish the spirit, anger, pity, happiness, care and anxieties must at all
costs be moderated’ (Needham, 1970). In another classic, All Men are
Brothers, it is pointed out that “The ancients have said that a soft temper
is the root of long life and a high (hot) temper is the beginning of Trou-
ble” (Buck, 1967). Excessive emotions can affect bodily functions.
How often have we seen unhappy people, bereaved or divorced women
approaching the health care system for somatic complaints? The Asian
population is known to somatize rather than to seek help for emotional
stress (Lau et al., 1981).
According to the systems of five elements (see Table 1), excess joy
can affect the heart, small intestine, tongue and blood vessels. The emo-
tions of excess anger can affect the organ system of liver, gall bladder,
eyes and tendons. Excess worry can affect the digestive system of the
spleen, stomach, mouth and muscles. Excess sorrow can affect the
lungs, large intestine, nose and skin. Excess fear and anxiety can affect
the kidney, urinary bladder, ears and bones (Yin et al., 1994). The dys-
functional systems will subsequently affect other bodily organs and
their functioning (Lei, 1988).
When Flora (42/F, housewife) discovered her husband was having

extra-marital affairs, she began to develop symptoms of insomnia,
mood swings, dryness of the eyes, knee pain, rough lines on her
nails and poor liver functions. These symptoms were all related to
her excess emotions of anger. She participated in a Reiki class
(hands-on-healing) and started working on her anger by putting
her hands on the right side of her lower rib cage where the liver
was situated. She learned that she would have to let go of her anger
to regain her health. She immersed herself into volunteer services
and finally came to forgive her husband for his infidelities. Her
condition improved two years after the therapy.
The first author has observed a qi-gong master at work. A woman

complained about sores on her elbows and the qi-gong master asked
her, ‘Why are you so angry?’ The woman said, ‘Yes, there are things
that I am very angry about.’ The qi-gong master said, ‘Let-go of your
anger or the pain on your elbows would stay.’ This is characteristic of
qi-gong masters and doctors of traditional herbal medicine who often
provide their patients with advice on how to control their emotions, be-
have properly and live well. In this sense, these healers are doctor,
counselor, spiritual leader, and exercise instructor, all in one.
There is much that social workers can learn from traditional Chinese
medicine. By making the connection between emotional states and
health, they can improve their clients’ physical health and well-being by
helping them let go of their excess emotions. A patient’s discomfort in
the liver system, for example, may be relieved by urging him or her to
reflect on the virtue of benevolence, humanity and service to other peo-
ple (see Table 1). In short, we have to facilitate our clients’ understand-
ing of the emotional and spiritual origin of their physical discomfort/
losses, and their ability to heal through the process of giving and
volunteerism (Lei, 1988).
RESTORING EMOTIONAL BALANCE THROUGH WORKING

WITH THE MIND
From Table 1, we can see that the relief of emotional strain can be
achieved through physical training of the body as well as spiritual re-
flection on the meaning of life (Barnard, 1990; Frankl, 1984). Indeed,
practitioners of traditional medicine under the influence of Buddhist11
and the Taoist schools of thought are always ready to preach by telling
their patients what to do and how to live (Chan, 1995, 1997; Lei, 1988).
For them, benevolence, helping other people, lovingkindness, respect
for humanity, forgiveness and finding new meanings in life are the
cures for excess “anger,” while trust in other people, sincerity and re-
spect for nothingness can reduce excessive “joy.” Resorting to reason,
discounting gains and losses, as well as humility is antidotes to exces-
sive “worry” (Leung, 1988; Yin et al., 1994). This reflects the heavy in-
fluence of the Buddhist teaching that “the more one wants, the more one
suffers” (Chan, 1997b; Yang, 1995a), and the Taoist philosophy that
one should accept life as ever changing and unpredictable (Chan,
1997b; Yang, 1995).
This growing interest in the link between one’s emotional and physi-
cal well-being is not confined to Chinese societies. In the West, there is
an increasing number of books and publications on spirituality and the
meaning of life, such as Chicken Soup for the Soul, and Inner Simplic-
ity, which address the issues of morality and value. Given such zeit-
geist, clients may be more receptive to a holistic,
body-mind-spirit-environment intervention. But before we set out to
help our clients to get in touch with and control their innermost feelings,
we may have to do some soul-searching on our own first.
Lucy (35/F, housewife) developed breast cancer when she was

about to divorce her husband who had been abusing her for 15
years. Depressed and suicidal, she approached the Hong Kong
Cancer Fund for counseling. Other cancer survivors helped her
understand that having cancer was not the end of the world. She
began to take part in the Fund’s weekly meetings and learned
about diet, acupressure, qi-gong, and alternative healing. She then
became a voluntary worker herself and spent much time helping
other cancer patients. She believed that having cancer changed her
life. No longer self-pitying and bitter about life, she grew into a
person who appreciated life and was devoted to helping others.
She has found new meaning in her life through serving on the hot-
line. She accepted her misfortunes in life and took them as chal-
lenges to accomplish personal growth.
BODY WORK
Working with the formula of body-mind-spirit interaction, social

workers can lead their clients on the pathways to cure through their bod-
ies, their mind, and their spirit. The flow of Energy (qi) through the
meridians is one of the most important and unique concepts in tradi-
tional Chinese medicine and acupuncture (Tsuei, 1992). The flow of

qi along the fourteen meridians governs the well-being of our internal
systems. Popular approaches to healing such as qi-gong, tai-jiquan,
yoga, acupressure, moxibustion, message, qi meditation, Reiki,
hands-on-healing, reflexology,12 are modifications of using concepts
of meridians and acupuncture points in the human body. Chinese phy-
sicians regarded massage and gymnastics as some of the best ways to
harmonize the qi, to nourish the body, and to expel noxious tumors
from the body (Koo, 1982). Acupressure and moxibustion at acupunc-
ture points in the body could be employed to maintain health and re-
lieve symptoms.
Many of these techniques can be taught to the clients during the pro-
cess of their healing and recovery. For instance, we can teach them acu-
pressure and qi-gong exercises in therapeutic and support groups, to
help them regain a sense of control. There is also a whole range of treat-
ment exercises and massage programs that they can practice to help
themselves. A 38 year old SLE patient said, ‘I felt empowered by the
group because there are things that I can do to help myself recover.’ In
China, the Cancer Clubs popularize a type of qi-gong, called walking
guo-lin qi-gong, which the patients practice four to five hours everyday
in the parks (Shanghai Cancer Club, 1993; Zhang, 1994). Apart from
physical exercises, patients are able to gain from the practice group sup-
port, mutual reinforcement and social interaction (Chan, 1997b; Shang-
hai Cancer Club, 1993). Such a practice can also be used as a
psychological distraction from the patients’ illness and a kind of stress
inoculation training (Michenbaum, 1985).
Massage is another means widely used in our groups to promote the
health and well-being of our clients. Women in our post-divorce single
parent group love facial massage (Chan et al., 1998). Cancer patients in
our groups are taught what acupuncture points to press to enhance their
immune system and help restore their bodily functioning (Leung,
1997). Bereaved wives love hugging and group massage activities as
they are deprived of physical intimacy and touch after the death of their
husbands, especially in a Chinese society that discourages physical con-
tact (Chow, 1995). Fourteen out of sixteen members of the SLE group
reported improvement after practicing acupressure and massage exer-
cises for six weeks.
PHYSICAL EXERCISES TO HANDLE EMOTIONS

On the other hand, physical well-being can restore emotional balance

too. Physical exercise can lift clients out of depression. A simple physi-
cal exercise is designed to facilitate emotional expression and augment
a sense of satisfaction (Chan et al., 1998). Some seemingly trivial
bodily movements, such as a blink of the eye, star jumps, hip swings,
hand massage, ear massage and the like are found to be very useful in
helping clients ventilate their emotional tensions and frustrations, as
well as the increasing their sense of satisfaction (Chan et al., 1998).
Alexander Lowen (1975) has designed a school of body-work called
bioenergenetics13 by blending psychoanalysis with physical exercise
and body-work. The adoption of the harmonious flow of qi in the body
is actually an easier framework to follow. Qi-gong exercises can relax
the person and transport him or her into a state of tranquillity and peace
of mind (Shanghai Cancer Club, 1993). Research on this topic has
shown that physical exercise can reduce depression. Our research also
found that participation in our body-mind-spirit-environment groups
improved the patients’ physical well-being, emotional well-being and
enhanced their sense of pride in life (Chan et al., 1996a; Zhang, 1994).
In fact, physical exercise is sometimes an effective alternative to
counseling (Chan et al., 1998). Not all individuals can articulate or want
to share their feelings and emotions with other people. By practising the
breathing exercises, acupressure and qi-gong exercises, they can de-
velop a sense of emotional and spiritual well-being (Shanghai Cancer
Club, 1993; Zhang, 1994). Action speaks louder than words.
SPIRITUAL TRANSFORMATION:
GROWTH THROUGH PAIN
Some of our clients have a hard time getting over their traumatic expe-
riences, loss and pain. Overwhelmed by a strong sense of loss of control,
they are resentful of their God, the supernatural creator, who had made
life so difficult for them. By turning depressed and angry, sad and fearful,
dispirited or aggressive, bitter and cynical about life, jealous and suspi-
cious, revengeful and unforgiving, self-pitying and socially destructive,
they are a miserable lot stuck with the negativities in life (Barnard, 1990;
Chan et al., 1998; Kleinman, 1988; Miller, 1983; Ngan et al., 1994).
But there are clients who behave otherwise. Despite their misfor-
tunes and bad experience, they come out positive, charming, energetic,
loving, forgiving, generous, kind and full of life. They are the winners
who grow and learn through pain and suffering by transforming their
traumatic experiences into a platform for personal growth (Chan,
1997a; Frankl, 1984; Leick & Davidsen-Nielsen, 1991; LeShan, 1989;

Yang, 1995a). This willingness to “hang in there” and meet the difficul-
ties head-on is the necessary first step we must take in waking the
Hero/Buddha within us (Shanghai Cancer Club, 1993; Yang, 1995a).
PHILOSOPHICAL AND SPIRITUAL INTERVENTION

Qi-gong practices also emphasize the morality of life, promote medi-
tation and letting-go (Yang, 1995). Under Taoist teaching, meditation
promotes the respect for nature (Hansen, 1992), promotes a detached,
easy-going and non-competitive mentality of life (Lee, 1995; Cloke,
1993; Reynold, 1993). It contrasts sharply with the Western values of
striving for excellence, competition, achievement, and success in life.
The Eastern concepts of accepting life as being unpredictable, toler-
ating hardship, finding meaning in suffering, letting go of the self and
expectations on others, self-affirmation and empowerment are some of
the key components of treatment in our groups (Chan, 1997, 1997a;
Chow, 1995; Leung, 1997). Being able to help others is an effective
way of giving meaning to suffering. It is also consistent with the
helper-therapy principle of personal growth through helping others
(Jeffers, 1993; Lee, 1995; Shanghai Cancer Club, 1993). Under the con-
cept of Karma, it pays to help others as by doing so one would be re-
warded in heaven (Chan, 1995, 1997b; Lei, 1988; Yang, 1995a).
Forgiveness and letting go are common themes in our work (Benson,
1992; Chan et al., 1996a, 1988; DiBlasio & Proctor, 1993; McCullough &
Worthington, 1994; Wanderer & Cabot, 1978). The negative emotions of
anger, hatred, worry and self-pity can suffocate and exhaust cancer patients,
bereaved or divorced persons, draining their energy from grow and change.
Through re-examining the meaning of life, exploring the concept of let-
ting-go, and learning how to acknowledge and work with emotions, our
group members have strengthened their mental resources. Even if their ill-
ness or situation worsens, their ability to handle loss and distress is enhanced.
CHANGING THE ENVIRONMENT:

A SOCIAL WORKER’S WORK IS NEVER DONE
Since Chinese find it hard to talk about their emotions, they have a
natural tendency to somatize their emotional frustrations (Cheung,
1986; Cheung et al., 1984; Cheung & Lau, 1982; Lau et al., 1981). As
pragmatic people, Chinese are always willing to comply with medical
instructions, usually preferring psycho-educational classes to psycho-

analytic psychotherapy (Leung, 1997).
Owing to the strength of family as an institution and the support
network it provides in Hong Kong, the patients are actually better off
than they are usually given credit for (Chan et al., 1996b; Oen, 1991;
Tang, 1994). Survivors of physical and mental illness are willing to
help new patients by sharing their experiences. For them, it is a way
to re-establish self-worth and repay society (Chan, 1997b; Chan et
al., 1992, 1993; Lee, 1995; Williams, 1989; Wong, 1993; Wong &
Chan, 1994).
To effect real changes, we must also work with the patients’ family
(Biegel et al., 1991; Dillon, 1985; Ma et al., 1993), the social system
(Conrad & Kern, 1986), the legislature and the environment (Jeffrey &
Madden, 1991). While health is still closely linked to poverty, social en-
vironment and access to service, social workers have to take on an ad-
vocate’s role in bringing about changes (Blackburn, 1991; Chan et al.,
1992; Wong & Chan, 1994; Davis, 1986; Ikeda, 1974; World Health
Organization, 1981).
CONCLUSION
Transcending the Western typology of body-mind duality, seeing

health as a harmonious interplay between an individual’s body-
mind-spirit components and the environment can energize social work
intervention. We can, for example, help clients improve the inner work-
ings of their bodies by showing them how to handle their emotions. The
teaching of such skills as qi-gong, acupressure and massage is not only
good for the clients’ physical health; it introduces an element of fun
and variety in our intervention. Fostering a sense of spiritual gain
through loss and pain is also effective in enhancing the clients’
strength and resilience to misfortunes. We are still a long way from de-
veloping elaborate interventions with the body-mind-spirit approach.
Yet with the encouraging results of the research we have done in Hong
Kong, we have every reason to believe this approach will soon render
itself very useful to social work intervention in health settings.
NOTES
1. The Qi Energy is a cosmic life force that flows through the human body in a very
orderly and logical way. Balance and harmony of the flow of Qi results in health. On
the contrary, the imbalance or disharmony of the flow leads to illness (Lei, 1988).
2. With a history of 2000 to 3000 years, Qi-gong exercise combines motion with
stillness and involves different forms and demands. Qi-gong can be done in the form
of a kind of walking exercise for relaxation, respiration training, breath control and
mental regulation (sometimes referred to as meditation). It consists of five kinds of
regulation exercises: regulation of mind, posture, respiration, voice production and
regulation of combined exercises. New Qi-gong is proven to have a definite effect on
chronic diseases, including cancer and cardiovascular disease. The principles of round-
ness, softness and extensiveness in movement should be observed in practice. Essential
attributes for doing New Qi-gong exercises well are confidence, determination and
perseverance (Tsuei, 1992).
3. Tai-jiquan , which has its origins in the Taoist philosophies, accords with the
principles of traditional Chinese medicine. It stresses the need to harmonize with na-
ture, and is a Chinese health-enhancement practice for the prevention and treatment
of disease. Tai-jiquan should be practised on a regular basis, which takes about thirty
minutes to complete one circle of exercise consisting of movements linked together
in a series of continuous steps. It requires a focused mind with a strong sense of pur-
pose, and coordinates with deep, calm breathing pattern (Nash, 1996).
4. Originated in India over four thousands years ago, Yoga means “union,” being at
one, at harmony with oneself and everything in creation. It is a holistic training for the
body-mind-emotions-spirit that emphasizes self-control through a series of exercises,
levels of breathing, postures, relaxation and meditation (Sheikh & Sheikh, 1989).
5. Aromatherapy is an ancient mediated practice recorded in the writing of early
civilizations including Egypt, India and China. It is a treatment of common ailments
and health problems with highly concentrated oils that have been extracted from
plants and trees. These oil essences are believed to contain properties of natural heal-
ing power. They are often used in massage, or hand and foot baths. There are more
than 130 different oils whose uses can be classified into the following three major cate-
gories: refreshing and uplifting, regulating and toning up of body, and relaxing and
soothing. Essences of the aromatic plant have been used for beauty and healing pur-
poses (Nash, 1996).
6. Herbal medicine had been used by different cultures of ancient civilizations
such as Egyptians, Greeks, Romans, Chinese and Indians. Herbal medicine is basi-
cally the Chinese ancient pharmacology, is heavily influenced by Taoism, in its ac-
cordance of the Yin and Yang practices. It has been used as a natural way of
improving health with great emphasis on the holistic approach in treating the physical,
emotional, and spiritual needs of the patients. Basically a plant-based medicine, its in-
gredients compose of minerals, animal components and extracts of the flowers, fruit,
leaves, roots, stems and seeds. It is especially used for strengthening and regulating the
deficient properties of the patients’ body systems (Lei, 1988).
7. Acupuncture, the best-known Chinese therapeutic technique, is a way of influ-
encing bodily functions by inserting needles in the xue (meridians). According to the
traditional Chinese medicine, there are 14 main meridians running from the hands
and feet to the body and head. Acupuncture helps to maintain health and restore the
balance between the physical, emotional, mental, and spiritual aspects of the patients,
the yin-yang balance and the Law of Five Elements, helping the individual to arrive at a
natural state of harmony. There are many factors which could upset the balance, disturb
the flow of Qi and cause the disharmony and ill-health, including excess emotions,
poor eating habits, drugs, environmental and occupational conditions, change of
weather, and the like.

8. Acupressure is a massage technique widely used in China and Japan for over
three thousand years. Instead of using the needles as in acupuncture, the therapist uses
his or her palms, thumbs, and fingertips to apply firm pressure massage on the pressure
points along the body(s) energy paths, or meridians. Acupressure balances the flow of
energy, enhances natural vitality and promotes maintenance of health and self-healing.
It is believed to be highly effective in relieving stress, preventing illness, and is used for
beauty purposes and treating ailments (Tsuei, 1992).
9. Moxibustion is the burning of moxa, a kind of herb collected, dried and pre-
pared by the herbalists themselves. Moxa is thought to be yang in nature and is suitable
for warming. One of the common treatments is to use a cylindrical moxa stick and
move it along the track of the meridians. The burning stick can also be held over the
meridians to cause heat to enter the body. Moxa used directly on skin will leave a dark
mark after treatment. Regular moxa treatment is believed to be helpful in preventing
disease (Sheikh & Sheikh, 1989).
10. The Law of Five Elements constitutes the fundamental analytical framework of
traditional Chinese medicine, its concepts of bodily functions and the systems of healing.
It is derived from the Taoist philosophy several thousand years ago. The five elements
(wood, fire, earth, metal and water) called wuxing, are the five basic components which
govern the universe. They are intertwined within two basic relationships: a productive
relationship, whereby one agent helps to create another; and a controlling relationship,
whereby one agent limits the impact of another. For example, wood produces fire; fire
produces earth; earth produces metal; metal produces water; and water produces wood.
Earth is controlled by wood; wood is controlled by metal; metal is controlled by fire; fire
is controlled by water; and water is controlled by earth. This complex system of relation-
ships can be explained through the yin-yang theory. It is also believed that any relation-
ship between the various elements of the universe can be seen as a kind of wuxing
relationship, allowing for a systematic categorisation of things and their interactions. Ac-
cording to this framework, our body, mind, and emotions can be compatible with the law
of five elements. This is the fundamental schema with which the Chinese physicians
categorise the human body’s organs, emotions, expression, mind and spirituality into the
system. Table 1 in this manuscript provides further information on how different sets of
relations can be integrated into one single system, and their causative and consecutive re-
lations with the body-mind-spirit functions (Yin et al., 1994).
11. Buddhists are followers of Buddhism, a religion originated in India. It was
spread into China and came under the influence of Taoism. Buddhist believes one
should never cause harm to any living thing. It emphasizes compassion and the peace-
ful co-existence. Through meditation, Buddhists hope to reach a state of “nothing-
ness,” or “emptiness,” the liberation or freedom from desires. Buddhist believes in
reincarnation, that each person will be born again and again until he or she reaches the
state of emptiness. It is important to practise the Four Noble Truths, and the Noble
Eightfold Path of Buddha. The Four Noble truths are: Life is full of suffering and is cre-
ated by humans. The suffering continues if man keeps on his pleasurable things. It is
only when a person surrenders his luxurious life and seeks the reason of why humans
suffer that he begins the footsteps of the Buddha. The Noble Eightfold Path are as fol-
lows: Right views (positive thinking, good in oneself, in others, and in creation), Right
thoughts (caring for others and everything in nature), Right speech (tell the truth and
kind in words), Right action (do not kill, steal, or hurt), Right livelihood (do not cheat
or harm others), Right effort (practise and work hard to follow the path), Right mind-
fulness (be aware of the consequences of thoughts and actions), and Right concentra-
tion (calm, peaceful state of mind) (Lei, 1988).
12. Reflexology is a kind of natural therapies, applies massage to major reflex areas
on the soles of the feet. It is believed that there are spots on the feet which are associ-
ated to different part of the human body. Treatment consists of applying special mas-
sage techniques to the appropriate spots (Nash, 1996).
13. Bioenergetics was developed by Lowen and is a way of understanding the per-
sonality in terms of the body and its energetic processes. These include breathing,
movement, feeling, sexuality and self-expression. Lowen’s well-known exercise is the
bow, which aims to build up the energetic charge of the body (Lowen, 1975).
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APPENDIX 1. A Body-Mind-Spirit Intervention for Cancer Patients in Hong

Kong
Cognitive Behavioral Emotional Physical Spiritual

Dimension Dimension Dimension Dimension Dimension
Cognitive Meditation & Emotional Breathing Faith
restructuring Guided imagery Healing exercises
Positive Relaxation Skills for dealing Physical Goal & meaning
thinking Training with emotions exercises of life
Secondary Affirmations Traditional Sense of
gains Chinese self-worth &
Perspectives dignity
Love & Mutual support
Forgiveness & understanding
Laughter &
Play
Life enrichment
plan
The social workers attempt to bring about change in the patterns through intervening at five
levels of cognitive, behavioral, physical, emotional and spiritual dimensions, Each session
of the group meeting deals with a few dimensions and the group is run as a ‘Cancer Fighter
Training Course.’ Patients are more willing to come to a training course than a counseling
group. Pre and post group research results show significant improvements among group
members on their physical, emotional and social well being.
(Source: Leung, 1997, p. 93).

APPENDIX 2. Themes and Contents of the Cancer Fighter’s Training Course

Session Theme of Session Specific Objectives Contents

1 You Can Fight Cancer • Introduce purpose of the • Informal lecture
group • Sharing about back-
• Explain concept of ground & expectation
body-mind connection, among patients
cancer, stress & relax- • Goal setting and con-
ation tracting
• Inspire ‘fighting spirit’ & • Meditation I *
confidence in self-healing • Breathing exercise
• Obtain commitment from • Encouraging song I
members • Home assignments
• Get acquainted
2 Enjoy Peace of Mind • Cognitive restructuring • Report back on home as-
• Introduce positive think- signment
ing, power of thought & • Sharing about secondary
will power gains
• Encourage appreciation • Informal lecturing
of life & nature • Meditation II *
• Physical exercise I
• Encouraging song II
• Home assignments
3 Love, Forgiveness & Letting • Relaxation training • Report back
Go • Explain therapeutic effect • Progressive muscle re-
of love, forgiveness & let- laxation
ting go • Informal lecture
• Introduce Chinese philos- • Mirror work
ophy of acceptance, • Cushion exercise
holding on & letting go • Meditation III *
• Introduce ways to love & • Physical exercise II
to forgive • Encouraging song III
• Promotion of acceptance • Home assignments
4 Taking Control of Your Life • Explain relationship be- • Report back
tween emotion & well- • Video appreciation
being • Informal lecture
• Dealing with emotions • Sharing ways to deal with
• Talk on cancer personality emotions
• Test on cancer personality
• Meditation IV *
• Physical exercise III
• Encouraging song IV
• Home assignments
5 Inspiring Hope & Search for • Introduce affirmations • Report back
the Purpose of Life • Develop life enrichment • Sharing of feelings and
plan achievement
• Evaluation and summary • Evaluation questionnaire
& recommendations
• Meditation V *
• Encouraging song V
* Meditation in each session was based on the same theme as that of the session.
(Source: Leung, 1997, p. 100)

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Social Work in Health Care

To link to this article: http://dx.doi.org/10.1300/J010v34n03_02

PLEASE SCROLL DOWN FOR ARTICLE

SUMMARY. Under the division of labor of Western medicine, the med-

Cecilia Chan is Dean, Faculty of Social Sciences, Professor, Department of Social

 2001 by The Haworth Press, Inc. All rights reserved. 261

adopted a body-mind-spirit integrated model of intervention to promote

KEYWORDS. Body-mind-spirit, Eastern responses

LOOKING TO THE EAST FOR SOLUTIONS

In response to the over-specialization of the health care profession

body-mind-spirit total well-being. This intervention, which focuses on

TRADITIONAL CHINESE MEDICINE

Traditional Chinese Medicine originates from the Taoist philosophy

THE BODY-MIND CONNECTION

one’s physical well-being and vice-versa (Borysenko & Rothstein,

atric morbidity of bereaved persons is found to be higher than that of

Category Five Elements

(Source: Tsuei, 1992, p.90; Yin et al., 1994, p. 20)

EMOTIONS AND PHYSICAL WELL-BEING

It is obvious that one’s physical functioning is linked to one’s emo-

Nancy (34/F, social worker) developed Tuberculosis (TB) in Jan-

“I AM SICK AND TIRED OF BEING SICK AND TIRED.”

Physical illness and discomfort can be annoying, irritating, depress-

When Flora (42/F, housewife) discovered her husband was having

The first author has observed a qi-gong master at work. A woman

RESTORING EMOTIONAL BALANCE THROUGH WORKING

Lucy (35/F, housewife) developed breast cancer when she was

Working with the formula of body-mind-spirit interaction, social

tional Chinese medicine and acupuncture (Tsuei, 1992). The flow of

PHYSICAL EXERCISES TO HANDLE EMOTIONS

On the other hand, physical well-being can restore emotional balance

1997a; Frankl, 1984; Leick & Davidsen-Nielsen, 1991; LeShan, 1989;

PHILOSOPHICAL AND SPIRITUAL INTERVENTION

CHANGING THE ENVIRONMENT:

instructions, usually preferring psycho-educational classes to psycho-

Transcending the Western typology of body-mind duality, seeing

weather, and the like.

Chan C, Chow A, Au T, Leung P, Chau P, Chang F, Ma J, Cheng BY, Tam V. Thera-

Kararn EG. The nosological status of bereavement-related depressions. British Journal

dissertation, Department of Social Work and Social Administration, University of

Taylor R. Medicine Out of Control. Melbourne: Sun Books, 1979.

and Healing in Asian Society. Cambridge, MA: Schenkman, 1978.

APPENDIX 1. A Body-Mind-Spirit Intervention for Cancer Patients in Hong

Cognitive Behavioral Emotional Physical Spiritual

(Source: Leung, 1997, p. 93).

APPENDIX 2. Themes and Contents of the Cancer Fighter’s Training Course

Session Theme of Session Specific Objectives Contents

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