Health care in Knox County, like many institutions in rural communities, is characterized by an interlocking series of personal relationships. Where people live and work in such a short space, close relationships can determine patterns of interactions. A closer examination of the relationships present within the health care systems of Knox County, then, should provide greater insight into the prevalence of holistic practices in the area.

One important type of interaction occurs between practitioners and patients. Allopathic medicine comes with specific expectations from the relationships involved within its institution. The physician, as health care provider, is expected to have greater knowledge than the patient about the conditions of concern. The patient is expected to fully explain all physical ailments and then to defer to the physician's expertise. Meetings between patients and providers generally take place in hospitals, offices, or other spaces in which the provider is most comfortable. However, in the rural community of Knox County, physician house calls are still made. In general, the allopathic practitioner has dominance over the medical situation. This is not to say that such relationships cannot be satisfactory for all parties involved. The basic power structure on which they are based, though, is unequal.

The relationship between a holistic practitioner and a patient is somewhat different. As described by a number of Knox County practitioners, the responsibility for bringing health rests with the patient. Miriam Harman, a Mount Vernon massage therapist, does not ask what the patient wants worked on before starting a massage session. Instead, she asks, "What are we gonna work on? Because this is your body." The locus of control in this interaction has moved from provider to patient, which changes the nature of the interaction. Patients are expected to actively work for their health, making serious contributions along the way.

Relationships between practitioners are also important. These relationships can be reflected in the system of referrals between practitioners, a formalized means of interaction. In a community as close-knit as Mount Vernon, personal relationships between practitioners is inevitable. Indeed, there does seem to be a community of alternative health interests in Knox County. Several practitioners, including those listed in the Complementary Health Services Guide, are involved in a group that meets regularly, puts out a newsletter about alternative health interests, and attends area health fairs. In 1999, this group occupied a Mount Vernon building in an effort to establish a community health center. Due to financial reasons, the group no longer holds tenancy of the house, but informal meetings are still regularly held at the homes of various practitioners. There is a great deal of networking between holistic health care providers, even if the connections are not immediately obvious.

A few relationships also exist between holistic and alternative practitioners. Again, these interactions, as reflected in referrals, are characterized by personal connections. These relationships do not seem to be nearly as extensive as those described above between practitioners of the same medical philosophies. Holistic practices in Knox County cannot be considered to be complementary or integrative without more connections between the systems. By integrating beliefs and working together for a common goal, perhaps Knox County can get, and stay, well.

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