Understanding unconventional medicine

Front matter

UNDERSTANDING UNCONVENTIONAL MEDICINE UNDERSTANDING UNCONVENTIONAL MEDICINE Ivan Souček • Roman Hofreiter

UNDERSTANDING UNCONVENTIONAL MEDICINE MUNI Press

UNDERSTANDING UNCONVENTIONAL MEDICINE Social Sciences on Traditional, Complementary and Alternative Therapies in Slovakia Masaryk University Press Brno 2022 Ivan Souček • Roman Hofreiter

Part I UNDERSTANDING UNCONVENTIONAL MEDICINE: GENERAL OVERVIEW

( 15 ) 1. The fi eld of unconventional medicine To describe the coexistence of different medical forms and traditions in non- Western societies, the term medical pluralism has been frequently used (Leslie, 1980). Several studies from the field of medical history have shown that the existence of unconventional medical practices, unrelated to mainstream healthcare systems, can be traced back several centuries (Jütte, 2013). However, it has been confirmed that the existence of medical pluralism and the (subsequent) availability of diverse healthcare options, are not entirely specific to non-Western societies, and they did not dominate pre-modern European history (Cant & Sharma, 2004). Today, perhaps more than ever, the situation regarding healthcare is clearly represented by a wide array of heterogeneous medical practices and ideas, serving the needs of clients. Notwithstanding the fact that the concept of medical pluralism has been subjected to criticism from representatives of various disciplines, it is still placed at the centre of discussions dealing with the pluralistic universe of healthcare (Penkala-Gawęcka & Rajtar, 2016). Medical pluralism in Western societies manifests itself in a variety of different methods and therapies, which are widely presented in opposition to official/conventional/classical me dicine. Probably the most widely used term in sociology and anthropology for a group of medical procedures, that are not currently considered as an integral element of conventional medicine, is that of complementary and alternative medicine (CAM). The compound name of the two attributes, complementary and alternative, evolved from the former designation, alternative medicine (AM). According to Cant and Sharma (2004), who have conducted extensive research into alternative therapies in the UK, the term, AM, was popular up until the end of the 1980s. On the other hand, the term, complementary, came to be used more widely among physicians, who underlined the possibility of closer cooperation between various medical forms. The British Medical Association (BMA) influenced the shift in terminology, from alternative to complementary, as a number of AM supporters blamed the association for a dogmatic rejection of any form of medicine other than conventional medicine and the widespread discreditation of non-biomedical healthcare as merely alternative and anti-scientific. However, the original term, AM, quickly became established among ordinary

( 16 ) people and various practitioners, despite experts pointing out that there was a difference between alternative and complementary forms of medicine. While in the case of alternative forms of medicine, their substitute or surrogate use in the therapeutic process is important, complementary forms of medicine are characterized by complementarity with conventional medicine. In order to capture the different nature of these phenomena, the combined term, CAM, was propagated by U.S. American institutions. Although in the discussion among academic authors and government representatives this concept quickly became established, the general population did not fully accept it. To solve the terminological obstacles, certain authors prefer the more value-neutral term, unconventional or non-conventional medicine (Blumberg et al., 1995; Dalen, 1998). It can even be found in the official European report on the status of unconventional medicine for the Committee on the Environment, Public Health and Consumer Protection (Lannoye, 1997). In the same vein and to employ a neutral term with minimum negative and/or positive connotations, the authors of this publication have decided to use the term, unconventional, when referring to complex medical ideas and practices that have evolved without the direct influence of Cartesian dualism, such as acupuncture, herbal medicine, yoga or homeopathic treatment.

Notwithstanding the term we are using to describe the phenomenon, challenges in defining unconventional medicine still persist. With respect to country-specific conditions, it is very difficult to establish an acceptable and wide definition of unconventional therapies in Europe (Falkenberg et al., 2012). Accordingly, a variety of definitions of unconventional medicine have appeared in the relevant literature, investigating the prevalence of traditional, alternative and complementary therapies’ usage. One of the most cited definitions of CAM was developed by the National Centre for Complementary and Integrative Health (NCCIH), formerly the National Centre for Complementary and Alternative Medicine (NCCAM), established in the US where it is broadly defined as: “ A group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals such as physical therapists, psychologists, and registered nurses” (Raszeja, 2012, p. 18).

Part I Understanding Unconventional Medicine: General Overview

( 17 ) The NCCIH, moreover, grouped diverse therapeutic practices into the following five broad categories: “Mind-body therapies include a large and diverse group of procedures or techniques administered or taught by a trained practitioner or teacher. It in cludes meditation, biofeedback, hypnosis, guided imagery, visualization, relaxation therapy, art and music therapy and other techniques stimulating the mind’s ability to affect bodily function.

Biological-based practices represent natural health products, such as vitamins, minerals and herbs.

Manipulative and body-based methods consist of a group of therapies based on manipulation of body parts such as chiropractic, massage and manual therapies.

Energy Medicine is a collection of CAM treatment methods focused on influencing energy fields and involves methods such as reiki, healing touch or magnet therapy.

Whole Medical Systems are complete medical systems with elaborated theories and practical administration and cover naturopathy, traditional Chinese medicine, Ayurveda or homeopathy”

Source: http://cameoprogram.org/about-cam/ As medical experts focus their attention more and more towards complementary medicine in recent years, the definition, developed by healthcare professionals, characterizes the subject as follows: “Complementary medicine is diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine” (Ernst et al., 1995, p. 506). 1. The field of unconventional medicine

( 18 ) Taking a more global perspective in relation to the existence of a traditional medical landscape in non-Western countries, the World Health Organization (WHO) distinguishes between traditional medicine (TM) and complementary medicine (CM), and instead of CAM prefers the acronym T&CM. In the Traditional Medicine Strategy: 2014–2023, two different definitions to convey the meaning of the subject are used: “Traditional medicine: It is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. Complementary medicine: The terms “complementary medicine” or “alternative medicine” refer to a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health-care system. They are used interchangeably with traditional medicine in some countries” (Qi, 2013, p. 13). While most of the CAM definitions are exclusively negative and designate AM in terms of what it does not represent, the Cochrane collaboration developed an operational definition, characterized by an inclusive, positive approach, allowing CAM therapies to be defined and classified (Wieland et al., 2011).

Authors of the CAMbrella project suggest that because of dissimilarities in the inclusion of various methods, the version of CAM, highlighted by the US Centre, could be different from the European understanding of the healthcare situation. Moreover, these authors insist that the WHO has not appropriately considered the existence of the European healing tradition, which has played a significant role in the medical environment on the continent for many centuries. Therefore, a pan-European research network for CAM, that conducted a research programme into the situation of CAM in Europe between 2010 and 2012, came with its own conceptual framework: Part I Understanding Unconventional Medicine: General Overview

( 19 ) “Complementary and Alternative Medicine (CAM) utilised by European citizens represents a variety of different medical systems and therapies based on the knowledge, skills and practices derived from theories, philosophies and experiences used to maintain and improve health, as well as to prevent, diagnose, relieve or treat physical and mental illnesses. CAM therapies are mainly used outside conventional health care, but in many countries, some therapies are being adopted or adapted by conventional health care” (Falkenberg et al., 2012). Such a “European” definition of CAM has, according to authors, ambition not to discriminate between the origins of a CAM therapy used or if it is provided by medical or non-medical practitioners and it includes all CAM methods used by European citizens (Falkenberg et al., 2012) . However, as authors of the CAMbrella project suggest, reflecting on the development of the terminology in CAM by citizens and providers in Europe, the establishment of a Europewide, acceptable definition of CAM still remains a challenging issue. Major concerns were raised in relation to different traditions, cultures and the history of terms that have been used in various countries over a long period of time. The definition of unconventional medicine is powerful in framing the discussion on medical pluralism in contemporary societies, therefore, further research activities have to be country-specific and should focus on particular experiences of unconventional medicine in the context of regional development. Moreover, it should inevitably take into account the fact that unconventional therapies are not universal, unchanging traditions, which are essential in nature; quite the contrary, current understanding identifies the therapeutic sector as a subject that is constantly undergoing transformation, under the influence of a shifting social and cultural environment (Brosnan et al., 2018). 1. The field of unconventional medicine

( 20 ) 2. Situating unconventional therapies in Central Europe In various regions of the world, the situation regarding unconventional therapies may differ considerably. It has been confirmed by the WHO Global Atlas of Traditional, Complementary and Alternative Medicine (TCAM), which provides tables and charts of preferences relating to TCAM globally, that the range of therapies and practises is wide, varying greatly from country to country and from region to region (Bodeker & Ong, 2005, p. vii). As attitudes towards healthcare in European countries have undergone various stages of development, in order to understand the situation regarding AM on the European continent, we must briefly consider the history of medical interventions.

Until the 19th century, due to the extremely diverse and eclectic healthcare situation in Western Europe, it was difficult to draw a line between orthodox and non-conventional medicine (Porter, 2004). There has been little difference in the healing methods and remedies, preferred by medical doctors and lay healers. The situation gradually changed with the establishment of qualified medical practitioners and the advanced development of biomedical knowledge at the turn of the 19th and 20th centuries, which resulted in a gradual distinction between orthodox medicine and other techniques of healing (Saks, 2000). Together with the attempts to professionalize medical care, a critical attitude distrusting the state sanctioned healthcare developed among people. For the purpose of providing alternative care for a wide range of health problems, various heterogeneous groups who dealt with healing, emerged in several European countries. One of the first was homeopathy, originally introduced by German physician, Samuel Hahnemann, which was most popular in the 19 th century, followed by the animal magnetism of Franz Mesmer or hydropathy, introduced in Britain during the first half of the 19th century by R. T. Claridge. Despite the different backgrounds and treatment methods used in real practice at that time, they shared a critical view of the official, academic, medicinal system. It became fashionable among the specialists of alternative therapeutics to blame the representatives of scholarly medicine for the use of narrowly focused methods. Despite not only academic medicine but also alternative Part I Understanding Unconventional Medicine: General Overview

( 21 ) forms of medicine have undergone radical improvements since then, this early antagonism clearly foreshadowed further developments in this area over a long period of time and essentially continues to this day. Early attempts of alternative treatment to achieve partial acceptance by official governments, can be traced to a nature-oriented movement, which evolved during the middle of the 19th century throughout most of continental Europe. This resulted in the German government introducing a law in 1935 regulating health practitioners, such that, all healers became officially instituted and unified under the label of Neue Deutsche Heilkunde (new German healing practice). Ernst (2001) points out that the aim was to appease various alternative practitioners by introducing the official, recognized title of ‘Heilpraktiker’ . With a few exceptions, they had same the rights and obligations as physicians. Due to considerable advances in medicine in the 1950s and 1960s, the government in Germany and other European countries, vigorously marginalized AM, and an almost total hegemony of biomedicine was established. This hegemony was severely disrupted, for the first time, by social processes that took place in the 1960s and 1970s in Western Europe and the USA (Saks, 2008). Public attitudes towards non-mainstream values and norms of behaviour changed, while a countercultural critique challenged rational progress and the superior role of science. As a result, patterns of behaviour among frustrated people played a crucial role in the increasingly popular phenomenon known as CAM, which included not just therapies rooted in European cultural history but also various healing techniques from different parts of world. Besides homeopathy and naturopathy, younger generations, dissatisfied with conventional medicine methods, devised predominantly Asian traditions like meditation, yoga, Ayurveda or chi gong. Cant and Sharma (2004) highlighted that the phenomenon of a new medical pluralism emerged at this time, while a vast number of systems, outside the purview of state, were heavily practiced. This highly structured diversity is characterized by the subordination of alternative methods of treatment to dominant biomedicine, and the practice of bricolage, entailing the idealization, essentialization and decontextualization of traditional ideas and healing methods. In Central and Eastern European countries, which did not experience the same (or comparable) changes in society as in the West, the development of a non-conventional healthcare sector was completely different. An investigation that is even more recent shows significant differences between Eastern and 2. Situating unconventional therapies in Central Europe

( 22 ) Western European countries in the prevalence of UM use. Analysis of data obtained from the ISSP survey conducted in 21 European samples has shown differences between the two parts of the continent, in terms of the overall prevalence of alternative/traditional/folk (A/T/F) practitioner visit (Souček & Hofreiter, 2022). In Eastern Europe, a total of 531 (5.5%) respondents reported an A/T/F healthcare practitioner visit during the preceding 12 months, the results of the survey showed that in Western Europe, similar visits were reported by 17,881 (11.6%) individuals. The study concludes, that in the Western region of Europe, CAM methods either provide a coping strategy for those on low incomes, with limited access to conventional healthcare or an alternative option for members of the younger generation. However, in the Eastern region, A/T/F practitioners are mostly visited by city dwellers, who have a higher socio-economic status, a relatively high level of trust in physicians.

The history of unconventional medicine in Central and Eastern European countries is closely associated with methods of traditional/folk medicine and the use of herbal products. Authors in the field of investigation point out that there is no generally accepted definition of Western herbal medicine (Waddell, 2020). However, some researchers claim that the foundations of traditional folk medicine and medical ethnobotany are rooted in distant pre-Christian culture (Nedelcheva & Draganov, 2014). Regardless, in the countryside, folk healing occupied a dominant position until the beginning of the 20 th century and, in some areas, even during the inter-war period (Horváthova, 1987). An early study in Poland, investigating what is now called AM or TM, predominantly focused on folk medicine practices (Penkala-Gawęcka, 1995). However, the number of general works on folk medicine from different regions of Poland, decreased significantly in the inter-war period, due to the stronger promotion of a positivistic paradigm.

The history of selected forms of unconventional medicine in Czechoslovakia up until 1918, is closely linked to the history of medical pluralism in the Austro- Hungarian Empire. This is especially so in the case of homeopathy, which spread relatively quickly in certain Czech regions, thanks to the Germanspeaking community (Křížová, 2015). There is also evidence to suggest the presence of other forms of unconventional medicine in Eastern Europe. For instance, articles in Hungarian me dical journals, published between 1831 and 1848, mentioned not only folk medicine and homeopathy but also Part I Understanding Unconventional Medicine: General Overview

( 23 ) other methods like magnetism (m esmerism), Brownianism, Broussaisism, Rasorism, hydrotherapy and the therapies of particular well-known healers. When analysing Hungarian medical journals, Kölnei (2006) assumed that these practices were widespread and gained the greatest popularity during the first half of the 19th century.

Aside from several differences (Souček, 2020b; Stöckelová & Klepal, 2018) during the communist period, most Eastern European countries faced a similar situation regarding the practice of unconventional medicine. Almost every kind of unconventional healthcare option was considered, to a great extent, as a backward and superstitious practice (Křížová, 2015; Souček, 2020b; Stepan, 1985; Stöckelová & Klepal, 2018). The ideological hegemony of Marxism, using a doctrine of materialism, led socialist governments to outlaw any kind of medical practice and ideas incompatible with a scientific explanation (Stepan, 1985). According to the principles of cultural evolutionism, folk healing methods, along with other unconventional therapies, were regarded as backward, a remnant of ancient religious thinking and superstitious or magical beliefs (Betts & Smith, 2016). Several ethnographic studies thus represented folk medicine in terms of primitive superstitions and relics of archaic thinking. Authorities and institutions tended to promote an image of folk medicine as a marginal manifestation of “primitive superstition” , inconsistent with the modern, scientific worldview. Such an approach was common in most Central European countries until the onset of processes that began to dismantle socialist hegemony.

The change occurred with the arrival of a new political establishment and the radical social and political changes that took place after the fall of communist regimes. In Hungary, as a result of the openness of the medical space, unconventional medicine became (in 1997) a legitimate part of the healthcare system (Lazar, 2006), and in Poland (in 1995), biofield energy healing (a technique rooted in Franz Anton Mesmer’s “animal magnetism”) was registered as a legal profession (Pietrzyk, 2014). In many countries, folk medicine and the use of herbal products not only survived the modernization of Central Europe and the radical transformation of rural lifestyles but also socialist experiments with a unified medical system. Moreover, studies suggest that the popularity of folk healing and herbalism has increased in recent years (Pokladnikova & Selke-Krulichova, 2018). By the mid-1990s, however, there had been a sharp turnaround in attitudes towards the practice of TM, AM 2. Situating unconventional therapies in Central Europe

( 24 ) or CM on the part of the state, academies of science and medical chambers. The pluralistic situation, in terms of medicine in Central Europe, gradually began to change after technoscientific modification in the constitution and practice of biomedical knowledge (Clarke & Shim, 2011). It still endures today and, among others, is resulted in an interactive process in which interventions for treatment and enhancement are progressively more reliant on sciences and technologies, are conceived in those very terms, and are ever more promptly applied (Clarke et al., 2010, p. 2).

Research (Buda et al., 2005) into the use of AM in Hungary pointed out that after a short period of uncontrolled pluralism in this country, unconventional medicine became the subject of regulation by law. In the Czech Republic, the shift in perception was accompanied by intensive disputes between supporters and opponents of unconventional forms of medicine, which ultimately led to a change in the law, strictly prohibiting healthcare practices that operated on the basis of licensed businesses. At the core of the escalating attack on AM was an ideological struggle between scienti fic and non-evidence-based practices, in an attempt to prevent various unconventional therapies from being covered by public health insurance (Křížová, 2015). Despite a partial shift in the perception of AM, the issue of legal status in this area has remained unchanged until today. This means that the legal position surrounding healing has not been explicitly formulated, that is, its practice is neither forbidden nor authorized (Souček & Hofreiter, 2017). The present legal status of unconventional medicine and the reimbursement of unconventional medicine and products in Slovakia is thoroughly discussed in following chapters.

Since the change of the political regime and the structural transformation of the social, political and religious sector, various complementary and alternative therapies have become widespread. Data on unconventional medicine use in this part of Europe (Bosak & Słowik, 2019; Hegyi, 2018; Pokladnikova & Selke-Krulichova, 2016, 2018) have revealed that the prevalence of CAM may differ considerably. For instance, in the Czech Republic, 76% of a survey respondents reported the use of one or more CAM modalities during the past 30 days (Pokladnikova & Selke-Krulichova, 2016), while in Poland, one in four respondents reported that they or a close family member had used CAM (Olchowska-Kotala & Barański, 2016). Moreover, a survey investigating the response of doctors to patients´ increasing demand for unconventional medicine in the Czech Republic have shown that around a quarter of Part I Understanding Unconventional Medicine: General Overview

( 25 ) physicians, especially general practitioners, have considerable knowledge of unconventional medicine and actively practice unconventional therapies in their medical offices (Křížová, 2002). The follow-up study conducted in 2012 concludes that despite some expectations that homeopathy might be weakening, no significant changes in practice and attitudes were identified (Krizova & Byma, 2014). A survey, conducted in Hungary, showed that 15 to 20% of the population had an experience of CAM (Buda et al., 2002). 2. Situating unconventional therapies in Central Europe

( 26 ) 3. Mapping the situation in Slovakia Despite the fact that the popularity of unconventional medicine in Slovakia is increasing, limited research from a social science perspective was conducted into the use of treatment practices outside the dominant medical paradigm, after the political change in 1989. Accordingly, Bužeková (2015) explained that the field of medical anthropology, directed towards the study of human health and disease in Slovakia, seems to be underdeveloped and has only recently started to expand. Inquiries relating to particular forms of alternative methods have been published sporadically, mostly by ethnologists and historians, engaged in the study of folk healing methods or New Age movements, formed in Slovakia in the 1990s.

Various cultural aspects of folk medicine in Slovakia have been discussed by ethnologist Belko who tends to focus primarily on magic healing practices (Belko, 1996, 1997b, 1998). Belko discussed in detail the magicmedical procedures, preserved in the traditional folk culture of Slovakia in the context of psychotronics interpretation levels of the body and healing intervention in several articles (Belko, 1997a). Various forms of magical procedures, related to health and sickness, have moreover been studied in cognitive anthropology, in which it is claimed that “magical thinking” can be explained by common, psychological mechanisms (Jerotijević, 2011). Selected aspects of neo-shamanic practices and the social dynamics of particular neo-shamanic circles in a Slovak urban setting have been investigated by Bužeková (2012). In one article she claimed that the development of the Foundation for Shamanic Studies, which is an international organization aiming to promote core shamanism at workshops and training courses, started its activities immediately after the fall of socialism, as the atmosphere after the change in the political situation was, by and large, liberal. One study openly discusses the theoretical background of the natural medicine movement in Slovakia and draws a historical and conceptual comparison between psychotronics and biotherapy, the medical branch of psychotronics (Rubens et al., 1995). An integral element of the recent medical landscape in Europe and the United States is the ayurvedic knowledge that emanated from India during the late 1970s and early 1980s (Wujastyk & Smith, 2013). One article, dealing with Part I Understanding Unconventional Medicine: General Overview

( 27 ) a particular form of Indian medicine that has been dubbed in the relevant literature as New Age Ayurveda claimed that in Slovakia, it would be difficult to find any practitioners using ayurvedic therapy or diagnostics in the period before 1989. At present, the practical aspects of Indian medicine in Slovakia are represented by practitioners of Indian origin, who carry out their practice under the auspices of specialized ayurvedic centres (Souček, 2017). The role of homeopathy in contemporary Slovakian society and the legitimizing efforts of this alternative medical system, have been analysed in one study. In relation to the selected cases, the article shows how homeopathy in Slovakia deals with the biomedical monopoly on medical care and the limited access to economic and social resources (Souček & Hofreiter, 2017). Lastly, psychotronics activities, as a specific form of alternative healthcare, along with an analysis of the healthcare situation that existed during the socialist period in the former Czechoslovakia and its comparison with the contemporary pluralistic situation that emerged in both the Czech Republic and Slovakia, has been described in the Czech Ethnological Journal (Souček, 2020b).

A quantitative survey of unconventional medicine was conducted within the module topic of Health and Healthcare within the International Social Survey Programme (ISSP) in 2012: a cross-national research programme, conducting annual surveys on diverse topics related to social sciences. Study published in journal Sociológia in 2017 (Souček & Hofreiter, 2017), examined data from the ISSP regarding the use of alternative/traditional/folk (A/T/F) healthcare practitioners. Moreover, the authors focus on the role of homeopathy in contemporary Slovakian society and analyse legitimizing efforts of this alternative medical system. The topic of complementary and alternative healthcare appeared in ISSP in three questions. The study concentrates on two of these questions, i.e., the one asking whether, alternative/traditional/folk medicine provides better solutions for health problems than [mainstream/ western conventional] medicine, and the other, asking respondents whether, during the preceding 12 months, they had visited or been visited by an alternative/traditional/folk (A/T/F) healthcare practitioner. The ISSP survey was intended to determine exclusively whether an individual had visited any alternative/traditional/folk practitioners in the last year; self-administrated healthcare practices were excluded from the analysis. The question was not related to (focused on) any specific form of alternative medicine or practitioner, and respondents answered using a five-point rating scale, ranging from 3. Mapping the situation in Slovakia

( 28 ) 1 (“never”) to 5 (“very often”). Authors of the study constructed a trust scale consisting of three items which covered key components of trust in physicians. The first component was global trust (“ All things considered, doctors can be trusted. ”); the second component was honesty (“Doctors discuss all treatment options with their patients. ”); and the final component was fidelity (“Doctors care more about their earnings than about their patients. ”). A survey discovered that in Slovakia, 12.7% of respondents fully or partially agreed that AM provides better solutions for health problems than conventional medicine. The second question showed that 13% of respondents during the past 12 months visited or were visited by an alternative/traditional/ folk healthcare practitioner (Souček & Hofreiter, 2017). Published research on the analysis of data from the ISSP in Slovakia, suggests that the presence of chronic disease increases the possibility of a positive evaluation of CAM and increases the assumption that the respondent has visited alternative/traditional/ folk practitioner in the last 12 months. The likelihood that the respondent will evaluate CAM in a positive way by comparison with conventional medicine is increased, due to a general dissatisfaction regarding the way in which doctors communicate, a distrust of doctors and the perception that doctors are primarily interested in their own benefit. The importance of education was only shown in the case of a visit to an A/T/F healthcare practitioner, whereby respondents with a university degree were twice as likely to have visited an A/T/F specialist in the last 12 months than respondents with primary school education. The effect of age and gender has not been shown in any other context. This is different in relation to the trust of homeopathic medicines. In this case, certain assumptions regarding the socio-behavioural model were confirmed. Women, younger people and those with a higher education are more likely to have confidence in homeopathic medicines. Another result from a recent study examining CAM use across 21 European countries, based on data from the seventh round of the European Social Survey, indicates that overall CAM use is 17.9% (Fjær et al., 2020). The study focused on the prevalence of traditional complementary and alternative provider use among a nationally representative population from 32 countries. It indicated a relatively low prevalence of CAM in a number of Eastern European countries, including Slovakia (Peltzer & Pengpid, 2018). Moreover, an investigation into one particular aspect of AM in Slovakia was conducted by BOIRON, a well-known manufacturer of homeopathic products from France. Data were Part I Understanding Unconventional Medicine: General Overview

( 29 ) gathered in 2016 as a part of an omnibus research, and the aim of the research was to obtain relevant information on support and trust in homeopathic remedies among the general population. The findings revealed that the level of trust in homeopathic treatment does not differ significantly by comparison with other European countries (Souček & Hofreiter, 2017). 3.1 Folk medicine in ethnology Many available historical and ethnographical sources confirm that various methods of folk healing and herbalism have a long tradition in Slovakia. An investigation into the history of medicine has shown that the Christian church played an important role in healthcare at the beginning of the feudal epoch, as one of the missions of monk orders was to take care of people suffering from various diseases (Bokesová-Uherová, 1973). Besides representatives of religion at that time (priests, monks), treatment was partially in the hands of various individuals, with knowledge obtained through oral transmission. Whereas from the 15th century onwards, specialized physicians began to operate in cities, in the countryside, medical treatment was regularly conducted by individuals without any professional training. They relied mostly on knowledge handed down from generation to generation, and in some remote areas, even until the middle of the 20th century, traditional healers exclusively, treated a number of physical problems. Records show that healers or folk doctors usually employed a great variety of techniques in relation to healing and held numerous views regarding the causes of health problems and prevention. As suggested, early evidence of folk healing techniques are presented in a number of ethnographic and folklorist works from the end of the 19th century. By and large, the romantic attitude towards the rural landscape, typical of this generation of ethnographers, is mirrored in its uncritical admiration of various healing techniques by emphasizing their archaic character. All these practices were labelled as folk medicine and were investigated as a part of traditional culture, mainly contained in the countryside. Motyčková (1992), who investigated the history of folk medicine in Czechoslovakia in detail, claimed that until the beginning of the second world war, ethnographers contributed markedly to the preservation of traditional medical knowledge, developed over generations. Several articles of different quality were published 3. Mapping the situation in Slovakia