The Philosophy and Practice of Holistic Health Care Deborah Ann Nelson 2004 A thesis submitted ...

358 Pages·2005·0.76 MB·English

The Philosophy and Practice of Holistic Health Care

Deborah Ann Nelson
2004

A thesis submitted to Auckland University of Technology in
fulfilment of the degree of Doctor of Philosophy
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Table of Contents
TABLE OF CONTENTS................................................................................................I
ATTESTATION OF AUTHORSHIP........................................................................VI
ACKNOWLEDGEMENTS........................................................................................VII
DEDICATION...........................................................................................................VIII
ABSTRACT..................................................................................................................IX
PREFACE........................................................................................................................1
INTRODUCTION...........................................................................................................3
IDENTIFYING THE PROBLEM............................................................................................3
1) It has no clear limits.............................................................................................4
2) It has no agreed core meaning.............................................................................6
3) It is wielded as a slogan........................................................................................9
4) There are few objections to vagueness...............................................................10
AND YET…..................................................................................................................12
THE REMEDY: TOWARDS UNDERSTANDING HOLISTIC HEALTH CARE............................13
Understanding ‘wholeness’.....................................................................................14
Understanding health..............................................................................................17
Understanding holism: leads from the health care literature.................................18
CONCLUDING REMARKS...............................................................................................19
CHAPTER ONE...........................................................................................................21
HOLISTIC HEALTH CARE: A DUBIOUS NOTION.............................................21
MORE THAN A SLOGAN?...............................................................................................22
THE HALLMARKS.........................................................................................................25
1) Alternative/complementary techniques...............................................................25
2) Integrated/biopsychosocial approaches.............................................................36
3) The ecological perspective..................................................................................54
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4) Ways of working.................................................................................................57
WHY HAS ‘HOLISTIC’ BECOME A THERAPEUTIC IMPERATIVE?......................................59
A CURIOUS STATE OF AFFAIRS......................................................................................64
CHAPTER TWO..........................................................................................................67
IN SEARCH OF HOLISM: A RELATIONAL METHOD......................................67
PREPARATORY QUESTIONS..........................................................................................68
What kind of knowledge is sought by this work?....................................................68
What is the relationship between thought and reality?...........................................74
How is method related to the nature of understanding sought?.............................78
THE IRONY...................................................................................................................81
WHAT ARE THE OBSTACLES TO CLARITY?....................................................................86
WHAT ARE THE WAYS TO OVERCOME THESE OBSTACLES?...........................................89
PHILOSOPHICAL INVESTIGATION CONGRUENT WITH GAINING AN UNDERSTANDING OF
HOLISM.........................................................................................................................96
CHAPTER THREE....................................................................................................102
LEUCIPPUS’ LEGACY: ATOMISM......................................................................102
ATOMISM AS CULPRIT................................................................................................103
ATOMISM AS CHOICE..................................................................................................105
ATOMISM’S OFFSPRING..............................................................................................106
1) Individualism....................................................................................................106
2) Dualism.............................................................................................................111
3) Reductionism.....................................................................................................116
THE COSTS.................................................................................................................117
CONCLUDING REMARKS.............................................................................................121
CHAPTER FOUR.......................................................................................................122
WHOLENESS: THE ADVENTURES OF A CONCEPT.......................................122
CONCEPTS..................................................................................................................123
What is a concept?................................................................................................123
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What understandings exist for the concept ‘wholeness’?.....................................127
THE FUNCTIONS OF WHOLENESS.................................................................................130
Wholeness as sacred.............................................................................................130
Wholeness as prescriptive.....................................................................................131
Wholeness as restorative.......................................................................................132
Wholeness as rebellion..........................................................................................133
THE NATURE OF WHOLENESS......................................................................................134
Wholeness as unity of everything..........................................................................134
Wholeness as an ideal end state............................................................................137
Wholeness as a complex entity with certain characteristics.................................139
Wholeness as a creative process...........................................................................142
GALLIE’S REQUIREMENT............................................................................................144
CHAPTER FIVE.........................................................................................................150
PARTS: FRAGMENTS OR CREATIVE CONSTITUENTS?..............................150
WHAT UNDERSTANDINGS EXIST FOR THE CONCEPT OF ‘PART’?.................................150
The ‘part-part’ relationship..................................................................................151
The ‘part-whole’ relationship...............................................................................155
The ‘part-nothing’ relationship............................................................................163
CONCLUDING REMARKS.............................................................................................167
CHAPTER SIX...........................................................................................................168
HOLISM EXPLORED...............................................................................................168
SO WHAT IS HOLISM?..................................................................................................170
‘DEFINITIONS’............................................................................................................171
HOLISM AND EVOLUTION...........................................................................................174
Smuts’ idea of holism............................................................................................177
Smuts’ understanding of wholes...........................................................................180
Holism and Mind...................................................................................................200
Personality (Self) as a whole.................................................................................205
HOLISM AND EVOLUTION THEORY.............................................................................209
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CHAPTER SEVEN.....................................................................................................225
HOLISM APPLIED....................................................................................................225
HOLISM IN SOCIAL SCIENCE.......................................................................................227
Holism of content..................................................................................................228
Holism of form......................................................................................................229
Holism 1................................................................................................................230
Holism 2................................................................................................................232
Holism 3................................................................................................................232
FALLACIES ABOUT HOLISM........................................................................................233
Addressing fallacy one..........................................................................................234
Addressing fallacy two..........................................................................................235
Addressing fallacy three........................................................................................241
Addressing fallacy four.........................................................................................243
Addressing fallacy five..........................................................................................246
CO-OPERATIVE POSSIBILITIES.....................................................................................250
REMAINING DIFFICULTIES WITH HOLISM....................................................................252
CONCLUDING REMARKS.............................................................................................257
CHAPTER EIGHT.....................................................................................................258
HOLISTIC HEALTH CARE: PATTERNS OF PRACTICE................................258
HEALTH AND WHOLENESS: GOOD BEDFELLOWS?.......................................................260
The absence of disease..........................................................................................262
Health as an ideal state.........................................................................................263
A commodity..........................................................................................................264
Personal resources................................................................................................265
Health as finding meaning....................................................................................266
Health as a cultural notion...................................................................................269
Health as quality of life.........................................................................................269
Health as Foundations..........................................................................................272
WHAT IS HEALTH CARE?............................................................................................278
SO PARTS IT IS............................................................................................................285
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CHAPTER NINE........................................................................................................292
HOLISTIC HEALTH CARE: WORKING WITH THE CREATIVITY OF
INCIPIENT WHOLES...............................................................................................292
1. WHAT SHOULD I DO TO BE MORE HOLISTIC IN MY PRACTICE?.................................294
2. BUT I STILL THINK THAT HOLISTIC CARE MUST BE ABOUT INCLUDING AS MANY
FACTORS AND PROVIDING AS MANY SKILLS AS POSSIBLE............................................298
3. SURELY THERE MUST BE A BASIC RECIPE, A METHOD YOU CAN EXPLAIN TO ALL
WOULD-BE HEALTH WORKERS....................................................................................299
4. WHAT ARE EMERGENT PROPERTIES AND HOW IS UNDERSTANDING THEM USEFUL IN
HEALTH CARE?...........................................................................................................300
5. HOW CAN I TELL THE DIFFERENCE BETWEEN A PART AND A WHOLE?.....................304
6. BUT I THOUGHT HOLISM WAS ABOUT WHOLES, NOT PARTS: WHOLENESS AS
EVERYTHING IN UNDIVIDED FLUX...............................................................................305
7. IF HOLISTIC CARE IS A WAY OF LOOKING AT HEALTH CARE, DOES IT REALLY EXIST IN
ANY REAL SENSE?.......................................................................................................308
8. OK, SO GIVE ME EXAMPLES OF HOLISTIC PRACTICE: HOW ARE THESE SKILLS USEFUL,
HOW DO THEY PRODUCE MORE HEALTH?....................................................................310
9. HOW WOULD I EVALUATE THIS? HOW WOULD I KNOW MY PURPOSE IS ACHIEVED?317
10. BUT THERE ARE QUESTIONS OF EFFICACY THAT RELATE TO UNSCIENTIFIC
TREATMENT METHODS...............................................................................................318
CONCLUSION. HEALTH CARE: ATOMISM TO HOLISM.................................................321
REFERENCES............................................................................................................323
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Attestation of Authorship
“I hereby declare that this submission is my own work and that, to the best of
my knowledge and belief, it contains no material previously published or written
by another person nor material which to a substantial extent has been accepted
for the award of any other degree or diploma of a university or other institution
of higher learning, except where due acknowledgement is made in the
acknowledgements.”
Signed Date
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Acknowledgements
It has been a privilege to be part of the PhD group of the National Centre for
Health and Social Ethics. This intrepid band shared their work and patiently
listened to mine, influencing me all the while. I thank each member of this group
for their support, the challenges they offered, for their encouragement. Writing
retreats with Fe Day and Jan Wilson were deeply sustaining and even
productive. I am very grateful for their companionship.
I would like to thank both Kate Diesfeld and Ann Kerwin for their talents shared.
The nurture offered in abundance by each of these people has been both
academic and personal. I acknowledge their contribution with deepest
appreciation.
Friends and family never escape these enterprises unscathed. To each of you,
for all you have been to me, I am truly thankful.
I wish to thank Auckland University of Technology for financial assistance in the
form of a postgraduate scholarship and to thank the library and professional
development staff for the help they have offered.
My greatest debt is to David Seedhouse who as my supervisor, believed in the
work, guided its progress in the most patient and reassuring way and kept faith
when my courage failed me. It has been a great privilege to have the
conversations, to refine the arguments, and to rewrite the chapters within the
context of expert supervision. The extent to which this work falls short of
demonstrating his skill and commitment, is my responsibility alone.
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Dedication
To my daughter Emma and my son Kieran.
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Abstract
For almost three decades ‘holistic health care’ has been a widely invoked term.
It is called upon as an antidote to mechanistic science, as justification for the
use of alternative therapies, as instruction to good practice and even as a
boundary marker in establishing professional identity. In the service of these
intentions it has assumed various meanings. The first aim of this study is to
identify from the literature, the illusion of shared meaning that saturates this
term and to expose the implications of this lack of clarity. The elusive nature of
the meanings attributed to holism and the problem of determining an
appropriate method of pursuing these meanings is addressed. A particular
understanding of conceptual analysis and practical reasoning are defended as
adequate tools. The group of ideas from which the term holism can be
distinguished, individualism, dualism and reductionism, form the context of the
examination of understandings of wholeness. Eight distinctions of wholeness
are examined and the common conceptual feature of ‘purpose’ is suggested.
This requires considerable justification which is provided by an exploration of
the notion of ‘partness’. Recourse to the seminal work of Smuts (1926) is
sought and the derivation of the idea of holism from evolution theory is
explored. A key understanding explored is the nature of emergent properties
and their role in the holistic doctrine, ‘the whole is more than the sum of the
parts’. Employment of the word holism in social science, philosophy, and
biology is examined and a number of fallacies about holism exposed. With a
somewhat clearer understanding of holism, and a working notion of wholeness,
theories of health are discussed as contenders for a philosophical basis for
‘holistic health care’. While several show some congruence, it is argued that the
Foundations Theory of Health can be shown to demonstrate the characteristics
of work for wholeness identified in this work. The conclusion that holistic health
care is in essence working creatively with incipient wholes, is explained and
justified by a discussion about how a health worker might become more holistic
in her practice.