Under the Cloud of Professionalism
Kent State University
"When science triumphs, humanities are the losers": Inquiry
into knowledge, science, and the inadequacies of a caring profession.
Singer, O.. (2002) Under the cloud of professionalism.
International Journal of Psychosocial Rehabilitation. 7, 35-43.
The scientific paradigm, as part of ‘professionalism’ in health care, has reached a moral crossroads. Scientific knowledge as a priority has in many ways de-humanized the compassionate touch and the understanding of the subjective world of our recipients. The primary role of this current essay is to re-evaluate science as an epistemology in healthcare education, training, and practice. The second purpose is to increase awareness to unfortunate attitudinal trends within healthcare professions in academia as well as in practice towards living subjects, in an aim to clarify the nature of professional-client interactions. The concluding discussion will portray human relationships as non-quantifiable interactions. Change and growth fostering relationships will be characterized as having a symbiotic nature rather than a dichotomous nature.
Social and behavioral sciences have borrowed their scientific notions from physical sciences (Heppner et al., 1999). However, modern sciences were also accompanied by a development of philosophical thought that suggested an extreme formulation of spirit/matter dualism. This formulation was the core of Descartes philosophy in seventeenth century science (Capra, 1991).
Psychology, as a field demonstrated its scientific rigor by modeling itself on Newtonian physics (Jordan, 2000). Ironically physics scientific emphasis was on objectification and distance from the known (Wolf, 1981). As scientific psychology was developed there was much attention to the separate self in the form of diagnostic manuals that use a medical/disease model to locate pathology in the individual (Jordan, 2000).
The promise of instrumental control given by scientific knowledge serves as a paradox to the etiquette of care and can become a blind passion (Lewin, 1996). In others a words, Western knowledge lays it’s foundations on Baconian notions of mastery over nature, objectification of the known instrumentally; ironically these notions stand in contrast with other epistemologies that rely more on knowing through joining, through a compassionate unity of empathic care (Keller, 1985 cited in Jordan, 2000).
The main concern of this essay is to understand the nature of relationship, in teachings and practice, presented by contemporary ‘professionalism’ in healthcare occupations. As social sciences in the helping professions borrowed scientific notions, they also borrowed the need to separate between the knower and the known, which is manifested in academic curriculum that emphasizes the infatuation with knowledge, science, and social distance. Professionals also perpetuate such notions in their language and through practice (Lewin, 1996; Spiro, McCrea Curnen, Peschel, & James, 1993; Szazs, 1974).
This essay will look deeply at science and scientific knowledge as epistemologies that conflict with the core nature of healing professions, which was knowing through symbiosis with the client rather than knowing through separation. This has, in many ways, de-humanized the helping professions (Spiro, McCrea Curnen, Peschel, & James, 1993; Lewin, 1996). Unfortunate trends in teachings and relationships will be revealed, and a call for a shift in paradigm in the helping professions’ education and practice will be discussed.
Science, virtues, and the therapist
An exploration into historical psychology reveals great importunity. Freud has overemphasized individual self-interest (Doherty, 1995). Psychological theories have been holding clinicians like a chair afloat, and on an even keel. In other words, therapists gain security from their theoretical notions, as from a fetish or a teddy bear, which helps them stay organized and effective (Michels, 1983).
The contemporary, Western, post-Freudian world emphasizes happiness and self-fulfillment as a significant personal goal (Doherty, 1995). It is not surprising that in a permissive and materialistic environment in which individualistic satisfaction is the higher goal, healthcare too, will attract many who want to receive from, rather than to give to the profession. Many may be seeking intellectual gratification, prestige, or economic advantage, but often service is not the priority (Spiro, McCrea Curnen, Peschel, & James, 1993).
Even when physics evolution called for a change in perception and in its scientific rigidity, the helping professions as a science fail to admit in the necessity for a new and alternative form of interaction. The attachment to the traditional notions of scientific interaction causes disconnection within the therapeutic arena. Therapeutic disconnections may be a direct result of a perpetuation of distance and separation in healthcare relationships (Jordan, 2000; Spiro et al., 1993; Laing, 1965).
Therapeutic disconnections are ubiquitous; people misunderstand one another and fail one another empathetically (Jordan, 2000). However, if mutual empathy is not met in the relationship, the disconnection from acute will become chronic, and the therapeutic relationship will loose authenticity, vitality, and eventually effectiveness (Jordan, 2000; Buber, 1970; Spiro, et al., 1993). Resistance to change, as a form of disconnection, often occurs when the clients feels, or perceives the caregiver as a formal, ‘cold’, unconnected agent (Laing, 1965, 1967; Adams, 1993; Carling, 1995).
Non-compliance, as another form of disconnection, is an evident phenomenon in Schizophrenia. Many individuals who live with the diagnosis of Schizophrenia neither recover nor improve (Modrow, 1996). Studies show that the majority of the clients who live with the diagnosis of Schizophrenia are noncompliant with medication treatment. Torreys’(1995) last explanation of this therapeutic noncompliance was the failure of doctor-patient relationships.
Diagnostic criteria: the husk of being
Diagnosis of mental disorders is generally based on behavioral symptomatology (Szasz, 1976). However, it is evident that the diagnosis may be maintained throughout time beyond post-mortem examination- despite the absence of demonstratable histopathology or psychophysiology (Szasz, 1976). In other words, the lack of factual measures of ‘objectivity’ in observation of human behavior may result in a debate of opinions on the validity of a certain diagnosis (Szasz, 1976).
Laing’s (1967) almost utopian analysis of behavior and experience portrays dimensions of the uncertainty of behavioral science. According to Laing (1967), our thirst for the evident stops at human behavior, with the neglect of hidden experiences. Diagnostic manuals, which are based on the medical/disease model, are mainly concerned with the observer’s view of things, rarely with the subjects’ view of their own experiences (Laing, 1967; Jordan, 2000).
The nature of relationships within the diagnostic arena, the relationship between the observer and the observed, represent relationships between I and it (object) rather than I and a subject (Laing, 1967). Interactions, such as in diagnosis, offer an empty and confusing existence. If we see the world only through our experiences, then we will miss much of that which is (Laing, 1967; Buber, 1970).
Separative dialogue in substance abuse treatment
Similar to diagnosis, the medical model of addictions views the phenomenon of addiction as pathology within the individual (Fisher & Harrison, 2000). That view influenced the relationship between professionals and clients, which included a language change. Clients who fail to comply with the counselor over certain notions of the disease model may be categorized clinically (Miller & Rollnick, 1991).
The view of addiction, behaviorally, as a disease reinforced an unfortunate trend of mere professional sarcasm tailored into everyday professional attitudes (Singer, Field Notes, 2001). The client that refuses to believe that the ‘disease entity’ exists in him may be viewed as ‘in denial’ or ‘resistant to change’. Clients who may fail to adopt the common view of addiction brought by the clinical staff may be metaphorically compared to "sick puppies" or to "broken toys". When a client is viewed as a recidivist, another unofficial diagnosis that the "client is wired wrong" will be attached (Singer, Field Notes, 2002).
Science and the academic world
Sociological analyses reveal ‘professionalism’ as containing several attributes. The first attribute is expert knowledge grounded in high and prestigious educational systems. The complex and discretionary knowledge is necessary for the benefits of the community. The medical profession, as well as psychology and other healthcare professions possess such attributes (Imanaka, 1997; Fry & Salameh, 1993).
The secret policy of ‘publish or perish’ among faculty members emphasizes the discovery of new knowledge. Promotional factors that are calculated by promotion committees often emphasize scientific achievements and involvements of staff rather than demonstration of compassionate qualities (Spiro, McCrea Curnen, Peschel, & James, 1993).
Research suggests that the process of change and growth is enhanced by mutual relationship between the professional and the client (Miller and Rollnick, 1991; Rogers, 1951, 1961; Lewin, 1996). However, academic training programs in the fields of psychiatry, psychology, counseling, and rehabilitation continue to emphasize the scientific methods through intensive curriculum (Dellario, 1996; Goodyear & Benton, 1986). As the higher education process continues from master’s level into doctorate level, knowledge and practice of the scientific method is increased.
The key focus of the scientific-practitioner model in healthcare education is the development of scientific reasoning skills. This approach emphasized systemic and thoughtful analyses of human experiences and application of the knowledge gained (Rumrill & Bellini, 1999; Meara et al., 1988,).
The right balance between science and humanity indeed needs to be established for bettering the quality of care provided. However, it is apparent that science within healthcare education has monopolized certain emphasis in the academic curriculum, which may have relegated the human aspects into a secondary role (Spiro, McCrea Curnen, Peschel, & James, 1993).
Students may be expelled for lacking the essential knowledge, but only few will be expelled for lacking empathy. In some cases, for example medical school, student selection processes emphasized scholastic achievements in entry examinations. This selective process favored academic brilliancy and competitiveness over the search for the right compassionate personality (Spiro, McCrea Curnen, Peschel, & James, 1993).
Literature suggests, that as the process of learning scientific methods to healthcare goes on, our students learn along with neutrality and objectivity, detachment and equanimity (Spiro et al., 1993; Jordan, 2000). Our infatuation with knowledge and science has priority over the delivery of compassionate care by emphasizing values such as neutrality and objectivity (Spiro et al., 1993; Jordan, 2000).
Objectivity? Quantum mechanics, social sciences, and the paradox
Throughout the twentieth century social science as a field borrowed it’s quantitative model from physical sciences (Heppner et al., 1999, Jordan, 2000). Ironically, as psychology and other social sciences modeled Newtonian Physics, the creative minds of physicists moved toward an appreciation of quantum physics, indeterminism, and uncertainty. An appreciation developed towards interconnectedness in relationships, not separation (Wolf, 1981; Jordan, 2000).
The quantum leap plummeted scientists into a bizarre and unexplained underworld. This new order, the basis for the new physics, was not in the objects or particles but in the minds of the scientists. Scientists had to give up their preconceived ideas about the physical world (Wolf, 1981).
The philosophical basis of science as a rigorous determinism was the fundamental division between the I and the world as introduced by Descartes. The consequence of such division was the world could be described objectively without ever mentioning the human observer (Capra, 1991). Quantum mechanics brought to light the insufficiency of our simple mechanical conceptions. This revelation has shaken the foundation of customary interpretation of knowing and seeing (Bohr, 1958).
A paradox introduced by modern physics involved the scientists’ view of science as a reasonable and orderly process of observing a phenomenon and describing the results objectively (Wolf, 1981; Capra, 1991). This notion was based on the assumption that whatever one observed as being there is indeed there. Quantum physics revealed, what seems to be nonsensical, that what one observes appears to depend upon what one chooses to observe (Wolf, 1981, Heisenberg, 1958).
The principle of uncertainty as taught by Heisenberg (1958; 1971) demonstrated that the limitations of such scientific method become increasingly apparent. The Principle of Uncertainty may also mean that to observe is to interfere, which means that the scientist cannot play the role of a detached objective observer, but become involved in the world he/she observes to the extent that one influences the properties of the observed (Wheeler, 1958 as cited in Capra, 1991).
The new physics as a science, necessitated profound changes in concepts like time, space, matter, object, cause and effect, etc… (Wolf, 1981; Capra, 1991). Within these changes, the universe was experienced as a dynamic, inseparable whole, which always includes the observer and the observed (Capra, 1991).
Today, almost one hundred years after the discovery of quantum physics, when science was shattered by change, doubt, and uncertainty, scientists are experiencing a new vast, deep way of relating to the universe (Aurobindo, 1957). The implications of the findings of quantum mechanics are crucial to the helping professions. They offer an alternative to interactions and relationships. The observer and the observed, the helper and the helped, fuse into a unified whole consisting of growth and change (Upanishads as cited in Capra, 1991).
Alternative communication: Buberian dialogue and the relational model of interaction
Quantum mechanics and the relational model to psychotherapy share similar conclusions- the knower and the known are inseparable, and growth process depends on the mutuality in interaction. This suggests that individuals grow through and towards relationships. Mutual empathy and mutual empowerment is the core of growth fostering relationships. The relational model view growth fostering relationships as a system in which both sides contribute to the growth. In relational therapy, mutual empathy is the vehicle for therapeutic change (Jordan et al., 1991).
Relational therapy is consistent with one of the deepest and most creative philosophies of human interactions- the I-Thou dialogue as presented to us by the Jewish philosopher Martin Buber (Buber, 1970). Buber makes the distinction between two types of relationships: I-It and I-Thou. Each of these represents different qualities of relationships (Berry, 1985; Buber, 1970).
In the I-It attitude, the self does not interpret the other as having any possibilities beyond those which the self has determined for it. In hermeneutic terms, the self can be understood as constructing an image of the other in which the self imposes possibilities on the other and does not recognize it as having any other possibilities of its own. In the I-Thou attitude, the self recognizes that the other has possibilities of its own beyond those which the self expects or imposes, hence respecting the otherness of the other (Buber, 1970).
Two ways of knowing
Knowledge can be put in two main categories: Logico-Scientific knowledge and Narrative knowledge. Logico-Scientific knowledge is used to collect and evaluate replicable, universal generalizable, and empirically verifiable data. The process is driven by hypotheses and generated by detached observers. Logico-Scientific Knowledge relies on formal operations as conjunctions and disconjunctions to establish testable propositions (Charon, 1993 in Spiro, McCrea Curnen, Peschel, & James, 1993). Logico-Scientific knowledge, or Rational knowledge described by Capra belongs to the realm of the intellect, whose function is to discriminate, divide, compare, measure and categorize (Capra, 1991).
Narrative knowledge, in comparison, does not suggest more certainty, but rather mutuality and growth. Narrative knowledge and social phenomenology, as two parts of the whole, seek to examine and understand experiences of singular events contextualized within time and place. Stories, fairy tales, and scriptures are all examples of such knowledge (Charon, 1993 in Spiro, McCrea Curnen, Peschel, & James, 1993).
Through narrative knowledge and through social phenomenology, humans come to realize themselves and each other, in order to know who they are, and eventually attain the classical-‘know thy yourself’ (Laing, 1967; Charon et al., 1993). Social phenomenology and narrative knowledge, as a phenomenon, represent a symbiotic process, in which human relationships have progressed into mutual exchange and deep understanding. This process may lead to the ultimate knowledge- self-knowledge (Buber, 1970; Jordan, 2000).
According to Heidegger (1962), the dreadful has already happened. Therapists are specialists in human relations. However, as the dreadful has already happened, for therapists too, as beings that lives in this world. The inner does not become the outer; the outer often becomes the inner. Without understanding the inner realms of the individual, the outer loses it’s meaning; the same way quantum leaps proved our view on matter as a superficial conception (Laing, 1965, 1967; Capra, 1991).
Transaction communication occurs between systems, computers, and so on. Human relationships are not only transactional, they’re trans-experiential, being a specific human quality. The more human sciences model itself after the old physics, the greater the dissonance between the knower and the known, the helper and his/her client, the professor and his/her student (Laing, 1967; Jordan, 2000; Spiro, McCrea Curnen, Peschel, & James, 1993).
An existential analysis of language and communication as suggested by Rollo May (1972), reveals that we make our language more and more technical, impersonal, and objective until we talk primary in scientific terms. When the transformation of language and communication has been made, we as individuals become alienated from others (May, 1972; Szasz, 1974).
The break in communication, or the nature of disconnections, in diagnostic sessions, therapy, or counseling, suggests a failure to connect authentically and compassionately to our clients (Spiro, McCrea Curnen, Peschel, & James, 1993; Adams, 1993; Lewin, 1996).
Objectification of existence is a phenomenon that started with traditional science and moved into language patterns used by professionals in everyday life (Szasz, 1974; May, 1972). Objectification of the known in scientific teachings within academic curriculum, objectification of mental disorders in diagnosis, and objectification of the client in treatments, opposes the fundamental epistemology at the core of the helping profession of knowing through joining (Jordan, 2000).
Growth and change process is attained through the mirror of relationships, through the understanding of the contents of his/her own mind, and through observation and not through intellectual analysis or introspective dissection. Man has built in himself images as a fence of security -- religious, political, personal. These manifest as symbols, ideas, and beliefs. The burden of these images dominates man's thinking, his relationships, and his daily life. These images are the causes of our problems for they divide man from man (Krishnamurti, 2000).
To resolve the dichotomous nature of relationships, an authentic and mutual dialogue ought to be established between professionals and their recipients (Jordan, 2000). When one is hurt in a relationship, but is able to communicate the hurt authentically to the other and the other responds empathically, disconnection can move back into connection (Miller & Stiver, 1997). If the disconnection is not resolved, the hurt individual may apply disconnection strategies of withdrawal and isolation, which may move the relationship from acute disconnection into chronic disconnection (Jordan, 2000; Gilligan, 1982).
Sealing the article with a sense of optimism, the future of science, psychotherapy, and relationships in general, depend upon the ability of the individual to maintain open-mindedness perception and the ability to apply social intelligence such as empathy and compassion on a mutual basis (Buber, 1970; Berry, 1985; Jordan, 2000). Martin Buber’s (1970) words represent a utopian vision of relationships based on humanitarian values:
"The world is not comprehensible, but it is embraceable: through the embracing of one of its beings. Each thing and being has a twofold nature: passive, absorbable, usable, dissectible, comparable, combinable, rationalizable, and the other, the active, non-absorbable, unusable, undissectible, incomparable, noncombinable, nonrationalizable. This is the confronting, the shaping, and the bestowing of things. He who truly experiences a thing so that it springs up to meet him and embraces him of itself has in that thing known the world" (Buber, 1970).
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