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Chiropractic Journal of Australia : CJA June 2012
Chiropractic Journal of Australia Volume 42 Number 2 June 2012 45 irreducible to those of its components due to the network of interactions that connected them into a whole in space and time. Feedback systems, such as homeostasis, that were characterized by “circular causality” were only special cases of general systems: “The concept of ‘general system’ is, in comparison, a broader one, and a general theory of systems should embrace dynamic interaction between many variables, maintenance in change of component elements, growth, progressive differentiation, mechanization and centralization, increase in the level of organization and the like.” 8 Any systemic model implied the possibility of transformation and evolution. A system was stable if its properties were maintained close to a position of equilibrium despite internal modifcations and interactions with its environment; i.e. its components tended to restore themselves after disturbances and to strive toward stability, or steady state. Instability might assume two forms: evolution toward disintegration of the system, or evolution toward stronger organization that could result in continual evolution. Bertalanffy distinguished mechanistic and organismic trends. Mechanistic trend was the type of “technological, industrial and social developments” and organismic trend had following characteristics: “In spite of irreversible processes continually going on, they [living systems] tend to maintain an organized state of fantastic improbability; they are maintained in states of non-equilibrium; they even develop toward increasingly improbable states, increasing differentiation and order, as is manifest both in the individual development of an organism and in evolution from the famous amœba to man.” 9 General system theory, or functional structural analysis, postulated that systems of any kind, including the universe, operated according to the same fundamental principles. A common methodology to study the behaviour and evolution of complex entities could therefore promote unity of science: “General system theory may be considered a science of ‘wholeness’ or holistic entities which hitherto, that is, under the mechanistic bias, were excluded as unscientific, vitalistic or metaphysical. Within the framework of general system theory these aspects become scientifcally accessible. General system, therefore, is an interdisciplinary model which needs, but also is capable of, scientifc elaboration and consequently can be applied to concrete phenomena.” 10 This is why the theory - a “humanistic endeavour” - could help modern societies to apprehend the complexity and dynamics of their organization with an approach of biological, societal, and epistemological domains that was “more realistic than previous, mechanistic philosophy.” It triggered enthusiasm among psychologists, theologians, sociologists, and politicians. Followers of Bertalanffy were Kurt Lewin, Anatol Rapoport, Edgar Morin, Herbert Simon, Gregory Bateson, etc. In the late 1970s general system theory became an autonomous feld that studied the dynamics of self-organization in domains such as engineering, computing, ecology, management, psychotherapy, etc. HEALTH CARE AT GRIPS WITH HOLISM Medical knowledge, practices, and institutions, all are shaped by cultural backgrounds that provide defnitions of health and its impairments; they are subject to controversies and evolutions. What is at stake is the human person. Centuries ago human dissection threatened its integrity. Nowadays, societies are confronted with what is regarded as fragmentation of individuals by biomedicine. A Cultural Background Since the 19th century medicine has been shaped by the analytical approach that was founded on biology. It became biomedicine over the last sixty years and the only scientifc acceptable reference of health care worldwide. This evolution resulted in the frequent minimisation of complex factors such as environmental, psychosomatic and symbolic interactions. It also strongly infuenced the intimate perception of our selves, far beyond scientifc strategies. In the 1970s medical anthropology broadened this perspective and took into account patients’ experience as individuals and as members of social groups. Impaired health was not only associated with biomedical factors, but also with psychological attitudes, societal circumstances, and representations. Three related notions were discussed: disease, illness and sickness. Disease consisted in biological and psychological pathologies or dysfunctions analysed and theorised by medical knowledge. Illness referred to an intimate experience and to the subjective signifcance of impaired health. And sickness was a societal appreciation; it defned the role of sick persons, as well as conditions that were culturally acceptable and might qualify a person as sick. In the subtle coincidence of disease, illness and sickness, biomedicine tended to absorb the last two notions into the former. This created a void where psychological, exotic, and metaphysical explanations could thrive.11 The popularity of complementary and alternative medicines, of their claim for holism and naturism (the preference for natural healing methods) illustrated this situation. Yet, in spite of sharply defined characteristics, the biomedical discourse was not merely founded on a collection and elaboration of data but also on options that were coined by subjectivity. Disease – diagnosis, therapeutic instructions, prognosis – was in many instances practitioners’ interpretations according to their university training (school of thought) and to scientifc advances; to changing offcial protocols; and to factors that were subject to cultural constructs. These constructs – erudite or popular; in the forefront or not -- were always present; they constituted a flling material between areas of certainty and gave coherence to the medical discourse. Similar observations applied to the chiropractic discourse. While it incorporated advances in basic and clinical sciences, it adapted to evolution of legislations, to development of other manipulative professions and of biomedicine. Individual practitioners accommodated their chiropractic education to local circumstances (lifestyles, popular habits, type of health care system, styles of media coverage, attitudes of other health professions) so that chiropractic practice became somewhat different according to countries and continents. HOLISM IN HEALTH CARE JOLLIOT
CJA March 2012
CJA September 2012