The Human Capacity for Intentional Self-Healing & Enhanced Wellness

A research proposal

John Heron, British Postgraduate Medical Federation, University of London

Peter Reason, Centre for the Study of Organizational Change and Development, University of Bath

March 1985

Aims of project

This project sets out systematically and critically to explore the human capacity for intentional self-healing and enhancing wellness. This means exploring, developing, and assessing self-help techniques for a) transforming illness into wellness for those who are currently “ill”; and b) for enhancing wellness for those who are currently “well” (ill and well being in the first instance defined by conventional standards).

Overview of method

The project will involve exploration in four domains of inquiry, using co-operative and experiential inquiry methods. The four domains and the general approach to be taken are outlined briefly in this section, and further detail of the method is given in the next section, Thus the inquiry will include:

A philosophical exploration of human potential in which intention and agency can be understood as central in the process of being and becoming “ill” and “well”.
The development and critical exploration of a conceptual model or map of what is involved in the processes of intentional self-healing and enhancing wellness.
The development, description and field-testing of practical methods of intentional self-healing and enhancing wellbeing, These will include:
Self-directed techniques involving both internal action (such as visualisation, meditation, etc), and external action (such as diet and exercise), and combinations of both.
Techniques undertaken alone, and in interaction with others such as peers and professional practitioners.
An important aspect of the project will be the development of training programmes for patients and practitioners.
The empirical investigation of the effects and outcomes of these methods, using collaborative and experiential inquiry methods.

Outline of method

1. Review the literature, consult a wide range of medical and health practitioners, a wide range of patients of both conventional and complementary approaches, discuss and reflect, and from this develop:

A list of techniques for self-directed healing and enhancement of wellness that are currently being used; make a provisional assessment of their feasibility and, if it can be assessed, their efficacy; speculate about innovative techniques; set all this in a historical and cultural context.
Evolve a provisional philosophy of illness and wellness, with special reference to agency and self-direction; from this evolve working definitions of illness and wellness that bear witness to but go beyond prevailing concepts.
Evolve a provisional conceptual model of the ways through which these intentional self-help processes work.

2. Recruit groups of people who are currently ill, both groups of those with the same illness, and groups of those with different illnesses, and for each group:

Initiate them into the perspective derived in 1 above; indeed they would be recruited and self-selected on the basis of the appeal of these ideas to them.
Facilitate their development as a co-operative inquiry group which would:
Define and record in physical and non-physical terms the state of illness of each person at the start of the inquiry process using criteria developed within each group.
Agree on appropriate self-directed techniques for recovery from illness and apply these over time, monitoring and recording their effects, periodically reviewing their efficacy, and if appropriate revising their design and use.
From time to time interact with other groups of both ill and well persons (see below) in order to share and learn from periodic review findings.
Define and record in physical and non-physical terms the state of the illness or wellness of each person at the end of the inquiry.
Judge from within the total experience and its internal findings the weight to be given to the different factors that have contributed to the return to wellness or the continuation of illness, Of particular interest, of course, will be the weight given to the use of self-directed techniques of self-healing, No control groups would be used for reasons elaborated in the discussion below.
The groups would be designed to maximise heterogeneity by having all the following combinations of: same illness, same technique; same illness, different techniques; different illness, same technique; different illness, different techniques.

3. Recruit groups of people who are currently well by conventional standards, and for each group:

Initiate them into the perspective derived in 1 above; indeed they would be recruited and self-selected on the basis of the appeal of these ideas to them.
Facilitate their development as a co-operative inquiry group which would:
Define and record in physical and non-physical terms the state of wellness of each person at the start of the inquiry process, using criteria developed within each group.
Agree on appropriate self-directed techniques for enhancing wellness and apply these over time, monitoring and recording their effects, periodically reviewing their efficacy and if appropriate revising their design and use.
From time to time interact with other groups of both ill and well persons in order to share and learn from periodic review findings.
Define and record in physical and non-physical terms the state of wellness (or loss of it) of each person at the end of the inquiry.
Judge from within the total experience and its internal findings the weight to be given to the different factors that have contributed to the enhanced wellness or the continuation of conventional wellness (or loss of it), Of particular interest, of course, will be the weight given to the use of self-directed techniques of enhancing wellness, No control groups would be used for reasons elaborated in the discussion below.
The groups would be designed to maximise heterogeneity by having some groups each of which uses the same technique, and some groups each of which uses a range of techniques.

4. Draw conclusions from the total study. These would include:

A philosophical statement concerning illness and wellness with particular reference to agency based in the experience of the project as a whole.
A conceptual map of the self-help process with respect both to illness and wellness, and maps of particular techniques used.
A set of practical procedures and exercises for teaching people how to use and develop their capacities for self-healing and for enhancing wellness, These might be written, on audio or videotape, and in the form of workshops for patients and practitioners.
An assessment of the efficacy of the self-directed techniques used in both illness and wellness groups in terms of the criteria internal to those groups; and further an assessment of those internal criteria.
A comparison of the use of techniques in the illness and wellness groups, using the different perspectives in order to understand better the self-help process.
Recommendations about the future use of self-directed techniques in health care; and recommendations with regard to further research.

Background

Healing and wellness

In our view, understanding, using, and enhancing the human capacity for self-healing is the central issue in the development of holistic medical and health-care practices, whether viewed from the perspective of orthodox medicine or the variety of complementary therapies. While interventions from outside are clearly important, it is only the patient as person who can develop a capacity for wellness, The danger in focussing research on different types of interventions is that we lose sight of the fundamental truth that it is the patient who gets well and stays well, rather than the therapy that does well or badly.

In our recent inquiry into the theory and practice of holistic medicine with a group of general medical practitioners we developed and critically applied a five-part model of holistic medicine. The five inter-related parts were: treating the patient as a whole being of mind body and spirit; using a wide range of interventions; power-sharing between doctor and patient; the doctor as “self-gardening”, by which we meant looking after themselves in a holistic fashion; and the patient as potentially an agent of intentional self-healing.

We meant by this last point not just the obvious fact that the human body is within variable limits a self-healing organism -for example the healing of wounds and the unaided recovery from viral infection — but also the more radical principle that each person as a mental and spiritual being has the potential capacity consciously and intentionally to facilitate healing in their bodymind by a variety of internal and external actions. In our view the range of this potential is unspecified and unknown, but we assume it to be much greater than either patient expectation or conventional medicine allow. We did not, in our holistic medicine inquiry, focus specifically on this dimension of the model, and so in many ways the current proposal builds on and is a development of this earlier work.

We are also aware of the enormous amount of work that has gone into the development and testing of a wide variety of approaches to self-healing such as biofeedback, autogenic training, meditation, visualisation, exercise and diet, co-counselling. (for references see, for example, Pietroni 1984). These have been applied and explored in a very wide variety of situations and clinical conditions. We are also aware of the work done in the educational and personal development fields which is designed to enhance the individual’s physical, mental, and spiritual capacities (for a recent example of this work see Houston, 1982), And thirdly, we are aware of enormous amount of experience and practice of healers and mediums. We intend that this project build on and develop this diverse work.

It is the emphasis on intentional self-healing and the enhancement of wellness which distinguishes this proposal from the earlier work. As Dossey argues in his radical approach to medical thinking, Space, Time, and Medicine (1982), the best health strategies are those which make the bodymind wiser, Our view is that many approaches to health and illness, both in orthodox and complementary practice, overemphasise the intervention and its impact, at the expense of the patient as a being who has an relatively undeveloped capacity to re-order their physical, mental, and spiritual processes to maintain, restore, and enhance their health, We therefore argue that a central task in the development of complementary and holistic medicine is to explore and develop our understanding of the intentional self-healing process, its potentials and its limitations.

We further argue that the issue of self-healing for those who are seen as ill by conventional standards needs to be explored in the context of the enhancement of wellness for those who are already well by those standards. This is because a focus on pathology may limit our vision of human potential, and thus limit also our view of the powers that can be used to heal. Similarly, inquiry with conventionally well people may generate a more imaginative and comprehensive range of self-help techniques: it may be that techniques that in the first instance appear only to be relevant to enhancing wellness may be highly effective in recovering from illness. Also, since illness and wellness are polar conditions dialogue between the poles may illuminate the nature of each. Finally, and most important of all, the long term welfare of society benefits more from the development of techniques that are prophylactic and life enhancing rather than curative. For all these reasons, an important aspect of the inquiry will be to compare and contrast techniques used for healing with techniques used for enhancement of wellness, to see what they have to contribute to each other in terms of development and understanding.

We do not argue that self-healing approaches will supplant current orthodox or complementary therapies; but that an understanding of the intentional self-healing process is an essential complement to practitioners’ interventions.

Co-operative inquiry

A major problem in the exploration of holistic health care strategies has been the lack of an appropriate inquiry method. Orthodox medical research, as a branch of orthodox science, offers methods which are inappropriate for the study of self-healing potential, based as they are on a deterministic view of the body as a chemical and mechanical machine, cut off from the influence of mind and spirit (Heron and Reason, 1984). Thus for example, the controlled clinical double-blind cross-over trial is designed to control out extraneous variables such as the patient’s intent to get well or stay ill.

In contrast to orthodox research methods, we have been developing and using over the past decade an approach to inquiry which is experiential and collaborative, in which all those involved in the enterprise contribute both to the thinking that goes into the inquiry and to the research action which is its object, and in which the primary instrument of inquiry is informed, critical, and discriminating human consciousness. This methodology has been set out in earlier books and papers to which we refer the reader for a more detailed exposition than can be included in this proposal (Heron, 1971; Reason and Rowan, 1981a; Heron, 1981; Heron and Reason, 1985.). We include as an appendix to this proposal a more detailed discussion of co-operative inquiry, and we also explore further issues of validity in the section below on outcomes.

Our view is that intentional self-healing can best be explored using co-operative experiential inquiry. Indeed, the research method and the research topic seem ideally matched, since they both take as fundamental the person as agent: in inquiry the self-directing intelligence, critically and creatively exploring experience; in self-healing the self-directing patient as intentionally managing their disease condition; and more widely the self-directing person enhancing their wellness through living a life which is healthy for the body-mind-spirit.

Indeed, we argue that if we wish to take this human potential seriously we can only explore and understand it using cooperative experiential inquiry methods. If illness and health are to any significant degree constructs of mind and spirit manifest in the body, we will only understand self-healing and the enhancement of wellness if we use a method rooted in personal experience; a method in which people can help each other critically examine their own experiences of healing and developing themselves.

Illness and wellness are fundamentally experiential concepts in that they can only be understood in terms of personal experience; and healing and enhancing wellness are similarly experientially defined processes. In this sense, illness is to be differentiated from disease, because the degree of experienced illness may or may not correlate with the degree of observed disease in the body. We have to allow for the paradox that experiential recovery from illness may not be the same as clinical recovery from disease. For example, a person with a clinically incurable heart condition may effectively recover from the associated illness by learning through intentional self-help to compensate for the disease physiologically. And of course, we would argue that there is often a major psychological and spiritual component to any experienced illness, as well as the physical component.

The experiential view of illness and wellness and the importance of intentional self-help is supported by Dossey:

In the modern view, because of these profound interrelations between consciousness and the physical world, rather than attempting to extinguish the subjective element in the healing process, we tend to maximise it; for we see it as a potent force in exerting purposeful change. Furthermore, we reason that this change can be initiated by patients as well as professional healers. In our new view of health, therefore, each patient has the potential of being his own healer. Healing becomes democratized in the new view. (Dossey, 1982).

As healing becomes democratized, so does the inquiry process. The human capacity for self-healing is the central issue for the development of holistic approaches to health care, and the appropriate way to study this is through co-operative inquiry. We have outlined above the method of such an inquiry; we need to discuss further the implications of its four main parts, philosophy, models of practice, experiential method, and outcomes, since what we are up to is the development of a whole new approach to wellness,

Discussion

Philosophy

The philosophical aspects of the inquiry must address the issues of our beliefs about the human being and about human potential. We must begin to build a philosophical system in which the intent to be well or ill can be seen as a central aspect of health, not just a rather awkward appendage on an essentially deterministic world view. In doing this it is likely that we will draw on modern approaches to systems theory and ecology, and the suggestions about the nature of reality coming from high energy physics and from consciousness research; as well as on modern humanistic psychology and those ancient disciplines and worldviews which are re-emerging. We will need to build a philosophy which includes the material world and the body, society and culture, the conscious and non-conscious mind, the transpersonal realities of symbol, myth, and archetype, powers and presences in other dimensions, and the power of Being itself. This philosophical inquiry is essential, and it is essentially integrated with the whole inquiry process: the self-healing person and the person involved in the intentional enhancement of their wellness is likely to have a radically different world view from that accepted normally in our culture today.

We would emphasise that this project affirms the values of heterogeneity, diversity, and creativity. The validity of the findings will be enhanced not only by the consistency and convergence of findings as in conventional inquiry, but also by the ways in which diverse perspectives overlap and illumine a common area of inquiry.

These philosophical investigations will start with visits and discussions with those persons and groups worldwide who are making fundamental contributions to thinking on these issues; it will involve reading widely and creatively, writing working papers and circulating them for comment; organising seminars and maybe a conference at which these emerging ideas can be critically discussed. And the philosophical investigations will also involve grounding the inevitably abstract ideas in seminars and discussions with those involved in our inquiry groups and other interested persons.

Phenomenology and conceptual models

A second and closely related aspect of the inquiry will be to build a phenomenology of the processes of self-healing and enhancement of wellness drawing on many different healing and developmental disciplines, the experience of practitioners in this field, as well as on our own experiential inquiries as they develop. This phenomenology will offer a conceptual map of self-healing work, encompassing a wide range of key variables such as consciousness and different states of consciousness; relationships with others such as family, peers, practitioners; specific self-directed interventions such as meditation, visualisation, diet, catharsis, ceremony, exercise, prayer etc; pressure and support from social and cultural influences; relationships with the natural world and other realities. And in addition to this the phenomenology will need to describe the dependence, independence and systems effects of these variables.

As with the philosophical framework, this phenomenology will be derived through discussions, papers, and wide-ranging personal contacts. It will be clarified, refined, revised, and grounded through the experiential knowledge arising from the co-operative inquiry groups on the project.

Experiential methods of intentional self-help

The third aspect of the inquiry will be critically to explore and describe practical methods of intentional self-healing. This will involve introducing self-healing techniques to groups of patients. These patients, working as co-researchers, will practice these methods, periodically taking time to reflect together on this practice and its outcomes in order to refine both the methods and the concepts on which they are based. They will then take these refined methods into further cycles of action and reflection. This research cycling between practice and reflection is a central part of the experiential inquiry method and of its validity procedures. Similarly groups of persons who are well by conventional standards would engage in co-operative inquiries on techniques for enhancing their wellness.

This aspect of the inquiry is the empirical core of the whole project: our aim is to set up 30 co-operative inquiry groups, each one including 10 – 15 persons, each group looking critically at self-directed methods of healing and enhancing wellness. Thus there will be a network of interacting co-operative inquiry groups, a kind of federation of inquiring self-healers and self-developers all fed by and reporting back to the central core of the inquiry process.

We envisage a range of different groups: one whose members have the same illness, and all use the same self-healing technique; another whose members have the same illness, and use different self-healing techniques; there may be a group whose members each have a different illnesses, but who will all use the same self-healing technique; and a group whose members have different illnesses, in which a range of different techniques are used. Complementing this could be two kinds of wellness groups, one kind whose members use the same techniques and another whose members use a range of different techniques. Of course these are guiding ideas only; in practice strategic decisions in the philosophical and conceptual stages of the inquiry may change this, and group members may decide for good reason to run their groups in ways that do not accord with this logical plan.

Such a set of groups would also be able to interact, exchanging views and discoveries, thus increasing the richness of the inquiry process. As a result, our empirical findings will be based not in controlled experiments, but in the critical interaction of different perspectives, building into a concatenated or pattern theory grounded in experience. The validity of this kind of research lies in the development of patterns of knowledge based on direct experience (Deising, 1972; Reason, 1985).

Strategic decisions about the inquiry process – what techniques to explore, what different sorts of illness to look at, what groups to set up etc – will be made by the Directors of the project in consultation with others involved as appropriate. At this stage it is an open question as to the kind of illnesses we explore, and how we choose from chronic and acute, functional and organic, curable and “incurable” conditions etc.

Outcomes

The final aspect of the inquiry is research into outcomes. In other words, what impact does the involvement with these self-directed methods, both specifically and in general, have on people’s health and on their lives? It is important to emphasise that the kind of holistic and experiential inquiry process we are proposing here will not produce the kind of positivist answers produced by the controlled clinical trial; nor do we believe this to be desirable. Any inquiry into an intervention, whether that intervention originates externally or through human agency, must view the whole person within their context, and take into account the many variables and their interaction. Thus we reject the use of matched control groups in this study, since these can only reduce comparisons to crude unitary dimensions, and do not help specify what factors internal or external are having what effect.

Rather than resort to experimental methods, we argue that it is possible for persons to discriminate within their experience as to whether changes from illness to wellness, or from wellness to enhanced wellness, are the result of intentional processes, external factors, or some of both (and if so to what degree). In the final analysis such an experiential discrimination is the only way in which such a weighting of factors can be achieved. As we have argued before, the primary instrument of inquiry is the individual inquirer in relation to her or his co-inquirers, and the primary issues for validity are to do with their perceptual discrimination, their emotional competence, and their critical acumen, both as individuals and as a group (Heron and Reason, 1984). We have developed a range of procedures which will assist an inquiry group develop these three qualities (Reason and Rowan, 1981b; Heron, 1982).

Also, this richly complex and heterogenous study, which offers many diverse perspectives, will enable us to build an assessment of outcomes based on contextual validity in which:

The validity of a piece of evidence can be assessed by comparing it with other kinds of evidence on the same point, Each kind has its own characteristic ambiguities and shortcomings and distortions, which are unlikely to coincide with those of another kind, (Deising, 1972, p 147-8).

In this kind of inquiry we are building a pattern and systems model of explanation in contrast to the linear causal model as with experimental method.

For the pattern model, objectivity consists essentially of this, that the pattern can be filled in and extended: as we obtain more and more knowledge it continues to fall into place in this pattern, and the pattern itself has a place in a larger whole, (Kaplan, 1964).

Programme and timetable

Our proposal is for a inquiry project over five years, the first year being a time of preparation leading to a block of three years in which the empirical work of the co-operative inquiries would take place, and the fifth year being one of pulling findings together and communicating through writing and direct teaching.

Year One

Overall objectives: Philosophical and phenomenological preparation and groundwork for co-operative inquiries.

As we have argued above, this project needs to interweave the philosophical with the practical. In this first year we plan to build on our current knowledge and experience through reading and visiting leading thinkers in the field of health and health development, talking with them, attending their workshops, and from all this developing an overall philosophy and starting perspective on the self-healing process. Through these visits and discussions we will also build up a network of critical and supportive colleagues who can comment on the project as it unfolds, and develop working relationships with those who we wish to invite as visiting contributors, for example as teachers of a particular approach to self-healing.

This leads to the second objective of the first year, which is to prepare the ground for the series of co-operative inquiries which will take up the middle period of the project. As suggested above, we plan to complete 30 such projects over the three years, for which purpose we will require about 10 competent inquiry facilitators on a part-time basis. While there are plenty of people competent to facilitate self-directed educational ventures, few of these will also have had experience of co-operative inquiry. Thus we intend toward the second half of the first year to mount a pilot co-operative inquiry into self-healing and/or enhancement of wellness, with ourselves as initiating facilitators and a group of potential inquiry facilitators as members of the project. Thus this group will have experience of the co-operative inquiry process at first hand, and we will be able jointly to select those who have the skills and interests to continue in the second phase of the project,

Thus during this first year the following activities will take place:

Visits to other researchers and attendance at their workshops etc.
A pilot/training inquiry project with potential inquiry facilitators.
Conceptual development — reading, writing and exchange of working papers, theoretical discussions and seminars.

Years two, three, and four

Overall objectives: the conduct of 30 co-operative inquiry projects, and the continuous integration of their findings into an overall theoretical and practical statement.

During this middle period of the project the great majority of the actual co-operative inquiries will take place. The strategic decisions about the direction of these inquiries will be taken by the Directors of the project in collaboration with those others who by this time are significantly involved, while detailed decisions will be decided co-operatively within the inquiry groups in consultation with the Directors as appropriate.

Thus we expect that during this period:

Different co-operative groups will be set up and will continue their work.
Such groups will meet with other groups to compare experiences.
As a result of these experiences, new groups will be set up to inquire into interesting directions.
All this empirical work will feed into continued conceptual development: working papers, seminars, conference papers, etc.

Year five

Overall Objectives: developing concluding statements.

This final year of the project will be used to pull together all the different findings into a final report. We would expect that this report would be partly written in book form, partly more specialist papers in journals, and partly in the form of practical exercises and workshops as a way of teaching others directly about our findings.

Organization

We propose that this project be jointly established at the British Postgraduate Medical Federation, University of London, and the Centre for the Study of Organisational Change and Development, University of Bath.

Directors

The project will be co-directed by John Heron and Peter Reason. Their responsibilities will be for the overall direction of the project, for recruitment, training and supervision of additional staff, and for much of the conceptual development and writing.

Advisors

We intend to recruit a group of honorary luminaries from both orthodox and complementary medical practice to advise and support. In addition to this, we expect the project to form close working links with doctors, complementary practitioners, and other interested individuals, as well as with institutions such as the BHMA, BHHA, RCCM etc.

Senior Inquiry Facilitator

As outlined above, this project will require the support of a number of part time co-operative inquiry facilitators. One of these will be more active in the project, working probably on a half-time basis throughout the five years, and on a full time basis during the middle three years. Her or his responsibilities would include helping the directors with the selection, training, and management of the inquiry facilitators, as well as conducting several herself, and assisting with the development of the ideas and practice of the project.

Part-time Inquiry Facilitators

Approximately ten such persons, skilled group facilitators, would join the project on a free lance basis to lead and conduct about three inquiries each.

Administrator

This is a complex project, involving possibly 500 people, money, premises, phone calls, papers and letters, and a mass of written and taped information. For efficiency, it will require at least a part-time administrator with typing skills.

Budget

The following proposed figures are very approximate.

Director’s fees £10,000 pa

Senior Inquiry Facilitator Year 1 £5,000 Year 2-4 £10,000 pa Year 5 £5,000

Inquiry Facilitators: 30 inquiries, 15 contact days each at £150.00 = £67,500

Administrator/secretary £7,000 pa

Travel £2,000 pa

Rent £3,000 pa

Equipment £3,000 pa

Administration £1,000 pa

Total £237,500 over five years

References

Diesing, P. (1972) Patterns of Discovery in the Social Sciences, London: Routledge and Kegan Paul.

Dossey, L. (1982) Space, Time, and Medicine, Boulder: Shambhala.

Heron, J.(1971) Experience and Method, Human Potential Research Project, University of Surrey,

Heron, J,(1981) Philosophical basis for a new paradigm, In P Reason and J Rowan (eds), Human Inquiry, a sourcebook of new paradigm research, Chichester: Wiley.

Heron, J.(1982) Empirical Validity in Experiential Research. Human Potential Reseach Project, University of Surrey.

Heron, J and Reason, P, (1984) New Paradigm Research and Holistic Medicine, In British Journal of Holistic Medicine, vol 1.

Heron, J and Reason, P. (eds),(1985) Whole Person Medicine. British Postgraduate Medical Federation, University of London.

Houston, J, (1982) The Possible Human, Los Angeles: J P Tarcher.

Kaplan, A, (1964) The Conduct of Inquiry: methodology for the behavioural sciences, San Francisco: Chandler,

Pietroni, P. (1984) Holistic Medicine. New Map, Old Territory. British Journal of Holistic Medicine, Vol 1.

Reason, P, (1985). Innovative Research Techniques: critical subjectivity and holistic inquiry, Paper read at the Conference on Research Methodology and Complementary Medicine. To be published in Complementary Medical Research, Vol 1.

Reason, P and Heron, J. (1985). Research with people: the paradigm of co-operative experiential inquiry. Working paper, Centre for the Study of Organisational Change and Development, University of Bath.

Reason, P and Rowan, J (eds), (1981a) Human Inquiry, a sourcebook of new paradigm research. Chichester: Wiley.

Reason, P and Rowan, J. (1981b). Issues of Validity in New Paradigm Research, In Reason, P and Rowan, J (eds). Human Inquiry, a sourcebook of new paradigm research. Chichester: Wiley.