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A paper prepared by John Heron for the Research Council for Complementary Medicine, London, 1985A REVISED WORLD-VIEW

We first of all need to go beyond Cartesian-Newtonian thought with a revised world-view based on some of the implications of new perspectives in physics, biology and psychology (cf. Bohm, 1980; Ferguson, 1980; de Vries, 1981; Sheldrake, 1981; Valle and von Eckartsberg, 1981; Wilber, 1981; Capra, 1982). Some features of this world-view can be conjectured as follows:

1. Reality is subjective-objective. The objective order is inseparable from subjective and intersubjective accounts of it. The constructs of the researcher are a part of what is being researched. Stated facts about the world are relative to a human context, individual and cultural, of experience, beliefs, norms and values (Kockelmans, 1975).

2. Reality is a whole made up of parts each of which is in turn a whole, subsuming further parts, and so on (Laszlo, 1972). Some features of whole-part systems are:

3. Reality is multi-leveled in respect of being, in two basic ways:

4. Reality is multi-leveled in terms of causation:


What kind of research in medicine stems from such a world-view? Presumably it would have the following sorts of features:

1. Medical treatment would be studied contextually as part of a total dynamic system of doctor-patient interaction. Medical research would be concerned with the pattern of such a system when it is effective, that is, when the patient emerges from it recovered. The focus is on a pattern or systems model -of explanation (Kaplan, 1964).

2. Medical research would inquire into both illness and disease taken together as a system. Illness is the subjective experience of having a disease; whereas disease is the observable degeneration of function and/or structure in the body. They are complementary parts of an integrated system, and normally interact together. Nevertheless each has a certain relative functional autonomy: a person can experience illness and have no observable disease; and experience no illness and yet have observable disease. Between these extremes, the same disease condition may be associated with different degrees of illness in different persons, or in one person at different times.

3. Medical research would co-opt the patient as co-inquirer, to a greater or lesser degree. This follows from the subjective-objective nature of the illness-disease to be studied.

4. Medical research would itself constitute a co-operative system, involving patient, doctor and researcher, generating overlapping perspectives from all three points of view on the pattern of the treatment system, and making co-operative judgments of relevance from within it about what weight is to be given to what parts of the pattern in producing the treatment effect (Heron and Reason, 1984; Reason and Rowan, 1981).


Finally, we can ask what research projects in the field of complementary medicine might look like if they were take account of this systems approach to medical research.

1. A study of de facto treatment systems in complementary medicine. This is a study of what actually goes on in existing treatment systems, as distinct from what is supposed to go on according to theory or tradition. The purpose is to find out what pattern of the components of the treatment system is therapeutically effective (if any).

Single practitioner study. A researcher co-operates with one practitioner, say an osteopath, to build up a composite portrait of the total treatment system of that practitioner. This could involve several stages:

Multiple practitioner study. This is a study of the actual treatment systems of several practitioners- either within the same therapy, or across different therapies, depending on the purpose of the inquiry. One researcher can work with different practitioners (and their patients) on a serial basis, one after the other; or a team of researchers can work concurrently one-to-one with different practitioners, with intermittent meetings of all researchers and practitioners. Whatever the manpower logistics, the same basic stages given just above would be followed. The purpose of this study would be to find out more about the therapeutically effective patterning of treatment systems, either within one therapy, or across different therapies – by overlapping, comparing and contrasting the composite views of each practitioner’s treatment system with the composite views of every other practitioner’s treatment system.

Codifying data and presenting findings. The findings have three aspects: (i) The overall pattern of a treatment system; (ii) The critical parts and relations of the pattern that are therapeutically effective (if any); (iii) The evidence of effective outcomes. (iv) Multiples of the first three. Aspects (i) and (ii) can be represented by qualitative graphics. In the early days it is probably better not to try to use some formal quantitative system, except the simplest. Nevertheless, sophisticated formal systems in current use that may prove helpful in some respects are catastrophe theory (Postle, 1980) and facet theory (Canter, 1983).

Validity. The kind of validity involved is contextual (see page 4 above). It also depends on a range of process issues internal to the group of all those involved in the inquiry (Heron, 1982).

2. A study of the formal properties and relations of treatment systems. Once there is some representative data about actual treatment systems, it would be possible to do some theory-building about the nature and dynamics of such systems. What follow are conjectures about where such theory-building might go.

3. A study of revisionary treatment systems. In this type of study new hypotheses about effective ways of patterning treatment systems derived from studies 1 and 2 above are field-tested, using the same kind of inquiry format as in studies of type 1 above.


What are the strengths and weaknesses of this systems approach to medical research?


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