Acupuncture Research and Practice: Some Philosophical Considerations

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Created on Tuesday, 20 June 2006 10:55

Written by Allen Parrott

Introduction: different ways of thinking?
Formal scientific research, using the conventional methods of biomedical
science, would seem to have an important, uncontested place in the
development of acupuncture in the west. The British Acupuncture Council
devotes several pages of its regular newsletters to the latest reports of
research projects or research findings from the local and the international
scientific research community.

The British Acupuncture Accreditation Board
requires all of its accredited institutions to include research as an integral part
of the undergraduate curriculum. There are good pragmatic and political
reasons for acupuncturists to embrace research in this way. Scientific
research and scientific method have been successful in shaping not just
western medicine but the entire western culture over the past 400 years, so
much so that it might seem politically counterproductive,
or even wilfully
stupid, for an emerging western acupuncture profession to adopt any other
policy. Who would not want to join the winning side?
There is another view, however. Western science itself lays claim to less
pragmatic, more profound reasons for doing research in the western scientific
way: namely, that scientific research methods are the only correct, valid and
reliable way to establish truths about the world. Hard, irrefutable scientific
findings are seen as the only sure way to lead human beings to more and
better knowledge, and to more and better understandings of reality. In this
article I will be exploring the extent to which this starting point, even though it
has popular support, may be incomplete, inadequate or even plain wrong.
Worldviews
change and never last forever, however triumphant and worldchanging
they may have been in their time. Over the past century the
currently dominant western belief system has been challenged from many
perspectives, not least by cuttingedge
scientists themselves – especially in
physics, biology and cognitive science. It now looks as though a 17 th century
European worldview,
which led directly to 18th, 19th and 20th century
technologies that have powerfully shaped if not created the entire modern
world, might have to give way to some quite different ‘common sense’
conception of the world by the end of the 21 st century. In such an event, it
would perhaps be even more counterproductive
for an emerging acupuncture
profession to join the losing side in a socalled
‘paradigm war’. Who would
want to join a sinking ship?
The aim of this article is to set out some of the ways in which the basic
philosophical assumptions about knowledge and reality that underpin
mainstream scientific thinking, and therefore most current research, can be
challenged, and to explore the relevance of such challenges to acupuncture
research and practice. One fundamental tenet of scientific method is that
mind is separate from body. Recently this Cartesian startingpoint
has been
comprehensively undermined by the use of conventional scientific methods
themselves. According to Lakoff and Johnson, there is overwhelming
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evidence from cognitive science that ‘the mind is inherently embodied’. Far
from being detached and disembodied, the mind and all its workings,
including reason, logic, language and thought, are
‘shaped crucially by the peculiarities of our human bodies, by the
remarkable details of the neural structure of our brains, and by the
specifics of our everyday functioning in the world’ (Lakoff and Johnson,
1999, p.4).
This notion of an inescapable connection between mind and body seems
likely to become a bedrock truth, or premise, underlying new kinds of thinking
in the 21st century. It would also seem to have an obvious affinity with the
thinking behind traditional acupuncture. So it may be possible that a practice
and a body of thought like traditional acupuncture, precisely because it has its
roots in a nonwestern
culture with different values and assumptions and with
different understandings of what constitutes knowledge and of what
comprises reality, could play a useful part in helping to teach human beings to
think in a different way.
Nearly forty years ago Gregory Bateson was defining the main problem of
western civilisation as ‘thinking in the wrong way’. Bateson pointed to another
inescapable and bedrock reality related to, but more comprehensive than, the
mindbody
link: the essential connection between human beings and the
natural world (Bateson, 1973). He argued that the conventional scientific
worldview,
of an objective reality ‘out there’ that could be represented with
complete fidelity by disembodied knowledge created by detached scientific
research, was no longer intellectually sustainable. This objectivist way of
thinking, which took delight in excluding the subjectivity of the human heart
and human emotion and human relatedness, was the underlying cause of the
deep ecological crises likely to face the planet in the near future. For
Bateson, the carbon crisis, the crisis of water shortage, the pollution crisis, the
crisis of agriculture, the loss of species crisis, and the crisis of new diseases
(or of old ones returning), had all been prefigured, philosophically speaking, in
Francis Bacon’s early 17th century vision of science as the means to tame,
conquer, and control nature and to ‘wrest her secrets’. Bacon had appeared
admirably prescient for perhaps ten or twelve generations but, to use his
military language, it would be impossible for nature to ‘lose’ such a war
however many battles human beings might think they had ‘won’. Implacable
nature plays the long game. And in any case it makes no sense to try to
‘conquer’ the whole of which one is a dependent part. The underlying ways of
thinking are, at the very least, misdirected.
The rational intellect is deluding itself if it thinks it has enabled human beings
to escape their connectedness and relationship to the natural world. Since
Bacon’s time the practice of scientific research has been as much political as
intellectual: not just a way to understand the world more fully, but also a way
to predict and thereby control it. Unfortunately, seeking prediction and control
of any single part or particular aspect of nature must always run the danger of
unintended consequences to the system as a whole. The planetary system is
now reaping what four centuries of apparently triumphant science and
technology have sown. Bateson argued, therefore, that good science needed
to be more humble, to engage in the exploration of relationships and of ‘the
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patterns which connect’, to seek new and deeper forms of understanding
without yearning for absolute knowledge and complete control. Objectivity and
detachment are useful, even essential, tools for researching and
understanding the world, but they do not and cannot encompass all that is
important and ‘real’ in the human condition. A new relational rationality
emphasising the relational aspects of reality and of knowledge is being
developed. (Shotter, 1993). The world in the 21 st century can no longer afford
to act as if current scientific and objectivist assumptions about reality and
knowledge are universally valid for all time, because this claim would appear
to be literally costing the earth.
Research paradigms: a broad definition
Enquiry or research can be defined, in very broad terms, as the systematic
attempt to arrive at some kind of knowledge about some aspect of reality.
Everyone involved in any kind of systematic research or formal enquiry,
whether small scale or large, will necessarily start the process holding, and
acting from, a particular worldview.
This must consist of an (often
unrecognised and valueladen)
set of beliefs about the nature of the reality
that they are researching ontological
assumptions, together with closely
related beliefs about what would count as acceptable knowledge of it at the
end of their enquiry efforts epistemological
assumptions. It is these basic
philosophical assumptions about reality and knowledge which also determine
the kinds of evidence or ‘data’ that the researcher will regard it as legitimate
and worthwhile to investigate methodological
assumptions. Any research
methodology is thus derived from, and linked to, a specific ontology and
epistemology. The three ‘ologies’ are interconnected
and together they
constitute what is often called a ‘research paradigm’. The particular paradigm
that is chosen will determine the various research methods to be used and the
enquiry’s eventual results, i.e. the research analyses, interpretations, findings
and product. It will also influence greatly the way in which people are treated
during the enquiry, or the research ethics.
Most people in their everyday life do not feel any need to ask themselves
deep philosophical questions like ‘what is reality’, or ‘what can we ever know
about it’? Everyone in the normal course of events will tend to absorb a
worldview,
largely unconsciously, from their upbringing, their schooling and
the culture around them. Skolimowski has pointed out how children in the
western world undergo stringent mental exercises at their secondary school
which induct them into objectivist ways of seeing the world and thinking about
it. He called this process the ‘yoga of objectivity’. (Skolimowski 1994). This is
an intentional aim in science lessons, where for example the personal
pronoun is forbidden when writing up reports of experiments, but it also
happens in all those lessons where the certainty of facts, information and
correct answers is prized above the uncertainty of interpretations, creativity
and criticality. But even though objectivism is the default position for nearly all
educated westerners, an essential part of becoming a competent researcher
is an appreciation of the many different forms and approaches that systematic
enquiry or research can take, based on different views of reality and
knowledge. New researchers, who are encouraged to look at the issues
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surrounding methodology, soon discover that everything to do with research
paradigms is contested and contestable. Unfortunately for the novice
researcher, there is no single common sense version of knowledge and no
nonacademic
version of reality which will save beginners the effort of having
to consider these difficult matters for themselves.
Research paradigms – a comparison
The definition of serious enquiry above is purposely broad. Under this
definition, any medical practitioner making his/her diagnosis of a new patient,
for example, could legitimately be regarded as ‘doing research’. He/She is
attempting systematically to obtain knowledge of the slice of reality that is the
patient and their current state of bodymind.
In the next few paragraphs I
have tried to imagine an experienced traditional acupuncturist in such a
‘research’ situation. The aim of this fictional case and comparison is to show
the ways in which the acupuncturist’s research paradigm, i.e. her
philosophical assumptions and methods, could differ from the more familiar
objectivist scientific research paradigm which might inform a western doctor in
a similar situation of meeting and ‘researching’ a new patient. (I call the
acupuncturist ‘she’ and the conventional practitioner ‘he’ solely in order to
avoid the clumsy ‘his/her’ construction, but readers are welcome to reverse
my use of the female and male pronouns if they find it provocative.)
The first thing to acknowledge and emphasise is the level of intellectual
knowledge and objective expertise that is needed in an initial therapeutic
meeting of this kind. Serious research requires the use of intellect. To attack
objectivism as a comprehensive worldview
is not to attack the need for
objectivity and rational, dispassionate analysis as part of all serious enquiries.
Advocates of nonobjectivist
research paradigms aim to supplement the
intellect, not to overthrow it. They may call for more heart, or even more gut
and more soul, but the idea is not to replace head knowledge with feelings,
intuitions and spirituality, simply to accept that they may be a valid,
complementary part of the enquiry or the ‘finding out’ repertoire. So, like a
scientificallytrained
GP, the acupuncture practitioner would ask systematic
questions about the patient’s presenting problem and symptoms, and she
would also take a general health history. Acupuncturists are taught to seek
evidence from a large number of potentially revealing physical signs, using a
variety of physical methods such as pulsetaking,
observation of tongue, eyes,
skin etc. They are also taught sufficient western medicine, including anatomy
and pharmacology, to recognise symptoms or conditions that might not
respond well to acupuncture treatment. Much of the acupuncturist’s diagnosis,
therefore, will demand the same level of logical thinking, intellectual
knowledge and rational judgement as that expected of western medical
practitioners. The difference is that intellectual detachment will not have the
ideological force, or burden, of being the sole valid methodological approach.
Whenever she ‘researches’ a new patient in order to make a diagnosis prior to
treatment, an experienced acupuncturist practitioner will be bringing to bear
professional judgement and intuition honed over years of practice, and over
years of reflection on that practice. Some of this can be articulated and
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rationalised and discussed with students or colleagues. There will be many
important aspects of the initial encounter that an observer could note and that
students could and should learn to replicate. But much may be taking place
below – or above? – the level of conscious intellect and will therefore remain
unseen by most observers. The more reflective students may begin to ‘see’
and appreciate this aspect of professional skill, once they have begun to
develop their own personal understanding of the ‘artistry of practice.’ This
notion of professional artistry, too, is not necessarily foreign to western
doctors, especially to experienced GPs, although the concept has become
quite unfashionable with the current dominance of scientific and ‘evidencebased’
medicine. In many professions, the skilled professional is said to know
more than he can express or articulate easily to others: ’We can know more
than we can tell’, wrote Polanyi, who also described this kind of ‘tacit
knowledge’, or knowing, as an ‘indwelling’ in our individual bodymind.
(Polanyi, 1966, p.4). All experienced practitioners will have such personal
and tacit knowledge operating alongside the more consciouslyheld
and
absorbed scientific knowledge that can be listed in syllabuses.
However, an acupuncturist will probably make more use of and have more
trust in her tacit knowledge and she will expect it to play a significant part in
this initial meeting. Each new case being diagnosed, or ‘researched’, takes
her a long time, seldom less than thirtyforty
minutes and sometimes up to two
hours. Unlike the normally rushed GP she will not feel strong pressure to
arrive rapidly at a generalisation about the life situation and the health
condition of this new patient. At the start she will want to establish in
considerable depth the patient’s uniqueness as a person and the particular
situation, or context, of their current life and health. Even if she finds the
presenting condition and physical symptoms of the patient quite
straightforward, the complexity and idiosyncrasies of the person will still be an
integral part of her enquiry. She will aim to attend to the significance of
everything that happens in the session including the things, or bodymind
responses, that happen to her. During any meaningful encounter of two
persons, there will be things ‘going on’ (to use Wittgenstein’s deliberately nontechnical
term) of a physical or unconscious nature, quite separate from the
content of the conversation. Paying close attention to physical mannerisms,
gestures, gaze and other cues from her patient’s body language is part of her
professional artistry and therefore part of this piece of ‘research’. Both
acupuncturist and patient have a ‘presence’, that comprises their body and
their mind, and each of their ‘bodyminds’
may be shaping the interaction, or
some key aspects of it. Apart from attending to the patient, the acupuncturist
will also be paying attention to her own wellbeing and to how she is feeling in
herself before, during and after the session. Monitoring her self in this way is
another part of her ‘research’ methodology. So too is the conscious attention
that she will pay to her own prejudices and biases and the equally explicit
attempt she will make to minimise their inevitable influence.
As well as attention, many traditional acupuncturists believe that intention is a
crucial factor in health contexts and finding cures. They have no intellectual
problem therefore with the socalled
placebo effect, which they know from
experience can play a significant part in the therapeutic encounter. Placebo
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effects may not be predictable or controllable, but if they occur as frequently
and as successfully as it would appear from reading scientific research
papers, they cannot be summarily dismissed as ‘nonspecific
effects’, or as
some form of external magic beyond the pale of rational discourse. The
problem is that they lie outside the scientific paradigm, in which, as already
noted, mind has to be seen as completely separate from body. The placebo
effect from that perspective cannot be truly ‘real’, because true reality must
consist of objective ‘things’ which, even if they cannot be observed directly,
must fit in with the prevailing ontological theories about what can and cannot
be regarded as ‘real’. For the acupuncturist, by contrast, reality is a matter of
patterns and relationships. A close relationship between the mental and the
physical is entirely to be expected, and it is no surprise that many patients use
the connection to make their own meanings of their situation and
consequently, perhaps, to ‘make themselves better’. The practitioner in this
case, therefore, will want to focus strongly on her own intention to heal, as
part of her overall effort to be fully present and fully human with and for the
patient. At the same time, perhaps, she may not want to lose the westernstyle
detachment that should be prompting all good medical practitioners on
certain occasions to ask challenging questions about their patient’s own
conscious or unconscious intentions: does this patient truly intend to get
better? Is there any sense in which the patient ‘intended’ to get ill in the first
place?
On top of all these differences from conventional scientific medicine, the
practitioner’s ‘enquiry’ into her patient may be informed by her deep personal
beliefs, whether humanistic, religious or spiritual. She may decide to use
playfulness, humour or even some appropriate form of ‘love’ in her quest to
find out more about the person beneath the symptoms. She will at all times be
guided as to what is appropriate by the patient and by the patient’s responses
and she can of course be trusted to stay safely within the bounds of
acceptable professional conduct. The point is that, from the epistemological
perspective of relational knowledge, all these subjective human touches can
be regarded as potential enquiry methods. In this research paradigm the
researcher builds up an extensive repertoire of skills that incorporates both
scientific and subjective ‘research’ methods, all designed to enable her to find
out more about the patient. The objective questioning remains important, but
by relating to the patient at a personal level the practitioner not only increases
her knowledge of the patient’s condition she simultaneously gains a deeper
insight into the reality of the patient’s life and world. It seems clear that this
kind of ‘research’ cannot be regarded as an easy option. Indeed it is probably
twice as hard, since the researcher has to be familiar with at least two
paradigms. She is actively encouraged to use her subjectivity, but only on
condition that it is constantly monitored by a welldeveloped
critical and selfcritical
intellect.
To reiterate, intellect and objectivity are not dispensed with. Indeed, the
rational intellect is enhanced and expanded by the concept of relational
rationality. It is given a wider canvas of acceptable ‘data’ to work on. But the
detached and disembodied intellect is not permitted to go on putting arbitrary
limits on what is permissible as reality and as knowledge. The acupuncturist,
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who accepts multiple levels of reality and different kinds of knowledge, knows
from the outset that she will have to make professional judgements and take
professional decisions in situations of uncertainty. Her knowledge is never
going to be more than partial. She does not expect the certainty, or even the
nearcertainty,
that is claimed for conventional ‘evidencebased’
medicine. In
sum, this approach makes her research more plausible and credible and more
recognisably human, precisely because the knowledge gained is subtle,
complex, deeply situated and contextualised while making no claim to
absolute truth. Finally, having used all the enquiry or ‘research’ methods
available to her in order to make a relationship with the patient and having
arrived at her conclusions (or findings) about a diagnosis, she would regard it
as inconceivable to offer her patient any acupuncture treatment that was less
than the best she could devise. She could never contemplate offering sham
needling, for example, or regard it as ethically acceptable. In her research
paradigm there are no possible ends that could ever justify such deceitful
means.
By contrast, many of the enquiry approaches described in the paragraphs
above would be unacceptable as ‘research method’ to the strictly scientific
practitioner/researcher. He starts with different conceptions both of what
counts as real, and of what constitutes valid medical knowledge. He might
well regard medicine as a form of ‘applied biology’ and downplay the
significance of clinical experience and professional judgement. He might find
notions like ‘presence’, ‘attention’ and ‘intention’ incomprehensible. He would
happily contemplate trickery in pursuit of objective knowledge. In this
dominant worldview
the ‘ends’ of research can be used to justify ‘means’,
because the ‘end’ is objective truth and scientific proof and these are the
highest values. The use of sham acupuncture, or sham surgery or sham
medicines, is considered acceptable and can be justified because it is a
relatively trivial deception and because it is believed that the research effort
as a whole may lead to the desired ‘end’ of some universally valid, objective
and timeless knowledge. The pursuit of absolute truth and certainty promotes
a high degree of ethical relativity. For the conventional scientist the ethics of
dealing with cohorts are very different from the ethics of dealing with his own
friends, family and loved ones. He is encouraged to regard the people in his
cohort of research subjects as anonymous and devoid of individuality and
social context, part of a statistical mass, an intellectual construct. As part of
the mainstream western science tradition, he operates in the belief that there
is just the one important ‘real’ reality and that it exists ‘out there’ waiting for
human beings to ‘know’ it through the application of scientific method. In its
most straightforward form this is known as the positivist worldview,
or the
positivist research paradigm.
The positivist research paradigm and its associated machine metaphor
Philosophically simple and internally consistent, positivism has no truck with
other, more complex versions of reality and knowledge in which multiple
possibilities, ambiguities and uncertainties are tolerated or even embraced.
The primary metaphor that defines the modern worldview
and its main
research paradigm, is of the world itself as a machine and of everything in it,
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including human beings, as a mechanism of some sort. The only valid way for
researchers to record successfully their findings about this objective and
machinelike
world, i.e. with complete fidelity to the observed reality, is
through the precise ‘language’ of measurement and mathematics. In this
paradigm the complexity and unpredictability of normal human behaviour
renders such behaviour less ‘real’. Laboratory experiments and controlled
trials will be closer to some ‘real’ reality, because they provide more certainty
and more opportunity for accurate predictions and successful control than
field research or case studies. In this way artificial environments and
predictable, controllable manmade
machines created by technologists can
seem to be more ‘real’ than the world inhabited by flesh and blood human
beings.
The metaphors of ‘nature as machine’ and ‘man as mechanism’ have been
powerfully shaping the modern consciousness since the 18th century.
Significant aspects of the natural and physical world have been forced to
submit to the power of the detached western scientific mind. Science in its
positivist mode has unquestionably given people in the modern world much to
be grateful for, when they compare their lives with their premodern
ancestors,
from aeroplanes and dishwashers
to penicillin and zip fasteners.
Industrialised machines have enriched the world as well as imperilling it. Who
could doubt that there are times in which it is wise for everyone to adopt the
positivist worldview?
When travelling as passengers in an aircraft, for
example, it is rational to want the pilot to be completely unaffected by
philosophical doubt, by personal emotions or by any of life’s multiple realities.
On entering the plane (or the bus, train, taxi or ship), sensible passengers
want to encounter skilled technicians who fully understand their machines and
who ‘know’ their particular ‘reality’ with a high degree of certainty. However
manmade
technologies, although significant and widespread in our daily
lives, represent only one part of the human experience. The machine/
mechanism metaphor is much too limited to embrace everything that human
beings might want to enquire into.
In areas of life where machines play a less significant part, in the social
sciences and humanities for example, the scientific project of the modern age
has been far less successful. And it is not for want of trying. The many
attempts to treat human beings and their social interactions scientifically, as if
they too were objective, rational, predictable and controllable (and lifeless?)
mechanisms, like specimens in a laboratory, have not led to the increase in
human happiness or to the creation of a perfect society that many were
predicting in the 19 th century. On the contrary, the things that are most
important to human beings and that provide them with most of the meaning in
their lives – birth, love, relationships, child care, humour, art, creativity,
learning, selfknowledge,
religion, spirituality, memory and death – are the
very things that have been largely resistant to scientific attempts at theoretical
understanding, prediction and control. All these things contribute to health in
the broadest sense. It is not surprising, therefore, that when it comes to
health care and medicine, which are on the cusp of the natural and the social
sciences, the dominant machine metaphor underlying scientific medicine has
a mixed record of successes and failures.
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Thanks to clean water, better nutrition and the eradication of some of the killer
diseases, people in the western world today can apparently expect to live
longer than their predecessors. Other successes of scientific medicine have
included dentistry; those forms of surgery where it is legitimate to regard the
physical body as no more than a mechanism; the more straightforward
medical conditions or illnesses where pills or potions can provide the cure,
and preventative treatments for whole populations, arrived at following
epidemiological studies. However, there are many health and illness
contexts, especially those where care rather than cure is the paramount need,
where the limitations of the scientific medicine approach are wellestablished.
All health professionals will know such situations: they may include people
with chronic and lifelimiting
conditions, with mental health problems, with
complex symptoms, or with some combination of mental and physical disease
that is unique to them and their particular life circumstances. Systematic
enquiry in these health areas might usefully place less emphasis on the
precision and detachment of objectivist research and focus more on the
common humanity that is shared by researchers/ practitioners and their
research subjects/ patients. As Hillary Rose put it in a plea for the ‘feminist
transformation of the sciences’, new forms of scholarship and research are
needed in which researchers are comfortable ‘looking at others as part of
ourselves’ (Rose, 1994).
For most of the past 350 years, since Pascal’s famous response to Descartes
that, ‘the Heart has its reasons that Reason knows not of’, the only significant
opposition to positivist science has come from nonscientists
– sometimes
philosophers, often romantic writers harking back to the premodern
and prescientific
era. Today’s opposition, as we have seen, is based not on nostalgia
for some distant past but on a clearsighted
and rationallyargued
view of the
near future. Quantum physicists, like ecologicallyminded
biologists and like
cognitive theorists, deny that reality can be confined to that which is
objectively observable and measurable (the empirical) or that which can be
theorised and tested in the mind (the rational). Our common sense, objectivist
version of reality is not to be trusted, because it ignores too much of the
available hard evidence. The world is simply not objectively definable and
mathematically describable in the absolute way that most mainstream,
empirical researchers continue to believe. To deal with the new multiple
‘realities’ unearthed by quantum theory, a new and enlarged version of logic
and of what it means to be rational have had to be developed.
Chris Clarke has recently argued for a relational reality to set alongside the
propositional reality of mainstream science:
‘It is assumed that there is a single real world; that it is adequately
describable by propositions obeying traditional rules of logic, and that
our theories can become closer and closer to the truth to the extent
that they match the structures of the real world…..This is an immensely
alluring conception… We are so used to this way of thinking that we
assume that it is simply how the world is. But this conception is just
one particular cultural form of one particular part (the socalled
propositional part) of the cognitive apparatus of the human species….
This (scientific) way of knowing can say nothing about what it is like to
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see the sun rising in the morning or to smell a rose garden on a
summer’s evening…It evades and denies the essence of our inner
experience, which lies in the relational subsystem..’
(Clarke, 2005, p.
144/5).
Clarke’s ontology is pluralist and not relativist. He argues that although there
is more than one valid kind of truth and more than one level of reality, this
does not imply that any version of truth and reality is as valid as any other. In
the new quantum world of multiple realities, it is still not the case that
‘anything goes’, i.e. that all truth statements are equally valid. Research in the
quantum world remains the search for truths, but serious researchers have to
recognise that these can take different forms and may lack the absoluteness
or apparent certainty of traditional scientific proofs and mathematical
equations. In the relational reality where human beings spend much of their
lives and where, for example, much of their state of health is likely to be
decided, there may be few objective truths or little propositional knowledge to
be discovered. The truths that are discoverable will include those that have to
be validated subjectively and intersubjectively.
The new forms of enquiry are
very likely to challenge conventional assumptions about research, because
the extended rationality underlying relational reality and relational knowledge
will also extend and expand what can legitimately be counted as ‘data’ or
‘evidence’. Researchers can expect to arrive at a different kind of knowledge
about a different, but equally valid, kind of reality. However, at the core of
these new forms of enquiry there will always need to be sound argumentation
based on good evidence, and some logical interpretation of the data that
makes sense to others. In seeking intersubjective
validity, the rational
intellect of mainstream scientific thinking is not dispensed with altogether: it is
embodied, fleshed out and made more whole. In becoming more whole,
researchers will be enabled to act less like calculating machines and more like
recognisable human beings.
Implications for acupuncture research?
It would take another lengthy essay to discuss in detail what such an
unfamiliar paradigm might mean for acupuncture research. But a few markers
can be set down. If research is not aiming, above all else, for objective truth
and proof, it would not be necessary for acupuncturists to prove to a sceptical
western audience, indoctrinated by its training in the ‘yoga of objectivity’, that
acupuncture ‘works’. This may be a genuinely important political aim, but it
can hardly be a genuinely important personal aim for the thousands of
western acupuncturists and
the tens of thousands of their patients who
are
already in no doubt about acupuncture’s effectiveness. (Acupuncture is
neither a new drug that needs stringent clinical trials, nor a form of snake oil
that needs unmasking. If, after ‘working’ for over two thousand years,
acupuncture should ever stop being effective, it will die out; and if there are
charlatans on our high streets masquerading as ‘Chinese doctors’ and taking
money off gullible people, this is a matter for public awarenessraising
and for
police enquiries rather than academic research.) In general, research into the
‘relational’ reality would have the modest aim of making the world a better
place, rather than seeking to prove things. Researchers would be part of the
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family of ‘action research’, a broad church in which the common theme is
forms of enquiry that are participative, experiential and actionoriented.
Everyday practice itself, and the ideas underlying such practice, could easily
provide individual acupuncturists with all their potential research questions or
issues for systematic investigation. All that is needed is a shift in thinking and
a willingness to be different. As John Rowan put it, when addressing readers
of Human Inquiry in 1981:
‘You don’t have to accept projects you don’t believe in and really don’t
want to do…You don’t have to toe the line of an orthodoxy which is in
many ways quite illusory. You can do research for you yourself and for
the other people involved in it. You can do research on questions
which are genuinely important’. (Reason and Rowan, 1981, p.xxiiixxiv,
emphasis in original).
Reason and Bradbury have provided a simple introductory typology of action
research in their recent ‘Handbook of Action Research’. Firstperson
action
research means becoming systematically more mindful and more aware of
how ones choices and moments of action impact on one’s clients or patients
and on the outside world. A key concept here is critical subjectivity, that is the
individual practitioner/researcher’s ability to combine the detachment
associated with ‘propositional’ reality with the involvement or participation that
is essential to an understanding of ‘relational’ reality. Secondperson
action
research involves interpersonal
dialogue and facetoface
enquiries with
others into issues of mutual concern, ‘for example in the service of improving
our personal and professional practice both individually and separately’.
This notion of ‘coresearchers’
engaging in ‘cooperative
enquiry’ is well
established (Heron, 1996). Thirdperson
action research strategies aim to
create larger and wider communities of enquiry, in which the participants or
collaborative researchers may never actually encounter each other facetoface;
but they would be expected to share the same aims, the same
participatory research values and an equal willingness to engage in and to
share the results of their own rigorous, selfcritical
firstperson
action
research/practice. (Reason and Bradbury, 2001, p.xxvi).
Stories and storytelling
are likely to feature strongly in such research, both as
part of the enquiry process or methodology and as part of the final ‘product’
for others to learn from. This is appropriate, since each human life is lived as
a complex story and since narrative has always been a powerful tool for
human learning. One way to regard the modern age is as an attempt by a
dominant western culture to impose only one author (positivist scientific
method) and just the one story line (scientific progress) on human history and
on the human condition. But other stories have always demanded to be told
and heard. Perhaps a new deep metaphor of story and coauthorship
is
urgently needed during this century, in order to mitigate the effects of the
currently dominant metaphor of machinery and mechanism.
12
Conclusion: research that is in tune with professional values?
Mainstream biomedical
research remains strongly positivist both in its
preconceptions and in its operating assumptions, yet positivism is in some
ways the polar opposite of traditional Chinese thought. When reflecting about
these matters, acupuncturists may come to the conclusion that the ethical
practices found in mainstream biomedical
research, the way for example in
which people in clinical trials are treated (using ‘treat’ in both senses), do not
fit with their professional and personal values. They may agree with the
South African emphasis on enquiry processes that place human dignity as the
highest value of all:
‘Truth as factual, objective information cannot be divorced from the way
in which this information is acquired: nor can such information be
separated from the purposes it is required to serve’. (Truth and
Reconciliation Commission Report, 1998, Chapter 5, p44).
Positivist research is always done ‘on’ people, while acupuncturists prefer to
do their work ‘with’ people. In positivist research, it is necessary to objectivise
and depersonalise
research ‘subjects’, in order for the science to ‘work’.
Acupuncturist practitioners, by contrast, like to explore the unique subjectivity
of their patients and to treat the person in all their complexity and wholeness.
For how long will acupuncture researchers (and practitioners) want to tolerate,
let alone embrace, a scientific research model where not only the underlying
ontology and epistemology but also the prevailing ethical values seem to be at
variance with their own beliefs? In the future, other kinds of research may turn
out to be more in tune with the philosophy and values of acupuncturists
themselves – research that is smallscale,
designed to improve rather than to
prove the practice of acupuncture; research that is aiming to do a little more
good in the world, rather than to predict it with complete precision or to control
it more effectively; research that is local rather than universal; research that
consists of actions in the world, each action infused with relatedness and
feeling, rather than actions on the world (Heshusius and Ballard, 1996);
research that is aimed at enhancing the work of professional practitioners,
rather than replacing professional artistry with some notional concept of
‘applied science’.
In this paper, research has been defined and discussed in the hope of
demonstrating its potential to see the world through a different lens.
Positivism can be described as a oneeyed
view of the world; other paradigms
and their associated forms of research offer the broader perspectives of
binocular vision, or even of the ‘third eye’ of wisdom. Each of these lenses
has its own place. Randomised and doubleblind
clinical trials, for example,
will always remain useful for the specific purpose of drugtesting,
where a
single highlyfocused
and ultrapositivist
version of reality and knowledge is
appropriate. But such controlled trials no longer need be esteemed as the
‘gold standard’ to which all serious enquiry should aspire. I have suggested
that for most healthcare
research, a different research lens is desirable, for
practical and ethical as well as for theoretical or more purely philosophical
reasons. A different way of thinking will also be needed if the world is to save
13
itself from the (unintended) dire ecological consequences of positivist science
and technology. The only sensible conclusion is that the western acupuncture
professions should at least be keeping all their research options open.
Bibliography
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MindBody
Connection) New York: Teachers College Press
Heron, J. (1996) Cooperative
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Polanyi, M. (1966) The Tacit Dimension. London: Routledge and Kegan
Reason, P. and Bradbury, H. (Eds.) (2001) Handbook of Action Research.
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Reason, P. and Rowan, J. (Eds.) (1981) Human Inquiry: a Sourcebook of
New Paradigm Research. Chichester: John Wiley and Sons
Rose, H. (1994) Love, Power and Knowledge: Toward a feminist
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Shotter, J. (1993) Cultural Politics of Everyday Life: Social Construction and
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Penguin (Arkana)
Note of Thanks
I should like to thank Ann Hopper, Paul Hougham, Henry McGrath, Fred
Parrott and Rosemary Richardson for commenting most usefully on an earlier
draft of this article. However the views expressed are entirely those of the
author who would welcome critical comment and/or discussion. He can be
contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it.
Allen Parrott June 2006
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