Analysis

Living on Borrowed Authority: Postmodernism and the Methods of Presentation

Science proceeds on assumptions that there are procedural norms to be followed by participants in the scientific endeavor. These norms exist both as ideals and as practical guidelines that are recognized by scientists, whose behavior is evaluated by adherence them. Guidelines are usually not spelled out as such in each scientific project, but are assumed. Scientists and clinicians are able to recognize others’ lack of adherence. The realities of scientific endeavor make these rules of conduct flexible to a degree, but without guidelines there could be no agreement as to who belongs to the scientific community, or which activities are acceptable.

For physician and academic scientists there are also educational standards. However, many nonphysician and lesser-degreed workers also have access to major journal publication and to receipt of deserved awards. Even Emily Rosa, a nine-year-old student who devised a clever test for the “human energy field” posited by Therapeutic Touch, was published in the Journal of the American Medical Association1. Thus, educational status, degree, academic status, or prior publication are no longer certain indicators of scientific legitimacy.

Postmodernism, the literary and philosophical movement under examination here, advances the blurring of legitimizing criteria and guideline limits on behavior. Postmodernism relaxes criteria for the acceptability of scientific/medical knowledge and accepts material that is more esoteric, a change making legitimization even more easily circumvented.

In The Prince, Machiavelli stated that it is not necessary for the prince to possess the virtues his subjects expect, only that he appear to possess them. In essence, this is the crux of my discussion. It is often not important that knowledge claimants actually perform scientific activities as defined by scientists and physicians—only that they appear to have done so. Adoption of the format and language of science by proponents of extraordinary claims lend unorthodox claims an appearance of legitimacy (postmodernists would call this adoption of scientistic legitimating discourse). This process may also render unorthodox claims more palatable to the general public, which may not be able to distinguish between real science and its pretenders.

Another controversy engendered by “alternative” or “unorthodox” medicine arises from the fact that the practice of medicine is not pure science. Medical practice is malleable—affected by personal and judgmental factors, similar to the relationship of architecture and engineering to physics and materials science. In practicing medicine, the physician relies on judgement and creative intelligence, and must juggle complex probabilities to decide on the best course of treatment. While medicine undoubtedly carries with it the methods of science, the “art” of medicine renders medicine open to infiltration from unscientific, emotionally, and ideologically motivated individuals. Postmodernism equates and allows for different forms of knowledge. Combined with the dual nature of medicine, this conceptualization has opened the door for “other forms of knowledge,” “other ways of seeing,” and “other ways of healing” to make significant headway towards acceptability.

I am presently examining the work of Dolores Krieger, one of the originators of Therapeutic Touch (TT). Krieger owes much to Eastern healing traditions of Ayurveda, and introduced TT as an alternative or supplement in the early 1970s. TT has since become popular among nurses in both Canada and the United States.2

In hospital or clinical settings, TT is based on the assumed existence of a “human energy field” (HEF). The HEF is a claimed aura of energy that surrounds the human body and becomes “disturbed” when a person is ill. The TT literature is based on this unsupported premise. The procedures (centering, unruffling, etc.) are there, but they apparently accomplish only confirmation of the proponent’s prior belief in HEF’s existence. It is possible to observe several divergent sets of “discourses” (rationales, claims) in Krieger’s work concerning the origins of TT. The “scientistic” legitimating discourse renders TT activities meaningful for professionals and subjects. In essence, TT “borrows” from scientific and mainstream medical discourses to gain legitimacy.

However, if this is the case, and if the process of appropriation of legitimating discourses masks so obvious an intent, why does it merit discussion? One reason is since the early 1970s and the rise of the counterculture, we have steadily and increasingly been bombarded with the notion that all forms of knowledge should have an equal measure of acceptability. Each disparate voice in society has an equal right to be heard, understood, and respected on its own terms. Any account of reality is to be treated as a “narrative” (another postmodern term) that serves only to reflect the prejudices of a particular culture3. If this is the case, however, why is it necessary for the alternative medicine advocates to invoke the symbols or forms of narrative of science to reinforce their views? If validity of knowledge or “truth claims” is predetermined, as some postmodernists suggest, why rely on any extra support from the “legitimating discourses” of scientific medicine?

The answers may be found in several places, most notably in the works of Goffman4 and Overington and Mangham5 and other dramaturgical sociologists. These theorists describe individuals as social actors playing out roles, either chosen or imposed, as if in front of audiences. The metaphor of the theater is intentional, and provides for an understanding of social processes. This is exemplified in the adaptation of characteristics that we may not ourselves possess (e.g., “I’m not a doctor, but I play one on TV”). Acting the role creates acceptance of our character in the minds of the audience. Goffman in particular places emphasis on the importance of the setting in convincing an audience of the veracity of one’s activities. “We are what we claim to be.” A physician would look out of place practicing medicine in a parking garage; the setting of a hospital or clinic would be much more convincing. The actions may be the same in or out of a medical setting, but they are more convincing with the latter.

One can now follow the theme of settings to the related theme of audiences. The audience, in a sense, guides the actor’s performance. It is assumed that a certain type of audience will attend a certain type of expected performance. A film, for example, is marketed mainly for children, young adults, women, or men, based on the subject matter. In the same way, one can expect that a certain type of audience, be it a single ill person or many, will attend the “type” of performance acted by the appropriate alternative practitioner.

If we may extend the analogy to include written discourse, it is similarly expected that a certain type of audience will prefer a certain type of written performance. The intent is essentially the same; they are both intended to convince an audience (reader) of the claimed identity of the actor (author). The writer can more easily convince the reading audience of the “truth” of the performance, for there are no unintended events to intrude on the performance. The “setting” in this case is an academic journal, a journal specific for alternative reports, or a popular book or magazine. Each serves in its own way to create the intended audience or readership for a given set of discourses and lends credence to expectations by providing the appropriate milieu for the performance. Without the intrusion of unintended events, it is possible for the author/performer to create a credible character far removed from the actor’s real life circumstances. Anyone who has read the diaries of Josef Goebbels can understand how, if we were not already familiar with the cruel and perverted nature of the author, one could accept his self-portrayal as a caring family man. In postmodern terms, “Texts have no intrinsic meanings. Rather, their meanings (and truths) are created by the reader.”6

As a result of the importance of “setting” for written discourse as in oral discourse, wide variations in “legitimating discourses” exist, even when they are addressing the same issues. The setting for the presentation of the discourse decides the format or mode of the discourse. Returning to Dolores Krieger, originator of TT, one can examine examples of her writings (written discourses) to demonstrate the various forms she uses to address different expected audiences. One will discover which particular facets of TT are particularly germane to this discussion.

We are here dealing with two aspects of TT: the theoretical, explaining why certain activities are performed; and the mechanical, the actual physical activities or actions that are performed. Taken together, they provide the complete picture of the concepts underlying TT. Taken separately, they illustrate why, in the age of universal legitimacy posited by postmodernism, it is necessary to invoke a scientific stand.

In the first case, that of the theoretical aspect, we see the widest range of legitimating discourses: accounts of TT that emerge from Eastern religious tradition. Quoting Krieger:

It turns out that the East does indeed have a better understanding than we do of the personalized interaction involved in Therapeutic Touch. They posit an energy system for which we, in the West, have neither the word nor the concept. In Sanskrit it is called Prana, and in the West the nearest translation is said to be vigor or vitality; it is said that which underlies the animation we call the life process.7

Equally important, if not more so, is a scientistic reinforcement of theory with reference to double-blind studies of her own.

In 1972, I conducted a full scale study with 43 persons in the experimental group and 33 persons in the control group. The hypotheses were upheld by a probability that exceeded the 1% level of confidence. . . . I replicated my study in 1973. My hypotheses were . . . again upheld; this time by a probability exceeding the .001 level of confidence. In this replication study there were 46 persons in the experimental group and 29 in the control group. . . .8

At the end of the latter, Krieger references several articles, some of which are her own, and others claimed to be based directly on her work.

Often references are taken out of context, but it is the number of references that lend legitimacy to written discourses, according to Latour9, not necessarily the original intent of the author. This process is referred to by Latour as “assembling armies” to support your claims. These references, originating from Krieger, are used as an “army” to reinforce her arguments and theories. It is in the final analysis a circular process, but as Latour points out, it is not necessary for those you reference to necessarily agree with your views.

One example of the differences in performance enhanced by the differences in setting is a 1979 article in the mainstream nursing journal American Journal of Nursing, in which there is little or no reference to the more “mystical” aspects of the theory of TT. This article instead concentrates on more technical aspects (scientistic discourses). It is a concrete example of the “discursive differences” noted above. The expectation is of a more scientific, professional discourse. During sessions observed by a team of researchers, the team was occupied by tending “the sophisticated technological equipment that measured the physiological parameters and simultaneously printed out the data coming through the computer.”10 During the tests, Krieger was connected to “electroencephalographic, electromyographic, and electro-oculographic leads.”

Krieger needs to use this presentation because TT, in its mechanical aspects as described by O’Mathúna,11 strongly resembles other types of what I will refer to as Paranormal Energy Therapies (PET). The act of TT “healing” involves making sweeping motions with hands over the prone patient’s body, “unruffling” the energy field over injured areas, ending with a “flicking” motion. Contrary to the impression given by the name, TT does not involve physical contact. If one were to observe TT without any points of reference, say on a dimmed stage with performers’ identities hidden, one would be at a loss to differentiate the act from that of faith healing, psychic healing, or some other form of PET. At the very least, we would be able to identify the act as an unusual one. Krieger must, in the course of making TT meaningful for observers (audience), differentiate her method of healing, or “laying-on of hands” (as it was called in the earliest references), from other, similar “healing” methods.

A mosaic of TT forms occurred in a 1998 interview for Alternative Therapies in Health & Medicin, in which Krieger explained that part of the process of TT is trying to understand the “data coming from the chakras.”12 This juxtaposition of discursive forms, the scientific with the spiritual, demonstrates the degree of freedom enjoyed by Krieger in an alternative journal. The anticipated audience has lower expectations for scientific reasoning, and is more open to esoteric theoretical discourses. The presentational constraints are lessened. This freedom to combine conceptual modes does not exist in more professional peer-reviewed journals.

Krieger’s work exemplifies the discursive strategies common to many proponents of aberrant medical practice. These varying strategies are only viewed as legitimate because of the prior acceptance of postmodern beliefs. In addition to rigorous scientific testing of unorthodox medical knowledge claims, it is important to recognize the strategies used by proponents to justify their activities and render their activities meaningful for themselves and others. One can then detect underlying and more basic flaws in “alternative” healing promotion. Awareness allows recognition of the hollowness of claiming that each form of knowledge is equally valid. “Alternative” proponents change their public presentations (legitimating discourses) from mystical to scientific and back to mystical depending on how they desire their cause to be perceived. By adoption of this structured analysis, including metaphor, often used by postmodern literary analysts, the social sciences can actually help to define the conceptualization problems presented by alternative medicine that postmodernism itself engenders.


REFERENCES

  1. Rosa L, Rosa E, Sarner L, Barrett S. A close look at Therapeutic Touch. JAMA. 1998; 279: 1005–1010.
  2. Krieger D. Therapeutic Touch Inner Workbook: Ventures in Transpersonal Healing. Santa Fe, NM: Bear & Company; 1997.
  3. Stenger VJ. “Postmodern” attacks on science and reality. Quackwatch Web site; http://www.Quackwatch.com/01QuackeryRelatedTopics/reality.html; documentary copy November 1998.
  4. Goffman E. The Presentation of Self in Everyday Life. New York, NY: Bantam Doubleday Dell Pub; 1959.
  5. Mangham IL, Overington MA. Organizations as Theatre: A Social Psychology of Dramatic Appearances. New York, NY: John Wiley and Sons; 1987.
  6. Stenger. “Postmodern” attacks on science and reality.
  7. Krieger D. Therapeutic Touch and healing energies from laying-on of hands. J Holist Health. 1975; 1: 23–30.
  8. Krieger D. Therapeutic Touch: the imprimatur of nursing. Am J Nurs. 1975; 75: 784–787.
  9. Latour B. Science in Action. Cambridge, MA: Harvard University Press; 1987.
  10. Krieger D, Peper E, Ancoli S. Therapeutic Touch: searching for evidence of physiological change. Am J Nurs. 1979; 79: 660–662.
  11. O’Mathúna DP. Therapeutic Touch: what could be the harm? Sci Rev Alt Med. 1998; 2: 56–62.
  12. Horrigan B. Dolores Krieger R.N., Ph.D.: healing with Therapeutic Touch. Alt Ther Health Med. 1998; 4: 87–92.