Postmodernism is both a philosophy and a cultural movement. The philosophy is sometimes impenetrable, at other times incomprehensible, apparently deliberately so. One philosopher put it this way: “Postmodernism is long on attitude and short on argument . . . [and] remains conveniently ill-defined.”1 Regardless, many postmodern catch-phrases have caught on as popular sound-bites: “Create your own reality.” “Question authority.” “If it works for you, that’s all that matters.” “Find yourself within.” “There’s no right answer.” It doesn’t seem to matter what these slogans mean, or if they mean anything. Many in society have drifted into accepting postmodernism without ever hearing the term or knowing what it entails. The growing acceptance of alternative medicine within the healthcare system stands as a prime example of how a nebulous philosophy like postmodernism can have significant practical effects. It stands as testimony to the fact that beliefs have consequences, as the following true story demonstrates.
A woman in her thirties awakens one morning with severe abdominal pain. The intensity of the pain itself makes it difficult for her to get out of bed. She takes some painkillers and tries to sleep, but the pain persists. She gets more and more worried, so she calls her doctor. A nurse answers and courteously inquires about her symptoms and recent activities.
The nurse tells the woman there is nothing seriously wrong with her. She doesn’t need to see the doctor, nor take any medication. Instead, she has an opportunity to explore her body and the meaning of her pain. The real source of her problem is her stress and anxiety about the pain. She needs to get in touch with her inner self and be enlightened by what her body can tell her. She should take two or three days to relax and focus on herself, and all will be well. In fact, this could be a turning point in her life if she learns more about herself and how to listen to her body.
Not impressed by what the nurse tells her, the woman insists on talking to someone else. She eventually gets an appointment with the doctor who discovers a huge growth on her ovary and recommends immediate surgery. The growth is very fragile, bursting immediately upon removal. If it had burst while inside her, the consequences could have been much worse—serious infection, at least, and possibly death. After surgery, the pain disappeared and has not recurred.†
Incidents like this occur as a direct result of postmodern thinking. The nurse had accepted some of the new approaches to health and healing widely promoted today, even in academic institutions.
More than eighty nursing schools teach Therapeutic Touch, one particular alternative therapy to be discussed below. The majority of U.S. medical schools include courses in alternative medicine, with very little critical analysis incorporated.2 Hospital wellness programs include many alternative therapies, like Tai Chi, yoga, Qigong, and meditation. How could this happen in an era of evidence-based medicine and validated outcomes? Part of the answer lies in the postmodern arguments used to promote alternative medicine to a society increasingly accepting of postmodern ideology.
ALTERNATIVE MEDICINE AND POSTMODERNISM
Postmodernism is not the source of the ideas underlying alternative medicine. Rather, postmodernism is the vehicle—a Trojan horse bringing dubious alternative therapies to prominence and acceptability in hospitals and on campuses today. Modern medicine has long known the claims and views of much of alternative medicine, but rejected them for solid scientific reasons.
Alternative medicine has been defined so broadly that it includes legitimate and effective approaches to health, such as diet, exercise, and relaxation techniques. Such broad definitions tend to obscure the boundary between the acceptable and the absurd. Proponents of alternative medicine cannot demonstrate objectively that many of their therapies work. But in a postmodern environment, demonstrable effectiveness becomes irrelevant, and in addition, unsubstantiated theories like those often used in alternative medicine cannot be freely critiqued in the postmodern atmosphere of total acceptance of all possibilities.
Postmodernism rejects many of the ways by which a worldview—or a medical therapy—can be assessed and judged. Bad research, therefore, carries as much weight as properly structured and controlled studies. Likewise, with the postmodern denial that truth even exists, arguments against an alternative therapy carry no more weight than the cries of one religion against another. Almost anything can gain credibility because scientific methodology is declared nothing more than a cultural bias—namely that of western Europe.
Postmodernism calls for a radical restructuring of the way we think. Postmodernists argue that reality is not as rigid as we once thought. They claim that the idea of objective reality is just a metaphor to help us communicate. Such a view of reality is compatible with alternative medicine in a way modernism never was. Rather than seeking to find the truth, postmodernism claims everything (or nothing) is true. Brugh Joy, MD, calls attention to different views people have and concludes: “The shocker here is not that these people embody particular contradictions but the more basic fact that no belief systems actually represent reality; they are only structured ideas created out of a small part of the human mind’s potential.”3 Once people stop trying to discover reality and accept the existence of multiple realities, Joy sees powerful consequences: “At this level of consciousness we can create anything we desire.”4
Dolores Krieger, cofounder of Therapeutic Touch (TT), admits that this new way of viewing reality has benefited TT and led to widespread interest in it.5 Jean Watson, former president of the National League for Nursing, in a talk entitled “Postmodern Nursing,” called for a “radical rethinking” about health and healing which would “turn our ideas upside down.”6 Deepak Chopra, the best-selling health guru, calls for “a completely new worldview” which will give us “the makings of a new reality.”7 A naturopath trying to bring alternative medicine into managed-care plans claims, “We need to change the way we look at reality.”8
This change in worldview falls in line with the “paradigmatic retransformation” and “coming revolution” of the New Age movement.9 This movement has given credibility to alternative medicine because of their many common concerns. While the content of alternative medicine theories is not necessarily postmodern or New Age, it is much more compatible with postmodernism than modernism. Three postmodern arguments are frequently used by promoters of alternative medicine. After listing them, we will examine each in more detail.
- Alternative medicine proponents cast doubt on the findings of biochemical medicine, arguing that it is merely an outgrowth of a Western (modernist) mentality which is materialistic, male-dominated, and cold.
- Criticisms of alternative medicine are primarily power-posturing by the medical establishment over cultures “marginalized” by Western society.
- Objective, rational, experimental data as the basis for accepting the value of a therapy may be replaced with a new basis: personal experience.
Rejection of the Medical Model
Postmodernism rejects modernism—the inheritor of the age of Enlightenment. Medicine in the modernist era has focused on the physical aspects of health and illness. It is reductionistic in its assumption that the more we understand about the body’s biochemical reactions, the better we can promote health and cure illness. From this comes a focus on testing biological fluids or tissues in diagnosing illnesses, and taking hi-tech scans and images. Good health is restored by adjusting abnormal chemistry or surgically correcting the ailing tissues. Promoters of alternative medicine critique and reject or downplay the value of the biochemical model of medicine.
At times, modern medicine has overemphasized the physiological aspects of health and underappreciated the contributions of people’s emotional, mental, relational, and spiritual dimensions. Interactions with the modern healthcare system often result in only cold, inhumane experiences.10 In addition, people get angry at modern medicine when their high expectations are not met. These frustrations make people more willing to listen to extravagant claims. Postmodernism has an antiestablishment aspect that makes alternative medicine seem attractive.
One nurse uses TT to move from “a world of technology,” “mechanistic reductionistic language,” and “the machinery of curing” back to the “art of caring.”11 A well-known teacher of Reiki, a Japanese life-energy therapy, implies that turning to physicians for help can be unhealthy. “The primary message you received was to go to the outside for healing and surrender to someone else your power for restoring your own health. In that process, you could easily experience a sense of loss of your own ‘life power,’ resulting in feelings of helplessness, depression, and defeat.”12
In the words of an Australian nurse-naturopath, “reductionist medicine” results in “continued disease, dependence on ‘management’ with drugs and surgery (control over nature being a fundamental need of patriarchal science), poor quality of life, and tremendous cost to patient and community.”13 Scientific answers are no better than others as they simply reflect a scientific paradigm which is “male dominated, exclusive, authoritarian, linear, and rigid.”14 Postmodernists do not envision reforming modernist paradigms. “Such paradigms require (indeed on a subconscious level they beg) to be overthrown.”15
Postmodernism also promotes a “back to the good old days” mentality. Proponents of alternative medicine claim—truly enough—that they derive insight from ancient traditional medicines. In their attempts to reject modern medicine, many proponents claim that human life was healthier when it was more natural and less civilized.16 The postmodern reshaping of history supports this claim even though it goes against well-substantiated historical facts to the contrary.17
Chopra, for instance, uses this postmodern analysis to his advantage by making use of both sides of the argument on this point. He claims that people in the past lived to great old ages because they worked hard and had less stressful lives.18 But elsewhere in the same book, to bolster his assertion that people should pamper themselves with the therapies he promotes, he claims that previous generations lived less fulfilling lives and died younger because of the severity of their living conditions.19
Alternative medicine’s postmodern proponents paint modern medicine as an enterprise characterized by uncaring chrome, concrete, and stainless steel. Alternative medicine postures itself as the soothing, wise hand of the ancients.
The postmodern critics do have some valid points. The medical community is well aware that medicine has drifted away from some of its humanitarian and spiritual roots. But these criticisms are not enough to justify a wholesale rejection of modern medicine. While science can lead to dehumanization, materialism, and impersonal interactions, this is not inevitable. In addition, we ought not forget the dark side of the not-too-recent past. Increased longevity and health in much of Western society attests to the many benefits of applying scientific principles to medicine and public health. Uncritically replacing well-established scientific reasoning with intuitive ancient wisdom will not benefit people’s health.
The Voice of the Marginalized
Postmodernists often claim to speak on behalf of a “marginalized” or oppressed group. When talking on postmodern nursing, Jean Watson emphasized how the medical model had marginalized nursing and its “caring model.” Other nurses find common ground with alternative therapists in their similar marginalization: “To maintain its dominant position, orthodox medicine subordinated its essential counterpart, nursing, and excluded or limited the natural therapies, constructed as fraudulent competitors.”20 In postmodernism, beliefs are socially constructed, not rationally established and supported. The rejection of any therapy is not viewed as an evidence-based decision, but a power play. Watson claims that important knowledge about health care has been “systematically excluded from human consciousness” by biases of the modern era.21 Westerners do not commonly believe that life energy fields sustain everything only because modern researchers have marginalized this view.22 Similarly, Ayurvedic medicine has supposedly been suppressed due to “centuries of foreign rule in India.”23 Yet today 75% of the preparations recommended by Ayurvedic practitioners in India, fifty years after achieving independence, were modern pharmaceutical drugs.24
A common reply to calls for scientific validation of alternative therapies is to claim that alternative medicine is being victimized by a double standard. A panel of healthcare professors at the University of Colorado was convened to evaluate research on TT. They concluded “there is not a sufficient body of data, both in quality and quantity, to establish TT as a unique and efficacious healing modality.”25 They recommended that the practice not be taught for another twenty years until sufficient evidence had been established to validate it. The dean of the nursing school claimed, “We would like to imagine our whole lives are rational and science-based, but only 15% of medical interventions are supported by solid scientific evidence.”26 Similar statements continue to be made about medical practice.27,28,29,30
The postmodern argument is that therapies are being marginalized by holding them to a standard that even conventional therapies do not achieve. Postmodernists claim that therapies are not accepted or rejected based on scientific evidence, but rather on whether a therapy fits in with the dominant paradigm in medicine. Whether true or not, the response to this claim should be the promotion of evidence-based medical and nursing practice. Accepting all therapies, regardless of evidence, or dismissing the scientific approach to health-care decisions, will expose patients to ineffective and potentially harmful therapies.
Before responding to this claim, however, its accuracy must be evaluated. Postmodern openness to all views of reality undermines the importance and necessity of evaluating claims. The claim that only 15% of medical decisions are evidence-based refers to a 1978 Office of Technology Assessment report.31 The person who originally made the statement has admitted that it was an off-the-cuff remark based on a 1960–1961 British survey of nineteen physicians.32 His statement was intended to challenge others to find better evidence about how physicians make clinical decisions. Researchers have responded to this challenge and evidence-based medicine and nursing have advanced significantly in the intervening decades. Recent studies have found that the majority of physicians’ clinical decisions can be supported by scientific evidence.33,34
Using 1960s data to make judgments about 1990s practice is inappropriate. This type of postmodern response distracts people’s attention from evaluating the evidence. Instead, people grow sympathetic to the underdog and more inclined to reject the conclusions of the “establishment.” Postmodern ideology thus outweighs physical evidence. An influential nursing textbook recommends accepting TT as a way to “celebrate the diversity among us. . . . Therapeutic Touch is rooted in Eastern philosophy. Because of our Western culture orientation, we search for research to explain its effects. To the Eastern mind, if it works, one doesn’t need research to prove how it works. The Eastern mind doesn’t care how it works, only that it does.”35 No mention is made of how we know “it works.”
Postmodern ways of thinking about science and medicine menace public health. Chopra revels in this state of affairs when he says that once a person has accepted the Ayurvedic way of thinking, he “will no longer be bound by society’s notions of what you should be doing, saying, thinking, or feeling.”36 Snake oil, miracle cures, bloodletting, and the like will flourish when any form of medical care is not required to demonstrate the validity of its claims.
Reliance on Experience
Chopra places a higher priority on experience than reason. “You sometimes see Prana defined as ‘life force’ or ‘life energy,’ but what is more important than a definition is to get experiential knowledge of it.”37 In the instructions accompanying some of his exercises he states: “In the three related procedures given here, you will experience the effortless way that intentions can get fulfilled, bypassing the ego and the rational mind.”38
Postmodern alternative medicine promoters argue that therapies should not be evaluated on the basis of objective evidence or quantitative results. Rather, they say, individual experience should be the judge. Krieger encourages her readers: “Therapeutic Touch works. . . . You can do it; everyone who is willing to undertake the discipline to learn Therapeutic Touch can do it. You need only try in order to determine the truth of this statement for yourself. So, I invite you: TRY.”39
Although Krieger claims that experiential knowledge is the key to assessing this therapy, every quack healing method ever devised has those who claim it worked for them.40 Anecdotal reports are well known of people levitating while meditating or shamans curing cancer. But strangely, when these events are brought into the laboratory, the feats cannot be replicated. There’s even a name for this: the shyness phenomenon. Anecdotal evidence plays a role in suggesting new developments in clinical practice—this is why case reports remain valuable to clinicians—but anecdotal evidence alone falls short of the standards of modern health care, in spite of postmodern objections that this only reveals prejudice.
Experiencing benefits after taking a therapy does not necessarily support the effectiveness of the therapy. The placebo effect is powerful and ubiquitous, which is part of the reason why high-quality clinical trials are complicated and time-consuming. But experience is not without value. We do need to experience some things before we can understand and appreciate them. We probably have to play a few rounds of golf before we can understand why some people love it so much. If personal experience were the best way to know if a therapy worked, we would end up trying out untested, harmful therapies on ourselves. If fortunate, we would only waste our time and money on ineffective therapies. We need some prior evaluation of potential therapies so that we experiment with only the relatively safe and effective ones.
The task of evaluating medical therapies and products falls to a number of government agencies and professional organizations. While the broader marketplace is governed by the premise, “let the buyer beware,” the health “marketplace” should be governed by the premise, “let the seller beware.”41 Consumer protection laws exist because of this belief. Few would argue that medicine should not be regulated when the dangers of bogus therapies are so great. However, accepting regulation of health-care practices and remedies requires giving over a certain amount of personal authority to the government. We decide not to experience everything for ourselves, but to let someone else test things and then we accept their advice.
Postmodern rejection of all forms of authority and their suspicion of government and law leads alternative medicine proponents to rejection accountability for their own therapies. Dana Ullman, president of the Foundation for Homeopathic Education and Research, rejects health-care regulation for these reasons: “It is sad that in this land of freedom some people seek to ‘protect’ others from making their own decisions in health care. Hopefully as we approach the 21st century and as more and more countries experience ‘glasnost’ and ‘perestroika,’ America will re-commit itself to real freedom and real democracy.”42
The consequences of this approach to health care were borne out in a court case in which a homeopathic midwife was accused of reckless conduct while assisting a birth in Maine.43 The baby began breathing immediately after birth, but then started to gasp. The midwife pushed a pellet of homeopathic laurocerasus into the baby’s mouth believing this would correct the breathing problem. Within ten minutes a squad arrived and placed an oxygen mask over the baby’s mouth. The midwife had the mask moved aside for a few seconds to give a homeopathic liquid call Nature’s Rescue. This liquid contained 27% alcohol, and was believed to focus the baby’s energy.
A neonatologist testified that it was inappropriate medical care to give a pellet, a liquid, or alcohol to a distressed newborn. The judge concluded that “the defendant’s conduct created a substantial risk of serious bodily injury” to the baby. However, both a homeopathic family physician and a homeopathic nurse practitioner testified that the midwife acted according to standard homeopathic practice. Because the defendant was not trained in medicine, she could not be held to medical standards. The judge found the midwife not guilty of reckless conduct since her alternative medicine training left her unaware of the dangers of her actions. Although ignorance of the law is no defense, it appears that ignorance of medicine is a good defense for those dabbling in medical areas!
Self-help books promote the idea that we should all decide everything about our health for ourselves. But with so many things to know and understand about health care, how can a person decide what is reliable? By law, advertisements may not be false or misleading, but popular literature isn’t regulated. William Jarvis points out that “the public is at a major disadvantage when faced with false and unproven remedies in books, magazines and newspaper articles, lectures, audio and video cassettes, talk show appearances, etc. The financial interest of promoters is often disguised in such communications.”44 High costs are paid for the postmodern right to “determine your own reality” through personal experience. As a result of this broad rejection of authority, billions of dollars are being wasted, harm is being done, and people are being diverted from proven, helpful therapies.
Postmodernism erects barricades against criticism of alternative medicine. Part of postmodernism is the rejection of an objective reality. Science is based on the pursuit of the most accurate description and explanation of an underlying reality postmodernists claim does not exist. Little wonder the two approaches collide. Ironically, postmodern proponents of alternative medicine retain their interest in scientific studies, but only to the extent that they support their preconceived beliefs. When the results don’t match their expectations, the scientific paradigm is critiqued. By attempting to discredit the possibility of unbiased, repeatable, and controlled studies, they resist pressure to demonstrate the effectiveness and safety of the therapies they endorse.
While postmodern ideology is abstract and academic, it has practical consequences. Promoting therapies in the name of diversity leaves no way to reject any therapy. Including coursework promoting unproven and potentially unsafe therapies is unjustified given the overwhelming amount of information students need to digest. Information should be provided about commonly used alternative therapies, but it should be taught in the context of how to evaluate claims of efficacy. Healthcare providers promoting unproven therapies just because they are in vogue, or financially lucrative, is selling health-care professionals short.
An understanding of postmodern arguments will assist concerned health-care providers in responding effectively when they are used to promote alternative therapies. People often have to be reminded of how valuable science is in determining efficacy and safety. Postmodernism is a house of cards built on the ever-shifting sands of multiple realities. The winds of reason are needed to bring it down to earth. Patients’ health will benefit when providers base their therapy recommendations on the best scientific evidence available, not the latest popular philosophy.
* Revised and updated version of Postmodern impact: health care. In: The Death of Truth. McCallum D, ed. Minneapolis, MN: Bethany; 1996: 58–84.
† This account, told to the author by the victim, involves postmodern ideas, but also malpractice. No suggestion is being made that postmodernism or alternative medicine necessarily leads to malpractice. The story still exemplifies the dangers of adopting postmodern beliefs in health care.
- Lilla M. The politics of Jacques Derrida. New York Review of Books. 1998; 45: 36–41.
- Wetzel MS, Eisenberg DM, Kaptchuk TJ. Courses involving complementary and alternative medicine at US medical schools. JAMA. 1998; 280: 784–787.
- Joy WB. Joy’s Way: A Map for the Transformational Journey: An Introduction to the Potentials for Healing with Body Energies. Los Angeles, CA: J. P. Tarcher; 1982: 19.
- Ibid., 20.
- Krieger D. Accepting Your Power to Heal: The Personal Practice of Therapeutic Touch. Santa Fe, NM: Bear & Company; 1993: 6–7.
- Watson J. Postmodern nursing. Presentation at Mount Carmel College of Nursing, Columbus, OH. 24 October 1994.
- Chopra D. Ageless Body, Timeless Mind: The Quantum Alternative to Growing Old New York, NY: Harmony Books; 1993: 5, 7.
- Hernandez M. Integrating Alternative Medicine & Managed Care. Pre-Conference Symposium at the National Managed Health Care Conference 1997 (INFOCUS, 4 April 1997); audiocassette #320-S3B.
- Levin JS, Coreil J. ‘New Age’ healing in the U.S. Soc Sci Med. 1986; 23: 889–897.
- Jarvis WT. Allergy-related quackery. NY State J Med. 1993; 93: 100–104.
- Wytias CA. Therapeutic Touch in primary care. Nurse Prac Forum. 1994; 5: 91–97.
- Ray B. The ‘Reiki’ Factor: A Guide to the Authentic Usui System. St. Petersburg, FL: Radiance; 1988: 16.
- McCabe P. Natural therapies in Australia: a nurse naturopath’s view. Nurse Prac Forum. 1994; 5: 114–117.
- Daniels GJ, McCabe P. Nursing diagnosis and natural therapies: a symbiotic relationship. J Holist Nurs. 1994; 12: 184–192.
- Ibid., 186.
- Brewin TB. Logic and magic in mainstream and fringe medicine. J Royal Soc Med. 1993; 86: 721–723.
- Dixon T. Postmodern impact: history. In: The Death of Truth. McCallum D, ed. Minneapolis, MN: Bethany; 1996: 126–142.
- Chopra, Ageless Body, 54, 82–83.
- Ibid., 69.
- Daniels, Nursing diagnosis and natural therapies, 185.
- Watson, Postmodern nursing.
- Russell EW. The fields of life. In: Future Science: Life Energies and the Physics of Paranormal Phenomena. White J, Krippner, eds. Garden City, NY: Anchor Books; 1977: 59–64. 23.
- Sharma HM, Triguna BD, Chopra D. Maharishi Ayur-Veda: modern insights into ancient medicine. JAMA. 1991; 265: 2633–2635.
- Cassileth B. The Alternative Medicine Handbook. New York, NY: W. W. Norton; 1998: 22–27.
- Claman HN. Report of the Chancellor’s Committee on Therapeutic Touch. Denver: University of Colorado Health Sciences Center; 1994.
- Martin C. Quoted in: Casper D. Healing touch wins bout. Boulder Daily Camera. 25 August 1994: 1B, 3B.
- Haddad A. Ethics in action: acute care decisions. RN. 1994; 57: 21–23.
- Swackhamer AH. It’s time to broaden our practice. RN. 1995; 58: 50–51.
- Robbins J. Reclaiming Our Health: Exploding the Medical Myth and Embracing the Source of True Healing Tiburon, CA: H. J. Kramer; 1996: 192.
- Kreitzer MJ. Complementary/alternative medicine: maximizing opportunities and minimizing risks. Digest: Med Liability Risk Manage Newsletter. 1998; 26: 1–8.
- Office of Technology Assessment, US Congress. Assessing the Efficacy and Safety of Medical Technologies. Washington, DC; 1978.
- White KL. Evidence-based medicine. Lancet. 1995; 346: 837–838.
- Ellis J, Mulligan I, Rowe J, Sackett DL. Inpatient general medicine is evidence based. Lancet. 1995; 346: 407–410.
- Michaud G, McGowan JL, van der Jagt R, Wells G, Tugwell P. Are therapeutic decisions supported by evidence from health care research? Arch Intern Med. 1998; 158: 1665–1668.
- Carpenito LJ. Nursing Diagnosis: Application to Clinical Practice, 6th ed. Philadelphia, PA: Lippincott; 1995: 356.
- Chopra D. Perfect Health: The Complete Mind/Body Guide. New York, NY: Harmony Books; 1990: 24.
- Chopra, Ageless Body, 261.
- Ibid., 99–100.
- Krieger, Accepting Your Power to Heal, 8.
- Jarvis WT. Quackery: a national scandal. Clin Chem. 1992; 38: 1574–1586.
- Ibid., 1576.
- Ullman D. Discovering Homeopathy: Medicine for the 21st Century. Rev. ed. Berkeley, CA: North Atlantic; 1991: xix.
- State of Maine v. Sally Morrison, Superior Court Criminal Action Docket CR-96-27 (28 January 1997).
- Jarvis, Quackery, 1574.