The placebo effect and a participatory worldview
John Heron, formerly Assistant Director, British Postgraduate Medical
Federation, University of London
Published in D.Peters (ed), Understanding the Placebo Effect in
Complementary Medicine, London, Churchill Livingstone, 2001, pp 189-212.
Outline
Inquiry paradigms
Cartesian anomaly
The downfall of positivism
A participatory worldview
Critical subjectivity and four ways of knowing
Methodology: co-operative inquiry
The body as a subjective-objective reality
The experiential body
Formative intentionality of the experiential body
Formative intentionality of illness and of recreating wellness
Symbolizing the experiential body
The formative power of others’ experiential knowing
Supportive data
The relevance and limits of conventional medical research
The relevance of co-operative inquiry
A co-operative inquiry project
Obstacles
Membership and roles
First reflection meeting
Cycles of inquiry
Completing the inquiry
Inquiry paradigms
Any method of inquiry presupposes an inquiry paradigm, which is a set of
basic beliefs about the nature of reality and how it may be known (Guba and
Lincoln, 1994; Heron and Reason, 1997). These are philosophical
presuppositions of the method and are not derived from the
method. However, the continued use of the method will start to show up the
limitations of the paradigm underlying it.
The beliefs within an inquiry paradigm are revealed by three fundamental
and interrelated questions. There is the ontological question, 'What is the
form and nature of reality’; the epistemological question, 'What is the
relationship between the knower and reality, and the extent of our knowledge
of reality?’; and the methodological question, 'How can the inquirer find
out about whatever he or she believes can be known?'.
I will look at the participatory worldview in the light of these
questions, then consider the implications of it for our understanding of the
body, illness and disease, and for the future of medical practice and
research, with a concluding focus on a project for using the participatory
research method of co-operative inquiry. But first I consider the paradigm
presupposed by conventional medical inquiry, and the limitations of it which
are shown up by continued use of such inquiry.
Cartesian anomaly
The inquiry paradigm underlying conventional medicine and mainstream
medical research is Cartesian and is fraught with the basic anomaly of the
Cartesian view. For Descartes, mind and matter are independent substances:
mind is nonspatial with none of the properties of matter, and matter is
spatial with none of the properties of mind. The human physical body is
included within the self-contained mechanism of the spatially extended
material world. This is the objective world: a real world independent of our
minds, operating according to causal laws, which we can find out by
observing how its component parts work together. Such is the objectivist,
positivist worldview of modern times, which Skolimowski (1994) calls
Mechanos, the legacy not only of Descartes, but also of Bacon, Galileo, and
Newton.
The anomaly in Descartes’ thinking is that, on the one hand, mind is
nonspatial with no bodily properties at all, yet on the other hand he says
that the mind is ‘very closely united’ with the body and ‘as it were
intermingled with it’ (1641). Indeed, he makes the anomaly very specific: he
says that the mind interacts with the body through the pineal gland. So,
without apparently realizing the difficulty, he gives the nonspatial mind a
precise spatial location in the body.
Medicine, typically in its use of drugs, perpetuates its own version of
this sort of anomaly. With its therapy hat on, it wants to prescribe
chemical substances which will have an independent effect within the assumed
autonomous mechanism of the body. With its research hat on, it also has to
acknowledge and allow for, by means of experimental design, the dynamic
influence of mental belief on this mechanism via the placebo effect. Thus it
wants to maintain, as the foundation of clinical practice, a view of the
body as a self-contained physical system, so that it can deliver purely
physical remedies for what it assumes to be purely physical defects. And it
can only do this by also accepting as a guiding rule of effective and
reliable medical research - in controlling for the placebo effect - that the
body is not a self-contained physical system but one that can react strongly
to mental events.
This is indeed a weird anomaly: the proven effect of mental belief on
bodily functioning - the placebo effect - is acknowledged only so that it
can be discounted in research and ignored in clinical practice. A remarkable
and undisputed healing effect of unknown potential is dealt with in
pejorative terms and is cast aside as an irrelevant distraction from the
pursuit of competent medicine. Harvard Medical School anthropologist Arthur
Kleinman asks: ‘Why is the placebo regarded as pejorative? Is it threatening
to medicine?’ (de Cuevas, 1995). Clearly it is: it is threatening to the
positivist, objectivist, mechanistic paradigm underlying medical research
and practice; and hence to the powerful, unilateral, external control which
medicine claims over people’s bodies. And the paradigm is cracking up under
the strain of the threat.
A human body is not just an objective reality, part of the autonomous
furniture of the universe. It is a subjective-objective reality. It is
experienced from within and observed from without. When it is dysfunctional,
there is both interior experiential illness and exterior observable disease
process. Cartesian medicine attends exclusively to the latter and expects
the patient to keep the former out of the doctors’ way. But an increasing
number of patients, lurking passively within observable bodies subject to
external medical control, want to become active agents within experiential
bodies subject to their own control.
The downfall of positivism
Medical science is one of the human sciences, and the limits of
objectivist, quantitative research in the other human sciences have been
well reviewed for many years. (Argyris, 1968. 1970; Bernstein, 1983; Gergen,
1973; Guba and Lincoln, 1994; Harré and Secord, 1972; Israel and Tajfel,
1972; Heather, 1976; Joynson, 1974; Lincoln and Guba, 1985; Reason and
Rowan, 1981; Shotter, 1975; Smith, Harré, Van Langenhove, 1995; Braud and
Anderson, 1998). I will give here a brief summary of some of the main
criticisms.
The overarching criticism is that there is no external world, entirely
independent of the researcher’s mind, against which to verify or falsify
hypotheses:
The findings of the observer are shaped by the observer in
interaction with the phenomena. This is evident both in the physical
sciences and the social sciences.
So-called statements of objective fact are theory-laden. They can
only be formulated within a pre-existing set of theoretical assumptions.
So-called statements of fact are also value-laden. The underlying
theoretical assumptions which shape them represent values preferred to
the values implicit in other rejected assumptions.
More specific criticisms relate to quantitative approaches that use
inferential statistics, the control of selected variables through randomized
designs, and imported categories of understanding. Their relevance to
medical research is no less telling than it is in the other human sciences
(Heron, 1986, 1996).
Selecting and controlling variables means the exclusion of others
that are influential, and can involve discounting some of those that are
selected and controlled. The resulting findings have little relevance to
understanding how all the pertinent variables are at work in the real
world.
This problem is chronic in medical research, which is designed to
discount the influential variable of the placebo effect. The result is
that modern medicine has no systematic grasp whatsoever of how the
effect of mental attitude on bodily processes is at work in the real
world of clinical practice, that is, in the day to day management of the
therapeutic process.
Inferential statistics bury individual differences under comparisons
of means, and throw no light on the idiosyncratic nature of individual
responses.
In medical research, clinical trials assume the homogeneity of their
research populations. The statistical method used hides what happens to
individuals in the trial. With respect to two treatment groups,
statistical analysis may show that one treatment is better than another,
yet there may be some people in both groups who are worse after
treatment. In general, medical research works to ‘obscure rather than
illuminate interactive effects between treatments and personal
characteristics’ (Weinstein, 1974). It can throw no light on the fact
that individuals respond differently to the same treatment. Therefore it
cannot help with the everyday clinical question ‘What is the treatment
of choice for this individual patient?’
There is thus a mismatch between research method and clinical
reality. The former assumes that patients are the same and obscures
their differences, while the latter repeatedly reveals the patient
differences that defeat this assumption. The inevitable result is a
therapeutic culture which has a significant iatrogenic effect. Treatment
based on conventional inferential statistics is bound sooner or later to
harm some patients in ways that medical research can neither predict nor
understand.
People cannot be understood either in terms of externally measured
variables, or in terms of researcher imported categories. A full
understanding of people necessarily includes the meanings and purposes
they invest in their way of being and their actions, as these are
interpreted through dialogue with them.
Medical research totally ignores the meanings and purposes which
people invest in their experiential illnesses and attends exclusively to
their observable diseases. By ignoring the intentionality of illness,
the way people choose to feel it, construe it and do it, medical culture
systematically and continuously disempowers people by regarding their
subjectivity as irrelevant to their healing.
The methodology presupposes strict causal determinism. A model of
relative indeterminism and autonomous agency is better suited to the
explanation of human behaviour.
Medical culture treats people as patients contained within bodies
subject to strict causal determinism, and as recipients of external
therapeutic control. The placebo effect suggests, on the contrary, that
people are autonomous agents who have within them the power to influence
what goes on in their bodies, whose processes are therefore relatively
indeterministic, or, which is the same thing, are only relatively
determined by causal laws at the purely physical level.
A participatory worldview
The inquiry paradigm of objectivist Mechanos is breaking down because it
cannot do justice, in an integrative way, to the full range of human
experience in so many fields: medical research, the other academic human
sciences, consciousness research, subatomic physics, systems research,
ecology, and so on.
An emerging alternative inquiry paradigm is that of participative
reality. This holds that there is a given cosmos in which the mind
creatively participates, and which it can only know in terms of its
constructs, whether experiential, imaginal, conceptual or practical. We know
through this active participation of mind that we are in touch with
what is other, but only as articulated by all our mental sensibilities.
Reality is always subjective-objective: our own constructs clothe a felt
participation in what is present. Worlds and people are what we meet,
but the meeting is shaped by our own terms of reference. (Merleau-Ponty,
1962; Bateson, 1979; Reason and Rowan, 1981; Spretnak, 1991; Heron, 1992,
1996, 1998; Varela et al, 1993; Skolimowski, 1994; Reason, 1994a).
The participatory paradigm asserts that we cannot have any final or
absolute experience of what there is: in the relation of knowing by
face-to-face acquaintance, the experiential knower shapes perceptually what
is there. And this is still so when the perceiving mind is relatively free
of conceptual labels imposed upon its imaging of reality. However, the point
about experiential knowing is that the very process of perceiving is also a
meeting, a transaction, with what there is. To touch, see or hear something
or someone does not tell us either about our self all on its own, nor about
a being out there all on its own. It tells us about a being in a state of
interrelation and co-presence with us.
When I hold your hand, my tactual imaging both subjectively shapes you
and objectively meets you. To encounter being or a being is both to image it
in my way and to know that it is there. Knowing a world is in this felt
relation at the formative interface between a subject and what is met. To
experience anything is to participate in it, and to participate is both to
mould and to encounter. In the relation of meeting, my subjectivity becomes
a perspectival window that frames and is filled with a world which also
transcends it.
Hence experiential reality is always subjective-objective. It is
subjective because it is only known through the form the mind, perceptually
and conceptually, gives it; and it is objective because the mind
interpenetrates the given cosmos which is shapes.There is an analogue here
with Rahner’s modern theology of revelation, in which he speaks
paradoxically of ‘mediated-immediacy’: we experience divine presence always
in mediated form (Kelly, 1993).
Merleau-Ponty shows how perception itself is participatory so that
... in so far as my hand knows hardness and softeness, and my
gaze knows the moon's light, It is as a certain way of linking up
the the phenomena and communicating with it. Hardness and softness,
roughness and smoothness, moonlight and sunlight, present themselves
in our recollection not pre-eminently as sensory contents but as
certain kinds of symbioses, certain ways the outside has of invading
us and certain ways we have of meeting the invasion. (Merleau-Ponty,
1964:317)
As Abram has it, this means that there is ‘underneath our literate
abstractions, a deeply participatory relation to things and to the earth, a
felt reciprocity....’ (Abram, 1996:124).
Or as Skolimowski puts it
Things become what our consciousness makes of them through the
active participation of our mind (1994: 27-28).
The cosmos or the universe is a primordial ontological datum,
while the 'world' is an epistemological construct, a form of our
understanding. (1994: 100)
Bateson makes the point that between the extremes of solipsism, in which
'I make it all up', and a purely external reality, in which I cease to
exist, there is
... a region where you are partly blown by the winds of reality
and partly an artist creating a composite out of inner and outer
events. (in Brockman, 1977: 245)
From all this it follows that what can be known about the given cosmos is
that it is always known as a subjectively articulated world, whose
objectivity is relative to how it is shaped by the knower. But this is not
all: its objectivity is also relative to how it is intersubjectively shaped.
For there is the important if obvious point that knowers can only be knowers
when known by other knowers: knowing presupposes mutual participative
awareness. It presupposes participation, through meeting and dialogue, in a
culture of shared art and shared language, shared values, norms and beliefs.
And, deeper still, agreement about the rules of language, about how to use
it, presupposes a tacit mutual experiential knowing and understanding
between people that is the primary ground of all explicit forms of knowing
(Heron, 1996). So any subjective-objective reality articulated by any one
person is done so within an intersubjective field, a context of shared
meanings - at one level linguistic-cultural and, at a deeper level,
experiential.
Critical subjectivity and four ways of knowing
A participative worldview, with its notion of reality as
subjective-objective, involves an extended epistemology (Heron, 1992, 1996).
A knower participates in the known, articulates and shapes a world, in at
least four interdependent ways: experiential, presentational, propositional
and practical. These four forms of knowing constitute the manifold of our
subjectivity, within which, it seems, we have enormous latitude both in
acknowledging its components and in utilizing them in association with, or
dissociation from, each other. This epistemology presents us as knowers with
an interesting developmental challenge, that of critical subjectivity. This
involves an awareness of the four ways of knowing, of how they are currently
interacting, and of ways of changing the relations between them so that they
articulate a subjective-objective reality that is unclouded by a restrictive
and ill-disciplined subjectivity.
Experiential knowing means direct encounter, face-to-face meeting:
feeling and imaging the presence of some energy, entity, person, place,
process or thing. It is knowing through participative, empathic resonance
with a being, so that as knower I feel both attuned with it and distinct
from it. It is also the creative shaping of a world through the transaction
of imaging it, perceptually and in other ways. Experiential knowing thus
articulates reality through felt resonance with the inner being of what is
there, and through perceptually enacting (Varela et al, 1993) its forms of
appearing.
Presentational knowing emerges from and is grounded on experiential
knowing. It is evident in an intuitive grasp of the significance of our
resonance with and imaging of our world, as this grasp is symbolized in
graphic, plastic, musical, vocal and verbal art-forms. It clothes our
experiential knowing of the world in the metaphors of aesthetic creation, in
expressive spatiotemporal forms of imagery. These forms symbolize both our
felt attunement with the world and the primary meaning embedded in our
enactment of its appearing.
Propositional knowing is knowing in conceptual terms that something is
the case; knowledge by description of some energy, entity, person, place,
process or thing. It is expressed in statements and theories that come with
the mastery of concepts and classes that language bestows. Propositions
themselves are carried by presentational forms - the sounds or visual shapes
of the spoken or written word - and are ultimately grounded in our
experiential articulation of a world.
Practical knowing is knowing how to do something, demonstrated in a skill
or competence. Practical knowledge is in an important sense primary (Heron,
1996). It presupposes a conceptual grasp of principles and standards of
practice, presentational elegance, and experiential grounding in the
situation within which the action occurs. It fulfils the three prior forms
of knowing, brings them to fruition in purposive deeds, and consummates them
with its autonomous celebration of excellent accomplishment.
It is equally important that action not only consummates the prior forms
of knowing, but is also grounded in them. It is in this congruence of the
four aspects of the extended epistemology that lie claims to validity. The
bipolar relationship can be shown as in Figure 1.
Critical subjectivity means that we attend both to the grounding
relations between the forms of knowing, and also to their consummating
relations. It means that we do not suppress our primary subjective
experience but accept that it is our experiential articulation of being in a
world, and as such is the ground of all our knowing. At the same time,
naively exercised, it is open to all the distortions of those defensive
processes by which people collude to limit their understanding. So we attend
to it with a critical consciousness, seeking to bring it into aware relation
with the other three ways of knowing, so that they clarify and refine and
elevate it at the same time as being more adequately grounded in it.
In addition, since our knowing is from a perspective and we are aware of
that perspective, of its authentic value and of its restricting bias, we
articulate this awareness in our communications. Critical subjectivity
involves a self-reflexive attention to the ground on which one is standing.
It also extends to critical intersubjectivity. Since our personal knowing is
always set within a context of linguist-cultural and experiential shared
meaning, having a critical consciousness about our knowing necessarily
includes dialogue, feedback and exchange with others, and this leads to the
methodology of co-operative inquiry.
Figure 1: Bipolar
congruence of four forms of knowing
Methodology: co-operative inquiry
The inquiry method within a participative worldview needs to be one which
draws on this extended epistemology in such a way that critical subjectivity
is enhanced by critical intersubjectivity. Hence a form of research in which
all involved are both researchers and subjects: they engage together in
democratic dialogue as co-researchers in designing, managing and drawing
conclusions from the research, and as co-subjects they engage in the action
and experience that the research is about (Heron,1971,1981a,1981b, 1985,
1988, 1992,1996; Heron and Reason, 1986, 2000; Reason, 1988a, 1994a, 1994b;
Reason and Heron, 1995).
In such co-operative inquiry people collaborate to define the questions
they wish to explore and the methodology for that exploration (propositional
knowing); together or separately they apply this methodology in the world of
their practice (practical knowing); which leads to new forms of encounter
with their world (experiential knowing); and they find ways to represent
this experience in significant patterns (presentational knowing) which feeds
into a revised propositional understanding of the originating questions.
Thus co-inquirers engage together in cycling several times through the four
forms of knowing in order to enrich their congruence, that is, to refine the
way they elevate and consummate each other, and to deepen the complementary
way they are grounded in each other. In simple terms, people move, in
successive cycles, from experience of a topic to shared reflection on it,
which revises the way they next explore it experientially, and so on.
Research cycling is itself a fundamental discipline which leads toward
critical subjectivity and a primary way of enhancing the validity of
inquirers' claims to articulate a subjective-objective reality. There are
also a range of further of procedures which develop this effect. These
include: managing divergence and convergence within and between cycles;
balancing reflection and action; securing authentic collaboration;
challenging uncritical subjectivity and intersubjectivity; managing unaware
projections and displaced anxiety; attending to the dynamic interplay of
chaos and order. These are mentioned in a little more detail later on. For a
full discussion, together with a set of radical skills of being and doing
required during the action phases of the inquiry, and for a comprehensive
account of co-operative inquiry, see Heron (1996).
Co-operative inquiry has been applied in diverse fields: altered states
of consciousness (Heron, 1998, 2000), black managers and subordinates, child
protection supervision, co-counselling, co-operation between conventional
and complementary practitioners (Reason, 1991), dental practitioners,
district council organizational culture, health visitors, obese and
post-obese women, other people with a particular physical or medical
condition taking charge of how their condition is defined and treated, whole
person medicine in general practice (Heron and Reason, 1985; Reason, 1988b),
womens’ staff in a university, young women managers, youth workers, and
more. For further references see Reason (1988a, 1994a), Heron (1996), Heron
and Reason (2000).
Co-operative inquiry is related to other forms of participative inquiry
such as action science (Argyris and Schon, 1974; Schon, 1983; Argyris et al,
1985), action inquiry (Torbert, 1991), participatory action research
(Fals-Borda and Rahman, 1991), some forms of feminist inquiry (Mies, 1993;
Olesen, 1994; Clements et al, 1998)), emancipatory action research (Carr and
Kemmis, 1986), appreciative inquiry (Cooperrider and Srivastva, 1987),
fourth generation evaluation (Guba and Lincoln, 1989), intervention research
(Fryer and Feather, 1994), and others (Braud and Anderson, 1998; Bradbury
and Reason, 2000). For how several of these differ from co-operative inquiry
see Heron (1996).
The body as a subjective-objective reality
On the participatory worldview, a human body is not a purely objective
reality, not something out there in the world quite independent of human
subjectivity. It is a participatory reality, a subjective-objective reality,
and the most basic sense in which this is so is in my knowing of my own
body.
The experiential body
In terms of the fourfold epistemology outlined above, the grounding
knowing of my body is in terms of experiential knowing, and the basis of
this is proprioception: feeling from within the movement, posture and
qualitative state of my body. This inner felt sense is spatiotemporal in
form. It is the foundational knowing of my body as extended in space, moving
- and pulsing rhythmically - in time. It is elaborated by how I image my
body in all other sensory modalities, that is, by touching and seeing it and
hearing it.
The subjective experience of my body is a proprioceptive imaging of it
which is transactional. It ‘intermingles with’ and is, in some indeterminate
measure, to some unknown degree, constitutive of my body. For the
participatory worldview, my body is a reality which partially consists of my
internal experience of it. Put another way, I co-create my body in and
through my inner felt sense of, my spatiotemporal participation in, the
cosmically given. The cosmos presents something which I shape up as the
experience of indwelling a body in a world. I will call this inner felt
sense of embodiment the experiential body. And the experiential body to some
degree shapes the given body: this is the subjective-objective reality of
the human body.
A polar, complementary way of knowing the given body is by external
observation, elaborated by a whole range of physical instruments and
interventions, and symbolized by verbal and numerical statements. This
observable body - as known in natural science - is certainly not the given
body in some external, absolute, objective sense. It is the given body as
shaped by, and relative to, our observing and cognitive capacities in
interaction with it. It is also a subjective-objective reality.
But the observable body can provide us with some grasp of how far the
experiential body shapes the given body. We can use it, cautiously, as a
mediate symbol, an external marker, of the interaction. We need to be
cautious, simply because the observable body is in part constituted by the
range of sensibilities and modes of cognition we deploy in framing it.
Always remembering this, we can talk for convenience of how the experiential
body does or does not shape the observable body.
Formative intentionality of the experiential body
The inner felt sense of my body is not merely passive receptivity. It is
active-passive, intentional-responsive: with greater or lesser awareness I
intend it. I shape my body by how I intend my spatiotemporal being in it, by
how I move, gesture, posture, breathe, make sound, by how I qualitatively
experience it, how I value and invest meaning in it, and by how I image it
in other sensory modalities.
All these thing all the time are intentional, chosen, however relatively
unaware the choice may be. It is this inherent and inalienable
intentionality which is co-creative with cosmic creativity. We may have made
some adaptive survival choices early in our life, which become so habitual
we lose any sense of them being choices and kid ourselves they are just our
given body. But that they are choices becomes clear when we realize that we
can unchoose them and become awarely purposive about changing the way we are
doing, being in, shaping our bodies.
Furthermore, every subtle micro-choice about how we do our embodiment, is
a preference for one way of doing it over another. Each such preference is
an embodiment of one emotional value favoured over another that is
discarded. Emotional appraisal is the very stuff of rapid decision-making
(Goleman, 1996). On this account, emotional attitude is formative of the
experiential body, and so to some degree the observable body. Hence the
significance of the new area of psychoneuroimmunology (Cousins, 1990).
On the participatory worldview, all these things - how I move, gesture,
posture, breathe, make sound, how I qualitatively experience my body,
emotionally value and invest meaning in it, image it in other sensory
modalities - shape what we come to know analytically and propositionally in
more external terms about body. What we do not yet in any great detail know
is how much they do and can shape what we know about the externally
observable body. We do not know how much the cosmos insists on its own
ontological datum, its own agenda of creation.
Formative intentionality of illness and of recreating wellness
It follows from all the above, that any observable disease, from the
standpoint of the participatory paradigm, is in part shaped by its
correlative subjective experiential illness: how the person is
spatiotemporally doing and being in, investing emotional value and meaning
in, imaging in all sensory modalities, his or her ill experiential body.
What the still prevalent Cartesian paradigm does is to create a cultural
climate in which people continually discount the way in which the
unacknowledged intentionality of their illness is to some degree shaping
their externally observable disease. The patient occludes this inner
intentionality by relying on the external authority of the doctor, and thus
relinquishes any sense of himself or herself as an agent whose illness is
affecting the disease, and who potentially has an unexercised, unexplored
and unknown capacity to change this process.
If all subjective illness is implicitly intentional and as such in part
shapes observable disease, then raising consciousness about this and being
explicitly intentional with full awareness about how I am spatiotemporally
doing, emotionally valuing and meaning, my embodiment, has the potential to
reshape observable disease. The first step is to raise my awareness of and
identify my past and current way of doing all this. The second step is to
change these ways in a significant manner: I recreate how I move, gesture,
posture, breathe, make sound, how I qualitatively experience my body,
emotionally value and invest meaning in it, image it in other sensory
modalities. This now extends to how I heartbeat, rest-exert, sleep-wake,
ingest-excrete, how I do all the other micro and macro rhythms of
embodiment. I set out to change the experiential illness into experiential
wellness and expect thereby to modify observable disease processes.
This is intentional self-healing. Its potential capacity is at present
unknown. The current labelling of certain observable diseases as incurable
rests on the unstated, conspiratorial Cartesian assumption that their
concomitant experiential illnesses have no relevance either to their
aetiology or their treatment. The question-begging stated assumption is that
these diseases will remain incurable until a purely physical remedy or
procedure is found.
Because the degree to which the unacknowledged intentionality of illness
shapes externally observable disease is unknown, the implications of the
participatory paradigm need to be used with consideration and caution. We
are not entitled to make the diseased feel inadequate and guilty by telling
them dogmatically that their diseases are nothing but the effects of their
unowned states of mind. It is an oppressive question-begging assumption that
a given disease in its entirety is a product of tacit intentional
experiential illness and is fully reversible. The most we are entitled to do
is put forward the hypothesis that it may to some degree be such a product,
and to invite those for whom this idea seems plausible and relevant to their
own condition to explore it in active practice.
Symbolizing the experiential body
Everything which anyone comes to know about the observable body in terms
of propositional knowledge - anatomy, biochemistry, physiology, aetiology
and pathology - rests on and presupposes the subjective experience of
indwelling a body. Each observer’s external account rests on a prior
experiential knowing of the body of the observer, a subjective knowing which
necessarily forever falls outside, and is always presupposed by, the terms
and methods of the external observation. In short, my experiential body is
the ground of and is irreducible to my knowledge of the observable body. Put
in another way, the observable body is a marker of how it is to some degree
shaped by the experiential body, never an explanation of the presence or
power of the experiential body.
My felt experience of indwelling a body cannot be described in statements
based on external, analytic observation; that is, in terms of kinaesthetic
relays from neural sites in the joints, muscles and so on. Such statements
neither describe it nor explain it, they only provide details of its
bio-mechanical concomitants. The experiential body is first and foremost
symbolized in its own terms, and most accessibly, through my movement,
posture, gesture and mode of breathing. How I am embodying myself I directly
convey in these presentational forms, which have their own inherent
emotional meaning.
To raise my consciousness about the sort of tacit intentionality at work
in my experiential body I need to have presentational knowledge of myself,
that is, I need to notice how my movement, posture and gesture and mode of
breathing symbolize how I am choosing to embody myself. I need to notice
what these living symbols tell me about the emotional value and meaning I
invest in my being in a body. This can then develop into the creative
intentionality of the experiential body: a conscious artistry of personal
motion, through which a person chooses awarely to symbolize the emotional
meaning and value they give to embodied life by how they move, gesture,
posture, make sound, breathe, and intend all the other micro and macro
rhythms of the experiential body. The foundation of intentional wellness and
self-healing, on this view, is to do with the radical connection between
life, motion, spatiotemporal form and rhythm, intentionality and emotional
attitude.
The formative power of others’ experiential knowing
You participate in the subjective-objective reality of my body by
experientially knowing it: by perceptually imaging it and intuiting the
meaning of its movements, sounds, postures and gestures, and through
empathic resonance with my experience of indwelling it.
This participative knowing of my body is also subjective-objective
transaction, which means that it too is to some unknown degree formative.
Perceiving another person and empathically resonating with their experience
influences and shapes the subjective-objective reality of their body. This
effect may (or may not) be minimal compared to the intentionality of that
person in co-creation with the shaping power of the cosmically given, but,
for the participatory paradigm it is there.
This means that the experiential encounter between medical practitioner
and patient can have some effect both on the patient’s illness and on their
observable disease. Furthermore, a practitioner, when experientially present
to a patient, can resonate and attune not only to how the person is actually
being in their body, but also with their as yet unexplored potential for
being in it in creative, transforming ways. Hence the power of satsang,
of being with the healer whose attuned presence elicits self-transformative
energy in the patient.
The primary impact of the practioner-patient relationship, on this view,
lies in the way the practitioner perceptually images, resonates and is
present with the patient, rather than on what is said. But what is said by
the practitioner will have a powerful secondary impact, when it is rooted in
and emerges from the primary impact of such presence.
Supportive data
There is a lot of data lying around in support of the participatory view
of the body as a subjective-objective reality, whose intentional
subjectivity is in part constitutive of it and has power to some unknown
degree to influence its processes. There is, of course, the placebo effect:
the fact that believing an ingested substance will have a bodily effect
makes it have that effect. There is the impact of human intention on bodily
processes mediated externally by biofeedback devices; and mediated
internally by autogenic training, relaxation, visualization and meditation,
control of movement and breathing. There is the powerful influence of
posthypnotic suggestion on the reversal of functional and structural bodily
disorder. And there are cases of attitudinal healing in which an intentional
transformation of an internal attitude of mind leads to a reduction or
elimination of obervable disease process.
There is also growing support for the participatory view of the influence
on outcomes of the experiential encounter between practitioner and patient.
Medical education and primary care practice underline the importance and
value of the doctor-patient relationship, and studies show significant
patient differences in response to how it is handled (Cousins, 1990).
Psychotherapy research indicates it is the therapists’ qualities of personal
presence brought to the therapeutic interaction which have a greater effect
on outcomes than any therapeutic techniques. Some complementary therapists
seek a charismatic engagement with their patients and claim this empowers
radical life-style changes in them.
The relevance and limits of conventional medical research
All this data, both experimental and anecdotal, is sufficiently well
documented and creditable, in terms of the participatory paradigm, to call
for further research. The question is: what sort of research? Conventional
medical research methods can be, and have been, with good effect, used to
compare a group of people who have some disease and who practice intentional
self-help with matched controls who are having no treatment and/or some
conventional treatment (Cousins, 1990).
The design needs to be non-randomized, with matched controls selected
from the records of centres of excellence. The use of a controlled trial
with random allocation entails a moral obligation to seek the informed
consent of people to participate in the trial. This means asking people to
agree to the possibility of being randomly allocated to a control group in
which they are not to practise intentional self-healing. Apart from
the dubious morality of this request, it is self-defeating, since the very
making of it is a powerful suggestion which undermines it. So medical
research using randomized designs is faced with a strong dilemma. If it
tries to explore patient intentionality it disempowers itself; if it
maintains its own authority, it ignores and disempowers patient
intentionality.
A non-randomized approach yields useful external data comparing
observable disease processes in the intentional self-healing group and a no
treatment or conventional treatment group. But the use of conventional
research design and statistical analysis can not tell us anything at all
about:
The internal strategies, the subjective processes, of intentional
self-healing as such: that is, the practical knowledge involved in know
how to do it
Individual differences among patients with respect to effective
strategies.
The therapeutic effect understood as a dynamic pattern of the main
influential variables: patient intentionality, psychosocial context,
observable disease process, co-patient interaction, relationships with
health care professionals, and external remedies and procedures used.
(Heron, 1996).
The relevance of co-operative inquiry
All these things can only be addressed if we cease to think of ill people
as patients and regard them as intentional agents and invite them to become
active in the inquiry process.
Agents, hitherto called patients, become members of a co-operative
inquiry, along with relevant health care professionals and co-operative
inquiry initiators. They become co-inquirers as well as co-subjects since
their agency and their mental states are key variables which can only
properly be used, and the use of which can only be properly understood, if
as agents they participate in deciding how and why they are to be used.
Self-healing, as intentional process, can only be researched by those who
are busy with their own subjectivity and at the same time busy with critical
subjectivity, as defined earlier. Internal agency, as practical knowing how,
can only be investigated by the agents concerned. And they need to
collaborate in their inquiry with each other, for critical subjectivity
means also, as we have seen, critical intersubjectivity.
Agents are involved not only in acquiring practical knowledge of
self-help methods. They also, along with relevant health care professionals
in the inquiry group, seek to understand the role of self-help in the total
pattern of influential variables, such as those listed above, and to grasp
what whole pattern makes for a significant effect on both experiential
illness and observable disease. The co-inquirers come to this understanding
through cycles of action and reflection, varying the pattern in the action
phases, and on the basis of this experience learning, in the reflection
phases, to discriminate what makes for a healing pattern. The validity of
the pattern is inherent in its organization, which can only be studied from
within it (Reason, 1986). Thus the influential variables are not split
between an experimental and a control group, but all of them are studied
together in the inquiry group.
Agents are involved in understanding the participatory worldview as a
shared worldspace, an intersubjective way of experiencing and construing
reality. The more the participatory worldview is made explicit, the more
people together co-operate in empowering their subjectivity by putting the
paradigm to work, the more potent that subjectivity is likely to become.
The outcome of all this is a form of participative medical research in
which illness is seen as a way in which people articulate their reality, and
as a project which can be restructured to influence their observable
disease, or to transform their experiential illness, or both.
A co-operative inquiry project
As mentioned above, co-operative inquiry has so far been used in the
health arena in two ways: among healthcare professionals, of the same or
different kinds, looking together at their work; and among peer groups of
people with a particular physical or medical condition taking charge of how
their condition is defined and treated. To my knowledge there has been no
small or large scale use of full-blown co-operative inquiry with a group of
patients who have been invited to revision themselves as potential
self-healing agents and who are co-inquirers with their relevant healthcare
professionals. For an early proposal about a related project, see Reason and
Heron (1986).
Obstacles
One obvious reason why the challenge has not been met, is that the
inquiry methodology is not well known, its underlying paradigm is not
understood, and its social and political implications are a potential
threat. Medical researchers still uncritically wedded to, and restricted by,
the positivist paradigm strongly resist the idea that there can be any
alternative method. This is buttressed by the fact that all forms of
participatory research which include patients as self-directed
co-researchers, threaten the political hegemony of conventional medicine in
controlling patients’ lives.
However some radical practitioners intuitively shift in the direction of
participative research. Schneider’s work with clients is on the edge of
informal co-operative inquiry, as is his vision for the future of a
self-healing community (Schneider, 1987). All healing centres in which
practitioners and their clients adopt a non-dogmatic, co-operative approach
to the healing process are also incipient, inchoate co-operative inquiries.
This applies, too, to peer self-help groups of patients with similar
complaints.
Another obstacle, of course, is the demoralizing climate created in
contemporary society by the powerfully publicized prevalence of the
Cartesian medical model. Patient subjectivity is downgraded and regarded as
an embarrassing irrelevance, for both patient and doctor, to the purely
technical project of physical medicine. In terms of the participatory
paradigm, such a pervasive intersubjective belief system will have an
influential negative, depressing effect on patient subjectivity and its
potential for self-healing.
The effect may indeed go further. The Cartesian model, by putting it
about that some diseases are autonomous faults waiting around, independent
of our minds, incurably to overcome some of our bodies, may cause some
people, through fear, mentally to induce them. It is not simply that the
practical application of modern medicine has inescapable iatrogenic effects.
Its underlying paradigm, per se, may also have such effects: it may
not only paralyze self-healing, it may induce experiential illness and hence
observable disease. All this follows from the participatory worldview that
we both subjectively and intersubjectively articulate and shape our
realities.
A third and related obstacle is well-known human resistance to
self-development: those who find it convenient not to notice and own the
negative attitudes that shape their way of being embodied, will have the
usual kinds of denial to dismantle before launching intentional
transformation.
Membership and roles
For these sorts of reasons, patients wanting to join a co-operative
inquiry about intentional self-healing need to self-select themselves
carefully: they are not too debilitated, are willing to take up the
participatory paradigm and rebuff the Cartesian medical model, open to
inquiry, not deluded by unwarranted assumptions, not too resistant, willing
to develop their own practical knowing how to be embodied.
A co-operative inquiry project about intentional self-healing would
involve self-selected patients, relevant healthcare professionals, and
co-operative inquiry initiators. Everyone in the project would be involved
in the thinking and planning that designs the inquiry, manages its ongoing
process, and draws conclusions from it. Everyone would also be involved in
the action and experience being researched, that is, in the chosen
intentional practices, either to transform experiential illness in patient
members or to enhance experiential wellness in nonpatient members. The
nonpatient members cannot properly understand and grasp the nature of, and
make decisions about, intentional practices, and their dynamic relation to
other factors, unless they engage in them themselves.
The project might go through the following stages. The very detailed
account which follows is purely conjectural. In reality, the inquiry would
be co-operatively designed and managed, step by step.
First reflection meeting
This first reflection meeting might indeed extend over several meetings.
The co-operative inquiry initiators would facilitate and guide these early
meetings, and support the group in evolving basic concepts in basic English.
They may offer tentative conceptual frameworks as a basis for consultation
within the group.
The group develops a provisional working model of how human intention
and subjectivity mould bodily process and form; of the tacit
intentionality of experiential illness and its relation to observable
disease; of bedrock intentional ways of transforming experiential
illness into experiential wellness, and of enhancing experiential
wellness.
The group agree a provisional working model of all the main
influential variables as well as intentional agency, and a provisional
model of an effective life-enhancing pattern of interaction among them.
Such variables may include: intentional agency (self-help techniques),
psychosocial context, observable bodily process, co-agent interaction
(between patients, between nonpatients, between patients and
nonpatients) and external remedies and procedures used.
The group agree criteria for defining and recording the state of the
subjective, experiential body of all those involved in the project. This
includes the experiential illness of the patients, and the relative
experiential wellness of the nonpatient members. This recording is done.
The group agree criteria for defining and recording the state of the
external, observable body with regard to the observable disease of the
patient members, and along the same paramaters, the observable bodily
integrity of the nonpatient members. This recording is done.
The group agree on the range of self-directed techniques for recovery
from illness and for enhancing wellness, and practice together the
skills involved. They also agree on ways of monitoring and recording the
ongoing use of these techniques and their apparent effects, both
subjective and observable. Individual inquirers then choose the
particular techniques each is motivated to use for the first phase of
application.
The group agree on their time framework: how long each phase of
application will be, and how long each intervening meeting for review,
reflection and further planning will be; and how many cycles of
application and reflection there will be overall.
Cycles of inquiry
The group now embark on the agreed series of inquiry cycles.
In the first application phases, everyone is busy applying their
chosen self-directed techniques of intentional self-healing and enhanced
wellbeing, in the context of the agreed pattern of other influential
factors. They are also keeping records, as agreed above, of the use and
apparent effects of these and their contextual pattern.
At the next reflection meeting, all this data is shared and made
sense of within the whole group. In the light of this, group members
revise the several decisions made at the first reflection meeting, and
plan the next application phase to take account of these revisions.
In similar manner, the co-inquirers proceed through the remaining
inquiry cycles, moving from appplication phases to reflection and
forward planning meetings. Progressively, cycle by cycle, group members
modify and extend the use of self-directed techniques, accumulate data
about their effects, refine and amend the model of how all the relevant
influential factors may fruitfully interact.
During these cycles, the co-operative inquiry initiators will prompt
the group to take time out to review validity issues, for a full
discussion of which see Heron (1996). They include:
Managing divergence and convergence within and between
cycles. This attends to whether people are doing the same or
different things within a given application phase; also in this
application phase compared to the previous one. The balance
between divergence and convergence relates to the balance
between partitive and holistic accounts of the inquiry topic.
Balancing reflection and action. This means checking that
there is neither too much time spent on application in relation
to time spent on reflection, nor vice versa.
Securing authentic collaboration. This is done by attending
regularly to the right of each participant to have a genuine say
in all aspects of research decision-making, and to engage fully
in the application phases of the inquiry.
Challenging uncritical subjectivity and intersubjectivity.
One basic method is the adoption of some form of devil’s
advocate procedure in which time is taken by any group member to
confront possible collusion, delusion and illusion.
Managing unaware projections and displaced anxiety. This
means attending to and clearing emotional and interpersonal
distress activated by the inquiry process.
Attending to the dynamic interplay of chaos and order. This
involves tolerating phases of uncertainty, disorder and
confusion, allowing authentic order to emerge in its own good
time out of chaos, without rushing anxiously into premature
closure.
Completing the inquiry
The concluding reflection meeting, or series of meetings, will draw
together the threads of the inquiry.
The co-inquirers, patient and nonpatient, record their end states of
experiential illness and experiential wellness, and of observable
disease and observable bodily integrity; and compare these with the
opening - and any intermediate - records.
They exercise, on the basis of the accumulated experiential data, a
final discriminating judgment about the pattern of influential factors
that has been effective in any way. This will include, in particular and
of special interest, the weight to be given to the use of intentional
self-help techniques, as well as the other factors. Both common and
idiosyncratic findings are honoured, for both patient and nonpatient
members.
It is important to grasp here that what constitutes a valid effect -
the interacting pattern of all the relevant influential variables -
cannot be understood by selecting and controlling them and splitting
them up between different groups, as in conventional positivist
research. Nor can they be understood by someone, who is not involved in
their use, but is seeking to control their total interaction without
selection and splitting. Since they centrally include intentional
subjectivity, they can only be understood by those who are busy with it,
that is, by co-researchers who are also co-subjects. Getting hold of
this idea is one of the main stumbling blocks for positivist
researchers.
It is also interesting to note that similarities and differences - of
techniques used, their effects, their relation to other influential
factors - between patient and nonpatient members of the inquiry, will be
hepful in clarifying, for both groups, an understanding of all these
things.
They refine their practical knowledge of effective intentional
self-healing techniques, and prepare some descriptive guidelines for
their use.
In the light of all the above, they refine their original working
model of how human intention and subjectivity mould bodily process and
form; of the tacit intentionality of experiential illness and its
relation to observable disease; of intentional ways of transforming
experiential illness into experiential wellness, and of enhancing
experiential wellness.
They review the validity of their findings in the light of their use
of validity procedures and their skills in exercising critical
subjectivity and critical intersubjectivity.
They plan how to prepare some co-operative report on the whole
project. All co-inquirers read, edit and offer amendments to any initial
draft; and all agree the final version.
While a written report is valuable and useful, the primary outcome of the
inquiry is the range of practical knowledge gained by the co-inquirers: that
is, the skills involved in using intentional self-healing and
self-development; and the skills involved in harnessing them within a total
pattern of effective life-enhancing endeavour. Furthermore, from the
viewpoint of the participatory paradigm, of a subjective-objective reality,
any written findings have only contextual validity, that is their validity
is relative to the inquiry group that generates them and to its articulation
of reality. They are not generalizable in the traditional positivist sense
of external validity. They are only suggestive guidelines for other similar
groups with similar interests to devise their own action-oriented inquiry
and articulate their own reality.
8540 words, excluding introductory outline and references.
References
Abram, D. (1996) The Spell of the Sensuous. New York: Pantheon.
Argyris, C. (1968) ‘Some unintended consequences of rigorous research’,
Psychological Bulletin, 70: 185-97.
Argyris, C. (1970) Intervention Theory and Method: A Behavioural
Science View. Reading, MA: Addison Wesley.
Argyris, C. and Schön, D. (1974) Theory in Practice: Increasing
Professional Effectiveness. San Francisco: Jossey-Bass.
Argyris, C. Putnam, R. and Smith, M.C. (1985) Action Science:
Concepts, Methods nd Skills for Research and Intervention. San
Francisco: Jossey-Bass.
Bateson, G. (1979) Mind and Nature: A Necessary Unity. New York:
Dutton.
Bernstein, R.J. (1983) Beyond Objectivism and Relativism. Oxford:
Basil Blackwell.
Bradbury, H. and Reason, P. (eds) (2000) Handbook of Action Rsearch.
Thousand Oaks, CA; Sage.
Braud, W. & Anderson, R. (eds) (1998) Transpersonal Research Methods
for the Social Sciences: Honoring Human Experience. Thousand Oaks, CA:
Sage.
Brockman, J. (ed) (1977) About Bateson. New York: Dutton.
Carr, W. and Kemmis, S. (1986) Becoming Critical: Education, Knowledge
and Action Research, Basingstoke: Falmer Press.
Clements, J., Ettling, D., Jenett, D. & Shields, L. (1998) 'Organic
research: feminine spirituality meets transpersonal research', in W. Braud &
R. Anderson (eds) Transpersonal Research Methods for the Social Sciences:
Honoring Human Experience. Thousand Oaks, CA: Sage.
Cooperrider, D. L. and Srivastva, S. (1987) ‘Appreciative inquiry in
organizational life’, in R. Woodman and W. Pasmore (eds) Research in
Organizational Change and Development, Vol 1. Greenwich: JAI Press.
Cousins, N. (1990) Head First: The Biology of Hope and the Healing
Power of the Human Spirit. New York: Penguin.
de Cuevas, J. (1995) ‘The Pleasing Placebo’, article on the internet,
copyright President and Fellows of Harvard College.
Fals-Borda, O. and Rahman, M.A. (eds) (1991) Action and Knowledge:
Breaking the Monopoly with Participatory Action Research. New York:
Intermediate Technology/Apex.
Fryer, D. and Feather, N.T. (1994) ‘Intervention Techniques’,
Qualitative Methods in Organizational Research. London: Sage.
Gergen, K.J. (1973) ‘Social psychology as history’, Journal of
Personality and Social Psychology, 26: 309-20.
Goleman, D. (1996) Emotional Intelligence. London: Bloomsbury.
Guba, E.G. and Lincoln, Y.S. (1989) Fourth Generation Evaluation.
Newbury Park, CA: Sage.
Guba, E.G. and Lincoln, Y.S. (1994) ‘Competing paradigms in qualitative
research’, in N.K. Denzin and Y.S. Lincoln (eds) Handbook of Qualitative
Research. Thousand Oaks, CA: Sage.
Harré, R. and Secord, P.F. (1972) The Explanation of Social Behaviour.
Oxford: Basil Blackwell.
Heather, N. (1976) Radical Perspectives in Psychology. London:
Methuen.
Heron, J. (1971) Experience and Method. Guildford: University of
Surrey.
Heron, J. (1981a) ‘Philosophical basis for a new paradigm’, in P. Reason
and J. Rowan (eds) Human Inquiry: A Sourcebook of New Paradigm Research.
Chichester: Wiley.
Heron, J. (1981b) ‘Experiential research methodology’, in P. Reason and
J. Rowan (eds) Human Inquiry: A Sourcebook of New Paradigm Research.
Chichester: Wiley.
Heron, J. (1985) ‘The role of reflection in co-operative inquiry’, in D.
Boud, R. Keogh and D. Walker (eds) Reflection: Turning Experience into
Learning. London: Kogan Page.
Heron, J. (1986) ‘Critique of conventional research methodology’,
Complementary Medical Research, 1(1): 12-22.
Heron, J. (1988) ‘Validity in co-operative inquiry’, in P. Reason (ed)
Human Inquiry in Action. London: Sage.
Heron, J. (1992) Feeling and Personhood: Psychology inAnother Key.
London: Sage.
Heron, J. (1996) Co-operative Inquiry: Research into the Human
Condition. London: Sage.
Heron, J. (1998) Sacred Science: Person-centred Inquiry into the
Spiritual and the Subtle. Ross-on-Wye: PCCS Books.
Heron, J. (2000) ‘Transpersonal co-operative inquiry’, in H. Bradbury and
P. Reason (eds) Handbook of Action Rsearch. Thousand Oaks, CA; Sage.
Heron, J. and Reason, P. (1985) Whole Person Medicine: A Co-operative
Inquiry. London: British Postgraduate Medical Federation.
Heron, J. and Reason, P. (1986) ‘Research with people’,
Person-centered Review, 4(1): 456-76.
Heron, J. and Reason, P. (1997) ‘A participatory inquiry paradigm’,
Qualitative Inquiry, 3(3): 274-294.
Heron, J. and Reason, P. (2000) ‘Co-operative inquiry’, in H. Bradbury
and P. Reason (eds) Handbook of Action Rsearch. Thousand Oaks, CA;
Sage.
Heron, J. and Reason, P. (1997) ‘A participatory inquiry paradigm’,
Qualitative Inquiry, 3(3): 274-294.
Israel, J. and Tajfel, H. (eds) (1972) The Context of Social
Psychology: A Critical Assessment. New York: Academic Press.
Joynson, R.B. (1974) Psychology and Common Sense. London:
Routledge and Kegan Paul.
Kelly, G.B. (1993)Karl Rahner: Theologian of the Graced Search for
Meaning. Edinburgh: Clark.
Lincoln, Y.S. and Guba, E.G. (1985) Naturalistic Inquiry. Beverly
Hills, CA: Sage.
Merleau-Ponty, M. (1962) Phenomenology of Perception. London:
Routledge and Kegan Paul.
Olesen, V. (1994) ‘Feminisms and models of qualitative research’, in N.K.
Denzin and Y.S. Lincoln (eds) Handbook of Qualitative Research.
Thousand Oaks, CA: Sage.
Reason, P. (1986) ‘Innovative research techniques’, Complementary
Medical Research, 1(1): 23-39.
Reason, P. (1988a) (ed.) Human Inquiry in Action. London: Sage.
Reason, P. (1988b) ‘Whole person medical practice’, in P. Reason (ed.)
Human Inquiry in Action. London: Sage.
Reason, P. (1991) ‘Power and conflict in multi-disciplinary
collaboration’, Complementary Medical Research, 5(3): 144-50.
Reason, P. (1994a) (ed.) Participation in Human Inquiry. London:
Sage.
Reason, P. (1994b) ‘Three approaches to participative inquiry’, in N.K.
Denzin and Y.S. Lincoln (eds) Handbook of Qualitative Research.
Thousand Oaks, CA: Sage.
Reason, P. and Heron, J. (1986) ‘The human capacity for intentional
self-healing and enhanced wellness: a research proposal’, The British
Journal of Holistic Medicine, 1(2): 123-34.
Reason, P. and Heron, J. (1995) ‘Co-operative inquiry’, in J.A.Smith, R.
Harré and L. Van Langenhove (eds) Rethinking Methods in Psychology.
London: Sage.
Reason, P. and Rowan, J. (1981) (eds) Human Inquiry: A Sourcebook of
New Paradigm Research. Chichester: Wiley.
Schön, D. (1983) The Reflective Practitioner: How Professionals Think
in Action. New York: Basic Books.
Shotter, J. (1975) Images of Man in Psychological Research.
London: Methuen.
Skolimowski, H. (1994) The Participatory Mind. London: Arkana.
Smith, J.A., Harré, R., and Van Langenhove, L. (eds) (1995) Rethinking
Psychology. London: Sage.
Spretnak, C. (1991) States of Grace: The Recovery of Meaning in the
Postmodern Age. New York: Harper Collins.
Torbert, W.R. (1991) The Power of Balance: Transforming Self, Society
and Scientific Inquiry. Newbury Park, CA: Sage.
Varela, F., Thompson, E., and Rosch, E. (1993) The Embodied Mind.
Cambridge, MA: MIT Press.
Weinstein, J. (1974) ‘Allocation of subjects in medical experiments’,
New England Journal of Medicine, 291: 1278-85.
Return to Practitioner papers