Archive for the ‘holism and reductionism’ Category

Reductionism and Holism: the Practical Holism of Nursing Practice (Part 3)

December 29, 2009

Holism and Reductionism in Nursing

In two previous posts, I have explored some of the meanings of “reductionism” and “holism” found in the philosophical literature (see Reductionism and Holism: Three Varieties (Part 1) and Reductionism and Holism: Ontological (Part 2)). While these conceptions of holism and reductionism have been influential in the nursing literatures, they do not exhaust the uses of the terms “holism” and “reductionism.” Indeed, there is a use of “holism” in nursing that seems to fit neither the epistemological nor the ontological senses of the term. It is nicely illustrated in the following passage from Rosemary Ellis’s “Characteristics of Significant Theories” (Nursing Research 17 (3): 217-222):

Holism, if used as the appropriate view for aiding a patient, requires that one be concerned with any factor, be it physiological, social or any other, which affects the patient’s health. It requires that the factors be treated in combination, not in isolation. It also means that the combination is not the same as the sum over each factor. Nursing requires the recognition of the inseparability and interdependence of many factors. (p. 218)

What conception of holism is embedded in this text?

Practical Holism

The first point to notice is that the topic—that about which one is to be holist or reductionist—is not theory; it is practice. This means that Ellis is not expressing epistemological holism. That is, she is not taking position on how theories are related (e.g. whether sociology might reduce to biology, for instance). Nor does she seem to be taking a position on what exists (at least not directly, more on this below). Holism, according to Ellis, is something that might be “the appropriate view for aiding a patient,” and it requires a specific kind of concern. It is a practical commitment to treat the factors influencing a patient’s health in combination.
The “reductionism” that Ellis implicitly opposes is found in medicine. Physicians were portrayed in this period (and often since) as narrowly concerned with the patient’s disease or dysfunction. (Whether this is an accurate portrayal is an open question.) The nurse, by contrast, was charged with a broad responsibility for the patient and his or her environment. A reductionist approach in this domain would consider a patient’s disease or dysfunction in abstraction from the other factors. Because of her role in health care, a nurse cannot be so limited.

The broad responsibility of a nurse is the source of the idea that nursing is committed to holism. The nursing role demands that a nurse attend to any and all factors that affect a patient’s health. To limit nursing concern to one organ system, or to one dimension of psychological or social dysfunction, would be to ignore the broader context of patient health which has been central to nursing since Nightingale’s time.

Practical holism, then, is the commitment to address the whole of a patient’s health. Each of the many factors that affect a person’s wellness needs attention, and they must be attended to in a way that recognizes the interactions among them.

Ontological implications

Practical holism is different from epistemological and ontological holism. But what are its implications? Does practical holism entail strong (or weak) forms of ontological or epistemological holism?

Arguably, practical holism is inconsistent with strong forms of ontological holism. A strong ontological holist about minds, for instance, holds that the existence of minds is independent from the existence of bodies. The mind and body are causally linked, to be sure, but the connections are contingent. Changes in the nervous system need have no affect on the mind. Ironically, ontological holism about the mind supports a kind of reductionism in the practical realm. An intervention might target the mind alone without consideration of the body, for after all, they are independent.

In the nursing literature there are some very strong commitments to ontological holism – in the work of Rogers or Parse, for instance. If the foregoing arguments are correct, then the metaphysical views of Rogers or Parse are incompatible with the nursing commitment to address the whole patient.

Practical holism, Ellis says, “means that the combination is not the same as the sum over each factor.” This suggests that the mind and body (to continue the example) should be understood as interactive. They are not two ontological kinds linked by contingent inputs and outputs, rather, they are aspects of the same reality. The moderate holism of the gate control theory of pain (see Reductionism and Holism: Ontological for a brief discussion) is much better suited to the commitments of practical holism. Nursing interventions need to consider the physiological, psychological, and social dimensions of pain in combination. If these “factors” are conceptualized in a unified way—pain is both something experienced and a physical phenomenon—it will be natural to design interventions that are not merely a “sum over each factor.”

Conclusion: Nursing and the Three Varieties of Holism

Nurse scholars often characterize their discipline by a commitment to holism. This commitment is sometimes used as a basis for rejecting certain kinds of research as not properly part of nursing science. Causal models of biological, psychological, or social systems are often marginalized for this reason. The foregoing discussion provides a new perspective on such claims.

A commitment to practical holism is a consequence of a traditional conception of the nursing role. If nurses are charged with attending to the full gambit of patient needs, then nurses are committed to the whole patient. They could not be reductionist in the sense of attending to just one factor affecting health. Practical holism, then, is arguably central to nursing practice. Epistemological and ontological holisms are not similarly implied by nursing practice, and therefore they are not central to the nursing discipline.

It is plausible to reject causal models because they conflict with the holism only if one conflates the different varieties. Once the varieties are distinguished, we can appreciate some of the subtle relationships among them. The moderate ontological holism of the gate control theory of pain, for example, is more compatible with the practical holism of nursing than the strong holism of Rogers or Parse. Far from being marginal to the nursing discipline, some kinds of mechanistic causal modeling might be central to it.

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Reductionism and Holism: Ontological (Part 2)

November 28, 2009

The story so far…

In Varieites of Reductionism: Three Varieties (Part 1), I discussed the problem of reductionism as it appears in nursing and described “epistemological reductionism.” This involves the relationship of one theory to another. There are two other kinds relevant to the issue of reductionism: ontological reductionism and practical reductionism. This post will articulate ontological reductionism.

Ontological reductionism and holism

Questions of ontology concern what exists and what kinds of things there are. Whether God exists, whether the number 2 exists, and whether cats have minds like ours are ontological questions. Questions of ontological reductionism ask whether one (purported) kind of thing can be identified with another. Thus, to say that there are no minds or spirits, only brains, is to take a reductionist position.

Note the difference between ontological and epistemological reductionism. In epistemological reductionism, the question about minds and brains is whether our knowledge of minds (and how they work) could be reduced to knowledge of brains (and how they work). The ontological question is whether there are two kinds of things (minds and brains) or just one (brains). The denial of ontological reductionism about the mind would hold that minds exist independently of brains.

Ontological holisms and reductionisms come in weak and strong forms. Strong holism contends that the two domains exist independently. Those who hold that the mind (or spirit) is a non-material entity which can survive the death of the body affirm a strong form of holism about the mind. Those who affirm that only brains exist affirm a strong form of reductionism.

Pain and weak holism

Middle positions are possible, and the Gate Control Theory of Pain provides an interesting example. The Gate Control Theory holds that pain signals travel along two kinds of neural circuit. One runs directly from the injured site to the motivational parts of the brain. The other goes through the higher processing, cognitive parts of the brain. The latter forms a “gate” which can block or modulate pain sensations. Is this a form of ontological reductionism? It seems so, insofar as pain is identified with neurological circuits. Notice, however, that the feeling of pain is not eliminated or explained away. It would be odd to be skeptical about the existence of the feeling of pain in a way that it is not odd to be skeptical about the existence of, say, souls.

The Gate Control Theory assumes that people feel more or less pain, depending on their emotional or cognitive state. Both the feeling of pain and the neurological states are assumed to exist. Hence, it is not strongly reductionist, since it does not deny that pains exist. Nor is it strongly holist, since the feeling of pain is said to depend on neural state; without neurological events, there would be no pain. The Gate Control Theory thus illustrates a weak form of ontological holism.

Conceptual Change

The ontological commitments of the Gate Control Theory are an intriguing example of the kind of conceptual change that comes about through scientific research. We come to understand our feelings of pain as complicated neural events. This is not as strange as it sounds at first. We understand hot and cold as the mean kinetic energy of molecules, and hot and cold are, in the first instance, feelings. There are not two things—heat and mean kinetic energy—there is but one, mean kinetic energy. The conceptual change instituted by theories like the kinetic theory of heat or the Gate Control Theory of pain are changes where two distinct concepts are unified.

To be continued…

Reductionism and Holism: Three Varieties (Part 1)

November 1, 2009

“Reductionism” is something of a dirty word in nursing and other health sciences. To call a theory “reductionist” is to criticize it as limited and uninteresting. Nurse scholars tend to view nursing as holistic, and therefore rejecting a theory because it is reductionist puts it outside the domain of nursing scholarship. This argument was very important during the rise of nursing qualitative research in the 1980s, and it continues to appear in discussions about the character of nursing science.

But what does “reductionism” mean? What makes a theory reductionist? And why is reductionism a bad thing? These questions are made more complex by the fact that “reductionism” is used in several different ways. It will go some way toward answering these questions if we can sort out some of the different things that people have meant by these terms.

Notice that the verb “reduce” typically implies a relationship. One thing (or sort of thing) is reduced to another. This means that we can gain some purchase on what reductionism amounts to if we begin by asking what is being reduced to what, and how are they related? In the context of scientific research, it is theories (or better, aspects of theories) that are described as reductionist. Hence it is a relationship among (aspects of) theories with which we will primarily be concerned. Moreover, questions of reduction typically involve a “higher” and “lower” level. The question is whether theories at the higher level can be reduced to those at the lower level.

“Reductionism” and “holism” are conceptually intertwined. At first glance they may seem to be contraries: to say that a theory is holistic is to deny that it is reductionistic, and vice versa. The vast literature in the philosophy of science shows that matters are not so simple. There are, of course, some extreme forms of reductionism and holism that do define the concepts in oppositional terms. To insist, for example, that the existence of the mind is completely independent from the existence of the body, as Descartes did, is a strong form of anti-reductionism (or holism) about the mental. It is opposed to a thoroughgoing materialism which insists that no minds exist, only brains. There are, however, a range of middle positions that relate mind and body, neither reducing one to the other nor insisting on their separation.

We will need to speak, then, of stronger and weaker forms of holism and reductionism. The strong forms of holism will hold that two domains (e.g. minds and bodies) are utterly distinct and independent; strong forms of reductionism will eliminate one domain by collapsing it into another (e.g. minds are nothing but brains). The weaker positions will hold that the two domains are distinct (thus denying strong reductionism) and that they depend on each other (thus denying strong holism).

Epistemological Reductionism

One motivation for reductionism has been epistemological economy. To reduce one theory to another in this sense is to show that knowledge of one domain suffices for knowledge of another. Philosophers, scientists, and mathematicians have been interested in epistemological reduction because it promises to tighten up justifications.

Classical empiricism is reductionist in the epistemological sense. Empiricists hold that all knowledge arises from experience, and the classical empiricists (Locke, Berkeley, Hume) understood experience in terms of perceptual ideas. Elementary or simple experiences of color, shape, taste, sound, and so on formed the indubitable foundation for all other knowledge. Their project was to show how complex ideas could all be constructed from simple ones. Challenges arose for empiricists in areas where it was difficult to show that the concepts and judgments were constructions of simple ideas. Hume’s critique of causality can be understood as a struggle to understand how knowledge of causes can be reduced to knowledge obtained through direct perception. Mathematics was also challenging: is “2+2=4” a generalization from experience? What about the Pythagorean Theorem? The rationalists argued that knowledge of mathematics and ultimate causes could not be justified by experience alone, and they therefore represent a form of epistemological holism.

In contemporary scientific inquiry, questions of epistemological reductionism are asked about different levels of inquiry. In the social sciences, for example, there has been a long debate about how social theories are related to psychological theories. Durkheim explicitly denied that his explanations of social relationships could be understood in terms of individual choice. This form of holism was opposed by the “methodological individualists,” who tried to think about social phenomena as the outcome of patterns of individual actions.

In epistemological reductionism, then, issue is whether one sort of theory or intellectual domain can be fully explained by reference to another. Strong forms of epistemological reductionism hold that the higher level theory can be entirely constructed or justified by our knowledge of the lower level theories. In other words, a reductionist about the social might hold that once we knew everything about individual choices and motivations, we would be able to predict and explain the character of institutions. Similarly, epistemological reductionists about the mental would hold that all psychological experience can be understood in terms of neurological mechanisms.

Strong forms of epistemological reductionism hold that some higher-level domain can be fully understood (predicted, explained, justified) in terms specified by a lower level domain. Strong forms of epistemological holism hold that knowledge of the two domains is independent: knowledge of the lower level (e.g. neurological events or individual choices) tells us nothing about the higher level (e.g. mental or social phenomena). There are many varieties of weak holism too. A weak form of holism would deny the strong reductionist claim, but not go so far as the strong holist. On these kinds of view, knowledge of the lower level is relevant, but not exhaustive. Higher level theories would require concepts and methods of justification that were different from those used at the lower level, but knowledge of the lower level is important for a full explanation of higher level phenomena.

Many theories in the health sciences exhibit a commitment to moderate epistemological holism. The gate-control theory of pain, for example, relies on an understanding of neurological mechanisms to explain pain. But a person knows that she is in pain because of her experience, not because of her knowledge of neuroscience.

Other Forms of Reductionism

Two other forms of reductionism are ontological reductionism and practical reductionism. The motivation for ontological reduction is ontological economy: trying to show how some parts of the world are constructed from others. When nurses affirm the value of holism, they are often not denying either epistemic or ontological reductionism. Rather they are affirming the value of a complete and integrated approach to the patient. This is practical holism, and in the next post, we will discuss how it is different from epistemological and ontological holism.

To be continued…

See: Reductionism and Holism: Ontological (Part 2)