USES AND ABUSES OF PHILOSOPHY IN CHIROPRACTIC
I.D. COULTER, PH.D.
"It was the best of times,
It was the worst of times,
It was the age of wisdom,
It was the age of foolishness,
It was the epoch of incredulity."
Charles Dickens A Tale of Two Cities
In many ways, these lines by Dickens accurately portray the present
state of philosophy in chiropractic. There is, on the positive side, a
new interest in philosophy and a small, but active, group of scholars
publishing papers in this area. Where Donahue could, in 1989, plead
for annual conferences on philosophy (1), two such conferences have
since occurred, at the Canadian Memorial Chiropractic College in
1990 and at Alice Springs, as part of the Chiropractic Association of
Australia meeting in 1991. In both instances, the presented papers
were published in refereed journals. Further, in 199 1, The National
College of Chiropractic published its first Philosophical Constructs for
the Chiropractic Profession and is currently publishing the second in
this series. While it is too soon to predict what the impact of this
activity will be on chiropractic, some major themes are already
emerging. This paper will comment on two such items.
THE NEW PERSPECTIVE ON PHILOSOPHY
The first theme is an increasing recognition that chiropractors have
abused the term "philosophy" to describe chiropractic. For the most
part, what was described was not philosophy, or where it was, it
was not chiropractic. Most of "chiropractic philosophy" turns out to be
begged, borrowed, or stolen from elsewhere. Philosophies such as
vitalism, holism, critical rationalism, etc, were neither developed by
chiropractic nor unique to it. This has led several authors to suggest
that there is no chiropractic philosophy, but that there could be, and
perhaps should be, a philosophy of chiropractic (2-5). As McAndrews
notes: "The meanings of the term philosophy are not, in my opinion,
well understood by the profession. It has been so distorted by use in
improper contexts, by use when assigned an inappropriate meaning
and by being involved when the subject had little or nothing to do with
philosophy (anecdotes about the effectiveness of chiropractic care)
that an effort to trace its use back to a clear beginning is almost
fruitless." (6) This situation led the present author to propose at the
Australian Conference three philosophical propositions:
1. Chiropractic philosophy has no future.
2. Chiropractic philosophy has no past.
3. Chiropractic has no philosophy. (7) Disturbing as this might seem
to most chiropractors, no other conclusion is possible to anyone who
is either conversant with chiropractic history, and the origin of
Palmer's ideas, or with philosophy. Writers, such as Kleynhans have
gone further and suggested that even a philosophy of chiropractic is
not possible. (8)
The second major theme that is emerging is that the solution to this
problem is not a retreat from philosophy, but a greater immersion in
the fields of general philosophy on the part of chiropractors, and the
application of these to chiropractic problems. That is, the solution is
for the APPROPRIATE use of philosophy and not its abuse.
Increasingly, the proposed candidate within the fields of philosophy is
either the philosophy of the science of chiropractic (9-13) or a newly
constructed philosophy of the science of chiropractic (6-14). The work
of such philosophers as Thomas Kuhn is being utilized in this task of
applying the philosophy of science to chiropractic (15 -22).
THE CAUSES
There is also an increasing understanding of why the abuse, rather
than the use, of philosophy occurred. Part of it is historical. Palmer,
for all his intellect, was himself confused about philosophy and its role
and passed on this confusion to the profession (23, 24). Further,
chiropractic philosophy emerged as a way of defending chiropractic in
court and not as a fundamental exercise to clarify chiropractic
thought. Under B.J. Palmer, the philosophical tenets became doctrine
and dogma which were challenged only at the risk of challenging true
chiropractic - the very antithesis of genuine philosophical inquiry (22-
24). The continuation of this unfortunate legacy was due in large part
to chiropractic's intellectual and academic isolation.
Had chiropractic formed part of mainstream university education, it
would have been forced to develop a more sophisticated
philosophical defense, or suffer the indignity of being laughed out of
the academic court (25).
The expression of the concerns of the new perspective is not itself
new. Weiant had earlier suggested that the term chiropractic
philosophy be abandoned since it described no academic discipline
(26) and Eisenberg, as early as 1969, was using the general
branches of philosophy - in particular, logic to both examine the
philosophical defense of chiropractic and the fallacies in allopathic
medicine's attack on chiropractic (27). Such writers as Watkins tried
valiantly to erect a powerful philosophy based on science for clinical
practice (28). But until recently these have tended to be isolated and
lonely voices within the profession. The real philosophy was held to
be that peddled by the metaphysical merchants and which amounted
to little more than practice-building motivational seminars - all given
by persons who, to steal a line from Donahue, would not know a
principle from a prince.
What has changed is the number of voices now being raised and the
source of the voices. As Donahue has noted, traditionally the
"philosophy" was left largely to those in the "straight" camp of
chiropractic while the "mixers" tended, as a reaction, to deny the
need for philosophy (1). Either rejecting, or embarrassed, by what
was proffered as philosophy, they abandoned philosophy altogether
and went in search of the Holy Grail of rational chiropractic, that is,
science. The new voices, however, are increasingly from the camp of
"rational" chiropractic. This traditional schism created a very false
dichotomy in chiropractic between those who choose science verses
those who choose philosophy, and the result has been described
elsewhere as the chiropractic wars (2). Tragically for chiropractic,
these never were philosophically alternative choices. The best of
science is inextricably involved in philosophy and is inherently
metaphysical (25). On the other side, metaphysical beliefs are
heuristically more useful in an applied field when tied to science and
placed within rational discourse. All the physical structures ever built
by humankind from the pyramids of ancient Egypt to the San
Francisco Harbor bridge contest to this principle. The sciences
underlying the structures, such as euclidean geometry, are not
metaphysically free, but metaphysics made useful.
DOES IT MATTER
There is a tendency amongst practitioners to write off such
discussions as academic exercises having no importance for them or
their practice. Two considerations of chiropractic will make the
illogicality of this stance obvious.
Quite clearly, the conspiracy by medicine against chiropractic hurt us
(and was judged to have done so by the courts or the injunction
against medicine would never have been issued). At the very heart of
the attack of medicine, and the way it was portrayed publicly, was the
claim that chiropractic was unscientific and that allopathic medicine
was scientific. Anyone familiar with the philosophy of science at least
from the 1930s with the introduction of the work of Sir Karl Popper,
would have known that the attempt by philosophers to demarcate
science from science (despite Popper) had failed. Furthermore, they
would have also known that medicine's claim to be a science had no
epistemological base. It is not that chiropractors did not suspect both
of these things, and some may have even understood them, but they
lacked both the philosophical sophistication or credibility to mount a
successful challenge. Furthermore, so called "chiropractic
philosophy" was totally incapable of providing the intellectual
weaponry for a successful counter attack. Chiropractors, for the most
part, made the intellectual mistake that this was a battle about
scientific research and either capitulated in the face of the total lack of
chiropractic research (on the grounds that medicine was right) or
turned to a form of rationalism that was in essence anti-scientific and
which said, in effect, that we do not need research since our patients
prove every day that chiropractic works. Chiropractic attempted to
fight a philosophical battle on the basis of patient testimonials. It is
little wonder that medicine was largely successful in this battle since
chiropractic failed to correctly identify the nature of the battle, the
weapons with which to fight it, or the strategies to win. Instead, it fell
back on its only defense, the use of politics. While this did allow
chiropractic to survive, it is often been falsely interpreted by
chiropractors as a victory. One only has to enter any university in the
land and begin a conversation with the science faculty about
chiropractic to understand the terrible damage medicine's
philosophical attack continues to inflict on the perception of
chiropractic. One result of this attack was to force chiropractic to
become more "scientific," but in the sense of including more science
in the curriculum. Keating has correctly identified this as a response
and has termed it a flight into rationalism although the present author
would term it rationalization not rationalism (29).
Perhaps, even more important, was the confusion that has been
created within the public and the patients of what chiropractic is. For
most of their history, chiropractors have identified themselves in two
philosophical camps, straights and mixers, and have done
considerable battle under these banners as if they meant something
important - worth living or dying professionally for. In the Canadian
study of chiropractors, the researchers attempted to investigate the
importance of these philosophical camps to both the chiropractors
and the patients (30). Each chiropractor was asked to identify which
camp he felt he belonged to, that is, whether they would describe
themselves as predominantly straight or mixed (no definition of the
terms were given). Furthermore, each chiropractor, at the end of the
study, was asked to give his/her definition of chiropractic and these
were coded according to the elements that were stressed. The results
are shown in Table 1.
In Table 1, the first column gives the percentage of the total sample
of chiropractors who stressed, for example, philosophy; the second
column gives the percentage of those who described themselves as
mixers who stressed philosophy, and column three, the percentage of
straights who did. The first obvious conclusion from Table I is that the
groups are not that distinguishable in terms of how they define
chiropractic and that in neither group is the philosophical element the
one most stressed. This is a result somewhat at odds with the
rhetoric of chiropractic which would have us believe that straights and
mixers have fundamentally different definitions of chiropractic.
However, even more interesting was the result that of those giving
essentially a straight definition of chiropractic (as judged by the
researchers), 47 percent were self-described mixers. Conversely, of
those giving an eclectic definition of chiropractic, 46 percent were
self- described straights. Whatever else these camps do in
chiropractic, it would appear that giving concise, clear, and distinct
definitions of chiropractic is not one of them.
A further question tapped the extent to which the chiropractor used
philosophy to explain the illness and treatment of the patients, and for
the justification of chiropractic. The study also asked the patients to
describe chiropractic. Their responses, like the chiropractors, were
coded with regard to whether they included any thing about the
philosophy etc. of chiropractic. The relevant information is given in
Table 11. In the table, the first column gives the percentage of the
chiropractors who stressed philosophy in explaining the illness; those
who used philosophy to justify chiropractic are in column two. The
third column gives the percentage of patients who utilized any
philosophy etc. in describing chiropractic.
The data in Table 11 (not included) indicate that philosophy is used
much more by chiropractors to justify chiropractic than to explain
illness or treatment which supports the contention that it traditionally
was introduced more for this reason than for anything else. More
importantly, however, is the fact that very little of the philosophy gets
through to the patient or is utilized by them in explaining what
chiropractic is. If chiropractic is truly an alternative health philosophy,
then it is apparent that the patients are unable to articulate what
chiropractic philosophy is. It is this lack of philosophical clarity
amongst chiropractors themselves that almost guarantees that the
patients, the public, and the politicians will have only the vaguest idea
of "chiropractic philosophy," That which defies clarification, definition,
and articulation generally also defies communication.
USE OF PHILOSOPHY
The solution to the problem of abuse is not that complicated. It
requires recognizing that philosophy is an activity not a doctrine.
Further, it is a reflective activity whose purpose is clarification of
thought. It does this through a process of critical reflection and
conceptual analysis, that is, by subjecting all the concepts of a
discipline to rigorous critique.
Ladd proposes four propositions for philosophy:
1. Philosophy is always the philosophy of something: it has no subject
matter of its own; hence we have a philosophy of law, of science, of
education, of chiropractic
2. Philosophy inevitably and necessarily implies a critical evaluation
of concepts and the structures in which they are framed
3. Philosophy is problem-oriented; in fact, it exists to solve problems
4. Philosophy is inexorably controversial (3 1)
Once the nature and purpose of philosophy is understood, the
second requirement is that chiropractors become educated in
philosophy at least to the same level that they now are in the
biological sciences. This would require at a very minimum that they
receive an introduction to the various branches of philosophy such as
metaphysics, logic, ethics, aesthetics, epistemology and the fields
most relevant to chiropractic, such as the philosophy of science.
However, if all that occurs is that some courses in philosophy are
added to the curriculum, while our graduates will at least be more
literate in philosophy, we will be repeating the problem alluded to
earlier with the basic sciences: rationalism. Therefore, a third step
requires that at least some of the profession become engaged in the
application of philosophy to chiropractic problems. Bernard Shaw, in
his play Major Barbara, berates the morality of the Salvation Army
taking money from an armament manufacturer. Major Barbara's
response is that they are only too happy to get the money out of the
manufacturer's hands and into the hands of the Lord where it will do
some good. Chiropractors similarly need to get philosophy into the
hands of some chiropractors where it can do some good for
chiropractic.
The purpose in all this is not to stifle debate, but to stimulate it. No
concepts should be ruled as a priori valid or invalid but each should
be subjected to debate within a rational discourse. Those that survive
such an intellectual baptism of fire will strengthen the profession;
those that do not hopefully will not survive. Our concepts would
emerge stronger, clearer and defended by intellectually respectable
argumentation. As Bachop has noted, in its present form, the concept
of innate is a form of word game whereby chiropractors assume that
by naming something they have, by that act, explained it (32). He
also notes that the argument in favor of the concept is a tautology;
that it is true by definition and is therefore an analytic statement.
Unfortunately for chiropractors, when they invoke the concept of
innate, they mean it to say something true about the body and health,
that is, they intend it as a true statement about the real world.
Logicians have already shown that analytic statements are
definitionally true irrespective of what may be true in the world. For
example, "all men are men" is a definitionally true statement since
there is no definition of man that would make it untrue. This would
mean, for example, if one man was in fact a wolf, the statement
would still be true. If one wishes to make an empirical statement
about the world, it cannot be made (logically) as an analytic
statement. A philosopher would therefore be legitimate in asking what
do chiropractors posit the concept innate as? Do you intend it as a
truthful statement about the world? If so, you cannot frame it as an
analytic statement or defend it with a tautology. Empirical statements
must, of necessity, allow for the possibility of being untrue. Of course
the truth is most chiropractors have no notion of what kind of concept
it is. It is for this reason that Donahue concluded that the concept
could not survive the critical evaluation of an undergraduate student
in philosophy (33). This is not, as some other chiropractors would
have it, a defeat of the metaphysical/philosophical system underlying
the concept of the innate (i.e. vitalism), but simply a defeat of the
inappropriate way it has been formulated and used in chiropractic.
CONCLUSION
This conclusion is more in the form of a plea. Neither of the broad
philosophical camps in chiropractic, irrespective of how they are
labeled, straights versus mixes, traditionalist versus eclectic,
rationalists versus innatists, scientists versus intuitive - has been
immune from the abuse of philosophy. We might usefully adopt a
biblical approach and announce a plague on both their houses. As
the author has noted previously, not only are they both wrong with
regard to philosophy, they are both wrong for the same reason:
ignorance (2).
What needs to emerge is scholars in chiropractic that are
philosophers. I mean persons literate in philosophy, who understand
the crucial debates occurring within the fields of philosophy, and who
are themselves engaged philosophically in the important issues of
chiropractic. One does not become a great scientist by observing
science, reading science, or talking to scientists. One becomes a
great scientist by doing science. It is this doing of philosophy that
chiropractic needs to get on with. To illustrate this point, several
chiropractic authors have now invoked the concept of paradigm of
Thomas Kuhn to describe chiropractic. However, to date, none of this
work has been done within the critical debate that surrounds Kuhn's
work within philosophy (20). Kleynhans has made an excellent
suggestion that the positive-empiricist paradigm of contemporary
science is inappropriate for understanding the doctor-patient
relationship and that phenomenology is a more appropriate paradigm
(34). But phenomenology itself has been widely discussed and
critiqued, within the social sciences along with other nominalist
paradigms such as symbolic interactionism and ethnomethodology.
To adopt these concepts or paradigms without immersing ourselves
in these debates will simply move chiropractic from the philosophical
fat to the philosophical fire.
Chiropractic could usefully learn from other disciplines in examining
how they have used philosophy for similar problems (35). Further,
they need to relate these issues to the task of deriving both a
philosophy of health and a philosophy of chiropractic health care that
is logically consistent with the former, and derivable from it (36).
Such work is time consuming and often tedious. Those doing it must
also continue to eat, earn a living, and for the most part, do other
things to survive. In chiropractic, at present, philosophy more
resembles a hobby than a career. It is possible to get research grants
and support; it is even possible to create a research career of sorts in
chiropractic. Your articles will get published in refereed journals. No
such support is available for philosophers, and while the articles will
probably get published, they will be in the commentary section where
the implication is that they are somehow less important, or took less
work, than original research. In the author's experience, philosophical
writing is much more onerous than scientific writing. It requires, as a
prerequisite, much more reading in more diverse areas of
scholarship. Any who doubt this are directed to review the leading
philosophical journals and merely look at the footnotes for the articles
which in themselves are frequently longer than many scientific
papers. It requires a greater demand for clarity, logical consistency,
and coherence, particularly since philosophy claims as its purpose
the clarification of thought and is therefore hoist by its own petard. To
paraphrase Ben Jonson, one should not wonder that it is not done
well; one should wonder that it is done at all. And at the end of it all,
you are almost certain, in the words of Charlton, to get up the
collective noses of the profession, but philosophy to which persons
are indifferent to would be no philosophy at all. There lies the
dilemma of the philosopher. How does one convince his/her
professional peers to support them in an exercise in which he/she will
challenge all the ideas they hold dear; suggest they reject much of
what they have learned as illogical, irrelevant, or philosophically
illiterate; and expect to get thanked, paid and honored for doing so
Perhaps they might turn to philosophy for comfort:
"Philosophy is that which enables the rich to say there is no disgrace
in being poor."
"Philosophy is the study which enables man to be unhappy more
intelligently."