Analysis
Postmodernism and Medicine
HEALING IS BELIEVING:
POSTMODERNISM IMPACTS NURSING
Susan Anthony Salladay
Abstract: Nursing’s most influential theorists of the
decades from the 1950s through the 1980s paved the
way for the profession’s almost universal acceptance of a
postmodern worldview that radically alters nursing’s understandings of personhood, healing, and health care.
No longer is the physician the healer, nor the nurse his
handmaiden. Instead, the healer is the Self—the Divine
within. Alternative therapies assist patients in accomplishing their own healing. The purpose and goal of the
nurse is to provide physical, psychosocial, and spiritual
care to empower patients to recover health through a variety of self-healing techniques involving direction and
exchange of spiritual forces or energies. Nursing theory
and practice reflect a postmodern worldview that contrasts with both the skepticism of modernism’s scientific
rationalism and orthodox Christianity’s biblically based
understandings of divine and human personhood, health
and healing.
Y
OU CAN HEAL YOURSELF!
A POPULAR THEME IN
health care today that is surfacing everywhere, it
promises wondrous results, encouraging and empowering
people to take responsibility for their own health. For example, a brief article in Better Homes and Gardens magazine’s “Health Update” column urges readers to “chant
away high blood pressure” by combining meditation
with medication. Reporting results of a study in the
American Heart Associations’ journal Hypertension, the
column claims that “Transcendental Meditation (TM)
effectively reduced high blood pressure in a group of
African-American men and women with high stress and
other high risk factors of the disease.” TM is described as
a “technique” that involves “sitting in a comfortable position and repeating a sound or word for 20 minutes, usually twice a day. The goal is to eliminate all distracting
thoughts and gain a deep sense of restful alertness.”1
Postmodern nursing has embraced Transcendental Meditation along with a number of other “techniques.”
Amid the tubes and lines and high-tech medical devices in intensive care units (ICUs) across the country,
a quiet revolution is spreading, accompanied by the
soothing sounds of music synthesizers and the gentle
touch of nurses trained in contemporary versions of the
ancient art of laying on of hands. Complementary therapies range from acupuncture, acupressure, aromatherapy, and massage to therapeutic touch, healing touch,
music therapy, and guided imagery—all are subsets of
holistic medicine which emphasizes a mind/body/spirit
approach to health.2
In claiming that holistic care has gained acceptance
in hospitals around the country, Medical Ethics Advisor
notes that nursing organizations tend to be less guarded
(than physicians) in their acceptance of “alternative,”
“adjunctive,” or “complementary” therapies.3 Nurses and
patients alike are attracted to these approaches for many
reasons:
Consumers are dissatisfied with impersonal, expensive interventions that treat the body as a mechanical object
and do not care for the whole person. Nurses are disillusioned with the health care system, including its lack of
Susan Anthony Salladay, RN, PhD, is director of the Center for Bioethics at the
Bryan LGH Medical Center in Lincoln, Nebraska.
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Vol. 4, No. 1 (Spring/Summer 2000)
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THE SCIENTIFIC REVIEW OF ALTERNATIVE MEDICINE
concern for the whole person and the relative impotence
of nurses within the system. . . . Alternative therapies
offer something “new” when nothing “traditional” seems
to help ease pain, provide hope and engender a sense of
human connectedness, wellbeing, transformation. . . .
[They] also appeal to a growing desire for power among
nurses . . . to diagnose, prescribe and treat without a
physician’s order, intervention or supervision. [They] edge
nurses into medicine, albeit “alternative” medicine.4
Part of the wide appeal of alternative therapies for
nurses and patients alike is their apparent simplicity and
benignity. Many appear noninvasive, easy to do and
teach, fairly inexpensive, and seemingly risk free. In a
medical environmental highlighted by catastrophic care,
life-support systems, prolongation of dying, and the perceived medical preservation of bodily functions without
any accompanying quality of life, “safe healing” has become a desirable commodity.
A CLASH OF WORLDVIEWS
What is not as readily apparent to many nurses and patients is the philosophical perspective (or worldview)
and the primary values underlying the self-healing
movement and key alternative therapies, including yoga,
acupuncture, therapeutic touch, guided imagery, and
various form of meditation or centering. Nurses and their
patients are often completely unaware that the worldview inherent in many alternative therapies favored by
the self-healing movement is distinct from and ultimately incompatible with each of two other worldviews
that have shaped the history and values of the nursing
profession. And because most nurses are not aware of important differences, they are not able to clarify them
with patients when discussing alternative therapies or in
seeking patients’ informed consent for their use.
In fact, most nurses and patients are not aware that
they even have a worldview or that it is something distinct from (but often related to) their religious beliefs—
or that other worldviews, quite different from their own,
exist. A nurse may not be aware that his or her worldview could be very different from that of a patient. And
these differences, whether overt or covert, can produce
conflict.
Few people have anything approaching an articulate philosophy . . . and even fewer have a carefully constructed
theology. But everyone has a worldview. Whenever any of
us thinks about anything—from a casual thought (Where
did I leave my watch?) to a profound question (Who am
I?)—we are operating within such a framework. In fact, it
is only the assumption of a worldview—however basic or
simple—that allows us to think at all. A worldview is a set
of propositions (or assumptions) which we hold (consciously or subconsciously) about the basic makeup of our
world. The first assumption . . . is that something exists.
What we discover quickly, however, is that once we have
recognized that something is there, we have not necessarily recognized what that something is. And it is here
where worldviews begin to diverge.5
In the latter half of the twentieth century, nursing
has experienced a significant worldview shift away from
both the religious worldview of theism and the worldview
of modern science (naturalism or materialism). These two
worldviews, theism and naturalism, together shaped the
foundations of nursing in the twentieth century, since
they were compatible on many points (although on
some they are incompatible). Nursing has, however,
through the efforts of some leading theorists, begun to
adopt various adaptations of the prevailing postmodern
worldview—a pantheistic monism. Pantheistic monism is
not new. But the term “postmodernism” is recent, and is
misleading as it suggests a more modern—a “new and
improved”—worldview.
Although all three of these worldviews may use
some of the same terms (“God,” “spirit,” “divine,” “energy,” “matter,” “person,” “holistic,” etc.) in describing
their various understandings of ultimate reality, the
meanings of these terms vary greatly from worldview to
worldview. When words that seem to be synonymous—
e.g., “prayer,” “mediation,” “centering”—are used in the
care of patients, the words may have different, even contradictory meanings, depending upon the worldview
context in which they are used. A nurse describing the
process of guided imagery must take care to avoid conveying the impression that meditation or centering is the
same as the biblical practice of prayer. Patients have the
right to be informed not only of any risks and benefits of
“alternative” therapies but they also have the right to
know that some “alternative” therapies are actually alternative religious practices that could conflict with patients’ religious beliefs.
All worldviews attempt to explain the most fundamental nature of reality, but do so quite differently. A
well-rounded worldview includes basic answers to each
of the following questions.
(1) What is prime reality—the really real? To this, we
might answer God, or the gods, or the material cosmos.
(2) Who is man? To this we might answer a highly
complicated electrochemical machine whose complexity
Salladay: Healing Is Believing: Postmodernism Impacts Nursing
we do not understand, or a personal being created by God
in his own image, or a sleeping god, and so forth.
(3) What happens at death? Here we might reply
that human beings experience personal extinction, a
transformation to a higher state, or departure to a
shadowy existence on the “other side.”
(4) What is the basis of morality? We might say,
among other things, the character of God, the affirmation
of human beings, or the impetus toward cultural or physical survival.
(5) What is the meaning of human history? To this
we might answer to realize the purposes of the gods, to
make a paradise on earth, to prepare a people for life in
community with a loving and holy God, and so forth.6
Nursing theorists have played a crucial role in introducing into nursing practice the postmodern worldview of pantheistic monism and the self-healing movement with its variety of therapies. In order to understand
the worldview shift initiated by these theorists, it is essential to contrast pantheistic monism with the two
other worldviews that have also influenced nursing practice: theism and naturalism. The “theology” of these
worldviews must also be examined, because nursing has
always been concerned about patients’ spiritual needs.
Much of postmodernism’s attractiveness to nursing lies
in its spiritual claims. Hence understanding nursing’s
traditional views on spirituality (predominantly Christian theism in Western countries) is important in appreciating nursing’s openness to postmodern ideology.
Naturalism, like pantheism, is a monistic worldview.
Monistic worldviews agree on the premise that ultimate
reality is one unified substrate: “all is one,” all apparent
distinctions or differences in what we see and experience
can ultimately be reduced to one, single, whole underlying
reality or being. This reality is impersonal. Naturalism
and pantheism disagree on what this one, unified ultimate
reality is: matter/physical energy or spirit/psychic energy.
Pantheism states that all that is is ultimately nonmaterial: ultimate reality is spirit (spiritual energy) or
God (sometimes spoken of as Divine Mind, but always
impersonal despite the capital letters). Those familiar
with the Star Wars movies might think of this ultimate
reality as the Force, recalling that the Force is “it,” not
“he” or “she.” Pantheism is the worldview underlying
many major Eastern world religions such as Hinduism,
Buddhism, and Taoism, and offshoots like yoga, the marital arts, Transcendental Meditation, acupuncture, and
Ayurvedic medicine. It is the worldview behind such
Western belief systems as Christian Science (a religion
despite the use of the term science), Theosophy, and
the New Age movement.
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Naturalism also requires ultimate reality to be one
substrate, but that is matter or physical energy. Naturalism denies the existence of nonmaterial realities or
forces such as “spirit,” “soul,” “mind,” “intent,” “will,” or
“freedom.” Naturalism is the worldview behind the
progress of Western science.
Theism is not a monistic worldview. It is often called
a dualism, although that term has confusing meanings.
Theism believers state that a personal God is the Ultimate Reality but that a reality distinct from God—the
created universe—also exists and is dependent on God
for its existence. The created universe is not identical
with God. God is spirit, but the created world is both
matter and spirit. Theism includes both matter and spirit
as real and does not deny the ultimate reality of one in
affirming the reality of the other. Theism is the worldview underlying religions like Judaism, Christianity, and
Islam.
Deism, an early form of scientific naturalism, attempted to harmonize some aspects of theism with naturalism but found it difficult to remain strictly monistic.
Many such attempts at unifying worldviews exist (e.g.,
Christian Science and the New Age movement attempt
to harmonize pantheism and naturalism or pantheism
and theism) but are ultimately unsuccessful because of inherent and unresolvable contradictions. Syncretism is the
attempt to combine worldviews by denying their real,
fundamental differences and attempting to reduce these
to “underlying agreement” or “universal truth.” It may redefine key terms to produce a harmonization of worldviews. Syncretism is a perspective of existence which itself is most consistent with monistic (“all is one”)
worldviews in which duality, otherness, contradiction,
difference, and particularity ultimately cannot exist.
POSTMODERNISM’S INFLUENCE ON THE
PROFESSION OF NURSING
Postmodernism is a convenient label to categorize a movement of ideas, beliefs, and cultural values that rejects many
assumptions of modernism—naturalism in the form of Enlightenment scientific rationalism. Modernism proclaimed
the emergence of discoverable reality through scientific
inquiry and rational thinking in a universe devoid of any
supernatural dimensions or ultimate purposes.
Most of us in the West have grown up under the sway of
modernism, a school of thought that stretches back to the
period in European history known as the Enlightenment.
By the early 1700s, advances in science . . . had persuaded
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intellectuals to reject the medieval view of nature. When
scientific observation directly contradicted church pronouncements, people discarded the church’s dogma.
People became modern. They were “enlightened” . . .
these modernists viewed nature as a grand machine whose
processes could be understood by . . . natural law. People
began to study nature by applying reason . . . more and
more scientists came to view God as an unnecessary
theory . . . the modernist worldview assumes naturalism
. . . [and] directly challenges the Christian view. . . .7
Postmodernism represents a movement away from
modernism’s dependence on rationalism and naturalism.
Postmodernism substitutes relativism for rationalism and
pantheism for naturalism but ultimately remains
monistic and syncretistic.
Relativism says that truth isn’t fixed by outside reality, but
is decided by a group or individual for themselves. Truth
isn’t discovered but manufactured. Truth is ever-changing
not only in insignificant matters of taste and fashion but
in crucial matters of spirituality, morality and reality itself
. . . this is the postmodern consensus . . . we in the West
have been taught that truth cannot be self-contradictory.
But in Asian religions and culture, truth can often be
contradictory . . . we are left with “local knowledges” or
“paradigms.” Within each paradigm people think differently and have their own truth which is real to them. . . .
Postmodernists use language that implies the existence of
the personal self, but their outlook points to the disintegration of self. The notion distinct personhood, according
to postmodernists, is an illusion.8
A hallmark of postmodernism’s impact on nursing is
the preeminence of holistic therapies and self-healing
techniques. These claim to be wellness-centered rather
than disease-centered. The concept of “healing” is based
on creating one’s own reality—a reality of well-being—
through being attuned to or “at one”—the Judaeo-Christian term “atonement” is sometimes reinterpreted to mean
“at-one-ment.” “Healing” occurs with supernatural energy, energy that is not visible or measurable by scientific
processes and not manageable or predictable according to
laws of cause and effect. A nurse’s task, then, is to assist or
empower patients to create their own healing by adjusting
healing energy in the body/psyche/ spirit through a variety
of interventions such as therapeutic touch’s “unruffling”
(passing the hands several inches above the body), centering, imaging, yoga, etc. Nurses and patients are taught
that a central part of this empowering, self-healing process
is the realization of one’s essential unity with all things—
one’s own inherent divinity.
A 1996 Time magazine feature article examined self-
healing, asking “can prayer, faith, and spirituality really
improve health?” Faith, as discussed in the article, was
understood not to be specific to any religion or denomination. The faith of postmodernism is generic. Faith is
believing, not beliefs—process, not content. Postmodern
faith is an active, holistic process engaging body, mind,
and spirit but seemingly free from adherence to any particular religious content, specific beliefs, or doctrines.
Creeds and dogmas such as one would find in the Christian tradition tend to be viewed as fundamentalistic,
narrow-minded, and rigid or are simply redefined
through syncretism into the postmodern pantheistic
context. Prayer, for example, is understood by postmodernism to be the equivalent of meditation or the “relaxation response,” involving the process of centering or
creating an internal focus on one’s inner self through the
repetition of words or mantras to produce an “altered”
state of consciousness. Specific religious content is seen,
in fact, as an impediment to the faith process, which
should be doing, not thinking.
What attracted me to meditation was its apparent religious neutrality. You don’t have to believe in anything: all
you have to do is do it. The God I have found is common
to Moses and Muhammad, to Buddha and Jesus. It is
known to every mystic tradition . . . it is Spirit, Being,
the All.9
Faith (meditation/centering/prayer) is understood
to be a spiritual, not religious, tool or technique involving a monologue with the inner self rather than a dialogue with God, a person distinct from the individual.
Where there is dogma conflict, syncretism enables the
postmodern believer to assert that the impersonal Self/
One/All/Divine/Mind/Spirit is simply another name for
the personal God. For Christians, for example, Jesus is
interpreted through pantheism to be a “manifestation of
the Christ” in the same sense that all souls are said to be
the Christ—the Divine within. For the Christian theist,
to define faith or its objects in this way would be considered misleading, even heretical.
Postmodern nursing practice has accepted the
generic, universal faith of pantheism:
. . . religion refers to a belief system—a product of the rational mind . . . attentiveness to spirituality goes beyond
a focus on religiosity. Spiritual care needs to be based on
a more universal concept . . . rather than focusing around
religious concepts.10
Postmodern nursing relegates religions to be products of human thought, composed of particular ideolo-
Salladay: Healing Is Believing: Postmodernism Impacts Nursing
gies and rejecting competing ideologies. The preferred
term, spirituality, enables the postmodern nurse to escape the need to deal with the truth or falsity of any one
set of exclusive faith claims as exist in Christianity and
Judaism. By defining faith as a neutral, generic, contentfree process, nursing is able to introduce patients to certain practices and beliefs (such as those connected with
Transcendental Meditation and therapeutic touch) as
alternative therapies rather than alternative religions.
In the last 30 years, both American society and American
nurses have changed what they believe and value, and
these changes have helped reshape the ways that nursing
professionals define religion and spirituality. Religious
words like God are frequently replaced with more broadly
defined words such as transcendence. Since nursing care
grew out of religious teachings that emphasized care for
the sick, that care was closely intertwined with religious
practices . . . the hospital is the product of centuries of
Christian belief and practices. But as America became
secularized in the 1960’s and 1970’s, the religious emphasis declined . . . and Eastern holistic views added a
concern for spirit as an essential component of nursing
care.11
POSTMODERNIST THEORIES SHAPE
NURSING PRACTICE AND PATIENT CARE
Worldviews and the theories that emerge from them
shape the consciousness and moral behaviors of their
adherents. Although fragmentary attempts at theoretical
nursing were evident in the work of Florence Nightingale in the nineteenth and early twentieth centuries,
the development of complex theories began around
1955.
Nursing theorists’ conceptual models are important
means for advancing and potentially improving nursing
practice by guiding the professional development of individual nurses, shaping values, and structuring nursing’s
contributions to society. But it was nursing theorists’ attempts to develop a comprehensive understanding of
human nature that made the profession of nursing most
receptive to the self-healing therapies of postmodern pantheism. These also paved the way for nursing’s rejection of
the secularism and skepticism of modernism in favor of a
focus on spirituality in nursing and an approach to spiritual care of patients that appears doctrinally neutral but in
reality is the antithesis of its theistic foundations.
Nursing theories provide a holistic or comprehensive perspective of human beings under varying life situations or
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environmental conditions and prevent nursing from
viewing human beings simply as organs, body systems, or
in other partial, fragmented ways.12
As nurses began reflecting on the conceptual aspects
of nursing practice . . . they turned to philosophical inquiry . . . to understand the philosophical premises underlying nursing theory and research. The emerging theories addressed the nature of the human being. . . .13
In the late 1960s the American Nurses Association
(ANA) initiated the development of standards of practice (published in 1973, revised in 1991), in which
nursing diagnosis is identified as an essential dimension
of nursing practice. Prior to this, diagnosis was defined by
law to be within the province of medicine and outside
the scope of nursing practice. The North American
Nursing Diagnosis Association (NANDA) defined
nursing diagnosis to be distinct from the medical diagnosis of disease. Nursing diagnosis is “a clinical judgment
about individual, family or community responses to actual or potential health problems and life processes.”14
When nurses make a nursing diagnosis for a patient,
they plan, carry out, and evaluate nursing interventions
based on the diagnosis. Nursing diagnosis is thus understood to be essential to all of nursing practice. Nursing
diagnoses are based on nursing theories which include
beliefs about the nature of human beings and health.
Despite the fact that nurses are not routinely trained
as chaplains or counselors, they diagnose and treat their
patients’ “spiritual distress.” NANDA defines spiritual
distress as a condition requiring such interventions as
values clarification, relaxation training, and centering
prayer. Nurses are to “encourage patients to take responsibility for their own life” and help them affirm that
“God loves and accepts you as you are.”15 These nursing
interventions are consistent with what has perhaps become the bumper sticker slogan of postmodernism: “Believe in yourself.” But for patients with other worldviews, theistic or agnostic, these are misleading
statements or perhaps even offensive.
NANDA recommends therapeutic touch as the preferred intervention for another nursing diagnosis, “energy field disturbance, . . . the state in which a disruption
of the flow of energy surrounding a person’s being results
in a disharmony of body, mind and/or spirit.”16
This is different from the alternative therapy of Therapeutic Touch (TT) introduced by nursing professor Dolores Krieger in the 1970s. Krieger developed her theory
of TT in relation to a worldview of pantheistic monism
expressed in Theosophy, a nineteenth-century combination of Eastern religion and occultism, in which the
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healer is the self—nurse/patient. Although practitioners
claim the therapy is nonreligious, elements of Buddhism,
Hinduism, Taoism, Native American spirituality, Wicca
(witchcraft), occultism, and goddess religions are often
advocated. Healing Touch (a form of TT), for example,
was developed, according to its founder, from techniques
channeled to her by spirit guides.17
Nursing’s acceptance of self-healing and the practices of alternative therapies began as nursing theorists
struggled to define health and illness, clarify the scope of
nursing practice and the role of the nurse, and appreciate
the concerns of patients in a health-care system that
was beginning to be rocked by changes—the development of complex technologies (e.g., dialysis, ventilators,
organ transplants, intensive care units), pressures from
consumer-rights and patient-advocacy movements, skyrocketing health-care costs and complex reimbursement
systems, and the emergence of an increased independence in nursing practice (e.g., home health, midwifery).
One of the first nursing theorists to suggest a postmodern understanding of self-healing was Ernestine
Wiedenbach, whose redefinition of the nature of the patient has been significant in shaping the nursing profession. She developed a perspective of human nature that
highlights a postmodern secular “faith” of self-reliance
and suggests the relativism of moral values.
Each human being is endowed with the unique potential
to develop—within himself—resources that enable him
to maintain and sustain himself. The human being basically strives towards self-direction and relative independence and desires . . . to make the best use of his capabilities and potentials. . . . Self-awareness and self-acceptance
are essential to the individual’s sense of integrity and selfworth. Whatever the individual does represents his best
judgment at the moment of his doing.18
Lydia Hall, another early theorist, developed concepts of personhood, self-awareness, and self-healing derived, in part, from Carl Rogers’s psychology of clientcentered therapy, which encourages individuals to
become self-directed.
Illness is directed by one’s feelings of out-of-awareness. . . .
Healing may be hastened by helping people move in the
direction of self-awareness. Once people are brought to
grips with their true feelings and motivations, they become free to release heir own powers of healing.19
Nursing theorist Jean Watson has developed a
theory of nursing as caring. Influenced by the works of
postmodern philosophers and psychologists including
Rogers, Maslow, Erikson, and Heidegger, Watson believes professional nursing culminates in a human care
project between nurse and client that transcends time
and space and has spiritual dimensions.
The goal of nursing is to facilitate the individual’s gaining
a higher degree of harmony within the mind, body, and
soul which generates self-knowledge, self-reverence, selfhealing. . . .20
For Watson, health and health care are holistic, involving transpersonal, metaphysical dimensions.
Health refers to unity and harmony within the mind,
body and soul. Health is also associated with the degree of
congruence between the self as perceived and the self as
experienced.21
Watson states that what has been traditionally called
health care is a myth: That which has been called health
care, the diagnosing of disease, treatment of illness, and
prescription of drugs, is medical care. True health care focuses on life style, social conditions and environment. . . .
Illness may not be a disease . . . but may be a disharmony
between body, soul and spirit. . . . Watson believes the individual should define his or her own state of health or illness
since she prefers to view health as a subjective state within the
mind of the person. . . . Nursing’s goal . . . is to help people
. . . gain insight into the meaning of happenings in life.22
Watson’s understanding of health and healing is
both postmodern in its relativism and pantheistic in its
subjectivity. The mind/self/spirit creates its own reality
without reference to any external or absolute realities or
truths. Watson clarifies these differences in greater detail
in a chart contrasting “traditional” and “emerging alternative” contexts (see p. 45).23
Nursing theorist Betty Neuman defines health as
“living energy” and understands that nursing has as its
goal those acts that conserve energy.24 However it is the
nursing theory of Martha Rogers that perhaps most fully
develops pantheistic themes. Rogers understands reality
to be a unified whole in which human beings are constantly exchanging energy with their environment.
. . . the four building blocks identified by Rogers [are] energy fields, openness, pattern and four-dimensionality. A
unifying concept for both animate and inanimate environments, energy fields have no boundaries; they are invisible and extend to infinity, they are dynamic. Thus, these
fields are open, allowing exchange with other fields. The
interchange between and among energy fields has pattern
that is perceived as a single wave; these patterns are not
Salladay: Healing Is Believing: Postmodernism Impacts Nursing
45
TRADITIONAL MEDICAL
NATURAL SCIENCE CONTEXT
EMERGING ALTERNATIVE
NURSING HUMAN SCIENCE
AND CONTEXT FOR CARING
Absolutes, givens, laws
Relativism, probabilism
Human as object
Human as subject
Objective experiences
Subjective—intersubjective experiences
Concrete—observable
Abstract—may or may not “be seen”
Human = sum of parts (bio-psycho-sociocultural-spiritual-being)
Human = mind-body-spirit gestalt of
whole being (not only more than sum of parts,
but different)
Physical, materialistic
Existential-phenomenological-spiritual
“Real” is that which is measurable, observable,
and knowable
“Real” is abstract, largely subjectively as well as
objective, but may or may not be ever fully known,
observable, fully measured, what is “real” holds
mystery and unknowns to be discovered
fixed but change as situations require . . . unitary humans
are defined as irreducible four-dimensional, negentropic
energy fields. . . . The science of nursing is directed toward describing the life process of humanity and toward
explaining and predicting the nature and direction of its
development . . . the nurse helps the individual move forward to a higher, more complex level of existence.25
The energy-based pantheistic theories of Rogers and
Watson most fully set the stage for nursing’s acceptance
of a postmodern, syncretistic worldview that denies absolute truth and reduces genuine doctrinal differences
among religions to a generic spirituality for all patients.
The editors of the New Age Journal report [that] all of the
healing systems that can be called “holistic” share a
common belief in the universe as a unified field of energy
that produces all form and substance. . . . This vital force,
which supports and sustains life, has been given many
names. The Chinese call it “chi’i,” the Hindus call it
“prana,” the Hebrews call it “ruach,” and the American
Indians name it “the Great Spirit.” This energy is not visible, measurable, scientifically explainable energy, but a
“cosmic” or “universal” energy based on a monistic (all is
one) and pantheistic (all is God) worldview. To enhance
the flow of “healing energy” in the body . . . one must “attune” to it and realize one’s unity with all things.26
CRITIQUE OF SELF-HEALING
THEORIES AND PRACTICES
Many nurses are attracted to postmodern theories and
therapies of self-healing because of their strong emphasis
on spiritual care, an emphasis that is often lacking in traditional health care. This spiritual focus is attractive because it is believed to provide benefits to both nurses and
their patients without creating risks. Perceived benefits
often include:
• a strong feeling of acceptance, closeness, bonding,
and rapport between nurse and patient that
deepens trust and helps patients cope with doubt
and fears;
• an increased feeling of self-confidence or a reclaiming of power in the face of a serious perhaps
life-threatening condition and within a traditional health-care setting that often leaves both
patients and nurses feeling helpless, powerless,
and out of control;
• the sense that deeper spiritual needs—including
needs for love, belonging, hope, forgiveness, and
acceptance—are being met without having to ac-
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tice therapeutic touch have told me they do not
usually inform patients, but practice the technique
on patients who are asleep. . . . The ethical issues
remain when the patient consents but is not fully
informed about rationale or worldview behind the
procedure. By relating therapeutic touch to the
[Christian] practice of laying-on-of-hands [for example] . . . the nurse . . . misrepresents the modality and violates the patient’s spiritual integrity.28
cede to the exclusive demands of a particular religious dogma, denomination, or ritual;
• a sense of appreciation of the mystery, the mystical, and the sacred in forms that are perceived to
be more vibrant or alive than the dry, listless routines of one’s childhood, culture, or past experience; and
• the promise of infinity or immortality in self-transcendence:
• A person’s body is confined in time and space, but
the mind and soul are not confined to the physical
universe. One’s higher sense of mind and consciousness transcends time and space and helps to
account for notions like collective unconsciousness, a causal past, mystical experiences, parapsychological phenomena, a higher sense of power,
and may be an indicator of the spiritual evolution
of human beings.27
• Patients who decline to use alternative therapies,
believing the therapies violate their religious beliefs, may discover that their refusal prejudices
their care. Such patients have been described (labeled) by nurses as “rigid” and “noncompliant” in
chart notes documenting the patient’s refusal.29
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But risks do exist; and because nurses are required by
their professional codes of ethics to be advocates for
their patients, they must be aware of these risks and advise their patients of them:
• With its message of healing that promotes wellbeing through self-effort, this spirituality of selfworship appeals to a narcissistic culture that is affluent, successful, young, and healthy; it is not as
appealing to those who are marginalized, disadvantaged, chronically ill, or physically or mentally challenged.
• Because faith is understood to be a belief process,
a self-striving or effort of the will, failure to attain
the desired wellness through one’s own effort may
cause depression and self-doubt, leading to a
“blaming the victim” mentality. One patient put
it this way in a letter to her nurse that was read
only after her death, “Please forgive me. If I only
had enough faith, I would still be alive today!”
• Often nurses and hospitals do not require a patient’s informed consent for alternative therapies.
• A clear violation of professional ethics occurs
whenever nurses use (alternative therapies) without the patient’s consent. . . . One nurse describes
an incident where she practices therapeutic touch
on an unconscious patient. Many nurses who prac-
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13. Ibid.
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18. Ibid.
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21. Ibid.
22. Talento B. Jean Watson. In: Nursing Theories, the
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47
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27. Watson, Nursing.
28. Shelly J. The healing touch. Unpublished paper.
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29. Salladay and Shelly, Spirituality in nursing theory
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