As has been noted on many occasions, the concept of health is intimately related to that of wholeness. As broadly defined by the World Health Organization, it encompasses the physical, psychological and spiritual well-being of the individual and is thus central to the concept of human and social development. It is therefore valuable to explore the evolution in the concept of health, as a form of integration, and as throwing light on the implications of such integration for an understanding of development.
This question has been admirably discussed by Larry Dossey (95), a physician, in the light of the conceptual implications of theoretical breakthroughs in 20th century physics, and notably as a result of the work of David Bohm (see above). The shortcomings of the current health care system are increasingly perceived as rooted in the conceptual framework that supports medical theory and practice. As the physicist Fritjof Capra states in introducing Dossey's work: "The crisis in medicine, then, is essentially a crisis of perception, and hence it is inextricably linked to a much larger social and cultural crisis....which derives from the fact that we are trying to apply the concepts of an outdated world view - the mechanistic world view of Cartesian-Newtonian science - to a reality that can no longer be understood in terms of these concepts." (95, p.VIII)
To describe the globally interconnected world, in which biological, psychological, social, and environmental phenomena are all interdependent, Dossey explores the implications of quantum physics as "the most accurate description we have ever discovered of the physical world" (95, p. l26).
Given the disturbing innovation of such physics, whereby the behaviour and subjectivity of the observer is necessarily incorporated into any understanding of the results of observation, he points out the weakness in the argument that such theoretical breakthroughs are only of significance to the abstract world of nuclear physics. He cites the physicist E Wigner who states: "The recognition that physical objects and spiritual values have a very similar kind of reality....is the only known point of view which is consistent with quantum mechanics" (123 ??, p.192). Dossey points out that the relevance of such supposedly sub-atomic preoccupations to macroscopic phenomena is also demonstrated by Bell's theorem as noted by the physicist H S Stapp: "The most important thing about Bell's theorem is that it puts the dilemma posed by quantum phenomena clearly into the realm of macroscopic phenomena....it shows that our ordinary ideas about the world are somehow profoundly deficient even on the macroscopic level" (124, p.1303). The theorem can be described as stating: "If the statistical predictions of quantum theory are true, an objective universe is incompatible with the law of local causes", which requires that events occur at a speed not exceeding that of light (124, p.1303).
This theorem has been substantiated by experiments which show that simultaneous changes in non-causally linked distant systems can occur when a change in one takes place. In some sense, as yet not understood, all "objects" thus constitute an indivisible whole, in contrast to the prevailing notion of an external, fixed, objective world of separate things. Furthermore, the theorem shows that the ordinary idea of an objective world unaffected by consciousness lies in opposition not only to quantum theory but to facts established by experiment.
In addition to the implications of quantum mechanics, Dossey draws attention to those from the logical limitations highlighted by the theorems of Godel (92), Turing and Church, and Tarski. These collectively demonstrate the inherent limitations of any symbolic language which purports to describe the world unambiguously but is also called upon to make self-referential statements about itself as part of that world. They show that no precise language can be universal and that no scientific system is complete. Any language used to describe health and development, must necessarily suffer from similar limitations.
In the light of these considerations, Dossey points out that if our ordinary view of life, death, health and disease rests solidly on seventeenth-century physics (and on the logic on which it is based), and if this physics has now been partially abandoned in favour of a more accurate description of nature, then:
"an inescapable question occurs: must not our definitions of life, death, health, and disease themselves changes? To refuse to face the consequences to these areas is to favor dogma over an evolving knowledge....We have nothing to lose by a reexamination of fundamental assumptions of our models of health; on the contrary, we face the extraordinary possibility of fashioning a system that emphasizes life instead of death, and unity and oneness instead of fragmentation, darkness, and isolation." (95, p.141-2)
After listing the characteristics of health and of the image of man arising from the "traditional" view (95, p.l39-141), Dossey outlines the nature of the concept of health which emerges in the light of the new participative descriptions of nature. He notes, for example, that even from the point of view of elemental biology and physiology, the body behaves more as pattern and process than as an isolated and noninteracting object. It cannot be localized in space and its boundary is essentially illusory as in the notion of "body" in de Nicolas analysis (above). Health and illness are then a characteristic of the dynamic relationship between bodies on which therapy should necessarily focus as a participative process. The divisions of time are also arbitrarily imposed.
"Connected as we are to all other bodies, comprised as we are of an unending flux of event themselves occurring in spacetime, we regard ourselves not as bodies fixed in time at particular points, but as eternally changing patterns for which precise descriptive terms seem utterly inappropritae." (95, p.l 42-9)
The ordinary view of death is then inadequate because it is based on two erroneous assumptions - that the body occupies a particular space, and that it endures through a span of linear time (95, p. 158). Dossey considers that during illness the experience of spacetime construction is distorted: "When we are sick we become a Newtonian object: a bit-piece stranded in a flowing time" (95, p.l75). Health and illness are field phenomena. Comprehending spacetime in this way is not a matter of intelligence and restricted to gifted scientists. It is largely a skill of the right-hemisphere. Such understanding has long been characteristic of certain oriental philosophies, and other cultures have developed with a concept of non-flowing time (95, p.l78). It is possible that such understanding is even to some extent characteristic of the musically-oriented (youth) in the West, for example. Desire for experience in this form may also contribute to widespread use of drugs as offering an alternative to domination of daily life by a Newtonian world view with its many limitations.
The emergence of such incompatible spacetime views in society as flowing or non-flowing time, isolated objects or shifting energy patterns, should perhaps be seen as constituting a vital complementarity of evolutionary significance. Dossey therefore stresses the importance of alternation between them:
"These two modes of time perception, working alternately, make sense. They strike a balance not conferred by either alone. Perhaps we find within us these two capacities for sensing time because we needed one as much as the other." (95, p. 180)
The two modes may then be seen as corresponding to Bohm's distinction between the explicate and the implicate order, the former being characterized by separated objects and the latter by flowing movement of totality (the holomovement). For Dossey it is the latter with which health is associated, disease being a disequilibrium in favour of the former:
"Seen in this way, health has a kinetic quality. There is an essential dynamism to it, grounded as it is in Bohm's proposed underlying implicate order...Health is not static." (95, p.l83)
Health and the Implicate Order
|Traditional View||Implicate View|
|1 The sensory world of objects and events is primary.||1. The sensory world of objects and events is not primary. They belong to the explicate order which is grounded, or enfolded, in an underlying indivisible totality, the implicate order.|
|2. Health is the absence of disease.||2, Health is not the mere absence of disease, but is the manifestation of the harmonious interaction of all apparent parts that inhabit the explicate domain.|
|3. Health and disease are absolutes|| |
3. Health and disease are not and are irreconcilable opposites. irreconcilable opposites. They are the "moving principles" of each other.
|4. All living matter is potentially dead. Everything awaits decay.||4. AH matter belongs to the implicate order, where everything is alive. "What we call dead is an abstraction" (Bohm).|
|5. Life is characterised by movement, and death by stasis.||5. The implicate order enfolds all, and is flux; thus, both life and death are movement. Nothing is static.|
|6. Health can be conceptualized as proper function of body parts.||6. "Parts" exist only in the explicate domain. Therefore, health transcends the function of parts, since all parts, which consist of matter, are ultimately enfolded in the implicate order, and thus consist of an indivisible whole.|
|7. The ultimate goal of health care is to forestall disease and, thus, death.||7. Since death is an abstraction ("everything is alive") this is an inappropriate goal of health care.|
|8. Health can be expressed in terms of objective measurements-laboratory tests, physical examinations, x-rays, etc.||8. All measurements refer to objects belonging to the explicate order and are thus not primary. They defy the unanalysable wholeness of the underlying totality in which all material bodies are grounded. As such, all measurements are arbitrary and are poor indicators of health.|
|9. The focus of health care is on the physical body. Consciousness is asecondary and irrelevant factor.||9. Both matter and consciousness are enfolded in the implicate order, where all things are one. Thus, all mailer is to some degree conscious. Health care cannot, therefore, ignore consciousness. To focus on matter is to focus on consciousness.|
|10. Health care focuses on individuals.||10. This is an arbitrary and illusory concern of the explicate domain. All matter is enfolded in the implicate order; thus, so too are all bodies. To is to focus on all, since all bodies (all matter) comprise a totality in the implicate order.|
|11. Therapy primarily is executed by mechanical means, by matter acting on matter-e.g., by medications and surgery.||11. Everything is alive. There is nothing in principle, therefore, preventing the use of consciousness as a primary form of therapeutic intervention at all levels of matter-from subatomic particles through molecules, cells, tissues, organ systems, etc.|
|12. Health care is of unquestioned value.||12. Insofar as traditional health care distorts the wholeness of the body by inappropriate concentration on function of mere body parts, it can be destructive. Health care, thus, is of qualified benefit, since it may create distortions in body awareness which may prove harmful and actually generate illness.|
|13. Transcendence of the concern about health is a mystical aberration usually leading toneglect and rejection of the body.||13. Transcendence of the concern about health may indeed lead to the view of health as irrelevant, but may also lead to an awareness of the body as being materially alive at all levels. This awareness can generate a spiritual regard for the body, a self-identity with the matter comprising it, leading to an enhanced pattern of health care.|
He contrasts this with a prevailing image of health as associated with some "frozen stage of youth, whereafter things never change. ...We view health as a frozen painting, a still collection of bits of information" (95, p.183). But this has no meaning if health is the harmony of the movement of interdependent parts. Dossey produces a 1 3-point table contrasting health based on the traditional view with that based on an implicate view (95, p.186-7). The problem is that modern health care (including holistic health), only focuses on the reality of the explicate order of separate objects and events. "The implicate domain, where the very meaning of health, disease, and death radically changes, is currently of no concern to medicine." (95, p.189) Explicate therapy has a purely mechanistic concern to "keep the parts running".
It is clear that Dossey's arguments with respect to health can also be made with respect to human and social development in general, especially since much development thinking can be viewed as directed towards "keeping the parts running". There is much to be said therefore for exploring the possibility of elaborating an implicate understanding of development as a vital complement to the prevailing explicate view. Any "new world order", to be of any long-term significance, could well be based on an alternation between these two modes.