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15 January 2002Printer-friendly versionEmail a friend

Touching a nerve
How a critic of postmodern nursing became a target of postmodern name-calling.

by Sarah Glazer

I recently became the victim of postmodern name-calling - apparently I am a 'scientific realist'.

I have been taken to task by a nursing professor of the postmodern persuasion in the pages of a forthcoming issue of the Nursing Philosophy journal (1). From the scorn the postmodern prof heaped on my rational leanings, I gather that I would never make it through a graduate school of nursing, never mind a postmodern humanities department.

So what brought about my fall from grace? It started when I decided to investigate why major nursing organisations in the USA were endorsing 'therapeutic touch' (see Nursing irrationality)- a technique where nurses move their hands a few inches from the patient's body but don't actually touch the patient and which some claim can heal everything from burns to sexual abuse (2).

At first, advocates of therapeutic touch used impressive-sounding lingo to justify their claims, arguing that therapeutic touch healers could sense an 'energy field' that emanated beyond a patient's body; could sense when the field was disturbed and therefore causing pain; and had the power to smooth out the field with their hands to induce healing. (There is no evidence that such energy fields exist and scientists consider it implausible.)

The idea that nurses could sense 'human energy fields' was debunked in 1998 in an article published in the Journal of the American Medical Association (3), which found that therapeutic touch healers did slightly worse than chance when they were asked to 'sense' the presence of a human hand in a blinded experiment. Yet therapeutic touch is still widespread in nursing, despite the fact that, as a review in the Nurse Practitioner Journal pointed out, no serious scientific study has found any real benefits to it (4). So what is going on?

Following the 1998 debunking of therapeutic touch, its advocates fell back on another argument: they cited postmodern philosophers like Michel Foucault, repeating his criticisms of medical science as merely an elite knowledge system that confers power on doctors. And if medical knowledge is only one of many truths, these nurses argued in nursing journal articles and PhD theses, then practically any other type of 'knowledge', including mystical healing rites like therapeutic touch, would be as valid as Western science.

'[I]n this postmodern time, science, knowledge and even images of nursing...become one among many truth games', wrote Jean Watson, former president of the National League of Nursing (the organisation that accredits nursing schools in the USA) in 1995 (5).

Seriously ill people could be subjected to all kind of New Age techniques
This argument, though arguably an oversimplification of the postmodern analysis, was attractive to the predominantly female nursing profession, which was increasingly vocal in its complaint that the male-dominated medical profession scorned nurses' bedside knowledge and relegated them to a low status in the hospital hierarchy.

In 2000, I published an article (5) describing the adoring stance that nurses with advanced degrees were taking towards French postmodern philosophers Foucault and Jacques Derrida, as well as their philosophical predecessors Martin Heidegger and Edmund Husserl. I recounted nurses' enthusiastic adoption of such postmodern terms as the 'narrative' - which was sometimes little more than an excuse to present sloppily constructed interviews with a handful of patients as if they were scientific studies. I found that, for these nurses, terms like 'objective', 'evidence-based practice' and even 'measurement' had become code words for all that was patriarchal and insensitive about modern science and modern medicine. In my article, I cited the case of a nurse who had responded to a hospital patient's complaint of postoperative pain by providing 'healing touch' - a variant of therapeutic touch - instead of a doctor's care. The patient later returned to the hospital with an infected bladder, which had to be surgically removed - an infection that might have been avoided if the patient had received the right treatment early on.

Some of those who read my article, admittedly a small sample of my acquaintances in academia and the nursing profession, found it scary to learn that hospital nurses might be abandoning Western medical techniques in favour of mysticism.

Some patients claim that therapeutic touch works wonders - but this can be explained by studies showing that therapeutic touch is about as effective as a placebo in inducing a sense of relaxation. So advocates of the practice argue that it should be used for that reason alone, to take advantage of the healing power of the placebo - although critics point out that such an approach could leave underlying physiological problems untreated. I argued that such an approach would be of no help to those patients who lack a sufficiently credulous attitude towards the powers of therapeutic touch to benefit from the placebo effect.

More recently, nursing conferences and continuing education seminars have given the imprimatur of respectability to other New Age techniques like herbalism and Reiki - another healing technique that claims to manipulate energy forces in the body. Some patient advocates are concerned that this new wave of fads could subject seriously ill people to a range of New Age techniques embraced by nurses, instead of Western medicine (6).

The British-American journal Nursing Philosophy recently reprinted my article (7), and invited a critique from 'postmodern' academic Dr Janice L Thompson, associate professor of nursing at the University of Southern Maine (8).

Since I criticise nurses who favour social interpretations of reality over knowledge derived from rigorous science, Thompson concludes that I must fall on the wrong side of the ideological divide from 'postcolonial thought'. 'Postcolonials' are presumably feminist, leftist and compassionate, as they side with oppressed peoples and indigenous, mystical healers - especially female witches. Apparently, I am squarely in the camp of their opponents: male, establishment imperialists and - worst of all - rationalists looking to scientific evidence to discern the efficacy of purported cures.

'This is not science, it is a pseudo-scientific cult', said Alan Sokal
In an essay jam-packed with familiar postmodern orthodoxies, Thompson claims that science is only 'one among many ways to produce meaning and truth', describing herself as sympathetic to those who do not 'privilege science as a single exemplar of clinically relevant knowledge'.

When it comes to the debate over the validity of therapeutic touch - or even over the purported cures reported by shamanic folk healers from other cultures - Thompson argues that those claims 'cannot be settled by scientific discourse itself'.

But Thompson's rebuttal does not address the underlying criticism in my article: the lack of validity for therapeutic touch. Nor does she address the central question of my article: why have nurses embraced such a highly dubious, one might even say 'bogus', procedure?

The closest she comes is to defend the creator of therapeutic touch's theoretical underpinnings - New York University (NYU) nursing professor Martha Rogers (who died in 1994). In writings that are a bizarre melange of praise for the paranormal and ill-defined scientific jargon, Rogers claimed that humans don't just contain 'energy fields', they are 'energy fields'. 'The ability to explain precognition, dj vu, and clairvoyance becomes a rational process in pandimensional human and environmental fields', writes Rogers (5). Huh?

I once described reading Rogers as an 'excursion into science fiction coupled with mysticism', calling her 'wacky' and wondering why on Earth she continues to be cited respectfully in nursing journals and textbooks (5).

Thompson expresses indignation at my characterisation of Rogers. 'We should at least acknowledge with respect the commitment of this intellectual who carefully studied the work of her mentors in theoretical physics', she writes. 'She was a widely read and very strong interdisciplinary scholar.' (1)

Astounded that nursing school departments continue to place Rogers in the pantheon of leading thinkers, I decided to consult a real physicist - Alan Sokal, professor of theoretical physics at New York University, to see if he could find anything of scientific merit in her work.

Facts are derided in the postmodern world of 'multiple realities'
Sokal emailed me: 'Her work can only be described as loony.... Rogers does not exhibit the slightest knowledge of theoretical physics. Rather, she borrows terms from physics and then throws them around without regard for their meaning. For example, "energy" and "field" both have precise (not metaphorical) meanings in physics; but "energy field", a key term in Rogers' writings, is meaningless in physics.'

When it comes to other pseudo-scientific terms that Rogers says are specific to the science of nursing, her purported definitions are as meaningless as the terms allegedly being defined. For example, she defines a favourite term of hers, 'pandimensional', as 'a non-linear domain without spatial or temporal attributes'. Neither the mathematical term 'domain' nor the term 'non-linear' have any meaning in this context, says Sokal.

'This is not science: it is a pseudo-scientific cult', Sokal says. 'I am surprised to learn that Rogers' writings are taken seriously in nursing schools. And I am ashamed to learn that this cult originated in a doctoral programme at my own university.'

I hope this exchange in Nursing Philosophy will crush the ill-earned respect held for Rogers and her ilk in nursing schools. I can't imagine what Alice-in-Wonderland world the novice nursing student must think she's stumbled into when handed Rogers' words on a silver platter and told to take them seriously.

Yet I doubt that simple 'facts' - so derided in the postmodern world of 'multiple realities' - can settle the simple question of whether Rogers knows her physics or whether there's any legitimacy to mystical practices like therapeutic touch.

Here's my own postmodern analysis of Thompson's subtext. I detect a touching search on her part for philosophers who could justify the nurse's unique role in providing compassionate caring - as opposed to medical curing - to sick patients. Science, Thompson rightly says, cannot answer the question of 'why compassion?' or 'compassion to what ends?'.

I agree that nurses have to look beyond science to find answers to such moral questions. Science is intended to answer factual questions - such as whether nurses can sense energy fields.

If we were looking for a model of compassion, would we really pick Foucault?
But are Foucault and his brethren the right philosophers to answer bigger moral questions? In his book The Reckless Mind, Mark Lilla, a professor at the University of Chicago's Committee on Social Thought, suggests that Foucault was so blinded by his conviction that medical claims to knowledge were merely claims to power that he denied the existence of AIDS - even as he was dying from the disease. In the autumn of 1983, after Foucault's health had collapsed and less than a year before his death, he continued to frequent gay bathhouses and bars. According to Lilla, Foucault laughed at the idea of 'safe sex' and apparently said, 'To die for the love of boys: what could be more beautiful?' (9).

Foucault's suspicion of the medical profession's discussion (or 'discourse', in Foucauldian terms) of what constituted disease 'had finally rendered him insensible to any distinction between a biological factum and its social interpretation', writes Lilla. 'If one believes that all "discourse" about disease is constructed by social power, and that one can invent any "counter-discourse" aesthetically, it is easy to convince oneself of a certain invincibility.' (9)

If we were looking for a model of compassion, would we really pick Foucault - with his denial that AIDS was a reality and his cavalier attitude towards its contagiousness, which may well have led him to infect others? Wouldn't compassion involve the recognition of an objective fact - that the disease exists, is fatal and contagious - and holding back from unbridled sexual pleasure that could ultimately infect others?

I grant the psychological truth that each person perceives the world through the lens of his or her own personal history and is influenced by their 'elite' (or not-so-elite) status in society. But ultimately, we must all agree on some kind of reality as a corrective - especially when it comes to identifying and curing diseases.

We need the scientific method to help us see past our delusions. Our attempts may be imperfect and groping - but unless we can agree on the possibility of discerning factual truths, pseudo-scientific cults will continue to gain legitimacy with the help of postmodern academia.

Sarah Glazer is a journalist in Larchmont, New York, who writes on health and social policy issues. Her articles on therapeutic touch and nursing have appeared in The Public Interest, The Washington Post Health Section, and in the book Research in Science and Technology Studies: Gender and Work (From the series Knowledge and Society, Vol 12, JAI Press, 2000)

Read on:

Put alternative medicine back in its box, by Dr Michael Fitzpatrick

Nursing irrationality, by Sarah Glazer

The rise and rise of CAM, by Brd Hehir

Watered-down science, by Howard Fienberg

Head cases, by Brd Hehir

(1) 'Which postmodernism: a critical response to "Therapeutic touch and postmodernism in Nursing"', Janice L Thompson, Nursing Philosophy, Vol 3(2), April 2002 (forthcoming)

(2) 'The mystery of Therapeutic Touch', Sarah Glazer, Washington Post health section, 19 December 1995

(3) 'A close look at therapeutic touch', L Rosa, E Rosa, L Sarner, S Barrett, JAMA 279:1005-1010, 1998

(4) 'Investigating therapeutic touch', Kevin Courcey, Nurse Practitioner Journal, November 2001, p 12-13

(5) 'Postmodern nursing' Sarah Glazer, The Public Interest, Summer 2000, p3-35 and 'Therapeutic touch and postmodernism in nursing', Sarah Glazer, in Research in Science and Technology Studies: Gender and Work (from the series Knowledge and Society, Vol 12, JAI press, 2000)

(6) Nursing irrationality, by Sarah Glazer, spiked, 11 October 2001

(7) 'Therapeutic touch and postmodernism in nursing', Sarah Glazer, Nursing Philosophy, October 2001, p196-212

(8) See (1) and 'Response to critique of "Therapeutic touch and postmodernism in nursing', Sarah Glazer, Nursing Philosophy, Vol 3 (2), April 2002 (forthcoming)

(9) The Reckless Mind: Intellectuals in Politics Mark Lilla, New York Review of Books, 2001, p 137-158. Buy a copy of this book from Amazon (UK) or Amazon (USA)

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