Applying Lonergan's ideas in health care

[AnneK]

At the June Workshop, the Lonergan Health Care Special Interest Group met for the first time. A number of us were seeking concrete examples of how to apply Lonergan's ideas in our own work (practice, research, education, policy). Perhaps we could respond to that desire for application through discussion, here.

[Richard Moodey]

Hi AnneK,

Each year, I teach the freshmen (mostly women, actually) enrolled in Gannon University's Occupational Therapy program.  It is a course called "Individual, Society, and Culture," and it is designed to help OT students and graduates cope better with the diversity among the clients with whom they will work in their professional lives.  I make Lonergan's transcendental imperatives -- be: attentive, intelligent, reasonable, responsible, and loving -- central to the prescriptive dimension of the course.  I spend a fair amount of time on each of these, using examples from OT practice, and, above all, eliciting responses from the students on how they think these imperatives might relate to their professional practice as they imagine it, and are learning about it in the courses they take in the OT program.

I also draw upon Carl Rogers' general law of interpersonal relations to get them to imagine their interpersonal relations with diverse kinds of clients.  I modify it somewhat, calling it a general law of interaction.  The basic argument is that good interactions are characterized by consistency between experience, awareness, and communication (openness and honesty) and bad interactions are characterized by inconsistency between these three elements (defensiveness and deceit).   I connect this with Lonergan's "be attentive," because defensiveness (Lonergan's dramatic bias) makes it difficult to be aware of one's own experience, thus interfering with a person's ability to follow the other transcendental imperatives.  I teach them Eugene Gendlin's "focusing" as a practical means of becoming more aware of their own experiences.

I also spend a good bit of time on Lonergan's discussion of kinds of bias, and their effects on individuals and communities.  I point out that psychologists have written about a long list of biases (google bias and be overwhelmed), but argue that Lonergan's four categories of bias are more general categories that include most of these other kinds of bias.  Four categories are heuristically much more useful than a list of 20 or 30.

In connection with "group bias" -- which I prefer to call "category bias," because I prefer to limit the meaning of "group" to sets of persons who interact face-to-face, unlike "all males" or "all females," I get into the problem of stereotyping.  Some knowledge about the culture or subculture of a group or category of others can be dangerous, because it can result in thinking that knowledge of the culture provides a person with knowledge of the personal characteristics of individual members.  The anthropologist Anthony Wallace, a leading figure in the field specialty of "culture and personality" -- now transformed into "cultural psychology" and "psychological anthropology" -- demonstrated quite conclusively that the individual members of any cultural group are psychologically highly diverse.  Nobody in the tribe fits the "typical personality" that anthropologists and others derive from knowing some things about the social and cultural arrangements of the tribe. 

Because one of the fields we focus on in the course is "race," I draw upon current research in population genetics that demonstrates that "race" is not a valid biological category.  The genetic diversity within any specified category of individuals is great, and there are no specific genes or gene complexes that distinguish one culturally defined "race" from another.  I use the PBS documentary "Race: The Power of an Illusion" to drive this point home (it's now on UTube). 

Within-group psychological diversity is analogous to within-group genetic diversity.  Genetic diversity does not contradict the fact that there is very little genetic diversity within the human species.  Fruit flies, for example, have ten times the genetic diversity as humans -- two fruitflies, in the same population of fruit flies, may be more genetically different from one another than a human is from a chimp. And psychological diversity does not contradict the fact that the basic structure of human actions -- experience, understanding, judgment, and decision  -- is present in all humans.  It is the content of learned dispositions that are so diverse.

Even though I am not myself a health care-giver, perhaps my efforts to use Lonergan in teaching future care-givers will prove useful.

Best regards,

Dick Moodey

[Catherine B. King]

Hello AnneX and Dick: 

(To Dick:  That sounds like a great inter-disciplinary course for practitioners.)

But here's another Lonergan point that is essential (I think) for understanding the fullness and import of what practitioners are doing in the applications process, where medicine is similar in this regard to teaching (my focus is education).  Here's the quote from Insight, which was written in so clear a fashion, it almost jumped off the page at me. Regarding:

(1) ". . . the indeterminacy of the abstract: classical laws can be applied to concrete situations only by adding further determinations derived from the situations."

(2)  " . . .the nonsystematic character of the further determinations. It does not mean that the further determinations are not related to one another by law; it means that the law is only an abstract part in a concrete relation of determinate numbers, magnitudes, relative positions, etc. It does not mean that these concrete relations cannot be mastered by insight into relevant presentations; it means that the concrete insight has a fuller object than the abstract formulation. It does not mean that no attempt can be made at a conceptual account of the concrete relations; it means that such a conceptual account bogs down in an unmanageable infinity of cases. It does not mean that concrete relations are never recurrent or that accurate prediction is never possible; it means that schemes of recurrence do not fall under some overarching scheme, that they are merely instances in which law triumphs over the empirical residue, that such triumphs of law do not occur in accord with some further classical law" (Insight/2000/124-25/chapter on The Canons of Empirical Method/section: Indeterminacy and the Nonsystematic.)

In brief, the content of the quote clarifies (a) applications as a distinct field with distinct foundational parameters, (b) the import of theoretical knowledge (and keeping up in the field) as an aspect of one's professionalism in any field, and (c) the high place of "practitioner wisdom" in fields of application, e.g., nursing and education, where other persons' well-being is involved.  It also puts theory, not to mention the different sciences, in their proper place.

Regards, Catherine

[Richard Moodey]

AnneK & Catherine,

That quotation from the "canons' chapter is important.  I bring this in when I explain what it means to be attentive, intelligent, reasonable, responsible, and loving in an interaction situation.  Being responsible is not just a matter of following conscience, if that is understood in the sense of following a set of rules.  It is also being committed to a fitting response to this person in this situation.  A fitting response requires the OT to be attentive to her experience, not only in the present interaction, but also to her experiences in the history of interactions with this client.  Being attentive to her own experience requires her to be as open as possible to her experience (not defensively denying or distorting aspects of her experience). 

But there is a problem with the imperative, "be attentive," because no one has direct control over her defense mechanisms.  This is where Rogers and Gendlin fit in.  I can become more open to my experience only to the extent to which I have good social relationships with enough other people in my life.  If too many of my social relationships are characterized by defensiveness and deceit, then I will suffer from a degree of dramatic bias that will interfere with my ability to be attentive to my experiences when interacting with a client -- or a student.  It is only by being relatively open to my own experience that I will be able to be attentive enough the the client or student to respond to him/her in a fitting manner.

This is vitally important for the task of "adding firther determinations" derived from an understanding of this client in this situation.   An OT's actions in her interaction with a client depends upon her being attentive to the unique characteristics of this client, and she can do so only to the extent that she is able to be attentive to her own experiences in the interaction.

In addition to the defensiveness of the OT, stereotyping of clients can be another major obstacle to adding the further determinations Lonergan calls for.  It the OT treats a client as little more than a token of a type, she will not attempt to understand the many ways this client differs from her stereotypical image of a person whom she puts into one of her pre-existing categories.  Stereotyping is the doorway to prejudice, and prejudice is an instance of group or category bias.

It is contrary to my understanding of professional ethics for a therapist or a teacher to rely primarily upon clients or students for the open and honest interactions that reduce his or her habitual level of defensiveness.  This means that it is a professional obligation for the therapist or teacher to cultivate open and honest relationships with family and friends.  This is, however, a topic that I can't develop more fully in this post.

Best regards,
Dick

[Catherine B. King]

To AnneK:  The Lonergan quote in my note above is particularly important to educators who, I found  in my experience, are suffering from "reality-wannabee fatigue," which of course is based in fiction. Nevertheless, the fiction is huge and pervasive. It reaches across the sciences, fields of study, school board meetings, and commonsense in general. Such fatigue is a remote but powerful harbor of a practioner's vague sense that one's profession (and therefore our students and patients) is not really important in the scheme of things, e.g., in the academy and in relation to the "real" sciences.

Unfortunately, the response to the problem often is a polemical objection to science as such and anything named "theory" or "jargon," which, unfortumately again, is how general bias settles in (in Lonergan's meaning of it).

Best, Catherine