Author: Virgil Seutter
Date: October 8, 1997
7.2 Holism: The Contextual Nature of Manual Methods
7.2.1. The nature of manual methods may be viewed from another perspective,
one that uses theoretical model building as a tool for inquiry. Robert D.
Mootz examines this model building by defining a Type A versus a Type B theory.
Much of this overlaps into definition that has been around awhile but he
attributes the perception of "molecular" and "contextual" healing to Dean
Black (7.2.1) as defining a characteristic
between traditional and alternative approaches to health care. Black emphasizes
the molecular model as a physiological reaction to the bioengineering model
in which causal relationships appear as a reducible form to "one cause, one
effect" as a root cause to disease. In contrast, the contextual nature of
disease may be viewed as a physiological reaction in response to a
biopsychosocial encounter. It contains the ingredients of the infomedical
model (6.0) previously discussed.
7.2.2. The problem of complexity for Mootz appears to be one of separating
the two types of approaches as mere contrasting features. The range of
theoretical approaches may vary from micro to macro (global), from simple
to complex, molecular to contextual, or in vitro to in vivo, etc. While Type
A theories tend to reduce the problem to a smaller component that is subject
to technological analysis, the Type B theory tends to be more subjective,
possibly relying on "creative inspiration" as the basis for observation of
phenomenon. The former would appear more capable of data management by organizing
and classifying data. Furthermore, dealing with micro features permits
experimentation with relative predictability since single variables can be
more rigorously approached as part of a reducible equation. On the other
hand, Type B theory tends to be contextual; it captures the gestalt of the
phenomenon by observing the pattern relationships which "can neither be derived
from the elements of the whole, nor considered simply as the sum of these
elements." There would appear to be advantages ...and disadvantages... to
7.2.3. The "middle ground" approach, for Mootz, would appear as a problem
logic;" that everything is a matter of degree and that "shades of gray"
exist in all things complex. The options for inquiry seem limited and yet,
the nature of social and economic changes in health care demand accountability.
Finding simplicity in nature may be possible, but the social context of medicine
has forced innovative changes in experimental design and assessment of clinical
outcomes. The emphasis on random
clinical trials (7.2.3) places the clinical
outcome on "the effectiveness and value to the society as a whole." The
accentuation depends less upon biological or theoretical rationale.
7.2.4. The building of theoretical models is dependent upon a discipline's
philosophical approach to health care. Emphasis on biochemical and genetic
research into disease by medicine has prioritized the research budget toward
the Type A model for inquiry. The problem for some disciplines, including
chiropractic, is the reliance upon the Type B model that only provides
observations and incomplete theories. These theories are inadequate to develop
a foundation for research technology. The nature of manual therapy prevents
the "perfect blinding and uncontaminated shams" required in a blinded placebo
control. On the other hand, some progress in demonstrating clinical successes
might be possible using
models for diagnostic screening. Outcomes, for chiropractic, must be
"reasonable, predictable, and reproducible." Increasingly, the trend is toward
7.2.5. Finding solutions may be dependent upon how chiropractic views its
theoretical model. While opportunity exists for more liberal inquiry, the
middle ground between Type A and Type B theory may not be sufficient to support
research design and investigation of chiropractic. Theoretical model building
may require a change in thinking.
HOW TO CITE THIS
Seutter, V. "Commentary: Holism, Alternative Medicine, and Why
Chiropractic Embraces It. Holism: The Contextual Nature of Manual Methods"
Chiropractic Resource Organization. 8 Oct 1997. ChiroZine
(c) 1997-2001 Chiro.org. All rights reserved.
(c) 1997 Chiropractic Resource
Organization. All Rights Reserved. Reprint by