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Educator as shaman and the sublated space
Nurse Education Today 32 (2012) 529–533
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Nurse Education Today j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / n e d t
Educator as shaman and the sublated space Gerard Kenny ⁎ University of the West of England, 50 Coomb Paddock, Westbury on Trym, Bristol, BS9 4UQ, United Kingdom
a r t i c l e
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Article history: Accepted 11 June 2011 Keywords: Educator Dialectic Sublation Shaman
s u m m a r y This paper seeks to identify and explore some of the tensions that nurse educators face when engaging in the competing internal and external demands that are made on their delivery of curricula. It offers that one of the ways to explore these tensions constructively is to see them dialectically. It seeks to identify three archetypal dialectical themes that can be present in our teaching and offers that the educator's role can be understood to be one of a shaman as they seek to resolve these dialectical tensions skilfully. © 2011 Elsevier Ltd. All rights reserved.
Introduction
The Dialectical Contribution
The tensions that exist for nurse educators in delivering education to a changing demanding health and social context have been well documented (Diekelmann,2002;Doane,2002;Kenny,2004;Randall and Tate,2007). The key themes that emerge from the literature on this topic include the challenges of making nurse educational philosophy consistent with changes in policy and clinical settings, changing conceptions of students and nurses and increased demands upon educators (Grundy,2001;Mackintosh,2006;Glen,2009). The existing literature explores the relationships between practice, policy, student and educator. This literature is important in bringing to life the competing external demands that are made upon education and those that provide it. This paper acknowledges this important work but seeks to move in a different but complementary direction. It seeks to offer an exploratory reflection on the tensions that might exist dialectically within and between the educator and the external environment, to explore a space between inner and external worlds and to do so in a spirit of creativity through the use of appreciating that these tensions can be understood dialectically. Kafka (1988, p, 398) writing in his journals described the fracture between his internal and external worlds as ‘two clocks that were not in unison’. This paper seeks to explore the fracture and make tentative steps to explore how they may be brought into balance. It seeks to find a creative space to engage with these tensions and offers that by doing this skilfully the educator may have something in common with the work of the archetype of the shaman.
The dialectic method is an ancient one that has remained relatively unchanged since its beginnings with Heraclitus (Lauer, 1980). At the heart of the dialectic approach is the understanding that reality as we perceive it is in a constant process of change and flux: there is nothing eternal and unchanging. Heraclitus identified that change occurred because it was driven by forces that were in conflict. Herman Hess (2000, p.5) in his novel the Glass Bead Game observes that ‘the more pointedly and logically we formulate a thesis, the more irresistibly it cries out for its antithesis’. Hegel (1979) is sensitive to how our experience can pull us in opposite directions and recognises that our senses give us an experience of the world from which we build a language to describe it. However, within this experience of description there is also a sense of unease that the language and concepts we have developed may be inadequate to describe our reality. Therefore a process of contradiction is set in motion.
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Hegel and Dialectic Merleau-Ponty (2002) recognises the influence of Hegel's thinking in many of the significant philosophical movements that came after him, such as Marxism, phenomenology and existentialism. Hegel offers that there might be an alternative to trying to resolve these tensions by keeping competing forces in check or coming to an uneasy peace; that there might be a deeper place of reconciliation that might move beyond balancing. Understanding of Hegel's dialectical method usually derives from an appreciation of his theory which is articulated in the following way; any thesis had within it the seeds of its antithesis and that the conflict between these two could be overcome by synthesis. The formula has a certain elegance and simplicity and it is understandable as to why it has passed into common usage. However Müller (1958) is clear that Hegel did not use the term thesis–antithesis–synthesis, and
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that Hegel believed that the use of these terms amounted to no more that a lifeless schema. Hegel warned against its use because he thought that it created oversimplification and that this can result in the process becoming resolved too quickly without the possibility for meaningful integration. For Hegel dialectic was a process that occurred in conscious activity. He identifies three movements in this activity: in itself (An-sich); out of itself (Anderssein): and in and for itself (An-und-fur-sich) (Hegel, 1979). Engels (1968) uses the analogy of water to describe the subtlety of Hegel's dialectics. When water changes in temperature from 0 °C to 100 °C, from a solid to gas, it remains water, but in a higher more subtle state. Resolution and change do not mean that the initial finite (thesis) is denied (antithesis) or that the infinite (synthesis) is reduced to the multiplicity of the finite. Briggs (2000) uses the example of the Mona Lisa as an example of sublation in the smile. Mona Lisa's smile has been described as saintly and wicked, cruel and compassionate. It can hold these contraries whilst at the same time transcending them. Consequently what happens is an integration and maintenance of both thesis and antithesis. It is this quality of the paradox of maintenance of difference and integration that I find seek to explore some of the current dynamics in nurse education and explore Hegel's philosophy as a means of coming to a creative solution. Sublation — Beyond Balance of Opposites Hegel offers that the quality that enables the dialectic process to avoid unnecessary resolution of competing opposites is the German term Aufhebung. Aufhebung translates as sublation and has the capacity to hold multiple meanings (Inwood, 1992). Hegel (1979, p.68) makes this clear when he says ‘Sublation exhibits its true twofold meaning it is at once a negating and a preserving.’ Inwood (1992) argues that Hegel intends that the multiple meanings in sublation should be present at all times. The first meaning contained in sublation is to raise something from a lower to a higher place. The second meaning is that in raising something up it is preserved. This is important because in the dialectical process the thesis and antithesis are not negated but preserved at a higher level. Finally sublation acknowledges the presence of a higher level where contradictions can not only be preserved but also overcome (Inwood, 1992). Sublation is therefore at the heart of the dialectic process. The sublated space has the potential to offer educators that rather than trying to resolve competing opposites within curriculum design and delivery we might seek some higher synthesis that allows us to be receptive to current economic and political condition whilst mainlining a sense of the key themes and ideas that lie within our own professional tradition. Scharmer (2009) believes that this can occur because that what is suspended is the internal voice of judgement, the perspective that seeks to resolve the dialectic in favour of one aspect or another. For Scharmer suspension is the beginning of becoming aware. Without suspension it will be difficult to move to a place of greatest potential for deeper understanding. Hegel (1979, p.82) describes this as a ‘unity, which appears as the middle term over against the independent extremes.’ I acknowledge the potential difficulties involved in extracting key terms from Hegel's thinking without deeper exploration of the wider context in which Hegel sets them. However, to go further than this would detract from the main topic of this paper. What Hegel offers is an orientation, a way of navigating the tensions that exist in teaching. The next part of this paper explores three key archetypal dialectical pairings that educators can be faced with. Logos and Mythos The first dialectic is that of logos and mythos. I use these terms in the sense that Armstrong (2001) outlines. Broadly, logos refers to ways of knowing that are governed by logic and are verifiable by
testing through the senses. Logos offers us the benefits that in an educational context we can teach our students those aspects of care where the precise, practical and exact have paramount importance. It enables us to measure and test what we teach and in doing so come to some agreement on what we have measured. In contrast, mythos is concerned with meaning, a way of knowing that speaks to the timeless aspects of our experiences and lives. Mythos may be unhelpful when trying to teach injection or aseptic technique, yet it is the source that we draw on when we need to reflect on the deeper significance of birth, sickness, healing and death. For these occurrences in our lives we require a deeper archetypal consciousness in order to derive meaning and make sense of what has occurred (Jung, 1991). Armstrong (2001) acknowledges that individuals, communities and societies require both logos and mythos in order to be balanced. However, in our modern context it is logos that has ascendency as being seen as the dominant force in enabling communities to deal effectively with the challenges of the external world. The nurse educator is faced with the challenge of bringing the dialectic of logos and mythos into greater balance; to find a place between Martin Luther's contention that ‘reason is the Devil's greatest whore’ (Clarke et al., 2004, p.78), and Kant's belief that reason was the only way forward. In the arena of nurse education the realm of mythos could be associated with realms of knowing and understanding that can be called tacit knowing. Nonaka and Takeuchi (1995) drawing on Polanyi's work on tacit understanding identify two types of knowing. The first is ‘codified’ this type of knowing can be transmitted in formal systematic language and as such can be explicit. In contrast tacit knowing is personal, subjective and context-specific and consequently can be difficult to communicate and is therefore implicit. To make a distinction between these two ways of knowing is initially helpful but Polanyi (1983) identifies how they work together. Polanyi employs the term ‘focal knowledge’ to refer to understanding that could be made explicit and ‘subsidiary knowledge’ to understanding which was implicit. For example, Polanyi uses recognition of a face to demonstrate that a person can recognise a face in a crowd out of many faces but may not be able to describe how the recognition came about. Polanyi identifies that we may not be able to speak of how this recognition occurred because it is our subsidiary/implicit knowing that is guiding our focal/explicit understanding. Therefore Polanyi reasons that we always attend from the subsidiary to the focal. Consequently we always know ‘more than we can tell’. For this reason Polanyi argues that all knowledge are personal because all knowledge are either tacit or rooted in tacit knowledge, because behind all the formal methods of inquiry lies the informal and tacit operations of the inquirer's own mind. Consequently our honouring of tacit within nurse education can help facilitate some of the tensions between mythos and logos by acknowledging our innate capacity to sense an underlying unity from contact with fragments and parts.
Hygeia and Panacea The second dialectical tension that educators are faced with is that of Hygeia and Panacea. Coulter (1990) identifies that Hygeia and Panacea were the daughters of Asclepius, a Greek physician who practised around 1200 BC. The original Hippocratic Oath sworn by physicians made the presence of all three very clear ‘I swear by Apollo the physician and Asclepuis, and Hygiea, and Panacea’ (Ghimire, 2005). Hygeia and Panacea are metaphors for approaches to health. Hygeia represents the vitalist school and symbolised the belief that people would remain healthy if they lived wisely and within the laws of common sense and balance. Florence Nightingale demonstrates such a perspective when she says,
G. Kenny / Nurse Education Today 32 (2012) 529–533
It is often thought that medicine is the curative process. It is no such thing; medicine is the surgery of functions as surgery is that of limbs and organs. Neither can do anything but remove obstructions; neither can cure. Medicine, so far as we know, assists nature to remove the obstruction but does nothing more. Nature alone cures (Allan and Jolley, 1986, p.89). In contrast, Panacea represents the perspective that there could be a specific remedy available for every condition. Elements of this philosophy were given expression in the thinking of Greek thinker Democritus. Democritus developed the theory of atoms and advocated that all matter was composed of invisible particles that were the basis of all material substance. Through the process of division, nature could be explained (Cartledge, 1998). Coulter (1990) identifies how the cult of Panacea through the philosophy of rationalism has become the dominant force in western thinking about health. It has also become the force that has an impact on medicalising nursing and consequently nurse education (Romyn, 2001). Rationalism emphasises the importance of understanding the structure of the body and the function of organs in order to know the cause of disease. The atomists of the rationalist school also believed in balance; however, they had different means by which it is achieved. One of the earliest advocates of this approach was Galen of Pergamum. Galen was a surgeon who gained fame working with gladiators in Alexandria. Galen wrote extensively of the four humours of the body, blood, phlegm, black and yellow bile. The Galenic system relied on bleeding and purges according to the humour they were seeking to balance and was described as ‘heroic medicine’ (Lindemann, 1999). Therefore, restoration of health could be achieved through draining people of their blood, poisoning them with mercury and purging them by inducing profuse sweating. Such an approach gave priority to the mechanical processes of the body rather than energetic presence of vitalism. A rational treatment was one which brought about remission or cure of the disease. This view was articulated by Benjamin Rush, one of the signatories of the American Declaration of Independence, Although physicians are in speculation the servants, yet in practice, they are the masters of nature.... Instead of waiting for the slow operations of nature, to eliminate a supposed morbid matter from the body, art should take the business out of her hands (Runes, 2007, p.275). Levi-Strauss (1995) identifies that polarisation is a common flaw at the heart of the way we use language; we define a thing by what it is not and in doing so we juxtapose a concept with its opposite. The consequence of this is that polarisation implicitly and explicitly creates a judgement as to how we perceive one pole or the other as being ‘good’ or bad’. For educators it needs to be borne in mind that even though the original Hippocratic Oath was intended for those practising medicine that we have been heavily guided by its presence and that in the original Hippocratic Oath both Hygeia and Panacea were present.
Noumenal and Phenomenal The third dialectic concerns the noumenal and phenomenal. Kant (2007) uses the metaphor of an island to describe the relationship between the two forms of understanding. This domain is an island, enclosed by nature itself within unalterable limits. It is the land of truth – enchanting name! – Surrounded by a wide and stormy ocean, the native home of illusion… (Kant, 2007, p.251). Kant sought to draw clear boundaries between what could and what could not be known. The phenomenal world could be known
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and understood by the senses and for this Kant uses the metaphor of the interior of the island. In contrast the surrounding ocean is the noumenal, the unknown, whose presence gives the boundaries of the island its shape and form. Kant's process of division and separation is a paradoxical movement to try and synthesise two contradictory schools of thinking. Prior to Kant the historically dominant philosophy of idealism, with its roots in Platonism, had been used to understand and explore metaphysics. Metaphysics is the search for knowledge of the noumenal as it is, independent of human cognition through the exercise of reason to construct theories using a priori knowledge. Consequently, Platonic idealism does not require experience to verify its conclusions; knowledge is derived from reason alone (Plato, 2008). In contrast, empiricism denied the a priori and affirmed the a posteriori, the world of the phenomena. Here knowledge could only be derived from experience and there were no innate ideas that could exist without the senses. Hume (2004) was the most articulate exponent of this philosophy building on Locke's doctrine that the mind was a blank slate, a tabula rasa, upon which experience imprinted knowledge. The blank slate became filled with ideas which were themselves copies of objects that had been transmitted to the mind by the senses. Hume advocated that nothing could be known outside of experience. However experience was not reliable but based upon subjectivity and this could never provide true knowledge of reality. Schopenhauer echoes a tradition that the noumenal is an interior state of being (Fanning, 2001). For Schopenhauer, intimate access was possible because of what he described as the ‘dream organ’ that made the connection between the phenomenal and the noumenal possible. The dream organ state was a quality of being that could come about in times of sleep, trances or hypnosis. In these states, Schopenhauer identified that the dominant functioning of the body and mind which dealt with receiving and responding to constant sensations from without are quietened. For example, sleep enables the activities of the senses to quieten and so makes us receptive to inner stimuli which Schopenhauer felt was the noumenal speaking to us and through us. For Durkheim (1976) the divisions between the states of being that comprise the noumenal and phenomenal are very difficult to overcome. He explains that human thinking, always presupposes a bipartite division of the whole universe, known and unknowable, into two classes which embrace all that exists and radically excludes each other (Durkheim, 1976, p.117). Durkheim identified that the contrast between sacred and profane was the widest and deepest the human mind could make. Yet my experience was that although the contrast might be the widest a human mind might make it could also be the most intimate when experienced directly. A person who wishes to engage with these tensions creatively and constructively has been described by Underhill (1999) as needing to be ‘amphibious’ to have the capacity to move easefully between seemingly incompatible worlds. This ease of movement requires a conscious intention to act as a bridge and bring balance to competing philosophies and ways of being. Aldridge (2000) identifies that the etymological roots of intention are in the Latin tendere, which means to stretch the mind to become attentive with expectation. It is this stretching of the mind with thinking and feeling that can create the conditions to initially keep the dialectical relationship open rather than resolving and restricting it to just one viewpoint. Within the nursing curricula and educational delivery the loss of the noumenal is often to be observed in the absence of teaching that concerns issues such as spirituality. Wright (2004) recognises that despite the advances in our technological capacity to care and cure the spiritual dimension in life remains extremely important. Any concept of wellness and the process of healing must extend beyond the physical and psychological to include the spiritual (Prilleltensky and
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Prilleltensky,2003;Oman and Thoresen,2005). For Coyle (2002) spirituality has a core role to play in determining health and therefore the link between spirituality and health is important. There are some important links to be made between spirituality and physical and mental well being (Musick et al.,2002;Koening and Larson,2001; Mohr,2006). Egnew (2009) identifies that spirituality is an important aspect of healing because it plays a role in bringing about a harmony between body and mind and itself. For Fleming and Evans (2008) the process of transcending illness and difficulty requires a spiritual dimension. The acknowledgement and inclusion of this dimension helps create a more holistic understanding of the person. Love and Simpson (2004) highlight the implications of working in this dimension are not only present for individuals but can also contribute to wider social well being due to the interconnectedness of the individual with the wider social collective. Educator as Shaman Harner (1992) identifies that the word shaman originated from the Siberian Tungus tribe word samann which means ‘to know’. Both Halifax (1982) and Eliade (1989) see this role as archetypal and that consequently its expression and practice is found not just in Siberia but throughout the world. A shaman is a person who through his/her skills can move between different worlds (e.g. material and the spiritual) (Eliade, 1989). Samann also means, ‘one who is excited, moved, raised’ (Walsh, 1990, p.8). My use of the term shaman may be viewed as contentious or inappropriate. I use it in it as an archetype and metaphor to hold and describe a key quality that is also shared in the process of teaching. McKercher (1993) identifies that one of the significant skills of a shaman is their dexterity in being able to make and break connections that no longer work and forge new ones so that concepts, situations and activities can be meaningful. The educator like the shaman must seek to overcome epistemological crises with a new outlook/perspective or action, so that the situation can be reorientated to cope with the unfolding context. Bakhtin (1982) is sensitive to the way in which this process of making and breaking connections/relationships was reflected in our use of language. One aspect of language that forged connections and enabled our experiences to be presented in a unified way was monologic language (monologia). Bahktin recognised that monologic language held the potential to shape society and the individuals within it but one of the consequences of this unification was a reduction in possible freedom to speak or act. This was due to the fact that the process of moving language towards something that is unifying has the consequence that other forms of expression which could lead to alternative forms of acting and thinking are either eliminated or ignored. The consequence of this was marginalisation or inappropriate unification of voices that held alternative ethnic and gender perspectives. This is in contrast to the centrifugal action identified by Bakhtin (1982). Bhaktin saw that language had the potential to be one of heteroglossia; a way of using language that moves towards multiplicity. Heteroglossia serves to break down existing connections and develops alternative ways of speaking. This is illustrated in the original model of the shaman as a person who lived on the periphery, outside of the village and so was in touch with those experiences which might facilitate heteroglossia; yet he/she was also required to have a strong sense of the unifying forces that permeate life in his/her dealings with sickness on a personal and social level. Illich (1976) understood that those at the fringes of the healthcare system can have the greatest understanding of the nature of the forces that disrupt and well as contribute to health and well being. Implications for Educators All of the dialectical pairings are important and get played not just in the educational context but also clinical practice. Each side of the
dialectic holds within its opposite. For example there is a tendency within curricula to become focused on logos, Panacea and the phenomenal. These aspects are attractive because they appear to be monological and unifying. The consequence of an over-emphasis on these aspects can be that time for teaching subjects such as spirituality and sexuality gets subsumed with hand washing competencies, post graduate courses for care of the dying get phased out and modules that offer technical high dependency skills are over-subscribed, skills of reflection are relegated to the regurgitation of facts that can be tested. However, as Hegel identifies that even when the dominant aspects of a dialectical is in ascendency there will be a growing awareness that what we are depicting and implementing are inadequate to describe our experience and in this context the wider realities of care delivery. So within the drive for unity there is inherent discord and disruption. Likewise, a reluctance to engage with the other side of the dialectic: mythos, Hygeia and noumenal, acknowledges that these aspects are difficult to teach, they create heteroglossia in that we can struggle to find the right vocabulary to describe and discuss and so make the connections with other aspects of their dialectical pairings. Yet, within that discord there is also an acknowledgement that in the caring process and the vocabulary and metaphors that accompany holistic care create an alternative movement that seeks wholeness and unity. The quality of the shaman's activity and that of the nurse educator is that the seeking of the sublated space there is a movement towards wholeness. The appreciation of wholeness lies at the heart of our human experience. For Assagioli (1971) the process of awakening to this underlying synthesis and wholeness would give us insight into who we are. Therefore the educator like the shaman must have the capacity to move between different worlds. To be able to hold both sides of the dialectic whilst at the same time moving beyond them so that the deeper meanings and appreciation of care delivery can be identified. Conclusion Hegel presents an ideal when he speaks of sublation; one that may not be tenable when so many pressures come to bear on curriculum design and delivery. Dialectical tensions may not sublate into a higher synthesis. What is important is embarking on the process of seeking to arrive at deeper appreciation of how this might be engaged with, so that discussions concerning what and how we teach are open and fluid. By engaging with existing imbalances that may no longer work and forging new ones may help us make sense of our activity of teaching, we might develop a sensitivity and receptivity to the dialectical tensions we are faced with. For the educator as shaman aspiring to the sublated space is a constant process of reconnection and change. References Aldridge, D., 2000. Spirituality, Healing and Medicine: Return to the Silence. Jessica Kingsley Publishers, London. Allan, P., Jolley, M., 1986. The Curriculum in Nursing Education. Croom Helm, London. Armstrong, K., 2001. The Battle for God: Fundamentalism in Judaism, Christianity and Islam. HarperCollins Publishers Ltd., New York. Assagioli, R., 1971. Psychosynthesis. Penguin, London. Bakhtin, M.M., 1982. Dialogic Imagination: Four Essays. University of Texas Press, Austin, TX. Briggs, J., 2000. Fire in the Crucible: Understanding the Process of Creative Genius. Phanes Press, Grand Rapids, MI. Cartledge, P., 1998. The Great Philosophers: Democritus. Weidenfeld & Nicolson, London. Clarke, K.J., Lints, R., Smith, J.K.A., 2004. 101 Key Terms in Philosophy and Their Importance for Theology. Westminster/John Knox Press, Louisville, KY. Coulter, H.L., 1990. The Divided Legacy (Vol 1): The Patterns Emerge: Hippocrates to Paracelcus. North Atlantic Books, Berkeley CA. Coyle, J., 2002. Spirituality and health: towards a framework for exploring the relationship between spirituality and health. Journal of Advanced Nursing 37 (6), 589–597.
G. Kenny / Nurse Education Today 32 (2012) 529–533 Diekelmann, N., 2002. “Too much content…:” epistemologies' grasp and nursing education. The Journal of Nursing Education 41, 469–470. Doane, G.A.H., 2002. Beyond behavioral skills to human-involved processes: relational nursing practice and interpretive pedagogy. The Journal of Nursing Education 41, 400–404. Durkheim, E., 1976. On Religion: A Selection of Readings with Bibliographies and Introductory Remarks. Law Book Co of Australasia, Sydney. Egnew, T.R., 2009. Suffering, meaning, and healing: challenges of contemporary medicine. Annals of Family Medicine 7 (2), 170–175. Eliade, M., 1989. Shamanism: Archaic Techniques of Ecstasy. Arkana, London. Engels, F., 1968. Dialectics of Nature. International Publishers Co., New York. Fanning, S., 2001. Mystics of the Christian Tradition. Routledge, London. Fleming, S., Evans, D.S., 2008. The concept of spirituality: its role within health promotion practice in the Republic of Ireland. Spirituality and Health International 9, 79–89. Ghimire, L.V., 2005. Snakes and staffs. Student BMJ 13, 221–264. Glen, S., 2009. Nursing education — is it time to go back to the future? The British Journal of Nursing 18 (8), 498–502. Grundy, L., 2001. Pathways to fitness for practice: National Vocational Qualifications as a foundation of competence in nurse education. Nurse Education Today 21 (4), 260–265. Halifax, J., 1982. Shaman: The Wounded Healer. Thames and Hudson, London. Harner, M.J., 1992. Way of the Shaman. HarperSanFrancisco, San Fransisco, CA. Hegel, G.W.F., 1979. Phenomenology of Spirit. OUP, Oxford. Hess, H., 2000. The Glass Bead Game. Vintage, London. Hume, D., 2004. A Treatise of Human Nature: Being an Attempt to Introduce the Experimental Method of Reasoning into Moral Subjects. Penguin Classics, London. Illich, I., 1976. Limits to Medicine. Penguin Publishers, Harmondsworth. Inwood, M., 1992. A Hegel Dictionary. Blackwell Philosopher Dictionaries, Oxford. Jung, C.G., 1991. The Archetypes and the Collective Unconscious, 2nd Ed. Routledge, London. Kafka, F., 1988. The Diaries of Franz Kafka. New York Knopf Doubleday Publishing Group. Kant, I., 2007. Critique of Pure Reason, Rev. Ed. Penguin Classics, London. Kenny, G., 2004. The origins of current nurse education policy and its implications for nurse educators. Nurse Education Today 24 (2), 84–90. Koening, H.G., Larson, D.B., 2001. Religion and mental health: evidence for an association. International Review of Psychiatry 13, 67–78. Lauer, Q., 1980. Essays in Hegelian Dialectic. Fordham University Press, Bronx, NY. Levi-Strauss, C.L., 1995. Myth and Meaning: Cracking the Code of Culture. Schocken Books, New York.
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Contents lists available at ScienceDirect
Nurse Education Today j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / n e d t
Educator as shaman and the sublated space Gerard Kenny ⁎ University of the West of England, 50 Coomb Paddock, Westbury on Trym, Bristol, BS9 4UQ, United Kingdom
a r t i c l e
i n f o
Article history: Accepted 11 June 2011 Keywords: Educator Dialectic Sublation Shaman
s u m m a r y This paper seeks to identify and explore some of the tensions that nurse educators face when engaging in the competing internal and external demands that are made on their delivery of curricula. It offers that one of the ways to explore these tensions constructively is to see them dialectically. It seeks to identify three archetypal dialectical themes that can be present in our teaching and offers that the educator's role can be understood to be one of a shaman as they seek to resolve these dialectical tensions skilfully. © 2011 Elsevier Ltd. All rights reserved.
Introduction
The Dialectical Contribution
The tensions that exist for nurse educators in delivering education to a changing demanding health and social context have been well documented (Diekelmann,2002;Doane,2002;Kenny,2004;Randall and Tate,2007). The key themes that emerge from the literature on this topic include the challenges of making nurse educational philosophy consistent with changes in policy and clinical settings, changing conceptions of students and nurses and increased demands upon educators (Grundy,2001;Mackintosh,2006;Glen,2009). The existing literature explores the relationships between practice, policy, student and educator. This literature is important in bringing to life the competing external demands that are made upon education and those that provide it. This paper acknowledges this important work but seeks to move in a different but complementary direction. It seeks to offer an exploratory reflection on the tensions that might exist dialectically within and between the educator and the external environment, to explore a space between inner and external worlds and to do so in a spirit of creativity through the use of appreciating that these tensions can be understood dialectically. Kafka (1988, p, 398) writing in his journals described the fracture between his internal and external worlds as ‘two clocks that were not in unison’. This paper seeks to explore the fracture and make tentative steps to explore how they may be brought into balance. It seeks to find a creative space to engage with these tensions and offers that by doing this skilfully the educator may have something in common with the work of the archetype of the shaman.
The dialectic method is an ancient one that has remained relatively unchanged since its beginnings with Heraclitus (Lauer, 1980). At the heart of the dialectic approach is the understanding that reality as we perceive it is in a constant process of change and flux: there is nothing eternal and unchanging. Heraclitus identified that change occurred because it was driven by forces that were in conflict. Herman Hess (2000, p.5) in his novel the Glass Bead Game observes that ‘the more pointedly and logically we formulate a thesis, the more irresistibly it cries out for its antithesis’. Hegel (1979) is sensitive to how our experience can pull us in opposite directions and recognises that our senses give us an experience of the world from which we build a language to describe it. However, within this experience of description there is also a sense of unease that the language and concepts we have developed may be inadequate to describe our reality. Therefore a process of contradiction is set in motion.
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Hegel and Dialectic Merleau-Ponty (2002) recognises the influence of Hegel's thinking in many of the significant philosophical movements that came after him, such as Marxism, phenomenology and existentialism. Hegel offers that there might be an alternative to trying to resolve these tensions by keeping competing forces in check or coming to an uneasy peace; that there might be a deeper place of reconciliation that might move beyond balancing. Understanding of Hegel's dialectical method usually derives from an appreciation of his theory which is articulated in the following way; any thesis had within it the seeds of its antithesis and that the conflict between these two could be overcome by synthesis. The formula has a certain elegance and simplicity and it is understandable as to why it has passed into common usage. However Müller (1958) is clear that Hegel did not use the term thesis–antithesis–synthesis, and
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that Hegel believed that the use of these terms amounted to no more that a lifeless schema. Hegel warned against its use because he thought that it created oversimplification and that this can result in the process becoming resolved too quickly without the possibility for meaningful integration. For Hegel dialectic was a process that occurred in conscious activity. He identifies three movements in this activity: in itself (An-sich); out of itself (Anderssein): and in and for itself (An-und-fur-sich) (Hegel, 1979). Engels (1968) uses the analogy of water to describe the subtlety of Hegel's dialectics. When water changes in temperature from 0 °C to 100 °C, from a solid to gas, it remains water, but in a higher more subtle state. Resolution and change do not mean that the initial finite (thesis) is denied (antithesis) or that the infinite (synthesis) is reduced to the multiplicity of the finite. Briggs (2000) uses the example of the Mona Lisa as an example of sublation in the smile. Mona Lisa's smile has been described as saintly and wicked, cruel and compassionate. It can hold these contraries whilst at the same time transcending them. Consequently what happens is an integration and maintenance of both thesis and antithesis. It is this quality of the paradox of maintenance of difference and integration that I find seek to explore some of the current dynamics in nurse education and explore Hegel's philosophy as a means of coming to a creative solution. Sublation — Beyond Balance of Opposites Hegel offers that the quality that enables the dialectic process to avoid unnecessary resolution of competing opposites is the German term Aufhebung. Aufhebung translates as sublation and has the capacity to hold multiple meanings (Inwood, 1992). Hegel (1979, p.68) makes this clear when he says ‘Sublation exhibits its true twofold meaning it is at once a negating and a preserving.’ Inwood (1992) argues that Hegel intends that the multiple meanings in sublation should be present at all times. The first meaning contained in sublation is to raise something from a lower to a higher place. The second meaning is that in raising something up it is preserved. This is important because in the dialectical process the thesis and antithesis are not negated but preserved at a higher level. Finally sublation acknowledges the presence of a higher level where contradictions can not only be preserved but also overcome (Inwood, 1992). Sublation is therefore at the heart of the dialectic process. The sublated space has the potential to offer educators that rather than trying to resolve competing opposites within curriculum design and delivery we might seek some higher synthesis that allows us to be receptive to current economic and political condition whilst mainlining a sense of the key themes and ideas that lie within our own professional tradition. Scharmer (2009) believes that this can occur because that what is suspended is the internal voice of judgement, the perspective that seeks to resolve the dialectic in favour of one aspect or another. For Scharmer suspension is the beginning of becoming aware. Without suspension it will be difficult to move to a place of greatest potential for deeper understanding. Hegel (1979, p.82) describes this as a ‘unity, which appears as the middle term over against the independent extremes.’ I acknowledge the potential difficulties involved in extracting key terms from Hegel's thinking without deeper exploration of the wider context in which Hegel sets them. However, to go further than this would detract from the main topic of this paper. What Hegel offers is an orientation, a way of navigating the tensions that exist in teaching. The next part of this paper explores three key archetypal dialectical pairings that educators can be faced with. Logos and Mythos The first dialectic is that of logos and mythos. I use these terms in the sense that Armstrong (2001) outlines. Broadly, logos refers to ways of knowing that are governed by logic and are verifiable by
testing through the senses. Logos offers us the benefits that in an educational context we can teach our students those aspects of care where the precise, practical and exact have paramount importance. It enables us to measure and test what we teach and in doing so come to some agreement on what we have measured. In contrast, mythos is concerned with meaning, a way of knowing that speaks to the timeless aspects of our experiences and lives. Mythos may be unhelpful when trying to teach injection or aseptic technique, yet it is the source that we draw on when we need to reflect on the deeper significance of birth, sickness, healing and death. For these occurrences in our lives we require a deeper archetypal consciousness in order to derive meaning and make sense of what has occurred (Jung, 1991). Armstrong (2001) acknowledges that individuals, communities and societies require both logos and mythos in order to be balanced. However, in our modern context it is logos that has ascendency as being seen as the dominant force in enabling communities to deal effectively with the challenges of the external world. The nurse educator is faced with the challenge of bringing the dialectic of logos and mythos into greater balance; to find a place between Martin Luther's contention that ‘reason is the Devil's greatest whore’ (Clarke et al., 2004, p.78), and Kant's belief that reason was the only way forward. In the arena of nurse education the realm of mythos could be associated with realms of knowing and understanding that can be called tacit knowing. Nonaka and Takeuchi (1995) drawing on Polanyi's work on tacit understanding identify two types of knowing. The first is ‘codified’ this type of knowing can be transmitted in formal systematic language and as such can be explicit. In contrast tacit knowing is personal, subjective and context-specific and consequently can be difficult to communicate and is therefore implicit. To make a distinction between these two ways of knowing is initially helpful but Polanyi (1983) identifies how they work together. Polanyi employs the term ‘focal knowledge’ to refer to understanding that could be made explicit and ‘subsidiary knowledge’ to understanding which was implicit. For example, Polanyi uses recognition of a face to demonstrate that a person can recognise a face in a crowd out of many faces but may not be able to describe how the recognition came about. Polanyi identifies that we may not be able to speak of how this recognition occurred because it is our subsidiary/implicit knowing that is guiding our focal/explicit understanding. Therefore Polanyi reasons that we always attend from the subsidiary to the focal. Consequently we always know ‘more than we can tell’. For this reason Polanyi argues that all knowledge are personal because all knowledge are either tacit or rooted in tacit knowledge, because behind all the formal methods of inquiry lies the informal and tacit operations of the inquirer's own mind. Consequently our honouring of tacit within nurse education can help facilitate some of the tensions between mythos and logos by acknowledging our innate capacity to sense an underlying unity from contact with fragments and parts.
Hygeia and Panacea The second dialectical tension that educators are faced with is that of Hygeia and Panacea. Coulter (1990) identifies that Hygeia and Panacea were the daughters of Asclepius, a Greek physician who practised around 1200 BC. The original Hippocratic Oath sworn by physicians made the presence of all three very clear ‘I swear by Apollo the physician and Asclepuis, and Hygiea, and Panacea’ (Ghimire, 2005). Hygeia and Panacea are metaphors for approaches to health. Hygeia represents the vitalist school and symbolised the belief that people would remain healthy if they lived wisely and within the laws of common sense and balance. Florence Nightingale demonstrates such a perspective when she says,
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It is often thought that medicine is the curative process. It is no such thing; medicine is the surgery of functions as surgery is that of limbs and organs. Neither can do anything but remove obstructions; neither can cure. Medicine, so far as we know, assists nature to remove the obstruction but does nothing more. Nature alone cures (Allan and Jolley, 1986, p.89). In contrast, Panacea represents the perspective that there could be a specific remedy available for every condition. Elements of this philosophy were given expression in the thinking of Greek thinker Democritus. Democritus developed the theory of atoms and advocated that all matter was composed of invisible particles that were the basis of all material substance. Through the process of division, nature could be explained (Cartledge, 1998). Coulter (1990) identifies how the cult of Panacea through the philosophy of rationalism has become the dominant force in western thinking about health. It has also become the force that has an impact on medicalising nursing and consequently nurse education (Romyn, 2001). Rationalism emphasises the importance of understanding the structure of the body and the function of organs in order to know the cause of disease. The atomists of the rationalist school also believed in balance; however, they had different means by which it is achieved. One of the earliest advocates of this approach was Galen of Pergamum. Galen was a surgeon who gained fame working with gladiators in Alexandria. Galen wrote extensively of the four humours of the body, blood, phlegm, black and yellow bile. The Galenic system relied on bleeding and purges according to the humour they were seeking to balance and was described as ‘heroic medicine’ (Lindemann, 1999). Therefore, restoration of health could be achieved through draining people of their blood, poisoning them with mercury and purging them by inducing profuse sweating. Such an approach gave priority to the mechanical processes of the body rather than energetic presence of vitalism. A rational treatment was one which brought about remission or cure of the disease. This view was articulated by Benjamin Rush, one of the signatories of the American Declaration of Independence, Although physicians are in speculation the servants, yet in practice, they are the masters of nature.... Instead of waiting for the slow operations of nature, to eliminate a supposed morbid matter from the body, art should take the business out of her hands (Runes, 2007, p.275). Levi-Strauss (1995) identifies that polarisation is a common flaw at the heart of the way we use language; we define a thing by what it is not and in doing so we juxtapose a concept with its opposite. The consequence of this is that polarisation implicitly and explicitly creates a judgement as to how we perceive one pole or the other as being ‘good’ or bad’. For educators it needs to be borne in mind that even though the original Hippocratic Oath was intended for those practising medicine that we have been heavily guided by its presence and that in the original Hippocratic Oath both Hygeia and Panacea were present.
Noumenal and Phenomenal The third dialectic concerns the noumenal and phenomenal. Kant (2007) uses the metaphor of an island to describe the relationship between the two forms of understanding. This domain is an island, enclosed by nature itself within unalterable limits. It is the land of truth – enchanting name! – Surrounded by a wide and stormy ocean, the native home of illusion… (Kant, 2007, p.251). Kant sought to draw clear boundaries between what could and what could not be known. The phenomenal world could be known
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and understood by the senses and for this Kant uses the metaphor of the interior of the island. In contrast the surrounding ocean is the noumenal, the unknown, whose presence gives the boundaries of the island its shape and form. Kant's process of division and separation is a paradoxical movement to try and synthesise two contradictory schools of thinking. Prior to Kant the historically dominant philosophy of idealism, with its roots in Platonism, had been used to understand and explore metaphysics. Metaphysics is the search for knowledge of the noumenal as it is, independent of human cognition through the exercise of reason to construct theories using a priori knowledge. Consequently, Platonic idealism does not require experience to verify its conclusions; knowledge is derived from reason alone (Plato, 2008). In contrast, empiricism denied the a priori and affirmed the a posteriori, the world of the phenomena. Here knowledge could only be derived from experience and there were no innate ideas that could exist without the senses. Hume (2004) was the most articulate exponent of this philosophy building on Locke's doctrine that the mind was a blank slate, a tabula rasa, upon which experience imprinted knowledge. The blank slate became filled with ideas which were themselves copies of objects that had been transmitted to the mind by the senses. Hume advocated that nothing could be known outside of experience. However experience was not reliable but based upon subjectivity and this could never provide true knowledge of reality. Schopenhauer echoes a tradition that the noumenal is an interior state of being (Fanning, 2001). For Schopenhauer, intimate access was possible because of what he described as the ‘dream organ’ that made the connection between the phenomenal and the noumenal possible. The dream organ state was a quality of being that could come about in times of sleep, trances or hypnosis. In these states, Schopenhauer identified that the dominant functioning of the body and mind which dealt with receiving and responding to constant sensations from without are quietened. For example, sleep enables the activities of the senses to quieten and so makes us receptive to inner stimuli which Schopenhauer felt was the noumenal speaking to us and through us. For Durkheim (1976) the divisions between the states of being that comprise the noumenal and phenomenal are very difficult to overcome. He explains that human thinking, always presupposes a bipartite division of the whole universe, known and unknowable, into two classes which embrace all that exists and radically excludes each other (Durkheim, 1976, p.117). Durkheim identified that the contrast between sacred and profane was the widest and deepest the human mind could make. Yet my experience was that although the contrast might be the widest a human mind might make it could also be the most intimate when experienced directly. A person who wishes to engage with these tensions creatively and constructively has been described by Underhill (1999) as needing to be ‘amphibious’ to have the capacity to move easefully between seemingly incompatible worlds. This ease of movement requires a conscious intention to act as a bridge and bring balance to competing philosophies and ways of being. Aldridge (2000) identifies that the etymological roots of intention are in the Latin tendere, which means to stretch the mind to become attentive with expectation. It is this stretching of the mind with thinking and feeling that can create the conditions to initially keep the dialectical relationship open rather than resolving and restricting it to just one viewpoint. Within the nursing curricula and educational delivery the loss of the noumenal is often to be observed in the absence of teaching that concerns issues such as spirituality. Wright (2004) recognises that despite the advances in our technological capacity to care and cure the spiritual dimension in life remains extremely important. Any concept of wellness and the process of healing must extend beyond the physical and psychological to include the spiritual (Prilleltensky and
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Prilleltensky,2003;Oman and Thoresen,2005). For Coyle (2002) spirituality has a core role to play in determining health and therefore the link between spirituality and health is important. There are some important links to be made between spirituality and physical and mental well being (Musick et al.,2002;Koening and Larson,2001; Mohr,2006). Egnew (2009) identifies that spirituality is an important aspect of healing because it plays a role in bringing about a harmony between body and mind and itself. For Fleming and Evans (2008) the process of transcending illness and difficulty requires a spiritual dimension. The acknowledgement and inclusion of this dimension helps create a more holistic understanding of the person. Love and Simpson (2004) highlight the implications of working in this dimension are not only present for individuals but can also contribute to wider social well being due to the interconnectedness of the individual with the wider social collective. Educator as Shaman Harner (1992) identifies that the word shaman originated from the Siberian Tungus tribe word samann which means ‘to know’. Both Halifax (1982) and Eliade (1989) see this role as archetypal and that consequently its expression and practice is found not just in Siberia but throughout the world. A shaman is a person who through his/her skills can move between different worlds (e.g. material and the spiritual) (Eliade, 1989). Samann also means, ‘one who is excited, moved, raised’ (Walsh, 1990, p.8). My use of the term shaman may be viewed as contentious or inappropriate. I use it in it as an archetype and metaphor to hold and describe a key quality that is also shared in the process of teaching. McKercher (1993) identifies that one of the significant skills of a shaman is their dexterity in being able to make and break connections that no longer work and forge new ones so that concepts, situations and activities can be meaningful. The educator like the shaman must seek to overcome epistemological crises with a new outlook/perspective or action, so that the situation can be reorientated to cope with the unfolding context. Bakhtin (1982) is sensitive to the way in which this process of making and breaking connections/relationships was reflected in our use of language. One aspect of language that forged connections and enabled our experiences to be presented in a unified way was monologic language (monologia). Bahktin recognised that monologic language held the potential to shape society and the individuals within it but one of the consequences of this unification was a reduction in possible freedom to speak or act. This was due to the fact that the process of moving language towards something that is unifying has the consequence that other forms of expression which could lead to alternative forms of acting and thinking are either eliminated or ignored. The consequence of this was marginalisation or inappropriate unification of voices that held alternative ethnic and gender perspectives. This is in contrast to the centrifugal action identified by Bakhtin (1982). Bhaktin saw that language had the potential to be one of heteroglossia; a way of using language that moves towards multiplicity. Heteroglossia serves to break down existing connections and develops alternative ways of speaking. This is illustrated in the original model of the shaman as a person who lived on the periphery, outside of the village and so was in touch with those experiences which might facilitate heteroglossia; yet he/she was also required to have a strong sense of the unifying forces that permeate life in his/her dealings with sickness on a personal and social level. Illich (1976) understood that those at the fringes of the healthcare system can have the greatest understanding of the nature of the forces that disrupt and well as contribute to health and well being. Implications for Educators All of the dialectical pairings are important and get played not just in the educational context but also clinical practice. Each side of the
dialectic holds within its opposite. For example there is a tendency within curricula to become focused on logos, Panacea and the phenomenal. These aspects are attractive because they appear to be monological and unifying. The consequence of an over-emphasis on these aspects can be that time for teaching subjects such as spirituality and sexuality gets subsumed with hand washing competencies, post graduate courses for care of the dying get phased out and modules that offer technical high dependency skills are over-subscribed, skills of reflection are relegated to the regurgitation of facts that can be tested. However, as Hegel identifies that even when the dominant aspects of a dialectical is in ascendency there will be a growing awareness that what we are depicting and implementing are inadequate to describe our experience and in this context the wider realities of care delivery. So within the drive for unity there is inherent discord and disruption. Likewise, a reluctance to engage with the other side of the dialectic: mythos, Hygeia and noumenal, acknowledges that these aspects are difficult to teach, they create heteroglossia in that we can struggle to find the right vocabulary to describe and discuss and so make the connections with other aspects of their dialectical pairings. Yet, within that discord there is also an acknowledgement that in the caring process and the vocabulary and metaphors that accompany holistic care create an alternative movement that seeks wholeness and unity. The quality of the shaman's activity and that of the nurse educator is that the seeking of the sublated space there is a movement towards wholeness. The appreciation of wholeness lies at the heart of our human experience. For Assagioli (1971) the process of awakening to this underlying synthesis and wholeness would give us insight into who we are. Therefore the educator like the shaman must have the capacity to move between different worlds. To be able to hold both sides of the dialectic whilst at the same time moving beyond them so that the deeper meanings and appreciation of care delivery can be identified. Conclusion Hegel presents an ideal when he speaks of sublation; one that may not be tenable when so many pressures come to bear on curriculum design and delivery. Dialectical tensions may not sublate into a higher synthesis. What is important is embarking on the process of seeking to arrive at deeper appreciation of how this might be engaged with, so that discussions concerning what and how we teach are open and fluid. By engaging with existing imbalances that may no longer work and forging new ones may help us make sense of our activity of teaching, we might develop a sensitivity and receptivity to the dialectical tensions we are faced with. For the educator as shaman aspiring to the sublated space is a constant process of reconnection and change. References Aldridge, D., 2000. Spirituality, Healing and Medicine: Return to the Silence. Jessica Kingsley Publishers, London. Allan, P., Jolley, M., 1986. The Curriculum in Nursing Education. Croom Helm, London. Armstrong, K., 2001. The Battle for God: Fundamentalism in Judaism, Christianity and Islam. HarperCollins Publishers Ltd., New York. Assagioli, R., 1971. Psychosynthesis. Penguin, London. Bakhtin, M.M., 1982. Dialogic Imagination: Four Essays. University of Texas Press, Austin, TX. Briggs, J., 2000. Fire in the Crucible: Understanding the Process of Creative Genius. Phanes Press, Grand Rapids, MI. Cartledge, P., 1998. The Great Philosophers: Democritus. Weidenfeld & Nicolson, London. Clarke, K.J., Lints, R., Smith, J.K.A., 2004. 101 Key Terms in Philosophy and Their Importance for Theology. Westminster/John Knox Press, Louisville, KY. Coulter, H.L., 1990. The Divided Legacy (Vol 1): The Patterns Emerge: Hippocrates to Paracelcus. North Atlantic Books, Berkeley CA. Coyle, J., 2002. Spirituality and health: towards a framework for exploring the relationship between spirituality and health. Journal of Advanced Nursing 37 (6), 589–597.
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