Nursing and the new physics

Numr Education T&y (1991) II, 347-353 0 Longman Gmp UK Ltd 1991

Nursing and the New Physics Barry Clifton

This article suggests that most current approaches based on a model of the universe and a definition physical science has moved away.

There have been a number of books published in the last few years, relating what has come to be called the New Physics to various other fields of knowledge, such as, for example, mysticism (Talbot 1981), philosophy (Powers 1982), psychology (Wolf 1985) and theology (Davies 1984), but as yet little about health, and still less about nursing. The article begins by looking at the three different scales on which we can look at the universe: the very small - the microcosmic the everyday world - the human level the very large - the macrocosmic

THE MICROCOSMIC Practitioners of medicine are pleased to think of themselves as scientists, building up a framework of factual knowledge, and basing all their activities on that ‘knowledge base’. Yet that catalogue of knowledge is based almost exclusively on the examination of the human body - as if the human body were all that existed

Ray

Uifton

RGN DipN Lilac Cottage, Western Road,

Jarvis Brook, Crowborough, East Sussex TN6 3EW (Requests for offprints to EC) Manuscript accepted 10 June 1991

to nursing and medicine are of science from which current

and all that were important. This examination takes the form of a classification of the body by systems, each considered, so far as possible, as an individual part of the body machine, and a reduction of each of these systems to its component parts, the cells, and the further reduction of each cell to the molecules of which it is composed. Medical science has not yet, however, followed the physical sciences into the further reductions - to atoms and thence to particles - and thence to the disturbing finding that the atom is mostly empty space, and that the tiny particles which move at speed within that space defy full physical description. Indeed at this level the demarcation between substance and energy becomes completely indistinct. From this finding Heisenberg drew the principle of uncertainty that states, as Talbot (I 98 1) phrases it: ‘that the observer alters the observed by the mere act of observation’. (p 21) This concept is extended by Wheeler: ‘Nothing is more important about the quantum principle than this, that it destroys the concept of the world as “sitting out there”, with the observer safely separated from it by a . . . slab . . . of glass. Even to observe so miniscule an object as an electron, he must shatter the glass. He must reach in. He must install his chosen measuring equipment. It is up to him 347

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to describe

whether

momentum. measure

TODAY

To

to measure

install

the

the one prevents

installing the equipment

position

or

equipment

to

and excludes

his

to measure the other.

Another of the cherished beiiefs of classical scientists has been that if information could be collected precise

in more

and

more

a map of reality

detail,

then

so

could be drawn

future events could be minutely

predicted.

that The

Moreover the measurement changes the state of the electron. The universe will never after-

new science has made it clear that in any situation

wards

there are so many variables -

be the

happened, “observer”

same.

To

describe

what

has

one has to cross out the old word and put in its place the new word

“participator”

‘. (Wheeler

1973, cited by Capra

personal -

that it is impossible to document even to identify

and measure,

detail can be ignored.

AT THE HUMAN

of Western

inaccuracies

accurate

or omissions

Dossey (1982), in the first of his two important books, ‘Space, time and medicine’, reviews much

outcome.

of the physics that has developed

from Einstein’s

situations where ignorance

theory of relativity and concludes

that we should

from this a unity between

ourselves

Gleick’s

involved

but that

data, then

will not

small

affect

thesis is that while there

small factors outcomes,

science: ‘that

could never be perfect’,

if you have broadly

LEVEL

that some of the

Gleick (1988) describes the

‘one small compromise’ measurements

or

them all, so that all predictions

are based on the assumption

1975, p 145)

understand

global, local and

bearing upon the most trivial events

are many

or disregard

of some

will not affect

predicted

we do not know when situations

going

The accepted religious view of mankind’s relation to the universe until the end of the

suffice. This is being found in computer science, where there are situations, he says, where:

Middle Ages was that the human world stood at of creation,

mate pinnacle. God.

This

scientific

its ulti-

Man was built in the image

picture

of man

revolution,

and 17th centuries succeeded

and represented

has survived

which began and the revolution

it in this century.

in the

of the

16th

which has

All branches

of

human science, but medical science in particular, have insisted that the progress and development of man is the sole aim of science,

so that our

‘tiny become

where

differences

approximation

are

and the universe.

the centre

to arise

the

in

input

overwhelming

. . In weather,

will not

could

differences

for example,

quickly in output

this translates

into what is only half-jokingly

known as the

Butterfly Effect - the notion that a butterfly stirring the air today in Peking can transform storm (Gleick

systems

next

month

in New

York’.

1988, p 8)

This tendency

for small initial differences

in

planet has been irrevocably damaged, and the balance of plant and animal life perhaps termi-

variables to make large differences

nally disturbed.

thetical Mr Smith may have acute cardiac failure

Perhaps the most interesting contrary opinion is that of Lovelock (1987) who suggests that the whole earth is an organism. He names this organism Gaia, and claims that throughout its life of billions of years it has been preserving a balance or homeostasis

enabling life to survive its

surface. This balance is being disturbed by the progress of mankind. It is an interesting and salutary speculation to see ourselves as commensals on the body of earth, against which defence mechanisms are being set in motion as we become pathological.

is surely applicable to nursing. and diabetes

and Mr Jones

to outcomes

Although

a hypo-

may have the same

diagnosis, even if they are admitted to the same ward on the same day, their subsequent careers may take very different courses. Other physical characteristics - for example, their cholesterol levels or their metabolic rate - may be quite different. situation,

Moreover,

in the

complex

human

it may well be that psychological

or

social factors, for example, family situation, personality traits, life-style, are completely different in their effect on the course of that individual’s illness.

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This of course can be used to support the case for individual care for the person rather than his disease. There are in every human being so many differences or variables from the next, that we can never hope to take them all into account, and consequently can hardly expect from one person’s experience to predict the next person’s

THE MACROCOSMIC There is no certainty available to us about the origins or the extent of the universe. According to the Big Bang theory which popular writers (e.g. Asimov 1975; Davies 1984) have made the most familiar and plausible of the current theories, the universe is of immense size and age, and is expanding into an emptiness without bounds. It becomes terrifying in the purest sense of the word to put the life of a man into scale against the 15 billions of years thought to have elapsed since the Big Bang. If the life of man - that ‘three score years and ten’ - were a single square on a sheet of graph paper, the length of the sheet that would be needed to demonstrate that time-scale would stretch from London to Liverpool. And in terms of space- well, it is thought that the constant hiss heard on radio telescopes is the sound of the Big Bang crossing 15 billion years at the speed of light. As light travels at 186 000 miles per second, it will have travelled . . . an awfully long way. Frighten yourself with the sums, then ask yourself why, in producing space craft that travel at 18000 miles an hour, mankind has been claimed to have conquered space. We laugh at the idea of King Canute trying to hold back the seas, or the Emperor Caligula bombarding it with stones from his catapults, then setting his army to work gathering seashells as the spoils of victory. Our claims about space are similarly grandiose. Another of the concepts that has sprung out of the new approaches to physics is that there is . only this present moment - no absolute time running as an arrow from past through present to future. If you stand outside on a clear night, the most recent star light you are seeing is at least 1

N.E.T

B

_

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4 years old, and the various lights you see each started its journey to you at a different time. Since nothing travels to you faster than the speed of light, that nearest star you see may have exploded 3 years ago in 1988. It may only be fragments rushing through space towards you. You will not have any inkling until 1992. Time is relative to you, the observer. Someone observing us from across the galaxy may just now be picking up the signals we have been sending out for most of this century. By the time his reply reaches us, we may have lost the technical skill to receive it. The American novelist, Paul Bowles, in his book ‘The sheltering sky’ crystallised the matter for me. ‘You know, the sky here’s very strange. I often have the sensation when I look at it that it’s a solid thing up there, protecting us from what’s behind.’ ‘But what is behind’ Her voice was very small. ‘Nothing, I suppose. Just darkness. Absolute night.’ (Bowles 1983, p 101) It is a dangerous thing so to stretch the mind to speculate about immensities, about which it is impossible that we should ever have knowledge. This does not, however, prevent a belief that this universe which we can observe is one of infinitely many universes, or that the cycle of bang, expansion, entropy, contraction is a repeating one. Even with what we think we know, mankind is an insignificant and probably very short-term incident in the history of the universe. Is it not perhaps true that we sometimes try to avoid thinking about our scale, to keep ourselves from being terrified? Might we as nurses not take a different view of our patients if the world of the human scale were not so paramount and exclusive in our system of belief and significance?

WHAT’S SO GREAT ABOUT SCIENCE? The theme that links the three levels considered above is that of uncertainty, a principle which is

350

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basic to the ‘New Physics’. It is necessary to doubt

the certainty of the most observed and demonstrated scientific fact, since the observer and demonstrator is always the human mind - this mind, in fact, making assumptions and ‘leaps of faith’, not knowing whether there are distortions in its transmission and reception. Equally, lacking the intellectual or technical equipment to check what it is told, this mind must rely on the integrity of those who have worked in these areas and on their freedom from error. I do not have a telescope, and cannot check what I am told about the stars not visible to the naked eye. Certainly, I have neither the mathematical skill, nor the learned observational skill, to say that this star is closer than that. I assume that other people who tell me about their observations are telling me the truth. That is only the truth, however, based on their limited knowledge and someone else tomorrow may make observations to refute everything that I have been told today and accept as knowledge. Setting aside those rare occasions, when scientists have apparently set out purposely to mislead, such as the ‘Piltdown man’ affair, how many scientific facts, apparently verified by experiment, actually remain unchallenged and unchallengeable for any length of time? What laws of science do we have of which we can say ‘This is certain, incontrovertible and eternal?’ It was very easy in a traditional nurse training course to suppose that the knowledge needed for nursing is cut and dried, that scientists have explored every explorable detail of the human body, and that this knowledge has been handed to doctors. No further effort was required from the nurse than to learn all the facts about the body machine, often from the doctors who came in as a special privilege to talk down to her, and a few facts about the mind relevant to her dealings with the body. She was not expected to question what was given to her, and certainly not asked to suppose that scientific knowledge was a changing and continuing process to which she might contribute, rather than the revelation of absolute truth. The approach to science that is described here is the classical science of Newton, who saw the universe in terms of a huge machine which could

be ultimately examined in detail and fully explained, and Descartes, who saw man as a part of that universal machine, but containing a mind, as a car contains a driver. Medical science still follows this approach to a large extent. The subsequent revolutions at the microcosmic and macrocosmic levels which have produced the uncertainty about the basis of matter described above, and the tentative and conflicting theories about the unfathomable dimensions of the universe in time and space, seem to have passed medicine by. It is therefore instructive to look at the philosophers of science who have used this uncertainty and conflict to question the preference for cut and dried mechanical solutions to scientific problems which still characterises much science, including most medical research. These philosophers are perhaps most accessible through historians and critics. The work of Karl Popper, for example, is described by Magee (1982) in a critical study. Popper’s view was that there is no way to establish what is true. His example is that of a man who sees only white swans and says ‘All swans are white’. When he comes across a black swan he must change his theory (Magee 1982, p 23). Similarly, Popper says, every scientific theory is only provisionally true. Today’s knowledge may be falsified tomorrow by some new observation. It is perhaps the belief induced by nursing training that what we are taught is true in some absolute sense that makes it so difficult for many nurses to change with changing information. He stresses the idea of ‘falsifiability’ - that we must look for observations that refute theories, rather than aiming for absolute verification of our current theories - and relates it to ‘fallibilism’ - which leads us, accepting our propensity for making mistakes, to be critical of our ideas, rather than looking for a certainty which can only be provisional. His conclusion from this is particularly pertinent to nursing. He says: ‘Life is one of those things which are very uncertain; we are all bound to die and death could come upon us at any time. My emphasis on the fallibility of human knowledge, and on

NURSE EDUCATION

its uncertainty, is, I think, more in accord with this aspect of the human situation than is the attitude of those who seek certainty’. (Popper, Eccles & Elders 1974, p 80) Losee (1980), a historian of the trends in scientific philosophy, describes the work of Kuhn (1970) on the way in which scientific thought becomes rooted in what he calls ‘paradigms’, which means that research and thought proceed along derivative tracks, without the assumptions underlying that theory being questioned, until a revolution in thought occurs. In simplified terms, Newton, for example, altered radically the way people looked at the physical world - but then his views became a dogmatic ‘paradigm’ and it required another revolution, that of Einstein, to change that view, a change which is still taking place in some sciences such as medicine, while other scientists are already treating Einstein’s views as a new ,paradigm. Losee explains the practical effect on mainstream or ‘normal’ science: ‘It is conceptual innovations which receive the most attention from historians of science. But much, if not most, science is carried on at a more prosaic level. It comprises “mopping-up operations“ in which an accepted “paradigm” is applied to new situations. Normal science is a conservative enterprise’. (Losee 1980, p 204) A cynical paraphrase of this would be to say that although, if you follow popular reporting of science, you hear most about the radical changes, most science is carried on by people who prefer to cling to a traditional dogma, and to spend their time underlining the facts that support it and ignoring the facts that do not. The traditional view of science is limiting to nurses, and makes them subject to a very narrow view of human beings. Of the radical scientific philosphers it is Paul Feyerabend (1988) who has been most influential on this author in reaching this conclusion. He attacks current attitudes to, and practice of, science from a number of directions. First, on education, quoting John Stuart Mill, he says: ‘A scientific education . . . as practised in our schools . . . cannot be reconciled with a

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35 1

humanitarian attitude. It is in conflict “with the cultivation of individuality which alone produces, or can produce, well-developed human beings” . . . The attempt to increase liberty, to lead a full and rewarding life, and the corresponding attempt to discover the secrets of nature and of man entails, therefore, the rejection of all universal standards and of all rigid traditions’. (Feyerabend 1988, p 12) He then asks whether scientists are really objective, and concludes that most conventional science is based on many unstated assumptions and that many scientists’ apparently objective statements of fact are based on such assumptions, which they cannot prove and of which, indeed, they may not even be aware. Both in themselves and in what they work with, everything: ‘is indeterminate in many ways, ambiguous, and never fully separated from the historical background. It is contaminated by principles which he does not know and which, if known, would be extremely hard to test’. (Feyerabend 1988, p 51) He also puts forward the controversial view that Big Money - governments and multinational companies - places constraints on what science is done. This is something that we are becoming increasingly aware of in health and education: ‘There are many ways to silence people apart from forbidding them to speak - and all of the are being used today. The process of knowledge production and knowledge distribution was never the free, “objective” and purely intellectual exchange rationalists make it out to be’. (Feyerabend 1988, p 131) The next of his targets selected here is the narrowness of the traditional scientific attitude. He condemns the traditional scientific view that individual attitudes, beliefs and values are irrelevant to science and asks: ‘Is it not possible that science as we know it today or a “search for the truth” in the style of traditional philosophy, will create a monster? Is it not possible that an objective approach

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that

frowns

between

the

TODAY

upon

personal

entities

Even

connections

examined

will harm

coming

‘alternative’

medicine

to rely on the adoption

seems

to

of different

be sets

people, turn them into miserable, unfriendly, self-righteous mechanisms without charm or

of techniques

toms or of antisocial behaviour,

where pharma-

humour?

cological or surgical techniques

have failed. This

“Is it not possible” asks Kierkegaard

“that my activity as an objective

observer

of

nature will weaken my strength as a human being?” I suspect the answer to all these questions must be affirmative and I believe that a reform of the sciences that makes them more anarchic and more subjective (in Kierkegaard’s sense) is urgently

needed’.

The final extract from his book deals with the status of medicine

as a hard science - and what

applies to medicine can be said with even more force of the humane social science of nursing: ‘What’s so great about science?

. . . There

are

large areas in which there is as yet no scientific answer. though

Take

the case of medicine

not a science,

which,

has increasingly

is at variance with the theme that has built up in this article of ‘uncertainty’. Larry Dossey (1982) is a Texan medical practitioner whose view of the world draws heavily on the ‘New Physics’ in describing approach human

(p 160)

been

to achieve cure of physical symp-

that is affected and macroscopic

a truly holistic

by the microscopic, levels. This

does not

accord man a special place at the centre of the universe manufactured by a higher power for his sole benefit; mankind

nor on the other hand does it see

as the accidental

coincidence

product

of cosmic

- a little curiosity in a vast universe,

fighting a futile battle for personal

survival for a

slightly longer instant. Dossey’s structure

explanation

states

of the universe

that

the

microcosmic

to

connected with scientific procedures. There are many schools in medicine, just as there are

which you cannot detach a particle or a molecule

many schools in psychology.

or a man for objective analysis, without affecting

tion of a scientific medicine”

Hence

comparison

with some

other

the ques-

of “scientific medical

system

makes no sense’. (pp 256-257) He points out that there are more directions medicine

than the Western

in

norm, and says that

there have never been systematic might lead to the conclusion

studies, which

that our medical

system was the sole scientific system, in the way that there is a worldwide ‘physics’ or ‘chemistry’. ‘Add

to this

that

culture-dependent

health

and

concepts

body machine here, harmonious

sickness

are

(good-working life there, for

example) and we see that there are domains such as medicine with no scientific answer to the question’. (pp 257-258)

macrocosmic

simply

from

is as it is - a seamless

coat from

the whole. Each man’s chief and unique importance is that he is here, and that if he were not here the universe would be otherwise. He cites the work of David Bohm (1980),

who

sees an ‘implicate order’ in the universe in which ‘everything particle

is enfolded

into everything’

holds the information

(as any piece of a holographic

plate contains the

whole of the hologram). There is an even more extreme The world of appearances

view of this.

that our brains inter-

pret as made up of individual fact, only that-a

and each

about the whole

solid objects is, in

world of appearances.

world is made up of infinitesimal

The real

particles travel-

iing at huge speeds in vast areas of empty space. I have heard the idea put forward that the relationship of the nucleus of an atom to the whole volume of the atom is equivalent to the relationship of one floating speck of dust to the dome of

CONCLUSION Medicine

has held to the traditional

scientific

model that man and his world are a machine of which fixed and absolute comprehensive knowledge can be obtained, and that when it is obtained,

the body will be totally reparable.

St. Pauls. I have even read a speculation that because of the vast speeds involved, there is only one particle doing all the work and seen by us, products of that one particle, as the myriad solid objects of the cosmos. Earlier in this article, there is a quotation from

NURSE EDUCATION

Wheeler on the idea that ultimate particles are immeasurable. If you can measure their velocity you cannot measure their momentum, and vice versa. We might then go a step further and see for all things are perceived and detected by the possibly distorted brain - no particles at all, but only energy. In such a climate of uncertainty, it seems no longer farfetched to question where the physical boundaries start between one individual and the next. Atoms are constantly passing from one to the other - to the extent that the material of every cell in our bodies, and not just stem cells undergoing mitosis, is broken down and replaced dozens of times in our life, some of them hundreds of times. From this position Dossey goes on to build a truly holistic model of health care, which can be usefully related to some current nursing models, which tend towards holism, such as that of Martha Rogers (1970), or Dolores Krieger (1951), which receive so little attention from British nurses. Certainly, such a position casts doubt on a current orthodoxy which sees nursing as an activity which can be reduced to precisely measureable processes and outcomes.

References Asimov I 1975 Asimov’s guide Penguin, Harmendsworth

to science;

vol 1.

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Bohm D 1980 Wholeness and the implicate order. Routledge and Kegan Paul, London: 177-178 Bowles P 1983 The sheltering sky. Grafton, London Capra F 1975 The Tao of physics. Fontana, London Capra F 1982 The turning point. Wildwood House, London Davies P 1984 God and the new physics. Penguin, Harmendsworth Davies P 1989 The cosmic blueprint. Unwin, London Dossey L 1982 Space, time and medicine. Shambala, Boulder, CO: 141 Dossey L 1984 Beyond illness. Shambala, Boulder, CO Elders F (ed) 1974 Reflexive water; the basic concerns of mankind. Souvenir Press, London Feyerabend P 1988 Against method - revised edition. Verso, London: 12,51-52,130-131, 159-160,256 258 Gleick J 1988 Chaos. Penguin, New York 8, 14-15 Krieeer D 1981 Foundations for holistic health nursing practice. Lippincott, Philadelphia Kuhn T 1970 The structure of scientific revolutions, 2nd edn. University of Chicago Press, Chicago Losee J 1980 A historical introduction to the philosophy of science, 2nd edn. Oxford University Press, Oxford: 204 Lovelock J 1987 Gaia (revised) Oxford University Press, Oxford Magee B 1982 Popper (revised edn) Fontana, London Popper K, Eccles J, Elders F 1974 Falsifiability and freedom. In: Elders F (ed). Reflexive water; the basic concerns of mankind. Souvenir Press, London Powers J 1982 Philosophy and the new physics. Methuen, London Rogers M 1970 An introduction to the theoretical basis of nursing. F A Davis, Philadelphia Talbot M 1981 Mysticism and the new physics. Routledge 8c Kegan Paul, London Wheeler J 1973 In Mehra J (ed) The physicist’s conception of nature. D Reidel Dordrecht: cited in: Capra F 1975 The Tao of physics. Fontana, London Wolf F 1985 Mind and the new physics. Heinemann, New York