Many ways of knowing

Editorial by David Peters

JHH 21.1 Many ways of knowing

Many kinds of knowledge and knowing

In today’s world, it is becoming difficult to discriminate facts from fiction; to distinguish truth from belief and delusion. This crisis of epistemology calls into question how we know things and what sorts of knowledge can be trusted. As old ways of thinking and the consequences of neoliberlism entrench the world’s many troubles, the disillusion and disappointment are feeding distrust in all that is established and time-honored. Post-truth echo chambers reacting to this insecurity breed fake news and conspiracy theories and weave webs of evidence-free ‘alternative facts’.

Modern medicine has been a typical target. Its historical authority having made such deep marks on our culture’s image of what humans are, now buttressed by technology and all the wizardry of analytical materialist science, it claims an exclusive right to define illness and treatment. Yet this raises expectations of delivering ever more cures by finding and fixing pathology and faulty chemical pathways. Struggling with the rising tide of chronic disease using these tools, it scales up and industrialises to meet these demands. In the process, shifting its gaze away from the art of medicine, it has become less concerned with caring, compassion, community, or healing and the creation of health. Medicine’s scientific knowing is immense but it must not lose the art that has woven its protective cloak of trust. For it is wearing thin.

Holism asks big questions about what’s worth knowing; how to value life’s – literally – intangible layers of feeling, suffering; to know how to nourish wellbeing; to know how to flourish as a practitioner. Holism implies that our everyday knowing, and the tramlines our culture has laid down, are far from giving us the whole picture. Science in its fullness accepts there are other ways of knowing and other kinds of knowledge. Many aspects of experience can’t be gathered up in nets of materialistic science: the knowing of the artist, the practical knowing of the craftworker, intuitive pattern recognition and insight, empathic knowing about someone’s feelings of joy or suffering, the knowing of friendship, ethical and moral knowing, how we know beauty, truth, goodness. Henri Poincaré wrote that ‘the scientist does not study nature because it is useful; he (sic) studies it because he delights in it, and he delights in it because it is beautiful. If nature were not beautiful, it would not be worth knowing, and if nature were not worth knowing, life would not be worth living’. For Einstein ‘the cosmic religious feeling is the strongest and noblest motive for scientific research’.

Bearing in mind that the map is never the territory, holism’s job is to imagine a deeper, wider map of wellbeing; of how to create health for people, practitioners and planet. Einstein (may have) said you can’t solve problems with the kind of thinking that created them. Yet at the farthest end of the spectrum away from ‘truth is whatever we say it is’, another extreme response to our unstable zeitgeist takes the form of a radical overvaluing of science and the scientific method: a conviction that measurement and quantification are the only way to judge what’s true. Perhaps those who cling to it most vociferously find comfort in the faith that science will explain life, the universe, everything, that certainty is a possibility. But beware this ideology if it eclipses the experiences and needs that make us fully human. Is this what has happened to medicine?

Holism spurns both of those extremes. Holists have long known intuitively that frailties of mind, mood and relationship penetrate every level of life, family and community. If in former times our lived experience of these connections was evidence enough, it’s satisfying to know we now have hard evidence. For, even though these immaterial qualities can’t be weighed and measured, their physiological impacts can. And robust studies have shown how long-term stress in all its emotional, financial, political and educational guises can trigger inflammatory processes and disturb immune function. If politics and education choose to incorporate the emerging science of whole systems, holistic development ought to follow.

Meanwhile education has barely begun to embrace them, and that is why our journal exists to bring together ideas and projects that reflect the full range of knowing and knowledge. JHH asks about educating, growing and sustaining ourselves as practitioners, and is always curious about the well-integrated psychologically informed teams needed to bridge between the confusion of professional languages and viewpoints. In JHH we wonder about creating health for people, practitioners and planet. So in this issue our ongoing medical education theme contains Rohini Sabherwal’s account of teaching about health inequalities; Louise Younie writes about the need for Flourishing Spaces; artwork by students Freya Qureshi and Sarah Mandourah illustrate how art expands medical students’ knowing. In a similar vein Jonathan McFarland’s poetics course for medics, and Drs Durga Mani & Hugo Jobst suggestion that practitioners need meditation, make a plea for medical education to include other ways of knowing. Education and selfcare should support one another, and yoga certainly invites us into new way of knowing the body. Paul Fox who develops yoga programs in the NHS outlines the evaluation of a course for staff; meditation teacher Sangasiha explores the benefits of deep listening and how it can draw us into mindful states of deeper knowing and nature connectedness; Chris Johnstone offers us an update on his emerging program for Sustainable Happiness. In a new ongoing community-oriented integrated practice (COIP) section of JHH Professor Paul Thomas and colleagues explain how we need different ways of seeking and testing knowledge to develop community-scale holistic care; former NHS CEO Lord Crisp who co-chairs the All-Party Parliamentary Group on Global Health sees a vital need for policies that support compassionate communities and the UK’s former ‘GP Czar’ David Colin-Thomé tells us why COIP will help the NHS transform itself.

Amid a dysfunctioning world order and a struggling NHS can we build alliances to create health and take action to bring about a healthier planet? We will have to play a long game. With this in mind at our BHMA’s 40th anniversary conference on 5 October we will propose a coalition to fan the flames of change in medical education and integrated care, to promote flourishing in healthcare and body-mind medicine.