Acupuncture and Oriental Medicine Education, Critical Thought and Complexity

First published in Acupuncture Today November, 2008, Vol. 09, Issue 11
Knowledge is not an object or a tool that can be used without studying its nature. It is a question of preparing minds to reach for clarity. Part of this comes with the awareness that what we know is subject to error. There are several bases for these errors of knowledge, which might include rational thought, emotions, blinding by paradigms, face saving, resistance to change, conformity, stereotyping and self-deception, the unexpected and uncertainty (Morin, 2001; Ruggiero, 2006). Understanding how knowledge is built should figure as a primary requirement to prepare the mind to confront the constant threat of error and lack of critical thought that can and has affected the progress of the profession of acupuncture and Oriental medicine.

The purpose of education is to transmit knowledge. However, education is “blind to the realities of human knowledge, its systems, infirmities, difficulties, and its propensity to error” (Morin, 2001, pp 11-12). Historically, certainty has posed a level of vulnerability that has been repeatedly proven over time by the likes of Galileo, Keppler and Prigogine. Yet, education in general still does not bother to teach what knowledge is.

Our way of knowing and acting in our world, continually reinforced by our cultural conditioning, has established a complex interlocking system. Everything, including language, educational systems, economies, commerce, politics, and social institutions: is dependent upon everything else. Underlying this great superstructure are our concepts, beliefs, assumptions, values, and attitudes, which are linked together like an underground network of pipelines connecting across a vast continent (Tulku, 1984). Universities teach emergent science and technology, however the premises of thought upon which all our teaching is based are ancient and…obsolete (Bateson, 2002).

It is time for an educational process that is based on inquiry into uncertainty, the global crisis and complexity. Education has an ‘anthropo-ethical’ mandate vis-à-vis individual-society-species (Montuori, 2005). It takes place through a human awareness of individuality concurrent with a conscious participation and awareness as a member of the species and a member of society. Taken as a mode of transformation and preparing members of society, we might consider four primary areas of scholarly inquiry for the professional, they include: personal transformation, improvement of professional practice, generation of knowledge, and the appreciation of the complexity, intricacy, structure and beauty of reality (Bentz & Shapiro, 1998).

It seems important to discuss the difference between “informative’ and “transformative” learning at this point. Informative learning is the acquisition of knowledge, skills and attitudes. Transformative learning brings about a transformation in self-identification, the role the individual maintains within the culture and in the ways of thinking, communication and defining knowledge. Therefore – all learning is transformational in some dimension. What becomes important is where the transformation takes place, for what purpose and whether it is designed as part of the educational outcomes.

If inquiry, learning and knowledge are to be pertinent, education must elucidate these factors: I must penetrate my reactions to and affinities towards the matters of question. I must unhinge myself from the biases of patterned belief to consider the great potential of error in thought, perception, recall and conclusions. This may create a space for learning, knowledge and inquiry to occur authentically and with a modicum of validity. To this end I will discuss six thought habits that can distort critical thinking including these concepts: mine-is-better, face saving, resistance to change, conformity, stereotyping and self-deception (Ruggiero, 2006).

Mine-is-Better

The idea that ‘mine-is-better’ is a basic human trait that can be observed in child-hood as well as various stages of civilization and culture. It is present in academia on the basis of conferred degrees and often supersedes the values of ‘meritocracy.’ The real contributions of an individual are as important as the past accomplishments or degrees achieved.

‘Mine-is-better’ thinking leads to thoughts that consider others are lesser or even subhuman. Historical examples of atrocities stemming from this form of thought abound in the prisons, insane asylums and leper colonies. A weak sense of self often drives this need to bolster the ego by somehow thinking of others as the lesser. We can move away from self-flattering errors and gain more objectivity about what may be a more unpleasant reality. And, if we can recognize the piece in ourselves it is possible to make contributions to unbinding the white male Euro-American dominator system that impairs partnership values in organizational development.

One example of this is the type of thinking that goes on between schools of thought in Asian medicine. We see the mine-is-better thinking in the way that TCM and Worsley practitioners have positioned themselves with each other in the market place. However they seem to both serve their patient populations well.

Face Saving

One of the strongest influences for upset and anger in interpersonal relations is ‘face saving.’ It triggers deep emotional conflicts from past traumas. Looking good is what it is about. People will attempt to take credit for work performed by subordinates and peers in order to look good. This poses an ethical quandary that impairs leadership because people do find out. In addition, they will blame peers, people in the position before and subordinates in order to save face. This disempowers leadership whereas owning the responsibility gains respect and honor. It is bizarre. The very attempt to save face actually causes a loss of face.

Here is an example in the story of the three letters. A president takes office and he finds three envelopes in her desk left by her predecessor. The instructions state: when you get into trouble, open the first envelope. If trouble comes again, open the second envelope. And if it comes again, open the third envelope. So, the new president hits a problem with an external regulatory agency and opens the first envelope and it says, “blame the previous president.” So she does. This gets her through the problem. However, the agency returns and there is another problem and she opens the second envelope. It says “blame your workers.” She gets through this one and a new problem arises so she opens the third envelope. The letter says “get three envelopes.”

Resistance to Change

This is the tendency to resist change and new ways of thinking without a fair analysis. Sometimes this tendency can be very unconscious. A child asked her mother, “why do you cut the end off of the ham when you cook it?” The mother replied, “I don’t know, my mother always did and that is how I do it.” So, the child approaches her grandmother to find out only to hear the same statement, “I don’t know, my mother always did and that is how I do it.” So, the child goes to her great grandmother as asks her “why do you cut the end off of the ham when you cook it?” The great grandmother replies, “we had a very small oven and I had to cut the ends of the ham off in order to get it into the oven.”

Culture is, the way we do things around here. Often this is tied not only to social convention or unquestioned behaviors but also to survival. The psychological drivers against the forces of change can be powerful, evoking survival responses and deep reactions that confound the ability to see what is real. Openness to change is not an abandonment of critical thinking. It is the suspension of judgment long enough to give new ideas a chance.

We saw this when the field went to the master degree in the late 1980s. There was tremendous fear that schools would be put out of business and that there would be unfair competition between practitioners in the market. These fears were never realized. Similar fears drive the current resistance to the development of specialties and first professional doctorates.

Conformity

Conformity can result in peer pressure and group values affecting decisions in place of critical thinking. Rooted in face saving, the desire to not stand out or be different from the group can be powerful. This has political and cultural value when large populations seek to maintain order and is seen as a virtue in Confucian ideologies where a peg must not stand above others on the board. To stand out like this has posed threat to life during various periods of Chinese history such as the Cultural Revolution and the Gang of Four, or the Khmer Rouge, a communist party in Cambodia.

These environments cause one to conform as a means of survival. The cultural developments then extend into work environments in the US and other ‘free’ countries. This problem extends to the personal and behavioral level. An individual can develop a response to a set of circumstances that are overwhelming such as a violent parent. Later in life, the person continues the behavior as a habit, even if it kills them. This is a learned pattern of behavior (habit) that once ensured survival but now impairs life. The conformity is to the learned patterns of behavior.

We find conformity in the national processes of Chinese medicine. For instance, sometimes California acupuncture politics are dismissed because it is “California.” This allows stakeholders in the profession from other areas of the country to write off the opinions of an influential state that has in the past led on legal and educational requirements in the field. In this instance, California politics in AOM are dismissed because they do not conform.

As a point of clarification, there are very good reasons for conformity. However, the need to conform is so powerful that to recognize it and suspend it while giving due consideration to new ideas and concepts will enhance the ability to think creatively and critically.

Stereotyping

Does functional stereotyping have a place? While stereotypes are a convenient way of organizing reality and may provide insight, they must be exposed: they distort our view of reality. “Blinded by stereotype” is a risk if it becomes an irrational and unbending generalization. The most common stereotypes are sexist, racist, religious and nationalistic. This type of thinking dazes and muddles the mind and impairs the ability to sort, analyze and contemplate the nuances of reality. Ruggiero quotes Walter Lippman, “Stereotypes are loaded with preference, suffused with affection or dislike, attached to fears, lusts, strong wishes, pride, hope. Whatever invokes the stereotype is judged with appropriate sentiment…Neither justice, nor mercy, nor truth enters into such a judgment, for the judgment has preceded the evidence” (2006, pp 56).

This is a difficult area. We are a field that is engaged in the transmission of knowledges across language and cultural chasms. Further, one can never underestimate the powers of assumption in multicultural environments to confuse and add fuel to the fire which supports stereotyping as a means of coping. One example is the statement that Asians must learn the rules and regulations of the American environment. While this is true, it becomes a way of dismissing a need for a critical examination of what we are doing in AOM education and the building of legal systems for practice.

Self-Deception

Katherine Anne Porter observes that, “One of the most disturbing habits of the human mind is its willful and destructive forgetting of whatever in its past does not flatter or confirm its present point of view” (Ruggiero, 2006, pp 55). Take blame and resentment for instance, when these are held from the past, they are hardly seen as ones own set of behaviors such as “I was angry.” But the finger of blame is readily pointed. As a teacher in AOM said to me once “it is good to have someone to blame.” This was said in jest, however, when I quoted him, he corrected me stating, “No, that is not what I said; this is what I said, ‘tis human to err, ‘tis more human to blame.” This was a rather humorous interaction and benign, and I recall it endearingly. However, recreating history according to the needs of self worth is powerfully motivating. Looking good and maintaining ‘face’ compel people to recreate history. However, in a group process, when there are discrepancies between the stories and the recollections, this process of self-deception can erode trust.

In Summary

Complex thought is contextual and connecting. An example is the perspective that comes from considering the recursive loop between the individual and society or a social system and global concerns. That idea that individuals make society, and society makes the individual becomes a powerful component of the socialization of the physician. To entertain ‘complex thought’, it may be useful to consider that while the whole is greater than the sum of the parts, the whole is also less than the sum of the parts, and the whole is greater than the whole (Morin, 2001).

References

Bateson, G. (2002). Mind and nature, a necessary unity (6 ed.). Cresskill, NJ: Hampton Press.

Bentz, V., & Shapiro, J. (1998). Mindful inquiry in social research. Thousand Oaks: Sage.

Montuori, A. (2005). Gregory bateson and the promise of transdisciplinarity. Cybernetics and Human Knowing, 12(1-2), 147-158.

Morin, E. (2001). Seven lessons in complex education for the future. Paris: UNESCO.

Nicolescu, B. (2002). Manifesto of transdisciplinarity. Albany: SUNY Press.

Ruggiero, V. R. (2006). The art of thinking. A guide to critical and creative thought. New York: Pearson Longman.

Tulku, T. (1984). Love of knowledge. Berkeley: Dharma Press.