|Paradigms, and Paradigm Shifts as Broad Context
for the Transition to "Health Care"
"This document was prepared by Janet M. Eaton under contract with the Nova Scotia Department of Health. It does not, however, necessarily represent the views, opinion or policy of this Department"
The primary purpose of this paper is to provide a conceptual basis for viewing the new "health care" policy within the broader context of the current shift, occurring globally, from an industrial, rational, mechanistic, reductionist paradigm to an emerging integrated, evolutionary, systemic paradigm. To understand that shift it is helpful to be aware of how the boundaries which shape our thoughts or our "paradigms" from the past sometimes prevent us from seeing new trends and knowledge which do not fit the old ways of thinking.
In the new kinds of decision-making structures and partnerships emerging in our province, like the new Community Health Boards, it is important to work together to "transcend" old paradigms so that it is possible to move on together to develop a new vision of a future health care system co-created by community based participation.
This paper discusses the concepts of paradigms, paradigm shifts and contrasts features of the new systemic paradigm with the older one, all of which can assist in "paradigm shifting".
Finally, it concludes by examining the transition from
a medical to health model as a shift from a reductionist to a systemic
There seems to be a consensus amongst thinkers and writers
from every field of knowledge that society, indeed civilization as
a whole, is undergoing a massive transformation or "paradigm shift"
that is occurring with far greater rapidity than at any corresponding transition
period in the history of the human race. Since the late 1950's, philosophers,
futurists, sociologists, management consultants and the like, have been
predicting, warning , tracking and describing trends during this global
Alvin Toffler's landmark book, The Third Wave (1980), provided yet another innovative look at this major paradigm shift to a new era and John Naisbett (1982) described 10 Megatrends which were beginning to reshape a new paradigm- included were the shift from an Industrial to Information Society; from a National to Global Economy, from a Representative to Participatory Democracy; from Centralization to Decentralization; from Institutional to Self-help; and from Hierarchies to Networking.
The interpretation most authors bring to the recent paradigm shift is to describe computers and telecommunications as the triggers of massive economic restructuring which, then, creates subsequent changes in all our social structures and relationships. Arthur Cordell, the former Chairman of the Science Council of Canada, in The Uneasy Eighties - The Transformation to an Information Society, reflected this new direction.
The advent of microelectronics is rapidly and irreversibly leading to a major and fundamental transformation of western society, with implications not only for the nature and organization of the economic infrastructure, but also for the quality of life, social organizations and relationships among individuals, private institutions, and government... An information society will test and challenge traditional values and norms related to work; ... an information society will involve restructuring of the very concept of work and of the relationships between skilled and unskilled workers... The uneasy eighties are a time of transition and uncertainty.... the early part of the Industrial Revolution was, similarly, a time of confusion and dislocation. (Cordell, 198--) Governments, in all industrialized countries, had to scramble to adapt policies to these shifts and, not surprisingly, the initial emphasis was on attempting to maintain or increase competitiveness in the global economy. Technology, human resource development, new organizational design and management, niche marketing and other "levers for competitiveness were policies adopted by federal and provincial governments. Nova Scotia, after a major consultation and planning process, adopted 'Creating Our Own Future" which articulated these kinds of policy initiatives. (Province of Nova Scotia, 1992)
Social policy, as we had come to know it since it began in post -war years, were also challenged to change. Canada followed other OECD countries in attempting to shift from a "passive to active" social security policy. The results of Social Security Reform, the largest public consultation process in Canada's history, has led to dramatic changes which Nova Scotia is beginning to experience in the form of severely reduced payments combined in block funding and new responsibilities devolved from federal government ( Phillips, [Ed] 1995; HRDCanada, 1994).
Around the same time, all of our values and beliefs were being challenged to change. Canadian academic and futurist, Norman Henchey (1986) noted :" Canada, along with most countries in the world today, is experiencing the effects of rapid economic and social change and deeper alterations in structures, values, and assumptions. Expectations developed in the post-war era, of progress, anticipated success in academic achievement, a good job, a general climate of stability and security, have begun to crumble. As our expectations overwhelm our abilities to satisfy them, basic assumptions and values have been challenged to change.' (Henchey, 1986)
Fundamental changes in values along with economic necessity, new heights of information access, and failure of old paradigm structures to function adequately in an information age, fuelled major changes in the nature of organizations, human resource management, marketing, participatory democracy and new forms of public policy which emphasized decentralization of decision making and community economic development among other things.
Since that time the continuing shifting of human values has continued to reshape organizational change, as well as our views of economic development, politics, citizenship, the family, community, friendship, and our own basic development throughout the lifespan. The latter trend is witnessed in the new emerging but pervasive emphasis on holistic health, wholeness, spiritual development, and interest in aboriginal and Eastern philosophies.
Today's information age, technologically literate, citizens have begun to assimilate knowledge in new, inclusive ways which is moving us away from the fragmented knowledge paradigm of the recent past to a new "wisdom" paradigm which moves toward wholeness, connectedness, a sense of community both locally and globally and compassion for the human condition.
From the developments described in this section of the
paper we can see that the new "Health Care " policies fall within
this framework of changing patterns in global economics, and public
policy shifts in social security programs, and basic value shifts
in the population. They also reflect a broader contextual shift in our
fundamental underlying view of the world which is described in this paper
as a dominant paradigm shift or transformation from an industrial, scientific,
rational, mechanistic paradigm to a new emerging, integrated, evolutionary,
2) Paradigms and Paradigm Shifts
a) What is a paradigm? (pronounced pair a dime)
The term "paradigm" came into usage as a result of the
landmark intellectual work in the early 1960's of Thomas Kuhn, Professor
Emeritus of Philosophy, Massachusetts Institute of Technology. In his Structure
of Scientific Revolutions he used the term "paradigm" to attempt to delineate
the core essence of a scientific community's "shared examples" of
what they believed and understood their science to be (Kuhn, 1962).
"Paradigm which comes from the Greek was originally a
scientific term but now is more commonly used to mean model,
theory, perception, assumption, or frame of references. In the more
general sense it is "the way we see" the world---not in terms of our visual
sense of sight, but in terms of perceiving, understanding, interpreting.
A simple way to understand paradigms is to see them as "maps".(Covey, 1989)
"A set of rules or regulations that do two things;
Jack Mezirow, Adult Education Professor from Columbia University, in his Transformative Dimensions of Adult Learning reviews a range of interpretations from many other fields of study and finds the following terms which provide parallel meanings - horizons of expectation, perceptual filters, frames, ideologies or schemas, personal constructs in addition to "paradigms" of Kuhn. (Mezirow, 1993)
b) What is a paradigm shift?
Stephen Covey suggests that a "paradigm shift" is what we might call the "AHA !" experience when someone finally "sees" the composite picture in another way or finally "sees the light". . Jack Mezirow, refers to this shift as a "perspective transformation" which he suggests could be caused by experiences or dilemmas which shake us out of our usual way of thinking about things- anything from a death in the family, to the kids leaving home, to a poem, visit to a foreign culture, a death of a loved one or losing a job suddenly. (Mezirow, 1993)
Another term for “paradigm shift”, which is commonly used by evolutionary systems thinkers, is "transcendence". Ken Wilber, who has developed a framework of human consciousness which includes Piaget's five stages of cognitive development as well as several transpersonal stages, describes how we "transcend" stages of human consciousness throughout a lifetime in a series of "paradigm shifts ". He notes the importance of arriving, at least, at Piaget's fifth stage of "formal operations" where you can operate or reflect upon your own thought process, or transcend them, take a different perspective or become highly introspective. This is akin to "executive thinking","critical thinking", and metacognition. (Wilber, 1995)
c) Why is it so important to know about paradigms?
Stephen Covey notes that, while many of us have maps or paradigms in our heads, we seldom question their accuracy and, in fact, we're usually unaware that we have them. Since our attitudes and behaviours grow out of these assumptions, the way we see things is the source of the way we think and the way we act. Canadian Economist, Dian Cohn, confirmed this reality for Canadians:
"... a way of thinking, a way of interpreting events-- a paradigm--dies invisibly.......establishing a new vision has been stunningly difficult for Canadians, as a whole, to absorb." (Cohn, 1993).
Another reason for attention to the idea of “transcending paradigms” is because of Kuhn's findings with the scientists he studied that their paradigms literally acted as “physiological filters" which prevented them from seeing data right before their very eyes. It seemed to him that:
"professionalization leads, on the one hand, to an immense restriction of the scientist's vision and to a considerable resistance to paradigm change.” (Kuhn, 1962: 64)
Peter Drucker bemoans the fact that third wave progress
has been blocked by an entrenched bureaucracy resistant to change- within
government, the research community, academia and big business all with
a vested interest in the old way of doing things. (Drucker, 1994)
For all these reasons and others, it is crucial
that new policies, programs and new kinds of organizational
and decision- making structures like partnerships, and community boards,
be informed by knowledge, about the potential of old paradigms to block
the goals of their initiative in predictable ways and to have the
opportunity to transcend old paradigms, before attempting to develop new
visions or shared mental models of a desired future.
Albert Einstein, whose stunning research was in fact a scientific revolution which created the foundation of the new science which proscribes the new systemic paradigm, knew well the nature and importance of paradigms.
"No problem can ever be solved by the consciousness
that created it . We must learn to see the world anew."
3) Dominant Paradigms of Civilization - and Paradigm Shift in a Global Context:
In the first section the concept of a "paradigm shift" as a major transformation of civilization was introduced. When we apply the concept of paradigm to the history of humankind we attempt to describe why cultures change, we are dealing with very powerful high-level theories, the kind that are referred to as grand theories, dominant paradigms, and conceptual frameworks. During the 19th century several powerful grand theories were developed including the theory of "cultural materialism", sometimes called "economic determinism". The view of the world offered by this theory is one where economics and technology determine the success and spread of the culture and social relationships and institutions are adapted to the productive and technological requirements of communities. Ideologies and values are adapted to useful behaviours in both, the social and economic realms. (Hayden , 1993)
Most social scientists, who view the world through the lens of "cultural materialism” or "economic determinism", have described four dominant paradigms. As shown in the chart below, technological innovations at three major transition periods in the history of human civilization, resulted in entirely new ways of making a living, doing business or, what we might call, work. Heilbroner (1962), Toffler (1980), Banathy (1994), Cohen (1993) are just a few of the many authors who describe this dominant economic paradigm.
In a synthesis based on evolutionary systems theory, new archaeological evidence of earlier "Mother Earth" cultures, and an enlarged vision of history, Rhiane Eisler developed yet another world view of "Cultural Transformation". In this theory, she proposed that there are only two major forms of social organization in regard to how power is distributed in a society - partnership relationships based on linking and dominator hierarchies based on ranking and power. (Eisler, 1987).
d) Why Learn About Major Periods of History or Dominant Paradigms of Civilization?
Examining dominant paradigms of history encourages us to see the patterns or larger frames of reference which shaped each of these periods. In recognizing these patterns we are encouraged to "transcend" old paradigms and to view the world from a higher vantage point. We can also find insights and principles from the past which can guide us into the future, e.g. in the earlier horticultural partnership societies and the perennial wisdom of earlier aboriginal cultures.
In the same way, the stark contrast and sharp discontinuity
between the characteristics of the industrial, mechanistic, reductionist
paradigm in juxtaposition or along side those of the integrated systemic
paradigm world which is emerging implies the need to develop new perspectives,
and new intelligent technologies in designing and redesigning social systems.
4) The Nature and Implications of the Rational/Scientific/Mechanistic/Fragmented Paradigm
Scholars agree that, throughout most of history, the world view which saw matter, body and mind as a vast network of mutually interlocking orders subsisting in Spirit, with each node in the continuum of being, each link in the chain, being absolutely necessary and intrinsically valuable. These three great domains were all one continuous and interrelated manifestation of Spirit, one Great Chain of Being. With the rise of modern science--associated with the names of Copernicus, Galileo, Bacon, Newton, and Descartes-- this great unified and holistic view of the world began to fall apart, in ways that none of these pioneering scientists themselves either foresaw or intended. (Wilber, 1996) This new science later became exemplified by Sir Isaac Newton's mathematical discoveries which allowed him to postulate a clockwork universe with parts that functioned like a machine. This metaphor of a clock or machine, which was synonymous with a closed system, was adopted in almost every field of knowledge.
Reference to Figure 2 provides an overview of the major characteristics of this older paradigm. In this machine-like paradigm the different parts were seen as more significant than the whole. They were seen clearly in relation to one another, and could be separated out and studied to determine cause and effect relationships. This lead to a tendency to study the parts while abandoning the whole. In this view of the world the observer was separated from the observed which tended to isolate people from their environment. Complete objectivity was assumed and events were seen in isolation. (Hutchins, 1995) Rational, knowledge with a preference for analysis, reduction, and a convergent focus became the dominant mode of thinking about and studying the world and the intuitive and spiritual was diminished and devalued. (Banathy, 1992) Problems came to be seen as something which could be isolated, as variables in linear problem/solution and cause and effect terms where a "quick technical fix" was possible.
Consequences of this reductionist mode of thinking included the separation of knowledge into separate disciplines or modes of experience. This has led to the development of unidisciplinary and single perspective theories in academia which have shaped the economic, political, social and organizational world for the past two centuries. This fragmentation of knowledge also in a growth of applied social sciences or professions which arose to offer services to fragmented humans, families, organizations, businesses isolated from that which provides the essence of humanity.
The results of this fragmentation led to a dominant economic paradigm which has taken us to the edge of environmental catastrophe because of its failure to view the whole; the factory model of piecemeal production and scientific management; schools, universities, social and health services which offered partial services to parts of a system. It is interesting to note the growing use of the concept of "ignorance" in academe as witness to this growing awareness of the great void of knowledge missing in a fragmented knowledge paradigm. We could also cite the situation in education, psychology and training where the science of behaviour shaped and limited thinking about human potential for many years.
The mechanistic, reductionist paradigm changed the maps of the world that each person carried unconsciously within them. This loss of the interior dimension of human nature reduced individuals to two-dimensional beings cast about by events on the physical surface of reality and it terminated our intimate bond with the rest of the cosmos, environment, community, and humanity. (Coombes and Holland, 1996) Thus science discouraged us from looking below the surface to our inner self where we find creativity, intuition, self-knowledge, compassion and will to act -- the very stuff that had formed much of the perennial wisdom of the ages. This result of this loss to the human psyche is eloquently expressed by new physicist, David Bohm, discoverer of "holography":
" For fragmentation is now very widespread, not only throughout society, but also in each individual; and this is leading to a kind of general confusion of the mind, which creates an endless series of problems and interferes with our clarity of perception so seriously as to prevent us from being able to solve most of them.....The notion that all these fragments are separately existent is evidently an illusion, and this illusion cannot do other than lead to endless conflict and confusion." David Bohm (in Capra, 1991) From a human consciousness perspective the rational state allowed the human species to move from a rule/role mind state of earlier mythical cultures and move to a new ego state where self-esteem replaced the need for belonging, abstract reasoning replaced concrete thought and moral development shifted beyond the approval of others to that of individual rights i.e. form conformist to individualistic. (Wilber, 1996)
5) The New Integrated/ Evolutionary Systemic/Holistic/ Paradigm
Fritjof Capra, in "The Turning Point" challenged the Newtonian world machine of closed systems with a description of a new world view which emerged from quantum physics as a universe as dynamic, even restless, and a web of interconnected relationships. (Capra, 1975, 1991) New physics embodied by the Einstein's general theory of relativity and Heisenberg's Quantum Theory together showed Newtonian physics to be a mere approximation of reality. (Coombes and Holland, 1996) According to David Bohm both relativity and quantum physics share the common perspective of wholeness. Relativity views space not as a void of nothingness between solid atoms-- but returns to a vision of the universe as continuous, unbroken fabric. Quantum theory is holistic in quite another sense viewing all action as continuous and unbroken, where the particles have no individual existence.
New physics evolved and incorporated new theories to become "new science" which Wilber, in his latest synthesis of knowledge, describes collectively as the "sciences of complexity” ---including General Systems Theory (Bertalanffy, Weiss) , cybernetics (Weiner), non equilibrium thermodynamics which includes self -organizing theory (Prigogine ), autopoetic system theory ( Maturana and Varela) dynamic systems theory (Shaw, Abraham) and chaos theories, among others." (Wilber, 1996). He refers to them all collectively as systems theory, dynamic systems theory or evolutionary systems theory.
The general claim of evolutionary systems theory is that there have now been discovered basic regularities, patterns or laws, that apply in broad fashion to all three great realms of evolution, the physical, biological and social spheres and that a unity of science --a coherent and unified world view--is now possible. These general systems theories claim in other words that "everything is connected to everything else"-- the web of life as a scientific and not just religious conclusion as it had been in period prior to the Rational Scientific Paradigm. (Wilber, 1996).
In contrast to the old paradigm the new systems sciences have provided evidence of a very different fundamental basis of the universe one which is much more akin to the perennial wisdom of the ages. The world is seen as an integrated whole instead of a dissociated collection of parts, i.e. the system is greater than the sum of its parts, with any events that occur being viewed as linked or interconnected. (Capra, 1991) The systemic, or systems approach, examines the world in terms of relationships and integration's.
Systems are treated as integrated wholes which properties cannot be reduced to those of smaller units. In this, the observer is connected to the observed- and subjectivity is assumed impossible to avoid (Hutchins, 1995). Recent research in the fields of 'bioenergy" and morphic field analysis of Rupert Sheldrake (Coombes and Holland, 1996) is bringing greater understanding to this area of energy fields which surround all living matter and connect us, research which has until recently been shunned because it did not fit the dominant paradigm. At the same time the Jungian psychologists are rejoicing with the discoveries which bring Jung's theory of "synchronicity" more perspective and credence within the new paradigm.
There is a preference for synthesis and divergent focus as opposed to the analytical and reductionist thinking of the old paradigm (Banathy, 1993). Within individuals there is a balance between the rational knowledge and cerebral thinking abilities and intuitive and spiritual abilities. This balancing of the human psyche or integration is the essence of the new paradigm, as described by Wilber and Gebser, who saw the link with the evolution of human consciousness and that of cultural evolution. Hence, transcendence, by a critical number of individuals from the rational paradigm to an integrated paradigm, could signal a dominant paradigm shift of civilization. What is of particular interest in connection with this paper, as context for a new health care policy, is the fact that "health" is defined as "wholeness" or "wellness" which is "integration" or transcendence of the "rational" paradigm which, as we have seen above, fragmented the human psyche and world view to such disastrous consequences.
Whereas the reductionist paradigm led to fragmentation of knowledge there is a growing awareness that all learning must be contextual to be effective:
" we need to end the travesty of the educator that is removed from context. Real life experiences, and therefore knowledge, do not come chopped up in discrete subjects, but are invariably interdisciplinary." (Hutchins, 1996)
The systems thinkers go a step further in recognizing that knowledge of life is not in fact interdisciplinary but is better understood as systemic knowledge, the understanding of social systems, ecological communities, and hundreds of other systems that provide the context for carrying out our purpose - survival. Systemic thinking provides that means of discovering systemic knowledge for systemic thinking is holistic and, therefore, contextual. It asks you to examine complex phenomena from many perspectives in order to understand that all system's functions interact in response to its environment. (Hutchins, 1995)
Contrary to the old paradigm, the new one would enable us to solve more of our own problems, either individually or in communities, without being dependent upon an expert or professional, i.e. there is a diversification of an individuals knowledge base, resulting in a less reductionist, more holistic understanding of all issues.
Evolutionary systems theory is providing an alternative to steady-state and equilibrium approaches for the design of socio-cultural systems. Within the evolutionary vision, old static theories of social change are being replaced by theories that are truly expressive of the full range of human potential . They recognize "evolutionary consciousness which stems from our capacity to direct our own evolution in a self-transcendent mode, our unique human ability to be self-aware, "to view a situation in a new light, or ..to jump over one's own shadow." (Bach, 1993). And new social systems design research and practice is developing new methodologies for assisting groups in "transcending old paradigms" to move on to co-create new open systems based on the knowledge of new science (Figure 3) contrast old closed and new open systems.
A central thesis of evolutionary systems theory, derived from Chaos Theory and Self- Organizing theory of Ilya Prigogine, is that all manner of systems - chemical, biological, physical- enter states of turbulence, reach a bifurcation point, and eventually either self- destruct or self-transcend. Most evolutionary theorists and humanitarians in general are now saying that human civilization has reached a bifurcation point and that the need to "transcend" old ways has never been more evident or imperative. From this theoretical vantage point moving to an integrated state, either as an individual or society, is synonymous with wholeness, or wellness which begins with integration of the human psyche.
Although there is not time in this paper to further pursue the new paradigm thinking, evidence of the pervasive imperative to "transcend" the old paradigm is shown in Figures 4 and 5.
6) The Medical to Health Care Paradigm Shift and some implications
Observation of Figure 6 provides a breakdown of the medical to health care shift as a rational scientific mechanistic to integrated systemic paradigm. In medicine the systemic of holistic approach suggests that we shift our focus from treating illness in specific parts of the body to preventing illness by focusing on the whole person and by promoting a healthy life style. We are now starting to understand health in a new light as one Native American Healer puts it:
" We now understand our own health as something created
thorough the pattern of our lives and we are beginning to understand disease
not as something bad or evil, that "comes to get us" but as a symptom of
an imbalanced way of life in which we walk on Mother Earth. With this understanding
we can begin the process of healing ourselves through proper nutrition,
physical exercise, new beliefs, and a more healthy environment,
By interpreting health in this broader paradigm perspective
we can see a benefit in a shift to a health paradigm beyond simply economic
savings, community empowerment and a healthier population. Health
as wholeness, as a natural state of integration, is what the evolutionary
systems theorists suggest is the essence of the new paradigm and the only
thing which will enable an imperative shift to a healthier planet and new
stage of humanity.
The implications of this systemic shift for Community Health Boards are many and include such things as the possibility of continued growth and demand for alternative health care services to be recognized as publicly approved services, the imperative of creating broad awareness amongst the general population of the importance of this shift, and of the need for boards to abandon old paradigms and to adopt new paradigm methods to carry out the function of planning for a new health care paradigm.
In a systemic paradigm individuals are assumed to be self-aware, in touch with their inner resources, moving to personal mastery, awakened to a creative life force, to feel a life purpose, and to feel connected to their community and environment around them.
This value shift corresponds with the economic and political necessity of devolving responsibility of decision making to those most affected by the decision, a basic tenet of democracy. Seen in this light, the shift to Community Health Boards is a serious responsibility and testing ground for new paradigm ideas and methodologies. Along with a shift to community comes a de-emphasis on professionals and a reliance on wisdom of the community . John McKnight's Careless Society, which is a diatribe against professionalism and a celebration of a return to community involvement as a basis for all social services, provides an excellent insight into this paradigm shift. (McKnight, 1995; McKnight & Kretzman, 1993). Another systemic characteristic is the shift in the new "health care" policy to more integrated and user - friendly services.
Finally, a few of the implications of new paradigm thinking which are relevant for Community Health Boards functioning: Board development will be enhanced by an awareness of the concept of a paradigm, paradigm shift and of the differences between the dominant paradigms discussed. In the same manner, board function will be further enhanced by opportunities to "transcend" old paradigms.
Learning more about open systems and evolutionary systems theory can be an asset in a community based approach that is decentralized and working in an open environmental system. In the new systems paradigm the planning behaviour of humans is another example of learning to adapt to an ever changing environment. Planning , which is the projection of what we will do to change, is less a product or road map to further action than it is a tool by which people and organizations learn.
The shift to a new paradigm suggests the need to contrast old knowledge, skills and attitudes needed with new ones. In fact, this will be equivalent to shifting from a "knowledge" to a "wisdom" or "systemic" paradigm. Systemic thinking, the most important attribute in the new systemic paradigm, becomes essential and would helps us to see, among many other things, the parallels between school councils, community economic development boards and community health boards; the parallels between human systems, ecological systems and social systems; and would assist us in the realization that knowledge and skills we learn in working together on a board and planning for the future are generic skills which we take, apply and share in our families, our communities and our workplaces. It also shows us how global thinking and local action are interrelated in a unique and holistic manner.
Finally as we become aware of "evolutionary systems theory" and all its implications we will find ourselves "leaping out of old paradigms. As Eric Jantsch has said:
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