Exquisite theory - paradigmatic bases in the concept of placebo

[Guest guest]

Emmanuel,

Just to quickly follow up my previous email, where I wrote

 

>we must be very careful to highlight that

the concept of placebo is based on paradigm considerations, perhaps

totally. In other words, it's not independant of paradigm

considerations, and the moment we speak about placebo, we must

consider paradigm issues, inter-paradigm issues, etc.>

 

We have not defined what a placebo is, but whatever definition we come

up with, it will have to have something to do with accepting that

there are various MECHANISMS in healing. Non-placebo healing will

involve certain of these mechanisms, placebo healing others. Now, it

should be immediately apparent that the concept of mechanism is a

paradigm-based concept. It cannot exist independently of a paradigm.

 

One of the reasons I object to much about what is being said about

placebo in relation to Complementary and Alternative Medicine is that

it's a stealthy way of asserting the epistemological supremacy and

authority of the biomedical paradigm over other methods and modes of

understanding, done by determining mechanisms. He who defines

mechanisms, and hence placebo, rules the medical world.

 

Wainwright

[Guest guest]

Ken - why do you point only to Kaptchuk, Bensky and Maciocia. There are

many more and I think that in your last post re: Heaven & Earth you glossed

over the issue as it relates to that book. While I understand that they

acknowledge the book as their creative input, it has had a HUGE impact on

the perception of CM in the US (it is all over Barnes and Noble) and Joe

Helms book as well. Not to mention the numerous books coming from China

that use language that makes it impossible to have any idea what they are

talking about. If we are going to have this discussion about books we need

to enlarge the group of authors that we are talking about. I think it is

as much an error for us to say that because H & E is creative it does not

need to conform to standards as it is for others to say that they do not

need to use translational standards. I had this discussion w/ Steve Birch

once - he was arguing that because he was working from Japanese sources and

not Chinese Nigel's gloss did not apply to him - and he is a HUGE supporter

of Nigel's work. I don't know if he still feels this way but I personally

think it is wrong. Any work - whether creative, derivative, translation

from Chinese or Japanese can and I believe should, still follow basic

standards of language usage. Again, I am a " Nigelist " but I don't care if

everyone is or not - as long as they give me the ability to understand what

they are saying by using an appropriate and readily available

glossary. Why shouldn't the standards of language and of sourcing

knowledge and of acknowledging roots etc. that you have applied to Kaptchuk

and admonish Dan for not apply to Harriet and Efrem, Joe Helms or the

Chinese? Isn't that a bit hypocritical? I actually have more patients

coming to me " understanding " CM based on H & E than on the Web and it is much

harder for me to help them to understand the roots of that book than it is

the Web. Just as the transaction between student and teacher is inherently

economic, so too is the transaction that occurs when one writes a book -

and Ted, Dan, Joe, Harriet & Efrem all understand that very well and are

certainly reaping the benefits of that economic relationship. However, I

suspect that Ted & Harriet & Efrem are reaping greater benefits than the

others because their books are " public " in that they are written for the

layman to understand (or think they understand) and so their audience is

much wider. H & E may not be used as a text in most schools but it sure does

inform a lot of people.

 

I think that one of the interesting things about the recent PU conference

is that there were several, very different authors there. And that as Rory

said, his challenge was not so much directed to " us " as a profession but

rather to each of you as published authors who are informing the public in

extremely diverse ways. If one thinks about the challenge in relation to

who was there it takes on a very different tone - and I believe an

important one. This is not to say that the challenge is not important for

all of us to think about - especially if we are writing or putting our

ideas out in public - but it is different. To address the question to that

group puts the responsibility for the current understanding back on those

who put it out there. Can (or will) they take their books out of

publication in order to revise, update etc. Not likely!! but what else can

they do with the influence that they wield because of those books.

 

As I teacher, it is my responsibility to have read and be able to talk

about all of the above mentioned (and more) texts. And I have. And there

are things in all of them that I find valuable - and I consider myself a

friendly colleague to all of them. But, if we are going to have this

discussion then I think it is important that we be more includsive in our

view.

 

Marnae

 

At 06:20 PM 10/23/2003 +0000, you wrote:

>Wainwright, and All,

>

>He who defines

> > mechanisms, and hence placebo, rules the medical world.

> >

> > Wainwright

>

>And he or she who defines Chinese medical

>terms rules the Chinese medical world.

>Now let's just stop a minute and compare

>the ways in which this process of definition

>of the terms and mechanisms of Chinese

>medicine has been conducted by various

>writers who have taken it upon

>themselves to represent a set of

>definitions and to represent the

>subject in a definitive fashion.

>

>Look at Macioccia's books and pay attention

>to the paucity of glossaries. He has

>made his views fairly clear: you just

>don't need to worry about that. Look at

>the Eastland Press Materia Medica book,

>particularly the introductory remarks

>to the glossary of the first edition.

>Look at Web with an eye to how the

>definitions of terms are handled.

>

>What I see is a disturbing pattern.

>I'll try and characterize it.

>

>Chinese language and therefore

>Chinese medical terminology is a very

>complicated and difficult subject.

>The words tend to have many meanings

>and are always open to interpretation.

>

>These, of course, are true statements,

>but the conclusion that these authors

>have come to is that because it's so

>darn difficult we should just forget

>about it.

>

>They, of course, do not forget about

>it. They proceed to define the terms

>that they are using and then proceed

>to rule their worlds...but the

>definitions, i.e., the correlations

>between what they are saying and what

>the Chinese concepts are that they

>are talking about, remains out of view.

>

>This, of course, leads right back

>to the most basic question of

>what is Chinese medicine? But

>the subtitle of Web is not Understanding

>Ted Kaptchuk's Medicine.

>

>And it is precisely the misrepresentation

>of individual and highly idiosyncratic

>interpretations of tradtitions as the

>traditions themselves that is in question.

>This approach is, frankly, dangerous.

>

>Compare that to the approach that

>Nigel and his various colleagues

>over the years have taken. He has

>spent years getting a PhD at Exeter

>which is based on the development of

>a methodology for how to handle the

>complex and diffilcult materials

>that the other writers ask us to

>take their word about. Yet on what

>basis are we asked to invest such

>trust?

>

>I have often seen Nigel villified

>as some sort of tyrant because he

>has taken the bold step of suggesting

>a comprehensive bilingual gloss and

>published the methodology that he

>developed and employed to create it.

>

>What Nigel has done, in fact, is to

>squarely face the stark reality

>that you have just pointed out, i.e.,

>that who defines the terms controls

>the discourse and hence, to a great

>extent the subject.

>

>Only his approach to how to deal with

>this fact is to democratize the knowledge

>and put into anybody's hands who wants it

>the ability to define the terms for themselves.

>

>That is what a translation standard accomplishes.

>

>It is a principal instrumentality for intellectual

>freedom to know the meanings of the words

>that you use. And the flourishing (or lack

>thereof) of the freedom of the profession

>and of the profession itself is directly

>linked to the extent to which such knowledge

>is held in common by the bulk of its members.

>

>Some may find it quite a contradiction

>that Dan Bensky requires students at

>his school to know Chinese. But it seems

>entirely in keeping with the approach

>to the nomenclature that is embodied

>in the now expurgated intro to the

>glossary in the first edition of

>his Materia Medica.

>

>I use his name, but I have no idea

>who did what on that book. Perhaps it

>was Andy Gamble speaking in those

>few paragraphs. But Dan's name is on

>it, and as recently as 2000 Dan was

>saying that translation standards

>cause more problems than they solve

>or are not worth the trouble they

>cause or something like that. So

>I assume he maintains his view that

>the nomenclature is a subject that

>should be reserved for his students

>and, for reasons that remain unstated,

>not widely promulgated throughout

>the educational establishment.

>

>This is really a very typically

>traditional Chinese approach to

>knowledge. Many teachers in China

>regard their knowledge as secret

>and special. They want to keep it

>from broad public view and to reserve

>it for their own students.

>

>The transaction between student

>and teacher is inherently economic

>in nature, regardless of whatever

>other characteristics it possesses.

>

>Many teachers never pass on their knowledge

>at all.

>

>I acknowledge the degree to which such

>traditions have been replicated by

>Westerners who went to China in search

>of authentic teaching and certainly

>found what they were looking for.

>

>But I am reminded of several stories about

>the late Cheng Man Ching. He was

>once asked what he thought about

>his students studying with other

>teachers. And he replied that only

>a teacher whose art is very small

>is jealous of the teaching of

>others.

>

>Asked why he didn't study other

>forms of martial arts, he replied

>that if he thought something was

>superior to taiji, he would study

>that.

>

>And with respect to the free flow

>of information and teaching, he held

>that not to teach what one knows

>loses the dao.

>

> From these three vignettes we can

>see an attitude towards the transmission

>of knowledge that was summed up in

>the title of a book written about

>Cheng, There Are No Secrets.

>

>The withholding of the nomenclature

>of the subject is not a minor thing.

>

>It is a major thing. It effectively

>makes the meanings of terms secret.

>For not to teach them loses their

>dao.

>

>It is of fundamental importance in

>the early development of the subject

>that a proper handling of the nomenclature

>was neglected by those who took it upon

>themselves to represent the subject

>authoritatively to an eagerly waiting

>public.

>

>I cannot speak to the intention that

>lay behind the decisions that were made,

>but if we can deduce intentions from

>results, I think it is clear that the

>strategies employed were primarily

>commercial in nature and intent.

>

>This, in and of itself, is certainly

>no crime. And if you are a follower

>of the political-economic philosophy

>known as capitalism, it is admirable

>indeed. Every one's got to look out

>for Number One, after all.

>

>I've always been fascinated by the

>arguments that emerge to explain and

>justify the anti-terminology position.

>

>I simply think that as the profession

>grows and matures we have to face the

>fact that such simplistic strategies

>may have worked for those early pioneers

>who blazed trails and opened up new

>markets for the subject and the practice

>of acupuncture and herbal medicine, we

>must now gather our resources and prepare

>to move beyond.

>

>I don't look to the existing educational

>institutions to accomplish such movement.

>

>It seems to me that the vested interests

>involved are too comfortable. No one wants

>to risk financial uncertainties, especially

>not in such troubled times.

>

>But I believe that knowledge must be

>wreckless and that everybody should be

>clamboring to know what everything means

>all the time.

>

>I've been on this grass roots campaign

>to promote literacy in Chinese medical

>language and literature among the members

>of the student, teaching, and practicing

>population of Chinese medicine in the West.

>

>I focus on the individuals and books

>that we have been talking about because

>I see them, in this light, as impediments,

>at least in terms of the influence they

>have had on the way in which the subject

>of the nomenclature of the subject has

>been handled.

>

>I want to see such impediments removed so

>that people can have greater access to

>more information.

>

>This is not an inquisition.

>

>It is a crusade.

>

>No one has to join and everyone is welcome.

>

>And since I brought up the subject of

>commercial interests, I want to make

>a disclosure. We all work for someone.

>And as a writer I work for readers.

>

>I was very moved yesterday by something

>that Harriet said to me. She was talking

>about the way she approaches her work

>as a writer and she said that whereas

>I seem very concerned with getting it

>right, she is mainly concerned about

>the reader.

>

>My disclosure concerns my intent to

>do a good job for my employers. In

>order to have a discussion of the

>subject really flourish, we've got

>to establish literacy in its language

>and its literature as a basic and

>inalienable right of those who study

>and practice it.

>

>This right has been denied. Not to

>teach what one knows loses the dao.

>And to write books about the subject

>that say this is the subject and it

>has no nomenclature is to deny readers

>the right to be literate.

>

>My sense is that in some way that surprises

>me as much as the rest of you, it

>is time that we reassert and reestablish

>the right to literacy firmly in the hearts and minds of

>everybody who is involved in the subject.

>

>I thought it worthwhile to take your time

>to read all of this because, incredibly,

>people have been telling me that I don't

>make myself clear or express myself

>adequately.

>

>Unblievable. But then that's another important

>reason why I engage in this activity at all,

>i.e., to help me come to terms with my

>many faults.

>

>So thanks, again, to all, and I do

>welcome feedback.

>

>Ken

>

>

>

>

>

>

>

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