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September 19, 2010

Explanatory Plurarlism

By Lewis Mehl-Madrona

I ask the question, what if all knowledge existed in the form of stories and all stories were true? If we practiced in this manner, as advocated by Uncle Albert, an aboriginal elder, how would we act? The notion of explanatory pleuralism argues that explanatory stories on any particular level do not have to relate to any other level of explanation; rather they must correspond to the level of which they are explaining.


This morning I sat on a beach near downtown Sausalito, in circle with a Zimbabwean community healer, Mandaza, listening to his explanation of the water ritual. The sun sparkled on the waters of the San Francisco Bay. The harbor was full of beautiful sailboats, a handful of luxury yachts, and ipod thin skulls gliding so effortlessly over the still water that it appeared the rowers were skimming over the water. Hints of fog still hung in the air.

Mandaza spoke about the mystery of how water heals immediately. One emerges from water, he said, completely initiated by the water. He said that we enter the water and die spiritually, returning to the womb, from where we are reborn. This is called, the water burial ritual, he said. Mother Earth becomes pregnant with the receiver. The receiver enters the water, doing silent meditation from inside the mother's womb. When children are born, they are taken to water for further cleansing. Water rituals are one of the chief ways of praying in his tradition.

"Many religions in many cultures use water in different ways than I have described," he said, "but what is important is that it is used in a good way for a higher purpose." The many different ways to see and do things is the focus of this essay, but first, Mandaza's water ritual.

"We give bread to the birds, for we believe they are our ancestors. We give beads to the ocean. We throw a coin into the ocean so we can learn how to give back. We humans are better at asking than we are at giving back. When we do this, we receive dreams for ourselves and others." Then Mandaza urged us to create dream circles (similar to the healing circles I have previously discussed).

This Labor Day weekend finds me at the 27th International Conference on Shamanism and Healing at the Santa Sabina Center of Dominican University in San Rafael, California. This conference was started 27 years ago by my friend, Ruth-Inge Heinze, a scholar of Mongolian shamanism at the University of California at Berkeley. Ruth-Inge wrote some wonderful books and marvelous academic papers and is now attending the conference from spirit world.

After his explanations, Mandaza invited us to walk into the water. The group waded into the cool waters of the Bay and stood silently in various depths of immersion. Some swam toward the yachts. Mandaza waded into the depth of his head and bade us to form a circle. Three times we immersed ourselves in the water. Then songs were song in Swahili, in Hebrew, in Tibetan by a visiting monk, and finally in Lakota by my friend, Philip Michael Scott. Then shivering people walked out of the water and onto the sand to return to the conference center.

Psychologist Juergen Kramer said that a Dene elder told him that to heal yourself, you must go back to the point of creation and retell your story as if it were occurring in balance. This is the essence of the narrative perspective.

My talk comes later today and is about explanatory pluralism. I began with the words of Uncle Albert, an Australian elder from Gippsland, who told me, "there are 500 different creation stories across Australia and they are all true." I waited for the further explanation that was bound to come. After an appropriate interval of silence, Albert continued. "Each story is true in the place where it is told." Stories arise from the spirits of the land and are channeled through the people who live on that land. Each location tells a different story because its spirits are different. The stories vibrate through and form the bones and flesh of the people who live there. The story is absolutely true in the place where it is being told. "All stories are true in the place where they are told." Of course, the implication is that some stories are less than true when told in a place where they did not originate.

An Ojibway elder from Saskatchewan further guided my talk. We were discussing regional differences in how sweat lodge ceremonies are conducted. "When I go to a Lakota lodge," he said. "I do it their way. When they come to my lodge, I expect them to do it my way." The discussion led to the question about why ceremonies differ between groups. Nathan answered that land is different. Ceremonies arise from the land upon which they are conducted. The spirits of the land speak through the people who live on the land and instill the stories into those people that will be enacted as ceremonies. Even the language spoken in a place arises from the spirit of the land. The words spoken and the music made and the songs sung come from the earth, from that particular place, and are perfect for that place, and perhaps not for any other place.

At the conference, Stanley Krippner had made this same point the day before when he spoke about Mexican curanderos coming to Albuquerque and how difficult it could be for them to heal in a new place. They are the healers for the place where they live, he said, and not necessarily for any other place. Their power, wisdom, and knowledge arises from the place where they are. It might not transfer to another place.

To get to the crux of my argument I must introduce the concept of narrative or story in a more formal sense. As I have written elsewhere (Narrative Medicine and Healing the Mind through the Power of Story: the Promise of Narrative Psychiatry), the default mode of the brain is to make up stories. In fact, our knowledge is stored in the form of stories. Yale computer scientist Abelson showed that even short statements of fact, like "Juliette's hair is brain", are short vignettes taken from longer stories that help us to remember the color of Juliette's hair.

In Narrative Medicine, I made the case that all theories are stories. All explanations about what happens in the world is storied. Science itself is a collection of stories, which, Sir Karl Popper, the famous philosopher of science, argued are stated in ways that can be falsified. Science for him is the process of falsifying stories so that they can be refined and improved. I further argued that conventional medicine is not the TRUTH, but a collection of stories, some of which have already been falsified, but continue to be practiced nevertheless. My favorite example of this is the story that psychiatric problems arise from defective brains and are best treated with medications. This story is falsified in the daily practice of almost every psychiatrist. We know that only 20% of people diagnosed with schizophrenia are still taking medications at the end of one year from the famous CATIE studies. Half stop because the medication isn't working and half stop because the side effects are unacceptable. Nevertheless the story continues to be enacted in the mental health center in which I work, as is true across most of the country. What do we make of all these contradictory stories?

Once upon a time, people traveled less and were confronted less often with different stories from their own, especially stories that seemed contradictory to theirs. Today, this is a daily occurrence. Creationists maintain that dinosaurs are less than 8000 years old while most paleontologists argue that dinosaurs are considerably older than that. Different religions sanction different spirits. For some Christians, there is only one spirit, the Holy Ghost. For the Ifa religion, there are 405 species of spirits called reishis, and nobody agrees on how to get into heaven, or if it even exists.

Deciding what is true has historically been a political process and often full of blood shed. Those in power typically decide the truth and create a dominant story that shoves all other stories to the margins of that society. Today, for health and disease, the conventional medical story occupies the place of power. Here in this conference, we heard the story of how the !hmong people in Merced, California, where they are particularly prevalent, got incorporated into the mainstream health care system. Because of their numbers and their unwillingness to attend biomedical health care as it existed, they refused to go to doctors when they were sick. They believed that the diagnosis was a curse and couldn't understand why a healer would curse them. Ann Fadiman's book, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, opened the dialogue between the hmong shamans and the local medical community. In this now famous book, Fadiman reveals how differently the hmong saw seizures than did the medical community. For them, seizures were seen as spirit capture and were to be respected and even cultivated. The book is about the radical differences in points of view. Each group saw their story as the only story. Now, thanks to dialogue between these groups, both sets of stories about healing can be respected.

Thus, I am inviting us to contemplate the radical idea that all stories are true somewhere for someone in someplace at sometime. To believe this, we must redefine truth. I prefer Karl Popper's thoughts on what is true, in which he says, "it corresponds with the facts". Within Popper's definition, many stories can be true. For example, here at the conference, a healer described his earlier position as being skeptical and critical of all attempts at healing that were not conventional medicine. However, when his mother traveled to the Phillipines to work with psychic surgeons there and, after her incurable (to the conventional physicians) cancer disappeared, he began to change his mind. He studies with these healers and accumulated many more examples of seemingly biomedically impossible changes. Hence, I believe the famous philosopher of science, Sir Karl Popper, would accept the statement, "Sometimes cancers disappear with the work of Fillipino psychic surgeons when conventional biomedical physicians have given up all hope." We have to say it this way, because it is true (corresponds with the facts) that sometimes cancers don't disappear and the patient dies as they work with the psychic surgeons. I have seen both conditions occur.

Through dialogue the Merced, California physicians came to similar conclusions. Sometimes the hmong shamans could help patients when they couldn't and sometimes they could help patients when the hmong couldn't. Immediately biomedical physicians want to define these circumstances, tending to make the hmong effective for more psychiatric conditions and stress-related illnesses and themselves more effective for what they would consider illnesses associated with tissue damage, but on careful inspection of the available stories, that distinction doesn't correspond to the facts (the observations). Sometimes the shamans work with a person and the incurable cancer disappears. Sometimes the shamans work with a person and the depression or the anxiety does not disappear. The situations in which one story works and the other does not are difficult to pin down. They remain mysterious, perhaps steeped in some of the social determinants of illness, in family dynamimcs, in the power of belief and faith, and in the many forces about which we know nothing, which nevertheless, influence our lives, making all of this a Great Mystery, as the Lakota said.

Hence, we arrive at the post-modern concept of explanatory pluralism, which states that explanatory stories can exist at multiple levels, all of which correspond to the facts, but none of which can be derived from the other. The lack of ability to derive, for example, the spiritual explanation from the biochemical explanation does not make either story "wrong". Both are equally acceptable. We don't have to understand the linkage between levels of explanation. We can accept a good story on its own level without reference to any other level. This reminds me of a talk I gave at a Catholic hospital in which one of the physicians present asked me to explain the mechanism of action of prayer. Luckily, in that hospital, I could defer to the administrator, a Dominican nun. However, the appropriate answer is to challenge the question. It is not necessary to establish a mechanism of action for prayer to accept that prayer helps some people some of the time in some places. I don't need to know how it does that to accept this statement.

Both Popper and Abelson argued that scientific theory, and human knowledge generally, is generated by the creative imagination in order to solve problems that have arisen in specific historio-cultural settings. Abelson writes that knowledge does not exist independently of a purpose for which it can be used. Knowing Juliette's hair color helps me to recognize her. This is the point of a story to tell us how to do something to accomplish a purpose. Thus, our stories about health and disease are meant to help us to get well or help someone else get well.

In All Life is Problem Solving, Popper sought to explain the apparent progress of scientific knowledge--how it is that our understanding of the universe seems to improve over time. He wrote that, in response to a given problem situation, a number of competing conjectures, or stories, arise. Then we attempt to determine which of these stories helps us best to solve our problem. Explanatory pluralism teaches us that we can use more than one story at the same time. We don't have to settle on just one best story. Science proceeds as a process of error elimination, performing a similar function for science that natural selection performed for biological evolution. Theories that better survive the process of refutation are not more true, but rather, more "fit"--in other words, more applicable to the problem situation at hand. We could argue that the current dialogue of conventional medicine with shamanism and other traditional cultural forms of healing arises out of the recognition (error elimination) that the pure biomedical model doesn't quite work. As we work toward the problem of greater healing, we need each other more and more.

Thus, how would we practice if we accepted explanatory pluralism. First, as Popper argued in his political philosophy, we would be intolerant of the intolerant. He wrote, "We should therefore claim, in the name of tolerance, the right not to tolerate the intolerant. We should claim that any movement preaching intolerance places itself outside the law, and we should consider incitement to intolerance and persecution as criminal, in the same way as we should consider incitement to murder, or to kidnapping, or to the revival of the slave trade, as criminal." (See The Open Society and Its Enemies: The Spell of Plato, by Karl Raimund Popper, Princeton University Press, 1971, ISBN 0-691-01968-1, pg 265).

Likewise, we must demand that conventional biomedicine cease its intolerance of other forms of healing. Medicine must recognize that it is just a story, also, and one that doesn't always work for everyone, everytime, in every circumstance. We're all in the same boat and we have to communicate or we'll get nowhere, tending to capsize. Without communication, none of us will survive. Collaboration must be the watchword and not intolerance or arrogance. Together we can explore the conditions under which our various stories work well or don't work, recognizing that this might be an unanswerable question related to larger forces that we can't even measure or comprehend yet. Nevertheless, we can be scientifically rigorous in our pursuit of the conditions under which some stories work better than others. As I suggested in Narrative Medicine, this invites us into a dialogue in which all healers (including physicians) have equal status with all stakeholders, including patients, their friends, and family members. When each storyholder presents his or her perspective to each shareholder, then the shareholders are free to debate and decide what combinations of stories they will use. Then, a true democracy arises in health care in which all stories can compete for the status of being chosen to be used in a clinical setting. I suspect this will do more than anything to move forward the evolution of medicine.

How do we make sense of how to make sense about this world of healing? I believe that scientific knowledge is constructed by scientists and not discovered from the world. I agree with the constructivists, who claim that the concepts of science are mental constructs proposed in order to explain our sensory experience. It thus is opposed to positivism, which is a philosophy that holds that the only authentic knowledge is that which is based on actual sense experience.

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Authors Bio:
Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and Narrative Medicine.