Chapter 2 Chiropractic Paradigms
After reading this chapter you should be able to answer the following questions:
| Question 1 | What is the importance of paradigm to a profession? |
| Question 2 | How are the characteristics of vitalism, holism, humanism, naturalism, conservatism, and rationalism applied to patient-centered care? |
| Question 3 | What is the significance of the ACC paradigm to the chiropractic profession? |
Within the Western health care system there are two basic paradigms, the dominant reductionist medical worldview found among mainstream health care practitioners, and the holistic perspective characteristic of practitioners of alternative medicine. Each paradigm provides a set of scientific and metaphysical beliefs, a theoretical framework in which scientific theories can be tested, evaluated, and applied. The vocabularies of the two frameworks comprise different languages, not easily translatable. These paradigms are what members of each scientific community share.1
Paradigm Defined
According to Kuhn,1 who articulated the concept, a paradigm is a constellation of group commitments that encompasses the following components:
1. Symbolic generalizations that encompass laws of nature and common language and definitions
2. Shared commitments to beliefs that include explanatory models, analogies, and metaphors (Communication and integration of chiropractic practice with mainstream medicine can be promoted through application of knowledge based on a reductionist paradigm without abandoning a holistic worldview.)
3. Shared values based on social need (and in the case of health care, patient need)
4. “Exemplars” consisting of “concrete problem-solutions that students encounter from the start of their disciplinary education” (Seeing the problem as similar to a problem already encountered solves new problems.)
Two Chiropractic Paradigms
A Patient-Centered Paradigm for Chiropractic Practice
A paradigm is useful as both a plan of action and a lens through which the doctor of chiropractic views the patient. The doctor of chiropractic is thus provided with a worldview by which the science of chiropractic can advance in the patient’s interest. Paradigm or worldview is a central issue in the understanding of a patient-centered model for chiropractic practice as it is for the integration of reductionist research into a holistic model. Phillips and Mootz2 noted in 1992, “The chiropractic model is a patient-centered hands-on approach intent on influencing function through structure.”
Chiropractic practice has traditionally been patient centered with anthropological and sociological studies providing evidence and seed material for a patient-centered paradigm.3–5 This patient-centered paradigm6 was further refined and agreed to by both chiropractic and multidisciplinary nominal panels and a 60-member multidisciplinary Delphi panel that followed the same three-tiered consensus process used to develop chiropractic terminology.7 (See Chapter 1.) The characteristics of this patient-centered paradigm are outlined in Box 2-1.
BOX 2-1 Characteristics of Patient-Centered Care
Recognition and facilitation of the innate organization and adaptation of the person
Recognition that care should ideally focus on the total person
Acknowledgment and respect for the patient’s values, beliefs, expectations, and health care needs
A proactive approach that encourages patients to takes responsibility for their health
The patient and patient-centered practitioner act as partners in decision making, emphasizing clinically effective and economically appropriate care based on various levels of evidence.6
Patient-centered care is not unique to the chiropractic profession,8 but those characteristics identified do distinguish chiropractic practice. As outlined, a chiropractic patient-centered paradigm encapsulates the uniqueness of the philosophical first principles of chiropractic that provide the basis for chiropractic practice.
Chiropractic Principles
Contemporary literature recognizes six doctrines that form the basis of the principles and philosophy of traditional chiropractic. These include vitalism, holism, naturalism, humanism, conservatism, and rationalism.9–15
Vitalism
The traditional philosophy of chiropractic has focused on the modulating function of the nervous system in the self-healing of the human organism.16 This principle is exemplified in the following statement:
One question was always uppermost in my mind in my search for the cause of disease. I desired to know why one person was ailing and his associate, eating at the same table, working in the same shop, at the same bench was not.18
Physical vitalism or that vital functioning of each individual was referred to by Palmer as the body’s innate intelligence. Palmer saw this as a manifestation of the universal regularities and laws that govern nature that he referred to as universal intelligence.18
The belief that the true locus of health comes from within by modulation of the nervous system is embodied in the chiropractic first principle, physical vitalism. Recognition of the role of the nervous system in health and disease has increased since the mid-1980s. The focus on neuroimmunology provides evidence supporting a strong relationship between central nervous system function and immunology.19 Short-term changes in immune function following manipulation have been demonstrated.20 (See Chapter 15.) Palmer’s concept that neural function enhances tissue resistance by modification of immune response and contributes to the body’s innate ability to fight disease can no longer be ignored. Advances in neuroimmunology provide strong evidence that supports Palmer’s 1890s convictions.21
Holism
The philosophy of holism states that the whole is greater than the sum of its parts.22 Human beings are viewed as irreducible units with everything in them related to everything else. From its inception, the chiropractic profession has embraced a holistic philosophy of health care, the object of which is to relate care to the total person. It is based on the view that the body is an integral unit, and that as long as integrity is maintained, the body is capable of maintaining it own health.9 Chiropractic practice largely encompasses the conventional ideas of holism outlined in Box 2-2.
BOX 2-2 Characteristics of Holism
The unity of body, mind, and spirit
Health as a positive state, not merely the absence of disease
Personal responsibility for health
Health education and self care, self healing
A relatively open, equal, and reciprocal relationship between patient and practitioner
Physical and/or emotional contact between patient and practitioner
A successful healing encounter that transforms both practitioner and patient
A preference for natural methods and an avoidance of highly technological health care procedures23
The chiropractic holistic approach views the patient as a whole person, not as a symptom-bearing organism. Rather than treating illness from the outside, doctors of chiropractic emphasize responsibility of patients for their own health and the importance of mobilizing their own health capacities. Recognition is given to personal, familial, social, and environmental factors that promote health.24
Naturalism
Palmer conceived the body as built on Nature’s order, thereby obeying Nature’s laws. The body’s ability to heal is supported by the use of natural remedies and recognition of the healing power of nature—Vis Medicatrix Naturae. Nature exerts pressure toward balance and this balance is the goal of doctors who employ natural remedies9:
Heal as Nature heals, in accordance with Nature’s laws. Compelling the body to do its own healing with its own forces.18
Humanism
Humanism implies a compassionate manner that requires empathy, nonjudgmental acceptance, congruence, and genuineness.6 Humanism has been defined as follows:
Any system or mode of thought or action in which human interests, values, and dignity predominate.25
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