The Paranormal in Nursing Education: A Critique of Rogerian Nursing Theory, Study notes of Nursing

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3 0 September/October 2000 SKEPTICAL INQUIRER

Rogerian Nursing Theory

A Humbug in the

Halls of Higher Learning

Schools of nursing at major academic institutions would seem to be unlikely places to find belief in

the paranormal, crackpot scientific theories being taught, and personality cults flourishing.

The emergence of pseudoscientific nursing theories, however, is cause for alarm.

JEF R A S K I N

Dead this!" my wife said when she came home

from the start of a new term at nursing school.

T h e book she handed me was Martha Rogers's

The Science of Unitary Human Beings. The more I read, the

more I thought I was the butt of an elaborate joke she had

somehow put together. It was no joke, she told me. "This is

one of the texts for our Nursing Theory course."

My wife's Nursing Theory course had a number of the

hallmarks of an indoctrination into a cult: Any serious intel-

lectual challenge to the basic ideas was treated as trouble-

making, and the leader was held in reverent awe, regarded as

having knowledge beyond the current reach of science. As I

did more research into the topic, I discovered that this

SKEPTICAL INQUIRER September/October 2000 3 1

will still be surprises from the physical world, and much work

would still remain to be done, even in centuries-old and well-

established fields such as fluid dynamics.

The range of tasks and disciplines that nursing includes is

extremely broad. An effective nurse must understand both the

human and the physiological aspects of illness. A nurse admin-

isters medication and performs procedures such as vaccina-

tions, installing intravenous catheters, and attending wounds;

a nurse checks on the propriety of medicines and dosages, sees

to the physical needs of patients who cannot tend for them-

selves, observes and records their physical and emotional sta-

tus, and can serve as the effector and senses of a doctor. In

practice, though not officially, nurses often suggest diagnoses

and therapies to doctors. Nurses also become mediators or

ombudspersons for the patient with regard to other health care

professionals, organizations, governmental bureaucracies, and

commercial entities such as insurance companies. This list cov-

ers but a fraction of the extraordinarily varied tasks that nurses

carry out. In short, a nurse must have a disparate and broad

range of interpersonal, organizational, clerical, and technical

skills. The knowledge and skill base is compounded from mul-

tiple disciplines, including physiology, sociology, psychology,

and bookkeeping.

Nursing educators should realize that it makes no sense to

claim that there is a single theory of nursing, although the

overarching goal of nurses' professional practice

to improve the wellbeing of their patients—

underlies all the other activities. Trying

to impose a "scientific" theory on such a

disparate range of skills and

techniques detracts from the

credibility of the profession.

Nursing Theory and the Philosophy of Science

The nursing theory research lit-

erature reveals the practitioners

as trying to achieve the cachet of

science while at the same

time distancing themselves

from its methods. For example,

section of Meleis's chapter on

Rogerian theory called "Theory

Testing" begins: "Gill and

Atwood (1981) attempted to

use Rogers' theory as the basis for

a study of wound healing in ani-

mals, but were legitimately

criticized by Kim (1983) for

reductionism, causality, and

inappropriate use of the ani-

mal model." Reduction, of

course, is one of the essential con-

tributions science makes to our

understanding of the world. When

Newton showed that the orbiting

ffwrmwiii

of the planets, the trajectory of projectiles, and the falling of

objects toward the ground were all described by the same

equations, and due to the same cause, he achieved a remark-

able reduction, and thereby an advance in our understanding

of nature.

Nursing theorists often use the word reduction to name the

unfortunate tendency of some clinicians to regard patients as a

set of symptoms and subsystems rather than as a person with

cultural, social, and psychological attributes. This confusion of

two meanings of the same word leads some nursing theorists to

disregard the beneficial aspects of reduction (in both senses), For

example, it is by isolating specific causes of diseases that medi-

cine has been able to eliminate so many of them as threats.

Nursing theory should embrace reduction where it is appropri-

ate, while at the same time resisting any tendency toward treat-

ing individual patients as less than full human beings.

To critique an experimental study for treating events as causal

again takes nursing theory out of the realm of science, which is

primarily concerned with questions of cause and effect. Even

where events seem to be acausal (as in the case of the radioactive

decay of atomic nuclei), the phenomena are still detectable,

demonstrable, measurable, repeatable, and well described by sta-

tistical laws. Nursing theorists, by contrast, are averse to causal

reasoning and criteria such as repeatability because the phenom-

ena in which they believe, including the paranormal, do not

meet with these common-sense standards. Nursing the-

orists also tend to avoid crucial experiments that

could jeopardize the theory in the rare cases

where it is coherent enough to permit test-

ing; or, as noted for therapeutic touch,

they reinterpret the theory to

make it impossible to test.

The experiments that do

appear in the literature usually

depend on subjective judg-

ments, rely on anecdotal reports,

or are purely speculative.

For the most part, nursing the-

ory has insulated itself from logical

or experimental evaluation by

avoiding precision and predic-

tion—or even meaningfulness.

For example, Rogers said (1980,

quoted in Meleis 1997), "Reality

does not exist but appears to exist as

expressed by human beings."

The Vested Interest

Nursing theory has an academic

structure that is medieval in

style. Academic titles take on great

significance, and most nursing theo-

rists display at least three sets of ini-

tials after their names. For example, an

article that tells us that "From the

purview of Rogerian thought, VR

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Rogers In Her Own Words

Analysis of quotes f r o m Rogers, Martha E., An Introduction to the Theoretical Basis of Nursing. Philadelphia, 1970. F.A. Davis Company.

Until you read her works, it is hard to believe how confused and vague Rogers's theoretical writings are. Where she does get precise enough t o judge the validity of her thought, she is often simply wrong. For example, Rogers's concept of negative entropy, which she calls "negentropy," is based on her misunderstanding of thermo- dynamics. After claiming, without exam- ples or citations, that, "With the rise of modern science, evidence that man did not develop according to accepted physical laws became more explicit" she found that, "The second law of thermodynamics, useful in predicting the physical world, was inconsistent with the ways in which living systems behaved" because "An increase in entropy posited a trend toward degrada- tion t o homogeneity of organization in contrast to a trend towards heterogeneity and complexity." She concludes that there is a "failure of physical laws to explain the evolution of life." (All the above quotes from p. 51.) She quotes, and summarily dis- misses, the correct explanation: "Rapoport endeavors to deal with this problem by stating that 'no living system is a closed sys- tem and so the second law does not apply t o i t ' " (52). There is no contradiction between the laws of thermodynamics and the behavior of living systems. Rogers confounds Darwinian evolu- t i o n , which she misunderstands, and the common use of the w o r d " e v o l u t i o n " t o mean change over time. She still accepts the long-abandoned evolutionary hierar- chy w i t h man at the top, "life encom- passes the simplest organism t o the most complex in an evolutionary h i e r a r c h y.... At the t o p of this scale man stands t r i - u m p h a n t " (67). All that evolution pre- dicts is improved adaptation, which may lead t o greater or lesser complexity. Rogers is as fuzzy w i t h physics as she is w i t h biology. She says (getting both the scientist's name and the name of the prin- ciple wrong), "Heinsenberg's principle of indeterminacy postulates an uncertainty in all k n o w i n g " (57). This is not true: Heisenberg's uncertainty principle casts no light at all on logical or mathematical cer- tainty, and does not say that we cannot predict w i t h certainty outcomes of macro- scopic events. If a swiftly moving bowling ball directly strikes a bowling pin, we can predict w i t h certainty that the pin will move, even if Heisenberg himself had launched the ball. Also, the principle was not "postulated" but derived from obser- vation and earlier work. Rogers also tells us that "human beings are radiation bod- ies" (113), but not what a radiation body

is. "Radiation body" is not a term f r o m physics or physiology, it is a phrase she has invented, and which (as is all t o o usual in her work) she presents w i t h o u t definition, leaving you t o guess its meaning. Rogers's theory is based on a number of what she calls "assumptions," and she is often "postulating" concepts. Assumptions and postulates are more the tools of math- ematics than of science, because in science t h e fundamental principles are not assumed or postulated but are based on observation. Here is a typical example: "The principles of homeodynamics... are four in number, namely: principle of reciprocy, principle of synchrony, principle of helicy, and principle of resonancy. These principles postulate the way the life process is and predict the nature of its evolving" (79). Another characteristic of her writing is stating the obvious as though it were a deep insight, for example, "Man's capacity to adapt to a wide range of environmental stresses has received considerable attention and has been proposed to be a significant factor in his survival" (49). Rogers's "second assumption on which nursing science builds may be stated thus: Man and environment are continuously exchanging matter and energy with one another" (54). This is no assumption, but a simple fact. She is not above window-dressing with high-sound- ing jargon. Her third "assumption" is: "The life process evolves irreversibly and unidi¬ rectionally along the space-time contin- uum" (59). In plain English: "The processes of life cannot be time-reversed." When she says that "Ontogenesis and phylogenesis evidence a lengthening of conscious awareness (the waking state) t h r o u g h time" (93), she is claiming both that during the development of an individual and dur- ing humanity's evolutionary history, people stay awake for longer periods of time. However, some people need increasing amounts of sleep as they age, and there is no evidence at all about the sleep habits of our prehistoric ancestors. A large part of Rogerian theory is based on the idea of an energy field. She says, without any substantiation, "An energy field is the basic unit of living things. It is this field which imposes pattern and orga- nization on the parts" (61). She says that the "the electrical nature of this field is well documented" (104) but gives no citations t o the claimed documentation. Rogers never takes her own advice to provide the "clear unequivocal concepts" needed for "a body of scientific knowledge" (81), and we are left w i t h no guidance as t o how t o detect or measure this field. She does get

very specific at one point and tells us that "A series of studies... were designed t o investigate the relationship between elec- trical potential differences, as measured by the Keithley Microvoltmeter, Model 153" (104). On what or where the potential dif- ferences were measured, a far more impor- tant piece of information, she does not report. In any case, it doesn't matter, for she then tells us that no positive results were obtained with this device, and the matter is dropped. Why then the specific mention of the piece of apparatus used? Because, I believe, Rogers felt t h a t it sounded impressive. Martha Rogers was not put off by con- tradictions in her theory. For example, she says, " A t death the human field ceases t o exist" (91), and also, a few paragraphs later, "The field projects into the future as well as into the past." She speaks of "delineating the boundary of the human field" with measuring instruments (113) and also that "The environment is defined as all that which is external to a given human field and is thus stated to be the environmental field" (97). But she also has told us that the human field extends to infinity in all direc- tions, so it has no boundary and nothing is external to it. Mathematics and symbolic notation are not ignored. Rogers, w i t h o u t an expla- nation of what topology is likely t o be able t o tell us, says, "A fundamental ques- t i o n needing exploration concerns the topology of the human f i e l d " (112). She introduces equations such as R = f(M>«Ei) which "can be read as: 'Reciprocy [R] is a function of the mutual interaction between the human field [M] and the environmental field [E]'" (97). The sub- scripts are never explained or even men- tioned. No use is made of the notation except as an alternative t o words: The only apparent justification for the symbolic form is t o introduce something that looks like mathematics into the book. Last, Rogers accepts sources uncriti- cally. "Further evidence of nature's law- fulness has come about t h r o u g h bio- rhythm research, expanded recognition of the cyclical nature of physical phenom- ena, and significant findings pointing up interrelationships between the t w o " (62). Biorhythms were a fad at the time she was w r i t i n g. She also thinks that "In recent years, scientific respectability has been granted t o the study of extrasensory phenomena. The existence of paranormal occurrences is well documented" (72). Perhaps often discussed, but not well doc- umented. Scientific respectability will be granted only when the supposed phe- nomena can repeatably produce positive results under conditions that rule out cheating and experimenter bias, an event for which w e are still waiting.

— Jef Raskin

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