ABSTRACT
The objective of this chapter is to examine the particular ways in which Habermas may be applied to issues currently facing Complementary and Alternative Medicine (CAM). To set the stage for this, the introduction begins with definitional issues regarding CAM, briefly considers the growing popularity of CAM, as well as the developing state interest across Europe in regulating CAM and on this basis makes the case for viewing key concepts of Habermas’ social theory as forming a method of social research, related to documentary analysis. The chapter then turns to a reflexive account of the explanatory usefulness of applying Habermas in novel ways to the growing state interest in regulating CAM. In many ways the term ‘CAM’ is little more than a convenient shorthand for the relationship between various alternative medicines and orthodox biomedicine, or else the foci of medical intervention, whether through the administration of herbs, food, vitamins and diet; the mind, through relaxation techniques, art, dance; or via energy fields, leading to various touch therapies, such as Riki; and/ or physical manipulation of the body, through massage, chiropractic (NCCAM, 2011). What is perhaps more clear-cut is that the popularity of CAM has soared in recent decades. In this respect, the numbers interested in practising and using alternative medicines have grown steadily across industrialised countries in recent years and this does not look like abating (Bodeker and Kronenberg, 2002; Thomas, 2008). The latest estimates suggest that one in four (England) and one in two (US, Germany, Australia) adults are now making use of alternative medicine in one way or another (Medscape, 2011). The growing urge by governments across the EU to create national institutions for self-regulating CAM is in part a response to the increasing popularity of CAM, but can also be seen in terms of a countervailing orientation to understanding CAM and how, where and by whom it should be practised. For example, in 2001 Ireland established a forum involving representatives of different therapies to develop a strategy for regulation, carried out in June 2001 (IPA, 2002). In the same year Portugal established a new law under which a range of alternative medicines – including acupuncture, homeopathy, osteopathy,
naturopathy, psychotherapy and chiropractic – would be regulated, ‘controlled and accredited by the Health Ministry while the education and the certification of degrees and diplomas for the practice of the therapies would be controlled by the Ministry of Education and Science and Higher Education’ (ECCH, 2005, p. 7). In 2004 Denmark set up a national register to regulate CAM practitioners, ensuring that practitioners ‘have well defined criteria for education and are members of an organisation for practitioners that will take on the necessary tasks for registration and maintaining the register’ (ECCH, 2005, p. 8). In the same year Sweden and Norway both set in motion the commitment to establish a national register for CAM practitioners (ECCH, 2005, p. 8). Successive UK governments have been at the forefront of self-regulation since the 1990s. The Conservative government, under the leadership of John Major, declared its intention to bring CAM under a national framework of regulation. As a consequence, in 1993 the UK became one of the first countries to establish a statutory register for complementary medicine when the Osteopaths Bill became law (GOC, 2011), followed by the statutory regulation of chiropractic (GCC, 2011). Four years later ‘the Department of Health commissioned the Centre for Complementary Health Studies (University of Exeter) to survey all CAM organisations to determine the state of self-regulation’ (Mills and Peacock, 1997). Their ‘survey found that, while the degree of selfregulation of organisations varied greatly, there was a clear motivation to selfregulate’ (Kohn, 1999, p. 11). However, the self-regulation watershed came in 2000 when the House of Lords Select Committee on Science and Technology (HCSCST, 2000) called for a more inclusive statutory and voluntary scheme of regulation: statutory regulation for homeopathy, acupuncture and herbal medicine practitioners and a single national self-regulated register for the vast range of alternative medicines.1 On the basis of the Report, the Foundation for Integrated Medicine (FIM) – under its new title of ‘Princes Foundation for Integrated Health’ (PFIH) – received funding from the Department of Health to facilitate the development of a national framework of self-regulation. The PFIH had a broad agenda, including consideration of the views of consumers of alternative medicine. However, its major contribution was helping to eventually establish a limited number of national regulatory Councils, charged with overseeing the bulk of alternative and complementary practitioners, including: UK Healers Regulatory Council (UKHRC), General Regulatory Council for Complementary Therapists (GRCCT), British Complementary Therapist Council (BCTC) and Complementary and Natural Healthcare Council (CNHC, 2011); (The Times, 2008). There has been, then, an intensifying urge to regulate CAM. My own research focuses on understanding the state’s urge to regulate the array of alternative and complementary medicines, and situating this understanding within wider social power relations. My data collection and analysis draws from written documentation and my aim is to transform the vast amount of information that has been written on CAM, in documents by public bodies, state agencies, the alternative
medical community and orthodox medicine, into social knowledge, as defined by Habermas’ thinking about three ways of knowing (more of which below). One of the key questions one faces in such an undertaking is how to bring order, or more precisely, how to make the key selections of text and represent them in such a way as to inscribe them with meaning and transform the information contained within them into socially useful knowledge. Theory has a special role to play in achieving this task, because it offers a means of framing the enormous amount of textual data in certain ways and not others. If we take a series of questions such as why are various European states moving to regulate CAM and professionalise practitioners and the related question ‘and who benefits’, then social theory can help articulate a compelling means of addressing these questions. In the case of CAM and the state, and with Habermas’ social theory to the fore, we can address the why question in just such a compelling way. In Knowledge and human interests, key to Habermas’ approach is the idea of three types of social knowledge, all of which a viable society requires if it is to progress and flourish (Habermas, 1987b). There is technical or scientific (scientistic) knowledge, which seeks by definition a technical explanation, with emphasis on logic and rational exposition. This mode of knowledge embraces politics as well as scientific communities, helping to transform ideology as objective observation and rational guidance for the social good. There is also what we can refer to as hermeneutic knowledge, which lays emphasis on understanding the meaning of social actions, individual and group behaviours and how this understanding emerges from negotiation and dialogue. Finally, there is emancipatory knowledge, which is knowledge that embarks on a critical reflexive account of social power arrangements, social inequalities and issues of who gains and loses from the other forms of knowledge, with an orientation again towards claims to be acting in the common good. Each form of knowing can weave a thought-provoking understanding of CAM, as this chapter hopes to demonstrate. Of course Habermas would not claim that the three forms of knowledge are neatly divided in society, which would be akin to expecting the complex ideas of individuals and social groups to be reduced to one form of knowledge; clearly, instead, they can and do colonise each other; hermeneutic knowledge can become a ‘medium of domination and power’ (Habermas, cited in Outhwaite, 1994, p. 25). More specifically, the social context, along with specific interests, will establish what can be described as a latent balance of all three within which at various times one or other is dominant. For example, instead of neatly ascribing to the state and medical orthodoxy (what some term biomedicine) a technical and scientific/rational driven apprehension of CAM and the requirement to professionalise its adherence, one might be sensitive to the dominance of this kind of knowledge within the documentation of the state and medical establishments, over and above the search for hermeneutic understanding and critical emancipation. In other words the tendency would be to close off the wealth of possible understanding tied to the three forms identified above. By the same token one
might expect a reversal of documented discourse arising from the alternative medicine movement, practitioners, consumers and activists, whereby preference is given to shared meaning and an exploration of the social power distributions involved in the attempt to transform the field of alternative medicine. In other words, Habermas’ social theory is a method of exposition, achieving much the same effect as other research methods, such as interviews, surveys, focus groups, etc. In each case, the task is to select information from the vast amount of data that could be collected and analysed in a specific way, usually as determined by the research method. Habermas’ three dimensions of social knowledge offer a selective framework through which textual data and other forms of data can be transformed into social knowledge. In this respect, social theory as research method is social theory applied. However, what is still missing in this social theoretical framework are Habermas’ other key concepts, which include ‘communicative competence’, ‘ideal speech situation’, among many others. In this chapter I wish to focus in particular on his concepts of the lifeworld, systems world and public sphere (Habermas, 1987a, 1989). For Habermas, these establish a means of understanding the social context within which the aforementioned forms of social knowledge operate. In fact it is the interplay between the two worlds and the vitality or otherwise of the public sphere that offers the dynamic ground within which the struggle for dominance of the three forms of social knowledge occur. In summary, in order to achieve clarity of exposition and at the risk of oversimplification I wish to utilise Habermas’ social theory as a method of social research by demonstrating how his social theory layers and unfolds knowledge towards a more complex grasp of the object of social enquiry; in our case, the urge to regulate CAM. For Habermas, the three different forms of social knowledge – technical, hermeneutic, critical emancipatory – do not sit on a scale with true at one end and false at the other. Each is a form of knowledge inscribed in human relations; each has its own relative truth-value. The flipside is that taken alone each is one-sided and of less value. It is in this sense that I use the term layered. The layering executed below in the transforming of information about CAM into social knowledge concerning CAM in society, is as follows:
• hermeneutic understanding of CAM; • technical/rational understanding of CAM; • critical emancipatory understanding of CAM.
