To the editor:

I was pleased to see the attention given to the theory of health as expanding consciousness in Yamashita and Tall's recent article (ANS 1998, 21:1). I would like to address a number of points in their critique that are not accurate reflections of the theory in the hope of precluding misunderstandings that may accrue.

The problem lies mainly in the paradigm from which the authors speak. They examine initial parameters of the theory with knowledge from other fields, fields that are derived from philosophies of science different from that of health as expanding consciousness. My understanding of scientific criticism is that it proceeds from within the paradigm of the theory being evaluated, not from another set of rules.

Yamashita and Tall begin by stating specifically that the Newman theory fits with the alternative medicine paradigm. It does not. The alternative medicine paradigm is an ill-defined conglomerate of therapies considered alternative to traditional medical therapies but with the same goal of promoting health in the sense of wellness (relief of disease). The Newman theory clearly is not limited by this goal. The Newman theory can (and often does) incorporate medical therapy but has an entirely different focus on the meaning of the whole experience.

In their discussion of the assumptions of the theory, Yamashita and Tall state that the second and third assumptions are "not surprising" to those familiar with psychoneuroimmunology and other named fields and then go on to paraphrase the meaning of these assumptions as "simply" that "psychic imbalance can create the conditions for disease to manifest." Not only does this language tend to trivialize the assumptions, but also the explanation of the theory in causal mind-body terms betrays the unitary nature of the phenomenon.

Referring to Lamendola and Newman's study of persons with HIV/AIDS, Yamashita and Tall challenge the use of the term "health" in relation to the devastating experiences accompanying this disease. That criticism would apply to other chronic disease situations as well. What is apparent in the authors' comments is that they do not accept the basic premise of the concept of health as expanding consciousness. As long as one is viewing health from the standpoint of wellness (ease), it is impossible to grasp the meaning of health as expanding consciousness in the experience of disease.

There are other misinterpretations of the theory and inaccuracies.

Yamashita and Tall's attribution of a "search for equilibrium" to the theory is inaccurate. The quotation they use to support this assertion [the citation of which should have been my 1994 book, p. 21] depicts a constant movement between equilibrium and disequilibrium, and the thought continues with my citation of Buckminster Fuller that the system moves from disequilibrium to disequilibrium, never pausing at equilibrium.

The authors' example from neurolinguistic programming psychotherapy aimed at refuting an insight-to-action relationship is based on action targeted at a specific behavior and does not apply to my theory. In health as expanding consciousness the insight emerges from recognition of the pattern of the whole. There is no way of knowing in advance what that will be or what action will be indicated.

In describing the nurse-client interaction, Yamashita and Tall equate my use of mirroring with Carl Rogers' theory. The mirroring that I have referred to is based on the pattern that has emerged in the first interview and is not the Rogerian sense of non-directive interpersonal communication. Further, the authors parallel my use of interpenetration of the nurse's and client's fields with the concept of therapeutic touch. They admit that they do not understand what I am saying about the field or if it is similar to the work regarding physical energy fields in other disciplines, but then proceed with an explanation of other concepts of physical energy, claiming that this explanation aids in understanding my theory. The ideas of interpenetration of fields and wave interference come from a holographic view of this interaction and do not imply an exchange of energy, as the authors suggest.

Toward the end of the article, Yamashita and Tall emphasize "negotiation, reciprocity, and empowerment" as dimensions of research as praxis. Admittedly I used those terms in my first glimpse of research as praxis but later dropped them from my concept of praxis because they are instrumental and inconsistent with the unitary-transformative paradigm. I thought I had made it clear to Yamashita on more than one occasion that these concepts are no longer consistent with my thinking, and I am puzzled as to why the authors persisted in including them as part of my concept of praxis, except perhaps as a basis for elaboration from the standpoint of other authors. The example they cited from Yamashita's research would be viewed from my standpoint as an evolving pattern of expanding consciousness.

Finally, there are a couple of inaccuracies in regard to the research method: the assertion that, "In all cases, the initial interview begins ..." and the claim that "None of the other studies ... have utilized such final [follow-up] interviews ...." I admit to having contributed to the image of a specific step-by-step approach by having published a research protocol in my 1994 book, but the method is not static and there are many variations on the theme of asking participants what is most meaningful in their lives, as reflected in some of the more recent studies. And my recommendation to Yamashita to use a follow-up interview was based on Litchfield's initiation of a follow-up interview in her 1993 research. Research within the context of evolutionary emergence is creative and interactive and arises out of the theory, the understanding of the researcher, and the circumstances of the selected participants.

SUGGESTED READING

Lamendola F, Newman MA. The paradox of HIV/AIDS as expanding consciousness. Adv Nur Sci. 1994;16(3):13-21.

Litchfield MC. The Process of Health Patterning in Families with Young Children Who Have Been Repeatedly Hospitalized. Minneapolis, MN: University of Minnesota; 1993. Master's thesis.

Newman MA. Health as Expanding Consciousness. 2nd ed. New York: National League for Nursing; 1994.

Margaret A. Newman, RN, PhD, FAAN

Professor Emeritus; University of Minnesota; St. Paul, Minnesota