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.
Originally Published on FutureHealth
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
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
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
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.
Lewis grew up in southeastern Kentucky and attended Indiana University where he majored in biophysics. He then attended Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is currently teaching in the Clinical Psychology Program at Union Institute and University in Brattleboro, Vermont, and has a part-time private practice there. He is the author of several books about integrating narrative and indigenous ideas with modern medicine and psychiatry including Coyote Medicine, Coyote Healing, Coyote Wisdom, Narrative Medicine, and Healing the Mind through the Power of Story.