A Philosophy of Nursing Forum
Thursday, October 08, 2009

Ok now that Professor Newsom has kicked off our discussion on realism, let's keep it going.

Realism versus anti-realism

Revolutionary ideas


Read: Rosenberg C 6.

Bergin, M., Wells, J., & Owen, S. (2008, July). Critical realism: a philosophical framework for the study of gender and mental health. Nursing Philosophy, 9(3), 169-179.

Hansen-Ketchum, P., & Myrick, F. (2008, July). Photo methods for qualitative research in nursing: an ontological and epistemological perspective. Nursing Philosophy, 9(3), 205-213.

1. Based on your understanding of Kuhn’s assertion that “we are no nearer the truth about the nature of things nowadays than we were in Aristotle’s times,” (pp 145-146) what are some examples from our profession of accepted paradigms? In applied disciplines, this usually relates to generally accepted practice guidelines.

2. What is your definition of realism as compared to anti realism? In your own words…

3. How do Hansen-Ketchum and Myrick justify the use of photography as a research method based on ontology and epistemology?

4. Select an article in nursing scholarship, which reflects or refutes Kuhn’s ideas. Share your critical assessment of author’s perspective.

Friday, October 02, 2009

This last week's discussion about science and epistemology has impressed me. I gather that the class is quite diverse in terms of how much philosophy the participants have taken, but folks appear to be picking up on many important concepts and ideas right out of the starting gate. Good job!

Let me suggest something further to think about. Caveat: what I am about to say is opinionated and contentious, and would not necessarily meet with widespread agreement by “paid up” philosophers of science. Still it might get the discussion rolling in useful directions.

ONE way to think about the big issues in philosophy of science is to organize the discussion around “realism” versus “anti-realism”, and see how that relates to the empiricism versus rationalism versus pragmatism debate. When we organize our thinking in that way, at least initially, we find an argument going on about the status of “theoretical” entities and forces which we cannot see. Take electrons as a simple example. We don't “see” electrons (or do we?). We take eggs to be “real” because we see them, hold them, eat them, etc. But we don't see, hold, taste or eat electrons in the same way. So why take them to be real?

And, why stop with electrons? What about “causes”? Logical positivists read Hume, famously, as being dubious about any claim of the sort “putting poison in his wife's tea caused her death”. Ayer and the positivists thought Hume would allow that we observed the act of putting poison in the tea, and that we observed the death of the little missus thereafter. He would allow that this same sequence of events has been observed many times in the past. He would allow that, so far, this sequence has been “exceptionless”, that is, that every time we have seen poison put in tea, death has followed on the part of the person drinking the tea. He would allow that we expect that death will follow putting poison in the tea if we do that tomorrow. Moreover, he would allow that expecting death to follow poisoning is perfectly natural on our part. It is a “habit of thought”. But that is ALL he (Hume) would allow, because what we see is the events; we don't SEE the cause. Note, please, that not everyone reads Hume this way. Strawson, Craig and Blackburn offer alternate readings. But, for this discussion, let's stick with the “Hume a la Ayer” version, because it is illustrative.

Illustrative, because we can use it to see what was bugging empiricists “back in the day”, and why empiricism classically can lead to anti-realism in science. “Empiricism” writ large is just the idea that “sense experience is the ultimate source of all our concepts and knowledge”, as contrasted with “rationalism”, which holds that “there are significant ways in which our concepts and knowledge are gained independently of sense experience.” As regards “causes”, or “electrons,” the classical empiricist position might be that, since we never actually see them, there is no reason to treat them as “real”.

Kant thought that, at least as to concepts like “cause”, he had put an end to the debate, arguing that “cause” was a “category of understanding”, a sort of operation that the human mind performed upon experience, thereby constructing the “phenomenal world”. We know, then, that putting poison in the tea causes death, but this is knowledge of the phenomenal world, not knowledge of the “noumenal” world, that is, the world not comprehended through the categories of human understanding. De Pierris and Friedman put it this way: “Kant agrees with Hume that neither the relation of cause and effect nor the idea of necessary connection is given in our sensory perceptions; both, in an important sense, are contributed by our mind. For Kant, however, the concepts of both causality and necessity arise from precisely the operations of our understanding—and, indeed, they arise entirely a priori as pure concepts or categories of the understanding.”

Not everyone agrees that Kant succeeded here, or even what all of that meant, exactly. But, even if he did succeed when it comes to “cause”, where does that leave “electrons”, or germs, or...? THEY aren't “categories” or “operations of the mind,” but rather, according to realists, putative “objects”, or things that (allegedly) exist whether there is any “experience” going on or not. So how does Kant have anything to do with this? How does this HELP? Let's take a brief detour through a bit of medical history and and then return to the question. Much of what follows is inspired by Dr. Marc Lange's article “Salience, Supervenience, and Layer Cakes in Sellars's Scientific Realism, McDowell's Moral Realism, and the Philosophy of Mind”, in Volume 101, Numbers 2-3, of Philosophical Studies. However, he might not agree with some, or much, of this, so don't blame him.

Consider Dr. Semmelweis, the Viennese obstetrician who was horrified to discover that, in the Doctors ward of the hospital, women were dying like flies of Puerperal fever, whereas, over in the nurse midwife ward, women got Puerperal fever less than half as often. And, he wasn't the only one to notice. Here in the good old USA, poet and physician Dr. Oliver Wendell Holmes, Sr. (Justice Holmes' father – a distinguished family) had noticed too. He wrote, years before Semmelwies, that
“. . . in my own family, I had rather that those I esteemed the most should be delivered unaided, in a stable, by the mangerside, than that they should receive the best help, in the fairest apartment, but exposed to the vapors of this pitiless disease."

Folks back then understood that diseases could be spread from person to person. They also presumed that bacteria existed, since Antony Van Leeuwenhoek's 1674 observations of “animalcules” through a microscope had been repeated many times for over 150 years. Some even guessed that “disease” could inhere, somehow, on physical objects like blankets, thus giving General Jeffrey Amherst the bright idea of giving native Americans blankets that had been used by small pox victims. Charming. No one, though, thought that “animalcules” could kill you, since they were so tiny. Thus, there was no “germ” theory of disease.

Semmelweis had before him a classic researchers' problem – discover why two groups, “Doctors' patients” versus “Nurses' patients” had different rates of death due to Puerperal fever. So he made Baconian “observations.” Observations of the organs of someone who had died of "cadaverous fever”; observations of the organs of women who had died of Puerperal fever; observations of Nun midwifes and what they did; observations of Doctors and what they did; observations about ward location, temperature, population and crowding; ton-o-observations, in other words, and he wrote these down methodically. Let's call what he wrote down “observation level” statements.

Not everything he observed, though, had anything to do with Puerperal fever. Semmelweis needed to figure out which observations were clues. He needed for some observations to “stand out”. Salience, per cognitive scientist Dr. Laurent Itti is that “which makes some items in the world stand out from their neighbors.”

In the event, the “right” observations were made “salient” for Semmelweis; that is, the right ones “stood out” for him, for the most part, and he ignored those observation level statements of his that didn't matter. What stood out for him were things like “the nuns wash their hands before and after touching the sick,” “the nuns don't go from cutting up corpses to examining women in labor,” “the nuns have clean clothes on that haven't been in contact with rotting corpses,” “the internal organs of people who have died of cadaverous fever look like the organs of women who die of Puerperal fever,” etc. Equally important was what didn't stand out – things like the color of the nuns' habit, the color of the doctors' trousers, the prayers the nuns said, the temperature in the ward.

What made some observation statements salient and others not? How about the THEORETICAL statements (thoughts, conceptual schemes?) in Semmelweis's noggin? His THEORIES, in other words. Note that they weren't the best of all possible theories. In fact, they were pretty much WRONG, consisting as they did of mostly of the stuff he had been taught – the “wisdom” of his day. The theoretical entities in his noggin were things like “miasmas”, and “vapors”, neither of which, in fact, exist. Still, they were good enough, close enough to how things are, to make the RIGHT observations salient for him, after postulating the existence of a new “theoretical entity”, the “cadaverous particle,” which, while not exactly a bacteria, is a step closer than a “miasma”. Based on his theories, he was able to utilize his observations to formulate some “laws of obstetrical ward hygiene”, which are, roughly, the same ones we subscribe to these days.

These laws of obstetrical ward hygiene can be expressed entirely in the terms used in Semmelweis's “observation level” statements. The only “terms” we need are soap, water, hands, wash, etc. So, once we have them, and we confirm the laws inductively – new moms don't get Puerperal fever when we adhere to them – what else is needed? Wouldn't the right thing for nurses to have done back then be to reason as follows: “we nurses will follow the 'laws of obstetrical ward hygiene' as long as they are inductively confirmed, but we will remain agnostics about vapors, miasmas, and cadaverous particles”?

At first glance that SEEMS right – agnosticism would keep researchers from refusing to look at better theories when they came along, like a theory that substitutes pathogenic “animalcules,” or bacteria, for “cadaverous particles”, say. Viewing science historically, with the benefit of hindsight, agnosticism might look sound. There are even respected philosophers of science who counsel something like this attitude today. Constructive empiricists, for example, allow that one can USE theorizing in order to formulate hypotheses and “observation statement” type laws, but are still of the opinion that it is okay to be skeptical, or at least agnostic, about entities and forces which cannot be directly observed by the senses. Perhaps, they say, today's “electron” is tomorrow's “miasma”, and anyone who is not at least open to that possibility is a pig-headed, lab-coated intellectual fascist.

Plausible as this seems, there are problems with it. For one thing, it assumes that there is some principled distinction between that which is “seen” with the naked eye, and that which is “seen” with a microscope, or by means of some other method which augments our senses. Harvard philosopher John Hall finds this highly suspect. It would mean, for example, that some tiny creature that can “see” a bacteria should “believe” in them, whereas we should be agnostic about them because we need microscopes to spot the little rascals. Or what about the moons orbiting the outer planets? Does this mean that we can be agnostic about them as long as we only “see” them through telescopes, but we can “believe” in them after astronauts “see” them through the spaceship's window?

A second problem is this: absent an assumption concerning the truth of our theories, how do we arrive at explanations? We want good laws of obstetrical hygiene, of course, but we also want an explanation for why they “work”. The philosopher Willfrid Sellars used the example of Boyle's law. Why does the equation P=VT work? BECAUSE (theory) heat = molecular motion, and (theory) gases are itty bitty moving particles. If confined, then, as they heat up they move faster, so they bump in to each other more often, so they exert more force on the confining vessel, so pressure rises. COOL!

A true theory, aided by an ASSUMPTION that the fundamental laws of the universe will be the same tomorrow as they are today, permits us to stop relying on inductions from observational statements, and start actually “deducing” things, as J. S. Mill noticed a while back. When our deductions don't work in terms of the observations we make, we go back and revise the theory, expecting (reasonably enough) that it will EXPLAIN not only the observations we do make, but why the old theory SEEMED to work as well as it did.

The miasma theory of disease is a good example to use here. According to that theory, disease was spread by noxious, vaporous things called “miasmas”, which contained tiny bits of rotting stuff called “miasmatas”, and this was the standard theory of disease in the mid 1800's. Nightingale accepted it, for example, at least at the beginning of her career. Accepting it as true lead to changes in public behavior. People started washing stuff that smelled bad (including themselves, thank God), covering sewers, inventing toilets and digging outhouses, and draining swamps so that the bad stinky air wouldn't blow in to town (eliminating the mal aria, in Latin. Isn't that an interesting tidbit?)

The miasma theory wasn't all that great, but it seemed to work. Malaria, for example, virtually ceased to exist in many parts of the industrial world. Public health visibly, measurably, improved. Observations seemed to confirm the theory. It began to be modified/abandoned only when anomalous phenomena were observed, and/or its explanatory power proved inadequate. And, our newer theories of disease explain the successes the miasmatic theory did enjoy. Drained swaps don't harbor mosquitoes, and so malaria disappears. Washed bodies are far less at risk for septicemia than unwashed ones are, due to a lower bacteria count. Cholera is less frequent when people stop throwing poop in to gutters, where it washes in to streams and shallow wells, because fewer vibro cholerae are getting in to the drinking water. In fact, one can go so far as to say that we wouldn't ACCEPT the germ theory of disease if it COULD NOT explain the successes of the miasmatic theory.

So where does this leave us? I think it ought to leave us back with Kant, at least in spirit, if not in detail. Nick Fearn and others have suggested that we think of Kant's BIG idea about categories of understanding as analogous to eyeglasses that we cannot take off, operations that the mind automatically and unceasingly performs on the information it receives, and indispensable to us, since without them we could not THINK at all. Similarly, we might think of theories and the entities and forces they postulate as indispensable eyeglasses which render certain observations salient. Without them, and the presumption that they characterize reality accurately, we cannot proceed.

The late and very much missed philosopher Jay Rosenberg put it much better than I ever could:

“...stories that postulate “theoretical entities” are not merely manageable second-class surrogates for more complicated and unwieldy stories about entities that we have good, i.e., observational, reasons to believe actually exist. Theoretical entities, rather, are those entities we warrantedly believe to exist for good and sufficient theoretical reasons. On this understanding, scientific theories explanatorily “save the appearances” precisely by characterizing the reality of which the appearances are appearances.”

So, don't forget to wash you hands, empiricists. They REALLY have animalcules on them.
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