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Critical theory and Rogerian science: incommensurable or reconcilable.

Denise Dredahal (1999, p. 10) recently asserted that "we need to develop theory, conduct research, and enact practice that consider elements of race, class, and gender." Nursing theories that help only to understand the unique differences among individuals and groups are no longer adequate. Inequalities, prejudice, social injustice, and abuses of power can serve to limit the ability of all persons and communities in achieving their potentials for health and well-being. If the goal of the Science of Unitary Human Beings is the actualization of human betterment for all, then the work of nurses practicing Rogerian science must encompass issues of racism, classism, and sexism in the mutual patterning of the human-environment field.

Background

There have been few attempts within the Rogerian tradition to address issues raised by critical theorists. Furthermore, there is no literature regarding Rogerian practice or research methods which addresses the need for the emancipation or liberation of human beings from oppressive social systems and the patriarchal, racist, and authoritarian environments that suppress human caring values. In fact, there have been concerns that critical theory is ontologically and epistemologically incongruent with Rogerian science. The very language of critical theory seems reductionistic, causal, prescriptive, and therefore incongruent with the tenets of Rogerian Science.

Cody (1998) illustrated a number of incongruencies between critical theory and Parse's Theory of Human Becoming, a theory with similar ontological foundations as Rogers' nursing science. He concluded that Parse's theory "provides a more satisfactory guide to practice than does critical theory" (p. 46). Cody argued that critical theorists impose normative judgements and limit freedom by prescribing solutions; however, he did not offer a way of addressing the larger forms of oppression that pervade the socioeconomic environments of persons and the health care system beyond the individual.

Purpose

Critical theory discourse has thus far not been connected to nursing theories (Cody, 1998; Dredahal, 1999; Ray, 1992). Instead, nursing scholars have adopted critical theory from a sociological perspective rather than reformulating it to fit within the unique perspective of extant nursing theories. The purpose of this column is to offer a way of conceptualizing and interpreting the issues raised in critical theory through the lens of Rogers' Science of Unitary Human Beings and thereby stimulate dialogue, critique, and possibilities for further ways to make critical theory congruent with Rogerian pattern-based practice.

Critical Social Theory

The roots of critical social theory can be traced to the Institute of Social Research founded in Frankfurt, Germany, in 1923. The goal of the Frankfurt School was to revise Marxism and the objectivist interpretation of historical materialism. It was a response to the domination of technological knowledge developed through logical positivist science and its consequent contribution to the oppression of working classes. Critical theorists seek to inspire others to explore instrumental or communicative action for social change through the promotion of justice and freedom. Kinchelore & McLaren (1994) defined a criticalist as one who uses their work as a form of social or cultural criticism and accepts the following set of assumptions. (a) All thought is fundamentally mediated by power relations that are historically and socially constituted. (b) Facts can never be isolated from values or be separated from ideological inscription. (c) Relationships between concepts and object and between signifier and the signified are never fixed or stable and are often mediated by the social relations of capitalist production and consumption. (d) Language is central to the formation of subjectivity (consciousness and unconscious awareness). (e) Certain groups in any society are privileged over others. (f) While the reasoning of privileging varies, the oppression that characterizes contemporary society is most forcefully reproduced when the oppressed accept their social status as natural or inevitable. (g) Oppression has multiple dimensions, and focusing on any one at the expense of others omits the interconnectedness among them (h) Mainstream research practices are generally and unwittingly involved in the reproduction of systems of class, race, and gender oppression.

While critical theory emerged from a social science perspective, its implications are intertwined with all disciplines. A growing number of nursing scholars, Allen (1985), Campbell & Bunting (1991), Chinn & Wheeler (1985), Stevens 51989), Taylor (1999), and Thompson (1987), have used a critical theory perspective to bring to awareness the systems of oppression, such as racism, sexism, classism, and homophobia, that are embedded in nursing and health care.

Relevance of Critical Social Theory to Nursing

It may appear that the goals of critical theory and nursing are different; however, both nursing and the actualization of health are inseparable from oppressive sociocuitural systems. Theoretical discourse in nursing has not linked nursing theories to critical theory as it has linked them to phenomenology, hermeneutics, empiricism, and to theories originating in psychology, sociology, biological sciences and the humanities. For example, there is little to no literature linking critical theory to conservation principles, self-care, adaptive modes, interpersonal relationships, goal attainment, transcultural care, nursing as caring, human becoming, unitary human beings, or health as expanding consciousness (Cod), 1998). Without linking aspects of critical social theory to nursing theory and thereby becoming aware of our own biases, privilege, and power, we as nurses can become instruments of oppression in maintaining the status quo. Issues of power and oppression impede the actualization of health potentials. These must be addressed and become integral to any model of Rogerian practice.

Rogers' Nursing Science

There can be no doubt that Martha E. Rogers addressed concerns about societal issues that impede the health potentials of unitary human beings. Rogers expressed her concerns clearly in Chapter 16 of her quintessential work An Introduction to the Theoretical Basis of Nursing. She discussed nursing's "direct and over-riding responsibility" toward "building a healthy society" (Rogers, 1970, p.122). She wrote:
 To maintenance and promotion of
 health must be added prevention
 and correction of health problems
 including those from social inequities,
 technological advances, and
 other events on the public scene.
 Advocates of community health
 point to poor and inadequate
 housing, ghetto areas, racial and occupational
 discrimination, economic
 and educational deprivation, criminal
 acts, suicide rates, drug addiction,
 property destruction, mental
 retardation, and poor and inadequate
 delivery of health services
 as in critical need of public action
 ... To deal with such a wide range
 of seemingly diverse problems as
 those indicated above requires the
 seeing of a pattern, a concept of
 the wholeness of man [sic] and his
 environment, and recognition of escalating,
 dynamic evolution.
 (Rogers, 1970, pp. 123-124)


Reeder (1993), based on conversations with Rogers, stated that early in her life, Rogers recognized how many "people lacked a zest of life because they lived in conditions that oppressed human potential rather than foster its development" (p. 14). Maximizing creative human potential is the substance of health in Rogerian thought; therefore, "all people have creative potential and deserve the conditions of freedom and autonomy that are necessary for creativity to flourish" (Reeder, 1993, p. 14).

In an ethical analysis of Rogers' life and science, Butcher (1999a) highlighted the concerns for human betterment, freedom, openness, responsibility, and justice-creating that are implicit in Rogers' writing and life. Rogers was a powerful social activist. She cried out against social inequities, inadequate housing, racial discrimination, and poor health care in underserved areas and populations. Since the meaning of "critical" in critical theory is to confront injustice (Kincheloe & McLaren, 1994), most certainly Rogers can also be understood as living the values embedded in critical theory. Her humanism and strong sense of egalitarianism evidenced her value of justice-creating for the purpose of human betterment. Arguing from a postmodern perspective that the values of the theorist are inseparable from the theorist's work, Butcher pointed out Rogerian practice models must include "making the cherished values of Rogerian-ethics intentional in mutual process with the environmental field" (Butcher, 1999a, p. 116). Thus, justice-creating needs to be integral to any unitary pattern-based nursing practice.

Reeder (1993) offered additional insight into the connections between Rogerian nursing science and critical theory. She illustrated the congruencies and inconsistencies between the Science of Unitary Human Beings and Habermas's contemporary reconstructionist interpretive critical science. Habermas (1981, 1987) created a new agenda for critical theory by specifying a comprehensive approach of rationalization to formulate a theory of rational communicative action thereby connecting two previously competing systems: the lifeworld and the system. Rationality refers to the way a person acquires and uses knowledge. This in turn is reflected in human actions. Habermas considered communicative action as the means for freeing fife of all forms of unnecessary domination. Life, from this perspective, is based on emancipation and requires both enlightenment and action (Ray, 1992).

Reeder (1993) pointed out that both Habermas and Rogers presented optimistic reconstructive world views that sought emancipation. Rogers fought for the emancipation of nursing from medical dominance, freedom from anti-intellectualism, professionalization of nursing, and for the democratic ideals of human freedom, autonomy and social responsibility. Both Habermas and Rogers provide a constructive, democratic approach to communication in which the individual is viewed as an equal co-participant in a mutual process (Reeder, 1993). Habermas' (1989) idea of reason as communicative action whose goal is "agreement between parties in dialogue that ends in intersubjective mutuality or reciprocal understanding, shared knowledge, mutual trust,, and accord with one another" (p. 12) resonates with Rogers' ideas of mutual process, knowing participation, awareness, and harmony. Reeder (1993) pointed out that both Rogers and Habermas viewed reality as having finite (immanent) and infinite (transcendent) features. Finite reality consists of pattern manifestations which are observable events of the world emerging out of the human-environmental mutual field process in a pandimensional (transcendent) reality. Furthermore, Habermas' notions of locating people in a social and historical context is congruent with Rogers' principle of integrality and illustrates the inseparable nature of human and environmental fields.

Reconceptualizing Aspects of Critical Social Theory within Barrett's Theory of Knowing Participation in Change

While inconsistencies between critical social theory and the Science of Unitary Human Beings exist (Reeder, 1993), the points of coherence provide a path for reformulating aspects of critical theory within a Rogerian nursing science perspective. Issues of gender, race, oppression, classism, sexism, discrimination, and homophobia are pattern manifestations characterizing the human-environmental mutual process. These pattern manifestations may be understood as irreducible human-environmental energetic manifestations characterizing human beings, groups, communities, organizations, or societies. Nurses need to be open to, knowledgeable about, and attend to perceptions and experiences of racism, oppression, classism, sexism, discrimination, and homophobia. These issues may be concerns expressed by individuals, groups and/or communities.

Inconsistencies between Critical Social Theory and Rogerian Science

Barrett's (1989) mid-range nursing theory of power enhancement offers further depth to reconceptualizing aspects of critical theory within a unitary perspective. Barrett (Barrett, Caroselli, Smith & Smith, 1997) contrasted three different views of power and distinguished them from both traditional critical social theory and feminist empowerment models. For example, critical social theory is particulate, mechanistic, and reductionistic. Critical theory is based on predictability and predetermined outcomes. Change is viewed as causal and deterministic. However, within a Rogerian perspective, change is acausal and based on freewill and knowing participation. Barrett's (1989) theory of power as knowing participation in change has inherent unpredictability and therefore no attachment to outcomes (Barrett, Caroselli, Smith & Smith, 1997). However, differences between the theories may be bridged by reconceptualizing aspects of critical social theory within Barrett's unitary science perspective of power.

Power from the Perspective of Rogerian Science

Barrett (1989) conceptualized power within a unitary perspective. She defined power as the capacity to participate in the nature of change characterizing the continuous patterning of human-environmental fields as manifest by awareness, choices, freedom to act intentionality, and involvement in creating changes. Within a unitary perspective, Barrett's theory of power as knowing participation in change was derived directly from Rogers' postulates and principles. From Barrett's perspective, power is a natural, continuous theme in the flow of life experiences and describes how human beings participate with the environment to actualize their potential. Barrett (1983) pointed out that most theories of power are causal and define power as the ability to influence, prevent, or cause change with dominance, force, and hierarchy. Power, within a Rogerian perspective, is being aware of what one is choosing to do, feeling free to do it, doing it intentionally, and being actively involved in the change process. A person's ability to participate knowingly in change varies in situations. Thus the intensity, frequency, and form power manifests varyies. Power is neither inherently good nor evil; however, the form in which power manifests may be viewed as either constructive or destructive depending on one's value perspective (Barrett, 1989). Barrett (1989) stated that her theory does not value different forms of power but instead recognizes differences in manifestations of power.

Power in Critical Social Theory and in Barrett's Power Theory

Power is also a central concept within critical social theory. Approaches to critical theory endeavor to understand how oppression operates within society and how human perception shapes the social world (Boutain, 1999). From a critical theory perspective, oppression is understood as unequal power relations embedded in the basic structures and functions of society (Stevens, 1989). While Barrett's power theory does not view power as causal abilities to influence, prevent, or cause change with dominance or force, power as knowing participation does not necessarily exclude experiences, perceptions, and expressions of oppression. Power as knowing participation in change focuses on how persons experience, perceive, and express power and issues of awareness, choices, freedom to act intentionally, and involvement in creating changes. Awareness, making choices, the freedom to act, and the ability to be involved in change are all inseparable from experiences of oppression. However, oppression conceptualized within a unitary perspective is not solely a "sociological" phenomenon, but an irreducible energetic manifestation characterizing the human-environmental mutual field process. Oppression may be a characteristic of the human/environmental energy mutual process.

Persons experiencing oppression are a concern for nursing since oppressive environmental patterns may be experienced as limiting one's: (a) choices; (b) freedom to act intentionally; (c) involvement in creating changes; and (d) potentialities for the actualization of human betterment and wellbeing. A key difference between critical theory and Rogerian science is that in critical theory an activist may identify and label a system as oppressive and act prescriptively by empowering individuals to change the system. On the other hand, within a Rogerian science perspective, the client is the primary source for verifying pattern information (Cowling, 1997). In addition, agreement occurs within the context of mutual process whereby the nurse and the client discuss options, mutually identify goals, and plan patterning strategies. The nurse works within a mutual process, not prescriptively. Participation in planning, as well as the actual change process, emerge through the mutual process of the client, nurse, and environment.

Critical theory and Barrett's power theory are similar in that both view increasing knowledge and awareness as providing opportunities to facilitate knowing participation in change. Within a critical theory perspective "change is facilitated as individuals develop greater insight into the existing state of affairs (the nature and extent of their exploitation) and are stimulated to act on it" (Guba & Lincoln, 1994, p. 115). The aim of critical inquiry is critique and transformation of the social, political, cultural, economic, ethnic, and gender structures that contain and exploit humankind. Confrontation, conflict, advocacy, and action are key concepts of critical social theory. They may lead to a transformation of oppressive structures.

Barrett's power enhancement nursing model also emphasizes increasing awareness as a means to facilitate change. The nurse does not simply provide information to increase awareness, but rather focuses on eliciting client descriptions, incorporating information concerned with the client's current health situation, and helping the person work through the complexities (Barrett, 1989).

Critical social science must be premised upon the development of practice and research approaches which empower those involved in change (Lather, 1991). Lather's assertion is similar to Barrett's notion of facilitating the actualization of potentials through knowing participation in change by being aware, making choices, feeling free to act on intentions, and orchestrating desired changes. Barrett explained that the objective is not to set goals but rather "to facilitate pattern evolution based on the client's awareness that they have a capacity to participate knowingly in change" (Barrett, 1989, p. 211). Similarly, from a critical perspective, Lather (1991) described empowerment as a "process one undertakes for oneself; it is not something done 'to' or 'for' someone"(p. 4). Therefore, in both Rogerian nursing science and Lather's description of critical theory, involvement in change occurs through increasing awareness and freely acting on one's own choices. On the other hand, critical social theory and Rogerian science differ in the way outcomes unfold. From a critical social theory perspective outcomes may be ascribed to particular causes; however, from a Rogerian perspective, outcomes unfold acausally and unpredictably.

Rogerian Praxis

Rogerian practice models need to include ways to address issues of racism, classism, and sexism in patterning the human-environment field if the goal of human betterment and the actualization of health potentials for all are to be achieved. Since the time of Aristotle, the term "praxis" has referred to activities or actions predominate in a person's ethical and political life (Bernstein, 1971/1999). Praxis involves the process of making theory "practical" and integral with the reality of the practice environment. Thus, praxis models link theory with political and ethical actions through practice and research. In a previous work, Butcher (1999a) synthesized Barrett's (1998) Rogerian practice model with Cowling's (1997) model of pattern appreciation as a means to create a more comprehensive Rogerian practice model. Rogerian-praxis focuses on (a) recognizing manifestations of patterning through pattern manifestation knowing-appreciation; (b) facilitating the client's ability to participate knowingly in change; (c) harmonizing person/environment integrality; and (d) promoting healing potentialities and well-being using noninvasive modalities through voluntary mutual patterning (Butcher, 1999a, 2000). In addition, the Rogerian praxis model incorporates the use of Barrett's power enhancement nursing model and the Rogerian ethics value of justice-creating (Butcher, 1999b) throughout the pattern manifestation knowing-appreciation and voluntary mutual patterning processes to expand awareness of possibilities for change.

All information about the human-environmental field is relevant within the Rogerian praxis model. Therefore, patterns experienced as oppressive are relevant. The patterns include oppressive experiences, perceptions, and expressions of racism, classism, and sexism. Pattern manifestations experienced as oppressive are conceptualized as nonlinear, irreducible, dynamic manifestations of patterning emerging from the human-environmental mutual field process. They may characterize human beings as individuals or as groups, communities, organizations, and/or societies. Using Barrett's (1989) nursing power enhancement model, the nurse addresses the client's concerns by facilitating the client's ability to participate knowingly in change of oppressive environmental field patterns. The nurse, in mutual process with persons, groups, and/or communities, works to mutually design patterning strategies designed to facilitate awareness, choices, freedom to act, and involvement in changing human-environmental field patterns experienced as oppressive. The nurse does not invest in changing the client in a particular direction but rather facilitates and with the client explores options and choices, provides information and resources, so the client can make informed decisions regarding the change process. Thus, clients feel free to choose with awareness how they want to participate in their own change process (Barrett, 1998). Only by mutually participating in changing human-environmental field patterns experienced as oppressing health potentials will nurses be able to fully facilitate the potentialities for well-being and human betterment for all.

Summary and Conclusions

Martha Rogers clearly addressed the need for nursing to take responsibility to deal with the societal issues that impede the unfolding of human health potentials. This column explored how issues of power and oppression addressed in critical theory may be reconceptualized within Rogerian nursing science. Reformulations of reductionistic and causal notions of power from critical theory do fit within Barrett's unitary and acausal conception of power as knowing participation in change. The Rogerian praxis model integrates the ethic of justice-creating with the processes of pattern manifestation, knowing appreciation and voluntary mutual patterning. Rogerian praxis offers a means to facilitate the transformation of perceptions and expressions experienced as oppressive that impede the well-being, human betterment, and health potentials of all.

Endnote: This author acknowledges the assistance of Effie S. Hanchett, RN; PhD at Wayne State University for her editorial contributions.

References

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Howard Karl Butcher, RN;PhD,CS

Assistant Professor

The University of Iowa

College of Nursing

324 Nursing Building

Iowa City, Iowa 52242-1121

Phone (work) 319-335-7039

Fax: 319-335-9990

Email: howard-butcher@uiowa.edu

http://www.nursing.uiowa.edu
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Title Annotation:CONTROVERSIES COLUMN
Author:Butcher, Howard Karl
Publication:Visions: The Journal of Rogerian Nursing Science
Date:Jan 1, 2000
Words:4025
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