1. Falk-Rafael, Adeline PhD, RN

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Fawcett's challenge to Chinn's editorial on physiology and holism provides a perfect example of "the problematic allure of binary thinking" identified by Thorne et al.1 Fawcett asserts that a view of holism that allows attention to any dimension of that whole does not fit with the simultaneity paradigm and thus must represent a reductionistic view of holism, i.e., one that is a sum of the parts. I would like to suggest that we move beyond such dichotomous thinking and consider both/and possibilities instead of confining ourselves to the either/or position advocated by Fawcett.


First, I need to begin with the understanding that paradigmatic models, however useful, are human constructions to help us organize the assumptions underpinning prevailing worldviews. As such, they are not infallible, not Truth, not absolute knowledge. This leads to my second point of suggesting that it is time to revisit pattern appraisal as the exclusive method by which human beings can be known in a unitary holistic sense.


I would like to suggest that quantum physics provides a model for a both/and approach to holism. Physicists now widely agree that quantum particles manifest both as wave patterns and as localizable particles with different characteristics from waves; in other words, particles of matter have a dual nature, each of which can be described but together adding to the coherence of the knowledge of the whole.2 The holographic paradigm provides a similar model; according to Bohm, any part of the hologram provides information about the whole, not only one aspect of the whole, albeit that information is lacking in some detail.3


Such developments in quantum physics would suggest to me that the idea that knowledge of the whole can only be known through/vadjust pattern appraisal is inconsistent with the very foundations in physics that gave rise to the concept of unitary human beings. It is also inconsistent with everyday experiences in which we fully accept that the whole is more than and different from a sum of its parts and yet we can recognize, appreciate, and describe those parts: a cake and its ingredients, a symphony and its individual notes and instruments, a rainbow with its seven colors. Perhaps it is time for nursing scholars to consider the idea that knowledge of a dimension of the whole can provide additional detail, giving us a more coherent picture of the whole without worrying about whether such knowledge is consistent with one's endorsement of any particular paradigm. Not doing so places nursing at risk for a perverse form of reductionism in which knowledge of whole human beings is compromised through privileging knowledge gained from pattern appraisal and ignoring or rejecting the additional detail available through examining specific dimensions of that whole human being.


Or, perhaps we have outgrown existing paradigms and discussions such as this mark the emergence of something new.


Adeline Falk-Rafael, PhD, RN


York University




1. Thorne S, Henderson A, McPherson G, Pesut B. The problematic allure of the binary in nursing theoretical discourse. Nurs Philos. 2004;5(3):208-215. [Context Link]


2. Peat FD. Einstein's moon: Bell's theorem and the curious quest for quantum reality. Chicago, Ill: Contemporary Books; 1990. [Context Link]


3. Weber R. The enfolding-unfolding universe: A conversation with David Bohm. In: Wilbur K, ed. The Holographic Paradigm and Other Paradoxes: Exploring the Leading Edge of Science. Boston, Mass: Shambhala; 1985:44-104. [Context Link]