J o u r n a l of Religion and Health, Vol. 22, No. 2, Summer 1983
The Art of Healing and the Many Worlds of Time T O M A S J. S I L B E R A B S T R A C T : This essay is a contribution to the u n d e r s t a n d i n g of the difficulties involved in i n t e g r a t i n g biomedicine and holistic medicine. The phenomenology of the perception of time as described by Mann, Siegler, and Osmond is postulated as underlying the different orientations to the practice of medicine.
History of the division between holistic medicine and biomedicine The expression "holistic medicine" has been recently adopted to encompass a great variety of innovative health care practices ranging from the wellaccepted area of public health to the fringe area of faith healing. This includes topics as variable as hypnosis, the therapeutic use of plants, autogenic training, biofeedback, acupuncture, homeopathic medicine, and many more. ~ Originally the term holism was coined by Smuts as an a t t e m p t to combat analytic reductionism in science. 2 Basically, it meant understanding whole organs and systems as distinct from the sum of their parts. In the 1980's the holistic medicine movement consists both of an approach to the whole person in his or her environment and of a large variety of healing and healthpromoting practices. Although most of these concepts have been an integral part of medicine (Osler's classic admonition was not to confuse the patient with his illness}, a vast array of healing modalities has been neglected or even openly rejected by most Western-trained physicians. 3 In the meantime a mass movement has developed which accepts the concept that the prevention of diseases afflicting the aged, overfed, and sedentary urban population has to come from changes in behavior, diet, and environment. 4 The tradition of this movement is, of course, quite old. Its origins may be traced to the ancient Chinese and Greek civilizations. Confucian philosophy held that in health yang (the masculine} and yin (the feminine) are in balance and harmony2 The disturbance of such equilibrium would be the cause of illness. The pre-Socratic Greeks also thought of man as part of nature2 In the Hippocratic writings the equilibrium among the four humors also resembles the Chinese idea of harmony. 7 Plato went considerably beyond the cosmologic views of the earlier Greek philosophers by postulating the existence of the soulY Thus, he insisted that in health the harmony of the li022-4197 8;I 1.Ilil1-1i105~117.75
105
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soul was as important as the harmony with the universe. Aristotle goes one step further and regards health as synonymous with virtue2 Greek medicine developed a sophisticated pattern in which the earlier E g y p t i a n and Babylonian pharmacopeias were viewed with distrust and more reliance was placed on diet, exercise, and rest. The physician-patient relationship was made a central theme. The physician was considered a demiourgos, public worker. '~ Later on, the Romans, with their practical view of the world, became chiefly oriented to public health and social medicine, as evidenced by the establishment of sewage systems, the establishment of the first hospitals, and the regulation of medical practice. All these currents of thought continue to express themselves poignantly at present in the different expressions of the holistic health movement. Though the early physicians at times made magnificent clinical observations, the origin of scientific medicine might be placed with the work of a French philosopher in the seventeenth century. Descartes separated the nonmaterial, transcendent mind from the material and mechanical operations of the body in order to make the practice of science acceptable to the church." This division brought with it an inevitable consequence: the concentration of science on the s t u d y of the body. By the middle of this century, however, this led to the development of a mechanistic model of medicine with three essential tenets: (1) microscopic pathogens could produce particular diseases and characteristic lesions; (2) vaccines could improve a person's ability to withstand these diseases; and (31 therapeutic agents could destroy germs while sparing their human hosts. During the second half of this century, an army of investigators and clinicians had brought antibiotics to the treatment of infection and insulin to the treatment of diabetes, introduced hemodialysis for the treatment of renal failure, and offered organ transplants, artificial organs, and test-tube babies. In the wake of these changes, it is not surprising that a change also took place in the prevalent view of disease. From time immemorial, disease had been related to guilt and punishment or, perhaps more benignly, with broken harmony. Only in our century was disease best expressed in concise scientific, pathophysiologic, and biochemical terms. Modern medicine thus became synonymous with advanced diagnostic technology that led to sophisticated surgical and pharmacologic interventions and focused heavily on disease processes. This honeymoon with medicine ended, however, some two decades ago, when the faith in the efficacy of the biomedical model began to dwindle and with it medicine's grip on exclusivity. It had become obvious that advantages obtained through antibiotics and other new treatment modalities had less impact on the health of the population of industrialized nations than did socioeconomic advances.'2. In the mid-1960s some of the serious side effects of medications became evident, and new, resistant strains of bacteria were emerging. The happy marriage of science and medicine perhaps came to an end on the day thalidomide produced babies with limb deformities. '3 In the 1970s the cost of medical care rose astronomically, bringing concerns about allocation of resources and equity. 14By then the scene was right for the growth of holistic medicine.
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In summary, the limitations of the current medical s y s t e m alienated many, increased skepticism, and stimulated the proliferation of new healing modalities. Some of these have already been accepted, others are accepted b u t not applied in practice, while still others are met with criticism and even outright rejection by the medical establishment. The fact is that there still remains at present a wide schism between biomedicine and holistic medicine.
A sociological perspective Two sociological theories may be used to explain the persistent division between partisans of biomedicine and holistic medicine: the theory of professional attitude toward groups advocating new therapies and the process of segmenting theory. Changing attitudes toward the acceptance of new medical disciplines have been studied by Rosen, 15 who notes that specialization is a fairly recent phenomenon. Initial opposition is always the rule: "Innovations in medical activity, j u s t as in other forms of human behavior, arouse resentment because they upset established ways of thought and action, and disrupt stable relationships, in short the mores of the group. ''|6 In addition, resistance to changes is particularly strong in difficult and unstable times: "Economic competition was undoubtedly an extremely important, if not a basic factor, in the hostility evidenced by the general practitioner to the appearance and multiplication of specialists. ''1~ Rosen also describes how professional pressure is exerted upon innovators, trying to coerce them to uniformity with the rest of the group. He also looks at the large community context: " . . . i t is apparent that the social climate of opinion within which innovating factors and forces will act will tend to retard or to expedite their operation depending upon whether they are in accord with or in opposition to this climate of opinion. '''s The preceding will indeed sound familiar to those who have been in the struggle to integrate both currents of medicine. The work of Bucher and S t r a u s r 9 also helps to illuminate the complex situations produced b y the development of holistic medicine. These authors state that many different identities, values, and interests m a y be found within a speciality. A natural consequence of this fact is the development of coalitions to further mutual interests. These coalitions are called "segments." Segments tend to take on the character of social movements; that is, they develop a sense of the past and goals for the future: " . . . they organize activities and tactics which will secure an institutional position and implement their distinctive mission."2~ An important characteristic of a segment is to see the same things as problems and to respond to them similarly. This phenomenon has been conceptualized as a "shared fate." When this is recognized, a segment may start a phase of expansion and claim territory. Members of a segment will eventually create associations that represent their interests. Members of a segment then may launch and proclaim "a new mission which expresses the unique contribution that they can make to medical practice. ''2! It is clear, by
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reviewing the development of holistic medicine, that its characteristics fit the process of segmenting theory. S o c i o l o g i c a l e x p l a n a t i o n s c o n t r i b u t e to t h e u n d e r s t a n d i n g of professionalization and the development of different specialties and segments. They do not provide us with the understanding of the reason for the original interest and choice of those who prefer one modality of practice over the others. In the following section I will develop a concept that may prove useful in comprehending this phenomenon. The many worlds of time Mann introduced the idea of the many worlds of time. ~2 Her theory was based on the concept of Umwelt as developed by Von Uexkull. 23 The Umwelt is the experiential world; the temporal-spatial dimension as we experience it. The time-space bubble that constitutes the Umwelt is different for each person, and the intuition of this difference is at the core of the existential anguish. Yet these dimensions are not so unique that classification of human beings according to the style of their temporal-spatial nature becomes impossible. This was precisely Mann's innovation: the description of a human typology based on the relationship of each person to present, past, and future and the personality characteristics that derive from this. Mann and her co-workers observed four basic temporal orientations: to the past, to the time line, to the present, and to the future. Orientation to the past. This corresponds to the feeling type in Mann's typology. For this type "time past becomes time present, and so the present may be perceived as deriving from the past."24 The continuity in life is seen as provided by the relation of past experiences to the present. The perception of time is therefore continuous in this type, and the flow is circular; "the past manifests itself in the present and then is immediately returned to the past as memory. ''25 Because of this, a person may tend to see situations in terms of how the present situation resembles events in his or her own past, rather than to see what is unique about the current situation. Thus, emotions are intensified and in the future recall a sufficient level of feeling will be available to recover the affect that accompanied the original event. The maintenance of relationships is of central importance to the feeling type, and such persons tend to see the events of the world in personal terms. They are prone to attribute sinister motives to others who might actually be quite impersonal in their desire to get things done. The feeling type of person cannot conceive that others may do things in a detached way because of principles (thinking}, because of practicality {sensation}, or simply out of a desire to make things more transcendent {intuition}. When facing difficult times, the feeling type may be unable to cope with disorganization and unpredictability; when empathy and understanding are needed, however, the feeling type is at its best. "To develop a language of the heart rather than of the mind is the goal of
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those with a primary feelings function. To develop those techniques which make memories live and dignify the act of remembrance: these are the essential concerns of past-oriented types. ''~8 Orientation to the time line. This corresponds to the thinking type in Mann's typology. " H e r e the directionality of time is a flowing from the past to the present and into the future. No particular dimension is of central importance; rather it is the flow itself, and the continuity of the process which is the crucial issue."27. The concern of the thinking type is to see a process unfolding to its completion. The past also is important, b u t it is not the personal past of feeling; rather, it is the detached historical past. Thus, issues cannot be understood unless it may be possible to identify how they originated and developed and in what direction they are moving. For this type, no single episode is as significant as the relevance of the moment to the ongoing situation in its totality. At times, this has led to the criticism that the thinking types are detached and unfeeling. This is not true: their concern does not express itself in any particular moment but, instead, is projected in time. "The extent of their joy is directly proportional to the scope of the past, present and future that can be glimpsed in any set of events. ,,28 The strength of this type is their talent to be scientific; that is, their ability to frame hypotheses, draw conclusions, and make predictions. Another remarkable trait of this type is the tendency to live according to principles. "Because they are so continuous, and care so much about continuity and consistency, it becomes necessary for them to behave in a way which guarantees that their actions will fit into some overall theory, and which reduces the likelihood of individual random events being carried out in a way which violates larger considerations."29 The consequence of this is often a time lag between stimulus and response, a certain lack of spontaneity, which, at times of emergencies, often shows this type to be ineffective. On the other hand, in situations that require planning and action based on logic, the thinking type is invaluable. " A r m e d with their theory, thinking types go out to do battle with the world, maintaining their version of reality frequently against heavy odds. ''3~ Orientation to the present. This corresponds to the sensation type in Mann's typology. The name is appropriate, since sensation is a function that is concerned primarily with that which is current and immediate. " I n no other type is the ability to perceive the present moment in all its shadings and ramifications so well developed as in those whose predominant function is sensation."3' Sensation, however, also is a discontinuous function, owing to its weak linkage with the past. As opposed to the thinking and feeling types the sensation types have trouble integrating past experiences into present activities. " E v e n t s are met in terms of their existential realities, with little concern for how they got to be this way. Life is a happening; where it comes from and where it is going is of minor importance; that it exists and can be perceived is paramount. ,,32 This lack of concern with the past or future allows
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this type to concentrate intensely on the present and enables them to be surprisingly effective in dealing with concrete reality. They respond directly to any stimulus and have a remarkable talent for practicality. "The object perceived to the senses at any m o m e n t is all of reality; it is the sensation type version of truth. Its concreteness is respected, its message read, it is accorded the t r e a t m e n t which nature suggests and the skills of the sensation type provide."~3 And indeed, this type desires to influence the environment. Thus, they are skillful in handling tools, materials, and people. Neither theoretical constructions nor sentimental feelings are of any importance to them. Since they are comfortable in dealing with the present, they act upon their perceptions without hesitation, and therefore handle themselves well in crises. But those who always live in the present have little ability to anticipate the future; and, in situations requiring planning, the "sensation t y p e " is at a great disadvantage. This type is the most commonly misunderstood. " I t is of great importance to realize that the sensation type is responding directly to stimuli rather than out of an intellectual commitment or from a predetermined plan, for unless this is understood this type can, and often has been, seen as treacherous and even diabolical. ''34 Orientation to the future. This corresponds to the intuitive type in Mann's typology. Since intuition is the function that relates primarily to the future time dimension, it is the least understood of the Umwelt. Sensation is well understood because present orientation is easy to observe and its products are tangible. Feeling and thinking are likewise clear, since it is easy to tell the difference between actions stemming from emotions and those deriving from logic. None of these is true in the case of intuition. It is difficult to imagine a temporal orientation that places faith in a not-yet-manifested future. However, "for intuitives, it is precisely the future which is first perceived and, to get to the current moment, the intuitive goes backwards from the vision of the future into the other and lesser reality of the present. ''35 Because of his faith in that which others cannot see, the intuitive type often appears to be flighty, impractical, and unrealistic. But the unrealistic quality may be true only if one considers that reality is only what can be touched, heard, or seen, and Mann's typology studies have indicated precisely that there are four realities: the sensation reality of immediacy and concreteness, the thinking reality of process and ideas, the feeling reality of memory and emotions, and the intuitive reality of anticipations and visions. "Within the framework of this latter reality, intuitives are as practical and realistic as the other types are in their special perceptions.'36 Having presented this brief s u m m a r y of Mann's typology, I feel obligated to add that any typology is an abstraction from reality. No person is purely one type, and every human being has a potential for all four functions. In addition, it is important to state that, in typology, it generally can be said that no orientation is good or bad in itself. Each trait or characteristic is advantageous in some situations and detrimental in others. In the discussion that follows, I
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will a t t e m p t to relate the divergent currents that have enriched the world of medicine to the many worlds of time. Discussion
It is not the object of this essay to postulate which approach to the art of healing is more effective, sound, or appropriate. Instead, the purpose is to advance a hypothesis as to why holistic medicine and Western biomedicine continue to struggle with serious differences. The extraordinary triumph of biomedicine is clearly related to its initial success as part of the Western civilization. Western medicine is the embodiment of a rational and scientific world View2 7 The disappearance of smallpox due to immunization, the conquest of previously untreatable infections with antibiotics, and the astounding accomplishments of modern surgery all have contributed to a state of optimism through which many believe that, once a particular offending pathogen is isolated or a particular metabolic error identified, the illness can be cured. For many years, this majority conviction, bolstered by the power and prestige accumulated by the medical profession, pushed dissenters into oblivion, or at best gave them marginal status. Now the pendulum is swinging back. No magic formulas have been found to attack today's health problems: arthritis, hypertension, and cancer. 38 In addition, the benefits of our present health care system are unequally distributed, and the costs are sometimes prohibitive. Our efforts to prevent illness and promote health have not been successful. All these result in a climate of disillusionment that allows previously discarded holistic concepts to re-emerge. The antagonism between organized medicine and other modalities of treatment had its origin in the nineteenth century and has been considered to be primarily owing to particular rigors of the scientific method. Though this m a y be so in some instances, I feel there is a deeper reason for this division: the leaders of each group live in a different world of time. The leaders in the field of biomedicine were deeply committed to a scientific view of the world. They felt at home with the orientation to the time line and thus brought to successful conclusion the work of their early hypothesis, their ability to make predictions--thus, the impact of Virchow's theory of cellular pathology, Koch's postulates, etc. The medicine we practice today in the Western world still reflects this scientific method of thought and relies on the technology it produced. B y contrast, Chinese medicine is based on an orientation to the past. The traditional Chinese concept of health and disease is found to be intimately tied to the philosophical construct of classical Chinese thought. 39 For the Chinese, man is a microcosm in the macrocosm, and both are subject to the same universal law or Tao. Man is a reflection of the universe. The aim of Chinese medicine, therefore, is to help people to live according to the Tao, that is, to follow the "order of nature" and to live in harmony with the "ultimate
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principle." If one does not live according to the Tao, the resulting disharmony will manifest itself in the form of physical or mental illness. Within this context, the terms yin and yang denote twin polarities that regulate both man and the universe. The way in which the Chinese healer works is by following the ancient tradition of yin and yang; and, therefore, he directs the therapy toward the re-establishment of balance and harmony. To the Western-trained physician, these concepts and the devotion of the healers to their past experience, as expressed in the yin and yang meridians in the practice of acupuncture, might seem bewildering. 4~ This could be better understood if these practitioners were viewed as living in the world of time of the past. Finally, a large variety of healing methods appeal to important intuitive responses, as evidenced b y the powers of meditation, relaxation response, and hypnosis. More important than the particular technique is the fact that a holistic approach to medicine is developing in which the patient is seen as an individual person, not as a s y m p t o m or an organism but as part of a system. Believers in the holistic approach are suspicious of the rational orientation that previously had been beyond criticism. This is understandable: our purely scientific orientation has created, or at least failed to prevent, a host of lifethreatening problems such as the energy crisis, pollution, and the population explosion. This is so precisely because our thought processes have not been synthetic and holistic enough to see all possibilities and deal with all realities. The truth is that human functioning, which is synthetic, metaphoric, and intuitive, has been neglected too long. The orientation to the future has indeed a unique vision to offer to the modern physician. This essay would, of course, be too simplistic if it would attribute all different approaches to healing to the time orientation of its members. It is, however, an important factor. To show that this is so, it is simple enough to demonstrate how leaders of one particular field (psychiatry) have diverged on their orientation to time and taken different therapeutic directions. Sigmund Freud, through systematic study and analysis, developed a discipline and a technique that may be considered the paradigm of the linear orientation to time, whereas Carl G u s t a v J u n g approached the concepts of depth psychology and interpretation of dreams with an amazing intuitive approach, and Alfred Adler developed the basic concepts of individual psychology (the struggle for power, for compensation) through his perception of what is manifest in the present and oriented to the present. This example serves to illustrate how, in spite of the existence of different orientations to time, these are all compatible with a quality approach to medical care. Certain orientations to time also seem to cluster and predominate in certain groups at certain times. The approach to the world m a y often even be biologically maintained. Recent discussions on how the brain functions and develops support the theory that the brain is split into two hemispheres, each controlling different functions. '1 The left hemisphere specializes in linear, sequential, and analytic functions (the linear time); and the right hemisphere mode includes simultaneous holistic, spatial, and intuitive operations (the future world of time). Among the practitioners of biomedicine, a v a s t
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representation is probably left-hemisphere functioning. Indeed, all universities choose as their faculty people who demonstrate high-quality left-hemisphere analytical and sequential thought. The history of educational systems confirms that the bias has always been to the left. Left-brain reading is the primary method of teaching and testing. Even standardized intelligence tests are constructed primarily with a linear format geared to a verbal, rather than a visual, content. In short, the scientific approach of biomedicine selects and perpetuates, through its professional socialization, persons best adapted to live in the linear world of time. Perhaps, I will speculate, there is an element of cultural evolution analogous to Darwinian biological evolution, where different orientations to time arose in response to societal needs and environmental changes. Then, by a process of selection, those orientations to time having survival value to a particular society are maintained and strengthened by being associated with social institutions {medical schools, chiropractic schools, etc.). The lesser-needed orientation becomes less significant and may even be eliminated along the way. In this way the historical development of the different approaches to healing and the phenomenon of professionalization make sense: one pushes for change; the other maintains the status quo. There is a balance. The purpose of this discussion is to encourage those involved in the debate on healing to think in terms of the Umwelt of each school of thought and to acknowledge the fact that, indeed, many of us live in different phenomenological worlds that allow for unique perceptions of reality. No single approach is necessarily right or wrong. This could be a first step toward integration of so many contributions that appear at present to be contradictory but that might prove very fruitful in the future.
Summary and conclusion Western civilization has been shaped by a system of thought variously described as rational, mechanistic, and scientific. Medicine has been incorporated into this tradition. Within this world view, the modern medical concept that disease is caused by agents must be followed by a natural corollary: individuals who have become ill as a result of the action of pathogenic agents may be cured through a counterattack against the agent. This view has, however, been challenged by critics who stress alternative pathways to the understanding of disease and to the delivery of medical care. At present, these pathways have converged in a world view and practice known as "holistic medicine." With the proliferation of many unproven ideas and techniques, hostility among a variety of practitioners, apparent incompability among their methods, and a seemingly impassable distance among their theories, confrontation seems inevitable. This article presumes that such need not be the case and postulates a hypothesis on why men have gone in such dramatic and diametrically opposed directions in their attempts to find cures for our afflictions.
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A phenomenological interpretation is advanced based on the concept that all humans perceive the dimension of time predominantly in one of four different orientations. Some types of perception of time may lead more easily to certain types of theories and lend themselves more to the development of certain methods. Conversely, some types of cultures, through their child-rearing style, encourage the predominance of one variety of orientation to time over the other. An explanation of the differences between biomedicine and holistic medicine is intimately related to the many worlds of time. These differences are not merely related to education, specialization, practice, and preference; they are based on utterly fundamental different perceptions of the world. Remarkable, and perhaps irreconcilable, they will continue to highlight the debate surrounding medical, political and bioethical problems. In order to work on the solution of these problems, the recognition of the existence of the many worlds of time and their manifold expression is a crucial step in the understanding of the different attitudes and philosophies subjacent to the various approaches to health care. Once such understanding is achieved, a fruitful synthesis of current knowledge might be facilitated and the best of science and holism may combine to enrich the art of healing.
References 1. Hastings, A.C.; Fadiman, J.; and Gordon, J.S., eds., Health for the Whole Person. Boulder, Colorado, Westview Press, 1980. 2. Smuts, J.C., Holism and Evolution. New York, MacMillan, 1926. 3. Sobel, D.S., ed., Ways of Health: Holistic Approaches to Ancient and Contemporary Medicine. New York, Harcourt, Brace, Jovanovich, 1979. 4. Knowles, J., ed., Doing Better and Feeling Worse: Health in the United States. New York, W.W. Norton, 1977; McKeown, T., The Role of Medicine: Dream, Mirage or Nemesis? London, Rock Carline Fellowship, Nuffield Provincial Hospital Trust, 1976. 5. Veith, I., The Yellow Emperor's Classic of Internal Medicine. Berkeley, University of California Press, 1972. 6. Castiglioni, A., A History of Medicine. New York, Knopf, 1941. 7. Hippocrates, Oeuvres Complbtes. Paris, Baillier Zindal, 1839. 8. Plato, Dialogues. New York, Random House, 1941. 9. Aristotle, Nichomachean Ethics. New York, Random House, 1941. 10. Pellegrino, E.D., Humanism and the Physician. Knoxville, University of Tennessee Press, 1979. 11. Gibson, E., The Unity of Philosophical Experience. New York, Scribner, 1973. 12. Dubos, R., -Mirage of Health. New York, Harper and Row, 1959; IUich, I., Medical Nemesis. New York, Pantheon, 1976. 13. Carlson, R., The End of Medicine. New York, Wiley-Interscience, 1975. 14. Fuchs, V., Who Shall Live. New York, Basic Books, 1975. 15. Rosen, G., "Changing Attitudes of the Medical Profession to Specialization." In Freidson, E., and Lorber, J., eds., Medical Men and Their Work: a Sociologic Reader, Chapter 7. Chicago, Aldine Publishing Co., 1972. 16. Ibid, p. 104. 17. Ibid, p. 107. 18. Ibid, p. 111. 19. Bucher, R., and Strauss, A., "Professions in Process," Amer. J. Sociology, 1961, 66, 325-334. 20. Bucher, R., "Pathology: A Study of Social Movements Within a Profession," Social Problems, 1962, 10, 40-51.
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21. Ibid, p. 51 22. Mann, H.; Siegler, M.; and Osmond, H., "The Many Worlds of Time," J. Analytical Psychology, 1968, 13, 35. 23. Von Uexkull, J., " A Stroll t h r o u g h the Worlds of Animals and Men." In Schiller, C.H., ed., I n s t i n c t i v e Behavior. New York, International Universities Press, 1957. 24. M a n n et al, op. cir., p. 36. 25. Ibid., ~. 37. 26. Ibid. p. 41. 27. Ibid. p. 41. 28. Ibid. p. 41. 29. Ibid. p. 42. 30. Ibid. p. 43. 31. Ibid. p. 45. 32. Ibid. p. 45. 33. Ibid. p. 46. 34. Ibid. p. 46. 35. Ibid. p. 50. 36. Ibid. p. 50. 37. Kuhn, T., The Structure of Scientific Revolutions. Chicago, University of Chicago Press, 1970. 38. La Londe, M., A N e w Perspective on the Health of Canadians. Ottawa, Information Canada, 1975. 39. Robert, M., The Theoretical Foundations of Chinese Medicine. Cambridge, M a s s a c h u s e t t s I n s t i t u t e of Technology Press, 1974. 40. Mann, F., The Meridians of Acupuncture. London, William H e i n e m a n n Medical Books, 1964. 41. Gatewood, T.L., " E x c i t i n g New Directions from Recent Research: Models and Working P r o g r a m s on how the Brain Develops and Functions," Transescence, 1981, 9, 10.
The Art of Healing and the Many Worlds of Time T O M A S J. S I L B E R A B S T R A C T : This essay is a contribution to the u n d e r s t a n d i n g of the difficulties involved in i n t e g r a t i n g biomedicine and holistic medicine. The phenomenology of the perception of time as described by Mann, Siegler, and Osmond is postulated as underlying the different orientations to the practice of medicine.
History of the division between holistic medicine and biomedicine The expression "holistic medicine" has been recently adopted to encompass a great variety of innovative health care practices ranging from the wellaccepted area of public health to the fringe area of faith healing. This includes topics as variable as hypnosis, the therapeutic use of plants, autogenic training, biofeedback, acupuncture, homeopathic medicine, and many more. ~ Originally the term holism was coined by Smuts as an a t t e m p t to combat analytic reductionism in science. 2 Basically, it meant understanding whole organs and systems as distinct from the sum of their parts. In the 1980's the holistic medicine movement consists both of an approach to the whole person in his or her environment and of a large variety of healing and healthpromoting practices. Although most of these concepts have been an integral part of medicine (Osler's classic admonition was not to confuse the patient with his illness}, a vast array of healing modalities has been neglected or even openly rejected by most Western-trained physicians. 3 In the meantime a mass movement has developed which accepts the concept that the prevention of diseases afflicting the aged, overfed, and sedentary urban population has to come from changes in behavior, diet, and environment. 4 The tradition of this movement is, of course, quite old. Its origins may be traced to the ancient Chinese and Greek civilizations. Confucian philosophy held that in health yang (the masculine} and yin (the feminine) are in balance and harmony2 The disturbance of such equilibrium would be the cause of illness. The pre-Socratic Greeks also thought of man as part of nature2 In the Hippocratic writings the equilibrium among the four humors also resembles the Chinese idea of harmony. 7 Plato went considerably beyond the cosmologic views of the earlier Greek philosophers by postulating the existence of the soulY Thus, he insisted that in health the harmony of the li022-4197 8;I 1.Ilil1-1i105~117.75
105
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soul was as important as the harmony with the universe. Aristotle goes one step further and regards health as synonymous with virtue2 Greek medicine developed a sophisticated pattern in which the earlier E g y p t i a n and Babylonian pharmacopeias were viewed with distrust and more reliance was placed on diet, exercise, and rest. The physician-patient relationship was made a central theme. The physician was considered a demiourgos, public worker. '~ Later on, the Romans, with their practical view of the world, became chiefly oriented to public health and social medicine, as evidenced by the establishment of sewage systems, the establishment of the first hospitals, and the regulation of medical practice. All these currents of thought continue to express themselves poignantly at present in the different expressions of the holistic health movement. Though the early physicians at times made magnificent clinical observations, the origin of scientific medicine might be placed with the work of a French philosopher in the seventeenth century. Descartes separated the nonmaterial, transcendent mind from the material and mechanical operations of the body in order to make the practice of science acceptable to the church." This division brought with it an inevitable consequence: the concentration of science on the s t u d y of the body. By the middle of this century, however, this led to the development of a mechanistic model of medicine with three essential tenets: (1) microscopic pathogens could produce particular diseases and characteristic lesions; (2) vaccines could improve a person's ability to withstand these diseases; and (31 therapeutic agents could destroy germs while sparing their human hosts. During the second half of this century, an army of investigators and clinicians had brought antibiotics to the treatment of infection and insulin to the treatment of diabetes, introduced hemodialysis for the treatment of renal failure, and offered organ transplants, artificial organs, and test-tube babies. In the wake of these changes, it is not surprising that a change also took place in the prevalent view of disease. From time immemorial, disease had been related to guilt and punishment or, perhaps more benignly, with broken harmony. Only in our century was disease best expressed in concise scientific, pathophysiologic, and biochemical terms. Modern medicine thus became synonymous with advanced diagnostic technology that led to sophisticated surgical and pharmacologic interventions and focused heavily on disease processes. This honeymoon with medicine ended, however, some two decades ago, when the faith in the efficacy of the biomedical model began to dwindle and with it medicine's grip on exclusivity. It had become obvious that advantages obtained through antibiotics and other new treatment modalities had less impact on the health of the population of industrialized nations than did socioeconomic advances.'2. In the mid-1960s some of the serious side effects of medications became evident, and new, resistant strains of bacteria were emerging. The happy marriage of science and medicine perhaps came to an end on the day thalidomide produced babies with limb deformities. '3 In the 1970s the cost of medical care rose astronomically, bringing concerns about allocation of resources and equity. 14By then the scene was right for the growth of holistic medicine.
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In summary, the limitations of the current medical s y s t e m alienated many, increased skepticism, and stimulated the proliferation of new healing modalities. Some of these have already been accepted, others are accepted b u t not applied in practice, while still others are met with criticism and even outright rejection by the medical establishment. The fact is that there still remains at present a wide schism between biomedicine and holistic medicine.
A sociological perspective Two sociological theories may be used to explain the persistent division between partisans of biomedicine and holistic medicine: the theory of professional attitude toward groups advocating new therapies and the process of segmenting theory. Changing attitudes toward the acceptance of new medical disciplines have been studied by Rosen, 15 who notes that specialization is a fairly recent phenomenon. Initial opposition is always the rule: "Innovations in medical activity, j u s t as in other forms of human behavior, arouse resentment because they upset established ways of thought and action, and disrupt stable relationships, in short the mores of the group. ''|6 In addition, resistance to changes is particularly strong in difficult and unstable times: "Economic competition was undoubtedly an extremely important, if not a basic factor, in the hostility evidenced by the general practitioner to the appearance and multiplication of specialists. ''1~ Rosen also describes how professional pressure is exerted upon innovators, trying to coerce them to uniformity with the rest of the group. He also looks at the large community context: " . . . i t is apparent that the social climate of opinion within which innovating factors and forces will act will tend to retard or to expedite their operation depending upon whether they are in accord with or in opposition to this climate of opinion. '''s The preceding will indeed sound familiar to those who have been in the struggle to integrate both currents of medicine. The work of Bucher and S t r a u s r 9 also helps to illuminate the complex situations produced b y the development of holistic medicine. These authors state that many different identities, values, and interests m a y be found within a speciality. A natural consequence of this fact is the development of coalitions to further mutual interests. These coalitions are called "segments." Segments tend to take on the character of social movements; that is, they develop a sense of the past and goals for the future: " . . . they organize activities and tactics which will secure an institutional position and implement their distinctive mission."2~ An important characteristic of a segment is to see the same things as problems and to respond to them similarly. This phenomenon has been conceptualized as a "shared fate." When this is recognized, a segment may start a phase of expansion and claim territory. Members of a segment will eventually create associations that represent their interests. Members of a segment then may launch and proclaim "a new mission which expresses the unique contribution that they can make to medical practice. ''2! It is clear, by
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reviewing the development of holistic medicine, that its characteristics fit the process of segmenting theory. S o c i o l o g i c a l e x p l a n a t i o n s c o n t r i b u t e to t h e u n d e r s t a n d i n g of professionalization and the development of different specialties and segments. They do not provide us with the understanding of the reason for the original interest and choice of those who prefer one modality of practice over the others. In the following section I will develop a concept that may prove useful in comprehending this phenomenon. The many worlds of time Mann introduced the idea of the many worlds of time. ~2 Her theory was based on the concept of Umwelt as developed by Von Uexkull. 23 The Umwelt is the experiential world; the temporal-spatial dimension as we experience it. The time-space bubble that constitutes the Umwelt is different for each person, and the intuition of this difference is at the core of the existential anguish. Yet these dimensions are not so unique that classification of human beings according to the style of their temporal-spatial nature becomes impossible. This was precisely Mann's innovation: the description of a human typology based on the relationship of each person to present, past, and future and the personality characteristics that derive from this. Mann and her co-workers observed four basic temporal orientations: to the past, to the time line, to the present, and to the future. Orientation to the past. This corresponds to the feeling type in Mann's typology. For this type "time past becomes time present, and so the present may be perceived as deriving from the past."24 The continuity in life is seen as provided by the relation of past experiences to the present. The perception of time is therefore continuous in this type, and the flow is circular; "the past manifests itself in the present and then is immediately returned to the past as memory. ''25 Because of this, a person may tend to see situations in terms of how the present situation resembles events in his or her own past, rather than to see what is unique about the current situation. Thus, emotions are intensified and in the future recall a sufficient level of feeling will be available to recover the affect that accompanied the original event. The maintenance of relationships is of central importance to the feeling type, and such persons tend to see the events of the world in personal terms. They are prone to attribute sinister motives to others who might actually be quite impersonal in their desire to get things done. The feeling type of person cannot conceive that others may do things in a detached way because of principles (thinking}, because of practicality {sensation}, or simply out of a desire to make things more transcendent {intuition}. When facing difficult times, the feeling type may be unable to cope with disorganization and unpredictability; when empathy and understanding are needed, however, the feeling type is at its best. "To develop a language of the heart rather than of the mind is the goal of
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those with a primary feelings function. To develop those techniques which make memories live and dignify the act of remembrance: these are the essential concerns of past-oriented types. ''~8 Orientation to the time line. This corresponds to the thinking type in Mann's typology. " H e r e the directionality of time is a flowing from the past to the present and into the future. No particular dimension is of central importance; rather it is the flow itself, and the continuity of the process which is the crucial issue."27. The concern of the thinking type is to see a process unfolding to its completion. The past also is important, b u t it is not the personal past of feeling; rather, it is the detached historical past. Thus, issues cannot be understood unless it may be possible to identify how they originated and developed and in what direction they are moving. For this type, no single episode is as significant as the relevance of the moment to the ongoing situation in its totality. At times, this has led to the criticism that the thinking types are detached and unfeeling. This is not true: their concern does not express itself in any particular moment but, instead, is projected in time. "The extent of their joy is directly proportional to the scope of the past, present and future that can be glimpsed in any set of events. ,,28 The strength of this type is their talent to be scientific; that is, their ability to frame hypotheses, draw conclusions, and make predictions. Another remarkable trait of this type is the tendency to live according to principles. "Because they are so continuous, and care so much about continuity and consistency, it becomes necessary for them to behave in a way which guarantees that their actions will fit into some overall theory, and which reduces the likelihood of individual random events being carried out in a way which violates larger considerations."29 The consequence of this is often a time lag between stimulus and response, a certain lack of spontaneity, which, at times of emergencies, often shows this type to be ineffective. On the other hand, in situations that require planning and action based on logic, the thinking type is invaluable. " A r m e d with their theory, thinking types go out to do battle with the world, maintaining their version of reality frequently against heavy odds. ''3~ Orientation to the present. This corresponds to the sensation type in Mann's typology. The name is appropriate, since sensation is a function that is concerned primarily with that which is current and immediate. " I n no other type is the ability to perceive the present moment in all its shadings and ramifications so well developed as in those whose predominant function is sensation."3' Sensation, however, also is a discontinuous function, owing to its weak linkage with the past. As opposed to the thinking and feeling types the sensation types have trouble integrating past experiences into present activities. " E v e n t s are met in terms of their existential realities, with little concern for how they got to be this way. Life is a happening; where it comes from and where it is going is of minor importance; that it exists and can be perceived is paramount. ,,32 This lack of concern with the past or future allows
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this type to concentrate intensely on the present and enables them to be surprisingly effective in dealing with concrete reality. They respond directly to any stimulus and have a remarkable talent for practicality. "The object perceived to the senses at any m o m e n t is all of reality; it is the sensation type version of truth. Its concreteness is respected, its message read, it is accorded the t r e a t m e n t which nature suggests and the skills of the sensation type provide."~3 And indeed, this type desires to influence the environment. Thus, they are skillful in handling tools, materials, and people. Neither theoretical constructions nor sentimental feelings are of any importance to them. Since they are comfortable in dealing with the present, they act upon their perceptions without hesitation, and therefore handle themselves well in crises. But those who always live in the present have little ability to anticipate the future; and, in situations requiring planning, the "sensation t y p e " is at a great disadvantage. This type is the most commonly misunderstood. " I t is of great importance to realize that the sensation type is responding directly to stimuli rather than out of an intellectual commitment or from a predetermined plan, for unless this is understood this type can, and often has been, seen as treacherous and even diabolical. ''34 Orientation to the future. This corresponds to the intuitive type in Mann's typology. Since intuition is the function that relates primarily to the future time dimension, it is the least understood of the Umwelt. Sensation is well understood because present orientation is easy to observe and its products are tangible. Feeling and thinking are likewise clear, since it is easy to tell the difference between actions stemming from emotions and those deriving from logic. None of these is true in the case of intuition. It is difficult to imagine a temporal orientation that places faith in a not-yet-manifested future. However, "for intuitives, it is precisely the future which is first perceived and, to get to the current moment, the intuitive goes backwards from the vision of the future into the other and lesser reality of the present. ''35 Because of his faith in that which others cannot see, the intuitive type often appears to be flighty, impractical, and unrealistic. But the unrealistic quality may be true only if one considers that reality is only what can be touched, heard, or seen, and Mann's typology studies have indicated precisely that there are four realities: the sensation reality of immediacy and concreteness, the thinking reality of process and ideas, the feeling reality of memory and emotions, and the intuitive reality of anticipations and visions. "Within the framework of this latter reality, intuitives are as practical and realistic as the other types are in their special perceptions.'36 Having presented this brief s u m m a r y of Mann's typology, I feel obligated to add that any typology is an abstraction from reality. No person is purely one type, and every human being has a potential for all four functions. In addition, it is important to state that, in typology, it generally can be said that no orientation is good or bad in itself. Each trait or characteristic is advantageous in some situations and detrimental in others. In the discussion that follows, I
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will a t t e m p t to relate the divergent currents that have enriched the world of medicine to the many worlds of time. Discussion
It is not the object of this essay to postulate which approach to the art of healing is more effective, sound, or appropriate. Instead, the purpose is to advance a hypothesis as to why holistic medicine and Western biomedicine continue to struggle with serious differences. The extraordinary triumph of biomedicine is clearly related to its initial success as part of the Western civilization. Western medicine is the embodiment of a rational and scientific world View2 7 The disappearance of smallpox due to immunization, the conquest of previously untreatable infections with antibiotics, and the astounding accomplishments of modern surgery all have contributed to a state of optimism through which many believe that, once a particular offending pathogen is isolated or a particular metabolic error identified, the illness can be cured. For many years, this majority conviction, bolstered by the power and prestige accumulated by the medical profession, pushed dissenters into oblivion, or at best gave them marginal status. Now the pendulum is swinging back. No magic formulas have been found to attack today's health problems: arthritis, hypertension, and cancer. 38 In addition, the benefits of our present health care system are unequally distributed, and the costs are sometimes prohibitive. Our efforts to prevent illness and promote health have not been successful. All these result in a climate of disillusionment that allows previously discarded holistic concepts to re-emerge. The antagonism between organized medicine and other modalities of treatment had its origin in the nineteenth century and has been considered to be primarily owing to particular rigors of the scientific method. Though this m a y be so in some instances, I feel there is a deeper reason for this division: the leaders of each group live in a different world of time. The leaders in the field of biomedicine were deeply committed to a scientific view of the world. They felt at home with the orientation to the time line and thus brought to successful conclusion the work of their early hypothesis, their ability to make predictions--thus, the impact of Virchow's theory of cellular pathology, Koch's postulates, etc. The medicine we practice today in the Western world still reflects this scientific method of thought and relies on the technology it produced. B y contrast, Chinese medicine is based on an orientation to the past. The traditional Chinese concept of health and disease is found to be intimately tied to the philosophical construct of classical Chinese thought. 39 For the Chinese, man is a microcosm in the macrocosm, and both are subject to the same universal law or Tao. Man is a reflection of the universe. The aim of Chinese medicine, therefore, is to help people to live according to the Tao, that is, to follow the "order of nature" and to live in harmony with the "ultimate
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principle." If one does not live according to the Tao, the resulting disharmony will manifest itself in the form of physical or mental illness. Within this context, the terms yin and yang denote twin polarities that regulate both man and the universe. The way in which the Chinese healer works is by following the ancient tradition of yin and yang; and, therefore, he directs the therapy toward the re-establishment of balance and harmony. To the Western-trained physician, these concepts and the devotion of the healers to their past experience, as expressed in the yin and yang meridians in the practice of acupuncture, might seem bewildering. 4~ This could be better understood if these practitioners were viewed as living in the world of time of the past. Finally, a large variety of healing methods appeal to important intuitive responses, as evidenced b y the powers of meditation, relaxation response, and hypnosis. More important than the particular technique is the fact that a holistic approach to medicine is developing in which the patient is seen as an individual person, not as a s y m p t o m or an organism but as part of a system. Believers in the holistic approach are suspicious of the rational orientation that previously had been beyond criticism. This is understandable: our purely scientific orientation has created, or at least failed to prevent, a host of lifethreatening problems such as the energy crisis, pollution, and the population explosion. This is so precisely because our thought processes have not been synthetic and holistic enough to see all possibilities and deal with all realities. The truth is that human functioning, which is synthetic, metaphoric, and intuitive, has been neglected too long. The orientation to the future has indeed a unique vision to offer to the modern physician. This essay would, of course, be too simplistic if it would attribute all different approaches to healing to the time orientation of its members. It is, however, an important factor. To show that this is so, it is simple enough to demonstrate how leaders of one particular field (psychiatry) have diverged on their orientation to time and taken different therapeutic directions. Sigmund Freud, through systematic study and analysis, developed a discipline and a technique that may be considered the paradigm of the linear orientation to time, whereas Carl G u s t a v J u n g approached the concepts of depth psychology and interpretation of dreams with an amazing intuitive approach, and Alfred Adler developed the basic concepts of individual psychology (the struggle for power, for compensation) through his perception of what is manifest in the present and oriented to the present. This example serves to illustrate how, in spite of the existence of different orientations to time, these are all compatible with a quality approach to medical care. Certain orientations to time also seem to cluster and predominate in certain groups at certain times. The approach to the world m a y often even be biologically maintained. Recent discussions on how the brain functions and develops support the theory that the brain is split into two hemispheres, each controlling different functions. '1 The left hemisphere specializes in linear, sequential, and analytic functions (the linear time); and the right hemisphere mode includes simultaneous holistic, spatial, and intuitive operations (the future world of time). Among the practitioners of biomedicine, a v a s t
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representation is probably left-hemisphere functioning. Indeed, all universities choose as their faculty people who demonstrate high-quality left-hemisphere analytical and sequential thought. The history of educational systems confirms that the bias has always been to the left. Left-brain reading is the primary method of teaching and testing. Even standardized intelligence tests are constructed primarily with a linear format geared to a verbal, rather than a visual, content. In short, the scientific approach of biomedicine selects and perpetuates, through its professional socialization, persons best adapted to live in the linear world of time. Perhaps, I will speculate, there is an element of cultural evolution analogous to Darwinian biological evolution, where different orientations to time arose in response to societal needs and environmental changes. Then, by a process of selection, those orientations to time having survival value to a particular society are maintained and strengthened by being associated with social institutions {medical schools, chiropractic schools, etc.). The lesser-needed orientation becomes less significant and may even be eliminated along the way. In this way the historical development of the different approaches to healing and the phenomenon of professionalization make sense: one pushes for change; the other maintains the status quo. There is a balance. The purpose of this discussion is to encourage those involved in the debate on healing to think in terms of the Umwelt of each school of thought and to acknowledge the fact that, indeed, many of us live in different phenomenological worlds that allow for unique perceptions of reality. No single approach is necessarily right or wrong. This could be a first step toward integration of so many contributions that appear at present to be contradictory but that might prove very fruitful in the future.
Summary and conclusion Western civilization has been shaped by a system of thought variously described as rational, mechanistic, and scientific. Medicine has been incorporated into this tradition. Within this world view, the modern medical concept that disease is caused by agents must be followed by a natural corollary: individuals who have become ill as a result of the action of pathogenic agents may be cured through a counterattack against the agent. This view has, however, been challenged by critics who stress alternative pathways to the understanding of disease and to the delivery of medical care. At present, these pathways have converged in a world view and practice known as "holistic medicine." With the proliferation of many unproven ideas and techniques, hostility among a variety of practitioners, apparent incompability among their methods, and a seemingly impassable distance among their theories, confrontation seems inevitable. This article presumes that such need not be the case and postulates a hypothesis on why men have gone in such dramatic and diametrically opposed directions in their attempts to find cures for our afflictions.
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A phenomenological interpretation is advanced based on the concept that all humans perceive the dimension of time predominantly in one of four different orientations. Some types of perception of time may lead more easily to certain types of theories and lend themselves more to the development of certain methods. Conversely, some types of cultures, through their child-rearing style, encourage the predominance of one variety of orientation to time over the other. An explanation of the differences between biomedicine and holistic medicine is intimately related to the many worlds of time. These differences are not merely related to education, specialization, practice, and preference; they are based on utterly fundamental different perceptions of the world. Remarkable, and perhaps irreconcilable, they will continue to highlight the debate surrounding medical, political and bioethical problems. In order to work on the solution of these problems, the recognition of the existence of the many worlds of time and their manifold expression is a crucial step in the understanding of the different attitudes and philosophies subjacent to the various approaches to health care. Once such understanding is achieved, a fruitful synthesis of current knowledge might be facilitated and the best of science and holism may combine to enrich the art of healing.
References 1. Hastings, A.C.; Fadiman, J.; and Gordon, J.S., eds., Health for the Whole Person. Boulder, Colorado, Westview Press, 1980. 2. Smuts, J.C., Holism and Evolution. New York, MacMillan, 1926. 3. Sobel, D.S., ed., Ways of Health: Holistic Approaches to Ancient and Contemporary Medicine. New York, Harcourt, Brace, Jovanovich, 1979. 4. Knowles, J., ed., Doing Better and Feeling Worse: Health in the United States. New York, W.W. Norton, 1977; McKeown, T., The Role of Medicine: Dream, Mirage or Nemesis? London, Rock Carline Fellowship, Nuffield Provincial Hospital Trust, 1976. 5. Veith, I., The Yellow Emperor's Classic of Internal Medicine. Berkeley, University of California Press, 1972. 6. Castiglioni, A., A History of Medicine. New York, Knopf, 1941. 7. Hippocrates, Oeuvres Complbtes. Paris, Baillier Zindal, 1839. 8. Plato, Dialogues. New York, Random House, 1941. 9. Aristotle, Nichomachean Ethics. New York, Random House, 1941. 10. Pellegrino, E.D., Humanism and the Physician. Knoxville, University of Tennessee Press, 1979. 11. Gibson, E., The Unity of Philosophical Experience. New York, Scribner, 1973. 12. Dubos, R., -Mirage of Health. New York, Harper and Row, 1959; IUich, I., Medical Nemesis. New York, Pantheon, 1976. 13. Carlson, R., The End of Medicine. New York, Wiley-Interscience, 1975. 14. Fuchs, V., Who Shall Live. New York, Basic Books, 1975. 15. Rosen, G., "Changing Attitudes of the Medical Profession to Specialization." In Freidson, E., and Lorber, J., eds., Medical Men and Their Work: a Sociologic Reader, Chapter 7. Chicago, Aldine Publishing Co., 1972. 16. Ibid, p. 104. 17. Ibid, p. 107. 18. Ibid, p. 111. 19. Bucher, R., and Strauss, A., "Professions in Process," Amer. J. Sociology, 1961, 66, 325-334. 20. Bucher, R., "Pathology: A Study of Social Movements Within a Profession," Social Problems, 1962, 10, 40-51.
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21. Ibid, p. 51 22. Mann, H.; Siegler, M.; and Osmond, H., "The Many Worlds of Time," J. Analytical Psychology, 1968, 13, 35. 23. Von Uexkull, J., " A Stroll t h r o u g h the Worlds of Animals and Men." In Schiller, C.H., ed., I n s t i n c t i v e Behavior. New York, International Universities Press, 1957. 24. M a n n et al, op. cir., p. 36. 25. Ibid., ~. 37. 26. Ibid. p. 41. 27. Ibid. p. 41. 28. Ibid. p. 41. 29. Ibid. p. 42. 30. Ibid. p. 43. 31. Ibid. p. 45. 32. Ibid. p. 45. 33. Ibid. p. 46. 34. Ibid. p. 46. 35. Ibid. p. 50. 36. Ibid. p. 50. 37. Kuhn, T., The Structure of Scientific Revolutions. Chicago, University of Chicago Press, 1970. 38. La Londe, M., A N e w Perspective on the Health of Canadians. Ottawa, Information Canada, 1975. 39. Robert, M., The Theoretical Foundations of Chinese Medicine. Cambridge, M a s s a c h u s e t t s I n s t i t u t e of Technology Press, 1974. 40. Mann, F., The Meridians of Acupuncture. London, William H e i n e m a n n Medical Books, 1964. 41. Gatewood, T.L., " E x c i t i n g New Directions from Recent Research: Models and Working P r o g r a m s on how the Brain Develops and Functions," Transescence, 1981, 9, 10.
