Original article

Therapeutic touch and postmodernism in nursing*

Sarah Glazer
8 Prospect Ave, Larchmont, NY 10538, USA

Abstract Therapeutic touch, a healing technique based upon the laying-on of

hands, has found wide acceptance in the nursing profession despite its
lack of scientific plausibility. Its acceptance is indicative of a broad anti-
scientific trend in nursing. Adherents of this movement use the jargon
of postmodern philosophy to justify their enthusiasm for a variety of
mystically based techniques, citing such postmodern critics of science
as Derrida and Michel Foucault as well as philosophical forerunners
Heidegger and Husserl. Between 1997 and 1999, 94 articles in nursing
journals referred to postmodernism, according to a database search.
This paper criticizes the postmodern movement for abandoning the
biological underpinnings of nursing and for misreading philosophy
in the service of an antiscientific world-view. It is also suggested that
nursing can retain its tradition of ‘caring’ without abandoning the
scientific method.

Keywords: postmodernism, therapeutic touch, Foucault, Heidegger,

Husserl.

In the late 1980s, Linda A. Rosa, a registered nurse
working in Denver, Colorado, was deluged with
brochures promoting courses for nurses in crystal
healing, colour therapy and a technique called ‘thera-
peutic touch’, derived from the laying-on of hands.All
the courses fulfilled the continuing education credits
then required for state relicensure of nurses in Col-
orado, but none appeared to have any scientific basis
(Rosa, 1994).1 Aghast at this antiscientific trend in
nursing, Rosa began to investigate the research and
claims behind therapeutic touch.

Correspondence: Tel.: (914) 834 3345; e-mail: sg@sglazer.com

1
* Originally published in Knowledge & Society 12, 319–341, pub- The Colorado State Board of Nursing accepted the courses for
lished by JAI Press. It is reprinted here with the kind permission continuing education credits. The state board dropped continu-
of the author and JAI Press. ing education requirements for relicensure in January 1994.

196 © Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212


Therapeutic touch is a technique with roots in
Eastern mysticism. Its practitioners claim to heal
people without actually touching them but by
‘smoothing out’ energy fields, which they contend
extend a few inches out from the body. There is no
evidence that such a phenomenon exists, and experts
consider it implausible.2 Rosa’s crusade to expose
what she has described as ‘silly nursing’ (Glazer,
1995a, p. 16). culminated in a widely publicized article
in 1998 in the Journal of the American Medical Asso-
ciation (JAMA). After reviewing hundreds of reports
on the technique, Rosa and her co-authors (Rosa
et al., 1998, p. 1009) concluded, ‘no well-designed
study demonstrates any health benefit from thera-
peutic touch’.
The article also reported the results of Rosa’s
daughter Emily’s fourth grade science project, which
tested whether practitioners of the technique could
actually sense a ‘human energy field’, as they claim.
Emily asked 21 therapeutic touch practitioners to
guess whether she was holding her hand above their
right or left hand. A screen hid Emily’s hand from
the healer’s view to provide blinded conditions. The
healers’ abilities to guess the correct hand (44% of
the time) were slightly worse than random chance.
The article concluded that therapeutic touch claims
‘are groundless and that further use of Therapeutic
Touch by health professionals is unjustified’ (Rosa
et al., 1998, p. 1009).
Yet therapeutic touch continues to be an
entrenched technique in nursing, endorsed at the
highest levels of the profession. Nursing journals
continue to publish articles claiming positive health
effects for therapeutic touch and enthusiastically
encouraging its use with patients (see, for example,
Peters, 1999 and Milton, 1998). The American Nurses’
Association (ANA), the main professional organiza-
tion, responded to Rosa’s JAMA article by publishing
a lead editorial defending therapeutic touch, written
2
In 1994, a committee of professors in nursing, medicine and
psychiatry convened by the University of Colorado Health
Sciences Center concluded, ‘There is virtually no acceptable
scientific evidence concerning the existence or nature of these
energy fields’ (quoted in Glazer, 1995a, p. 16).
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212
Therapeutic Touch and Postmodernism in Nursing 197
by the nurse who introduced therapeutic touch into
the profession. Dolores Krieger (1999, p. 9), profes-
sor emerita of nursing at New York University,
denounced the study as a ‘parlor game’ and said
therapeutic touch had been the target of ‘reactionary
forces whose viewpoints are embedded in materialis-
tic and reductionist philosophies’. The same issue of
the ANA’s official journal ran an enthusiastic article
on ‘healing touch’, a variation of therapeutic touch,
with this come-on headline ‘Take a closer look at one
of the “energetic” therapies. It might just recharge
your practice’ (Hutchinson, 1999, p. 48).
Therapeutic touch is taught at more than 100 col-
leges and universities around the world. It is used
by nurses in at least 80 hospitals in North America.
Proponents claim that at least 43 000 health care pro-
fessionals have been trained in the technique. The
National League for Nursing, the agency that accred-
its nursing schools in the United States, has promoted
the technique through books and videotapes. A past
president, Jean Watson, is a prominent advocate.
The North American Nursing Diagnosis Association
names therapeutic touch as the only appropriate
treatment for a diagnosis it dubs ‘energy field distur-
bance’. It defines energy field disturbance as ‘a dis-
ruption of the flow of energy surrounding a person’s
being which results in disharmony of the body, mind,
and/or spirit’ (NANDA, 1994, p. 1005).
Therapeutic touch is not the only holistic healing
technique adopted by nurses, but it is probably the
most widely recognized and used. A nurse casting
about for a way to fulfil the continuing education
requirements in the state of Michigan in 1996 could
attend workshops that promised to teach her how
to ‘sense angelic presence’, understand ‘the human
aura’ and ‘contact people who has [sic] passed over’
(phenomeNEWS, 1996, p. 28). Workshops in these
techniques carried the approval of the National
League for Nursing.
How have techniques steeped in mysticism gained
such a foothold in the nursing profession? Ironically,
their acceptance has coincided with another move-
ment within the profession toward enhancing the sci-
entific foundation and orientation of nursing practice.
In the early 1990s, organizations like the ANA were
lobbying federal legislators to treat their most highly
198 Sarah Glazer
trained nurses on an equal level with doctors for
reimbursement from federal and private health insur-
ers. Their lobbying effort focused on an elite group of
‘advanced practice nurses’ – nurses who hold master’s
degrees or specialty certification permitting them to
practice as nurse practitioners, certified nurse mid-
wives or certified nurse anaesthetists, among other
specialties. At the time, nursing association leaders
pointed proudly to advanced practice nurses who
operated in solo practices in rural areas and impov-
erished inner-city neighbourhoods. Much like
doctors, these nurses conducted examinations and
doled out prescriptions – with a distant doctor’s tele-
phone authorization. Unlike doctors, they also put a
premium on spending time with patients, listening to
them and providing more patient education. Nurses
with PhDs in academia were also calling attention
to their research using scientific methods as a way
to come up with innovative recommendations for
nursing care distinct from traditional medical studies.
As a health journalist who had written an article in
1992 on nursing’s rising professional status, I was sur-
prised to discover that therapeutic touch had been
embraced by the same mainstream nursing organiza-
tions where I had just been interviewing leaders
(Glazer, 1992). As I researched the bizarre history
and claims of the therapeutic touch movement, its
respectful treatment by nurses seemed even more
puzzling. Proponents cited studies claiming that the
technique could speed growth in plants and healing
in animals. In humans, claims for its benefits ranged
from relieving pain from burns to helping to bring the
dead back to life (Glazer, 1995a, also Rosa et al.,
1998). The founder in the early 1970s of the technique
within nursing, former New York University profes-
sor of nursing Dolores Krieger, drew on Eastern and
Western traditions of mysticism. In her book Thera-
peutic Touch, she acknowledged her debt to Dora
Kunz, a former president of the mystical-religious
Theosophical Society, for deriving the method from
the laying-on of hands. Initially, Krieger described
therapeutic touch’s crucial mechanism as prana, a tra-
ditional Indian concept of ‘life force’. She argued that
the healer manipulated ‘pranic current’ through her
intention to help or heal an ill person (Rosa et al.,
1998, p. 1006).
Early in the movement’s history, however, the
explanation for therapeutic touch shifted to western-
sounding terminology with a physics veneer. Martha
Rogers (1992), dean of nursing at New York Univer-
sity, claimed that humans do not merely possess
energy fields but are energy fields, which constantly
interact with the ‘environmental field’ around them.
She dubbed her approach the ‘Science of Unitary
Human Beings’. Delving into one of her articles on
why therapeutic touch is ‘efficacious’ feels like an
excursion into science fiction coupled with mysticism.
‘The ability to explain precognition, deja vu and
clairvoyance becomes a rational process in pandi-
mensional human and environmental fields’, Rogers
(1992; pp. 27–34) writes of her unitary science per-
spective. ‘Within this science such occurrences
become “normal” rather than “paranormal”.’ The
Science of Unitary Human Beings’ unique perspec-
tive, Rogers claims, legitimates alternative forms of
healing, such as therapeutic touch, which is otherwise
inexplicable using traditional scientific methods.
Rogers’ jumps of logic from one concept to another
are hard to follow, but her general gist is that tradi-
tional science is no longer applicable because, as she
says, ‘Humankind is on the threshold of a new cos-
mology transcending an earthbound past’ (Rogers,
1992, p. 27). In the same article, Rogers predicts that
humans are on the verge of evolving within about
50 years into what she calls ‘Homo Spatialis’ – an
adaptation to space living – and that accelerating evo-
lution explains today’s phenomenon of hyperactivity
in children. In a foreshadowing of more sophisticated
philosophical rationales made by nurses for aban-
doning scientific method, Rogers misuses systems
theory to eliminate causality as a part of her brand of
science. ‘In a universe of open systems’, Rogers writes
‘causality is not an option’ (ibid., p. 30).
As odd and distorting of basic concepts as Rogers’
remarks are, her work continues to be cited respect-
fully today in nursing journal articles on a variety of
subjects, and almost all therapeutic touch discussions
today are based on Rogers’ concepts (Rosa et al.,
p. 1006).
Rogers’ article praising the paranormal was pub-
lished in 1992, the same year that nursing leaders
were positioning themselves as mainstream providers
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212

of health care. In some ways the two movements seem
as far apart as could be, but as I became more famil-
iar with the players in both movements – therapeutic
touch and science-based nursing training – I detected
a common theme. In both movements, nurses were
seeking a professional identity that would distinguish
them from doctors yet provide equal status in a realm
of their own. Indeed, much like nurse practitioners,
nurses trained in therapeutic touch often set them-
selves up in private practice as independent healers.
In both movements, there was a revolt against
doctors’ power in the hospital structure and against
doctors’ perceived disdain for nurses. Nurses in both
arenas argued that doctors neglected patients’ emo-
tional needs, ignored the importance of patients’ feel-
ings in evaluating treatments and undervalued
nurses’ expertise.
The increasingly militant tone of nurses could be
heard in 1992 in nursing organizations’ demands that
they gain authority to write prescriptions and the
right to be reimbursed directly by Medicare, Medic-
aid and private insurance carriers. The American
Medical Association (AMA), representing 300 000 of
the nation’s doctors, publicly opposed giving nurses
such authority, saying they were inadequately trained.
Lucille Joel, then president of the American Nurses’
Association, defiantly disputed the AMA’s view that
doctors were, as she put it, ‘the captain of the ship’.
Joel argued that patients should have ‘access to a
variety of providers’ with the financial freedom to
choose a nurse practitioner over a doctor (Glazer,
1992, pp. 12–15). An increasingly feminist tone could
also be heard in 1991 in the wake of Senate hearings
on sexual harassment charges against Supreme Court
Justice nominee Clarence Thomas. I recall the warm
response from the all-female convention of nursing
school deans when National League for Nursing
President Claire M. Fagin attacked the Senators as
men in power who just ‘didn’t get it’.
Resentment against doctors as a male-dominated
oppressor group, coloured by a strong feminist per-
spective, continues to drive nursing scholars’ argu-
ments that their profession has been insufficiently
appreciated for its unique ‘caring’ approach. Central
to this perspective is the view that nursing is a human-
istic profession and that caring has benefits distinct
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212
Therapeutic Touch and Postmodernism in Nursing 199
from the ‘curing’ mission of doctors. A typical
example of this argument can be found in a 1996
article in the International Journal of Nursing Studies
by Patricia E. B. Valentine, who is on the faculty of
nursing at the University of Alberta, Edmonton,
in Canada. Valentine argues that nursing, as a
female-dominated field, has been a ‘ghettoized’,
demeaned profession because it is associated with
traditional female, domestic values like caring, rather
than skill.
Nursing’s affiliation with domesticity contributed to hospi-
tals becoming symbolic homes where male physicians
became authority figures who generally have been unsup-
portive and often hostile toward increased status for nurses.
In hospitals where the majority of nurses work, a ghetto
culture is supported by both parties. The female (nursing)
world, based strongly on caring is usually invisible to the
male (physician) world based mainly on curing. Even though
nurses and doctors worked side by side . . . physicians rarely
treat nurses as equals but rather remain in the dominant role
with nurses usually acceding . . . to their demands. (Valen-
tine, 1996, p. 104)
What has kept nurses from demanding equality,
according to Valentine, is nurses’ fear of doctors and
their tendency to idealize the medical profession,
both conditions that ‘serve to maintain the oppression
of nurses’ (ibid, p. 105).
The science path
The nursing profession has taken two very different
roads to the goal of separate, equal professional
status. The first road I would describe as the ‘Caring
plus Science’ path. Nurse advocates have argued that
‘caring’ rather than curing is a highly beneficial char-
acteristic of nursing that is often missing from the
cold, increasingly technological world of modern
Western medicine. In fact, they have argued, the
effect of a ‘caring’ nurse on a patient is so powerful
that it can often be an essential part of the ultimate
cure. Depending on who is talking about it, the
concept of ‘caring’ in nursing can range from holding
a patient’s hand by the bedside to giving an expert
massage to administering the right kind of pain relief
medicine. It has also involved research into such
200 Sarah Glazer
issues as how a patient’s sense of self or level of opti-
mism will affect their recovery from surgery.
Nurses in this school of thought have employed tra-
ditional scientific methods and experimental designs
to try to determine what kind of caring is most effec-
tive in helping patients. For example, in 1990, a PhD
nurse, Sandra J. Weiss of the School of Nursing,
University of California, San Francisco, reported that
if nurses gently touched or massaged heart disease
patients in the hospital, their heart rates decelerated
and blood pressure was lowered. By comparison,
simply talking to patients in a sympathetic way had
no effect on heart rate or blood pressure. The finding
is significant because nurses can use the technique to
convert patients’ irregular heart rhythms to regular
heart rhythms without resorting to a drug that can
cause complications of its own.3 The study used a
standard scientific technique, randomly assigning
patients to the different methods of talking, stroking
or touching-plus-talking in varied sequences. In her
analysis of the results, Weiss reflected nurse
researchers’ broad interest in the effect that a com-
passionate atmosphere could have had on the
patients’ responses.
[Patients’] spontaneous verbal responses suggested that
most patients perceived the entire experience as a support-
ive expression of caring that was calming and comforting to
them. They described the nurse as being fully present, avail-
able, attentive and completely focused on their person
rather than the technology surrounding them. (Weiss,
1990, p. 479)
Antiscience path
Yet the promise held out by the movement toward
advanced nursing education – that nurse researchers
would discover through scientific means which
aspects of caring were most effective – was not
entirely fulfilled. True, many PhD dissertations in
nursing have continued to use standard research
methods to investigate such concrete questions as the
benefits of exercise for heart failure patients or
3
Interview by Sarah Glazer with Susan Gortner, December
1999.
whether there are gender differences in the experi-
ence of pain relief (Gortner, 1999).
In another ideological camp, however, nurses with
advanced degrees have essentially become post-
modern nurse theorists, citing an impressive-sounding
array of philosophers as supporting their abandon-
ment of Western science. In article after article in
current issues of nursing journals, these nurses advo-
cate discarding such Western scientific methods of
proof as control groups and substituting an entirely
new paradigm, often dubbed ‘qualitative research’.
Advocates argue that the qualitative approach, which
generally relies entirely on patients’ or nurses’ com-
ments – known as ‘the narrative’ in postmodern
lingo – is better attuned to hearing patients’ needs
and arriving at effective caring than ‘quantitative’
investigation. (See below for a discussion of the
merits of qualitative research in providing a type of
evidence.)
For these nurses, words such as ‘reality’, ‘objective’,
‘evidence-based practice’, ‘quantitative research’, and
even ‘measurement’ have become code words for all
that is evil, patriarchal and insensitive about modern
science and modern medicine. In their place they
have substituted the fashionable phrases of feminism,
postmodern philosophy and hermeneutics: ‘con-
structed reality’, ‘social construction’, ‘lived experi-
ence’ and – to a baffling extent – such terms as
‘phenomenology’ and ‘epistemology’.
Nursing is divided into two warring camps.
Nowhere is that better demonstrated than in a fic-
tional dialogue recently composed by two PhD nurses
from the antiscience faction. The dialogue was pub-
lished October 1999 in Nursing Science Quarterly,
which has become a repository for science bashing
together with some of the profession’s more peculiar
quasi-scientific theories, including that of Rogers. In
the dialogue, a fictitious researcher of the ‘natural
science’ school (read old-fashioned science) attempts
to recruit a fictitious researcher who represents the
‘human science paradigm’, the holistic antiscience
view to which the authors subscribe (Mitchell &
Pilkington, 1999).
At the outset, the ‘human science’ nurse announces
that she cannot possibly collaborate on research with
the ‘natural science’ researcher because their world-
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212

views are so different. As readers, we can tell imme-
diately that the natural science researcher is the
bad guy (girl) because she believes in ‘an objective
reality . . . measurement, control . . . theory testing
and inference making’. The human science researcher
is the good guy, who believes in ‘constructed
reality, mutual process and epistemological notions
of description, pattern, interpretation . . . and par-
ticipation’ (Mitchell & Pilkington, 1999, pp. 283–
284).
The human science researcher views patients’ com-
ments as taking primacy over all other types of
research data. She asserts proudly, ‘I believe that
quality of life is exactly what the person describes it
as being, and I would accept the participants’
accounts as truth’. In contrast, she says accusingly of
old-fashioned science: ‘When you reduce persons to
numerical representations, you strip them of all
meaning’. She bewails the tendency for peer review-
ers (presumably at stodgier journals than Nursing
Science Quarterly) to penalize nurse researchers who
fail to employ standard methods like a hypothesis,
controls or discussions of the reliability and validity
of their methods and data. In a bewildering double
standard, this same nurse admits that she thinks
‘numbers make sense for counting drug reactions in
clinical trials or for evaluating complications linked
to the testing of new equipment or procedures’ (ibid.,
pp. 284, 287, 288).
Just in case there’s any doubt about who wins this
ideological battle, Violet M. Malinski RN PhD, and
associate professor at Hunter-Bellevue School of
Nursing, Hunter College, New York, comments
approvingly that the authors ‘show the flaw in the
argument for evidence-based practice’ (Malinski,
1999, p. 283).
As part of these culture wars, nurse practitioners,
initially regarded within the profession as the peak of
skilled accomplishment, have come in for criticism
from the antiscience camp. Nurse practitioners are in
danger of giving in to ‘the temptation to mimic physi-
cians’ and of becoming too partial to ‘causal bio-
medical thinking’, charges Hunter College RN PhD
Steven L. Baumann (1998, p. 89) in an attack entitled
‘Nursing: The Missing Ingredient in Nurse Practi-
tioner Education’.
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212
Therapeutic Touch and Postmodernism in Nursing 201
By contrast, Baumann praises those nurse practi-
tioners who are not biomedically oriented, who ‘rely
less on diagnostic testing’, and who buy into a world-
view that ‘reveals the limits of reductionistic cause-
effect thinking’. Such nurse practitioners, he argues
approvingly, are more likely to ‘respect alter native
healing modalities and folkways’. From there its a
short leap of faith for Baumann to speak approvingly
of nurse practitioners who integrate therapeutic
touch into their practice (ibid., pp. 89–90).
Postmodern thinking
Nurse-scholars engaged in a war against the medical
establishment and its research methods have devel-
oped increasingly sophisticated-sounding arguments,
marshalling thinkers from philosophy, feminism
and social theory. A review of the nursing literature
in recent years reflects ‘our inclination to adopt a
philosopher of the month’, writes Susan R. Gortner
(1993, p. 482), professor of nursing emerita at the Uni-
versity of California San Francisco and an outspoken
advocate for the importance of scientific evaluation
and biology in nursing. ‘[O]ur first white knight’
according to Gortner, was Thomas Kuhn (1962),
whose studies of accepted scientific theories led him
to conclude that major upheavals or ‘paradigm shifts’
resulted not just from conventional scientific reason-
ing but also from social influences and individual
whims. Nurses of the postmodern cast (Watson, 1995)
have cited Kuhn to support an oversimplified version
of his findings: that there is no benefit from scientific
method and there are no laws of nature to be dis-
covered (Gross & Levitt, 1998).4 (Defenders of
science have since noted that this is a vulgarization
of the ideas put forward by Kuhn, who did indeed
believe that scientific methods have produced
genuine discoveries about the nature of the universe.)
From Kuhn, nurses have moved on to citing such
postmodern critics of science as Jacques Derrida and
Michel Foucault as well as the philosophers who influ-
enced them – Martin Heidegger and Edmund Husserl
4
Gross & Levitt (1998, p. 139) argue that Kuhn is ‘a firm believer
in scientific progress and in the power of science to “solve
puzzles” ’.
202 Sarah Glazer
(Gortner, 1993). Between 1997 and 1999 alone, 94
articles appeared in nursing journals making refer-
ence to postmodernism, typically approvingly
(C I NA H L [ Cumulative Index to Nursing and Allied
Health Literature] ).
In many ways, of course, the trends in nursing
scholarship have mimicked the ‘science wars’ taking
place in academia, in departments of literature, phi-
losophy, women’s studies and the social sciences.
Nurses working towards their PhDs are exposed
through the nursing curriculum as well as through
courses in other departments to the postmodern cri-
tique. In nursing journal articles and PhD theses, that
critique is often boiled down to the simple statement
that all scientific discoveries and science methods,
being socially constructed and largely determined by
the power of an oppressive elite knowledge group, are
of equal value. In many ways, that critique is ready-
made for graduate-degree nurses chafing under the
authority of doctors, resentful that their personal
knowledge of patients’ emotional life is given short
shrift in the medical arena, and seeking an equally
exalted platform to present their findings about the
interaction between a person’s inner life and their
health.
Nurses searching for professional distinctiveness
have plugged into a philosophical tradition that
declares there is no absolute truth – one that they fre-
quently dub the ‘postpositivist’ position. Nurses who
have adopted the relativist view in its most simplistic
form have simply taken it to its natural conclusion: If
science does not represent truth, then anything goes.
‘Anything’ can include therapeutic touch, the Science
of Unitary Human Beings or communicating with
the dead.
The workaday nurse who has learned therapeutic
touch from her nursing supervisor in the hospital has
probably never heard of Foucault, but critics inside
the nursing profession see postmodernism as the
theoretical rationale that keeps therapeutic touch in
vogue. One of the most vocal critics of therapeutic
touch, Dónal P. O’Mathuna, a professor of bioethics
and chemistry at Mt. Carmel College of Nursing,
Columbus, Ohio, calls postmodernism the ‘Trojan
Horse’ that has brought questionable practices like
therapeutic touch ‘to prominence and acceptability
on campuses today’. The postmodern assertion that
scientific method is nothing more than a cultural bias
means that ‘bad research carries as much weight
as properly structured and controlled studies’
(O’Mathuna, 1996, p. 62).
O’Mathuna boils down the postmodern argument
against scientific method in the nursing world to three
basic points. Biochemical medicine is ‘materialistic,
male-dominated and cold’. Alternative medicine is
the product of an oppressed minority culture in the
West. Objective experimental data should be
replaced with personal experience as the basis for
therapy. Because Western science is morally and
philosophically bankrupt, the postmodern nursing
view goes, alternative healing cannot even be evalu-
ated with scientific techniques. Larry Dossey, a pro-
ponent of therapeutic touch, editor of the journal
Alternative Therapies in Health and Medicine and co-
author of Postmodern Nursing and Beyond (Watson
et al., 1999), exemplifies this kind of philosophical
name-calling. Newer alternative therapies, he
asserts, ‘seem to have no possibility even in principle
of being explained in the local, physicalistic, reduc-
tionistic framework’ of modern medicine (Dossey,
1993, p. 44).
The themes of societal oppression (in this case,
doctors’ domination of nurses), scientific relativism
and the inhumanity of modern science echo through-
out a 1995 essay by Jean Watson, a former president
of the National League of Nursing and professor of
nursing at the University of Colorado, a hotbed of
therapeutic touch. Watson (1995, p. 62) sees nursing’s
evolution ‘into its own postmodern paradigm’ as a
way of returning the profession to its historical roots
as a caring profession and turning away from strict
rationalist approaches. Citing Derrida’s and Fou-
cault’s insistence that claims to knowledge are really
claims to power, Watson comes to the essentially
nihilistic conclusion that since ‘there is no one way of
knowing, being, and experiencing reality’ and since
‘the rationalist model does not fit’, essentially any way
of describing reality is as good as any other.
In drawing a contrast to rationalism, Watson’s
language often falls apart into free-flowing poetic
imagery, leaving the reader in a kind of New Age
daze. At the same time, the article could be a glossary
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212

for postmodernism. Watson argues that all knowledge
is constructed, that nursing must move from a ‘strict
rationalist’ view toward the values of ‘ambiguity,
poetic, aesthetic and imaginary’, toward hermeneutics
and finally toward nursing’s ‘most ancient’ healing
knowledge (presumably techniques like therapeutic
touch) in addition to modern skills. In a wholesale
embrace of relativism, Watson writes:
The art and science of nursing with its concern with caring-
healing and health as a field of study, research, and practice
within its own paradigm is realizing that in this postmodern
time, science, knowledge, and even images of nursing, health,
environment, person become one among many truth games.
(Watson, 1995, p. 63)
Foucault’s argument that claims to knowledge by
experts in fields like medicine are actually claims to
power fits perfectly into the view many nurses have
of doctors as pompous bullies who devalue nurses’
bedside experience. In one article criticizing science-
based nursing, the nurse-authors employ Foucault’s
assertion that power relations underlay the claim to
scientific objectivity to attack several nursing text-
books as overly medical. The nursing texts, the
authors complain, provide ‘rules for care based on
human anatomical systems, using scientific “facts” ’
instead of an emphasis on ‘the subjective meanings’
of the patient and the nurse’s practical reasoning
(Cheek & Rudge, 1994, p. 595). The power of scien-
tific discourse, the authors charge, is stifling nurses,
often with their own compliance. ‘Nurses’ ability to
speak about their knowledge is constrained by
dominant practices, such as medical notes, medical
consultation and the consequent silencing and inval-
idation of nursing knowledge within the hospital
setting’ (ibid., p. 586).
Nurses make some good points about the medical
profession’s tendency to overlook the emotional
consequences of medical practice. As a legitimate
example, the authors of this article cite the years of
strident campaigns by cancer specialists for universal
mammograms as the best way to detect and prevent
cancer. Until recently, oncologists gave short shrift to
the subjective but very real trauma of mammograms
to the women themselves: the emotional distress
caused by inordinately high false positive readings,
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212
Therapeutic Touch and Postmodernism in Nursing 203
the sometimes unnecessary biopsies ordered as a
result and unnecessary mastectomies for harmless
lesions that look like cancer in mammograms. These
drawbacks are most pronounced for women under 50,
for whom mammograms are far less reliable than for
older women.
The much higher emotional cost and limited
medical benefits for younger women received official
recognition in 1997, when an expert panel appointed
by the National Institutes of Health found insufficient
evidence to recommend population-wide screening
for women in their 40s (Glazer, 1997).5 Breast self-
examination, a nontechnological approach, may well
be more cost-effective in detecting cancer while
causing less distress to women, the nurse-authors
note. Yet despite recent criticisms by blue ribbon
panels that mammography has been oversold, self-
examinations have not received the same level of
funding or promotional support from the medical
establishment or government agencies.
What the postmodern nurse critics ignore is that
reaching the right answer requires not just compas-
sion for the individual but also scientific rigor. Statis-
tically trained experts, who did not share oncologists’
almost ideological fervour about mammography,
were the first to raise questions about the technique’s
ability to detect cancer accurately. Cancer doctors can
be just as emotional about their patients as nurses, to
such an extent that it blinds them to the data. In the
mammography debate, it has been oncologists and
radiologists, relying on anecdotal memory about the
patients they have ‘saved’ through mammography,
who have been the true believers. Epidemiologists,
who take a skeptical look at the data, have been the
ones noting the modest percentage of lives saved by
mammography and thus putting into greater relief
the emotional disadvantages to women for whom
there is little medical benefit (Glazer, 1997).
5
The National Cancer Institute (NCI) rejected the recommen-
dations of the National Institutes of Health panel. The NCI rec-
ommended in 1997 that women in their 40s have mammograms
every 1–2 years. Critics of this recommendation charged it was
the result of political pressure from members of Congress, rather
than a scientifically based conclusion.
204 Sarah Glazer
In setting science against humanism, nurse-
theorists seem to have forgotten that there is still an
important biological component in nursing. The post-
modern critiques focusing on power relationships,
gender and class ‘are appropriate to contemporary
social science and to nursing in so far as it is a social
science. However, nursing is not exclusively a social
science’, Gortner (1993, p. 486) points out.
It has a biological science component, which it will continue
to incorporate in its disciplinary structure until such time as
it decides to be an exclusively social activity.
Heidegger and Husserl:
why attractive to nurses?
In recent years there has been a proliferation in
nursing journals of research reports embracing a free-
flowing research method that nurses ascribe to the
German philosophers Edmund Husserl (1859–1938)
and his student Martin Heidegger (1889–1976).
Nurses enamoured of these philosophers clearly see
them as a way to legitimize the study of feeling and
emotion over cold-hearted quantification (Draucker,
1999).6 Unravelling why these philosophers are so
attractive to nurses is a complicated task, but recently
a few scholars familiar both with philosophy and
nursing have been able to shed light on the attraction.
Essentially, nurses have read (or misread, critics
would say) both philosophers as hostile to science.
Invoking their names, and adopting their quite
abstract terms about the nature of perception, nurses
have created a simple-minded methodology that
exalts a person’s subjective experience over tradi-
tional methods of ‘objective’ science.
Husserl was the founder of phenomenology, a
method for describing and analysing consciousness.
Husserl’s method strived to resolve the opposition
between empiricism (based on observation) and
rationalism (which stresses reason and theory) by
6
Over 25 research reports claiming to use Heideggerian philos-
ophy were published in nursing journals between 1987 and 1997.
Many reports include references to both Husserl and Heideg-
ger. The notion of applying Heideggerian thought to nursing was
introduced by P. Benner, according to Draucker (1999).
‘indicating the origin of all philosophical and scien-
tific systems and developments of theory in the
interests and structures of the experiential life’
(Encyclopedia Britannica, 1994–99: ‘Edmund
Husserl’, unpaginated).
Nurse researchers have seized on Husserl’s inter-
est in the nature of experience and borrowed Hei-
degger’s term ‘lived experience’ to create a method
that simply asks subjects of research – usually patients
or nurses – about their experience and usually does
little else. Nursing research reports claiming to be
based on Husserl’s phenomenology rely heavily on a
technique known as ‘bracketing’, in which nurses
claim to lay aside their preconceptions about a phe-
nomenon to get at the true ‘essence’ or ‘essential
structures’ of experience.7 While these terms are bor-
rowed from Husserl, they refer to an extremely
abstract form of philosophical thinking. Nurses,
relying on secondary sources for their interpretation
of Husserl, have endowed these terms with definitions
more closely allied to nurses’ notion of subjective
experience. They have used ‘Husserlian phenomenol-
ogy’ to study subjects with highly subjective over-
tones, such as comfort, courage in chronically ill
adolescents, addiction, anorexia and caring (Paley,
1997).
In this exercise, nurses are borrowing from the
fashion for the ‘new hermeneutics’ in the social sci-
ences and humanities. This approach builds on
Husserl’s concepts to provide a framework for dis-
cussing the subjective perspective and humanity’s
tendency to structure the world in ways that reflect
our culture but of which we’re often unaware
(see Routledge Encyclopedia of Philosophy 1998,
p. 575). What makes nursing’s use of hermeneutics
7
It is not clear that Husserl’s use of the term ‘brackets’ means
what nurses say it means when they claim to ‘bracket’ their
biases in research, thus presumably eliminating them. Nurses
have been criticized by John Paley (1997) for misconstruing
Husserl’s concept. In Husserl’s own words ‘We may also radi-
cally leave the natural attitude, put the subjects we were con-
cerned with there in brackets (my emphasis) and instead reflect
on our own consciousness and its structures’ (quoted in Rout-
ledge Encyclopedia of Philosophy 1998, p. 575).
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212

unusual and possibly unique among disciplines is
that it has translated a philosophy into a research
methodology.
This is a bizarre translation of rarified philosophi-
cal thinking. Husserl is describing a philosopher’s
solo, abstract, solipsistic thinking exercise, not a
method of gathering data, argues John Paley (1997),
a principal research fellow at the Institute for Health
Services, University of Luton, UK. Moreover, nurses’
efforts to find ‘essences’ that can be applied generally
to a broad patient population are contradicted by
their own phenomenological technique, which tends
to insist on the uniqueness of each individual’s state-
ment. The dissonance caused by this contradiction
is perhaps the source of too small samples and
extremely poor sampling techniques found in most
such research reports.
Although some nurse studies identify themselves
as Husserlian and colleagues as Heideggerian, in
practice they tend to jumble terms from both philoso-
phers together. For example, both kinds of studies
claim to rely on ‘lived experience’ research, borrow-
ing Heidegger’s term to create a research method that
relies on individual narratives. The titles of so-called
Heideggerian nursing studies give a flavour for the
kind of one-dimensional, uncritical reporting that the
method encourages, seemingly devoid of any skepti-
cal analysis.
For example, a report entitled ‘Relieving pain
through ordinariness in nursing: a phenomenological
account of a comforting nurse–patient encounter’
puts forward as its purpose to describe a nursing
encounter between one nurse and one patient (this
report and others are described in Draucker, 1999).
Judging from summaries of University of Colorado
dissertations, metaphor has been elevated to the level
of scientific insight. In one thesis purporting to
employ ‘phenomenological reduction’, nine paedi-
atric nurses provide descriptions of their experiences
of moral conflict. ‘Two Robert Frost poems were
selected as metaphorical expression of the intelligible
structure’, according to the thesis summary (Kiernan,
1991 summarized in Rosa, Nursing PhD dissertations.
University of Colorado 1988–1992. Unpublished).The
problem with such studies, Paley (1998, p. 822) notes,
is that ‘lived experience’ research ‘becomes a code for
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212
Therapeutic Touch and Postmodernism in Nursing 205
a narrow band of subjectivity that is immune to exter-
nal correction’. Consciousness becomes the only topic
of interest to these researchers, Paley observes, and
reality is no longer of any interest.
If you are a Heideggerian, ‘[y]our data takes the
form of a word or a story or a narrative’, says Gortner.
‘The Heideggerian folks are so committed to their
belief that this is the only way to view reality that its
almost like a religion. It makes them very uncom-
fortable to view investigation in any other form – an
empirical form or a controlled randomized trial.’8
Importing Husserl’s and Heidegger’s abstract
philosophical terminology into nursing research
easily degenerates into a sloppy method for finding
whatever the author wants to find. A hilarious
example is a PhD dissertation submitted to the Uni-
versity of Colorado School of Nursing in 1991.
Through the use of Husserlian phenomenology, the
author tested children’s ability to sense the human
energy field purportedly accessed through therapeu-
tic touch. A handful of interviews with 11 children
aged 3–9 years is presented as ‘a phenomenological
study on children’s lived experiences of perceiving
the human energy field’. The author, Nancey E. M.
France (1993), claims to use Husserl’s method of
‘bracketing’ to set aside her presuppositions.
Yet practically every quote from a child becomes
support for her conclusion that children can feel the
human energy field and that therapeutic touch must
be ‘an innate potential’. Take this statement:
The pre-school children didn’t directly say they saw the
energy. Their experiences influenced me to question the pos-
sibility that they did indeed see it. After receiving thera-
peutic touch, Elizabeth traced her hands with the crayon.
Then she coloured the tracings of her hands purple. When
she finished she said. ‘These are my hands. They feel purple’.
(France, 1993, p. 325)
Believers in therapeutic touch often claim to see
colours as part of the experience, so presumably the
reader is supposed to read this story as evidence that
Elizabeth sensed or ‘saw’ an energy field. Obviously,
skeptics of therapeutic touch could come up with any
8
Interview by Sarah Glazer with Susan Gortner, December
1999.
206 Sarah Glazer
number of explanations for this toddler’s comments,
including simple enjoyment of her purple hands,
besides sensing an energy field.
One can only concur with Paley (1997, p. 187) that
the nursing project of identifying ‘essential structures’
is ‘unintelligible’ and incoherent after reading sen-
tences like this from France’s conclusions:
The essential structures that emerged through the child’s
lived experience are ‘being with’, ‘taking in the world to
know more’ and ‘struggling to make sense of it’. The essen-
tial structures revealed features constant across all the chil-
dren throughout the concomitant diversity, illustrating the
unity and diversity of lived experience recognized through
phenomenology. (France, 1993, pp. 327–328)
Or this:
As I systematically dwelt with the data, I moved beyond the
essential structures to discover the synthesis of unity. The
synthesis of unity is ‘that look’ and is captured within each
child on videotape and affirmed by faculty judges for the
study. . . . That look gave rise to an insight that recognizes
knowing self and knowing other as self but as separate from
self. The essential structures and the synthesis of unity
revealed a ‘knowing’ and ‘being’ reflected in the eyes of the
child. (ibid., pp. 328–329)
Why are nurses falling for this stuff? Perhaps, as
Paley surmises, nurses, having discovered through
philosophers the crucial role of interpretation in
scientific observation, have fixed on the idea that
interpretation is all. According to this world-view,
medicine is forced to treat persons narrowly as
objects, ignoring their social context, whereas nursing
can achieve a holistic perspective, incorporating
subjectivity and social context. The nursing articles
employing the language of phenomenology sound
more sophisticated than Rogers’ and Watson’s spiri-
tual musings – and, one can hardly resist adding, far
more pretentious – but they are essentially employ-
ing fancy code words for the same goal: abandoning
scientific research methods.
Does science persecute women?
The argument that Western science oppresses and
devalues nursing echoes a broader ongoing debate in
academia: Does Science Persecute Women? That is
the title of a thoughtful article by two philosophers,
Karen Green & John Bigelow (1998), which looks at
this contention in light of an oft-cited example, the
European witch hunts of the 16th and 17th Centuries.
As the authors note, the witch-hunts have become a
kind of ‘icon’ for feminists. Feminists and critics of the
scientific method have contended that the hunts were
a campaign by early male believers in science to crush
a witch religion that reigned among women. Some
writers argue the hunts were campaigns by male
doctors to supplant early women healers. Already we
can see the seeds of nursing’s argument that the
modern exemplars of science (doctors) are the per-
secutors of alternative healers (nurses and therapeu-
tic touch practitioners). A relativist strand in some
feminist critiques of science – such as rejections of
‘objectivity’ as a masculine value – together with a
belief that women can rediscover a lost strength
through magic have further contributed to a school of
philosophical thought that ‘rejects science, logic and
reason as masculine’, Green & Bigelow (1998, p. 197)
note.
An influential thinker in this regard has been Paul
Feyerabend, whose 1975 book Against Method
argued that science and the myth of witchcraft shared
rigid ideologies. Feyerabend argued that both scien-
tists and those 15th Century theologians who
believed in witchcraft confirmed their theories ‘on the
basis of observation’, although ignoring facts that
could demolish their beliefs. To Feyerabend, science
is another kind of dogmatism (ibid., p. 197).
Green and Bigelow, however, reject Feyerabend’s
argument. Citing primary sources from witch-hunts,
they argue that ‘acquiring knowledge is not just a
matter of choosing the dogma that suits your interest’
(ibid., p. 198). Rather they do find witch hunters
speaking the rhetoric of early science – arguing that
man can only know things through the help of reason
and observation. Unfortunately, the witch hunters
claimed to detect actual cases of witchcraft through
reason and observation. After all, the witches con-
fessed to their traffic with the devil! Green and
Bigelow also reject the conventional historical
view that persecutions of witches and belief in witch-
craft by the educated ceased with the rise of science.
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212

They show that the mass killings of witches began
during the rise of science in the Renaissance and con-
tinued through the lifetimes of Kepler, Galileo and
Harvey.
What distinguished those who argued against the
witch-hunts was not science, but their exercise of a
valuable human emotion – sympathy, Green and
Bigelow contend. In 1584, Englishman Reginald
Scott, arguing against witch persecution as foreign
‘cruelty’, noted that the witnesses who made the accu-
sations of witchcraft had other motives. They were
envious, impoverished people. He ascribed unforced
confessions by women ‘witches’ to ‘melancholy’
(ibid., pp. 205–206). A Spanish inquisitor named
Salazar turned against the witch-hunts because he
found credible the explanations by so-called witches
that their confessions had been forced from them. In
addition to his careful record keeping, the authors
argue, Salazar exercised sympathy.
It is the exercise of this traditionally ‘feminine’
emotion that in the end made the opponents of witch
hunting more rational than the witch hunters, Green
and Bigelow contend. The witch hunters heard the
same arguments from the accused that their confes-
sions had been coerced, but their interpretation of the
evidence was coloured by their fear of – rather than
sympathy for – people they saw as supremely evil.
Green and Bigelow argue that emotions such as sym-
pathy are cognitive, moral virtues that are part of a
broader and more accurate concept of rationality
than the traditional narrow definition. ‘Our examina-
tion of the men who were involved in the witch-hunts
shows . . . that it was those who were “soft” who got
the facts right’(ibid., p. 204).
How narrow is the scientific method?
Some feminist philosophers sympathetic to Green
and Bigelow’s point of view argue that the scientific
method needs to be broadened explicitly to take into
account affective virtues like sympathy for the objects
of research. Critics have rejoined that the feminists
have failed to come up with any very specific or con-
vincing prescription for how to improve scientific
method to answer their criticisms (Gross & Levitt,
1998). But one could also argue that today’s scientific
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212
Therapeutic Touch and Postmodernism in Nursing 207
method already has the scope to encompass subjec-
tive feelings and social context. Rather it is post-
modern nurses who have taken an overly simplistic,
narrow view of how science is traditionally conducted
in assuming that questions about feelings and subjec-
tive states cannot be tested scientifically.
That is the position eloquently expressed by Schu-
macher & Gortner (1992, p. 5) in an article that seeks
to clear up some of the fuzzy thinking promoted by
the Heideggerian disciples in nursing. ‘One of the
most egregious assumptions about traditional science
is that it constitutes a paradigm that disallows the use
of qualitative data’, they write. ‘There is no philo-
sophical or historical basis for the supposed iden-
tification of traditional science with quantitative
methods.’ In fieldwork, dating back at least as far as
19th Century biology, researchers have talked with
people to elicit their experiences and subjective
meanings. This is science – it is simply the gathering
of another kind of data. The mistake nurses are
making now, according to Schumacher and Gortner,
is in thinking that qualitative research constitutes ‘a
paradigm rather than a type of evidence’.
What the phenomenological nurses seem to have
discarded are two principles crucial to improving
science: causation and generalizability. Both are
important for explaining physiological as well as psy-
chological issues. Without caring about causation,
nurses would not have come to the conclusion that
excessive bed rest after surgery can lead to pneumo-
nia and that consequently getting the patient to start
walking after surgery is an important preventive
measure against postoperative pneumonia, Schu-
macher and Gortner note. Similarly, at the social
plane, the observation that family members caring for
an ill relative get depressed because of the lack of
social support has led to the creation of special
support groups for these caregivers (Schumacher &
Gortner, 1992, p. 7).
Critics of science have attacked science’s search for
universal laws, holding them up as ‘the antithesis
of the contextual historical understanding of human
phenomena that nursing seeks’. But as Schumacher
and Gortner point out, if generalization were not
allowed it would be difficult for clinicians to use the
findings of research beyond that conducted with
208 Sarah Glazer
their own patients (Schumacher & Gortner, 1992,
p. 6).
Ironically, nurses’ attacks on science as a belief in
‘theory-neutral facts’ appears to refer (sometimes
explicitly) to the logical positivists (Routledge Ency-
clopedia of Philosophy 1998, pp. 789–795), who
believed that an understanding of the world could be
built up by the accretion of observations. The posi-
tivists were committed to the existence of a single, a
priori universal scientific method. However that
school of philosophy, led by Rudolf Carnap in the
1920s, began to wane in the 1960s, partly due to the
rise of thinkers like Thomas Kuhn, with his histori-
cal–sociological approach. The description of science
as a monolithic, static entity seems to be employed
primarily as a straw man by nurses seeking to
promote their own alternative approaches. Schu-
macher and Gortner see Karl Popper’s view of
science as closer to the way it is actually conducted.
Popper disputed the traditional view that accumu-
lated observations lead to hypothesis. Rather, Popper
argued that hypotheses come from our ability to
guess and then must be tested against experience.
Popper saw science as a continual process of refine-
ment through the elimination of error as some theo-
ries are found to be false and better theories replace
them. According to this view, science ‘is a rational
endeavour by virtue of its critical attitude, not by the
certainty conferred by the “brute facts”’(Schumacher
& Gortner, 1992, pp. 3–4).
Perhaps nurses have confused the very human ten-
dency of doctors to present ‘brute facts’ as received
wisdom with the process of scientific exploration. If
anything, it’s the biases and prejudices of doctors who
do not follow the scientific method rigorously that
pose dangers. For example, it was widespread practice
among psychiatrists up to the mid 1990s to prescribe
antidepressants to children even though controlled
studies showed the drugs in use were no more effec-
tive than placebos for children. Two psychologists
(Fisher & Fisher, 1996, p. 101) who questioned this
practice in 1996 noted, ‘There has been continued
resistance’ among doctors ‘to adopting a definition of
physician activity that is synonymous with taking a
scientific orientation’. Theirs is one of numerous cri-
tiques bewailing the failures of medical schools to
teach aspiring doctors the basics of experimental
design, statistical significance and skepticism about
anecdotal reports published in medical journals. Only
through the use of control groups and double-blind
trials can consumers of health care overcome the
unjustified enthusiasm of a doctor convinced that
something ‘works’ based on anecdotal evidence from
his own office.
Sophisticated scientists recognize that current
theories of how the world works may not necessarily
be true. Perhaps we’ve missed important data. That
does not mean there is no absolute reality out there
that can eventually be discerned through scientific
method. Just because scientists’ perceptions are
coloured by a social, class, race, gender or time-bound
lens does not preclude their making real discoveries.
When it comes to airplane travel, as the scientist
Richard Dawkins has often been quoted as saying,
‘No one is a social constructionist at 30 000 feet’
(Hacking, 1999, p. 67).
What’s the harm?
That is the question asked by proponents of thera-
peutic touch. Since the publication of Rosa’s article
demolishing therapeutic touch, some leading propo-
nents of the technique have backed away from claim-
ing a basis in physics to saying it’s a nice method of
relaxation. Yet a leading proponent recently con-
cluded that even studies of physiological indicators of
stress ‘provide no real evidence that any effects of
therapeutic touch are significantly greater than
placebo’ (Meehan, 1998, p. 121). (The comparison
group used in controlled tests of therapeutic touch is
usually subjected to ‘mimic’ therapeutic touch, where
nurses imitate the hand movements of therapeutic
touch healers but do not try to ‘feel’ or ‘smooth out’
any energy fields. Studies generally find no difference
between the feelings reported by ‘real’ and ‘mimic’
subjects.)
Critics have long surmised that patient reports of
pain relief from therapeutic touch probably reflect a
placebo effect. Recently, a proponent of therapeutic
touch, Therese C. Meehan of the Department of
Nursing Studies, University College, Dublin, came to
essentially the same conclusion. In a review of con-
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212
 Therapeutic Touch and Postmodernism in Nursing 209

trolled studies, she concluded there is ‘limited and better . . . doesn’t mean they are better or that the problem
inconclusive scientific support for its proposed has resolved. Meehan is asking us to consider elevating
effects’. However she argues that the placebo effect placebos to the status of interventions, which they are not.
is so powerful that it ‘offers nurses a natural oppor- This claim is analogous to saying ‘I’m going to help you by
tunity to better understand and use this phenomenal powerfully letting you think I’m going to help you’. Cer-
function of human interaction to facilitate patient tainly we owe our patients more than that.9
healing and well-being’ (Meehan, 1998, p. 123).
Patients have been offered therapeutic touch in
In reviews of medical treatments overall, it has
place of medical treatment – with disastrous results,
been estimated that in uncontrolled studies where
according to Linda Rosa. In one malpractice case
both patient and doctor believe the treatment being
settled out of court, a male patient entered the hos-
tested will be effective, the placebo could account on
pital to have a liver biopsy. After the operation, he
average for 70% of positive outcomes. Drawing on
complained to a nurse of severe pain, exacerbated
such studies of placebo effectiveness, Meehan sug-
when he lay on his right side, even after receiving the
gests that if patients ask for therapeutic touch, it is
maximum dose of pain medication ordered by the
usually because they believe it will help them and it
doctor. According to Rosa, the location of the com-
is therefore likely to facilitate their recovery. By
plaint should have been an indication to the nurse
extension, she suggests, therapeutic touch could have
that the patient’s gall bladder might have been
a positive effect 70% of the time where the patient,
nicked. The response of the nurse should have been
nurse and doctor all believe in it (Meehan, 1998,
to call in the doctor. Instead, the nurse offered to help
p. 123).
the patient with his pain by calling a practitioner
Yet should nurses intentionally use placebo as a
of ‘healing touch’, a variant of therapeutic touch.
tool? Meehan suggests they should. This is a line of
Apparently it was not a relaxing experience. When
thinking heard increasingly among proponents of
the patient saw the practitioner waving her hands
alternative healing. To bolster her argument, Meehan
above him, he thought he was dying and was receiv-
points out that in 31 double-blind trials of the proven
ing the Last Rites. The doctor was never notified.
ulcer drug cimetidine, the placebo was just as effec-
Three days later the patient returned to the hospital
tive as the active drug 60% of the time.
with an infected bladder, which had to be removed
But this example raises yet more troubling ques-
surgically.10
tions about purposely using a placebo. What would
The danger is that there could be more incidents
happen to the remaining 40% of patients whose
like this if nurses reject their biological training in
gastric distress responded only to the drug, if a nurse
favour of the new paradigm of faith. The thought that
offered them only a placebo like therapeutic touch?
placebos might be imposed on patients is particularly
Meehan’s example ignores the very real physiologi-
scary for a committed rationalist like Alan Sokal
cal effects of the drug, argues Kevin Courcey, a nurse
(1996), the physicist who shook up the academic
at Sacred Heart Medical Center in Eugene, Oregon,
world by publishing a parody of postmodernism. ‘For
who has been an outspoken critic of therapeutic
me nothing would work; I’d just die’, he told me.
touch.
It’s particularly scary when one realizes that the so-
called placebo effect for therapeutic touch only
One does not evaluate a gastric acid inhibitor based simply
occurs in cases of mild problems, such as relatively
on patient report of symptom relief. What you look at is
mild headache pain, according to Meehan (1998). By
whether pH of the stomach has decreased. Saying that a
placebo was ‘just as effective as the active drug 60% of the
9
time’ only looks at patient reports of symptom relief, not E-mail from Kevin Courcey to Sarah Glazer, 5 December
gastric pH reduction, which is the key to ultimately resolv- 1999.
10
ing the problem, which usually is, or will soon be, an ulcer. Interview by Sarah Glazer with Linda Rosa, 22 December
Just because people can make themselves feel somewhat 1999.

© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212

210 Sarah Glazer
contrast, there’s apparently no substitute for drugs
when things get serious. In one study of postoperative
pain reported by Meehan, patients who got thera-
peutic touch experienced only a 13% decrease in pain
compared with the 42% decrease experienced by
patients getting a standard narcotic pain-killer.
Clearly, the power of the placebo effect raises a
wealth of fascinating questions about the mind–body
connection and its effect on health. But the road to
understanding it lies in employing rigorous methods
of exploration. The federal government has financed
grants to study the effects of relaxation methods
like biofeedback, meditation and massage on a wide
variety of symptoms from pain to nausea. Some
studies suggest that massage reduces stress hormones,
which may supply a Western physiological explana-
tion for the out-of-body sensation that people who
have massage experience (Glazer, 1995b). A sense of
well being can have startling impact on the prognosis
of people with fatal illnesses. Science philosopher Ian
Hacking (1999) cites the dramatic improvement in
prognosis among a large sample of breast cancer
patients who participated in support groups, experi-
encing 18 more months of life on average than
patients who were resigned, depressed and did not
make efforts to improve their mood.
So the placebo effect may tell us a great deal about
humans’ need for compassion and personal contact
and its ultimate effect on their health. But why should
patients be subjected to the hocus-pocus of a nurse-
believer in energy fields if they can benefit even more
from massage or feel just as good if a nurse sits and
talks to them compassionately?
Ironically, proponents of therapeutic touch initially
tried to justify their technique by supplying Western
science explanations: energy fields that they claimed
were drawn from quantum physics (Meehan, 1998,
p. 118). As a postmodernist might say, nurses have
attempted to invoke the ‘elite knowledge system’
of science. When that didn’t work, some of them
shifted to yet another elite knowledge system:
postmodern philosophy. They’ve managed to avoid
much serious challenge by invoking an obscure
vocabulary that even philosophers have difficulty
understanding and that intimidates or baffles almost
everyone else.
Already there are suggestions that nurses drawn to
therapeutic touch may be falling back to yet another
kind of justification – religion, the original basis for
the technique. Meehan’s latest article on therapeutic
touch respectfully cites recent correspondence with
Doris Kunz, therapeutic touch’s theosophist origina-
tor, in noting ‘particular religious backgrounds can be
drawn upon, naturally, to help practitioners facilitate
their ability to practice therapeutic touch effectively’
(Meehan, 1998, p. 119).
In a recent editorial, the president of the Emer-
gency Nurses Association encouraged nurses to use
prayer with their patients. The editorial led a special
issue on alternative healing in the Journal of Emer-
gency Medicine (Manton, 1998). Another article
aimed at emergency nurses recommends prayer as
one of several complementary therapies, including
therapeutic touch, as beneficial for treating pain
(Milton, 1998).
It should be possible to rely on serious science and
proven medicine at the same time as providing true
caring, as nurses like Gortner have argued. But
presenting religion and dogmatic belief systems as
science – a temptation nurses have a hard time
resisting, judging from recent articles – can be haz-
ardous to clear thinking as well as to an individual’s
health.
It is intriguing to consider that the historical–
social–gender conditions that gave rise to therapeutic
touch in nursing are beginning to fade away. Could it
be that nursing’s professional leaders took this antag-
onistic path to Western medicine, employing Foucault
and others as their weapons, because their generation
of women by and large could not become doctors?
Now that women can make the choice between
nursing and doctoring, women are invading medical
schools, constituting at least half the new doctors in
specialties such as paediatrics. Will women doctors
bring the traditionally feminine values of compassion
and caring to medicine, blurring some of the distinc-
tions that nurse-theorists have been so anxious to
claim? Will the presence of men in nursing, admit-
tedly in much smaller numbers, make a difference in
the sense of oppression experienced by that tradi-
tionally female profession? In today’s highly pres-
sured hospital world, where nurse staffing has been
© Blackwell Science Ltd 2001 Nursing Philosophy, 2, pp. 196–212

severely cut back and everyone feels the cost-cutting
pressures of managed care, some nurses say, there’s
little time for the power plays of old. They describe
the atmosphere as being more like a military
M.A.S.H. unit, with every doctor and nurse pitching
in desperately to keep patients alive, regardless of
status. It remains to be seen whether the noble vision
of providing compassionate nursing care with a sci-
entific base can be realized in today’s rapidly chang-
ing health care world.
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