Have you ever wondered what really divides the chiropractic profession? For decades the story was that it was the straights vs. the mixers. The straights adhered to the adjustment of the vertebral subluxation only and the mixers added other modalities to chiropractic. The wars between these two factions marked a unique epic in 20th century American history as a conflict between several worldviews.
That story evolved and split over the years. For a time it revolved around educational standards and scope of practice issues. Eventually this schism grew into a spectrum between therapeutic vs. non-therapeutic approaches. Across the middle of the spectrum is where most chiropractors practice.
There is no simple dichotomy anymore, although for many the line ultimately gets drawn at the inclusion of drugs and surgery into chiropractic.(1,2, 3)
And yet, as I have pointed out in other blog posts,[4, 5] the split really comes down to perspectives. There are many ways to discuss this fact such as orienting frameworks, levels of complexity of thinking, values, morals, the list goes on.
For this month’s post, I want to emphasize the importance of distinguishing between the inside and the outside perspectives, especially in relation to the organism. I view this as the heart of the conflicting perspectives within the profession and also a place of common-ground.
This distinction, that the organism may be viewed from the inside and the outside is relatively new in philosophy.[6, 7, 8] American philosopher Ken Wilber has recently codified these two perspectives into his 8 Zone methodology. The zones are created by taking an inside and outside perspective on the four primary domains of reality; subjective (“I”), intersubjective (“we”), objective (“it”), and interobjective (“its”). (I explore how this applies to chiropractic practice, research, and principles in the eight-hour online continuing education course and also in a recent article.)[10, 11]
By acknowledging the inside and outside views of “it,” or the objective observation of the organism, Wilber incorporates the latest insights of neurophysiology and anatomy, as well as systems theory and the new biology. For example, anatomy and physiology are the outside view of the body. These can be measured through visual observation and various tests. The inside view of the organism looks to homeostasis, dynamic equilibrium, autopoiesis, and of course, innate intelligence as it relates directly to these processes of life. The processes may be measured in terms of how well the body expresses its organization and how well it adapts.
There is a long history of this line of thinking in chiropractic. B.J. Palmer originally wrote about how health comes from above downward and from inside outward as the essence of the philosophy of chiropractic. At the heart of this approach is an emphasis on the body’s ability to self-heal and self-organize. This view of the body is shared by most chiropractors.
B.J. contrasted this to the outside inward and below upward approach characteristic of Western medicine. Relying on this view includes an emphasis on materialist and mechanistic paradigms.
By acknowledging the importance of inside and outside views of biology, we can more consciously bridge the divides within the profession by embracing a more holistic framework. This is easy because we already share such a framework.
The outside view is simple enough. It relates to any focus on the structures of the organism; brain, spine, muscles, signs and symptoms, pathological processes, and even vertebral subluxation as a clinical and definable entity. The inside view includes the body’s natural ability to self-organize, self-heal, effectively adapt, and create its own parts. Traditional philosophy of chiropractic refers to this as innate intelligence.
This common ground within the chiropractic profession is a starting place for unity of definition. It is apart from scope of practice questions and definitions of primary care, which are at the heart of the current controversies in chiropractic accreditation standards.[3, 13]
Chiropractic is based not only on an outside view of the body but also on an inside view. This insider view is one defining characteristic of the profession. It sets chiropractic apart from other paradigms of health care.
We should always remember however, in order for chiropractic to rightly be defined as its own paradigm, it must have a defining set of practices, not just its own unique viewpoint. One argument in the profession suggests that the defining praxis is the chiropractic adjustment of the vertebral subluxation.[14, 15] To me, this makes the most sense as it is congruent with the characteristic insider view of the body and consistent with the most common practice of chiropractic, the adjustment.
What if we could all agree that the two most defining characteristics of the chiropractic profession were the two most common aspects to chiropractic worldwide; the insider view of biology and the chiropractic adjustment?
Of course state laws and educational standards will often include more than just the adjustment in terms of scope of practice. Chiropractors love to include other professions within their daily practices from nutrition to acupuncture to physical therapy. But the key to unity is to find where we have common ground. The insider view is the best place to start.
1. Painter, F. Is “Expanded Practice” our Pandora’s Box? September, 13, 2011.
2. Edwards, J. Drugs and Chiropractic: Exposing the red herring and the Trojan horse. Dynamic Chiropractic, 2011. 29(20).
3. Kent, C. The profession formerly known as chiropractic. Dynamic Chiropractic, 2011. 29(10).
4. Senzon, S. Chiropractic Honesty, in Chiropraction. August 27, 2012.
5. Senzon, S. Chiropractic Evolution, in Chiropraction. June 21, 2012.
6. Maturana, H. and F. Varela. Autopoiesis and cognition: The realization of the living. 1980, Dordrecth: D. Reidel Pub. CO.
7. Piaget, J. Biology and knowledge: an essay on the relations between organic regulations and cognitive processes. 1971, Chicago: University of Chicago Press.
8. Thompson, E. Mind in Life: Biology, Phenomenology, and the Sciences of Mind. 2007: Harvard University Press.
9. Wilber, K. The ways we are in this together: Intersubjectivity and interobjectivity. Ken Wilber Online, 2003.
10. Senzon, S. Constructing a philosophy of chiropractic: Integral Map. Online Continuing Education. 2011-present.
11. Senzon, S. Constructing a philosophy of chiropractic I: an Integral map of the territory. J Chiropr Human, 2010. 17(17): p. 6-21.
12. Palmer, B. The known man or an explanation of the “phenomenon of life”; Volume 19. 1936: Davenport, IA: Palmer College.
13. Edwards, J. Primary Care: Be careful what you wish for. Dynamic Chiropractic, 2012. 30(8).
14. Rutherford, L. The role of chiropractic. 1989, Eugene, OR: Health Education Pub. Corp.
15. Gelardi, T. The science of identifying professions as applied to chiropractic. J Chiropr Hum, 1996: p. 11-17.