by Margaret A. Newman

Assumptions

The theory of health as expanding consciousness stems from Rogers’ theory of unitary human beings. Rogers’assumptions regarding patterning of persons in interaction with the environment are basic to the view that consciousness is a manifestation of an evolving pattern of person-environment interaction. 

Consciousness is defined as the informational capacity of the system (in this case, the human being); that is, the ability of the system to interact with the environment (Bentov, 1978).  Consciousness includes not only the cognitive and affective awareness normally associated with consciousness, but also the interconnectedness of the entire living system, which includes physiochemical maintenance and growth processes as well as the immune system.  This pattern of information, which is the consciousness of the system, is part of a larger, undivided pattern of an expanding universe.

Rogers’ insistence that health and illness are simply manifestations of the rhythmic fluctuations of the life process is the foundation for viewing health and illness as a unitary process  moving through variations in order-disorder.  From this standpoint, one can no longer think of health and illness in the dichotomous way characterized by medical science; that is, health as absence of disease or health as a continuum from wellness to illness.  Health and the evolving pattern of consciousness are the same. 

A person is identified by her or his pattern, which reflects the pattern of the person within the larger pattern of the environment.  The pattern is evolving through various permutations of order and disorder, including what in everyday language is called health and disease. Pattern recognition emerges from a process of uncovering meaning in a person’s life.  Meaning is inherent in pattern, and vice versa. 

Supporting Theory

David Bohm’s theory of reality as undivided wholeness supports the view of health and illness as a unitary process (Bohm, 1980).  Bohm posits an unseen, underlying pattern (called the implicate order) as the primary order of reality.  All the tangible things of the world are explications of the implicate order.  Disease (and all other observable manifestations of human functioning) can be seen as the explication of the implicate order.  From this perspective, disease is considered a manifestation of the wholeness of the underlying pattern, not a separate entity.  The view of health as the evolving pattern of the whole requires a nonfragmentary world view.  Disease and non-disease are simply different points of view of a much larger reality.  They cannot be separated from the whole, except in a fragmentary way of viewing them. 

The situation that brings a person to the attention of a nurse represents a time in people’s lives when the old rules don’t work anymore, a time when one must make a choice. The task is to learn how things work, to discover the new rules, and to move on to a new level of being and understanding.  Both Gregory Bateson (1979) and Arthur Young (1976) emphasized this task as the purpose of life.  It is the crux of situations in which nursing can assist people in their search for understanding of the evolving pattern of their lives.  A person moves through stages of consciousness involving the loss of freedom in the development of self-identity until a turning point is reached (Young, 1976).  At this time, the things that worked in the past don’t work anymore. What was considered progress is no longer progress.  It is at this stage that the task is to learn the new rules.  There is a realization of self-limitation that precedes the transformation that makes it possible to go beyond oneself in expanding consciousness.  The mutuality of the nurse-client relationship facilitates this insight and transformation.   

The transformation that occurs at the turning point may be understood from the standpoint of Ilya Prigogine’s theory of change (Prigogine, Allen & Herman, 1977).  Prigogine asserts that the usual fluctuations of deterministic processes interact with chance events to bring about a kind of giant fluctuation that propels the system to another, higher level of organization and functioning.  Disorder places a strain on the existing structure and is resisted by the structure. If the force of the fluctutation is great enough, the structure is forced to change and moves through a temporarily chaotic situation to a new higher order.  Transformation takes place as the system moves far from equilibrium.  The action at the critical point of the fluctuation has the potential to go in a number of directions, and it is impossible to know which way it will go.  At some point one direction takes over and a new order is established.  In this new order, new rules apply.   

Movement through the period of disruption, disorganization and uncertainty is facilitated by the presence of a caring other.  Current research documents the importance of a nurse’s supportive partnership with the client in allowing the process of expanding consciousness to unfold.

A Paradigm Shift 

To see health as the pattern of the whole, one needs to see disease not as a separate entity but as a manifestation of the evolving pattern of person-environment interaction.  The paradigm shift is: 

• From treatment of symptoms to a search for pattern.
   
• From viewing disease and disruption as negative to viewing them as part of the self-organizing process of expanding consciousness. 
   
• From viewing the nursing role as addressing the problems of disease to assisting people to get in touch with their own pattern of expanding consciousness.

http://www.healthasexpandingconsciousness.org