Tuesday, January 22, 2008

Intuition as a justification for ignorance

Homebirth advocates, like most believers in complementary and alternative medicine (CAM), place a great deal of emphasis on intuition. Partly, this is just magical thinking, the fervent belief that wishing can make it so. However, it also serves as an important justification for ignorance.

In Alternative medicine: A psychological perspective, Finnish scientists Marieke Saher and Marjaana Lindeman explore the reliance on intuition in "alternative" health. First the authors describe the difference in the two thinking styles:
... [I]ntuitive thinking is described as an unconscious, fast and effortless style of thinking, making use of such information sources as personal experiences, feelings, concrete images and narratives. Because the information processing is emotional as well as mostly unconscious, intuitive judgments are slow to change. ... [R]ational thinking is characterised by conscious reasoning and mental effort, using all available objective information to come to a true answer, and willingness to adjust conclusions in the light of new facts.
The opposite of intuition is rational thinking. Homebirth advocates, like most advocates of "alternative" health, lack the knowledge base to think analystically about health and disease. They suffer from a fundamental lack of knowledge of science, the scientific method and statistics. Because they cannot participate in a meaningful way in rational scientific discussions, they self servingly discount the value of rational thinking, and substitute intuition in its place. The "beauty" of intution in healthcare is that it allows lay people to believe that they are "experts" in their own health and that they do not need doctors, or other rational thinkers, to advise them.

According to Saher and Lindemann:
... CAM messages favour familiar concepts ("naturalness"), similarity, personal experience and testimonials over abstract concepts like general principles and probabilities ... Moreover, since CAM appeals to an intuitive thinking style, it may be especially attractive to people with a preference for this type of information processing.

... CAM beliefs and its use are not explained, predicted, or influenced by rational thinking and rational health information. Scientific information, which is central to the distinction between conventional and alternative medicine, involves numerical risk information and outcome statistics. Analysis of such material requires rational thinking ... Although delivering rational health information will logically lead to an increase in rational health knowledge, it is likely to co-exist with intuitive knowledge rather than replace it. Actually, the 'alternative' status of CAM treatments alone is a rational message that they are not supported by science. Rationally spoken this can be interpreted as a warning, but for many CAM advocates it seems to come closer to an asset.
Reliance on intuition represents continuity with a pre-rational view of health and illness. Intuition is a more palatable name for the combination of ignorance, superstition and magical thinking that characterized healing among ancient and medieval peoples. The parallel can be extended further. In this model, direct entry midwives are the modern day equivalent of shamans. Instead of offering rational prescriptions for health, they offer supersitions, affirmations, and support in rejecting rationality. They anthropomorphize the process of birth into a "being" that demands fidelity ("trust") and punishes non-believers with bad birth experiences. Like shamans, they offer substances with no efficacy (herbs, homeopathy) and provide friendship and companionship (long prenatal visits) as a substitute for knowledge.

The reliance on intuition is a central defect in homebirth advocacy. It signals, it the clearest possible way, a rejection of rational thinking, knowledge and statistics. Ultimately, it is nothing more than a justification of ignorance.


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