Abstract

Centered around the thesis that for those engaged in clinical practice there are two worlds present in parallel, this article defines the characteristics of the supposed second, qualitative world. Contrasting these characteristics to those of the world as seen in continuous metric dimensions of space and time, we derive the nature of the qualitative elements and their coherent interaction, as well as the rules governing these dynamic elements’ interactions. The second world claimed to exist turns out to be made of individual worlds centered in coherent perspectival interaction. Its polycentric agency enacts individual perspectives and mutual information uptake. This hermeneutical approach conforms with some recent developments in theory, such as that of Nobel Prize winner Elinor Ostrom, or the enactment theory of cognitive science. Following this theoretical process, two practical consequences are drawn. The first consists of an advanced model of biopsychosocial interaction, as extensively published throughout the years. The second presents the concept of quality-oriented self-aid groups open to all exposed to or working in care and healthcare. The corresponding training helps practitioners to consciously and deliberately move, perceive, and perform in the duplicity of worlds, the one the conventional quantifying, metric one, the other the mostly rationally unknown world emerging from qualifying interactive agency.

1 Living in two worlds – Theoretical aspects

1.1 Introduction

This article has two aims: to prove that an exclusively metric worldview does not cover the world’s totality and to show that we also live, simultaneously and in a mandatorily perspectival way, in a qualitative world. Through automatized, tacit processing, we combine both disparate worldviews. In medicine and elsewhere, the parallel use of quantifying and qualifying approaches is achieved under the silent premise that they somehow fit to each other and do so based on an identical nature and common inherent logic. However, the logics of the metric and the quality-focused approach differ profoundly, with the main difference concerning use of an interpretative versus a non-interpretative interaction concept, respectively. We manage to suspend this logical split because language, as an internally homogeneous and thus homogenizing tool, effectively conceals the hidden heterogeneity. Use of this homogeneous descriptive system tacitly suggests an overarching homogeneity also of the topics it deals with. In fact, and it is no surprise, qualitative, structure-bound, and structure-enabling interactions need to be described and understood differently. This is because interactive creation of a shared coherent quality is an interpretative, mutually adaptive task. This task may be fulfilled without an explicit will or an anticipating intention, to be judged only ex post, in retrospect. In living beings, tacit anticipation allows for also process-implied intentions contributing to interactions, and in men these intentions may be verbalized and made explicit.

To enable both the specification and the adaptive flexibility of interactions, required to achieve a coherent co-processing, a structure-bound and structure-enabling energy is at work. In the present article, we focus on this type of energy because, to our knowledge, it has been described only in metaphorical terms, not systematically. Also, continuing a path already paved in biology and cognitive science, we systematize the specifics of qualitative and qualifying interactions regarding all levels of dynamic complexity. The bottom-up approach to complexity and its corresponding adaptive systems logic also issues a concept of situationally qualified space and time. This refers to phenomenological concepts such as insideness, place, and placelessness, and a mandatory being-in-the-world.

The roots of biosemiotics can be addressed this way, as also lived bodily experience in the corporeal form of non-metric semantic positions and localizations [1-8]. The space addressed in these approaches is evidently not a metric one, and Edward Relph, complaining that analyses of problems “are so frequently mechanical and abstract, simplifying the world into easily represented structures or models that ignore much of the subtlety and significance of everyday experience,” does not refer to a metric space [1].

Regarding the polycentric nature of a world made of worlds, Elinor Ostrom’s research on the evolution of institutions for collective action, focusing on commons gives useful hints [9-10]. Since our research group’s meetings were hosted by the Heidelberg University chair of philosophy, Reiner Wiehl, follower of the Heidegger scholar Hans Georg Gadamer, there was an intense reference both to Heidegger’s and Gadamer’s philosophy. In relation to the primordially dialogic, mutually interpretative nature of communication, as addressed by Gadamer, we generalized his approach in terms of a formal theory of dynamic information [11-13].

Having detailed the theoretical background of our hermeneutical approach, we turn to the practical consequences of a quality-oriented view of interactions. Addressing them as interpretative and perspectival in principle and as concerning all levels of complexity, we can see situations and biopsychosocial interactions as embedded wholes. This holistic approach affects the way we provide care and healthcare, allowing an explicit implementation of situational and personal perspectives into corresponding interactions. Training in empathic, but not self-denying respect for the uniqueness of others’ worlds is provided in the form of self-aid groups, open to all engaged in and exposed to care and healthcare, regardless of any hierarchical level.