A number of people (including, notably Seth Godin) have pointed out out that one of the behaviors humanity has exhibited throughout its history is the hunger to connect with others we share something with: a tribe we can feel part of. ‘Tribes’ can be based on criteria of inclusion (“We all LOVE it when the Village People sing ‘YMCA’!”) or on criteria of exclusion (“No one wearing a purple hat is welcome here”). The former embraces diversity, while the latter requires uniformity. Each brings its own benefits and challenges; there is a vibrancy and uncertainty possible in an inclusive tribe, and safety and predictability are possible in an exclusive tribe. Inclusive tribes promote vitality, because it’s an opportunity for collective contributions. Everyone is potentially able to contribute or model things others do not have, but may benefit from. In contrast, exclusive tribes become echo chambers, where heterogeneity ultimately cannot be tolerated.
What’s the relevance of this for chiropractic? What’s relevant is that we’re becoming more and more a set of exclusive tribes–exclusive of others in the profession. And we do not seem to be interested in the damage this will cause.
Evidence of a profound present-time cultural shift towards smaller, exclusive tribes can be seen in nearly any direction we look, on nearly any issue. Polarization is becoming expected, the new normal. One of the most obvious and potentially toxic examples of dysfunction is Congress, but the comfort of smaller and smaller tribes is a strong driver at many other levels of our social order. Polarization has not just become an outcome but also a tactic, used intentionally to define tribes and make them stronger. With smaller, more exclusive tribes we can identify more and more with others based on what we agree we dislike (exclude) rather than what we agree we like (include). And perhaps the most subtly damaging effect of this is that when we create polarization using an appeal to emotion, we too often stop thinking in the process. The more emotionally based our decisions about our tribes become, the smaller and smaller the tribes get, because the spectrum of what can be tolerated grows shorter and shorter.
I’m not sure why we’ve stopped being interested in being around people who are different but with whom we share something, but I think it’s toxic to our culture. Whatever is advancing this dynamic is deeply woven into something that spans the globe, because it’s evident everywhere. I can imagine the continuation of a culture (professional or social) that embraces diversity, establishes appropriate boundaries and limits on behaviors and actions, because that is a culture that is dynamic and will evolve over time. What will it look like a few years ahead? No one knows. But the journey to get to the future will at least embrace the vibrancy of multiple sources of contributions, development and expression.
On the other hand, I have trouble imagining the continuation of a culture that shuns those opportunities, and demands the safety and comfort of homogeneity. Smaller tribes grow more exclusive, and that’s dangerous; in nature, homogeneity creates conditions for extinction. Where homogeneity affects physical reproduction, the quality of individuals’ DNA degrades until life simply isn’t viable. Survival requires diversity. I believe there’s an intellectual and emotional corollary: in cultures with forced homogeneity growth and development stop, because by definition and nature things that threaten that homogeneous identity must be rejected and excluded. The hunger for safety trumps growth.
But these perspectives are based on values, and reasonable people can hold different sets of values. If I believe I’m basically good the way I am, I have no need of new information to help me grow. If I believe I can and should grow through new experiences, information and exposure to people and ideas, then I need those things available to me. Is either value set right, and the other wrong? That’s hard to say. But there are some outcomes of applying each of those values that may or may not be what we want. What choices are we making in chiropractic?
Chiropractic has had two main tribes for most of its history, and that schism persists in basically the same form to this present day. As in any case where tribes compete for territory–geographic, economic, statutory, or whatever–there has been friction. Some of that friction has been, is and will be pretty profound and divisive. But overall, the profession has held together based on what most could agree was important to include in its identity, beliefs and practices. The core was essentially homogeneous; diversity occurred outside that core–but it was connected to that core.
That cultural ‘gravity’ that held this together was driven by leaders who viewed themselves as stewards of the profession, and that sense of responsibility conferred an understanding that maintaining the profession as an entire community–however diverse–was more important than the option of splitting and creating two misaligned tribes. But it seems that we’ve stopped generating a class of leaders who feel that collective responsibility, and consequently the cultural force that has held us together has weakened. It sometimes appears as if it’s even being intentionally dismantled. For reasons it views as intrinsically valid, a portion of the profession is committed to expanding its legal scope and adopting new skills and abilities in the treatment of spinal and related disorders. Another portion that subscribes to views also held as intrinsically valid is equally committed to preventing expansion of its legal scope, and rejects those new skills and abilities, preferring to continue its focus on a philosophic and clinical paradigm more consistent with the profession’s origins.
Is one right, and the other wrong? I think that’s the wrong question to ask. I think a far more important question is whether or not the positions these factions–these tribes–are taking are going to lead to a stronger or weaker culture (profession). Each tribe has problems with the other. But because both tribes’ commitment to maintaining shared elements of professional identity is weakening, a split is inevitable unless that dynamic is reversed.
What’s really the harm, some will ask, if chiropractic becomes two professions? Let the one go off and get additional training, work more like allopaths, prescribe drugs, carve out a stronger niche role in the system, and let the other work to maintain the purity of its historical, clinical and philosophic focus. We can be neighbors, some argue, even if we can’t be friends.
One way of viewing that question is to ask whether we think of the profession as a single host or as a marriage. If it’s a single host, then a split is fatal, because there are systems that can’t be divided. If it’s a marriage, though, then partners in the relationship need to define the degree of diversity that can be tolerated while still preserving the marriage, and the internal systems that support both. Responsibilities increase in a marriage: diversity can lead to divorce if what’s held in common isn’t maintained, nourished, and developed.
Another way of viewing the question is to ask what the marketplace wants. Anyone who tells you they know the answer to this one is making it up, because the question hasn’t been put to the marketplace in any systematic way. In place of that knowledge, what’s really driving the positions of the providers are the positions of the providers. Those closer to the allopathic practices side of the marketplace view a more fuller development of that role and position as self-evidently valuable. Anyone else in that position must agree; anyone who doesn’t occupy that position may find it confusing and destructive, and their protests are discarded as irrelevant or misguided.
In similar fashion, those closer to the historical, core identity that emphasized distinction from allopathic medicine will view a more fuller development of that role and position in relation to the marketplace as self-evidently valuable. As above, those on the other end of the clinical and philosophic spectrum will view this position as confusing and destructive, and others’ protests misguided and irrelevant.
What I’d like to submit is that there’s a cultural dynamic at work here, the same cultural dynamic that is fostering, emphasizing, using and even requiring polarization as a tactic across many strata of our society and other cultures. There’s an end game at work, I suspect, and depending on your cosmologies and beliefs you can either personify that end game or not. But the polarization to chiropractic is certainly not unique, so the end game within the profession is probably also not unique as well. On some probably very deep level, we’re being played.
I’d like to see us challenge ourselves to ask if the outcome of seeking the comfort and safety of polarized, smaller tribes is really what we want to create. I have trouble seeing anything but a corrosive, toxic split, one that will ultimately either kill the profession or drive it into a set of directions we may not recognize.
Worse, I think this whole thing is unnecessary. I don’t think we understand how close we actually are to winning the struggle we’ve been in for acceptance and inclusion. The terms of engagement certainly need to be redefined, but anyone who’s tracking what’s going on in integrative medicine will tell you that medicine is redefining itself, and all of medicine is going to change. It’ll take one or two more generations, but medicine, interestingly, wants to look, act and feel more like us. Do we really want to look, act and feel more like them? Especially the version of them that they are leaving behind?
It’s our choice. And it’s one we’re making daily. Just as we tell our patients: choose wholeness or choose disease.