Context #2 (Fall,
1999, pp. 14-17); copyright 1999 by The Nature Institute
Seeing Things Right-side Up: The Implications of
Kurt Goldstein's Holism
In the first issue of In Context I mentioned my "discovery" of Kurt Goldstein. It is hard to express the joy and gratitude I experienced in finding a like-minded thinker and scientist, from whom I can learn so much. In this article I attempt to articulate some of the essential features of Goldstein's approach to biology, drawing on his books The Organism (1) and Human Nature (2). Goldstein heralded an approach to science that is sorely needed in the twenty-first century. A colleague of his wrote after his death: "It would be petty to raise the question of whether Kurt Goldstein stood first chronologically or logically among the proponents of holistic thinking, for the essential fact is that he went all the way" (3, p. 32). About Kurt Goldstein.
Do Reflexes Exist?Most of you probably can recall having a physical examination before the beginning of a school year. One of the procedures you were subjected to, and as a child probably never understood, was the doctor tapping your leg with a rubber hammer right below the knee. Your lower leg kicked forward. This odd responsewhich may have been slightly embarrassing, since you experienced your body as if from the outside doing something you weren't in control ofis known as the patellar reflex and is a sign for the doctor that you have no spinal cord damage.
The patellar reflex is a classic example of the reflexes one learns about when studying human or animal behavior and the nervous system. They appear to be the most simple, automatic responses. A text for a college biology course explains the patellar reflex this way:
A sensory receptora neuronhas its end wrapped around a muscle fiber embedded within a muscle of the thigh. When the tendon of the knee is stretched, the receptor is activated and generates a neural impulse. Some of the terminal processes of the sensory neuron end in the spinal cord associated with synapses that lead to motor neurons that ennervate thigh musculature. Impulses from these motor neurons cause the muscle to contract and the leg extends forwardthe so-called "knee jerk response".... Reflexes are involuntary responses to simple stimuli in a stereotypical manner. (bio2000.ucdavis.edu/bis10/nervous/nervous-2.html)Faced with this standard description of reflexes, Kurt Goldstein asked a modest-sounding but radical question: What do concepts of this sort actually tell us about living organisms?
The patellar reflex is elicited under very particular conditions: the person sits with one leg crossed over the other; the hanging leg is relaxed and then the tendon below the knee is tapped. When we say the reflex is an automatic, stereotypic response to a stimulus, then we need to remember that the situation belongs to the reflex; it is part of the phenomenon. Change the situation and you may also change the reflex, which therefore turns out to be not so automatic and stereotypic after all. For years I have let tenth graders in a human biology course experience the patellar reflex. Without fail when I asked them to concentrate hard on trying not to kick, the leg kicked out more than ever. The reflex (as singular event) was modified by the situation.
It is true, however, that reflex-like movements comparable to the patellar reflex can be noticed in real-life activity. As Goldstein remarks,
If you jump down a steep incline in such a way that you always touch the ground first with your heel, then the muscles located on the anterior [front] part of the lower segment of the leg and the quadriceps are first passively stretched and then contracted reflexively. This very sensible reaction seems to take place without any voluntary innervation and to be the consequence of a reflex process. It seems to happen without any relation to the organism as a whole."But," he goes on, "correct and plausible as such an explanation seems to be, it is not really so."
This is to be seen by the fact that, under other conditions of the whole organism, we observe a totally different phenomenon during the same kind of abnormal tension of these muscles. If, as one walks, let us say, through a forest, one's foot sticks fast behind an object, say a stone, the muscles we mentioned before are stretched. They do not contract, however, in response to that tension. On the contrary, they relax, and the opposite musclesthose of the back of the legcontract, for only so can the foot be released and a fall be avoided. This reaction, too, takes place...reflexively; yet it is certainly not an innervation caused by the abnormal tension alone, but one determined rather by the condition of the organism as a whole. (2, p. 124f. Emphasis in original.)If the reflex were truly an independently functioning mechanism as it is commonly portrayed, then the latter reaction would not have occurred. There is reflexive activity in our actions, but it is determined just as much by the state and needs of the whole organism as by the specific stimulation. Only in the context of the isolated experimental situation is the reflex an isolated, automatic, and stereotypic behavior.
The textbook "nerve mechanism" described above is a model that nicely fits the picture of an isolated, automatic behavior, but proves inadequate to behavior in the context of the whole organism in a natural situation. Careful, situation-attentive examination of all reflex-type reactions shows them to be more variable than the usual descriptions suggest:
If, in examining a man's pupillary reflex, we obtain a relatively constant contraction of the iris, this is possible only because the individual, so to speak, surrenders his eye to us and completely foregoes the usual act of seeing, i.e. the visual prehension of some environmental feature. Of course, it is true that in real vision the diameter of the pupil changes according to the amount of light on the seen object. But it certainly is not true that the same light intensity will produce the same contraction when it affects the organ in isolation (as in the reflex examination), and when it acts upon the eye of the person who deliberately regards an objects. Although it is not easy to prove this experimentally, one only needs to contrast the pupillary reaction of a man looking interestedly at a brightly illuminated object with the reaction of an eye which has been exposed "in isolation," to the same light intensity. The difference in pupillary reaction is immediately manifest. (1, p. 172)What the pupillary reflex is, then, depends on what you are looking at and what your interests are. The "classic" reflex is a reaction of the body under artificial experimental conditions. In relation to actual experience, it is an artifact, and when we say that humans (or animals) have such-and-such reflexesmeaning automatic, stereotypic reactionsthen we are projecting an abstraction into the organism. In contrast, as part of actual behavior the reflex is a
special type of reaction of the organism as a whole. We may say then that so-called reflexive reactions appear during certain states of the organism as a whole, i.e., in situations of danger in which the organism cannot react quickly enough voluntarily. (2, p. 126)`
The Nature of "Facts"As a careful observer and concrete thinker Kurt Goldstein recognized that the methodology of science, despite its precision, is inherently problematic:
We have said that life confronts us in living organisms. But as soon as we attempt to grasp them scientifically, we must take them apart, and this taking apart nets us a multitude of isolated facts which offer no direct clue to that which we experience directly in the living organism. Yet we have no way of making the nature and behavior of an organism scientifically intelligible other than by its construction out of facts obtained in this way. We thus face the basic problem of all biology, possibly of all knowledge. The question can be formulated quite simply: What do the phenomena, arising from the isolating procedure, teach us about the "essence" (the intrinsic nature) of an organism? How, from such phenomena, do we come to an understanding of the behavior of the individual organism? (1, p. 7)In Goldstein's view true scientific rigor requires us to look at the conditions under which a phenomenon arises. Those conditions include our own activity as observers together with all the instrumentation. When we treat the results of experiments or phenomena, viewed through the lens of a particular theoretical framework, as "scientific facts" isolated from their genesis, we erroneously "elevate the phenomena obtained...to absolute and real entities"(1, p. 468). Because "`empirical' facts are not a simple expression of reality but are also produced through a method of investigation" (2, p. 27), it is "an important scientific task to decide in every case what kind of a fact an observed phenomenon represents" (2, p. 7). All experimental results must be examined very carefully:
If we want to use the results of such experiments for understanding the activity of the organism in normal life (that is, as a whole), we must know in what way the condition of isolation modifies the functioning, and we must take these modifications into account. We have every reason to occupy ourselves very carefully with this condition of isolation. (2, p. 10)It is astounding how little attention has been given to this problem and at the same time what far-reaching consequences follow upon taking the problem seriously. The more we concentrate on performing precisely controlled experiments to test a particular hypothesis, the less, it seems, we recognize these results as a narrow revelation of that very experimental situation.
Most of us todaylay persons and scientists alikethink of biological processes in the framework of the isolation attitude: we imagine individual factors constituting mechanisms that "cause" biological outcomes. An organism is driven by neural mechanisms, hormones, genes and survival strategies. But we are less aware of how all these concepts are based on both practical (experimental) and theoretical (conceptual) procedures of isolation. Their relevance to actual living organisms is highly questionable.
It can be unsettlingand the beginning of an inner revolutionto realize that no scientific concept can be taken naively and at face value. Once the activity of science and the contextual nature of phenomena become part of the object of science, everything changes. It is as if one is looking at the world with new eyes and catching a glimpse of things for the first time right-side up. But we need to go all the way.
Once we become acutely aware of the problem of isolation and its consequences, statements like "scientists find obesity gene" or "new pain center in brain discovered" elicit many questions: How do they know this? What kind of experiments were they? Were they animal experiments? Which animal? What theoretical framework informed the experiments and conclusions? Only such questions can bring the statements back to earth and root them in a concrete life situation.
Rethinking Prevailing BiasesIt would be a worthy task for the next couple of centuries to rethink all biological concepts from a contextual perspective. I suspect most of the alleged causes and mechanisms would disappear.
Let me give an example out of Goldstein's own work as a neurologist. One of his patients with damage to the frontal lobe of the brain (cerebellum) could not repeat sentences like "the snow is black." He could only repeat sentences that conformed to his real experience ("the snow is white"). To make "untrue" statements
demands, so to speak, the ability to live in two spheres, the concrete sphere where "real" things take place and the non-concrete, the merely "possible" sphere, for in saying meaningless things we must shift from one to the other. This the patient is unable to do. He can live and act only in the concrete sphere. He is therefore always himself. He is unable to place himself in the situation of other people; he is not able to imitate other people, nor is he able to impersonate as an actor is.A typical interpretation of emotional changes associated with frontal lobe damage is to say that certain types of emotions are produced or controlled by the frontal lobe and when it is missing, so also are these emotions. This conclusion proves spurious the moment we attend to the way the whole relation of the patient to his environment has changed. In this changed situation certain kinds of feelings don't arise. It is not because a "feeling center" in the brain is missing. As Goldstein puts it:
We have become so accustomed to regard symptoms as direct expressions of the damage in a part of the nervous system that we tend to assume that, corresponding to some given damage, definite symptoms must inevitably appear. We do so, because we forget that normal as well as abnormal reactions ("symptoms") are only expressions of the organism's attempt to deal with certain demands of the environment. Consideration of this makes it evident that symptoms are by no means certain to become self-apparent. Symptoms are answers, given by the modified organism, to definite demands. (1, p. 17 f.)In other words, when a person suffers brain damage it is not sufficient to catalog the associated abnormalities and then state "emotional deficits caused by frontal lobe lesion." Rather, with great care one must observe how the symptoms relate to the whole person and his or her altered relation to the world. What then at firstin the isolation attitudeseems to be directly caused by the brain damage may in fact be an expression of the way the person is coming to terms with effects of that damage. Neurological texts would read very differently if the reality of the whole situation were taken seriously.
Understanding WholenessThis wakeful, critical attitude that seeks to place isolated claims into a living context is a first step toward meeting the richnessor as Goldstein would say, the holistic natureof the phenomena themselves. Goldstein describes three methodological postulatesbased on his decades of work as a neurologist with brain-damaged patientsthat can help us understand organisms (1, p. 21ff.):
First, when observing, give no special preference to any given aspect of the phenomena. Stay open and take in the impressions as fully and precisely as possible.
Second, take great care in describing phenomena comprehensively. This helps us to hold back judgments we so easily make based on theoretical bias. In relation to experimentation, following this postulate entails making slight changes in procedure in order to observe variations and nuances that may otherwise be overlooked.
For example, when brain-damaged patients were asked to pick out red skeins from wool samples, they often placed the skeins in a row from lightest to darkest. We might form the judgment: the patient orders the skeins according to the concept of brightness. But Goldstein looked more closely, modified the situation and asked different questions. It turned out that the patient could not, when explicitly asked, order according to light-dark gradations. Or when one skein was removed, he could not replace it in "correct" order. Goldstein finally concluded that the patient was actually only comparing neighboring skeins. "By this procedure of `successive pairs' he finally came to an arrangement which in toto looked like a scale of brightness, but really was not.... [We see] how vital it is, for an accurate interpretation, that the description of the phenomena be minute and exact." (1, p. 23ff.)
Third, consider every phenomenon with reference to the organism as a whole and to the situation in which it appears. We saw the importance of this awareness in the examples of the reflex and brain damage.
In this approach the careful observation of details is essential, and this in turn requires an analytical element. But as long as the analysis is counterbalanced by a continual return to the larger context, so that every analytical detail is re-integrated into its whole, then the atomization of the subjects of investigation, so common in science, does not occur.
Gaining knowledge is a matter neither of piecing together a whole that was previously analyzed, nor of general theories under which the results of analysis are subsumed. Holistic knowledge has another quality. In Goldstein's words:
We do not construct the architecture of the organism by a mere addition of brick to brick; rather we try to discover the actual Gestalt or the intrinsic structure of this building, a Gestalt from which the phenomena, which were formerly equivocal, would now become intelligible.... [We look] for an idea, a reason in knowledge, by virtue of which all particulars can be tested for their agreement with the principlean idea on the basis of which all particulars become intelligible, if we consider the conditions of their origin. We can arrive at it only by using a special procedure of cognitiona form of creative activity by which we build a picture of the organism on the basis of the facts gained through the analytic method, in a form of ideation similar to the procedure of the artist. Biological knowledge is continued creative activity, by which the idea of the organism comes increasingly within the reach of our experience. It is the sort of ideation, however, which springs ever and ever again from empirical facts, and never fails to be grounded in and substantiated by them. The German poet, Goethe, to whom we owe much for important discoveries in the field of biology, has called this procedure of acquiring knowledge Schau, and the "picture" by which the individual phenomenon becomes understandable (as a modification), the Urbild (the prototype).Goldstein knew that some people might take this description to be edging towards a kind of mysticism. But nothing could be farther from the truth. He is simply describing a process of knowing. Goldstein mentions Goethe, who keenly strove to find a way of knowing appropriate to life. Neither Goldstein nor Goethe was interested in vague notions.
To illustrate holistic knowing Goldstein gives an unexpectedly simple and concrete example: learning to ride a bicycle (1, p. 402). The learner at first makes all sorts of movements in the effort to "get it right." Many of these movements are actually inappropriate for successful riding, although they play an important role in the learning situation. (One of the worst things a person learning a new capacity can do is to try to avoid making mistakes.) After a shorter or longer time, suddenly the moment comes when the child "gets it." The smile, the coordinated movements and the smoothly propelled bike all reveal the accomplishment.
What has happened? In a moment all movements become coordinated in relation to the task at handa whole has been created. This new capacity was not built up as the sum of the trial-and-error maneuvers. The latter are a necessary feature of the learning process, but the new capacity then informs every part of the movement.
Once we follow a learning process in such a careful way, we can notice this embodiment of wholeness in manifold variationswhether in learning to play an instrument, in understanding a mathematical concept, or in grasping an organism. It is ironic that many theories about developmental processesincluding the Darwinian interpretation of evolutionignore what careful observation of the processes themselves reveals. Instead, "bottom-up," building-block theories are rampant, where the whole is conceived as built up out of simple elementsexactly what we do not observe in life.
As Goldstein remarked, normal scientific thinking is theory-driven (1, p.514). As a result, the epitome of knowledge has become the general, quantitatively expressed law. In physics you have the search for the general theory of everything. Again, Goldstein swam against the current: "In the view which we have advocated [the advancement of knowledge] clings to empirical data" (1, p. 514). His whole attention to the experimental situation and the specific context in which a fact arises stems from his desire to do justice to the nature of the phenomena he is dealing with. Biological knowledge is therefore specific and qualitative.
Practicing this way of knowing is strenuous, since we must continually overcome the tendency to construct a fixed system. But it also keeps the process of knowledge alive and vibrant through the continual return to the phenomena themselves. Moreover, the way we interact with organisms changes if we are actually practicing holistic knowledge. As Goldstein says: Our goal is...to provide the kind of environment which allows for the most complete realization of the nature of each creature. (2, p. 233)
Imagine technology becoming infused with this goalanother task for the twenty-first century.1. Goldstein, Kurt (1963, originally published in 1939). The Organism. Boston: Beacon Press. (A reprint was published in 1995 by Zone Books in New York.)
2. Goldstein, Kurt (1963, originally published in 1940). Human Nature. New York: Schocken Books.
3. Murphy, Gardner (1968). "Personal Impressions of Kurt Goldstein," in The Reach of the Mind: Essays in Memory of Kurt Goldstein, edited by Marianne L. Simmel, New York: Springer Verlag, 1968, pp. 31-34.
4. Simmel, Marianne L. (1968). "Kurt Goldstein 1878 - 1965," in The Reach of the Mind: Essays in Memory of Kurt Goldstein, edited by Marianne L. Simmel, New York: Springer Verlag, 1968, pp. 3-11. Most of the information for the biographical sketch is based on this book. I refer the interested reader also to Anne Harrington's book, Reenchanted Science (Princeton: Princeton University Press, 1996), which treats Goldstein's work in the context of the historical development of holism in Germany.
5. Ulich, Robert (1965). "Kurt Goldstein," in The Reach of the Mind: Essays in Memory of Kurt Goldstein, edited by Marianne L. Simmel, New York: Springer Verlag, 1968, pp. 13-15.
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