Ae s t h e t ic s a n d t h e I n d iv id u a l in t h e

P r a c t ic e o f R e s e a r c h

David Aldridge

T here is a demand made of arts

therapists by the wider community
that they validate their work with clinical
of this paper is that when we study
human behaviour, and in particular what
it means to be sick, to become well again
studies (Aldridge, 1990a; Aldridge, or to live through the process of dying
1990b). This is often countered with the then both forms of acquaintance, artistic
argument that scientific methods are and scientific, are necessary for the
often inappropriate to the study of these practice of research in medicine.
forms of creative In medical research
therapy. A similar cry most of the modern
is also heard in initiatives for that
orthodox medicine research have come
that the strict from the field of
methodology of natural science. Such
science is often found research when applied
wanting when applied to the study of human
to the study of human behaviour is partial
behaviour. This has and neglects the
stimulated calls for important creative
innovation in clinical elements in the
medical research process, and practice
(Hart, 1984). A significant factor of that of healing. This is not to deny the
innovation is a growing awareness by the scientific, rather to emphasize the
doctor of the patient's social and cultural aesthetic such that both may be
milieu, and an understanding of health considered together. Unfortunately the
beliefs (Gregg, 1985; Underwood, Gray, tension of understanding both elements
& Winkler, 1985; Wilkin, 1986). What of human understanding results in one or
we may need then in clinical research is the other being denied. Such is the
to facilitate the emergence of a discipline current situation in modern medicine.
which seeks to discover what media are However, the continuing problems of
available for expressing clinical change. chronic illness and human suffering urge
These media may be as much aesthetic as us to go beyond our partisan beliefs and
they are scientific thereby emphasizing look again at how we know as well as
the art of healing in parallel with the what we know (Aldridge & Pietroni,
science of healing (Aldridge, 1989; 1987). This is literally the art of re-
Gregg, 1985; Underwood, Gray, & search.
Winkler, 1985; Wilkin, 1986) The problem facing the clinician is
Both science and art are activities that he must often mediate between the
which attempt to bring certain contents of personal needs of the patient and the
the world into cognition. The contention health needs of the community. These

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A es t h et i cs an d t h e I n di v i du al D av i d A l dri dg e

needs are informed by differing world the goals of the collective, the private
views. Similarly there is often a split in ethic is informed by the public ethic and
medical science between researchers and objective empirical data are the means by
therapists. One group seeing themselves which goals are assessed (see Figure
as rational and rigorous in their thinking One). These data are related to the
and others as sentimental and biased economic regulation of health care
which in turn elicits comments about delivery (health as commodity); public
inhuman treatment and reductionist order (the regulation of deviance), and
thinking. Neither of these stances is true, hygiene (the quality of food, water and
each perspective has something to offer. the environment).
However, the predominating ideas in From this viewpoint we have the
published medical research are those of notion of health care, and knowledge
natural science as informed by statistical about that health care, which is regulated
data. by the State. The objects of that health
care (patients) , the practitioners of that

Figure One: Comparative and complementary perspectives

on health research

scientific perspective individual perspective

• state regulation of health • personal regulation of health
• constancy predictability and control: • creative irrationality:
the future is based on past data being and becoming
• technology of the body: • techniques of the self:
observations, examinations and music, art, personal narratives
case reports and poetry
• objective statistical reality based on • subjective and symbolic reality based
instrumentally monitored data on the senses and human
consciousness
• the health of the body is an • self maintains it´s own identity
imperative of the State
• scientific • aesthetic
• time as chronos • time as kairos

Historical context health care (therapists ), and the

The science of statistics developed in providers of that health care (health and
eighteenth century France (Tröhler, State insurance) are informed by the
1988) as part of the centralized apparatus same world view. Such was the strength
of the State (Foucault, 1989). of modern science, it offered a replicable
``Statistics´´ as the science of state was body of knowledge in the face of the ever
the empirical numerical representation of increasing solipsism of metaphysics in
the resources available to the State and the eighteenth century.
formed the components of a new power From a modern scientific stance the
rationality. Health care became, as it is body is to be manipulated as an object of
now, a political objective, as well as a the State to whose ends it serves. Such
personal objective. Health, from this manipulation is served by the processes
perspective, is seen as the duty of each of classification and normalization.
member of society and the objective of People are observed, classified and
all. Individual needs are subsumed within analysed as `cases´ according to their

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deviance from a given norm. Disease

becomes a category like any other rather
than the unique experience which it is.
The epistemology of this
normative process is the that of natural
science which emphasizes reason,
constancy and predictability. In the face
of death and disruption the imperative of
health is to maintain continuity and
control. It is a philosophical assumption
that the positive instance of an
hypothesis will give ground for further
instances. However, there is no logical
necessity which will safeguard our
passage from past to future
experiences(Ayer, 1982).

A critique of scientific
methodology
Implicit in many criticisms of art therapy
research is the notion that there are 'right'
premises for doing science. The
implication is that there is a common
map of the territory of healing, with
particular co-ordinates and given
symbols, for finding our way around and is a product of our own perceiving. This
that the orthodox map of scientific is not to not to put forward a purely
medicine is the only one. Any different nominalist argument (Gillon, 1986)
map is seen as deviant, and any challenge which would be to plunge us backwards
to the construction of that map as into the darkness of metaphysical
heretical (Watzlawick, 1984). speculation and dogma, rather to
emphasize the relativity of perspectives in
thinking about healing.
Similarly, when we speak of
scientific or experimental validity, that
validity has to be conferred by a person
or group of persons on the work or
actions of another group. This is a
'political' process. With the obsession
for 'objective truths' in the scientific
community then other 'truths' are
ignored. As therapists we have many
ways of knowing ; by intuition, through
The implication of such heresy is experience and by observation. If we
that those who question the method of disregard these 'knowings' then we
mapping human experience, or offer an promote the idea that there is an objective
alternative map, will be excommunicated definitive external truth which exists as
from the scientific and therapeutic 'tablets of stone' to which only we, the
community. Alternative practices are initiated, have access.
implied to be 'cultish' and at best
'unscientific'. Bateson (Bateson, 1978) , Methodological Issues
however, reminds us that although we While clinical controlled trial
think in terms of coconuts or pigs there methodology may appear to be
are no coconuts or pigs in the brain. In scientifically sound a number of articles
clinical research that which we report on

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have questioned the scientific premises the result of counting and can be accurate
of such methods. because there is a discontinuity with one
The first of these criticisms is that a integer and the next. We can count one
random selection of trial subjects cannot boy, two boys, three boys and see the
be achieved because any group of difference. When we come to the
patients comprises a highly selected non- measurement of quantity then we have
random group (Burkhardt & Kienle, greater difficulty in being precise.
1980; Editorial, 1983). Any results Quantity is approximate.
concerning this trial group cannot be It is easier to see three boys than
generalized to other trial groups. These it is to measure exactly three litres of
inductive generalizations, it is argued, are water. This problem has bedevilled
no more respectable than those made clinical measurement. Although methods
from anecdotal experiences. of measurement are continually being
Two, group generalizations from refined, the very process of measuring,
research findings raise problems for the when introduced into a clinical trial,
clinician who is faced with the individual influences the trial itself.
person in his or her consulting room. The people with whom we work
Individual variations are mocked by the in the therapist / patient relationship are
group average (Barlow & Hersen, not experimental units. Nor are the
1984). If a group of 50 patients in a measurements made on these people
treatment group does statistically better isolated sets of data. While at times it
than a control group of 50 patients then may be necessary to make this split we
such a difference could be due to a small must be aware that we are making the act
number of patients in the treatment group of separating data from people.
showing a larger change while the When we come to measure
majority of patients particular personal
show no changes or variables then we
deteriorate slightly. It is face many
the patients who change complications.
significantly which are Consider a person
of interest to us as who sits before a
therapists and would practitioner in a
want to know the surgery who has
significant factors been treated
involved that change. unsuccessfully for
These factors however chronic leukemia
are lost within the group with a bone marrow
average. transplant. The
Third, there are issues of reliability clinical measurements of blood status,
which are linked to the practice of weight and temperature are important.
scientific research. The reliability of our However, they belong to a different realm
knowledge is only as good as the to those of anxiety about the future, the
underpinning hypothesis (Dudley, experience of pain, the anticipation of
1983). An hypothesis by definition is personal and social losses and the
capable of being disproved. Inevitably existential feeling of abandonment.
the reliability of a trial when extended to These defy comparative measurement.
a broader population is an act of Yet, if we are to investigate therapeutic
induction (Burkhardt & Kienle, 1983). approaches to chronic disease we need to
investigate these subjective and
Not everything is measurable by qualitative realms (Clark & Fallowfield,
numbers. 1986; Gold, 1986; Spitzer et al., 1981) .
At a fundamental level there is a major In terms of outcomes
fault in much research thinking about measurement we face further difficulties.
human behaviour. This is the confusion The people we see in or surgeries, or in
of number with quantity. Numbers are our clinical trials, do not live in isolation.

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A es t h et i cs an d t h e I n di v i du al D av i d A l dri dg e

Life is rather a messy laboratory and to deal with our fellow human beings and
continually influences the subjects of our how we want to be dealt with by them .
therapeutic and research endeavours. As therapists the concern for the
Even more daunting is the fact that subject prevails over the interest of
subjects influence themselves. society at large and scientific medicine as
Finally, there is no such thing as a an institution. Individuals are not treated
purely 'physical' treatment (Heron, as a means to some collective end in
1984). Treatment always occurs in a clinical practice, although we may
psychosocial context. Medicine is a subscribe to a notion of community
social as well as a natural science health. Furthermore, we discover a
(Kleinman, 1973; Mechanic, 1986) . dilemma for research in that scientific
The way people respond in situations is standards of acceptability are juxtaposed
sometimes determined by the way in with the ordinary therapeutic standards
which they have understood the meaning of the therapist. The standards of
of that situation (Harre & Secord, probability necessary for scientific
1971). By studying the accounts people statistical validity may be more exacting
give of their symptoms in the context of than the standards of probability
their intimate relationships then we can acceptable to either the patient or the
glean valuable understandings of illness therapist. Such standards can vary
behaviour. The meaning of a headache in according to the context in which they
the context of a therapist-patient are applied. For the dying person the
relationship may be a far cry from the rigour of the clinical trial and the level of
meaning of a headache in a husband-wife probability in terms of treatment efficacy
relationship. may be quite different to that of the
This reflects one of two 'healthy' person, a woman in mid-term or
fundamentally differing approaches to an infant.
science. One is to develop precise and A further difficulty of accepting
fixed procedures that yield a stable and levels of probability is that trials of
definite empirical content. We have this treatment are often scrutinized or judged
in controlled trial methodology. The by therapists and scientists who have a
other approach to investigation depends world view which is different to that of
upon careful and imaginative life studies those carrying out the trial. While it is
which although lacking some of the necessary to have questions posed by
precision of technical instruments have 'outsiders' it is important that trials of art
the virtue of continuing a close therapies are assessed by panels which
relationship with the natural social world have representatives of these therapeutic
of people. directions. By incorporating experts
from differing disciplines then it is
Ethical and Political Issues possible to design procedures whereby
The subject matter of our research any prevailing dogma is not granted a
endeavours, and the way we carry out monopoly status as a compulsory
those endeavours reflect our views of the 'current status of scientific knowledge'
society we wish to live in, how we wish and that minority groups representing
other forms of therapeutic practice are
not suppressed by the majority vote .
This plurality of opinion will enliven
research endeavours and offer a broad
platform of therapeutic practice (Pietroni
& Aldridge, 1987).
While trials may be set up to
conform to an experimental
methodology, those practising within the
trial invariably approach their work from
a clinical viewpoint. For the subjects of
the trial their agenda is likely to be

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A es t h et i cs an d t h e I n di v i du al D av i d A l dri dg e

'clinical' in so far as their expectations are

of treatment. Similarly the results of a
trial need to be interpreted and applied by
therapists. Perhaps what we have failed
to ask are the questions “what is the
exact nature of therapeutic judgement,
what realms of information are used to
make that judgement and who is to
assess the legitimate outcome of that
judgement ?'.
When controlled trials are carried out
in a therapeutic setting then the benefit
for the individual is set against the
benefit for the group. The Declaration of
Helsinki States (Declaration of Helsinki,
1975):
'In any medical study, every patient -
including those of the control group, if
any - should be assured of the best
proven diagnostic and therapeutic
method'.
The clinical judgement of the
therapist is on the side of the individual
patient even if it means the corruption of
a research project. When therapists, who
are bound by contracts for treatment, take action. Furthermore, these actions take
part in clinical trials then the dilemma is place as processes in natural settings and
revealed. Either they fulfil their belong to social contexts. Not all
individual contract for treatment with the patients have the same means of
patient, or they abdicate that contract and articulating their problems and concerns
fulfil their obligations to the research as do their therapists.
contract which are concerned with group When a person consults a therapist
benefit. This raises further the and presents a problem then that problem
conceptual issues for health care of can be seen in varying ways according to
whether 'health' is an individual or a the perspectives of the patient and the
societal concept. Are we as therapists therapist. The presentation of that
committed to improving the health of problem will have occurred after previous
individuals we see, or are we directed to discussions with other family members,
improving the health of the communities and previously attempted health care
we serve? activities (Aldridge, 1990d) . Similarly
the choice of healer and the available
Meaning and reality treatment is also part of a cultural context
A social science explanation of human which embraces the therapist and the
behaviour has emphasized that human patient (Kleinman & Sung, 1979).
beings are not solely organisms Scientific medicine emphasizes one
responding to stimuli from the particular way of knowing this seems to
environment, or simply the sum of their maintain the myth that to know anything
interacting organ systems. The very we must be scientists. If we consider
difficulty of studying such behaviour is people who live in vast desert areas they
that people make sense of what they do, find their way across those trackless
impose different meanings onto reality terrains without any understandings of
and alter their behaviour accordingly. scientific geography. They also know the
When we try to understand social action pattern of the weather without recourse to
we have to take into account that there are what we know as the science of
different available interpretations of that meteorology. In a similar way people

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A es t h et i cs an d t h e I n di v i du al D av i d A l dri dg e

know about their own bodies and have person is alienated from the study
understandings about their own lives. (Reason & Rowan, 1981) . Yet we
They may not confer the same meanings know that the attitudes and belief of the
as we do, yet it is those meanings and experimenter and the subject are
particular belief about health to which we important, and that the experimenter and
might best be guiding our research the subject interact with each other.
endeavours . While as therapists we may When we study health then we have to
help to bring about a change in behaviour take into account biological
by technical means, it is the person who psychological and social factors (Engel,
we have to rely upon to describe the 1977; Schwab & Schwab, 1978) . They
meanings and implications of that are not independent factors but interact
change. This also leaves out the with each other. It is we as researchers
burdgeoning problem for us as scientists who separate to the world into categories,
for explaining how a change in meaning yet social life occurs in natural settings
can bring about a change in behaviour. quite different from the artificial ones
created for research.

Single case designs

There are ways of researching the person
scientifically in the form of single case
studies, where the possibilities for blind
intervention and randomisation are
retained (Aldridge, 1988) . In this
practice the patient is their own statistic.
These single case approaches may be a
useful middle ground from which art
therapists can begin their research
The practical difficulty of endeavours as therapists researching
researching subjective variables is they their everyday practice (Aldridge, 1990c).
are not accessible to quantitative These forms of clinical study can collect
methods, nor are they generalizable; they multivariate data over time. They
are indeed subjective. To combat this therefore lend themselves to the study of
difficulty and potential disruption of our regulatory processes within the
knowledge we tend to ignore such data individual, where any deviance is from
and reduce our variables to those which the norm of the person themselves. The
are easily manipulated. To do so reduces person becomes their own statistic, they
the person to simply being a vessel for are not compered with the group.
the containment of a disease. When we
include subjective variables such as Art and science
emotion, we treat them as if they could be Research from this standpoint is not
weighed (Porter, 1986). science in that has no generalizable
When we intervene or treat persons reference. The importance of such work
in our research studies then we are is in its particular subjective and
engaging in an activity which is not unconventional reference. While the
stable. Our intention is to bring about aesthetic may appear to occupy a pole
change. This too poses a problem for opposite to the scientific, we may
generalizability beyond that seen in the propose that both poles are necessary to
earlier section. Not only do we have to express the life of human beings.
extrapolate from one group to another, Both art and science bring an
we have have to induce meanings from a appreciation of form and the expression
situation which is in a state of flux. of meaning. Maps, traces and graphs are
In natural science studies objectivity articulate forms of an inner reality. So
is sought by separating the subject from are the objects of art. They exist as
interfering with the experiment. Some articulate forms; they have an internal
authors state that by doing this the structure which is given to perception.

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A es t h et i cs an d t h e I n di v i du al D av i d A l dri dg e

However, while the graph is a regularised and utter ideas about human sensibility.
form whereby the individual, as content, A reliance on verbal methods alone
is charted upon given axes, the object of assumes that we can know and speak
art is both the expression and the axes of about all that we are. A reliance on
that expression i.e. form and content. machine expressions of our inner
In expressive art sensory realities assumes that all that we are is
qualities are liberated from their usual measurable and material.
meaning. While science requires the The art form presents the whole
graph for regularity, art requires that intelligible form as an intuitive
forms are given a new embodiment ; they recognition of inner knowledge projected
can be set free to be recognized. In this as outer form: subjective is made
way qualitative form can be set free and objective but in the terms of the subject.
made wholly apparent in direct contrast In artistic expression we have the
to the questionnaire method where inner possibility of making perceptible an
subjective realities are submitted to an inner experience.
external objective form. This is not to
deny the use of the questionnaire, rather
to emphasise the possibility of
considering expressive forms when we
wish to discover what the quality of life.
Sensual qualities then become of vital
import to the whole, not to be rated on a
scale, but intrinsic to the total gestalt.
In this way of researching we are
concerned with showing rather than
saying. For example, there are important
factor in heart disease related to the Type
A behaviour which can be discovered by
interview . However, the picture of the Conclusion
individual gained from such interviews is A time has come when we can judge our
rather negative (Aldridge, 1990e) and research on 'whether it makes a powerful
may be an artefact of the assessment and important contribution to the
method. A more neutral stance may be to cumulative evidence (Pringle, 1984) on a
allow subjects to improvise music. particular issue rather than whether or
not it formally proves a point. This
Expression recognition of subjective data is
The artistic symbol negotiates insight not occurring at a time when an emphasis is
reference. It expresses the feelings from being placed on the 'whole' patient rather
whom it stems and is a total analogue of than fragmenting the person into organ
human life.The symbol and that which is systems (Pietroni, 1984).
symbolized have some common logical It is possible to have a descriptive
form i.e. they are isomorphic. science of human behaviour which can
Science negotiates reference not be based upon the aesthetic. In this way
insight. That which is within the we can ask of our research that it
individual is placed within a context. expresses what it is to be human, what it
Music and art are concerned, not is to be well and what it is to fall sick.
with the stimulation of feeling, but the
expression of feeling. It may be more A phenomenological perspective
accurate to say here that feelings are not on research concerns itself with the
necessarily ´emotional state´, more an person as they are `coming into being´
expression of what the person knows as rather than the verification of hypotheses
inner life, which may exceed the the which are predicated on observations of
boundaries of conventional the past. To say that the future will be as
categorisation. By encouraging non- the past was is a cultural artefact of our
verbal forms of expression we can learn dominant scientific epistemology. From

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A es t h et i cs an d t h e I n di v i du al D av i d A l dri dg e

such a deterministic view of the past how eloquent for the travellers. The
can we account for change and all that is preservation of the values of humanity
new? within our culture are as much in the
The mistake made by empiricists hands of the clinician/ researcher as artist
is to introduce sense data as objects, as they are in the clinician/ researcher as
whereas it is a pre-objective realm we scientist.
have to explore in ourselves if we are to Human behaviour cannot be
understand our experience and that of studied from one point of view only.
others. Consciousness becomes not a Within the total repertoire of
matter of "I think that", but a matter of "I psychological medicine it is necessary to
can". This is the important of element of have different approaches to
intentionality which cannot be measured understanding the world: the scientific
but can be heard, seen and demonstrated. and the aesthetic. This position, of
The politics of medicine, and the multiple understandings, offers an
technology of modern medicine which acceptance of orthodox clinical trials
serves it, places the existence of the together with a promotion of new
individual in question. Personal means of understandings (Touw-Otten &
health are concerned with a subjective Spreeuwenberg, 1985). By doing so
reality which is symbolic. As human differing studies inform each other.
beings we are capable of self-regulation, It is vital that we pursue academic
and the foundations of this regulation are rigour in our experimentation. But not by
not confined to objective criteria. In burying our heads in the sand. Rigour
many cases we are mysterious to without imagination leads to stagnation
ourselves. We have properties which are just as imagination alone leads to
concerned with a created knowledge. anarchy. Modern clinical research can
As therapists and researchers combine the two. A combination of
then, how are we to face the problem of rigour and imagination is necessary to
how to constitute an ethics of existence meet the challenges of health care. Our
not solely founded on a scientific intellectual endeavours should be astute
knowledge of the self which is enough to see that science can
comparative to group norms, but one in accommodate multiple viewpoints
which the principal act is creative? Our (Freeling, 1985; Howie, 1984; Rose,
task is to ask of ourselves, and then of 1984) and search for a reconciliation of
our patients, `How can we create difference within the framework of the
ourselves as a work of art?´ (Rabinow, scientific, which is Truth, and the
1986) aesthetic, which is Beauty.
The implications of this thinking
for research practice is that we can
encourage people to develop an
articulacy of self based on their own
expressive realizations. These may be
expressed in the form of music, or
pictures or stories. We can encourage
people to document their journeys
through life not as the accumulation of
material quantities of flesh and blood but
in sounds, words and pictures. The
documentary of lifes journey through a
chronic illness may be realized in a series
of case notes. However, it can also be
possible to document that journey as a
series of photographs which are far more

9
Aldridge, D. 1987. One body: a guide to healing in Dudley, H.A.F. 1983. The controlled clinical trial
the Church. London: S.P.C.K. and the advance of reliable knowledge: an outsider
looks in. British Medical Journal 287,
Aldridge, D. 1989. Music, communication and
medicine. Journal of the Royal Society of Medicine Editorial. 1983. Ethics, philosophy and clinical
82, , 743-745. trials. Journal of Medical Ethics 9, , 59-60.

Aldridge, D. 1990a. Complementary medicine in Engel, G. 1977. The need for a new medical model:
Europe: some national perspectives. a challenge for biomedicine. Science 196, , 129-
Complementary Medical Research 4, , in press. 136.

Aldridge, D. 1990b. The delivery of health care Foucault, M. 1989. The birth of the clinic an
alternatives. Journal of the Royal Society of archaelogy of medical perception. London:
Medicine 83, , (in press). Routledge.

Aldridge, D. 1990c. The development of a research Freeling, P. 1985. Health outcomes in primary
strategy for music therapists in a hospital setting care: An approach to problems. Family Practice 2,
therapists. The Arts in Psychotherapy 17, , 231- , 177-181.
237.
Gillon, R. 1986. On sickness and health. BMJ
Aldridge, D. 1990d. Making and taking health care 292, , 318-320.
decisions. Journal of the Royal Society of
Medicine 83, , 720-723. Gold, J. 1986. Quality of life measurements in
patients with malignant disease. Journal of the
Aldridge, D. 1990e. Physiological change, Royal Society of Medicine 79, , 622.
communication, and the playing of improvised
music: some proposals for research. The The Arts Gregg, I. 1985. The quality of asthma in general
in Psychotherapy practice- a challenge for the future. Family ractice
2, , 94-100.
Aldridge, D, and P Pietroni. 1987. Research trials
in general practice: towards a focus on clinical Harre, R, and P Secord. 1971. The explanation of
practice. Family Practice 4, , 311-315. social behaviour. London: Basil Blackwell.

Aldridge, D.R. 1988. Single case research designs. Hart, J. 1984. Where is general practice going?
Complementary Medical Research 3, , 37-46. New octor 33, , 8-10.

Ayer, A. 1982. Philosophy in the twentieth Heron, J. 1984. Critique of conventional research
century. London: Weidenfeld and Nicholson. methodology. Complementary Medicinal Research
1, , 12-22.
Barlow, D.H, and M Hersen. 1984. Single case
experimental designs: strategies for studying Howie, J. 1984. Research in general practice:
behaviour change. New York: Pergamon Press. pursuit of knowledge or defence of wisdom. British
Medical Journal 289, , 1770-1772.
Bateson, G. 1978. Mind and Nature. Glasgow:
Fontana. Kleinman, A, and L Sung. 1979. Why do
indigenous practitioners successfully heal? Social
Burkhardt, R, and G Kienle. 1980. Controlled Science and Medicine 13, , 7-26.
clinical trials and drug regulations. Controlled
Clinical Trials 1, , 151-164. Kleinman, A.M. 1973. Medicine's symbolic
reality. On a central problem in the philosophy of
Burkhardt, R, and G Kienle. 1983. Basic problems medicine. Inquiry 16, , 206-13.
in controlled trials. Journal of Medical Ethics 9, ,
80-84. Mechanic, D. 1986. The concept of illness
behaviour: culture, situation and personal
Clark, A, and L. Fallowfield. 1986. Quality of life disposition. Psychological Medicine 16, , 1-7.
measurements in patients with malignant disease: a
review. Journal of the Royal Society of Medicine Pietroni, P. 1984. Holistic medicine. New map,
79, , 165-169. old territory. The British Journal of Holistic
Medicine 1, , 3-13.
Declaration of Helsinki. 1975. Recommendations
guiding doctors in biomedical research. Tokyo, Pietroni, P, and D Aldridge. 1987. Summary of
Japan: discussion on BMA report. Holistic Medicine 2, ,
95-102.

10
A es t h et i cs an d t h e I n di v i du al D av i d A l dri dg e

social sciences in general medical practice. Family

Porter, R. 1986. Psychotherapy research: Practice 2, , 42-45.
physiological measures and intrapsychic events.
Journal of the Royal Society of Medicine 76, , Tröhler, U. 1988. The history of therapeutic
257-261. evaluation. In Talking health. Edited by J. Watt.
41-48. London: Royal Society of Medicine.
Pringle, M. 1984. A minority interest: why?
British Medical Journal 289, , 163-164. Underwood, P, D Gray, and R Winkler. 1985.
Cutting open Newton's apple to find the cause of
Rabinow, P. 1986. The Foucault reader. London: gravity: a reply to Julian Tudor Hart on the future
Penguin. of general practice. British Medical Journal 291, ,
1322-1324.
Reason, P, and J Rowan. 1981. Human inquiry.
Chichester: John Wiley. Watzlawick, P. 1984. The invented reality. New
York: W.W.Norton and Co.
Rose, A. 1984. Chronic illness in general practice.
Family Practice 1, , 162-167. Wilkin, D. 1986. Outcomes research in general
practice. Journal of the Royal College of General
Schwab, J, and M Schwab. 1978. Sociocultural Practitioners Jan, , 4-5.
roots of mental illness. London: Plenum Medical
Book Co.,.

Spitzer, W.O., A.J. Dobson, J. Hall, E.

Chesterman, J. Levi, R. Shepherd, R.N. Battista,
and B.R. Catchlove. 1981. Measuring the Quality
of Life of Cancer Patients. Journal of Chronic
Diseases 34, , 585-597.

Touw-Otten, F, and C Spreeuwenberg. 1985.

Multi-disciplinary research between natural and

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