Original article
Chiropractic Professionalization and Accreditation: An Exploration of the History of Conflict Between Worldviews Through the Lens of Developmental Structuralism

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Abstract

Objective

The purpose of this commentary is to describe the conflicts in the history of chiropractic’s professionalization and conflict through the path of increasing educational standards and accreditation using the lens of developmental structuralism.

Discussion

Within the story of chiropractic’s professionalization and accreditation lie the battles between competing worldviews. Gibbons proposed 4 periods of chiropractic’s educational history; this article proposes a fifth period along with a new methodological approach to explore the complexity of chiropractic’s history. The methodology draws upon constructive developmental psychology and proposes 5 levels of thinking common to the individuals from chiropractic’s history. By using a psychological framework to analyze historical events, it appears that the battle within chiropractic education continues at present. Several important issues are explored: the Council on Chiropractic Education's origins in the medical paradigm and rational thinking, the pre-rational, rational, and post-rational critics of the Council on Chiropractic Education, the schools of thought that were reified or emerged from the history, as well as the more recent legal, economic, and social pressures, which helped to shape chiropractic's accreditation and professionalization.

Conclusion

A transrational approach, one that includes the partial truths of all perspectives, is a first step to allow for a richer understanding of how the interior worldviews, individual actions, and the exterior forces (legal, economic, political, and educational) brought forth the chiropractic clashes together. Viewing the conflicts within chiropractic from this approach may foster new educational structures to evolve.

Introduction

DD Palmer’s chiropractic philosophical paradigm was, in part, a response to the rationalization of society.1 His philosophical approach was an early-systems view of the body as a dynamic system.2, 3 According to Palmer, the adjustment of the vertebral subluxation impacted spirit, matter, and life; had a global impact on the spine and body; improved the person’s health; and had the potential to transform society as a whole.4 His paradigm included a practice (the adjustment), along with a rational scientific approach to knowledge, which also expanded rationality into a more embracing and dynamic viewpoint. Palmer’s philosophy represented an early postrational perspective without a clear strategic plan for how to bring it forth into the world.

One cannot fault Palmer for lacking a more strategic plan. His final years were spent battling his students to define chiropractic. After his death in 1913, a century of warfare followed between the “straights” and the “mixers.” The “straights” defined chiropractic as focused on the analysis and correction of the vertebral subluxation to foster the fullest expression of the individual’s innate intelligence. The “mixers” defined chiropractic more broadly. Some mixers were eclectic practitioners, medical doctors, osteopaths, homeopaths, and naturopaths, who not only added chiropractic to their armamentarium but in many cases redefined the term chiropractic to include their other practices.5, 6, 7, 8, 9, 10 Palmer’s writing stated that chiropractic should be distinct from all other methods.4 He wrote, “No, thank you, I do not mix, I give Chiropractic straight. If it were mixed with all the methods offered, it would soon lose its identity.”4(p80) Thus, there was tension between these 2 viewpoints.

Strategic thinking in the profession’s first hundred years was limited. Organized efforts that demonstrated strategic thinking were related to increasing educational standards or passing legislation. Those attempts often crossed boundaries of the factions in hopes of establishing short-term and long-term positive developments.11 However, most educational initiatives were one-sided.

In 1974, the United States Department of Education (USDE) recognized the Council on Chiropractic Education (CCE), which unified the profession; but it also seemed to separate the 2 factions even more. The circumstances leading up to recognition and the decades thereafter led to infighting.11, 12 This included lawsuits from schools and an investigation from the United States Department of Justice (requested by one of the schools).13, 14, 15, 16, 17 Since 1978, public meetings of the CCE’s renewal of recognition before the USDE have included hours of testimony for and against.11, 18, 19, 20

One can view this conflict as part of the historical conflict. For example, the original CCE standard (developed by the Council on Educational Standards) published in 1941 was based on the standards set by the American Medical Association (AMA).21, 22 The inclusion of rationally focused medical perspectives was characteristic of the broad-scope (“mixer”) faction and anathema to the postrationally focused philosophical (“straight”) faction. Villanueva-Russell23 writes, “The recognition of the CCE meant not only that chiropractic could now receive federal grants, students loans, as well as be perceived as having increased legitimacy in the system of professions, but also meant that the sponsors of this accreditation, the broad-scope mixers, were able to institutionalize their agenda and jurisdiction into the structure and curriculum of all of the colleges.”

After CCE’s recognition, new philosophical movements and dissenting schools developed.24, 25 In this author’s opinion, in the 40 years since CCE’s recognition, a profession-wide flattening of chiropractic’s philosophical tradition ensued. No systematic strategy was undertaken within the profession to strengthen the philosophical approach within academia,26 even though chiropractic curricula include a variety of topics on philosophy and philosophy was still acknowledged as central to the profession.27, 28 There is no systematic instruction in DD Palmer’s paradigm throughout all of chiropractic education.

I suggest that reviving the philosophical knowledge of DD Palmer’s paradigm could enrich the lives and practice of the current generation of chiropractic students and practitioners. Palmer directly challenged the overrationalization of society almost a century before postmodern critiques of social structures and practices emerged.1 To the extent that the chiropractic profession can foster and develop the postrational essence of Palmer’s philosophy, it might play a leading role in shaping the transformation of health policy and practices currently under way within the United States and across the world. Palmer’s postrational stance currently subsumed into terminology like vitalism, holism, and therapeutic conservatism29, 30, 31, 32 may offer an opportunity to integrate the various competing schools of chiropractic into a coherent postrational strategic approach addressing the larger health issues currently raging in society. Drawing on Palmer’s philosophy and building upon it with new insights could place chiropractic at the forefront of the emerging worldwide health revolution.

The clashing worldviews within chiropractic are far more complex than a simplistic divide between “straights” and “mixers.”33 The conflict may be depicted rather as a continual clash of several competing worldviews.34 One of the challenges of such a clash is that each worldview tends to assume that its own viewpoint is best, thus assuming that one perspective holds the most truth, whereas other’s claims to truth are suspect.35 Furthermore, few worldviews use strategic thinking. Developed and integrated, Palmer’s philosophical approach offers an opportunity to integrate competing worldviews and develop a strategic endeavor that brings more depth and rigor to each of the worldviews.

It is my opinion that the complex problems within the chiropractic profession require strategic thinking. However, evidence of real strategic thinking in the general population is rare. Individuals who think and act as “strategists” comprise only 4% of the population.36, 37 The strategist focuses on the short-term and long-term by generating personal and organizational transformation.36 This level of complexity is similar to what Commons and Richards38 describe as the paradigmatic order. Individuals acting from this perspective create new paradigms from seemingly unrelated metasystems by integrating diverse approaches.39

Loevinger40 considered the analogous autonomous stage of human development as a point when individuals recognize their own process of development. Ideas that seemed incompatible at earlier levels of self-complexity may now be integrated. It is this ability to apprehend one’s own earlier levels of thinking and being that is a hallmark of this level of consciousness.41 This ability allows one to think strategically into the present and the future.

By applying these insights, we may learn about the ways different worldviews interacted and clashed. Viewing the history of chiropractic from this perspective may help us embrace a more rigorous view of philosophy and how it was received, forwarded, developed, or thwarted. Using developmental research as a method may provide the necessary tools to discuss the complex issues surrounding the acceptance, rejection, or development of Palmer’s postrational perspective.

In DD Palmer’s day, there was little access to information about the structures of human thought. Few articles in recent chiropractic literature make reference to constructive developmental psychology and adult cognitive development.1, 42 This suggests a lack of depth in the literature about how chiropractors think and act.43 Viewing the current situation in chiropractic philosophy, education, and accreditation from this perspective may foster a new level of strategic thinking and elevate the dialogue to a new level of complexity. Therefore, this article uses the lens of developmental structuralism to explore the conflicts in the history of chiropractic's professionalization, especially the conflict through the path of educational standards and accreditation.

Section snippets

Methodological Approach

The discussion in this commentary develops a simplified model of 5 levels of thinking from developmental psychology to explore the history of chiropractic's professionalization and accreditation. These levels are explored at the end of each section and discussed when appropriate to provide perspective.

The historical timeline is divided into 5 educational periods. The first four were described by Gibbons: the Tutorial Period (1897-1905), the Classical Period (1905-1924), the Proprietary Period

Developmental Worldviews

Constructive developmental psychology may help us to address the complexity of thought structures inherent within the chiropractic profession. The research into adult human development grew from Piaget’s45 work, on the development of cognitive structures in children. He found that formal operational thinking, or the ability to think rationally in third-person perspectives, was the height of human development. Researchers following Piaget found several levels of postformal operational thinking

Chiropractic Professionalization

Chiropractic emerged as a profession with its own specialized accrediting agency, which was recognized by the USDE.11 From DD Palmer’s first school of magnetic cure chartered in 1896 to today’s federally recognized educational standards provides an interesting story in the history of American education. In 1980, chiropractic historian Russ Gibbons writes,

“Chiropractic can declare itself to be the only professional group in America that has literally elevated itself from a limited, insular

Tutorial Period (1897-1905) and Classical Period (1905-1924)

The period between the Civil War and World War I was referred to as “the Age of Standards” by McConn.67, 68 According to Gibbons, chiropractic went through a brief Tutorial Period (1897-1905) and then entered its Classical Period (1905-1924) of education.44 It was not until after the Classical Period that chiropractic would embrace standards across the profession. By then, the divides in the profession were so vast that plans were developed to establish 2 different tracts of standards.11

The Proprietary Period (1924-1960)

Gibbon’s describes the Proprietary Period as being marked by new directions for chiropractic education. The biggest change was the movement towards standardization and accreditation. From the political splits, which started in 1924 with the neurocalometer (NCM) debacle to the onslaught from the AMA, this period was marked by major transition and growth. Hallmarks were educational reform, school consolidations, more rigorous standards, and competing accreditation agencies. In the opinion of this

The Professional Period (1960-1986)

When Gibbons named the Professional Period in 1980, he did not give it a closing date.44 I propose that this period closed in 1986 with the first of the major lawsuits against CCE by a school.13 By doing so, the period remains mostly how Gibbons described it, with the exception of a few important events. Gibbons emphasized the continued reforms, massive campus renovations, and the recognition of CCE by the USDE during this period. This article adds a few more important events like the new

The Litigious Period (1986-2003)

I propose that the Litigious Period begins with the first of the big lawsuits against CCE by a school, when Sherman and the new Straight Chiropractic Academic Standards Association (SCASA) sued the CCE, ACA, NBCE, and Sid E Williams. The other lawsuits of this period included suits against CCE by Life and Palmer. I feel that this period is important because it demonstrates that perspectives and worldviews were still being fought over into chiropractic’s second century. I feel that it is also

Conclusions

In my opinion, 3 important issues emerge from this article. The first is that the CCE has maintained that it does not represent a doctrinal side of the traditional dispute within the profession, although, in my opinion, court documents and historical evidence suggest otherwise. However, viewing this information using developmental structuralism, we may see this paradox more clearly. An understanding of CCE’s position may include that viewing chiropractors as “physicians” or as “primary care

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

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