Forms of disciplinary fragmentation: Holistic healthcare and the categorical division of academic labor

Abstract

This dissertation approaches holistic healthcare as a problem of disciplinarity in that it articulates a challenge with which any holistic endeavor, however conceived, would invariably contend. I call this challenge disciplinary fragmentation. The understanding of disciplinary fragmentation given by the dissertation is informed by the Biglan model of subject matter difference. Appearing in 1973 as a tool to study the organization of the research university, the model formalized a system of subject matter classification that hinges on three pairs of oppositions: 1) applied-pure, 2) hard-soft, 3) life-non-life. The model’s creator, psychologist Anthony Biglan, postulated the existence of cognitive styles drawn along these lines. Conceiving disciplinary fragmentation as the theoretical splitting of cognitive styles into these categories, the dissertation asks what would consolidate the styles and how could they pose unforeseen obstacles to the flourishing of more holistic approaches in mainstream medicine. The answer it gives involves medical textbooks, learning objectives, electronic medical records, cultural competence training materials, peer-reviewed journal articles and several other pervasive and mundane forms that govern the three arms of mainstream medicine: patient care, research and medical education. Using a new formalist methodology, the dissertation shows how the form of these pervasive and mundane forms could enact the three pairs of Biglan oppositions postulated to underlie disciplinary fragmentation. In so doing, it renders a grounded explanation of why disciplinary fragmentation makes mainstream medicine inimical to holistic healthcare while providing concrete ways it could begin to cultivate more holistic perspectives.