Diversity versus unity: does making things count mean making everything count?

Ian D Coulter, PhD

Throughout its history chiropractic has faced two disparate and at times conflicting demands, unity and diversity.

To survive and to flourish has required unity at some level, at least politically. Not that a review of chiropractic history would convince any outsider that unity has been an operational imperative. In many countries and in the US, the profession is still largely divided around two political associations with two differing images of what constitutes chiropractic. Canada of course has provided a vivid contrast where for most of its history there has been one political association and originally only one college. Even now with two Colleges, this is not because of political or philosophical differences.

But even in Canada break away groups have always raised their heads to offer an alternative to the main political body. But despite the rifts, the profession has been able to present a common profession. The disagreement might be about what constitutes chiropractic but not about whether chiropractic is a distinct and separate profession.

Part of the challenge for chiropractic as a profession is there have always been a strong element of diversity within the profession. It is sociologically interesting to ponder why this is the case. Why have these groups not been driven out or broken away to form a new profession as opposed to forming just different associations?

Part of the answer might be that as a group that has been widely discriminated against in the wider health care system, chiropractors have been reluctant to disown, disbar members of the profession even those with which they have strong disagreements.

It might also reflect the fact that unlike medicine where a dominant paradigm (biomedicine) has characterized the profession, no such paradigm has enjoyed such dominance in chiropractic. At least two major paradigms have coexisted, straights and mixers, but even here within these groupings individual chiropractors have enjoyed considerable freedom to “mix and match” therapies. I recall when our group at the University of Toronto, were first observing chiropractors in practice, we noted that each chiropractor tended to have a unique combination of therapies.

Tremendous variation in practice patterns has always characterized chiropractic along with differing definitions of chiropractic. This has often made it difficult for the public and particularly legislative bodies, to clearly understand what chiropractic is and there is no doubt it has often hurt the profession. The question for the profession at this point in its history is can it carry this diversity into the future and still remain united as a profession.

Unity

We might begin by looking at what these two concepts mean. Bismark stated “organized hatred, that is unity.” (1898). The dictionary defines unity as “a condition of harmony; accord; a totality of related parts; the quality or state of not being multiple; oneness; continuity without deviation or change.”

In that case it would very difficult to apply the term to chiropractic. Chiropractic has been many things but not even the wildest optimist could claim for it harmony, accord, and oneness. If ever a group has been rift by discord, disharmony and disagreement it would be chiropractic. The late Dr. Ken Smith once said to me that chiropractic is the only group when faced with an enemy circle the wagons and shoot inwards. Yet here we are with over 100 years history, still a recognized distinct profession, with more chiropractors than ever, with more colleges than ever and more students than ever. So either the dictionary is wrong or chiropractors have invented a new form of unity.

Let us start with what scientists would call axioms and others might call self evident truths.

“Honest differences of views and honest debate are not disunity. They are the vital process of policy-making among free men.” Walt Witman.

“There are two sides to every question, because, when there is no longer two sides it ceases to be a question.”

“Compromise is odious to passionate natures because it seems a surrender; and to intellectual natures because it seems a confusion.”

“Consensus is that which a group will agree to collectively that nobody holds to be true individually.”

You could find no better paradigm than Canadian chiropractic to discover what chiropractic unity means. Despite great differences amongst the profession they opted for one association; initially one college; they opted for political unity. Whatever the conflicts and fights between individuals and groups within the profession, they tended to keep them within the profession. “what happens in the profession stays within the profession” and even when major conflicts did occur when they were over, the profession has tended to join ranks again.

So unity here means unity of purpose, the coming together not necessarily to agree, but to achieve outcomes that all can support even when they do not even agree about what constitutes chiropractic. This argument about what constitutes chiropractic, and which has separated chiropractors for a 100 years, is of burning relevance to chiropractors and to virtually no one else. Patients do not care, the public do not understand it and politicians do not want to hear about it.

Canadians tend to be pragmatists. Probably at no time in their history has the profession actually agreed about what kind of college CMCC should be. What they have agreed about is that Canada must have a college and now of course two colleges.

Diversity

The dictionary definition states “to make diverse; give variety to; to balance” where diverse means “differing from one another; unlike, composed of distinct or unlike elements or qualities.” Or “the art of thinking independently together” (Malcolm Forbes).

Diversity has become one of those buzz words that take off and become infused with political overtones. Biodiversity is now inextricably linked with the ecosystems, the loss of habitat with issues of sustainability and with issues of ethnobotany, ethnomedicine and health. We now speak of the biosphere to encompass biodiversity and the ecosystem.

In the areas of society and culture diversity has come to replace older terms such as multiculturalism. Here diversity is a “form of individualism, unique characteristics, beliefs and values.” It usually includes: culture, ethnic groups, languages, physical features, socioeconomic background, opinions, religion, sexuality, gender.

Diversity recognizes that all peoples contribute to humanity and culture. Where biodiversity refers to ecological communities, diversity refers to human communities. It stresses respect and tolerance for differences.

It should be noted that since it is a social construct it changes historically. In the US and elsewhere it has become highly political in areas such as affirmative action where the state may mandate that recruitment must be done to ensure diversity (and as in the case of the University of California, then reverse the mandate and make affirmative action illegal).

The Wikipedia encyclopedia notes that in liberal circles diversity is associated with tolerance; with desirability, with minority groupings; the disadvantaged; pluralism. It also has come to mean privilege in that certain groups are held not to be criticizable. This is highly associated with political correctness. You cannot tell ethnic jokes anymore. So the term is currently carrying a lot of emotional and psychological freight.

Wade Davis (a Canadian anthropologist) has used the word ethnosphere to capture the notion that social and cultural diversity is as crucial to the world as biodiversity. To put this in context he notes that in the span of his lifetime (and mine) there were 6000 languages being spoken when he was born and of those, half are not being taught to children. There remain only 300 languages that are spoken by a million people or more. As a process of extinction that far exceeds the rate in biodiversity.

Unity Versus Diversity

There is therefore a dilemma here for the profession. Can you have your cake and eat it too? Unity and diversity may in fact be difficult to achieve together.

Joe Janse, a truly great chiropractor used to quote this poem

“Here’s to those of my own breed

Good or bitter bad as they might be

For they hear the things I hear

They see the things I see.”

But the thing about diversity is that we do not hear the same things or see the same things. If in fact, we are truly diverse we will see things quite differently. This may not matter if we have the social space to tolerate these differences, to express them without fear and when acting on them poses no harm to others. Your liking soccer, or gridiron, Aussie rules, rugby league while I like rugby, despite how stupid those other choices are, poses no threat to me and no threat to any unity. The fact you might support any rugby team other than mine might be the grounds for serious disunity.

But in a profession, in the political arena, tolerating all points of view may be a barrier to developing any joint action and can be used by others to ensure you do not achieve your political aims. This is the classic, divide and conquer strategy. How do we decide where diversity makes us stronger, richer in ideas, better as chiropractors, as healers, as professionals?

There is a definition of a sociologist as an anthropologist who learnt to count. But the question is count for what? And this is our dilemma here. How do we ensure that people do count, their views count, that they feel they count while at the same time ensuring that views that are harmful to the profession, the public, and the political process do not count.

An easy answer is the majority rules. While in one sense this may be democratic, the problem with that strategy, as we know, is that groups will break away and form new associations of their own breed.

Do we have a solution for this?

On the one hand, diversity should be valued and at the individual level, for the most part, individuals should be free to pursue their differences. But even here there are always limits. You must practice within the scope established by the law. Some groups within the profession would claim chiropractors have tolerated too much diversity in the hope for unity.

Historically unity has come to chiropractors when they were confronted with external enemies. While those enemies have not disappeared they are certainly much less of a threat, much less able to hurt chiropractic. There is little doubt now that chiropractic will survive. For many commentators chiropractic is now seen as part of the mainstream and no longer part of the alternative systems and certainly not part of the marginal groups. While this is something that the profession has struggled for over 100 years to achieve, it may come with a cost and that cost might be to favor unity over diversity.

Perhaps the solution lies in focusing on not what is good for the profession but what is good for the public. Is it in the public interest to continue to tolerate all forms of chiropractic? Is chiropractic now large enough and strong enough to say this we will not tolerate as part of the profession? Has the time come when too much diversity is not in the public interest? Has the time come when those who cannot abide this break away and form new professions?

In his novel Officer Factory, Hans Kirst, has two German soldiers discussing the war and one says to the other “one day we will have a country worth dying for “ and the older soldier says “no, one day we will have a country worth living for.”