A Vitalism Ethos and the Chiropractic Health Care Paradigm

Abstract

Objective

The purposes of this article are to describe the development of vitalism from its earliest Hellenistic form to that of a contemporary vitalism ethos and to propose the importance of vitalism in the philosophy of chiropractic and the chiropractic health care paradigm.

Discussion

A review of the history of vitalism is offered to clarify the use of the term within the chiropractic literature and to provide a defensible position for vitalism as a foundation for future research in the philosophy of chiropractic. The founder of chiropractic, Daniel David Palmer, drew heavily from spiritualism and vitalism in his construction of early chiropractic philosophy. As chiropractic practice and philosophy have evolved, that vitalistic foundation has become a polemic used by factions within the profession, resulting in political challenges. The controversy within chiropractic mirrors similar debates within academic philosophy regarding vitalism. The philosophy of vitalism has developed beyond its classical constructs, emerging as an ethos amenable to informing research within clinical applications and a perspective capable of informing the identity of chiropractic.

Conclusion

Exploring the broad historical context of vitalism may allow for an understanding of the plurality of vitalist ideas and a clarification of the concept within chiropractic literature. Adopting vitalism within the philosophy of chiropractic as an ethos based on the work of Georges Canguilhem provides a view of life as fundamentally original, adaptable, and unpredictable, and therefore not sufficiently understood in purely reductionist terms.

Introduction

Few ideas are more controversial within the chiropractic profession than the definition and use of the term vitalism.1, 2, 3, 4, 5, 6 Debated for centuries in natural science and philosophy, vitalism was also central to the early philosophy of chiropractic. This is evident in the metaphysical images of Universal Intelligence (UI) and Innate Intelligence (II).² Conceptualized by Daniel David Palmer, UI and II appear as an amalgam of post-Enlightenment themes taken from spiritualism, transcendentalism, and classical vitalism. Influenced by 19th-century vitalists, along with various works in the healing arts, Palmer's philosophy reflected “part of a new and evolving worldview, an embodied attempt to reconcile the fractures inherent to Western culture between mind and body, and spirit and nature.”⁷ In defining this worldview, however, he created categorical errors by combining testable hypotheses regarding tone with religious language and metaphysical metaphors.⁸ These early metaphors integrating vitalism are, as Coulter et al affirm, at the root of the traditional chiropractic paradigm and “lead to a different philosophy about health, about healthcare, and about the healthcare provider,” but they can also lead to reification of concepts.⁵

A misunderstanding of the contextual basis of these metaphors may have created division between those referred to as “straights” and “mixers” as subsets within the chiropractic profession.⁴ Historically understood to be a disagreement regarding the use of therapies and modalities within the practice of chiropractic (ie, straights argued for hands-only adjustment of the spine, whereas mixers argued for including other modalities such as exercise, nutrition, and physiotherapeutics), the divide between straights and mixers is also ideological. Senzon defines straights as those chiropractors “focused on the analysis and correction of the vertebral subluxation to foster the fullest expression of the individual's innate intelligence” and mixers as those who define chiropractic more broadly.⁹ McAulay has assessed this polemic, describing “authoritarians” who “tend to bring a lack of questioning in their writing and analysis, primarily supporting previously established notions,” and “dismissivists”: those who “accept traditional concepts without the use of accepted methods of rigorous analysis.”¹⁰

Any path toward bridging the divide between authoritarians and dismissivists regarding the issue of vitalism may begin by better understanding chiropractic's metaphysical roots in concepts of academic philosophy. To bring about a better understanding, we must begin with a recapitulation of vitalist theory. In the following sections, I will discuss the history of vitalism from its Hellenistic origins, explore its influence on the early philosophy of chiropractic, and show that changes within contemporary vitalism toward a vitalistic ethos, as observed in the work of Georges Canguilhem, offer a tenable construct integrating elements of Palmerian concepts that can inform a holistic health care paradigm amenable to research. Adopting vitalism as an ethos may provide the chiropractic profession with an understanding of health and disease as unified expressions of normativity. I propose that this understanding supports a clinical approach that sees each patient as a highly complex expression of nature, displaying emergent properties such as originality, adaptability, and unpredictability that cannot be fully explained by reductionist methods. I also propose that this understanding substantiates the necessity of vitalism as an ethos within the philosophy of chiropractic and the chiropractic health care paradigm.

Discussion

I. The Historical Evolution of Vitalism

The Hellenistic Roots of Vitalism

The focus of vitalism is the very nature of life, which, as Federspil and Sicolo state, “spans the entire history of philosophic thought but also runs through the whole history of biologic and medical cognition.”¹¹ Hippocrates of Kos (460-377 BCE) is universally credited as the father of modern medicine for taking a methodical and rational approach to the diagnosis and management of disease rather than referring to purely supernatural causes. Influenced by the Pythagorean concept that nature was composed of 4 elements—earth, water, fire, and air—Hippocrates postulated that health was maintained by the balance of 4 humors (black bile, yellow bile, phlegm and blood) and 4 elemental conditions (cold, hot, dry, and moist).¹² Hippocrates is stated to have said that the physician should study anatomy, in particular that of the spine and its relationship to the nervous system that controls all functions of the body. Moreover, the Hippocratic tradition emphasized environmental causes and natural treatments of diseases, the causes and therapeutic importance of psychological factors, nutrition and lifestyle, the independence of mind, body, and spirit, and the need for harmony between the individual and the social and natural environments.¹³ Foundational to Hippocrates's approach to health was the healing power of benevolent Nature, a concept also adopted from the Pythagoreans, “who believed that benevolent Nature was divinely created by musically harmonious defined laws.”¹²

The nature of life was already a long-debated topic in 4th-century Greece when Plato, a contemporary of Hippocrates, spoke out against the hard determinism of the atomists, typified by Leucippus and his student Democritus.^14,15 Atomist theory sought to explain all of nature by the action of fundamental particles.¹⁵ Democritean atomism was a nonteleologic answer to Parmenides's problem of change ex nihilo, representing a novel conclusion to those of the Eleatics who antedated him, themselves seekers of the fundamental elements composing the universe and all life within it. Atomistic determinism, however, created a moral, political, and epistemological problem for Plato in that it made the divine intervention of the gods and the volition of the soul superfluous to the relationship of finite atoms.¹⁴ As the compiler Diogenes Laertius suggested, the extent of Plato's rejection of Democritean ideas was such that he wished all the works of Democritus to be gathered together and burned.¹⁶ The voluminous writings of Democritus were by that time well dispersed, securing the unique materialism and hard determinism of the atomists in the epistemic horizon of early scientific inquiry.

Plato countered the materialist argument by stating that physical phenomena were but weak examples of ideal forms not accessible by the senses. Ideal forms composed the essence of reality and the soul, which, ever hindered by the material body, must overcome its corporeal limitations in order to attain true wisdom. Plato considered the soul to be immortal: a universal substance existing prior to birth and not extinguished in death, providing a universal against inevitable change.¹⁷

Aristotle furthered his teacher's themes regarding the nature of change, albeit in a different direction, the result of which established what many consider to be the earliest form of vitalist doctrine. In the second chapter of De Anima, Aristotle's hylomorphism, in seeking to differentiate potentiality (dynamis) from actuality (energeia), offered an alternative to atomistic ontology, positing life as a primary substance composed of both matter and form, or soul (entelecheia).^18,19 The term soul in this sense was related to essence or purpose, and therefore not to be confused with mere material composition or the ideal forms of Plato. In this way, “Aristotle brought the Ideal Forms down into the world as things striving to express their ideal.”⁷ An essence or soul constitutive with the body was essential to Aristotle's explanation of how all things come into being, which he expressed in a teleologic doctrine of causes.²⁰

In Aristotle's explanation of causes, we find the parts of any object in existence for the sake of the whole. This was a conclusion shared by both Plato and Hippocrates, of whom, in “‘Hippocrates the Asclepiad,’ Plato writes, it is impossible ‘to understand the nature of the body without the nature of the whole.’”²¹ For Aristotle, the raw material an object was made of, for instance, was regarded as its material cause. The primary source or driver of any change to an object was its efficient cause. The shape an object was to take was considered its formal cause, and “the end, that for the sake of which a thing is done,”²² was considered its final cause.

For Aristotle, a final cause was indicative of a telos or ultimate end independent of psychological factors like belief, desire, or intent. In this sense, Aristotle's teleology removed any purely psychological element from nature.²³ The teleologic unity of form (essence) and an infinitely divisible matter established life for Aristotle as a substantial form, exempting it from a purely material or atomistic, and therefore deterministic, description. The teleologic foundation of life displayed in Aristotle's metaphysics became an integral part of Galen of Pergamum's (130-200 CE) views on medicine. Schiefsky states:

Like Aristotle, Galen identified the body as the “instrument” (organon) of the soul, the tool that enables it to carry out its characteristic activities. The body and its parts are for the sake of the soul, in the sense that they are adapted to the performance of the organism's activities. If one is to understand why an organism has the parts it does, it is necessary to have knowledge of its characteristic activities, as expressed in the “character and faculties” of its soul. The underlying idea, as in Aristotle, is the explanatory priority of the whole organism to its parts. The organism's activities are not explained by reference to its parts; rather, the parts are explained by reference to the total pattern of the organism's activities, as expressed in the character and faculties of its Soul.²⁴

Galen revived the Hippocratic belief in a benevolent Nature (vis medicatrix naturae) formed by the 4 elements in addition to the necessity of maintaining the 4 humors of the body as a means of maintaining health.²⁵ Building upon these concepts, he added the importance of “the Platonic tripartite soul: head (sophia, reason), heart (thumos, emotion or spiritedness), liver (epithumos, desire).”²⁶ Plotinus challenged Aristotle's views in a Neoplatonic form that spoke of the descent of the soul, stating in Ennead IV that “Plato's views on the descent of the soul are not inconsistent with his views on universal soul.”²⁷ This concept of the “universal soul” would, as Senzon points out in discussing the premodern roots of chiropractic philosophy, find a similar metaphor in the concept of UI.⁷ Plotinus further states, “Universal Intellect contains individual powers and intellects. Just as a genus includes species the universal Soul includes individual souls. Universal Intellect exists in the intelligible world whole and entire, but includes actualized individual intellects.”²⁷ The concept of the individualized soul having “a double-life, partly in the intelligible world, partly in the sensible world, as Plato implies in Timaeus,”²⁷ rooted Plotinus firmly in Platonic thought while carrying forward an undeniably vitalistic metaphor.

The Soul and Body at the End of the Medieval Era

There were harbingers of change against Aristotelian dominance in Bernardino Telesio's (1509-1588) philosophic naturalism toward the end of the Renaissance. Giglioni states:

By redefining the notion of sentience (sensus) as the ability, inherent in the two principle forces of the universe (heat and cold), to react and adapt to a reality in constant change, Telesio championed a view of nature and man that radically departed from the principles of Aristotle's natural philosophy.²⁸

Telesio did so by developing a new notion of sentience based on the aspects of receptivity and awareness. This allowed a replacement of the Aristotelian concept of unintentional (nonpsychological) teleology with a self-organizing power inherent in nature, and endowed the material spirit with the ability to feel and react to all phenomena occurring in the universe (spiritus omniscius omnio).²⁸

As influential as Telesio's work proved to be, the greatest shift from Aristotle's hylomorphism arrived with René Descartes's (1596-1650) Discourse on Method. Wheeler, writing on Descartes and the mechanization of the mind, states that “Descartes was, for his time, a radical scientific reductionist” and that “what made him so radical was his contention that (put crudely) biology was just a local branch of physics.”²⁹ Prior to Descartes, the prevailing thought was to understand life by applying to it special incorporeal vital forces or invoking Aristotelian forms. Descartes did exactly the opposite, arguing that organic bodily functions would eventually be fully explained by what we today consider biochemical and neurobiological processes. To Descartes, these processes were lawlike and reducible, and as such would be revealed by the emerging laws of physics.²⁹

The substance dualism of Descartes separated the mind (res cogitans) from the body (res extensa) in purely mechanistic terms, and in so doing relegated the body to an automaton.¹⁶ His profound influence in philosophy and geometry carried over into medicine in the form of iatromechanism (sometimes also called iatrophysics or iatromathematics), which, as Brown states,

is generally considered a by-product of the Scientific Revolution, representing the attempt, foolish at worst and premature at best, to achieve in the medical domain what had already been done in the physical by the “mechanization of the world picture.”³⁰

Iatromechanists imagined the body as a hydraulic machine, composed of pipes with fluids perpetually circulating through them.³¹

If the earliest forms of Hellenistic vitalism reflected the difference between Platonic forms and Democritean atomism, the animism of Georg Ernst Stahl (1659-1734) presented a similar reaction to Cartesian iatromechanism and laid the foundation for modern vitalism. Animism for Stahl was the idea that life was not merely the relation of bodily parts and their respective functions but rather the expression of a special force or soul animating and directing the parts of the body.²⁸ “Stahl for his part called the living body ‘an organism, and not a mechanism.’”³² Stollberg describes Stahl's animism in relation to Aristotelian notions:

God realises himself as an active principle, as life. He gave man a vivid soul, which lives in the body. This soul may be regarded as threefold, like Aristotle did; it makes the body alive. From this base Stahl develops a conception of an organised dynamic of matter in living bodies. He criticises Aristotle's atomism. From the thesis that the body is assembled from very small parts, results the conclusion that the body consists of these small parts, only. In De mixti et vivi corporis vera diversitate (1707) Stahl differentiates between the material structure of the body - which consists of small corpuscles, indeed - and its “aggregated state”, which can only be understood in its living order. The bodily matter is heterogeneous. It remains functional only in its vivid aggregation. When the body dies, the matter dissolves into its chemical parts and decomposes. The mixture of matter in the body does not directly result from its environment, but emerges primarily in its own context. The living things reproduce themselves in their own forms. They take food from their environment, but change it into matter naturally belonging to the body. These processes are guided by the soul.³²

Those who later categorized Stahl's work as the most extreme form of vitalism omitted or mischaracterized key underlying features of his philosophy.³³ Characterizing animism in terms of a metaphysical animating force acting upon a corporeal substance misses the emphasis he placed on organization and the relationship of matter as necessary to life. This set Stahl apart from Descartes's irreconcilable substance dualism and proved foundational to later vitalistic schools of thought.³⁴

Stahl's opposition to Cartesian doctrine was supported by Gottfried Wilhelm Leibniz (1646-1716), who also argued against the claim that life could be understood in purely mechanistic terms. Leibniz disagreed with Stahl, however, on the divisibility of matter and thus the very nature of reality. The issue of infinite divisibility of matter held implications for the relation of chemistry to medicine and the ability to understand life.³⁵ Most notably, it was Leibniz who with his Most Determined Path principle reaffirmed Aristotle's teleology of final causes in the context of optics and, in natural philosophy in general, in his Tentamen Anagogicum. There were 2 ways in which this principle represented Leibniz's defense of teleology. The first is that, along with other immutable laws, it revealed God's intention to create the best possible version of not just this world but all possible worlds. The second is that these principles were essential in showing the necessity of teleologic explanations in the study of physics.³⁶

Despite his defense of teleology, a polarization between mechanistic explanations and finalistic (teleologic) considerations has been found in Leibniz's work, revealing a “dialectic between ‘teleology’ and ‘mechanism’, with particular reference to the concept of ‘living being.’”³⁷ Though a foundation of divine teleologic causation provided a useful heuristic for Leibniz's attempt at reconciling the Catholic and Reformed churches,³⁸ within later forms of vitalism it proved problematic.

Newtonian Mechanics, Metaphysics, and the Nature of Causation

Newton's Principia Mathematica³⁹ was controversial for its time and criticized by his contemporaries on the nature of causation, the basis of which was forces inherent in living and inanimate bodies. The forces investigated by Newton were essential to settling the debate intensified by the Cartesians and early mechanism. Berkeley reflected that though Newton's work had succeeded in “unifying disparate sorts of observed regularities of motion in an ingenious mathematical scheme, of obviously great practical utility, it did not explain the deeper, proper, agent sense of cause.”⁴⁰ Like the Platonic argument centuries before against the atheistic causation of the atomists, for Berkeley causation was yet tied to God as the first mover. Newton had demonstrated the limits of explanation in natural philosophy, but Berkeley insisted that the level of real cause ought to be left to metaphysics.⁴⁰ The elegance of Newtonian physics allowed science a set of entailing laws that were enchanting in their reductionist promise to reveal the secrets underlying the workings of the universe. Classical mechanics in physics thus catalyzed an epistemic shift that became a backdrop for the Enlightenment and beyond.

Newton's work found application in British medicine, which was transformed into British Newtonian medicine from a purely Cartesian iatromechanism, based on the general principles offered in the Principia—particularly those regarding forces of attraction as they applied to the human body. Williams writes:

These physicians were greatly troubled by the problem, left in the wake of the Cartesians’ assault on the Galenic doctrine of the soul, of the origin and character of “the power that moved the machine.” Newtonian physicians were profoundly hostile to what they took to be the Cartesian view that everything in nature could be explained by the blind action of the tourbillons.⁴¹

Tourbillons, or what has come to be known as Descartes's theory of vortices, were based on a perceived motion of the planets that subsequently affected all matter within a universal plenum. This vortex theory was preferred against what was then considered a mystical or occult force (gravity) in the Newtonian system.⁴² The tension between the English and French regarding the nature of force was wittily summed up by Voltaire, who wrote in his Letters Concerning the English Nation:

A Frenchman arriving in London would find philosophy, like everything else, very much changed there. He left the world full, and found it empty; he left the world a plenum, and found it a vacuum. In Paris the universe was seen composed of vortices of subtle matter; but nothing like vortices were to be seen in London. In Paris everything was explained by a pressure that nobody understood; in London everything was explained by an attraction that nobody understood either.⁴³

Newton's work was of great interest to the Dutch physician and professor Herman Boerhaave. Considered the father of clinical education, he was skeptical of reducing life to universal rules and general theory.⁴⁴ He maintained that chemistry was the guide to physics and medicine, affirming that “common mechanics explains the motion of bodies while sublimer mechanics or chemistry deals with the active powers, the forces of bodies of which all motion depends.”⁴⁴

Inspired by Newton's ether, 1 such motion identified by Boerhaave in his Elementa chemiae was effluvia, a subtle aspect of the juices found in nervous tissue, wherein resided the individualizing character of each animal. These effluvia were also comparable to a spiritus rector, or presiding spirit in all matter, giving each body its own individuality. This represented a quasi-vitalism based firmly in a Hippocratic, physicalist philosophy bridging Newtonian reductionism and later vitalist ideologies.⁴⁴

Montpellier Vitalism and Göttingen's Lebenskraft

As Newton's work was beginning to transform physics and medicine in the 18th century in a revised form of iatromechanism, François Sauvages de Lacroix brought Stahl's animism to the faculty of the University of Montpellier. Williams explains: “From the beginning of his career, Sauvages was an avowed enemy of what he viewed as ‘pseudomechanical’ as opposed to ‘genuinely mechanical’ explanations in medicine, especially those he associated with Descartes and his followers.”⁴¹ Some of Sauvages's most important publications blended elements of Stahlian animism and Newtonian principles that physicians had used to challenge the physiological, pathologic, and therapeutic fundamentals of iatromechanism. One of Sauvages's student theses, Dissertatio medica atque ludicra de amore—roughly translated as A Medical Review and the Love of Amusement—indicated an interest in a kind of medicine that postulated an intimate body-mind connection that sought the origins of disease in human passion.⁴¹

Although Newtonian forces and causes played an important role in Sauvages's thinking about the origins, nature, and treatment of disease, so too did the Stahlian soul. Sauvages's thinking underwent dramatic change as a result of these influences, the result of which was an “attempt to overcome the rigid dichotomies of body and soul, reason and passion, law and spontaneity that characterized classical Cartesianism.”⁴¹

From Sauvages's influence, the dean of the school at Montpellier, Paul-Joseph Barthez (1734-1806) in his principium vitale introduced the concept of vital force into medicine as a basic principle of life. It was in reference to Barthez that the term vitalist was coined at the dawn of the 19th century. When the first vitalistic ideas were being considered, however, a range of conflicting attitudes existed at Montpellier surrounding what qualities constituted the phenomenon of life. Some supported a Stahlian animism as presented by Sauvages, whereas others favored a mechanistic approach typified by the work of Antoine Fizes (1689-1765). An additional powerful influence was that of the German-Swiss anatomist and physiologist Albrecht von Haller (1708-1777), who posited irritability or contractility, along with sensitivity, and immanent force (vis insita), as properties inherent to life.⁴⁵

Philippe Huneman, discussing Haller's influence on Montpellier vitalism, states:

Part of the self-definition of French vitalism was elaborated through a discussion of Haller's thesis, and a restriction to sensibility newly defined (with no reference to the nervous system, i.e., a central organ). This allows us to make an important distinction between soul and vital principle, properties, or forces: for Haller, sensibility attached stimulations to a soul, connected to the nervous system - whereas irritability was proper to the organism as such. The Montpellier vitalists replaced this pair of properties with sensibility alone, thereby depriving it of its relationship to a soul. Barthez, introducing the “vital principle” to account for manifestations of life, similarly avoided the reference to a soul in order to understand vital phenomena.⁴⁶

German physician Johann Friedrich Blumenbach (1752-1840) of the Göttingen school, building on Barthez's work, described vires vitales (vital forces), which brought the concepts of contractibility, irritability, and sensibility together with what he considered the vira propria (the life of the parts of the body) as forces whose character could not be defined. He went further, introducing a novel vital force he termed nisus formativas as a natural effort to build form.³²

These works shared a common influence in Brownianism. Much like with Telesio's concept of receptivity and awareness, the Scottish physician John Brown (1735-1788), in his Elementa Medicinae, differentiated life from nonlife by its excitability.⁴⁷ Brown's concept was similar to that of British physician Francis Glisson (1598-1677), who, years before, introduced the term “irritability” (irritabilitas) in his De natura substantiae energetica (1672) and De ventriculo et intestinis (1677). For Glisson, life expressed irritability in maintaining a constant state against inertia. This irritability was dependent on a vigoratio tied to nerve fibers, which in later works came to represent a perception before sensation.⁴⁸ Seen by Glisson as a general property of matter, irritability was later interpreted to be a form of atheistic materialism termed hylozoism hidden within his treatise, De natura substantiae energetica.⁴⁹

Toward the end of the 18th century, Friedrich Casimir Medicus (1736-1808), whose lecture “Von der Lebenskraft” (translated as “On the Vital Force”) at the Mannheim Academy of Sciences started from the questions of how the soul could influence the human body and how voluntary movements could come into being. Medicus outlined 2 distinct views: the first, Montpellier's animist vitalism as seen in the work of Stahl, Sauvages, and others, who proposed that the soul was the cause of all movement; and the second, the empirical approach of Boerhaave, Haller (a student of Boerhaave), and Friedrich Hoffmann, who posited that all bodily movement resulted from physical causes. Medicus sided with the latter position, insisting that the main properties of the soul were thinking and wanting. He went on to distinguish the soul from vital force and in so doing furthered the divide between the physicalism of Boerhaave and the animism of Stahl.³²

These 2 sides of the debate evolved into distinct branches of vitalism that Wolfe describes as “functional” vs “substantival” vitalism⁵⁰:

Substantival vitalism presupposes the existence of something like a (substantive) vital force which either plays a causal role in the natural world as studied by scientific means, or remains a kind of hovering, extra-causal entity. Functional vitalism tends to operate “post facto”, from the existence of living bodies to the desire to find explanatory models that will do justice to their uniquely “vital” properties in a way that fully mechanistic (Cartesian, Boerhaavian etc.) models cannot.⁵⁰

By the turn of the 19th century, the concept of vital force was well established in medicine, with a variety of examples under consideration. The divide between physicalist and vitalist concepts in natural philosophy established at the end of the 18th century had clearly grown.

Immanuel Kant and the End of the Enlightenment

Immanuel Kant (1724-1804) enacted a revolution in epistemology toward the end of the Enlightenment. In his Critique of Pure Reason,^51,52 he undertook both to determine the limits of human knowledge and at the same time to provide a foundation for the scientific knowledge of nature.53, 54, 55 He attempted to do this by examining our human faculties of knowledge critically.⁵⁶ Steigerwald states:

Kant, in fact, addressed not only questions regarding a system of knowledge, but also those regarding a system of nature, engaging with contemporary issues in the natural sciences throughout his philosophical career. From his earliest writings he wrestled in particular with the problem of the place of organisms in such a system.⁵⁷

Kant's publication of the Critique of the Power of Judgment,⁵⁸ which featured the Critique of Teleological Judgment (1790), was concerned with determining to what extent it is legitimate to think of nature in teleologic terms—that is, in terms of ends, goals, or purposes.⁵⁹ Teleology was foundational to Aristotle's approach to change and, as we have seen, woven into the reasoning of many philosophers who followed. The Antinomy of Teleological Judgment found in Kant's third critique explored

an apparent opposition between two maxims or principles of scientific investigation. According to the first, or mechanical, principle, “all production of material things and their forms must be judged as possible according to merely mechanical laws”. According to the second, or teleological principle, “some products of material nature cannot be judged as possible according to merely mechanical laws (their judging requires quite another law of causality, namely that of final causes)”.⁶⁰

For Kant, resolving this antinomy was essential to conceptualizing the nature of what sets living organisms apart from nonliving matter. His approach to the scientific explanation of nature was categorically Newtonian, yet as Steigerwald states:

[Kant's] argument was not that the concepts of efficient or mechanical causality determinative of our understanding of nature do not apply to organisms; indeed, we conceive many organic phenomena in terms of causal and mechanical principles. Rather, he argued that these principles are not sufficient to explain their organisation and self-organizing capacities. Yet he also rejected the attribution of the immediate formation of individual plants and animals to a supernatural origin as untenable. The critical question posed by living organisms for Kant, given his commitment to a scientific system of nature based on mechanical laws, was how to conceive living organisms as natural products.⁵⁷

For Kant, the method developed by Blumenbach for explaining self-organization—that is, starting from an original organization and attributing a formative process or Bildungstrieb to the reproductive matter—held the greatest predictive power and accuracy.⁵⁷ “Kant argued that the theory of organic form must be based on an epigenetic theory of development and that no one had done more in the way of properly conceptualizing the theory of epigenesis than Blumenbach.”⁶¹ In the “First Introduction” to the Critique of the Power of Judgment, Kant argues that there are

among the products of nature some special and very widespread genera, in which the efficient causes are connected in such a way that we must ground this connection on the concept of a purpose, if we want so much as to experience, that is, observe them in terms of a principle appropriate to their inner possibility.⁵⁸

The idea of purpose, for Kant was necessary in a teleologic sense but ultimately unknowable. Quarfood recounts Kant's stance by stating, “On the philosophical level we cannot claim to know the objective existence of purposes in nature.”⁶² Toward the end of the Critique, Kant famously states:

Absolutely no human Reason (in fact no finite Reason like ours in quality, however much it may surpass it in degree) can hope to understand the production of even a blade of grass by mere mechanical causes. As regards the possibility of such an object, the teleological connexion of causes and effects is quite indispensable for the Judgement, even for studying it by the clue of experience.⁶³

Some have tried to interpret from this statement a vitalistic tendency in Kant's reasoning⁶⁴: “According to the vitalist interpretation, Kant claims that teleology is an objective property of organisms, and that the use of teleology is genuinely explanatory.”⁶² It is shown, however, that though teleology is accorded an essential role by Kant, it is not, in the sense used in the Critique, explanatory, and therefore it does not invoke vitalism.⁶²

If not supporting a vitalistic notion, the teleologic identification of objects as functional units (natural purposes) did at least demarcate a separate “order of things,” thereby making biology possible as a special science. However, it did not claim that there were processes taking place that defy ordinary chemistry.⁶² Though Kant admitted that some processes expressed in living things (assimilation and transformation of matter) were inexplicable in mechanistic terms, he was likely Newtonian in his approach to the object of life.⁵¹ It has been argued that “Kant retreated to a ‘foundationalist’ account of Newtonian physics” in reaction to those who searched for nonmechanical accounts of causality in the life sciences.⁶⁵ It was Kant's critique of purely mechanistic accounts of ontology that gave way to new forms of post-Enlightenment investigation in philosophy and science.

Vitalism in the Romantic Era

Beginning around the 1780s and ending by the 1830s, the Romantic era presented a refocusing in philosophy, literature, and medicine toward the value of feelings, emotions, and instinct, which championed unique individuals and their abilities.⁶⁶ It was in this environment that modern vitalism was born and flourished, sharing many of the same distinctive ideals of the era. Based on vitalistic principles and an emphasis on patient experience, the work of Franz Anton Mesmer (1734-1815) introduced the idea of animal magnetism to the scientific community.⁶⁷ It was a concept that profoundly affected later religious and sectarian therapeutic approaches in the 19th-century United States, including chiropractic.⁶⁸ The concept of animal magnetism was first hinted at in Mesmer's medical school dissertation De planetarum influxu in 1766 and seems largely plagiarized from the work of acclaimed English physician Richard Mead (1673-1754).⁶⁷ Mead had posited that the orbits of the planets had a direct influence on what he called “atmospheric tides.” He further hypothesized that these tides influenced human health and disease. Mesmer's contribution to the concept was the presence of a force within individuals that “maintains, relaxes, and disturbs cohesion and elasticity, irritability, magnetism and electricity, which may not improperly be called in this respect ‘animal gravitation.’”⁶⁹

This Mesmer explained by the presence of “fluidum,” an invisible fluid that runs within the subject or between the subject and the therapist, or “magnetizer.”⁷⁰

[He] promulgated “animal magnetism” as a pervasive property of nature that could be channeled as an effective therapy for a wide variety of conditions. … Mesmer proposed that “magnetic matter, by virtue of its extreme subtlety and its similarity to nervous fluid, disturbs the movement of the fluid in such a way that it causes all to return to natural order, which I call the harmony of the nerves.”⁶⁷

The culture of medicine was beginning to change, though, as Lanska points out: “mainstream medical practitioners, professional societies, and political bodies rejected Mesmer and his treatments, and ultimately moved to eliminate Mesmer's practice and that of his disciples.”⁶⁷ This was accomplished by 2 Royal Commissions consisting of members of the Royal Academy of Sciences—including Benjamin Franklin and Antoine Lavoisier—investigating mesmerization as practiced by Charles d'Elson, Mesmer's chief disciple. Ricciuto explains:

The presence of a magnetic force was quickly dismissed using an electrometer. They also conducted several clever, blinded experiments testing the therapeutic effect of various concealed objects that were “magnetized” by D'Elson. Any treatment effects or cures were ascribed either to imagination, psychological causes or fraud.⁶⁹

Despite Mesmer's retreat into obscurity after the Royal Commission's final report, mesmerism was still being practiced in Europe. Magnetic healing, based on Mesmer's work, was introduced to the United States by Charles Poyen in the late 1830s and was being promoted, albeit quietly, when James Braid transformed the practice into hypnotism in 1842.^69,71 Braid rejected the idea of animal magnetism, instead ascribing the trancelike state to physiological processes. The use of hypnotism in this manner evolved into the modern medical practice of clinical hypnosis and helped shape psychological theory.⁶⁹

Grounded in similar vitalistic concepts to Mesmer's, Samuel Hahnemann (1755-1843)—influenced also by the work of Swiss-German renaissance physician and alchemist Paracelsus (1493-1536)—published his Organon der Heilkunst⁷² in 1810, arguing for a “spirit-like vital force (dynamis) animating the material human organism.” This dynamis was foundational to his new homeopathy.⁷² Hahnemann clearly adopted 1 side of Aristotle's contrast of dynamis and entelecheia in the Organon der Heilkunst and engaged with 1 side in the controversy between physicalism and vitalism. His work suggests that he did not want to reconcile physicalism and vitalism or animism. As Stollberg points out, “His point of view is clearly that of antiphysicalism, and he stresses the nonmaterial aspects of homoeopathic drugs.”³² Hahnemann's dynamis was often compared with the forces of magnetism, which were modern in his time. In contrast to Mesmer, however, Hahnemann stressed the immaterial character of force. In contrast to others, Hahnemann's vitalism was firmly antimaterialist.³²

As seen in the works of Mesmer and Hahnemann, medical romanticism, inspired by vitalist theories, invoked various notions of a “life force” that cut across disciplines which had, by the mid–19th century, seen institutions segregate philosophy from hard sciences in order to keep academic peace.⁷³ Thus it was in this climate of heightened emotion and idealization that vitalism, far from the polemic we find it today, was a safer middle ground, bridging the extremes of mid–19th century spiritualist influences and the bold assertions of the mechanical materialists.⁷⁴ Spiritualism, in the philosophical sense, pointed to a way of thinking that affirmed an imperceptible, immaterial reality. It was a form of thought applicable to any philosophy accepting the idea of an immaterial intellect and will. It also supported belief in an immortal soul and an infinite, personal God.⁷³

Spiritualism, a fundamental aspect of the Romantic era, was under strain from heavy political upheaval in the United States and Europe, in addition to the advancement of materialism, which, once established in the scientific community, pushed out of science into the larger cultural consciousness, leaving representations of spiritualist and idealist thought fragmented in response.^73,75 Vitalism, though more accepted, was also under attack.

It was during this time, in 1828, that German chemist Friedrich Wöhler artificially produced an organic molecule (urea) from inorganic components. He claimed that by doing so he had disproven the vitalists’ argument that organic structures could not arise from inorganic compounds. This allegedly undermined the vitalist claim that organic compounds could be “made only in plants or animals by a mysterious vital force that could not be replicated in the laboratory.”⁷⁶ Ramberg points out that Wöhler's triumphant claim or “myth” was more an invention by Wöhler and his closest associates than a reporting of the true direction of chemistry or philosophy, as evidenced by many later works.⁷⁶

During this time of growing controversy over the ontology of life, conceptual shifts took place in the philosophy of medicine that would find expression in art. Literary works of American transcendentalism shared commonalities with idealistic German notions like those of Joseph Schelling (1775-1854), whose Naturphilosophie conceived of nature as a single vast organism imbued with a “one-world soul” permeating throughout.⁷⁷ Schelling's vitalistic monism was a common influence among Romantic-era vitalists and encouraged a speculative or intuitive approach to research and medicine as a viable alternative to the positivist materialism or rationalism that emerged after the Enlightenment.⁷⁸ Vitalism was varied in perspective, and toward the end of the 19th century it returned to stricter empiricism in the functional or physical vitalism of Claude Bernard (1813-1878) and the more extreme processual vitalism of Hans Driesch (1867-1941).

Neovitalism and the Modern Era

Claude Bernard might not have considered himself a vitalist, but his approach to the organization of life was based on vitalistic themes. Normandin suggests that Bernard's “understanding of medicine is as epistemologically significant in its time as Newton's contribution was to the physical sciences in the seventeenth century.”⁷⁹ His views represented a rational movement away from the concept of vital force while likewise rejecting the materialist notion of pure mechanism. In his 1879 publication Leçons sur les phénomènes de la vie communs aux animaux et aux végétaux (Lessons on the phenomena of life common to animals and plants), Bernard stated that the vital force cannot manifest itself but must borrow from the general forces of nature in order to act. He addressed mechanists’ assertions, stating that though vital manifestations remain directly under the influence of physicochemical conditions, these conditions cannot group or harmonize the phenomena in the order and succession apparent in living beings.⁸⁰ His philosophy was concisely summarized in the ideas that “the vital force directs phenomena that it does not produce; the physical agents produce phenomena that they do not direct” and “the ultimate element of a phenomenon is physical; the arrangement vital.”⁸⁰ Bernard is perhaps most famous for his Introduction to the Study of Experimental Medicine.⁸¹ His Experimentalism marked “the end of conventional vitalism and the elusive notion of a ‘vital force’ as a legitimate scientific concept,”⁷⁹ though later versions of classical vitalism, classified as “neovitalism,” would live on in the work of the late–19th century embryologist Hans Driesch.

With regard to modern or neovitalism, “it is Driesch's name that first is mentioned in every modern summary of the problem, his views first discussed, his objections given first hearing”.⁸² His life work focused on the nature of life and the teleologic orientation—static or dynamic—of various organisms.⁸² Seeking answers to perplexing results in his experiments, Driesch began studying philosophy, and as early as 1892 he began referring to Lebenskraft, adapted from Medicus's work, as an inherent aspect of life.⁸³ His experimental work on the development of isolated sea urchin cells led to the publication of Analytische Theorie der organischen Entwicklung (Analytical Theory of Organic Development)⁸⁴ in 1894, The History and Theory of Vitalism⁶⁴ in 1905, and his 1908 Gifford Lectures.⁸³ It was this rigorous experimental approach to the study of vitalism that most set Driesch apart from previous vitalists and garnered respect even from those ardently devoted to positivism. Driesch claimed that it was impossible to ascribe ontogenesis to an “automatic machine,” though he continued to accept mechanistic interpretations for subordinate steps in ontogenesis. He instead entrusted the task of purposeful spatial and temporal embryologic coordination to a novel immaterial agent. Although not resident in space, this agent was claimed to continuously act into space, representing a view Driesch termed “dynamical teleology,” by contrast with the “statical” or unchanging teleology inherent in the developmental machine.⁸⁵ It was to this immaterial agent that he attributed the name entelechy, borrowing from the earliest vitalist doctrine of Aristotle. Thus, at the dawn of the 20th century the concept of vitalism returned, though altered by centuries of thought and enterprise, to its epistemic origin in Aristotle. Having decided in 1895 that vitalism alone could explain the actions of animate things, Driesch published his first proof of vitalism in Die Lokalisation Morphogenetischer Vorgänge (The Localization of Morphogenetic Processes).⁸⁴ Around this same time, D. D. Palmer, a magnetic healer steeped in vitalism, performed the first chiropractic adjustment and founded the chiropractic profession.^86,87

II. The Vitalism of Early Chiropractic

The Founder: D. D. Palmer

Chiropractic was founded on a philosophy that expressed, in part, an attempt to reconcile colliding worldviews, including that of mid–19^th century American metaphysical culture, which emphasized the communing of individuals with the universe through energetic and spiritual harmony.⁷ An example of this kind of communing between humans and the universe was seen in the rise in popularity of religious spiritualism.

Often confused with the spiritualism of Romantic-era philosophy and literature, the mid- to late–19^th century American religious movement known as spiritualism was based on the belief that departed souls could interact directly with the living.⁸⁸ Spiritualist adherents attempted, through the use of a medium, to make contact with the dead. A medium was someone claiming to have special abilities allowing them a supernatural form of communication with the deceased.⁸⁹ The horrendous loss of life during the American Civil War (1861-1865) left thousands grieving, further popularizing the movement.⁸⁸ The rise of spiritualism in the United States represented both a reflection on the nature of religious ritual and the unresolved tensions emerging from a rapidly changing cultural milieu.⁹⁰

D. D. Palmer was well read on vitalism and religious spiritualism,^91,92 and was writing on the topics as early as 1871.⁹³ Gielow and Brown suggest that he first became interested in spiritualism by way of the culture surrounding an influential pioneer named William Drury.^86,92 Palmer's view of spiritualism was initially one of skepticism; he vowed in 1 pamphlet dated 1880 to “bust frauds” and expose charlatans.⁸⁶ His introduction and marriage to clairvoyant Abba Lord, however, helped him to overcome negative preconceptions of spiritualist practices, which he began formally studying and practicing himself.⁹³ He combined these spiritualist beliefs with magnetic healing after studying the work of Paul Caster, a disciple of the teachings of Mesmer.⁹²

In his advertisements as a magnetic healer, Palmer explained his methods, which centered on locating the affected area of a person's body, contacting that area with his hands, and directing his personal energies through the area to break up “congestion.” This was considered an innovation, as indicated by testimonials of other magnetic healers.⁹⁴ By the time of Palmer's interest, magnetic healing was growing in popularity and was considered a reasonable alternative to the heroic medicine of the day, which involved the notion that the harshness of a doctor's remedies should be in proportion to the severity of the patient's disease.^68,95 Oliver Wendell Holmes described the harsh medical interventions of that time:

How could a people which has a revolution once in four years, … which insists in sending out yachts and horses and boys to out-sail, out-run, out-fight, and checkmate all the rest of creation; how could such a people be content with any but “heroic” practice? What wonder that the stars and stripes wave over doses of ninety grains of sulphate of quinine, and that the American eagle screams with delight to see three drachms of calomel given at a single mouthful?⁹⁶

Palmer also criticized heroic medical practices, which were by the late 19th century falling out of favor:

Daybreak of the Christian era found Medical science a mixture of arrogance and superstition, of which there is still too much today. … Medical practice is founded on superstition. … We will leave superstition in the background. The ignorance, the bigotry that is so often in evidence in medical lore, will also have to sink into well-deserved oblivion.⁹⁷

In its use of toxic heavy metals and bloodletting, heroic medicine earned scorn from members of the public and the scientific community, leading ultimately to reforms in medical practice and training.⁹⁸ Before these changes, however, new forms of treatment, some based on vitalistic concepts, comprised the reactionary Popular Health Movement, from which the Thomsonian, hydropathic (water-cure), homeopathic, and hygienic healing systems emerged.^68,98 These systems were based on lifestyle changes and philosophically aimed to democratize health care, asserting that every person should be his or her own healer.⁹⁹

Palmer's response to heroic medicine, along with results he was observing in his own magnetic healing practice, led him toward the development of the concept of tone:

Healing as a profession started for D.D. when he began asking questions about the cause of sickness and disease. … This quest to find the cause of diseased conditions culminated in D.D.’s understanding of tone. In his 1896 publication, The Magnetic Cure, D.D. announces tone as a cause of digestive disturbances: “tone up the digestive organs”, “Lack of vital tone the cause of this debilitated condition”, “a life giving force, a healthy tone, a healthy stimulus”. D.D. would continue to develop his understanding of tone until his death in 1913. Consequently, tone developed from D.D.’s understanding of health to a concept of health and disease that eventually became the foundation of the chiropractic profession.¹⁰⁰

In 1895, Palmer's correction of “vertebra racked out of their normal position,”⁹⁷ resulting in the restoration of hearing for Harvey Lillard, marked both the pivotal moment of the founding of chiropractic and a shift in Palmer's scientific concepts, in that afterward, “Palmer reasoned that spinal misalignment and resulting nerve irritation were the cause of congestion.”⁹⁴ In describing the earliest subluxation theories, Senzon states:

D.D. Palmer's first substantive writings on chiropractic came in 1902, the year he started using the term luxations to describe a cause of dis-ease. Palmer described how the spinous processes were used as handles or levers. He wrote of spinal nerves, foramina, and nerve irritation and focused on nerve pressure and the art of chiropractic. He wrote that by relieving pressure, nature or innate intelligence could perform normal functions. Palmer hypothesized that luxations led to interference with function.¹⁰¹

Palmer's philosophy included the metaphysical concept of an II, which he described as the eternal part of human duality, with “Educated Intelligence” representing the ephemeral part.⁹⁴ The emphasis on the role of II acting through the nervous system to affect the self-regulating, self-healing characteristics of life, however, characterized the biological basis of Palmer's chiropractic paradigm. Chiropractic adjustment, therefore, was a method of allowing the II to reestablish self-regulation. In this sense, chiropractic could be viewed as not just another therapeutic treatment of disease, but rather a means of normalizing neurophysiology, reversing pathophysiology, and creating a state of higher function. It could be said that the biological role of Innate was a precursor to later hypotheses of pathophysiology, pathos, and abnormal function.

Palmer explicitly connected the concept of UI with religious metaphors and vitalistic doctrine:

When it receives a life directed by an intelligence, a living soul, that which runs the vital functions when we are asleep and awake; that which knows much better how to mend a fractured bone the first day of its life than the surgeon will ever know; that intellect which is known as Hahneman's Vital Force; New Thought's Divine Spark; Hudson's Subconscious Mind; the Allopath's Vis Medicatrix Naturae, the healing power of nature; D. D. Palmer's Innate Intelligence; I repeat, when it begets a living soul, it (the immaterial) will live throughout the eternity.⁹⁷

Palmer was not alone in hypothesizing a metaphysical relationship between bodily structure, function, and health. In June 1874, A. T. Still (a self-proclaimed magnetic healer) had developed the manipulative system of osteopathy. In The Philosophy of Osteopathy (1899), Still placed an emphasis on anatomic and physiological order based on the principle

that order and health are inseparable, and that when order in all parts is found, disease cannot prevail. … And if order and health are universally one in union, then the doctor cannot usefully, physiologically, or philosophically be guided by any scale of reason, otherwise.¹⁰²

The parallels between Palmer's philosophy and Still's are notable. It is this author's opinion that Still's philosophy stressed organization (order) as a necessary condition of life, much like Bernard's and Stahl's. Still's philosophy also resembled the substance dualism of Descartes, seeing the human form as a harmonious working of the material body and the immaterial spirit and mind. Like Still, Palmer established a substance dualism, emphasizing in The Chiropractor's Adjuster (1910) the role of the nerves: “The dualistic system—spirit and body—united by intellectual life—the soul—is the basis of this science of biology, and nerve tension is the basis of functional activity in health and disease.”⁹⁷ Palmer's view, based on the concept of tone, was somewhat reminiscent of Glisson's vigoratio of nerve fibers:

Life is the expression of tone. In that sentence is the basic principle of Chiropractic. Tone is the normal degree of nerve tension. Tone is expressed in functions by normal elasticity, activity, strength and excitability of the various organs, as observed in a state of health. Consequently, the cause of disease is any variation of tone—nerves too tense or too slack.⁹⁷

Both Still and Palmer took an empirical view of the causation of disease in its relation to life, as had the vitalists of Montpellier. In The Science of Chiropractic (1906),¹⁰³ Palmer “contrasts his theories with those of the osteopathic authors. For example, he writes that ‘the lesion theory of the Osteopaths, is not that of subluxation of the Chiropractor.’ For D.D., the lesion was secondary and the vertebral subluxation was primary.”⁹⁴ Palmer's theory of disease was that “the cause of disease is intelligible”⁹⁴ and follows a certain progression:

He theorized that the Innate Intelligence tries to carry out growth and repair but it cannot do so when the body is out of order. … Since the cause is within the individual, as is the cure, the adjustment corrects the wrong that is producing the cause by allowing the impulses to be carried to the intended organs. Thus, disease is intelligible and determined by ascertaining the neural involvement. Locating the excessive or hindered functions and their relationship to displaced vertebra was the key.⁹⁴

Palmer's view of the material body gave contrast to his vitalistic view of the immaterial. He stated:

All beings which possess life, exercise certain functions requiring energy. Molecular alterations, tissue change, accomplished by an intelligent vital force, constitute a living being. To live, necessitates the possession of life. Life possesses an intelligence which pervades the universe and is expressed in accordance with the environment and the quality of the material in which it manifests itself.⁹⁷

His view of “an intelligent vital force”⁹⁴ was often related to spirit or soul (the terms were used interchangeably at times) and reflected his spiritualist influences, with fluctuations in tone imparting this force to his scientific theory of the cause of all disease. According to Palmer, life was supplied energetically in a metaphysical form and hindered materially by the presence of tonal derangement. It was an expression of a philosophy that set chiropractic intervention at the interface between the realms of teleologic spirituality and entropic physicality:

Chiropractic science includes biology—the science of life—in this world, and the recognition of a spiritual existence in the next. The principles which compose it are substantive in their independence and incentive to human and spiritual progress. They originate in Divinity, the Universal Intelligence, and constitute the essential qualities of life which, having begun in this world, are never ending.⁹⁷

What set Palmer apart was “his ability to theorize a mechanism by which a spiritual force directs the material universe.”¹⁰⁴ This carried an influence from theosophical doctrine. Writing in the Universal Cyclopedia and Atlas in 1903, William Q. Judge (a cofounder with H. P. Blavatsky and Henry S. Olcott of the Theosophical Society in 1875) described theosophy in similar terms to Palmer's early philosophy of tone and intelligence:

Through all thrill ceaselessly vibrations which are the inexhaustible impulse from the First Cause. … By means of these vibrations are brought about all forces — phenomena in nature, specialized differentiations and effects of creation, preservation, and mutation — in the world of forms as well as upon the ethereal planes. Thus every atom of the universe is infused with spirit, which is life in one of its phases of manifestation, and endowed with qualities of consciousness and intelligence — likewise phases of the spirit — in conformity to the requirements of its differentiation.¹⁰⁵

Folk categorized Palmer's philosophy as part of what American religion scholar Sydney E. Ahlstrom designated as many “Harmonial Traditions” of the time, characterized by a “series of spiritual and philosophical movements unified by a sense of integration between the individual believer and the cosmos,” sharing “an interest in spiritual composure, physical health and, sometimes, economic well-being.”¹⁰⁶ This also formed a moral imperative:

For Palmer, the necessity of keeping individuals adjusted to Innate had implications for the cosmic evolutionary process that gave the chiropractor a religious mandate: “Knowing that our physical health and the intellectual progress of Innate (the personified portion of Universal Intelligence) depend upon the proper alignment of the skeletal frame, prenatal as well as postnatal, we feel it is our right and bounden duty to replace any displaced bones, so that the physical and spiritual may enjoy health, happiness and the full fruition of earthly lives.” In Palmer's view, chiropractors had a religious duty not only to remedy diseases but also to perform an act of service to Innate by adjusting human spines.¹⁰⁴

Palmer's philosophy was an amalgam of varied sources, including vitalistic and theosophical themes born of the zeitgeist of the Romantic era. Its roots could be found in Emanuel Swedenborg's (1688-1772) doctrine of correspondences, whose spiritual influence carried over into the works of transcendentalists, particularly Emerson.^{68,92,107,108} “Palmer's philosophy, which connected the biology of the organism via the nervous system to the integrating intelligence of the cosmos, was an aspect of the intellectual and spiritual movement of the era.”¹⁰⁸ Given the various competing ideologies of the time, Palmer seemed to rouse controversy less by the tenets of his philosophy than by his critical approach to orthodox (heroic) medicine,⁶⁸ regularly decrying poor outcomes from what he considered barbaric treatment. As Palmer's reaction to heroic medicine led to his foundation of chiropractic on vitalistic influences, the publishing of his most influential book, The Chiropractor's Adjuster⁷⁷ incidentally coincided with the publishing of Abraham Flexner's report Medical Education in the United States and Canada,¹⁰⁹ marking a dramatic shift in the practice and education of medicine toward a reductionist philosophy, which was anathema to classical vitalism.

The Developer: B. J. Palmer

Palmer's son Bartlett Joshua (B. J.) graduated from the Palmer School and Infirmary of Chiropractic on January 6, 1902. Due in part to legal troubles incurred by his father, B. J. became the president of the Palmer School of Chiropractic and remained in that position from 1906 to 1961. Building on his father's vitalistic foundation, B. J. developed his view of the philosophy of chiropractic around what Waagen and Strang describe as “three distinct ideas: (1) the ‘principle of chiropractic’; (2) the ‘big idea’ a mystical concept; and (3) a comprehensive and unique life view that included detailed descriptions of health, chiropractic care, and related matters.”¹¹⁰ Like his father, B. J. asserted that the job of the chiropractor was not the treatment of disease but rather the location and correction of chiropractic vertebral subluxation by a chiropractic adjustment. B. J. reframed the nature of chiropractic vertebral subluxation away from the distortion of tone, which D. D. had defined as renitency of the tissues, toward an emphasis on “mental impulse”:

Function is the expression of mental impulses through an “instrument.” If at any time an accident, strain or wrench occurs and produces a vertebral subluxation, this, by occlusion, impinges nerves, as they pass through the intervertebral foramina, that are transmitting mental impulses to that “instrument” at periphery regardless of where located.¹¹¹

B. J.’s “principle of chiropractic” was seeing subluxation as a physiological phenomenon that linked the physical body with the immaterial II responsible for the restoration and maintenance of health.¹¹⁰ Innate intelligence was considered an expression in vivo of a UI governing all natural phenomena. By this reasoning, the nervous system becomes a receiver and conduit of UI, expressed as an individual's II. This was summarized in the chiropractic axiom “Above down, inside out.”¹¹² A trust in the individual's II (the individual manifestation of UI) to restore and maintain health in the absence of the interference of chiropractic vertebral subluxation represents what may have been a strong influence of D. D.’s philosophy on B. J.’s work. Waagen and Strang described the concept: “When innate is in control, the person is healthy and perfectly functional. It is only necessary to let innate express itself and everything the person does will be functionally ideal.”¹¹⁰

D. D. stated in The Chiropractor's Adjuster, “That which I named Innate (born with) is a segment of that Intelligence which fills the universe.”⁹⁷ B.J. was given these ideas at the age of 18, and answering the question “What is II?” became his personal quest and life's work.¹¹³ Throughout his life, B. J. developed the concept of II to include a hierarchy of personal development. He believed that II could be developed biologically from normal metabolic responses; mentally from instinctual responses; and spiritually from a deep intuition and connection to the cosmos.^7,114

A philosophy straddling the spiritual and material divide required clarification. The first 5 of B. J.’s books (volumes 2-6) laid the foundation of his philosophical approach; volume 1 was primarily an unsanctioned reproduction of D. D.’s prior publications. These books developed the philosophical approach B. J. followed for 50 years.⁹⁴ He built upon his father's ideas “about the integration of spirit and matter in relation to the chiropractic adjustment.”⁹⁴ Affirming the importance of his metaphysical approach, “he proposed that the philosophy bridged the gap between the spiritual and the material and that man was a ‘psychospiritual unit’”.⁹⁴ In volume 2 he introduced a circle-of-life metaphor “designed to capture the cycle that begins the moment when the intelligence of the universe is transformed into the brain impulse.”⁹⁴

This vitalistic concept of transformation from universal to mental was related to his lectures on power, where he posited that environmental energies were concentrated in the brain by means of the afferent nervous system.⁷³ B. J. hypothesized that once environmental energies were detected by the sensory nervous system, they were converted into an impression or vibration transmissible to the brain. Once they were collected, the brain converted the accumulated impressions into an ethereal power that was useful or constructive to the body. For B. J., life was an expression of universal power in the body.⁹⁴

B. J. proposed that external forces were transmitted to the brain as force units, or “foruns,” which through the interpretation of intelligence created a new impulse that was then transmitted to tissue cells to be expressed as power in action.⁹⁴ He was especially interested in the energetic interactions between afferent and efferent cycles. It was at this interface, he proposed, that a new thought was created. This creation he credited to the II, which formed a part of the infinite or cosmic UI and was therefore sacred.⁹⁴

The concept that was elaborated from his circle-of-life model evolved into the “Normal Complete Cycle,” which he considered a solution to Cartesian dualism.⁹⁴ Ralph W. Stephenson attempted to integrate B. J.’s varied philosophical principles in the Chiropractic Textbook¹¹² (1927), which included a version of the Normal Complete Cycle represented as “the safety pin cycle.” This book presented, in the form of 33 principles, a codified representation of B. J.’s core concepts. These principles are invoked when a chiropractor is considered by some to be “principled” in their outlook on the philosophy of chiropractic.⁹⁴

Endorsed by B. J. Palmer, the 33 principles represented the unique perspective he brought to the philosophy of chiropractic and, perhaps most importantly, attempted to shift the definition of UI and II slightly away from the religious metaphors used in earlier works, though not without some difficulty. For instance, the introduction to Stephenson's text stated:

Again we want to emphasize what Chiropractic Philosophy is and what it is not. It is the explanation of everything chiropractic. That means the Chiropractic view of the material, as, anatomy, chemistry, etc. The Chiropractic view of abnormalities in anatomy and physiology. The Chiropractic view of the immaterial, as mind, force, function, etc., and of abnormalities of function. The Student should not make the mistake of believing that Chiropractic Philosophy is a sort of psychology, telepathy, occultism, or the classic philosophy of Plato and Socrates. It is not Theology.¹¹²

This statement seems to contradict later ones in the same text regarding the divine:

The Infinite Intelligence that is the Source of everything in the Universe. The Infinite Intelligence pervading all space and matter, which creates and governs all things, both material and immaterial. It occupies all space and distance. It has existed always. It is older, wiser, greater, stronger and better than anything in the Universe. It created everything and must have been first and indefinitely superior in order to do it. It must have been and is VERY intelligent. Having these virtues it must have never made a mistake and therefore is always right. Being always right is always good. Being infinitely good is God.¹¹²

In utilizing religious metaphors like this, B. J. Palmer's writings on Innate and UI reflected a spiritual view, similar to his father's without necessarily pointing to any specific religion. It is clear, though, from D. D.’s posthumous 1914 book The Chiropractor that he considered, at least as a means of establishing legal protection, establishing a religion for chiropractors.¹¹⁵

The presence of UI and the embodied II was the central a priori assumption in B. J.’s philosophy and underscored a core concept known as the “Chiropractic Standpoint.” This was a term coined by B. J. in volume 6 that he considered the “big revolutionary idea.”⁹⁴ It became an enduring theme throughout the entire green book series.⁹⁴ The concept was useful as a perspective on the living organism that considered the organism's point of view. The Chiropractic Standpoint was broad in its scope, viewing all subjects in relation to what II was attempting to accomplish through the nervous system and how this related to wider questions about the intelligence inherent in the universe. In formulating this concept, B. J. brought forth a unique philosophical perspective grounded in classical vitalism.

III. Academic and Chiropractic Notions of Vitalism From the Modern to the Postmodern Era

From Classical to Critical Vitalism

Published around the same time as D. D. Palmer's Chiropractor's Adjuster, Henri Bergson's (1859-1941) Creative Evolution¹¹⁶ (1907) brought forward a modern interpretation of the vital force or vital impetus (élan vital) that would lead to international fame and the founding of Bergsonism. Bergson's work at this point drastically reframed the concept academically and foreshadowed later vitalistic notions.¹¹⁷ Ideas based on Bergson's élan vital have often been conflated with the Palmerian use of vitalism in the philosophy of chiropractic.

Bergson elaborated a theory of life in which our ordinary intellectual categories are incapable of grasping the essence, or the whole of life.¹¹⁸ This was a philosophical approach that looked to one's conceptualization of the nature of life as dependent on one's understanding of the evolutionary process, and tried to show that the complexities of life could not be adequately explained by the mechanistic or finalistic premises of evolutionary theories.¹¹⁸ It is in this context that his notion of an élan vital or vital impetus both broke with the mechanistic perspective and profoundly transformed the teleologic perspective.¹¹⁸

For Bergson, life was coexistent with consciousness or the manifestation of consciousness in matter. He wrote:

It is as if a broad current of consciousness had penetrated matter, loaded, as all consciousness is, with an enormous multiplicity of interwoven potentialities. It has carried matter along to organization, but its movement has been at once infinitely retarded and infinitely divided.¹¹⁹

This concept is remarkably similar to B. J. Palmer's concepts of an intelligent force working through matter.⁹⁴ The following views on the creativity of consciousness, expressed in matter, established the core of Bergson's theory of life and appear similar to those of the Palmers in other respects:

Life, that is to say consciousness launched into matter, fixed its attention either on its own movement or on the matter it was passing through; and it has thus been turned either in the direction of intuition or in that of intellect. … From this point of view, not only does consciousness appear as the motive principle of evolution, but also, among conscious beings themselves, man comes to occupy a privileged place. Between him and the animals the difference is no longer one of degree, but of kind.¹¹⁹

The infusion of matter with consciousness, the manifold potentialities of that consciousness (particularly in humans), and the resistance of the expression of consciousness by matter all bore resemblance to concepts found in the early philosophy of chiropractic. Linstead explained that Bergson's élan vital “should not be thought of as an organismic or personal property but as immaterial force whose existence cannot be scientifically verified but is nevertheless implied by all scientific endeavour and provides the imperative that continuously shapes all life.”¹²⁰ It is in Bergson's understanding of intuition and intelligence as a duality of consciousness that we see the uniqueness of his approach and some parallels with B. J. Palmer's ideas of an innate mind and educated mind, though it is unclear whether D. D. or B. J. Palmer were familiar with Bergson's ideas.

Like Claude Bernard, Bergson did not see himself as a vitalist, though he is characterized as one, sometimes in the extreme.¹²¹ Where it is true that Bergson sought to explain from the life sciences a metaphysical aspect of life, never in doing so did he propose vitalism as a wholly sufficient explanatory principle.¹¹⁸ His was rather a rejection of both mechanistic assertions and vitalistic inferences. In the former he saw a model of life devoid of essential creativity, and in the latter a radical teleology of life devoid of meaning. It is in this way that Bergson differed fundamentally from the view presented in Stephenson's text, which asserted that UI is the ultimate first principle.¹¹² Bergson did view the material milieu, however, as an impediment to consciousness, what could be referred to in the philosophy of chiropractic perhaps as “limitations of matter,”¹²² and concurred with the Palmers in seeing the physical as a landscape of potential expression. Caeymaex described this unfolding as “a radical becoming” in Bergson's meaning of life.¹¹⁸ It is this relationship between matter and consciousness that distinguishes Bergson as a link between earlier views and later vitalist thinkers. The principle idea of élan vital was later clarified by DiFrisco “not as a spiritual ‘vital force’ but as a tendency of organization opposed to the tendency of entropic degradation.”¹²¹ This is the same underlying principle of self-regulation and self-healing we find in both D. D. and B. J. Palmer's views on life. Bergson's emphasis on the organization of living beings was a central theme of the emerging philosophy of holism.

Vitalism and Organicism as Holism

Bergsonism, along with Driesch's entelechy, represents what Allen describes as varying interpretations of holism.¹²³ The term holism was coined in 1926 by Jan Smuts,¹²⁴ and describes “the tendency in nature to produce wholes from ordered grouping of units.”¹²⁵ Holism in chiropractic has been conflated with vitalism and organicism,^126,127 where by contrast it has been regarded as the foundational influence in current systems-based medicine in health care.^128,129 Holism in the early 20th century grew essentially out of 2 reactions:

first to a rigid mechanism beginning to dominate Biology by young researchers looking to legitimize the discipline to the level of physics and chemistry; second to the cultural fragmentation associated with “modernism” (especially with Darwinism), World War I, urbanization, and industrialization and the increasing mechanization of everyday life.¹²³

It seemed at that time as if those

who engaged philosophically with the life sciences were either logical empiricists who sought to impose the explanatory ideals of the physical sciences onto biology, or vitalists who invoked mystical agencies in an attempt to ward off the threat of physicochemical reduction.¹³⁰

The philosophic landscape of the early 20th century was much more diverse, however. Nicholson and Gawne have argued “that the most important tradition within early twentieth-century philosophy of biology was neither logical empiricism nor vitalism, but the organicist movement that flourished between the First and Second World Wars.”¹³⁰

Ferrario and Corsi described organicism as the materialistic form of holism, with vitalism representing holism's nonmaterialistic form. They further contrasted the 2 “with vitalism as a distinct, competing position with respect to organicism, … in some respects diametrically opposed to it.”¹³¹ Organicism sided with vitalism against mechanism.

At the start of the 20th century, mechanism had changed, as the work of Jacques Loeb (1859-1924) and Hans Spemann (1869-1941) introduced a “philosophical Mechanism that would become the foundation of a ‘new biology’ that sought to establish the life sciences on the same solid and rigorous foundation as the physical sciences, including a strong emphasis on experimentation.”¹²⁹ Technological advances in the first half of the 20th century, most notably in computer processing and genetics, spurred further expansion of these mechanistic philosophical themes.

In 1932, Walter Cannon (1871-1945) introduced the term homeostasis to the scientific lexicon in “The Wisdom of the Body,”¹³² alongside an idea that expanded on Bernard's earlier work of a milieu intérieur, or constantly moving internal environment.¹³³ Erwin Schrödinger (1887-1961), crossing over from physics, added to the ongoing conversation in 1944 with What Is Life?, suggesting the limitations of mechanistic approaches to the study of biology and the comparison of life to machines.¹³⁴ Although these works were clearly antimechanistic, they were not inherently provitalistic.

The rejection of vitalism was a position growing more popular in mid–20^th century research after the influential Vienna Circle (a group of prominent philosophers and natural scientists)¹³⁵ argued against Driesch, “Given the causal closure that physics reveals in the world, how could there be an immaterial vital impulse, force, entelechy or elan vital which causes events in this world without itself being caused?”¹³⁵

Francis Crick (1916-2004), in the closing of his 1966 book Of Molecules and Men,¹³⁶ summed up the antagonism toward vitalism in the 20th century: “And so to those of you who may be vitalists I would make this prophecy: what everyone believed yesterday, and you believe today, only cranks will believe tomorrow.”¹³⁶ Antivitalism and antimaterialism represented a shift in the natural sciences toward a middle ground that acknowledged the uniqueness of life without invoking a metaphysical or purely materialistic ontology.

Systems Theory, Autopoiesis, and Vitalism

Senzon recognized an early systems approach in Stephenson's view of chiropractic vertebral subluxation in the context of the organism's intelligent attempt to adapt to the environment.¹³⁷ Building on Leibniz's work, Ludwig von Bertalanffy (1901-1972) introduced systems theory, which rejected a purely linear and reductionist description of life.¹³⁸ Contrasting the bottom-up approach of reductionism, systems theory offered a top-down approach to the understanding of life as a gestalt “comprising properties that cannot be found by simple addition of the components’ properties, and that furthermore disappear when the Gestalt is destroyed.”¹³⁹ Beyond merely asserting that the sum is greater than its parts, Bertalanffy's ideas could be traced back to Kant, whose Critique of the Power of Judgment⁵⁸ asserted that “parts … are possible only through their relation to the whole”—what Beisbart describes as a holism condition in Kant's teleology of natural ends.¹⁴⁰ Callender sees a mechanistic/vitalistic dualism when comparing the antimechanist approach of D. D. and B. J. Palmer with that of Bertalanffy. Drawing parallels between Stephenson's principles 24 to 26 and similar statements made regarding systems theory, Callender proposes that there is a foreshadowing of systems theory in the Palmers’ philosophy and a “new, improved, more sophisticated vitalism”¹⁴¹ of that era that looked more to the functioning of living organisms than their constituent parts. Though the two philosophies share certain tenets, Callender also quotes Bertalanffy's position against vitalism:

Vitalism must be rejected as far as scientific theory is concerned. According to it, structure and function in the organization are governed, as it were, by a host of goblins, who invent and design the organism, control its processes, and patch the machine up after injury.¹⁴¹

Bertalanffy took issue with not only the invocation of a metaphysical causation but also the tendency of vitalism and mechanism to divide living beings into discrete parts. This view was also central to the organicism of German neurologist and psychiatrist Kurt Goldstein, whose work asserted that “no biological entity is inherently divided in parts, and parts are just (pretty much illicit) abstractions, produced by our investigative efforts and attitude.”¹³¹ Whereas it is clear that Goldstein and Bertalanffy were categorically against vitalism as a scientific theory, a case could be made that the philosophical assertion behind systems theory as an “organismic concept” and Goldstein's theory of organicism paralleled the vitalistic perspective of recognizing the primacy of the whole and the indeterminacy of becoming in life.

The primacy of the whole exerted a strong influence on Varela and Maturana, who in 1973 introduced a theory of life based on organization that they termed autopoiesis, from the Greek meaning “self-production.”¹⁴² In its basic sense, autopoiesis held certain similarities with principles introduced in Stephenson's work, which saw life as composed of “organized matter” and described the adaptation of forces and matter as coordinated action within the body limited by universal law.¹¹² Varela and Maturana's claim, for instance, was that living organisms could only be characterized unambiguously by “specifying the network of interactions of components which constitute a living system as a whole, that is, as a unity.”¹⁴³ They argued that all living systems must share a common organization and that “the great developments of molecular, genetic, and evolutionary notions of contemporary biology have led to the emphasis of isolated components … and hence, [do not] ask about the organization which makes a living system whole.”¹⁴³ They further claimed that reproduction and evolution were secondary to the establishment of this organization.¹⁴³ Instead of taking a reductionist view, asking “What are the necessary properties of the components that make a living system possible?” Varela and Maturana began with the question “What is the necessary and sufficient organization for a given system to be a living unity?”¹⁴³

Autopoiesis described

a unity realized through a closed organization of production processes such that (a) the same organization of processes is generated through the interaction of their own products (components), and (b) a topological boundary emerges as a result of the same constitutive process.¹⁴⁴

Maturana proposed autonomy as a fundamental feature characterizing living systems and emphasized the nervous system as both a “component subsystem in an autopoietic unity” and integral to the “structural coupling” necessary to build language and express identity.¹⁴⁴

Building on this theory, Maturana and Varela attempted to “conquer the dualistic gap between objects and perceivers, or things and subjects, that [had] haunted philosophy since early modern time.”¹⁴⁵ Where Maturana in his later work stayed on a more mentalist, less embodied account of cognition, Varela moved to what he later called “enactivism,” whereby organisms enact the world they are living in by the process of their autoconstitution. For Varela, the shortest definition of an organism was the process of constituting an identity.¹⁴⁵

The process of autopoietic self-creation offered new perspectives on the intrinsic teleology of self-organization introduced by Kant in the Critique of Teleological Judgment.¹⁴⁶ For Kant, things that organize themselves were considered natural purposes, and as such were both the cause and effect of themselves. This described a circular interrelation of means and goals which complicated the popular biological view of organisms as nonteleologic. In this way, as Weber and Varela state:

Kant had been right in denying a Newtonian, mechanical character of the living: Evolutionary thinking had to re-discover the autonomy and self-organization of the organism and their importance for evolution, so that the Newtonian dominance consequently could be trimmed down considerably, making place for the organism's creativity.¹⁴⁶

Acknowledging the creativity and indeterminacy of life underscored later critical vitalism and the continued use of vitalism in chiropractic—the foundation of which began, as Bennett reflects, with what Driesch identified as a “not wholly-calculable, not-quite-material impetus … responsible for organic becoming that underscored the open-endedness of life.”¹⁴⁷ Driesch's work attempted to experimentally account for this by offering an immaterial creative force apart from the spiritual, as did Bergson's élan vital. What was also required was a concept of time opposed to a simple, linear scale, seeing time instead as a multidimensional variable in a complex way of thinking of life.¹⁴⁸ This was a view essential to the nature of becoming as “time's message written across life” representing an active evolution.¹⁴⁸ Nietzsche reflected this view of time, as Shostak writes: “Indeed, Nietzsche's becoming is close to evolution, not an historical evolution or historicism, to be sure, but an active evolution. This activism is suggested by the ‘taskmaster who once bade himself, and not in vain: “Become what you are!”’¹⁴⁸ An alternative view of becoming inherent in nature and life, beyond Darwinian evolution, that was shown in early–20th century vitalism posited, as Bergson stated, that the “vital principle might indeed not explain much but it is at least a sort of label attached to our ignorance, … while mechanism invites us to ignore that ignorance.”¹¹⁶

Critical Vitalism and the Vitalism Ethos

The French philosopher and physician Georges Canguilhem (1904-1995) was labeled a vitalist at a time when being one invited criticism. His approach was revolutionary and inspired numerous new perspectives on the topic.^135,149,150 He bridged the old classical notions of metaphysics by building on concepts introduced by Bergson¹³⁵ in appreciating, as Greco points out:

not what [vitalist theories] say - and whether what they say is scientifically defensible - but rather what they do, by providing a form of resistance or antithesis to the recurrent possibility of reduction, and to the temptation of premature satisfaction.¹⁴⁹

Canguilhem chose to acknowledge the historical untenability of classical vitalism and build upon this fact, as Greco has, in establishing a new diachronic dimension to the question of vitalism “that supplements and subverts each one of its [historical] settlements.”¹⁴⁹ As we have seen, most historical manifestations of vitalism fall into what Wuketits describes as either animist or naturalist definitions, the former invoking a metaphysical force that imbues raw matter with life, the latter positing organic law(s) that supersede, at least locally, physical explanation.^149,151 Either approach commits the “inexcusable error,” per Canguilhem, of reducing life to object. A notable exception is the medical vitalists of the Montpellier school, who, as we have seen, took a Newtonian approach to the “vital principle” as merely a placeholder for what they saw as limits to mechanisms that would be eventually overcome.¹⁵² This was evident as well in the empirical approach of the Palmers, who based their philosophy around what they considered to be a law of nature “as old as the vertebra” that would someday be revealed experimentally.⁶⁸

Approaching the history of vitalism from Canguilhem's perspective, we find “vitalism a unique kind of historical object”¹⁵² or “valid—not in the sense of a valid representation of life, but in the sense of a valid representative.”¹⁴⁹ This speaks to Canguilhem's assertion that “life is concept,” which can be understood in the tradition of Goldstein and of Uexküll's Umwelt or phenomenal emergentism. Similar statements by biologists assert that “human knowledge is a ‘general method for the direct or indirect resolution of tensions between man and milieu.’”.¹⁵³ Vitalism in this context should not be restricted to humanity but rather “addressed to reality as a whole, eliding the categorical difference between animate and inanimate, living and nonliving entities. An implicit enthusiasm for the ‘vital’ as a signifier of contingency, potentiality, and the possibility of change.”¹⁵⁴

Having explored the history of vitalist thought in Western medicine and the life sciences, we can begin to fully appreciate Canguilhem's decision to embrace the untenable a priori historical assumptions of classical vitalism and use them as a point of departure. In 1974, Benton published a typology (grouping by type) of varying forms of vitalist philosophy popular during the 19th century. If vitalism was not “the belief that forces, properties, powers, or ‘principles’ which are neither physical nor chemical are at work in, or are possessed by living organisms,”¹⁵⁵ as defined by Benton and exemplified throughout history, then what did Canguilhem mean in applying the term? And what could such a definition add to our understanding of the nature of life in the health sciences, including chiropractic?

Bianco states that Canguilhem's work “rests on a double deontological dogma: a ‘vitalism of norms’ and, as a consequence of this, a normative vitalism.”¹⁵⁶ Put plainly:

According to Canguilhem, life consists in the plastic power, proper to all organisms, of creating qualitatively new norms; if life is essentially a potentiality, then this means that the living being is not simply a machine, an assembly of pieces reacting to the environment, but is what modifies and creates it.¹⁵⁶

Rabinow and Caduff concur: “Life [for Canguilhem] is not stasis, not a fixed set of natural laws set in advance and the same for all, to which one must adhere in order to survive. Life is action, mobility, and pathos.”¹⁵⁷ This means for Bianco “that pathology cannot be described as a deficit or a disorder of a supposed normal state, but it is just a qualitatively different norm proper to the living being confronted with an obstacle.”¹⁵⁶

For Canguilhem, approaching pathos as a qualitatively different norm was a departure from his early mentor Alain, whose idea of pathology was that disease is a state of the organism which is quantitatively different from the normal one: it consisted of an irritation or disproportionate reaction to an exterior excitation.¹³⁰ Alain's philosophy could be traced back to Descartes, whose ideation of the body as machine meant that medicine was “just an extension of physiology, the science concerning the laws that govern the ‘animal’ part of man.”¹⁵⁶

This same reductionist approach was behind biomedicine throughout the early to mid–20th century in the form of Boorse's biostatistical theory of health,¹⁵⁸ which framed health and disease as objective concepts. In order to capture the psychological and social aspects of health missing from Boorse's model, Engel proposed a new theory in medicine: the biopsychosocial model, which though holistic was solely grounded in empiricism.¹⁵⁹ Engel's model has been acknowledged within chiropractic and promoted as a sufficient alternative to vitalism by those calling for a removal of metaphysics from the profession.^160,161 This side of the metaphysical debate—those whom Biggs et al refer to as “rationalists”¹⁶²—sees an evidence-based biopsychosocial approach (Engel's model) as the only path forward for chiropractic in terms of greater validity and acceptance within health care. A purely evidence-based approach, even within the context of a biopsychosocial model, however, commits the same “inexcusable error,” whose limit is the dead end of reductionism that sets the patient apart from pathos and a fortiori from nature.

Alfred North Whitehead took a similar stand against separating life from nature, which occurs in medicine when interaction within the body is seen only in terms of fundamentally separate parts. For Whitehead, interactions occurring within fixed inflexible boundaries are a misconception. He posited that all matter interacts and partakes of each other through, “in some sense or other,” a “mutual immanence.”¹³⁸ Like Canguilhem, Whitehead presented what seemed a metaphysical proposition (the idea of mutual immanence) against the “philosophical prejudice of the scientific community.”¹⁶³ His was an attempt at a commonsense understanding of the immanent mutual interactions of matter in the universe, which must defy purely linear causation.¹⁶³ Acknowledging pathos as a qualitative norm of life, as Canguilhem does, bears similarity to Whitehead's processual cosmology, which, as Greco points out, “is to conceive nature so that the qualitative vividness of experience—including human experience, in all its positive and negative vicissitudes—appears intrinsic to it, arising out of its most basic elements.”¹⁵⁴ Osborne promotes the same acknowledgment of pathos:

The pathos principle—that life is subject to sub-normativity, to pathos, disease—is crucial. Canguilhem repeatedly stresses that only the biological organism is capable of falling sick, that pathology is always “existentially first” and at the heart of any rigorous, as opposed to any merely analogical, extrapolative or generalizing vitalism.¹⁵⁰

For Canguilhem and others, vitalism described the tension inherent in organisms adapting and maintaining functionality or form despite an ever-changing milieu. It is thus, as Canguilhem suggests, an “exigence” or ethos. Greco writes:

Vitalism as ethos posits nature as a whole in the register of pathos, assuming sensitivity as the ontological norm rather than the exception. It admits death—disease, pain, disintegration—into its imaginary of what is irreducibly real, as the ebb and flow of becoming, instead of treating it as a clandestine occurrence with no right of existence in our experience, forever surprising us.¹⁵⁴

D. D. Palmer's concept of disease expressed the same view:

Disease does not involve any new functional expression which the body does not already possess; it is only a change in the amount of energy and function performed; the body, in disease does not develop any new form of energy; what is already possessed is diminished or increased, perverted or abolished.⁹⁷

We could understand this as a fundamental, biological aspect of life central to his original concept of Innate. The role for the doctor, in our discussion the doctor of chiropractic, is therefore to be

always on the side of life, aiming to restore the organism to relatively balanced norms even if these are less than fully “normative”. In this sense sickness is not an absence of “normal” functioning but the advent of a more constricted normative world.¹⁵⁰

Greco's conclusion regarding a vitalism ethos is that taking a pathic view allows for both an epistemological “need to be attentive, to take care of the multiple and diverse forms of ontological sensitivity, including sensitivity to our imaginaries and desires,” and cognitively “not being driven by fear and denial of death, of pathos, but rather by the confidence that every occurrence can expand and add value to experience, and should be honoured as such.”¹⁵⁴

What such a vitalism ethos essentially provides for chiropractic is a return of health and disease to unified expressions of normativity, in line with the original biological conception of the Palmerian Innate. Each patient can be seen as a highly complex manifestation of nature itself displaying emergent properties that derive new information, information that recursively informs further unfolding within the temporality of nature. A vitalism ethos affirms the noninvasive approach of the chiropractic adjustment, which seeks to work with, not override, the body's adaptive responses to facilitate greater healing or more favorable qualitative norms. Though no longer in need of metaphysical forces, a vitalism ethos acknowledges life as concept taking form within and through the physical milieu, subordinating each of us, doctor and patient, to the infinite expanse of nature. We have the opportunity to see chiropractic vertebral subluxation not as just another mechanical disorder to be corrected but as a natural expression of nature responding to itself. The opportunity to administer an adjustment, therefore, is an act of nature coalescing around an intended norm and asserting through a salutogenic act the persistence of life.

Toward Mending the Philosophical Schism

As we have observed in this exploration of the history of vitalism, the development of thought within various philosophical and medical schools around the world has led to tremendous advancement over the centuries, but not without the cost of conflict. This same conflict was woven into the development of the philosophy of chiropractic. “[D. D.] Palmer's philosophy represented an early postrational perspective without a clear strategic plan for how to bring it forth in the world,” and partly as a result, “after [Palmer's] death in 1913, a century of warfare followed between the ‘straights’ and the ‘mixers.’”⁹ It has been said that D. D. Palmer was not solely at fault for this outcome, but that limited strategic thinking on the part of leaders in the early years of the profession was also to blame.⁹

To date, there is no consensus regarding core concepts or definitions of terms in the philosophy of chiropractic such as II or UI. McAulay makes clear the danger in this: “The discipline of the philosophy of chiropractic cannot advance until the scholars who study and teach philosophy formally agree on definitions for these core concepts.”¹⁰

On 1 side of the debate are those whom McAulay has deemed “authoritarians,” who discuss “the philosophy of chiropractic as a ‘fait accompli’, completed in its development early in the twentieth century. Advocates of this approach tend to bring a lack of questioning in their writing and analysis, primarily supporting previously established notions.”¹⁰ An example of this position can be seen in the description of UI in Maynard's biography of the Palmers:

There are certain laws at work in the universe, but there is apparently more at work than the laws of chemistry and physics. We might say at this point that there are certain truths which we perceive intuitively and which cannot be perceived any other way.¹⁶⁴

This approach has been labeled faith or dogma by those who are critical of the vitalistic notions inherent in the metaphysical aspects of the philosophy of chiropractic.^4,6,165, 166, 167 McAulay has deemed “dismissivists” the group who attack “traditional concepts without the use of accepted methods of rigorous analysis,”¹⁰ and he provides several examples of dismissivist positions in the literature.

An example can be seen in the International Chiropractic Education Collaboration (ICEC) position statement that addresses vitalism as it pertains to chiropractic vertebral subluxation: “The teaching of vertebral subluxation complex as a vitalistic construct that claims it is the cause of disease is unsupported by evidence.”¹⁶⁰ In a footnote, the ICEC specifically mentions a “form of vitalism as distinct from holism,” then references a quote by B. J. Palmer instead of specifying which form of vitalism is in question.¹⁶⁰ In my opinion, this conflates B. J. Palmer's ideas with all other forms of vitalism and obfuscates the issue of vitalism's usefulness. Canadian Memorial Chiropractic College has issued a clarifying statement supporting the ICEC's view and stating that few practitioners would deny the very simplest use of the

concept of vitalism (or “neo-vitalism”) … to describe the body's inherent ability to regulate and heal itself. It is when the use of the term expands to include metaphysical connotations of a life force connected to all organisms and which becomes blocked by vertebral subluxation, that most scientists, and the Position Statement, reject the concept.¹⁶¹

This statement first conflates neovitalism (which points to Driesch's view) with all other forms of vitalism, then offers 2 limited definitions. The first definition seems to align with the Hippocratic notion of benevolent nature or vis medicatrix naturae, and the second to a classical notion of vitalism based on a “life force connected to all organisms” that bears a resemblance to Stahl's animism. Neither of these definitions captures the fullness of meaning provided by either D. D. or B. J. Palmer in their descriptions of UI and II, nor do they reflect broader contemporary notions of vitalism in academia. Presenting vitalism in this way obfuscates the substantial differences in meaning across various representations of it and reduces the topic to a form inconsistent with any theory so far defined in the literature.

Others within the chiropractic profession have taken liberties with defining the term vitalism. Some chiropractic college websites offer a variety of definitions and perspectives on the concept to the public. Life University's website promotes vitalism as a “recognition that the Universe itself is self-conscious, and as such, creates itself as a dynamic system wherein living organisms are self-developing, self-maintaining and self-healing.”¹⁶⁸ This definition comes close to representing autopoiesis, which, though related to vitalistic concepts, does not reflect the same perspective on life as most vitalistic theories. Life University does, however, embrace an ethos of vitalism.¹⁶⁸

Sherman College of Chiropractic offers a definition of vitalism that seems to this author to closely resemble holism and organicism:

Vitalism is a “vital” part of chiropractic philosophy [because] chiropractic approaches health from a holistic perspective, recognizing the innate intelligence that uses the brain and nervous system to maintain the body's health. … Vitalism understands the human body is striving for organization and that disruptions to the body's nervous system, in the form of vertebral subluxations, can be addressed through specific chiropractic adjustments.¹⁶⁹

Life West's website mentions a “commitment to producing strong, vitalistic, subluxation-based programming” and “The WAVE: a three-day celebration of vitalistic chiropractic” but never offers a clear definition of which form of vitalism the school promotes.¹⁷⁰ It claims to be conducting vitalistic research, such as a study of biomarkers before and after chiropractic adjustment as related to “vitality,” but does not elaborate on how this relates to any philosophical understanding of vitalism.¹⁷¹ Likewise, the website for Palmer College of Chiropractic in Davenport, Iowa, affirms the importance of vitalism in the philosophy of chiropractic but stops short of identifying any specific form of vitalism: “The philosophy of chiropractic is built upon the constructs of vitalism, holism, conservatism, naturalism and rationalism.”¹⁷²

These examples show that even those who support vitalism as integral to the philosophy of chiropractic have varying interpretations. It could be inferred that those in the profession who support vitalism may do so in a similar fashion as Bergson by applying the term as something of a placeholder for our ignorance and a barricade against the claims of scientism and reductionism without being fully explanatory. If this is the case, using the term vitalism in this way is perhaps useful but inadequate. The development of vitalism as a philosophy within academia demands that chiropractic educators and philosophers make clear their stance.

The vitalist philosophy and worldview of the Palmers is understandable in the context of 19th century America and proved beneficial in establishing a unique identity for chiropractic within health care. The metaphysical concepts of UI and II can be seen as examples of substantival vitalist thought, with roots extending as far as ancient Hellas and perhaps beyond. The Palmers’ use of religious metaphors combined with empirical hypotheses regarding subluxation created confusion within the profession that obscured the value of these concepts. The cost of this confusion has been a growing conflict within chiropractic which has threatened its identity and political stability. Conflict over the meaning of terms, however, is evidence not for their removal from the philosophy of chiropractic but rather of the need for their clarification.

As we have seen throughout this article, the debate within chiropractic over vitalism echoes a similar conflict over vitalism observed throughout the history of philosophy and the life sciences.^2,6 The principal arguments for and against vitalism within the philosophy of chiropractic have until recently been built on antiquated versions of the concept that have not been seriously considered since Driesch and Bergson. These debates regarding vitalism omit D. D. Palmer's original theory that the patient's pathophysiological process is a normative response to environmental stimulus and an expression of life's underlying intelligence, moderated by the nervous system's sensibility.

Vitalism as a concept has evolved. It is no longer an answer to the question “What is life?” any more than a pointing toward entelechies. It is a recognition of the indeterminacy of nature, to which human life is subordinate. It is an observation of the interface between the entropic material milieu and the sustained expression of adapting form. It is an ethos observing a patient's pathos as part of a natural becoming that defines the expression and resilience of life. As Koch points out:

A vitalistic viewpoint on human functioning has given the chiropractic profession a respect for and a trust in the naturalness, the integrity and the self-determinism of life that has provided a much more correct attitude, a humility if you will, in the face of life's awesome power to create and define itself with or without our help.¹

Vitalism begins at reductionism's end in the indeterminate unfolding of the biosphere, without the need to stand as an antithesis to physical law. We should accept, as Canguilhem did, that in light of this indeterminacy, health as a normative state cannot be statistically or mechanically defined.¹⁷³

A vitalism ethos acknowledges that the phenomenon of life is fundamentally original, adaptable, and unpredictable. It is original in its ability to create meaning from milieu; adaptable in its normativity through confronting pathos; and unpredictable (indeterminate) as it transforms itself and evolves. To call oneself a vitalist, or make a philosophical argument for vitalism, may be logically defensible through this contemporary view of life. In this way, chiropractic philosophers and practitioners have a solid footing in calling themselves vitalists. Holding to prior classical notions of vitalism, however, represents a regression into untestable or occult forces. Denouncing vitalism outright, pointing to its animist or extreme form alone, is a straw man fallacy.

I propose that the philosophy of chiropractic should embrace vitalism as an ethos that allows for the indeterminate response of the body and the inherent value of diversity within chiropractic approaches to care. From the perspective of vitalism as ethos, research could be framed around qualitative normative states, or what has come to be called “normative medicine,”¹⁷⁴ extending beyond the limitations of Boorse's model and reductionism to embrace the experiential Umwelt or relevant beyond from which life is centered.¹⁵⁰ Examples of this could be framed around cohort studies and whole systems research, where, as Hawk points out, “a central concern is ‘model validity,’ which means that the research methodology must be congruent with the worldview (paradigm) of the system being studied.”³ Similarly, McDowall et al offer the concept of tone as an interface for the metaphysical providing fertile ground for future research: “Tone may hold value in the context of functional neurology as a medium for the health effects of nutrition, environmental, and metaphysical interventions such as religiosity, prayer and meditation.”¹⁷⁵ Adapting D. D. Palmer's concept of tone as a unification of material and immaterial, toward a “new platform for a hybrid health care model” or a “true personality … that underpins the identity of the chiropractic profession” is inherently vitalistic from the perspective of normativity.¹⁷⁵ These approaches support Senzon's prediction that “by relinquishing a reductionistic and allopathic research model, chiropractic could remain true to its philosophical leanings toward holism and non-therapeutic practice.”²

Vitalism as ethos, born out of classical notions of metaphysics at the turn of the 19th century, honors the philosophical metaphors of chiropractic's founders, building from them a philosophy of chiropractic that is both open to innovative approaches in research and congruent with developments within peer-reviewed literature in academic philosophy.

Limitations

This article is a discussion of my viewpoints on the topic of vitalism and the chiropractic health care paradigm. It is limited to my choice of supporting references and theoretical framework. Others may have differing viewpoints from those presented here.

Conclusion

By approaching the topic of vitalism from a broader historical context, I have attempted to illustrate the plurality of vitalist ideas found in academic philosophy and in doing so correct some of the inaccuracies and misrepresentations that have been used within the chiropractic literature as a strawman fallacy against vitalism. Further, I have proposed the adoption of vitalism within the philosophy of chiropractic as an ethos based on the work of Georges Canguilhem. A vitalism ethos would allow us to observe the phenomenon of life as fundamentally original, adaptable, and unpredictable. In this sense, life cannot be sufficiently understood in purely reductionist terms. By adopting vitalism as an ethos, we have an opportunity to approach the discipline of the philosophy of chiropractic through a form of vitalism that may help open the profession to new philosophical inquiries and innovative approaches to patient care.

Funding Sources and Conflicts of Interest

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

Contributorship Information

Concept development (provided idea for the research): J.T.T.

Design (planned the methods to generate the results): J.T.T.

Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): J.T.T.

Data collection/processing (responsible for experiments, patient management, organization, or reporting data): J.T.T.

Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): J.T.T.

Literature search (performed the literature search): J.T.T.

Writing (responsible for writing a substantive part of the manuscript): J.T.T.

Critical review (revised manuscript for intellectual content, this does not relate to spelling and grammar checking): J.T.T.

Practical Applications.

• •This article documented the history and development of vitalism and its role within chiropractic for reference within chiropractic-specific literature.
• •It discussed the ongoing debate about the nature of vitalist philosophy within chiropractic.
• •It offered a construct of vitalism that may be useful to the chiropractic profession for ongoing research.

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