Reflection as transformation C ollaboration and reflection across boundaries

1. Reflection as transformationCollaboration and reflectionacross boundaries Steen Wackerhausen Dept. of Philosophy and the History of Ideas Aarhus University, Denmark steen@wackerhausen.dk

2. Content • Why inter-professional collaboration? • An ontological perspective • An epistemological perspective • Ethical requirements • Professional identity and boundaries • The anatomy of professional identity • Forms of identity possession • Ways of acquiring professional identity • Reflection and collaboration • 1. order reflection • The “immune system” – or the empire strikes back • 2. order reflection • Inter-professional reflection • A plea for the future

3. Why inter-professional collaboration? (a) Ontological perspectives ‘Ontology’ – the study of the basic structures and dynamics of existing phenomena A solid ontological result: Every existing phenomenon is the center of a highly complex and dynamic field: a causal field. Nothing comes of nothing (and only “nothing” causes nothing). Consequently, every phenomenon owes its existence to something else. Metaphorical speaking: Every phenomenon is a child with many parents, grandparents, great-great parents, etc.

4. Why inter-professional collaboration? (a) Ontological perspectives (cont.) Example: A specific person’s back pain after a football match What made this phenomenon come into existence? X = f (a, b, c, d, e, ……) For causes and explanations: physiology physics psychology cultural studies rules of football etc. X

5. Why inter-professional collaboration? (a) Ontological perspectives (cont.) What can make this phenomenon change or disappear? (q, z, y, w, etc.) X = f (a, b, c, d, e, ……) Passive Active X A phenomenon’s causal field .. and only “nothing” causes nothing

6. Why inter-professional collaboration? (b) An epistemological perspective The size and complexity of a causal field … • outside the epistemic reach of any given scientific discipline • “The truth, nothing but the truth”, but not the whole truth • epistemic humility – far more to be know And .. • No profession knows all what are relevant to know • A professional humility is warranted

7. Why inter-professional collaboration? (C) The ethical demand The goal Doing what is best for the patient The means Relevant knowledge, skills, and competence The ontological condition The complexity and size of a causal field are “infinite” The epistemic limitations of any profession No profession has all the knowledge and skills to do what is best for the patient. Collectively, the professions know and can do more. The ethical demand For the purpose of the patient’s well-being, inter-professional collaboration is a requirement.

8. Professional identity and boundaries Inter-professional agreement (in a philosophical moment) .. on the ontological conditions, the epistemic limitations, and the ethical demands but often no genuine collaboration! Why? Some of the reasons are to be found in the constitution and roles of the identity of professions (professional identity)

9. Professional identity and boundaries Macro level of professional identity • not the professions decision alone • acknowledgement and negotiations • other factors: history, economy, political factors, prestige, technology, scientific progress, etc. Micro level of professional level • practitioners, communities of practice, etc. • to be “one of our kind” • formal qualifications • explicit knowledge, tacit knowledge, skills, etc. But more is needed to be a fully acknowledge member of a profession ..

10. Professional identity and boundaries (a) The anatomy of a profession A way of speaking (terms, concepts, etc.) A way of questioning (relevance) A way of understanding and explaining A way of seeing A way of doing And acknowledgement of the professions.. symbolic capital, status, metaphors, narratives, conceptions of other professions, etc. • To become, to be, and to stay “one of our kind” • Habitual approach: perspectives and dispositions

11. Professional identity and boundaries (b) Forms of identity possession • Explicit levels of possession • Embodied levels possession Embodiment, habituation, and habits Everyday habits and professional blindness excursion:A cow named Maren The habitual/the usual does not thematize itself

12. Professional identity and boundaries (c) Ways of acquiring professional identity • Scholastic learning (secondary) • Informal and tacit learning in communities of practice (primary) informal learning of: a way of talking a way of questioning a way of explaining etc.

13. Professional identity and boundaries On the micro level of professional identity habitual ways of talking, questioning, explaining, doing, assuming, etc. often embody unwanted boundaries constraining genuinely inter-professional collaboration On the macro level of professional identity we often witness embodied boundaries of and barriers to inter-professional collaboration too. Survival, symbolic capital, higher salary, etc. plays significant roles. Often too many unexamined background (embodied) concepts and assumptions are serious obstacles to collaboration. Concepts and assumptions in disharmony with the ontological, epistemic, and ethical arguments for collaboration. It seems reflection is needed …

14. Reflection and collaboration Is reflection a solution? It depends! • Reflecting on (theme, topic, etc.) • Reflecting with (concepts, beliefs, etc. • Reflecting from (perspective, interest, etc.) • Reflecting in (context, surroundings, etc.)

15. Reflection and collaboration 1. Order reflection • Reflection as usual: habitual reflection? • 1. order reflection • Effective? Maybe! Transformative? Probably not! • Many topics, concepts, perspectives, contexts, etc. • Background concepts and dogmas of a profession are often undisturbed

16. 2. order reflection • “Becoming a stranger to oneself” • Making the invisible visible • Reflection on our habitual way of reflecting • Reflecting on our 1. order reflections • on something (what and why we thematize) • with something (basic concepts, beliefs, etc.) • from a perspective (tacit interests, values, etc.) • in a context (the motivating/constraining surroundings) • Destabilizing the stabilized Enough?

17. “The immune system” - The Empire strikes back! • “One of our kind” – rules of conduct and membership • Attacking the destabilizer • Ignoring • Re-education (rehabilitation) • Marginalization • Isolation or exclusion • Courage and the willingness to be proven wrong • Minimizing “the immune system” • Changing conditions, diversity, and fit

18. Inter-professional reflection • A shared set of goals • Professional humility • Acknowledgment of the ontological, epistemic, and ethical conditions and requirements • Critical and constructive • Non-fundamentalist attitude • A way of being professional • Transformative • Surely, not all reflective activities (reflection) fulfill the normative characterizations.

19. A plea for the future • Reflection as a transformative and collaborative quest • The requirements • 1. and 2. order reflection • A quest for what is right and what is true • A willingness to be proven wrong • An epistemic awareness • Intuition, habits and consensus are no guarantee • Humanism (renaissance) • Fighting self-deception • “Raw realism” • Human flourishing (is and ought)

20. A plea for the future • Reflection in a humanistic perspective • Reflection as a human obligation • Reflection as a critical and constructive activity • Reflection as an unending journey • Reflection as a productive disharmony • Reflection as a way of being • That is, reflection as a transformative and collaborative quest