The Pioneer Health Centre

The emergence of spontaneous order




This is an extract from Biologists in search of material, an interim Report on the work of the Pioneer Health Centre of Peckam, London. The interest of this report consists, among other things, in presenting a new paradigm concerning health care based on the distinction between disease and disorder. The entire report is available on the Internet and its reading is highly recommandable.



Our problem is the ‘man in the street’. He is the man without egotistic drive; he is the diffident and the meek. Because he seems to lack initiative he is left to his own resources—of which he seems to have none. To attract him to any organization is difficult enough; to keep him in it is still another problem. But because he forms the bulk of the public he is most worth study, for on him the success of any social organization depends.

The first tentative approach to encouraging the members to do things was based on the common assumption that ordinary people like to emulate their betters; that an exhibition of a high degree of skill, of relative perfection, would stimulate the imitative faculty and lead to like action.* That method of approach we have found useless; the assumption is not borne out by the experiment.

Primarily, individuals are conscious only of their own capacity and act accordingly. They may admire, they may even be envious of outside standards, but they do not use them even as stimulants to try out their own capacity. Skill beyond their own capacity tends to frighten, to inhibit rather than to tempt them to emulation. The status ‘teacher’ tends inevitably to undermine self-confidence.

Our failures during our first eighteen months’ work have taught us something very significant. Individuals, from infants to old people, resent or fail to show any interest in anything initially presented to them through discipline, regulation or instruction which is another aspect of authority. (Even the very ‘Centre idea’ has a certain taint of authority and this is contributing to our slow recruitment.)

We now proceed by merely providing an environment rich in instruments for action—that is giving a chance to do things. Slowly but surely these chances are seized upon and used as opportunity for development of inherent capacity. The instruments of action have one common characteristic — they must speak for themselves. The voice of the salesman or the teacher frightens the potential users.

How does this fact reflect on organization and the opportunity for experimental observation on this material?

Having provided the members with a chance to do things, we find that we have to leave them to make their own use of them. We have had to learn to sit back and wait for these activities to emerge. Any impatience on our part, translated into help, has strangled their efforts—we have had to cultivate more and more patience in ourselves. The alternative to this cultivation of patience is, of course, obvious—the application of compulsion in one or other of its many forms, perhaps the most tempting of which is persuasion. But having a fundamental interest in the source and origin of spontaneous action— as all biologists must — we have had to discard even that instrument for initiating activities. Even temptation, the gentlest form of compulsion, does not work because human beings, even children, recognize carrots for what they ultimately mean; we have at least progressed beyond the donkey!

We do not suggest that communion, teaming, regulation, system, discipline, authority and instruction are not desirable things but neither can we agree that there is anything wrong with those who spurn these things; we are not missionaries seeking to convert people to desirable things, but scientists seeking the truth in the facts.

Civilization hitherto has looked for the orientation of society through an imposed ‘system’ derived from some extrinsic authority, such as religion, ‘cultural’ education, or political suasion. The biologist conceives an order emanating from the organism living in poise in its environment. Our necessity, therefore, is to secure the free flow of forces in the environment so that the order inherent in the material we are studying may emerge. Our interest is in that balance of forces which sustains naturally and spontaneously the forms of life we are studying.

The Centre is the first experimental station in human biology. It asks the question—‘What circumstances will sustain human beings in their capacity for full function (i.e. in health); and what orientation will such fully functioning entities give to human living (i.e. to society)?’

Clearly then any inquiry into the nature of health in the organism, to which our experiment is directed, demands first and foremost a study of methods, free from compulsion, of collecting human material and retaining it for continuous observation.

It also demands a critical study of the conditions and controls which are so fundamental a part of scientific experimentation. The values of variables must be known or conclusions will remain matters of opinion. Dealing with matter or form, as the chemist does, with motion or force as the physicist does, or with isolated organs as the physiologists do, permits of a straightforward technique for conditioning and controlling any experiment. The biologist studying the human organism must deal with free agents. Moreover, their freedom is highly susceptible to limitations. This presents us with a seemingly insoluble difficulty, since those limitations come from other free agents and particularly from the observer. Can the scientific method of experiment be applied at all to the study of the human organism? Is it possible to make due and proper allowance for the observer’s and the free agent’s participation in the experiment?

As one of our colleagues remarked—It seems that a ‘sort of anarchy’ is the first condition in any experiment in human applied biology. This condition is also that to which our members most readily respond.

To the scientist who must accept this condition for his experiment, the question will be: What is it that makes anarchy possible as a condition? That merely shifts the question from the individual under study as a free agent to the individual-plus-his-self-created-environment as a free agent.

In the Centre the question is often asked by visitors—‘Is it the personality of one or other of the staff or the staff as a whole that gives this anarchy a sort of desirable order? Or is it the thing called ‘atmosphere’ of the Centre, which again may be a compound of the personality of the staff and the members themselves? Or again, is it some more fundamental subjective condition inherent in the human organisms (e.g. altruism or its antithesis egoism) which creates this autonomous order and of which the so-called atmosphere is but the objective symbol?

Clearly these are very pertinent questions, the answers to which must come by direct inquiry and experiment. For this seeming anarchy demanded by our members is the operation of something contained in the material and worthy of analysis. Further, any imposed action or activity becomes a study of authority, discipline or instruction and not the study of free agents plus their self-created environment.

The active-passiveness of the observer is not easy to attain without the essential extension of the laboratory scientist’s discipline which allows facts to speak for themselves. In human biology the facts are actions which seriously complicate the problem but do not put it beyond the possibility of solution.

The biological necessities of the situation then compel us to leave the members to themselves, to initiate their own activities, their own order of things. We have no rules, regulations nor any other restriction of action, except a very fluid time-table. Within eighteen months the seeming chaos and disorder is rapidly developing into something very different. This is apparent even to our visitors, one of whom on leaving described the life in the Centre as being like a stream allowed to form its bed and its banks according to the natural configuration of the land.

So it would seem that a very strict ‘anarchy’, if we can use that term, will permit the emergence of order through spontaneous action, and so provide a field of observation for the biologist.

To sustain the anarchy as order emerges is more difficult, for the order tends to degenerate by habit into system which is rigid.

There is a further difficulty which arises in connection with the maintenance of spontaneity, this time one emanating from within the individual himself. He tends to bind himself in habits due to the dominance of age. Children tend to seize upon opportunity, adults constrained by habit tend to reject it. That this necessarily must be so we cannot yet say, for later in the report we shall see that as age advances disorder and disease become unnecessarily prevalent. Limitation of free excursion is a natural compensatory remedy resorted to inevitably by the ailing. Until there has been an opportunity of preventing the onset of disease in the ageing, we cannot know whether or not active limitation belongs to ‘ageing’ as well as to ‘disease’. All that we do already know is that spontaneity in action returns with great rapidity to a child who is cured of a disorder, but with far greater difficulty, if at all, to an older person.

Whether we can go further and say that any observed new limitation of action is a sign of sickness is still to be determined definitely, but all our experience points strongly to that conclusion. In the course of our present research the detection of these limitations of action have not yet failed to lead us to discover in the individual some cryptic disorder. The same is generally true of limitation of action of the family organism—there is disease or disorder underlying it. There is a temptation to speculate that this process might be true also of societies and of nations.


[Home] [Top]