By Laura Rathbone
This month we are exploring causation as a construct and causation within healthcare practice.
Causation is a tricky idea to grasp, partly because there is some disagreement about what it actually is - causation without causation...make it make sense!
In the simplest sense, causation is exploring events that are necessary and sufficient in bringing about the next event. Philosopher David Hume has been influential in developing a method for understanding causation which relies on repetition and patterns, he used the idea of two billiard balls colliding (ball A and ball B). Ball B moves because of some causal influence exerted upon it, the job of the researcher is to determine what has had causal power that was necessary and sufficient to bring about this movement. Our job as scientists is to try and determine what brought about the movement of ball B and is that a singular cause (monocausality / reductionism) or multiple events with a combined causal influence (pluralism).
As I understand it, according to the Humian approach, if you wanted to prove causal power, then you would have to be able to observe in the moment or 'verify' it. only by doing this over and over again, could we build up the empirical probability that would help us to navigate the complex world. This is where the large data bias began.
But ultimately, causation is about trying to establish a kind of truth (ontology - what 'is') and build up a kind of knowledge around that truth (epistemology - a set of rules and a narrative that expresses those rules).
Scientific truth or objective truth is an attempt by scientists to build up reliable, repeatable and predictable models about the the world around us and within us. Through the scientific method, researchers hope to uncover 'truth' about what it is to be human, and to be human on earth.
For me, truth in itself is a complex topic and science has a complex relationship with truth, which we are seeing played out every day around us as our communities and societies become more polarised as pro-science and anti-science.
This is what Kipling's poem The Legend of Truth is inviting us as professionals interested in pain to reflect upon.
Not even Pilate's Question called her forth,
Kipling draws our attention to how old this question of truth is by conjuring up Pontius Pilate asking Jesus “What is truth” (John 18:38) whilst on trial for blasphemy. Pilate enquires into the royal and godly nature of Jesus who’s word was supposedly The Truth from God, a word that was counter to the belief system of the time. The irony being here that, following on from this trial, Jesus was crucified as a blasphemer and a heretic.
Interesting then, that in the following sentence also contains reference to a person convicted of heresy and blasphemy:
Nor Galileo, kneeling to deny
The Laws that hold our Planet 'neath the sky.
Galileo of course, being trialled as a heretic by the Church for his scientific discoveries and held in isolation and home arrest for the remainder of his life for asserting that the earth does in fact move around the sun and not vice versa.
Kipling, sets up a feeling of discomfort within us a readers by bringing us face to face with the ways in which “truth” has been weaponised over time and that we are more comfortable in ‘fiction’.
Kipling’s experiences as a young man living in India and the Boer War may well have influenced his work exploring truth and lies from systems of power. This is apparent in the subsequent stanzas which invite us to feel the enormity of war and violence upon people and the denial of those responsible to claim the reality.
“She called for proof. It came. The dossiers grew.
She marked them, first, "Return. This can't be true."
Then, underneath the cold official word:
"This is not really half of what occurred.”
What does this poem invite us to contemplate as healthcare professionals?
Why is truth an important concept to contemplate?
It is said that we live in a Post-Truth era, this being the period after the scientific renaissance and a move towards beliefs about science with increasing anti-science rhetoric and conspiracy theories. Elon Musk even sent a doll out to circle the earth in a Tesla Roadster in the effort to once and for all quash the flat-earth theory (you can track it here) but yet, the flat-earth movement continues to grow.
This speaks to me about the relationship between science and the public, a relationship that is hard pressed with the problem of pain. How can we trust a science-based healthcare profession, when science has not yet understood pain?
Exploring causation therefore feels essential because it may help us to understand why certain scientific methods are better or worse, more or less able, to answer certain questions. It helps us to hold ‘empiricism’ and ‘positivism’ in a context so that we are more able to move between scientific approaches and perhaps develop new ones.