Reasoning and judgement in health care entail complex responses to problems whose demands typically derive from several areas of specialism at once. We argue that current evidence- or value-based models of health care reasoning, despite their virtues, are insufficient to account for responses to such problems exhaustively. At the same time, we offer reasons for contending that health professionals in fact engage in forms of reasoning of a kind described for millennia under the concept of wisdom. Wisdom traditions refer to forms of deliberation which combine knowledge, reflection and life experience with social, emotional and ethical capacities. Wisdom is key in dealing with problems which are vital to human affairs but lack prescribed solutions. Uncertainty and fluidity must be tolerated in seeking to resolve them. We illustrate the application of wisdom using cases in psychiatry, where non-technical aspects of problems are often prominent and require more systematic analysis than conventional approaches offer, but we argue that our thesis applies throughout the health care field. We argue for the relevance of a threefold model of reasoning to modern health care situations in which multifaceted teamwork and complex settings demand wise judgement. A model based on practical wisdom highlights a triadic process with features activating capacities of the self (professional), other (patient and/or carers and/or colleagues) and aspects of the problem itself. Such a framework could be used to develop current approaches to health care based on case review and experiential learning.
For many years Irish rural sociology came to be defined in relation to Arensberg and Kimball's celebrated anthropological study, Family and Community in Ireland, for which fieldwork was undertaken in Clare between 1932 and 1934. It has been observed that ethnographers in Ireland post-Arensberg and Kimball were strongly inclined to take the community as their unit of analysis, focus their analysis of social life on kinship and social networks, and adopt structural functionalism as their theoretical model of local society. The essay republished here in abridged form accompanied the re-publication of Family and Community in Ireland in 2001. It critically examines the intellectual and political background to Arensberg and Kimball's ethnographic fieldwork in rural Clare, the manner in which their research unfolded and the subsequent reception of their published work over a period of some sixty years.
The concept of wisdom, popularly associated with the idea of old age, was neglected during the 20th century. It has recently revived as a matter of academic concern, but remains imperfectly understood. This article therefore begins to explore both the concept of wisdom and some forms we might expect wise behaviour to take. It emphasises the contemporary relevance of historical approaches through an examination of Hebrew and Greek writing on wisdom. Recent contributions from psychology develop aspects of these traditions; but studying wisdom ethnographically also substantially expands our understanding of what wisdom is. An ethnographic interview from Austria exemplifies social as well as psychological aspects of wisdom, showing that part of the meaning of wisdom resides in its effects on a social setting. Aspects of discourse in rural Ireland, when interpreted in the light of maxim-related wisdom traditions, extend this claim, showing more about how wise interventions activate wisdom in the society surrounding them. Other ethnographic cases also develop this notion of wisdom as based on social interaction, by exploring its effects. If we face the methodological challenges entailed in tracing wisdom ethnographically, we enhance our understanding of the concept itself and stress the fruitfulness of the idea of wisdom as an attainment of the lifecourse.
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