Critical Realism (CR) is the epistemological foundation for a knowledge based practice (KBP). I am claiming that this is contrary to the more empirically founded evidence based practice (EBP). This page attempts to hash out a bit more what I mean by CR.
Critical realism (Bhaskar, as discussed in McGrath) takes common sense realism and scientific realism (“am empirical notion, in that it is grounded in an actual encounter with reality. Its justification is not to be founded in a priori philosophical reflections, but in a posteriori engagement with the natural world itself. Its plausibility and confirmations arise from direct engagement with the real world, through repeated observations and experiment” (McGrath)) and points out important considerations about reality and knowledge.
McGrath provides a nice concise definition of critical realism: “Reality is apprehended by the human mind, which attempts to express and accommodate that reality as best it can with the tools at its disposal - such as mathematical formula or mental models.” Critical realism explicitly identifies the human mind as part of the process of knowledge. This makes explicit use of models to represent the reality encountered. In other words - the mental models that are constructed are knowledge and their goal is to fit with reality even when we cannot empirically verify each and every component of such models. Reality orders what we encounter. Therefore reality frames our mental models and empirical evidence thus frames and constrains our mental models. But they are mental models. And will lead to inferences that extend beyond what can be observed while still being representative of the real, after all our powers of observation are limited (basic reliability in sensory perception). An important aspect of critical realism already discussed is that Ontology determines epistemology - and its importantance was pointed out when considering the analogical use of language since language is simply the use of words that are representations of ontologies. The final major contribution of critical realism as the foundation for knowledge based practice is its stratification of reality. This is in part based on ontology determines epistemology. “The world must be regarded as differentiated and stratified (McGrath).”
Interestingly, when McGrath is explaining the stratification of reality in his volume: “A Scientific Theology: Reality” he makes use of the International Classification of Impairments, Disabilities and Handicaps (ICIDH) from the World Health Organization (WHO). He points out the necessary consequences of recognizing that health can be defined across levels from pathology, impairments, activity and participation. They are connected, but are also very different due to the strata of reality. I thoroughly enjoyed reading about ICIDH back in 1994 while on my clinical rotation in Fort Lauderdale FL (I was alone there so had lots of time to read) - and I recall realizing how important it was to recognize the differences between but connections throughout these hierarchies (strata) of reality (well before I read it in McGrath).
Then in 2009, when I came across this in McGrath while being introduced to critical realism, I started to seriously consider the implications of critical realism as an epistemological foundation for clinical practice vs a scientific realism (which is slanted heavily to empiricism). More work needs to be done on this for sure. If a KBP is going to propose changes to how clinical practice guidelines are developed based the use of critical realism for epistemology as opposed to scientific realism then the case needs to be stronger. To that end I am working on a few things: one, a better understanding of the connections between these realisms based on their development. Two, an understanding of Peirce’s realism (called realicism by Mayorga), which seems to fit nicely with critical realism and offers pragmatism for the empirical (observation) - rational (mind) balance in claiming to know something.
If anyone has insights please post; interest in reading more and need suggestions (see the sources page or contact me), interested in dialogue to move the ideas forward, let me know.
For now, in the blog, I will leave justifying critical realism as a foundation for knowledge based practice behind for a while, and will move on to some implications.