Self-Management and the Control of
Chronic Pediatric Illness
Thomas L. Creer Ohio University, Athens, OH
In his seminal work, Kuhn ( 1996) described how science does not advance in an evolutionary manner, but as a series of peaceful interludes punctuated by crises and revolutions. The crises generate revolutions because existing paradigms--what members of a scientific community share--are unable to manage anomalies or confounding information. The result is a rejection of the existing paradigm and the development of a new one. Because new paradigms emerge from old ones, there is a period of transition from abandonment of the traditional paradigm to adoption of the new paradigm. This period--often tumultuous--allows a number of events to occur. For example, new paradigms generally incorporate much of the vocabulary and apparatus, both conceptual and manipulative, of the traditional paradigm. Because these borrowed elements are not used in quite the same way within a new paradigm, there is a transition period during which there is a shift in allegiance from one paradigm to another. The period is marked by resistance from those loyal to the old paradigm to advances made by proponents of the new paradigm; this transition is necessary because the transfer of allegiance from paradigm to paradigm is a conversion experience that cannot be forced. It is only through scientific research that the professional community of scientists succeeds, first, in establishing the scope and limitations of the older paradigm and, second, in confirming the need and rationale of a new paradigm.
A revolution in paradigms, analogous to what Kuhn described as occurs in science, is currently taking place in two areas: providing health care