In healthcare, clarity is rare — and coherence, rarer still.
In the often chaotic world of healthcare and human development, we are constantly faced with competing ideas, approaches, and “truths.” Should we prioritize diagnoses or processes? Target symptoms or systems? Focus on the brain, the body, the behavior, or the story? Too often, these debates feel like ships passing in the night — well-meaning clinicians and researchers talking past each other, unaware that they may not just disagree on the what or how, but on the why behind their entire approach.
To make meaningful progress — in treatment, education, or innovation — we must go deeper than tools and techniques. We need to explore the underlying philosophical worldviews that guide our thinking.
Philosopher Stephen Pepper identified four foundational worldviews, or “world hypotheses,” that act like lenses through which we interpret and engage with the world. Each worldview is organized around a root metaphor — a guiding analogy that shapes not only how we see reality, but also what we consider to be true. These worldviews are not just academic abstractions; they influence everything from clinical reasoning to research design, to how we educate, evaluate, and intervene.
Understanding these worldviews can help us recognize why different approaches in healthcare and science often clash — not just over data, but over the deeper assumptions about what counts as truth, how problems should be framed, and what solutions are considered valid. Below, we explore each worldview in turn, including its root metaphor and how it determines what is seen as credible or effective.
Mechanism sees the world as a machine made up of discrete parts operating in linear cause-and-effect relationships. If something is broken, it can be disassembled, diagnosed, and repaired — much like replacing a faulty gear in an engine.
This worldview underpins much of modern biomedical thinking: diseases are caused by identifiable biological abnormalities, and treatments aim to correct those abnormalities through targeted interventions.
From this perspective, truth is determined by identifying efficient causes — that is, what leads to what. If an intervention produces a predictable, replicable effect under controlled conditions, it is considered valid.
Formism organizes the world through categorization and classification. Truth is found by comparing individual phenomena to idealized forms, types, or diagnostic categories.
Many classification systems in psychology and medicine (e.g., DSM diagnoses, ICD codes) stem from this worldview. The focus is on defining the essential features of a condition or type, and placing individuals into pre-existing conceptual boxes.
Here, something is “true” if it resembles or matches a conceptual ideal — if it corresponds to the defining features of a known form. Treatment, from this perspective, often begins with naming and labeling.
Organicism views reality as a dynamic, evolving whole — not reducible to parts, but understandable only in terms of the system’s internal coherence and developmental trajectory.
This worldview underlies theories that focus on maturation, self-organization, and the unfolding of life processes — such as developmental psychology, psychodynamic theory, and many holistic health models.
Here, truth is not about isolated causes or static categories. Instead, it’s about coherence: whether an explanation or pattern fits meaningfully within the system’s structure and function.
Contextualism emphasizes that nothing exists in isolation — actions, meanings, and outcomes are always shaped by context: the “when,” “where,” “how,” and “for what purpose.”
Rather than seeking universal categories or linear causes, contextualism focuses on what works in a given situation, for a given outcome, in a specific context.
Truth, in this worldview, is evaluated based on pragmatic success — does a given idea or action lead to desired outcomes in context? If yes, it is “true” in a functional sense, even if it doesn’t fit a fixed form or operate the same way in every case.
Among these worldviews, Contextualism stands out as particularly relevant for fields that deal with complexity, variability, and change — like psychology, rehabilitation, and education. Contextualism views actions not as isolated or universally defined, but as embedded in ever-shifting contexts of time, place, and function.
From this broader worldview, a more precise scientific approach has emerged: Functional Contextualism.
This is the foundational philosophy behind disciplines like behavioral science, Acceptance and Commitment Therapy (ACT), and our very own Human Rehabilitation Framework (HRF). Functional Contextualism doesn’t aim to label or explain behavior in isolation. It seeks to understand how behavior works in context — and more importantly, how we can influence it to support meaningful change.
Its truth criterion is elegant and pragmatic: successful working.
“Successful working” doesn’t mean proving an absolute truth. It means evaluating whether an idea, method, or intervention leads to effective action — does it work, in context, for the outcome we care about?
It reframes success from being “right” to being useful.
Importantly, the definition of “success” must be explicitly stated for this philosophy to hold water. If we’re not clear on what we’re working toward — function, value, reduction of suffering, increased movement, improved relationship — we won’t be able to evaluate whether something is working.
And when context shifts, what “works” might shift too.
If this sounds abstract, it’s because most of us never received training in philosophical coherence. But this lack of clarity is exactly what leads to confusion in healthcare debates.
For example, one clinician might argue against pain neuroscience education by saying, “education doesn’t work.” But what does “work” mean? To reduce pain? To increase participation? To shift beliefs? And by what criteria?
Without clearly articulating assumptions and success criteria, discussions turn into incoherent eclecticism — mixing metaphors, shifting worldviews, and arguing at cross-purposes.
This is not just confusing. It’s dangerous. It can undermine patient trust, team collaboration, and professional development.
In a time when evidence-based practice often collapses into data without direction, Functional Contextualism invites us back to a more grounded, transparent way of thinking. It urges us to be clear about our assumptions, define success within the context we’re working in, and choose strategies that work — while remaining flexible enough to change them when they no longer do.
It also challenges us to stay philosophically coherent when educating others, designing systems, or crafting treatment plans. This doesn’t mean we must rigidly adhere to a single model or discipline; rather, it calls us to integrate ideas intentionally, with clarity and purpose, rather than haphazardly mixing incompatible approaches.
Functional Contextualism doesn’t promise easy answers — but it gives us a compass in a world full of noise. When we know where we’re trying to go, we can navigate complexity with more clarity, compassion, and contextual wisdom.
When used skillfully, this philosophy empowers us to build practices, policies, and systems that are not only evidence-informed — but contextually wise.
Explore our mentorship opportunities and growing library of coursework as we continue to unpack how Functional Contextualism is shaping the future of rehabilitation, mental health, and adaptive systems science. Let’s keep learning, together — in context.
Co-Founder
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