several weeks to gain insight into patterns of mean-
ingful people and events in his life, the process
seemed to be blocked, with the pattern not emerg-
ing and little insight being gained. He spoke of how
he felt he had lost himself several years back when
he went from being a straight A student from a sta-
ble family to stealing cars, drinking, getting into
fights, and eventually murdering someone. One
week he walked into the room where the nurse was
waiting and his movements seemed more con-
trolled and labored; he sat with his arms tightly
cradling his rounded abdomen, and his chest was
expanded as though it were about to explode. His
palms were glistening with sweat. His face was
erupting with acne. He talked as usual in a very de-
tached manner, but his words came out in bursts.
The nurse chose to give him feedback about what
she was seeing and sensing from his body. She re-
flected that he seemed to be exerting a great deal of
energy holding back something that was erupting
within him. With this insight, he was quiet for a few
minutes and tears began rolling down his cheeks.
Suddenly he began talking about a very painful
family history of sexual abuse that had been kept
secret for many years. It became obvious that the
experience of covering up the abuse had been so
all-encompassing that it was suppressing his pat-
tern. This young man had reached a choice point at
which he realized his old ways of interacting with
others were no longer serving him, and he chose to
interact with his environment in a different way. By
the next meeting, his movements had become
smooth and sure, his complexion had cleared up,
he was now able to reflect on his insights, and he no
longer was involved in the chaos and fighting in his
cellblock. He was able to let go of his need to con-
trol everything and was able to connect with the
emotions of his childhood experiences; he was also
able to cry for the first time in years. In their subse-
quent work together, this young man and the nurse
were able to distinguish between his implicit pat-
tern, which had now become clear through their di-
alogue, and the impact that keeping the abusive
experience a secret had had on him and on other
members of his family. Since that time, the young
man has been able to transcend previous limita-
tions and has become involved in several efforts to
help others, both in and out of the prison environ-
ment. He has entered into several warm and loving
relationships with family members and friends and
has achieved academic success. This was evidence
of expanding consciousness for the young man. He
reflected that he wished he had had a nurse to talk
with prior to “catching his case” (being arrested for
murder). He had been seen by a nurse in the juve-
nile detention center, who did a physical exam and
gave him aspirin for a headache. A few days before
the murder, he saw a nurse practitioner in a clinic
who wrote a prescription for antibiotics and talked
with him about safe sex. These interactions are
explicate patterns of the implicate order of the
U.S. health-care system and the increasingly task-
oriented role that nursing is being pressured to take
(Jonsdottir, Litchfield, & Pharris, 2003, 2004).
That which is underlying makes itself known in
the physical realm, and nurses operating out of the
HEC theory are able to be in relationship with pa-
tients, families, and communities in such a way that
insights arising in their dialogue shed light on an
expanded horizon of potential actions (Newman,
1997a; Litchfield, 1999).
Another example, at the community level, arises
out of the work of Frank Lamendola and Margaret
Newman (1994) with people with HIV/AIDS. They
found that the experience of HIV/AIDS opened the
participants to suffering and physical deterioration
and at the same time introduced greater sensitivity
and openness to themselves and to others. Drawing
on the work of cultural historian William Irwin
Thompson, systems theorist Will McWhinney, and
musician David Dunn, Lamendola and Newman,
state:
They [Thompson, McWhinney, and Dunn] see the
loss of membranal integrity as a signal of the loss of
autopoetic unity analogous to the breaking down of
boundaries at a global level between countries, ide-
ologies, and disparate groups. Thompson views
HIV/AIDS not simply as a chance infection but part
of a larger cultural phenomenon and sees the
pathogen not as an object but as heralding the need
for living together characterized by a symbiotic rela-
tionship. (Lamendola & Newman, 1994, p. 14)
In making the appeal that AIDS calls us to a
reconceptualization of the nature of the self and
greater interconnectedness on the interpersonal,
community, and global level, Lamendola and
Newman quote Thompson (1989, p. 99), who states
that we need to “learn to tolerate aliens by seeing
the self as a cloud in a clouded sky and not as a lord
in a walled-in fortress.”
Sharon Falkenstern (2003) found the commu-
nity pattern to emerge as significant when sheCHAPTER 15 Margaret A. Newman’s Theory of Health as Expanding Consciousness and Its Applications 231