In today’s fast-growing and changing, complex world, medicine, like other disciplines, needs a better understanding of “otherness” or “the other.”
In this section we will introduce some concepts and language used in the humanities to discuss and understand difference. We will then, from the perspective of the humanities:
explore why there is an increasingly urgent need to fine-tune our sensibility to the reality of diversity and difference
discuss the need to develop appropriate means of approaching and being receptive to “the other”
humbly question and re-evaluate our assumptions, knowledge and understanding of any given situation,
begin a process of self-awareness which might take effect within the context of our use of language in everyday communication
We will explore this by drawing on examples and terms found both outside and within medicine. The notion of “otherness,” while directly related to the question of gender, reaches beyond it and can, hopefully, help to complement current approaches to patient care.
In this section we will be trying to understand diversity and difference, to understand the "Other", in a gloabalized world from the perspective of cultural theory.
Let’s begin with what “otherness” or “the other” means to you. At the end of this section we will return to your ideas of "other" and see if/how they have changed.
In order to understand “otherness,” diversity and difference in the specific context of medicine, we need to understand these terms in a broader context, to understand how they are used in the Humanities. Throughout this discussion we have highlighted a number of key terms and concepts often used to refer to various aspects of today’s globalized reality. These highlighted terms are explained and expanded upon in the "Related Topics" below.
As an example, let’s think about progress.
History as a topic of intellectual discourse has recently gained renewed importance. One of the reasons for this comes from the fact that we are burdened with a significant weight of responsibility in being the ones to inaugurate the 21st century. Indeed, questions pertaining to the actual progress achieved by humankind; how we arrived at our current state; and how we should now proceed, have become particularly significant for us at the beginning of a new millenium. Further to this, as a result of technological progress, we now live in a world which is undergoing radical transformation and which faces unprecedented possibilities. Given this, there is a growing need to evaluate the status of our progression by situating ourselves in relation to the past and future.
Discussing the past today does not, as often previously, simply consist in addressing what happened and when something took place. History has become a reflection on the ways in which we conceptualize the past and how we each respectively live with it. Historical research is no longer an isolated task carried out by specialists but a central topic of interest to professional historians and the general population alike. Many scholars, researchers and interested individuals are increasingly concerned with the past, both at a collective and individual level. In a certain sense, the same can be said of medicine.
While it is practised by specialists, medicine concerns all human beings, and individuals are increasingly concerned to take agency in negotiating the terms of their own physical and mental health or well-being.
Like everything else, the writing of history currently participates in what has come to be known as the process of globalization. History is working to account for and understand this very process as it is taking place.
Like many areas of intellectual inquiry that have been internationalised, the process of writing history faces significant and new challenges. One of these challenges is to find ways to account for, and be open to, identities which transcend national boundaries or the nation-state. Until recently, the writing of history was dominated by a European or Western perspective which upheld a notion of universality without necessarily having any awareness of, nor interest in non-Westernized conceptions of history or the past. The same can be said of, virtually, all systems of knowledge which dominate our world. For example Western allopathic medicine stands as one system among a world of potentially infinte and, equally valid, alternative approaches. If this same conception of history continues to remain at the basis of what is known as universality, it follows that globalisation will bring with it the suppression of alternative understandings or approaches to history. This will lead to an impoverishment of historical thought and our general understanding of human reality both past and present, carrying with it continued and renewed dangers of oppression, prejudice and discrimination.
One of the questions we face, within the present context of globalization, is that of acknowledging and accounting for identities and perspectives which transcend the nation-state. Will our historians succeed in this endeavour or will they seek to legitimize what they do by maintaining the memory of the nation-state in a world without nation states? In brief, if, in writing history, we maintain our age-old concept of universality, this will reduce the vast range of possibilities of writing, conceptualizing and understanding the past to a single dominant perspective of world history determined by Western norms and thus abolish the reality of difference.
Again, the same can be said about our attitudes and biases in medicine. Are we able, not only to be receptive to other approaches and practices in the caring for patients, but also to work with patients whose approaches to all areas of life, including illness, the role of physicians and medicine, are not universal and clearly, far from our own ?
Going back to the issue of the writing of history, who, might we ask, is qualified to write history? Who is in a position to adequately define or re-define the relationship between universality and particularity, that which transcends the boundaries currently set by Western norms? Objectively speaking, perhaps no one. And yet this does not mean that history won’t continue to be written nor, for that matter, that it should stop being written. The question then remains as to how to go about this task?
Those aware of the dominance of the European or Western model of writing history are most often not part of it. Non-Western historians or specialists in non-Western histories usually oppose this sort of universal globalised discourse. In their view, globalising historical discourse should be guided by diversity. Stated differently, they believe that people should familiarize themselves with, and become aware of histories and approaches to history of countries and regions which are not their own. That said, dealing with other histories and integrating them into one’s own worldview still implies proceeding from a universalizing approach (cf. Orientalism). Such an approach fails to recognize, to take into consideration or account for the different ways in which histories are and might be written elsewhere. Many parts of Africa, Asia and countless other regions throughout the world deal with their respective histories in ways which do not conform to the norms set by Western tradition. By not being aware of these different conceptualisations of history, not only do we neglect an enormous and crucial facet of our collective historical reality, but in exclusively adhering to the Western tradition, we also miss the worthwhile opportunity to probe our history writing practices, to potentially refine them or open them up to the diversity of a new and very real world.
In today’s world, where almost everyone is likely to cross national boundaries on one or more occasions, intercultural exchange has become an inevitable and common part of our reality, one which is of crucial importance. In order to seize the worthwhile possibilities offered by this context of exchange, we need to be increasingly receptive to “the other”. This means that we must allow ourselves to question existing models through which we perceive and claim to understand history and more generally the human world. To do this, we must allow other perspectives to coexist; allow ourselves to be receptive to these possibilities by allowing them to emerge and potentially contradict or perhaps even refute some of our assumptions; and finally, be prepared to question, re-evaluate, abolish and/or revise some of our most acertained claims and forms of understanding. This also means trying to see world history as a sum of histories written according to a multitude of different cultures and traditions of history writing which continue to emerge and evolve. This way of globalising our knowledge and understanding world history stems from the fact that we are living at a time where the world is progressing to a stage beyond an organisation based on nation states and that we can no longer claim nor try to understand the writing of the world without fully taking into account its diversity (cf. cultural relativism).
As doubts about our understanding of the past both as producers and consumers of historical knowledge emerge and are acknowledged, we need to become more attentive to the significant relationship between history and memory. Indeed, where the grand narratives lose their persuasiveness, individual memories gain importance. They become particularly important when it comes to accounting for a past that has not left any written sources behind. And the smaller the unit of inquiry – the more specific the element of the past at issue, the more we have to rely on non-historical or oral sources.
That said, accounting for diversity does not stop at history writing. Indeed, as suggested, diversity and difference impact and inform every established and specialized field of intellectual knowledge. And in each case the same question as to how we should go about this task arises. The first step, it would seem, involves acknowledging that there are other conceptualizations and approaches to knowledge and the second, being receptive to and welcoming the possibility of “the other”.
Why speak of world history when what ultimately interests us here is medicine? The quick answer is that history and medicine are indissociably linked to one another as fields of inquiry pertaining to human existence which are rooted in a tradition and continue to evolve over time. Medicine, having a history of its own, constitutes but one of a multitude of possible accounts within the vast web of human knowledge. Yet, like history, it holds a priviledged position in being of undeniable concern to every living individual. One could say that medicine, within the broad realm of human knowledge, emerges as a specialized field striving to ensure human physical and mental welfare in the face of what can loosely be termed illness. Everyone has a past, one which has a determining role, not only in defining ones reality and understanding of the present but, also, in what we have alluded to as human welfare. As we become increasingly aware of the possibility and reality of concurrent conceptions of history and, as a result, begin to have certain doubts, with regards to our understanding of the past, so too our assumptions in medicine, as they pertain to understanding the human body or, more generally, the human condition, are today subject to competing perspectives which raise doubts as to their validity and reliability.
Its role, then, is to intervene when this welfare is at risk of being undermined or threatened. It would thus appear that medicine concerns itself with punctual moments within individual existences. However, seen as a science, it has established itself as a specialised field of knowledge. In other words, it must foresee and thus account for the possibility of individual affliction through universal concepts. It, thus, like history, today, finds itself in a perpetual position of contradiction or potential doubt.
In practical terms, each patient brings with him/her a singular and complex set of experiences, both physically and mentally incurred, which we can never hope to know fully but to which we should try to be as receptive as possible. For, beyond the universal symptoms, these experiences constitute the patient as a whole, as a person. They impact on their approach to, experience and capacity to deal or not deal with a particular illness. It is thus to our and their advantage that we acknowledge the fact of all factors, physical and other, whether knowable or not, that come into play when dealing with a patient, a person, that is, “the other”.
Having completed this part of the module, how do you think of "the other" now? How has your understanding changed?
1. While we are offering possible definitions and explanations for terms and concepts, these are, by no means, exhaustive. They are intended as starting points. Suggested readings will be provided for those wishing to further explore related questions and issues. Most definitions were drawn from Cultural Theory: The Key Concepts. Eds Andrew Edgar and Peter Sedgwick. London and New York: Routledge, 2002