To Dwell at the Border

by Austin Lam

The medical humanities dwells at a border: a border between the biomedical model and the humanities. Reflecting on this border, I explore two questions that emerge. In what sense can it be said that one dwells at this border? And what does it mean to make this border a home?

At first glance, the medical humanities represents a bridge spanning across the divide: bringing together two seemingly disparate worldviews. While the biomedical model tends to view the person in terms of the biological processes that constitute the human body, the humanities, on the other hand, emphasizes human experiences. To paraphrase neurologist Donald Borrett, a biomedical ontology defines the essence of the patient in terms of the patient’s signs and their origin in a disturbed physiology; in a humane ontology, the essential locus of being-a-patient shifts to the patient’s illness experience, including the patient’s symptoms and their effect on the patient’s life. Borrett continued, drawing from philosopher David Morris’ phenomenological analysis of chronic illness: “illness has an effect on experience that is more fundamental than an alteration in these contents of that experience.”

The medical humanities dwells at this border by opening up a gathering space. This gathering place reflects and exemplifies what was described by philosophers Hubert Dreyfus and Charles Taylor in Retrieving Realism: “[the] interweaving of the bodily, the symbolic, and the narrative and propositional illustrates… the inseparability of the life and human meanings in the stream of human existence.” The medical humanities is the bridge, the gathering point of different sources of understanding. To paraphrase philosopher Martin Heidegger, the medical humanities is the bridge that brings stream and bank and land into each other’s neighborhood.

What does it mean, then, to make this bridge/border a home? It means to dwell. Heidegger, in his essay “Building Dwelling Thinking,” described dwelling as sparing and preserving. By this, he meant that to dwell somewhere is to safeguard that place. More than that, however, is to free the place to its own nature, to return it to its own being. This can be gleaned from the etymology of the word “spare” from the Old English sparian meaning to allow to go free.

For the medical humanities, then, to dwell at the bridge/border is to realize an area where the possibility of shared understanding can manifest across disciplines, where conversations can take place. For it to be freed to its own nature as a gathering place, it means that those gathered become engaged in an enterprise of fusing different horizons, to borrow the phrase from philosopher Hans-Georg Gadamer. The meanings involved in philosophy, literature, aesthetics, anthropology, sociology, etc. are each immersed in a tradition of history and language. A fusion of horizons involves immersing oneself in the richness and complexity of these histories and languages. To safeguard this space is to ensure that preconceptions are recognized and contextualized. A critical stance can then emerge: an “inward turn” that appreciates, loosens up, possibly shakes up, and has the potential to re-build the structures of relatively or certainly unquestioned assumptions and presuppositions that have been constitutive of one’s architecture of thought.

The border becomes home when one is immersed into a new history and language. For Heidegger, to dwell is to stay with something and to safeguard it. That which was unknown becomes familiar in a homely sense as one takes care of and stays with it. In concrete terms, for example, rather than reading-in presupposed expectations in a literary text, the process of dwelling is one of letting-go and disclosing the revelations of a hitherto unexplored area of understanding: to let the ideas bubble away in one’s mind, sink away, and re-emerge. One’s own horizon of understanding, the initial standpoint of understanding, moves with, towards, and is moved by a further horizon that comes into contact. In these movements, one must take care to let the subject or matter-at-hand speak for itself, as opposed to speaking for it. This is the safeguarding entailed by dwelling at the bridge/border.

Nevertheless, an insidious danger lies at the border. While dwelling entails a fusion of horizons, there is also the risk of horizons taking over another horizon’s voice and autonomy. For instance, narratives/stories may provide an avenue to illuminate a shared humanity. Yet, literature can also be used purely or primarily to fulfill the circumscribed objectives of the biomedical model, such as by reading-in only what one expected beforehand. This way of engaging with literature covers-up and distorts the richness and depth of the stories, the very qualities which would be central to uncovering a shared humanity.

There is a danger when pre-conceived notions or expectations are imported into an unknown or new area of understanding, whether with or without awareness. In particular, there may be “bad faith” attempts to utilize the medical humanities as a pliant and benevolent companion who humanizes the biomedicine. For example, stories may be read in order to increase empathy, defined in an almost mechanized sense. In this situation, it would be an act done by those in biomedicine to drag stories within biomedicine’s domain of influence/power so that the stories can serve its goal of “humanizing” the relationship between patients and healthcare professionals. The expectations engendered in this dynamic would already provide the subtext of any possible literary interpretations and these expectations would remain un-contextualized. There would be no “inward turning.” The danger is one of denaturing the insights, histories, and beauty of different horizons of understandings.

Dwelling starts from a position of naïveté, immersed within the vast reaches of the humanities without having to ask “what utility would this be to me from a medical standpoint?” This is when dwelling at the border becomes a home. Paraphrasing Heidegger, one can say that to dwell is to come into oneself without abandoning our stay amongst the things around us; spaces open up as they are let into our dwelling.

In dwelling, the medical humanities makes a home, a gathering place at the border between the biomedical model and the humanities. This sense of dwelling at the border as home is captured by the German Romantic poet Friedrich Hölderlin (1770-1843) in an excerpt of his poem “The Journey”:

It turns to a dream should anyone

Come at it by stealth and punishes

Anyone violently setting himself up as equal;

Often the one it surprises

Has scarcely been thinking it.