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The Other lecture transcript

Donald Lush, London - UK, donald.lush@gmail.com


Towards the end of the mediaeval period, the many thousands of institutions set up to care for
lepers began to close. This was partly because Europe had been cut off from the sources of infection
and the number of sufferers was dwindling but it was also because of a change in attitude towards
the disease. People continued to be infected but the rituals of the priests in casting them out of the
Catholic church, the leper as the symbol of all that was evil and undesirable in society and the great
organisations that existed to ensure their separation from society declined.
It is not known what changed in people's minds. It may be simply that they were no longer enough
lepers to support the meaning that had been given to their condition. However, the theme of the
outcast, the non-human, the dangerously strange did not disappear and never has. Indeed, it might
be concluded, from a study of our history, that the figure of frightening and dangerous outsider is a
necessary condition against which humans build their civilisations.
Into the vacuum left by the fear of leprosy came a new phantom to frighten the citizens. This
phantom was called madness. In the painting, The Ship of Fools, by Hieronymus Bosch, we find the
perfect image to represent the early modern idea of madness. It might be thought that this ship is a
metaphor, that Bosch is saying to us that madness is a voyage to another, unknown and
unknowable, country which only a selected, unlucky few undertake.
In fact the painting is believed by some to be much more literal than that although it contains that
metaphorical sense as well, I think. Especially in Germany and the Low Countries it is believed that
those whom we would now consider ill, as people deserving compassion and we would wish to help,
were forced onto ships and boats and left to cruise Europe's canals and rivers living as best they
could. The ships passengers were always certain of being unwelcome everywhere and most cities
and towns had both laws and officers whose purpose it was to drive the mad outside, away, to keep
sane society clean and pure. These laws were enforced effectively and thoroughly. Whether its true
or not, the metaphor is extremely powerful.
I think in these two examples it is easy to see the essence of the idea of the other. The other or
others are the ones who are not like us, who must be driven away, who are some sort of threat to us
because of their difference. This difference, this otherness, crucially gives us permission to abandon
all thought of what we regard as civilised behaviour. Unfortunately, tragically, it is extremely easy to
make a list of catastrophes that have resulted from one group of human beings deciding that
another group of human beings has some quality of otherness and therefore no longer deserve a
place in society. South Africa, Rwanda, Northern Ireland, Nazi Germany spring to mind though of
course the list could be much longer than just these four notorious examples. But what does seem to
be at the heart of each of these four cases is that people who had lived in peace together for many
centuries suddenly exploded into violence against their neighbours, those with whom they had
almost everything in common; culture, values, religion, politics, economy and language. And that
long-standing neighbours suddenly became unacceptable, to be expelled, and often to be murdered.
This, it seems, can happen anywhere.
In fact, in preparing for this lecture, I began to see otherness everywhere. And as Einstein must've
done when he was doing his great work on gravity and concluded that gravity was the engine of the
universe I began to think that the creation of otherness, the separation of human beings into
categories of the acceptable and the unacceptable, those who do and those who are done to, power
and object, was the engine of civilisation. When you think about it, when you reflect, when you read
the newspaper or watch the news on TV it seems to be lurking in the background of almost every
story. I think this is the natural result of all academic work. I suspect economists probably believe
that all of human endeavour can be explained through economic transactions. But in thinking about
this issue in much more depth than before I have come to the conclusion that the alienation of the
human race from its espoused moral values has been and remains a very powerful force in every
sphere of activity, including medicine.
For a few moments, I want to take our journey off in a new direction. As I was thinking about how
human beings construe other human beings who are exactly like them as in some way alien I began
to wonder how it is that we are sure we know anything. There is a great example from medicine
that illuminates this beautifully and it has entered popular culture as well. It's simply the reported
experiences of patients of things that cannot be true. There are well documented cases of blind
people describing the things they see in vivid detail and amputees who can feel and report using
their lost limbs. They know, in the face of overwhelming evidence to the contrary, things that
cannot possibly be the case.
The explanation is that perception is not simply a photocopier recording faithfully what it is
presented with. If you doubt me, just think about colour. Colour cannot (as we describe and use it)
simply exist out there - for some people there is no difference between red and green. Some
cannot perceive colour at all. Before the nineteenth century the colour pink did not exist anywhere
in the world. It was invented. We learn colour but we quickly assume (because we are so good at
learning) that what we have constructed and stored in our minds is how the world really is we
know, with certainty that is not justified, that pink is a colour because we can see it.
Epistemology, the study of how we know things, is one of the oldest and most honourable areas of
intellectual research. It will not surprise you to hear that after thousands of years of effort no one is
able to say for sure that we humans know anything at all. This may sound like a flippant remark but I
assure you it's not. It may be the greatest wisdom that we possess. In fact, I will go further than that
and say that I'm sure it is the greatest wisdom we possess. One of my favourite sayings comes from
the great Greek philosopher Socrates who said
I may not be very clever but I'm not stupid enough to pretend I know something I don't.
This is something I would like to have printed on a T-shirt and given to every undergraduate in every
university in the world. I'm sure it would raise many exam scores and save many lives. Let me explain
why.
The greatest of recent attempts at trying to answer the question of whether or not we know
anything was made by Ludwig Wittgenstein in his book On Certainty. I don't want to reduce a
great work to a slightly surreal joke but if you're not familiar with this book it concerns
Wittgenstein's philosophical attempts, using his left hand as the object of investigation, to discover if
he could be sure that his left hand really was the thing he thought it was. It's worth noting that in his
lifetime Wittgenstein only published one book because he was tortured by his belief that he could
reach certain knowledge and conclusions but had failed to do so.
For those of you not as enthusiastic about philosophy as I am (something I find hard to believe) this
debate, which has run across the millennia with Wittgensteins contribution the latest in a long line
of investigations, starts from a very simple question. The question is
What is there?
In other words, when I open my eyes and my ears and pay attention to my senses what is it that I'm
paying attention to? To the non-philosopher this may seem like the greatest of all non-questions and
yet when I gave the examples about colour I hope I undermined that belief a little.
Science has, perhaps, done itself no great favours in this area. It has allowed the greater public to
believe that the enormous advances in science of the last three centuries have increased our
understanding and knowledge of the world. Stephen Hawking in his book A Brief History of Time
demolishes this belief as the myth it undoubtedly is.
Hawking explains that the immense and valuable achievements of science have come about through
ever more sophisticated and systematic observation of the natural world combined with equally
developed ability to work with probability. But he says quite clearly that scientists have never been
able to explain anything only to predict, based on scrupulous observation. Wittgenstein concluded
his investigation by saying that if he thought it was his left hand, then it probably was. Unsatisfying,
isn't it? But it was the best the greatest philosopher of the 20
th
century could come up with.
Let's work this shocking idea that we don't know or understand anything through one more
example.
If I say to you that I expect the sun to rise tomorrow morning I will not be saying anything remotely
interesting or surprising to you. We all know the sun will rise in the morning. If I ask you to think
about why you believe you know that you will probably tell me that your belief is based on the fact
that it has risen every morning for the 4.5 billion years of the existence of planet Earth. This seems
like overwhelming evidence but as Hawking points out it does not equate to certain knowledge that
the sun will rise tomorrow. It is extremely probable that it will but this is not guaranteed by the
previous sunrises there may be something we are unaware of that will prevent it. Because
something happened yesterday it does not mean it will happen tomorrow. And yet nearly all of our
world is based on a belief that is rationally shaky something happened before, so it will happen
again given the same conditions. We haven't done too badly believing that though, have we? It's
just we ought to be aware that it's a belief, not an established and invariable principle.
And we do need to remember that the Romans knew as certainly as we do how it is that the sun
rises each morning. It is dragged over the horizon by Phoebus and his team of horses. And if
something happens to Phoebus the sun may not rise which is why several pagan cultures thought it
a wise precaution to pray, every evening at dusk, for the safe passage of the sun through the night.
And, indeed, the dawn brought verifiable observational evidence that their prayers were successful.
They were not mad or ignorant, they were acting on their knowledge and beliefs as informed by
their observations. We might be just as wrong.
Two great philosophers who made their particular concern to try and explain why it is that
phenomena in the real world seemed to be susceptible to explanation in an almost infinite variety of
ways were Kant and Schopenhauer.
I don't want to reduce the work of two of the greatest and most challenging thinkers and writers of
all time to one line in a short lecture. But they do provide, in the form of some of the most elegant
and also longest and most complicated investigations ever undertaken justification for my case
that reality as we live it and perceive it is a construction as artificial as a James Bond movie and
considerably cleverer. In fact, it's so clever, we are not aware of the process of construction and go
about our everyday lives believing that everything is as it appears to us to be. This is a dangerous
illusion and moreover one that we have created for ourselves.
And of course, thorough philosophers that you now are, you will also be thinking about Plato as I am
speaking. Two thousand years ago his theory of forms identified ideas as the highest form of reality
and the perceived world as just shadows on a cave wall, created by a fire we can't even see. Us
humans are natural theorisers. Faced with shadows on the wall of a cave, we will try to identify
them, explain them, categorise them, turn them into the reality of ideas. A lot of the time we will be
wrong but in theorising about the world based on our observations, we will learn and we will make
decisions about how to act. Many of those beliefs and their consequent decisions will bring us great
benefits and some will lead us into danger and mistake. But the only really big mistake we can make
is to take our theories and beliefs as certain, unshakeable knowledge.
I'm in danger of repeating myself but I am doing it deliberately. I find whenever I think along these
lines the world looks a bit odd for a few hours afterwards. I feel like I don't know anything much and
that I have to be wary of what things appear to be. This is the state I am working hard to encourage
in you.
Now one last thing about certainty before we move on. On an everyday basis, as we have seen,
we are usually not even aware of the beliefs we hold about the world even though we take
important decisions based on them all the time. We know. We are born without our parents
memories and knowledge and we are not telepathic. In constructing our world and our theories
about it, alone, from scratch, it is all too common for us to assume, because we do it so well and
cleverly, without being aware of it, that the world is the way we see it. Or rather, how I see it. But
you have your own theories, your own experiences, your own fears and desires. And I have no way
of knowing what they are unless I make an effort to find out. That effort requires setting aside my
own beliefs and entering and accepting the world of another without judgement. It is not an easy
thing to do but (as any scientists or philosophers will tell you) unless you try to eliminate your own
bias from your research, you will fall into error very quickly.
Now you may be wondering when you are going to hear something more about medicine well, we
are nearly there. There are two more great thinkers to visit who were , at least, medical doctors
Sigmund Freud and Jacques Lacan.
Freud's adventures in psychoanalysis began in Vienna with the psychological treatment of women
who had become mentally ill as a result of reported sexual abuse by their fathers (at the time this
was called hysteria although the name has now dropped out of use, in its 19
th
century meaning).
Freud, at first, believed he had discovered an immense epidemic of sexual abuse and indeed he may
well have done. It has been estimated that about a third of all people suffer some sort of sexual
assault as a child, usually perpetrated by a close relative.
However, Freud began to wonder if what he was hearing was a representation of another, inner
reality a construction that had some other meaning and he began to explore the implications of
that belief. From this startlingly original (and possibly mistaken and still very controversial)
beginning he asserted that the mind has thoughts that are not conscious, that are driving us and our
behaviour in a way that is outside our control. Moreover, these thoughts are hidden from our
conscious mind precisely because they are unacceptable and dangerous to society, concerning as
they do, drives that find their energy in sexuality, violence, fear and death. Freud's view of a human
being is a little like an iceberg, most of it invisible, the invisible part being the most dangerous but
the most important. Some say it is a cynical, pessimistic portrait of us. But in the year he died,
World War 2 broke out and tens of millions of humans set about slaughtering each other with great
energy and enthusiasm justified by perceived otherness, labels of sub-humanity using religion,
nationality, race, political belief as an excuse. I think he had good cause for his pessimism and
cynicism.
What's particularly significant for me about Freud's later theory of personality is it's dynamism
personality is forged over and over again in a tension of conflicting beliefs and desires. Humans are
always a bit provisional and changeable not just fleshy robots executing a programme.
Lacan, in the 1950s and 1960s led what he described as a return to Freud (although I think it's such a
reinvention that he should claim it as original thought). He was very concerned with how an infant
comes to construct its belief that it is a separate, autonomous, individual represented by the
personal pronoun (the I we all use, all the time, as though we knew what it meant).
Essentially, Lacan theorised that this I is constructed in alienation. At some point in early life the
infant develops a theory to explain its existence based on observation. That is, I am one of those,
a child, like the other child I see in the mirror who is, in fact, me. Lacan called this theorising the
Mirror Phase. He argued that ones sense of self hood is something one has a relationship with
through an external image and that at our roots there is always something of the other, something
outside and not us even about our own selves. Lacan's theory is still controversial (as is almost all
of psychoanalysis) but if we take it as philosophy rather than science I think it has huge value. Even
asking the question of how we, as physical animals that grew out of the dust of the universe, can
construct a sense of self and then use it as an object of investigation implies a division, us from the
real world out there, us from ourselves as objects of our own reflection and us from our own
conscious and unconscious thoughts and desires. As I said earlier, just asking the questions
dismissed all possibility that we are fleshy robots.
So, in conclusion, let me flatter myself and assert that you have paid interested attention to
everything I have said and have accepted the ideas I have put forward. What have we learnt about
ourselves?
We are naturally, powerfully, driven to construe that people who are different from us can
easily be consigned to a category of existence in which they lose their humanity and can be
treated in any way we like without damaging our moral worth.
We can't really ever be certain we know anything at all. We can observe and make
predictions and as we get more skilled we become more accurate. But we can and will be
wrong.
The reality we take for granted every day is very much other than we think it is. It's a
product of our own sophisticated minds and not reliable or consistent.
Much of our behaviour is driven by thoughts and processes that we are not even consciously
aware of.
Our personality is dynamic and ever shifting.
There is a good deal of the other the alien, stranger, outsider even in our most intimate
theories of who and what we are.
In short, it's no surprise that we are often tense, unhappy, distracted, fearful, indecisive, contrary,
stubborn. It's in our natures to be so. It's my belief that the ability to love to put another before
yourself and to merge with an other is also integral to our nature and for for the same reasons. But
this requires another lecture and I am almost done.
If you are a doctor you are made of just the same stuff as your patient. The only thing that
distinguishes you from your patient is that you have a medical degree or two and sometimes, well,
you will be treating other doctors so that doesn't always apply. But medical school did not (couldn't)
remove your humanity. Not without killing you anyway.
So I would like to leave you with a reminder about Socrates. Remember he said that he was not
stupid enough to pretend to knowledge he did not possess?
Make this thought the moral guardian of your work and your life tell yourself that doubt is the first
sign of intelligence and ask if there is another, equally valid, explanation for the things you observe
in your patients and in your professional life and in yourself.
If you do, I am sure that one day, and before not much time has passed, asking that question will
save someone's life.
Thank you!

Recommended readings
First of all two general books:
Bertrand Russell, A History of Western Philosophy
A general book about Western Philosophy written in a very lucid and clear style. Some of its
viewpoints are still controversial.
Brian Magee, Confessions of a Philosopher
Magee is not a philosopher and is best known for his TV work in the UK. Nonetheless, philosophy is
his passion and he is a great populariser of philosophical ideas. This book is especially useful for
anyone who wants to critically examine the idea of common sense and maybe begin to approach
the work of Kant and Schopenhauer, the modern philosophers who demonstrated beyond doubt
that what we regard as perception is, in fact, constructed, unreliable and partial.
To discover if it is possible to know anything for certain:
Ludwig Wittgenstein, On Certainty
Wittgenstein, in his usual fiercely rational way, digs beneath assumptions that are taken as
knowledge and discovers them all to be without foundation. Thrilling journey although potentially
destructive to your peace of mind.
For essential theory on personal identity, inner conflict and the personal/public world:
Jacques Lacan, The Four Fundamental Concepts of Psychoanalysis
A revisionist view of Freudian theory from the white hot period of French intellectual enquiry in the
1960s. Very challenging and exciting reading, even now. Contains his exposition of the mirror phase
and transference.
Michel Foucault, The Birth of the Clinic
A history of the philosophical ideas that underlie modern medicine. Particularly strong on the power
relationships in medicine between doctor and patient. Foucault was a contemporary of Lacan and
shared his revolutionary enthusiasm.
Michel Foucault, Madness and Civilisation
A history of the approaches to madness since the medieval period in Europe and its journey from
utter exclusion to containment as an illness. Beautifully written.
Sigmund Freud, The New Introductory Lectures in Psychoanalysis
The clearest and most elegant exposition of Freuds ideas from a series of lectures given by their
originator. Any modern understanding of the other must include Freuds concept of the
unconscious.
Finally, three classical works that are essential reading for anyone trying to act morally or
understand ideas:
Aristotle The Ethics
Xenophon The Conversations of Socrates
Plato The Republic