This essay begins with a conundrum noted in modern western medical practice: Patients relate to the body in an objective way, commensurate with our modern, rational and scientific world-view. This position is one of emotional separation or distance. However, should the equilibrium of the body become disturbed, as in illness or disease, then the emotional connection is made in a more direct way, usually with fear, anxiety, or panic; that is, engaging the patient in an instinctual and primal emotional manner. Then the body receives an importance not hitherto given, illustrating that the aforementioned separation is somewhat illusory and indicating the rather enigmatic relationship that we customarily have with our physical state “in the world”. This somewhat enigmatic and paradoxical position may be referred to as “marginal” or “liminal”. For the purpose of this essay the more familiar former term will mainly be used but interchanged with the latter, which seems to be more apt (see definitions).
If more broadly applied, then the concept of marginality in medicine would seem to engage other dimensions of our experience, most immediately those of the mind that extend beyond its common, rational and limited usage: a restricted and limited position that commentators of the mind’s depths and mysteries, such as Wilber, have often referred to as “flatland”. And, instead of complying to this neat rational perspective of finding a “cause” to any illness or malaise, we find that such a simple concept of dysfunction – and hence also normal function by inference – does not exist; yet we struggle with the consequences of such a causal paradigm, seeking ever deeper or occult “hidden causes”, instead of recognising that the paradigm itself may be wrong.
It would be tempting to offer other paradigm models to explain this apparent confusion and murkiness that occurs when we explore these issues more deeply (maybe just to make us feel more secure, but ultimately to avoid facing our fears). Indeed many, including myself, have done this (see my book: Medicine at the Crossroads) and one tentative conclusion is that a more holistic paradigm would better embrace marginality – but I am getting ahead of myself. However, here we will be restricting ourselves and exploring the issue of marginality as a conundrum that can be explored and understood far better than it currently is and, with this knowledge, the alternative paradigms can be considered more completely beyond a simple rational appreciation.
This marginal or liminal concept is by no means limited to medicine: In fact, it could be considered universal or archetypal to human experience. We will be approaching this concept of marginality in various other disciplines as the essay unfolds, but in the meantime it would be appropriate to use health and medicine as a lens or window into the concept.
The historical and mythical figure that stands behind medicine is the shaman. Versed in the arts of body, mind and spirit, and initiated into the vocation by a “calling” usually marked by a severe illness, the shaman exists currently in marginal cultures, probably being most familiar in the figure of the “medicine man” of North American Indian tradition. Yet this figure has a universality that may itself be described as archetypal, such that the shaman and shamanism as a vocation or discipline would seem to embrace the patterns that all medicine would hold.
Or so it would seem. There is a strong argument that modern western medicine, enamoured with science and rationality, has lost its deeper connection to the art of medicine and with it the pattern of marginality that the medicine man or shaman embraces. Such a figure often seems to have a rather peripheral relationship to the society in which he – or she – lives; acquainted with dreams and madness, called upon at times of need yet often shunned otherwise, mediator of the world of spirit with initiation, ritual and ceremony.
At the border of myth and history Jesus performed some astonishing miracles, most notably of the insane and dead. Indeed, such mystical figures often have a magical inclination, sometimes of good and other times of evil: the figure of Rasputin springs to mind. In the Middle Ages doctors such as Culpeper and Paracelsus existed on the edge of the medical profession of the time, yet had enormous influence on the development of the healing arts into modern times. Paracelsus is even noted as the father of modern pharmaceutical medicine, a title he may not want to bear; maybe he would prefer to be remembered by his quotation, that “emotion is the vehicle of the soul”.
What characterises marginality, or the practitioner of the liminal? We have, to some extent, characterised normal existence as being rational and governed by cognitive approaches such as causality, reductionism and quantitative analysis (as exemplified by the deification of statistics and resulting definitions of “normality”). Such a person has an extraverted orientation into the world as is and defined by the four dimensions of time and space.
It is not that the practitioner of the liminal eschews this perspective, he simply sees this reality as limited and resting on a far greater one. In the series of books by Carlos Castaneda, the “sorcerer” Don Juan, who was also Castaneda’s teacher and mentor, defined this limited view as the “tonal” and the greater reality that extends infinitely beyond, yet includes the tonal, as the “nagual”. He likened the tonal to the restricted and two-dimensional view on the top of a table placed out in the environment, which fails to see the depth beneath it or the infinite reaches beyond into the surrounding world. The sorcerer engages in both worlds and mediates between them, as does the shaman, medicine man, and true healer.
Sorcerer is a challenging term. Although it attracts dark and negative connotations, it has not always been so, and could be considered connate with the term “magician”. Here we are on vague and slippery ground; terms like myth, magic and mysticism have been denigrated – “flattened” – in the modern era. Not only flattened, but even distorted and turned into their opposite; such that myth becomes falsehood, mysticism equated with woolly thinking, and magic the realm of the childhood of Harry Potter.
It would take us too far to restore the depth and authenticity of these terms and others associated, such as cult and imagination. One interesting feature is that all these terms can be seen to relate to marginality and be a doorway into the realm of spirit, a realm debased and ignored in the modern West. If we restrict ourselves to magic and mysticism, it could be that the mystic is someone immersed in the nagual and the magician one who, like the sorcerer, mediates between the worlds; the former passively and the latter more actively.
The cognitive features of this position are a comfort with dualism, the abstract, holism, and the realms of the instincts, mood and emotions. This position is more fluid and nebulous than the order and structure of the day-to-day world of the tonal. It moves beyond the known and explores the unknown, differentiating what can be known from that which remains forever unknowable… the domain of the divine maybe. Here the practitioner is comfortable with the processes that stand behind the structure of daily reality. He also feels comfortable actively working with them, although what may distinguish the white from the black practitioner of this art is the respect for and conformity with the deeper unknowable patterns – archetypes maybe – that stand behind this realm of process and with which he allies.
In modern times how would such a practitioner appear? He may be drawn to the creative arts, the vocations of medicine or religion, or be the village eccentric. The relationship with madness is closer, indicating that the world of insanity may be far more than a neurobiological disturbance. He confronts existential issues such as death, isolation, and meaning. He listens to dreams and portents, such as the patterns revealed in synchronicity. In illness or any disturbance in the fabric of reality he seeks the deeper patterns and process, and engages with them. He has overcome the fear of estrangement and aloneness, and although mindful of the opinions of others, it is not these that guide his direction. His relationships are few, but close. He is comfortable challenging conventional mores, such as sexuality, and he may actively and openly practice these differently. He may be a visitor to the asylum, or gaol. Wealth and social acceptance are not his dictates although, ironically, he may become (in)famous.
If the discipline of modern medicine is taken above as an example, it can be seen that the liminal position explores the deeper patterns in illness and disease. The practitioner would work with these in a ritual and ceremonial context, with a strong emotional connection to the sufferer. Although modern medicine itself would not accept this – and often disciplines practitioners who engage in this manner – it is becoming obvious that we are reaching the limits of what modern medicine can achieve. The marginal position would see modern medicine as governed by fear, anxiety, and principally the fear of death, and that it instils these fears into the patient, not recognising the deeper existential and spiritual positions that govern such a view. Medicine, in its hubris and arrogance, believes that the rational and scientific will ultimately prevail. The signs are not good.
Yet, as we radiate out from this limited perspective, it is obvious that the Emperor is wearing no clothes. But the difficulty is that at the edges of flatland there is no clear boundary – there is marginality; the boundaries become frayed, blurred, and grey. The rules are different; time and space are no longer neat and ordered: indeed, there may be more than these four dimensions, as string theory in physics posits at least eleven. We could explore many disciplines to illustrate the same pattern, but here we have strayed into the only one we will give active consideration to: modern physics. It was Einstein who entered marginality and brought back, magician-like, the fact that matter and energy are interchangeable and also that the boundaries of time and space are themselves interconnected, warped and blurred.
Then quantum physics, at the other end of the scale of the enormously large to the infinitely small, finds that matter is not all it seems. It is mainly all empty space and lacking substance; reality becomes an illusion if this position is furthered. All is not as it seems and more like Alice in the Looking Glass. Particles behave contrary to mechanical physics and even pass backward in time. Information can pass instantaneously and matter materialise as a rabbit out of the magician’s top hat. This is a strange world.
But isn’t that exactly what is proposed here? That the liminal world is indeed strange, if judged from the position of consensus reality. It requires a familiarity and experience with this world to first know it, and then second to adopt it as a new position from which to view consensus reality. This is a symbolic death – of the ego maybe – and a Copernican revolution in the inner worlds, if our consciousness can make the transition and face the attendant fears, anxieties, and yet excitements that mark it. It means seeing the spiritual world as primary and the physical as secondary. The marginal position may ultimately equate to what religion calls soul.
There are some deep principles in operation here. As medicine extends its knowledge, based on the scientific rationality and technology of the tonal, it encounters indeterminacy and uncertainty. The regressive rearguard position is to imply that future knowledge based on the same causal, reductionist and quantitative principles will eventually capture this uncertainty into the rational known. There are many indices that this is not the case, as further exploration based on these principles simply broadens the uncertainty, creating confusion and anxiety. It could be and is argued that a paradigm change along holistic principles is necessary: not the limited “holism” of alternative medical persuasion, but one that is inclusive of mind and connects across disciplines.
In psychology the reductive basis of the psychoanalysis of Freud, based on the personal and the historical past of the individual, was superseded by the analytical psychology of Jung. This explored the uncertainty and looked for deeper governing principles in psychology and human behaviour that extended beyond the personal into the uncertainty, there to posit the archetypes and a transpersonal psychology as the ordering patterns of us all.
It is maybe no surprise that, beyond his mystical inclinations, Jung associated with physicists such as Pauli to extend his thesis across disciplines. The principle of synchronicity was one result of this work. In modern physics has indicated that there are similar ordering principles in relativity, quantum physics and more recently in chaos theory (strange attractors here look uncannily like archetypal principles) and the multidimensionality of string theory. All of these emerging from the uncertainty following the breakdown of the mechanical universe posited by the Newtonian world-view.
There appears to be a general principle in operation when these and other disciplines are explored in detail. When the boundaries of any discipline are reached the unknown beckons. The conventional reality principle determines that this unknown can become known by extending the existing beliefs and techniques. It is implied – in medicine above – that this principle runs into progressive difficulty and even breaks down in a confusion resulting in anxiety and even fear. What is being suggested here is that this boundary state requires – demands – a change in perspective, a paradigm shift. It further demands distinguishing what is unknown and can be known from that which is unknown and ultimately unknowable.
In physics there are four defined forces: gravity, electromagnetic, the strong and weak nuclear. These forces act in a world governed by the second law of entropy: that the universe is progressively winding down into increasing chaos and disorder. Yet, as discussed, in this chaos are patterns of order that are emerging into our consciousness. There is an unknown – maybe unknowable – force that seems to defy the inevitable slide into disorder. This force is standing Darwin (and his modern proponents) on his head and pushing evolution more toward creative intelligence and divine intervention than most are comfortable with: Indeed, the Oxford English Dictionary definition of the word holism includes the enigmatic “creative evolution”.
Because man is a work in progress: If the marginal vision is embraced it becomes obvious that we are drawing to the end of an evolutionary era. Man has gone as far as he can go with his rational intelligence and technology. To go forward he must first reconnect with deeper patterns that he has earlier sidelined to the asylum, monastery, or nursery. This is the realm that exists under Don Juan’s table and in entering this he must face the fear of disease, madness, and death. Then he must radiate out into the vast inner beyond that is reflected in his present exploration of the physical universe, to not only change the paradigms of modern disciplines, such as medicine, but to partake in a co-operative manner with his own evolution.
What is this force, this fifth force that is vague, undefined and marginal, variously seen as the “ether” in times past? What is this evolutionary and creative impulse within which we are all – like it or not – variously embedded? Some would call this force consciousness, but would it be too grand to call it love? Maybe this fifth force is the love espoused by a quasi-mythical Middle Eastern mystic of some two thousand years ago? In this Age of Aquarius maybe we are finally coming home and ET has found the phone… the line is embedded in the dreams and visions of us all.
Here are some New Oxford American Dictionary definitions:
of, relating to, or situated at the edge or margin of something.
occupying a position at, or on both sides of, a boundary or threshold.
the theory that parts of a whole are in intimate interconnection, such that they cannot exist independently of the whole, or cannot be understood without reference to the whole, which is thus regarded as greater than the sum of its parts. Holism is often applied to mental states, language, and ecology.
Medicine: the treating of the whole person, taking into account mental and social factors, rather than just the physical symptoms of a disease.
Some further and slightly more elaborated terms and definitions that may help orientation in the liminal world (computer driven):
- One that is puzzling, ambiguous, or inexplicable.
- A perplexing speech or text; a riddle.
- One that is not fully understood or that baffles or eludes the understanding; an enigma.
- One whose identity is unknown and who arouses curiosity.
- A mysterious character or quality.
- The skills, lore, or practices that are peculiar to a particular activity or group and are regarded as the special province of initiates.
- A religious truth that is incomprehensible to reason and knowable only through divine revelation.
- Something that represents something else by association, resemblance, or convention, especially a material object used to represent something invisible.
- An object or image that an individual unconsciously uses to represent repressed thoughts, feelings, or impulses.
- A seemingly contradictory statement that may nonetheless be true.
- One exhibiting inexplicable or contradictory aspects.
- An assertion that is essentially self-contradictory, though based on a valid deduction from acceptable premises.
- A statement contrary to received opinion.
- A figure of speech in which a word or phrase that ordinarily designates one thing is used to designate another, thus making an implicit comparison.
- One thing conceived as representing another; a symbol.