|Reading doctors' writing
Aboriginal Studies Press, Canberra, 2004
The power of dominant culture, language, education and social position to control and manipulate the world-view of less well placed groups and individuals is not a new phenomenon. The famous sage Lao Tzu advocated the use of dominant power to keep people ignorant for their own good. 'The sage must strengthen the bones and weaken the minds of the people he rules'1.
In his book based on publications in the Medical Journal of Australia (MJA) over almost a century, Dr Thomas has injected new life into the debate about the role of ideology and modern science in particular, in his discussion of the treatment of Indigenous people in Australia by those spurred on by the ruling ideology of the time. The book has undertones of Paulo Freire2 and his analysis of how the language, education and hegemony of foreign cultures serve to oppress and dis-empower people who are not adherents to or included in that culture. These very sentiments moved Ivan Illich3 to argue against the structure of schools generally because, he said, that they serve to separate, stream, isolate and alienate certain groups and classes in society from their own knowledge forms as well as from those of the ruling ideology. Schools and education, he argued, were simply a mechanism for reproducing the dominant ideology and resultant class system that supported the ruling class, as Marx also argued in relation to the ownership of capital4-6.
Those who wield the power of capital establish structures to ensure that this power is not distributed more generally, lost or diluted over time. Rather power is passed from one 'ruling' class or culture to the next to ensure, in the capitalist world at least, that the hard work of one generation7-8 accumulates for the benefit of future generations of dominant and ruling capitalists. These successors, in their turn, must also control the social and economic fabric of their society through similar processes. The contexts and motifs of this class struggle may vary, but the form remains the same; exclusion, oppression, alienation and violation of the dominated by the dominators.
My reading of Dr Thomas's book also recalled for me Karl Popper, the father of modern scientific method, as I winged through the pages of this wonderfully written and argued book. Indeed, Dr Thomas refers directly to Popper's falsifiability criterion of science on page 76 of his book9-10. To paraphrase Popper, if your theory holds that all crows are black, your should test this theory by searching for an exception to it, but if you are closed to the possibility of your finding a white crow you might spend most of your efforts counting black ones and call this proof of the theory that crows must be black. This sentiment is nicely aligned by Dr Thomas with the failure of early medical scientists to test properly the ill-conceived attempts to use blood type matching to prove that fundamental differences exist between Aboriginal and European people. The irony appears to be that such testing actually demonstrated more similarities than differences between the two.
Over time we have learnt that our perceptions and beliefs about the tools with which we explore our world colour and condition the way we look at things, our values, our priorities and finally our notions of truth and reality. Objective science and empiricist philosophy might not only constrain our view of reality (limiting us to a world of 'black crows') and our social relations, it can impact adversely upon other cultures and social orders that do not accept its fundamental premises. Indeed, belief in and promulgation of the myth that scientific philosophy can deliver truth above all truths can be quite dangerous, as many nations conquered and oppressed by the west might attest!
Heisenberg also noted that the more you try to define something with language or science, such as the position of an atom or electron, the less likely you are to find it. To add more complexity, the very process of measuring the position and behaviour of an electron changes the way it behaves or even its very nature.
Even the rock-hard tenets of science cannot produce absolute truth. This must be why so many thinkers (Buddhism, Zen, Advaita Vedanta, Hinduism, Zoroastrianism and others with more metaphysical approaches to the definition of reality) attempted in various ways to go beyond the straight jackets of formal language to grapple with our diverse reality. As Wittgenstein wrote, 'Philosophy aught really to be written as poetic composition'11 (p 24). There are more things in Heaven and Earth Horatio than in your philosophy!
To bring this epistemological argument back to the social and cultural context of Aboriginal health, Dr Thomas then examines the way our dominant ideological framework has served to interfere with, mis-interpret and oppress Aboriginal people in Australia. He follows publications in the MJA from 1870-1969 dealing with Aboriginal health issues, and demonstrates how the nature and extent of these publications tells us interesting things about the perceptions of the dominant ideology of the time about Aboriginal people in Australia; perceptions ranging from the same scientific and empiricist traditions that saw Europeans oppressing and obliterating the cultures of the people they invaded from South America to Africa, India, China, Indonesia, New Zealand and Australia.
Dr Thomas demonstrates how the extreme paternalistic attitudes of scientists resulted in Aboriginal people being reduced by 'white lies and placebos' (p 83) and constrained by 'white condescension' (p 126) to the status of a defeated and compliant people, all of this through the power of 'writing, books and paper' (p 97). The possession and application of these one-sided tools of science and the devices of the dominant culture completely alienated and debilitated Aboriginal people because they lacked the skills (weapons) to defend themselves against its advances. Things are changing, however!
Although we have such a myopic and ideologically tainted history when it comes to the way western cultures, both Protestant and Catholic, have dealt with new lands and their inhabitants, there are positive signs that some vestiges of this kind of world-view are slowly being corrected and healed in Australia. We now have a multi-cultural and more tolerant society and we are coming to value the knowledge and ideas of a wider range of people and cultures; the Indigenous culture included. Also, Indigenous people are now acquiring and using the hitherto mystifying knowledge of science and the language of western politics and philosophy to defend their position and to take more control over their affairs, their economies and the processes of research that they choose to apply in their communities. Aboriginal people are regaining strength, confidence and assurance from the knowledge that doctors and medical science represent a useful approach to and epistemology through which they define their health and wellbeing (p 127), but not the only approach!
The release of Dr Thomas's book is especially apt at this time (2004), given the recent establishment in South Australia of the new Centre of Clinical Research Excellence in Aboriginal and Torres Strait Islander Health. Through this initiative the issue of research forms in Aboriginal communities is being addressed and new and more relevant approaches to useful and practical research are being developed. These new structures influencing the nature and extent of research in Indigenous communities will lead to increase involvement by local people in determining the type of research that is carried out in their communities and ensure that the mistakes of the past, described at length by Dr Thomas, are not repeated.
Today more and more Indigenous people are becoming involved in the health sector as educators, health professionals and research scientists. Their presence and input will continue to improve the quality and relevance of the research work being done for the benefit of Indigenous Australians. This increasing engagement with the philosophy science and modern economy, synthesized with and informed by confidence in Aboriginal culture, will support Aboriginal people to develop the knowledge and skills they need to ensure that the language and methods of science are used for constructive ends. This is a far cry from what Dr Thomas described in his study as the curious enquiry into the phenomena of a vanishing people.
Whatever may be one's sentimental views on the passing of the primitive peoples, from the scientific or even the utilitarian aspect it will be more than unfortunate if our records are not completed before they vanish (p 53).
To be fair, however, even Dr JB Cleland, although labouring under the misconceptions of early twentieth century philosophy of science, was becoming aware of the destructive impact of modern culture upon Aboriginal people. In one of his many articles in the MJA he wrote about the deleterious effects of European culture upon Aboriginal people and promoted the proposition that Indigenous communities should be allowed to live in their natural environment without interference from European settlers.
They [Aborigines] should be allocated extensive hunting grounds in their own country, and Europeans should be prohibited from trespassing on those grounds under any pretext. This concession we surely owe to those people from whom, by force and without any compensation whatsoever, we have taken away the land they possessed, and deprived them, in too many instances, of the means of obtaining food in their own way and even water (p 86).
This insight into the adverse impact upon Aboriginal people and culture of European influences did not, however, stop Cleland from proposing that the University of Adelaide purchase a unique parcel of land adjacent to a major Aboriginal reserve in order to 'protect its inviolate status', and to 'ensure continued opportunities to study' Aboriginal people in an 'ethnographical laboratory' (p 86). The University, reports Thomas, rejected his proposal and the 'laboratory' did not proceed.
The fact that such patronizing language and associated ideology is no longer taken seriously is testament to a much more constructive synthesis of cultures and attitudes in Australia that will hopefully underpin a positive future for health care generally and for Indigenous people particularly.
Dr Thomas' book provides a wonderfully referenced history of the adverse impact of western philosophy and ideology upon the wellbeing of Indigenous Australians. It also serves to remind and warn us that, however socially enlightened we may judge ourselves to be today, we should be constantly vigilant to avoid making again the mistakes of history fueled as they often were, and are, by the best of intentions.
Peter Harvey, PhD
Spencer Gulf Rural Health School
University of South Australia, Australia
1. Lao-Tzu. Tao Te Ching. London: Penguin Classics, 1963.
2. Freire P. Pedagogy of the Oppressed. London: Penguin Books, 1972.
3. Illich I. Deschooling Society - including the essay 'Dawn of Epimethian Man'. London: Galder and Boyars, 1971.
4. Heilbroner R. The Worldly Philosophers - the lives, times and ideas of the great economic thinkers. 6th edn. New York: Simon and Schuster, 1986.
5. Heilbroner R. Marxism for and against. New York: WW Norton, 1998.
6. Marx K, Engels F. The German Ideology Pt 1. New York: International Publishers, 1978.
7. Smith A. An inquiry into the nature and causes of the wealth of nations. London: William Benton, 1776.
8. Weber M. The Protestant ethic and the spirit of capitalism. London: Unwin University Books, 1958.
9. Popper K. Conjectures and Refutations. London: Routledge & Kegan Paul, 1963.
10. Popper K. Conjectures and Refutations: the growth of scientific knowledge. London: Routledge and Keagan Paul, 1969.
11. Wittgenstein L. Culture and Value. Oxford: Blackwell, 1980.