Editor's Preface: Alterity, Answerability, and the Call to Dialog

Watching, hearing, and reading about the current debate over the future of health care in America, I have struggled to comprehend, not the issues or the terms of the debate, but its tenor, the violence with which so many have taken their stands and have pursued their particular agendas. I have watched town hall meetings, those idyllic sites of utopian grassroots democratic process, transformed into places of mistrust, accusation, and fear. I've seen the decency of democracy unhinged and freedom of speech silenced as debate has become demagoguery. And I have wondered what, if anything, the work of humanities scholars and journals like this one, concerned as we are with all matters medical, might bring to the discussion. What, I asked myself, could the essays in this issue have to offer?

It was a startling and unsettling question that invited me to look not only at the particulars of this particularly eclectic issue of Literature and Medicine, which seems remarkably far removed from the town halls of any American city I know, but also more broadly at what our collective work might say to a world so divided by anger and a deep distrust of ideas. More importantly, what might we say to a world seemingly committed to the proposition that any person occupying a point-of-view different from mine must be my enemy and everyone else's enemy as well? The answers to the questions I asked led me farther afield than I expected, and then they led me home again.

In a section of "Author and Hero in Aesthetic Activity" subtitled "The Excess of Seeing," M. M. Bakhtin offers a description of how human beings encounter one another that seems to me both appropriate and important.

When I contemplate a whole human being who is situated outside and over against me, our concrete, actually experienced horizons do not coincide. For at each given moment, regardless of the position and the proximity to me of this other human being whom I am contemplating, I shall always see and know something that he, from his place outside and over against me, cannot see himself: parts of his body that are inaccessible to his own gaze (his head, his face and its expression), the world behind his back, and a whole series of objects and relations, which in any of our mutual relations are accessible to me but not to him. As we gaze at each other, two different worlds are reflected in the pupils of our eyes.¹

Bakhtin's description of the encounter of one person with another is a reasonable algorithm for any experience of alterity: science with art, medicine with literature, economics with human suffering, innocence with experience, and even one citizen with another at a town hall meeting. It is fundamental to the work of this journal and other journals that attempt to bridge or to bring together the humanities and medicine. If the two different worlds "reflected in the pupils of our eyes" were as far as we could go, the raucous town halls of America in which my world never meets your world might seem perfectly normal, but Bakhtin goes on to describe the way contemplation creates both an internal sphere of activity in which only the "I" who sees can engage and an external sphere in which ethical activity can take place and the way in which self and other are bound together in the mutual work of creating wholeness.

For Bakhtin, the fact that we see different worlds does not engender a romantic or essentialized self. As Michael Holquist puts it in the introduction to Art and Answerability, the uniqueness of the self with its particular experiences of alterity leads to "the paradoxical result that we are therefore fated to need the other . . . . Far from celebrating a solipsistic 'I,' Bakhtin posits the uniqueness of the self as precisely that condition in which the necessity of the other is born."² Out of this necessity arises Bakhtin's most celebrated concept, the dialogic self, which asserts that "we are unique, but we are never alone...