Several different topics have come together this week – refugees, healthcare, social care of the elderly, English as a second language, and religion – that I realise have a common theme. The theme is ‘otherness’.

I use otherness because it is a gentler and more forgiving word than dehumanisation, but both words are in the same word cluster that also includes elitism, and probably that most English of English words, ‘class’.

The current ‘problem’ in Europe concerns the tide or flood of people arriving mostly from Syria and Iraq. These people are, according to the original meaning of the word, undoubtedly refugees.

refugee 1685, from Fr. refugié, prop. pp.of refugier “to take shelter, protect,” from O.Fr. refuge (see refuge). First applied to Fr. Huguenots who migrated after the revocation (1685) of the Edict of Nantes.The word meant “one seeking asylum,”till 1914, when it evolved to mean “one fleeing home” (first applied in this sense to civilians in Flanders heading west to escape fighting in World War I). 

They are seeking shelter, asking Europeans for protection, fleeing from their homes in fear of their lives. Few of us could imagine circumstances in which we would leave behind nearly all our possessions, our homes, our careers and friends, our native country, to undergo a long and hazardous journey that we knew we might not survive. Even fewer of us, I suspect, can imagine doing all of this because it was preferable to staying where we were. Many of the Syrians leaving their country are, through their ability to gather up the resources to move, educated and professional people. They find themselves often being treated like, and in conditions worse than, animals. Women are taking tiny babies and children with them  and sometimes giving birth during their journeys. I have read reports of people losing count of the numbers of countries that they have travelled through, always in fear, often in danger.

Our Prime Minister and his parliamentary colleagues have largely dropped the word refugees and taken to calling people migrants. ‘Refugee’ does not appear in a list of synonyms for the word ‘migrant’, but these words do: ‘drifter, gypsy, itinerant, tinker, transient, vagrant’, and the word offered as closely related to migrant is ‘alien’. I suggest that all these words have pretty negative connotations for the average English person. Even more derogatory are the phrases ‘swarm of migrants’ and ‘bunch of migrants’ (the latter offered by David Cameron most unfortunately on Holocaust Memorial Day). These words and phrases dehumanise the people to whom they refer as do phrases such as ‘refugee dispersal plans’. Once we stop recognising one another as people and treat others as a faceless nameless mass we become able to think and behave in ways that we would not contemplate when communicating face to face.

I believe that this ‘othering’ has become a problem in healthcare. One of the basic principles of medicine when I was training and then working as a hospital doctor was ‘do unto others as you would wish to be done to’. Treat your patients as you would hope that you and your family would be treated. This sort of practice requires empathy, and ability to put yourself into the other’s shoes even if their life is a million miles removed from your own. Empathy is often innate (and I think used to be a quality that drew young people to the healthcare professions) but can also be learned. I believe that it is greatly facilitated by activities that stimulate creativity and the imagination such as reading a wide range of novels, watching a variety of films, and keeping up with current affairs through any of the available media. Just about every aspect of  medical practice now mitigates against this. Medical students have an enormous learning load and often have financial burdens that require them to work part time; junior hospital doctors work erratic hours that destroy their sleep patterns and leave little time for establishing their own healthy relationships let alone empathising with others. General practitioners are overwhelmed by their clinical workload and mountains of paperwork, for much of which they see little purpose. A recruitment crisis has left many GP practices short-staffed, and instead of offering their patients a holistic approach and adequate time to explore what lies behind the presenting problem they offer focus on a single issue in the short time available. Patients’ problems are ‘chopped up into bits’ suitable to be dealt with by the practice nurses, the healthcare assistants, or needing the doctor. A patient becomes no longer a person but a series of compartmentalised problems. They become dehumanised.

Exactly the same concerns apply to care of the elderly, but they are compounded by the vulnerability and frailty of extreme age, especially if a person suffers with dementia. An older person with Alzheimer’s is similar to a refugee – unable to speak your language, fearful, vulnerable, at the mercy of others. The classical English way of dealing with people who can’t speak English is to speak repeat oneself speaking more slowly and more loudly, implicitly suggesting that the other person is deaf and stupid. We who cannot empathise or communicate project our own frustration and fear of otherness onto the other person.

Finally issues of religion strikes a chord at deeply buried superstitions, beliefs and fears. It is widely agreed that in practice we live in a secular country in the UK, and the numbers of regular churchgoers is dwindling. However, a majority of the population still claim to believe in God, and the God that they believe in is usually a Church of England God, or at the very least a Christian God. The perceived threat of Islam is clear from the massive overestimation of Muslims in the UK given by many surveys – the actual figure is 4.5%. Of course the irony of the ‘my God is better than your God’ xenophobia is that the three monotheistic religions that have spent centuries persecuting one another (Judaism, Christianity and Islam) all believe in the same God. However each lays claim to the right path, and those who differ are ‘other’. David Cameron’s recent comments about helping Muslim women in Britain to speak English illustrate the way in which an entire body of people can be made ‘other’ and thus dehumanised. Singling out Muslim women (and threatening them with deportation) also ignores the English language needs of other immigrant women such as Iraqi Christians and Hindu or Sikh Indians.

Refugees and migrants are strangers to us. Those of different religions from our own are strangers to us. People with dementia are strangers to us. They are all ‘other’, but so is the 17y old unemployed boy at the end of my road, the mother who works in a factory, the chief exec of a multinational company. Their lives are unimaginable to me and if I were to enter their world I would be ‘other’ in it.

Thesaurus.com provides a number of alternatives for the word stranger:


These are all negative terms, familiar to readers of tabloid newspapers (and of some broadsheets). They are not words that invite welcome, integration, mutual respect.

There are two more words given as alternatives for stranger.

They are ‘visitor’ and ‘guest’.

What does it take for us to see those who are different from us as guests rather than invaders?

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