Critical consciousness: the object of learning in critical humanities

Instead ot a body' of knowledge of critical humanities—a ‘Critical Canon’ of sorts—that one learns, we would argue that the object of knowledge and the goal ot learning in this field are not as much content as ways of knowing and acting in the world. This orientation may be termed ‘critical consciousness’ and represents an awareness ot Self, Other, and the World, as well as an awareness of social injustice and a commitment to act to address injustice.

Critical consciousness, or conscientizcifao, is a concept originally developed by the Brazilian educational theorist Paulo Freire (1993) to describe a way of learning to perceive (‘to read’), and act on, educational, social, economic, political, and historical contradictions that lead to oppression and suffering. It posits that human beings are conscious, reflective, social beings who are capable ot interacting with fellow human beings to address inequities and injustices in the world. This approach is not only epistemological but also existential and embodied: it is both thought and action in the world.

As a form of thinking, teaching, learning, and being, critical consciousness is distinct from the notion ot ‘critical thinking,’ to which educators devote innumerable hours of thought and effort. Critical thinking is analytical and evaluative; it involves abstraction and attempts to assess facts and phenomena as objectively as possible. The individual who engages in critical thinking uses the Cartesian res cogitans—the ‘mental substance’—that exists separately from being. Critical thinking may be done by oneself alone in a room—it is ‘monological’; that is, the meaning and product ot thought may be the outcome of a single individual, disconnected from others and the world (Burbules and Berk 1999). In medicine, one may engage in critical thinking regarding a differential diagnosis, diagnostic strategy, and treatment plan ot a patient without regard to the social context in which illness and its consequences play out—without consideration of the ethical, societal, historical, political, and structural issues that have resulted in a given patient presenting for care at a given time in a given set of circumstances. Issues of privilege, power, equity, or justice do not enter into the picture; they are often considered as separate, or not considered at all. In contrast, critical consciousness addresses these social and societal issues in the context of illness and medical care. Critical consciousness demands answers to the question ‘why?’; not only why does a specific disease process result in these clinical findings and sequelae, but also why have social forces resulted in an individual being unable to flourish in health and wellness at a given time and a given place?

The point here is not that critical consciousness is ‘better’ than critical thinking. Critical thinking itself is an essential activity in medicine; alone, however, it is insufficient to deliver care with excellence, compassion, and justice (Kumagai and Lypson 2009). Critical consciousness connects differential diagnoses to societal and structural inequities and links diagnostic strategies and treatment plans with human needs and contexts. Its emphasis on both understanding and action ties identification of inequities into the social determinants of health to address such inequities and to support the social contract and consequent accountability underlying health care (Sharma, Pinto, and Kumagai 2018). From an epistemological point of view, in contrast to critical thinking, which takes an instrumental approach to understanding abnormal processes to discover effective interventions, critical consciousness is fundamentally emancipatory: it addresses interests and action with human social needs in order to alleviate suffering and oppression (Kumagai 2013). But here too is an ethical challenge: who decides on who shall be ‘emancipated,’ for what reasons, and what form the ‘emancipation’ shall take can all constitute a form of imperialism, a ‘violence,’ conscious govemmentality, or an imposed religiosity.

The power of stories

Narratives—‘stories’ in the broadest sense—may play a crucially important role in the development of critical consciousness, in the ability, as Freire (1993: 39) describes it, “to see the world unveiled.” Whether through literature, the visual arts, music, song, or oral traditions, stories have the ability to create an affective link between individuals of different backgrounds, identities, life experiences, and even time periods; and to imagine the world through another’s eyes (Kumagai 2008). This may be particularly important in stories from individuals whose views are traditionally silenced in a process that the writer bell hooks (1994) calls “coming to voice.’ In Borderlands/La Frontera, the Chicana writer Gloria Anzaldua (2012) speaks of a capacity, which she terms la facultad, that allows individuals from marginalised groups to see beyond superficial appearances: “to see the deep structures below the surface” that oppress and dominate the lives of individuals without power. These stories have the capacity to stimulate shifts in perspective and create allies in struggle.

There are, however, risks to narratives. Although stories have great power to transform perspectives and values, not all stories and the ways they are told are ‘good.’ As the feminist writer Megan Boler (1999) points out, the suffering and oppression of silenced groups may be appropriated—often unwittingly—by privileged individuals or groups, who upon hearing the stories conclude that they ‘now get it,’ i.e., they understand the experience even though it is not one that they have had themselves. This returns us to our earlier warning about ‘emancipation’ as potentially colonising rather than liberating. In this sense, instead of fostering empathy and forging allies, the appropriation of stories can replicate existing power hierarchies and result in ‘re-victimisation’ of those who are the subjects of the stories themselves. Boler talks of two types of narratives: “spectating,” in which the listener, while moved by the story, leaves the story unchanged; and “bearing witness,” in which the listener acknowledges responsibility for addressing suffering and is prompted to act. There is thus a moral dimension to storytelling itself, where stories become instruments to sharpen one’s moral vision towards justice and humanistic care.

Narrative disruption

An element of stories that plays an essential role in the development of critical consciousness is the power to disrupt: to produce discomfort in order to prompt reflection on self, others, and the world, prompting ‘thinking otherwise.’ Boler’s concept of “the pedagogy of discomfort” is useful in this context. She argues that in contrast to “spectating,” where individuals consider the lives of others living under conditions of injustice and oppression from a privileged distance—a “gaping distance between self and other”—a pedagogy of discomfort prompts the individual to engage in an act of “witnessing” in which she recognises historical responsibilities and individual agency as well as the possibility of taking action for change. Here,

The aim of discomfort is for each person, myself included, to explore beliefs and value; to examine when visual ‘habits’ and emotional selectivity have become rigid and immune to flexibility; and to identify when and how our habits harm ourselves and others.

(Boler 1999: 186)

A pedagogy of discomfort recognises complexity and prevents us from letting ourselves off the hook for moral responsibility and challenges. It done skilfully, a nuanced approach to speaking about justice and injustice can move beyond questions of guilt and innocence and may instead invite students “to leave the familiar shores of learned beliefs and habits and swim further out into the ‘foreign’ and risky depths of the sea of ethical and moral differences” (ibid.: 181). This approach recalls Paulo Freire’s (1993) idea of “reading the world,” i.e., to lift the veil of naturalness behind dehumanising conditions to understand the complex relationships of power, privilege, and oppression that operate underneath. For Freire, this type of learning- through-contradiction often takes the form of a ruptura—a break—from the past: “|T]here is no creativity without ruptura, without a break from the old, without conflict in which you have to make a decision. I would say there is no human existence without ruptura" (Horton and Freire 1991: 38).

Shielding learners from confrontation and controversy through attempts to remain ‘neutral’ or ‘objective’ in fact tends to reinforce both individual preconceived ideas and the status quo and to perpetuate existing hierarchies of power, by-passing resistance. In this setting, one may talk about race without speaking about racism, gender without speaking about sexism, homosexuality without speaking about homophobia (Kumagai and Lypson 2009; Sharma and Kuper 2016). One may also diligently list all of the ‘social determinants of health’ as factors that explain why the health status of a given patient is poor without attempting to understand or address the larger societal or structural issues that prevent health and wellness (Sharma, Pinto, and Kumagai 2018). Deliberate attempts to shake up complacent assumptions and beliefs—in which implicit biases and dehumanising ways of labelling and thinking lurk—can force reflection and new ways of thinking and being.

On the other hand, exposure ot learners to uncomfortable things—either in an attempt to disrupt thinking or as an intrinsic part of the learning to care for the ill, the injured, the distraught, or the dying—can provoke more than produce discomfort. Depending on the learner’s background, lived experiences, identities, or life situation, teaching and learning about subjects of societal and social significance, such as bigotry, violence, abuse, suffering, suicide, and loss, may not remain as abstract subjects of an educational curriculum, but instead become sources of profound personal distress. For example, any lecture to a health professions class on domestic violence or sexual assault will invariably expose individuals who are actual survivors in the audience. In this sense, use of literature, stories, art, or movies to teach about socially relevant issues can ‘cut close to the bone’ and provoke distress in ways that are neither predictable nor desired (Kumagai et al. 2017). Rather than attempting to avoid such trauma—which is arguably unavoidable in medicine—by making the teaching of such subjects as sterile and abstract as possible, institutions must demonstrate sensitivity, creativity, and foresight in addressing these risks as part of a fundamental educational responsibility to learners and their needs.

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