920774
research-article2020
ALN0010.1177/1177180120920774AlterNativeWilson et al.
Article
Double perspective narrating time,
life and health
AlterNative
1–9
© The Author(s) 2020
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https://doi.org/10.1177/1177180120920774
DOI:
10.1177/1177180120920774
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Shawn Wilson1,2 , Anna Lydia Svalastog2, Harald Gaski3,4,
Kate Senior5 and Richard Chenhall6
Abstract
The goal of this article is to explain the concept of double perspective and the impact this may be having on the health of
Indigenous people. In inter-cultural communication, there are sets of meanings that are discernible to anyone, and an
extra set of underlying meanings that are only accessible for people who have the cultural knowledge to discern them.
These different sets of meanings embody a double perspective. We will discuss the double perspective involved in the
interactions between public healthcare institutions, the clinicians and staff of these institutions, and Indigenous people.
By realising the potential for improved resilience that a double perspective brings to Indigenous people, an awareness
of the inclusion and exclusion of Indigenous persons, cultures and histories should become established in healthcare
institutions and health research. A double perspective carries resilience, and as such it should be understood as a key to
support individual health and the collective well-being of Indigenous people.
Keywords
Indigenous health, cultural understanding, inter-cultural communication, health communication
“Western” facts of the case:
75-year-old Indigenous male, suffers vertigo attack (dizziness,
loss of balance and coordination) and falls in local shop, feels
nauseous and subsequently vomits, but no loss of consciousness.
Ambulance is called, paramedics administer O2 on the scene
and transport to Emergency Department (ED) at local hospital.
Attending physician runs checks for possibility of stroke but
determines that unlikely. After several hours’ observation in
the ED, patient seems fine now, so is directed to attend the
local general practitioner (GP) clinic for further testing.
Shawn’s “Indigenous” facts of the case:
My mother phones to tell me that Dad had a fall in a local shop
and she’s just got back from the Emergency Department. Dad
is still in the hospital. Mum doesn’t want me to worry about
him but doesn’t know for sure what caused his fall. She is
obviously very worried herself. She knows that a stroke was
mentioned and isn’t sure when he’ll be out of the hospital.
Knowing the importance of a quick response and early
treatment of stroke, one of the first thoughts that went through
my head was, “I hope that it happened on the reserve so that
someone helped him.” When my dad later tells me the story,
one of the first things that he mentions is that after he fell in a
shop in Town (next to our reserve), “There was someone from
the reserve there that came over and asked me if I needed
help.”
As he’s 75 years old, my father has already outlived all but a
very few of the people he grew up with. Growing up in a
northern town where he is easily visibly identifiable as Cree,
he has faced too many experiences of racism to count,
including being turned away from the hospital for suspicion of
being “drunk”, when going to the local ED suffering a severe
allergic reaction. As a professor of education at a prestigious
university (as is my mother), he was often asked, “Which floor
do you clean?” or whether he “Appreciates the ‘affirmative
action’ policy that gave him his position.” As they are both
now retired, he and my mother live back on the reserve that is
our home community.
I’m reasonably sure someone else, that is, a White person,
would have stopped to help my father that day. However,
previous experiences with the healthcare system (4 years
earlier, an Indigenous man died in the waiting room at the ED
of our closest big city hospital, after 34 hr still waiting to be
seen by a doctor [Geary, 2017]), judgemental reactions we’ve
observed from White people towards Indigenous behaviour
(any Indian that falls over is drunk), the socio-historical context
of Indigenous–settler relations, and knowledge of the overprevalence of disease and early death was the reality that we
viewed that day, in addition to the Western facts of the story.
1Southern
Cross University, Australia
University College, Norway
3The Sámi University of Applied Sciences, Norway
4UiT the Arctic University of Norway, Norway
5The University of Newcastle, Australia
6The University of Melbourne, Australia
2Østfold
Corresponding author:
Shawn Wilson, Southern Cross University, Lismore, NSW 2480,
Australia.
Email: shawn.wilson@scu.edu.au
2
Introduction
The goal of this article is to discuss and better understand
the layers of meanings which are involved in the interactions
between public institutions, such as healthcare and
Indigenous peoples. We describe a double perspective,
where communication may hold a set of meanings
discernable to the outsider and a second set of restricted
meanings, only accessible for people who have the cultural
knowledge to discern them. This double perspective
embodies meaning. It may be an important form of
resistance used by Indigenous peoples when interacting
with Dominant society, but it also has the potential to cause
confusion in interactions between Indigenous people and
the Dominant culture. This confusion may become
particularly problematic when Indigenous peoples access
services provided by the Dominant culture, such as
healthcare, education and legal services.
We start by pointing towards examples of Indigenous
descriptions of the relation between Dominant society and
Indigenous peoples. The stories illuminate how the
explanation of Indigenous lives is framed by nonIndigenous peoples. These narratives are general in their
conclusion, pointing towards the ongoing impact of colonial
experiences on their lives, such as language, livelihood,
and ownership of knowledge and history. In this article, we
present examples of Indigenous experiences to further
underline the societal context of public institutions and
clinical practice. We then explore the concept of time,
arguing that Dominant cultures’ construction of time
excludes and reduces Indigenous’ lives and histories,
generating miscommunication between Indigenous peoples
and Dominant society. What concerns us is how the lack of
communication and disparate power relations generate
failure and blame by the Dominant culture to Indigenous
peoples, instead of understanding and support. As an
answer to this concern, we have found it useful to develop
the concept of Double perspective, to describe the realities
of Indigenous lives together with the relationship between
Dominant culture and Indigenous peoples.
A double perspective combines an individual’s
understanding of the perspectives and lives held by the
Dominant culture as well as a particular Indigenous
understanding of history and the life it contains. Our
conclusion is that Dominant culture and Double perspective
are two concepts that together can be used (a) to create
awareness of inclusion and exclusion of Indigenous lives in
everyday life situations, such as healthcare, (b) it can be
used as a frame that public institutions and their staff can
use to start listening and learning and to approach excluded
Indigenous life stories and knowledge as important to
include in health policy and planning, and not the least, (c)
the concept can be used as a starting point for analysis of
why activities (projects, programmes, organisations)
succeed or fail to ensure that discourses of blame and
failure are avoided.
Utilising a double perspective in making introductions,
for many Indigenous people there are essential protocols to
follow in making personal introductions. Introductions are
also important in academic writing, as they begin the
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process of building relationships between us as the authors,
and you as the reader (Wilson, 2008). So before we go
further, we are:
Shawn Wilson is an Opaskwayak Cree man who
currently lives on Bundjalung territory on the east coast of
Australia. With a background in both health and Indigenous
studies and a lifetime of lived experience in his Cree
culture, Shawn has worked with many Indigenous groups
internationally.
Anna Lydia Svalastog is a folklorist and a historian of
religion, with her family from the Telemark region of
Norway. She has worked in northern Sweden/Sápmi for
many years, where her background in feminism, ethnology
and folklore helped her collaborate on various Sámi
projects.
Kate Senior is a medical anthropologist who has studied
how Indigenous people interact with the health services
available to them. She has extensive experience in remote
Indigenous settings in Australia.
Harald Gaski is a Sámi from Tana, Norway. His research
focuses on Indigenous methodologies and Indigenous
peoples’ literatures with specific emphasis on Sámi
literature. He also specialises on oral tradition—especially
the transition of the traditional Sámi singing, the yoik
poetry, into contemporary lyrics.
Richard Chenhall is a medical anthropologist who has
worked with Indigenous people in urban, rural and remote
Australia on a range of topics, including the social
determinants of health, sexual health and youth identity.
The article is not written to or for Indigenous people, as
they do not need us to either Whitesplain nor to justify their
worldviews. It should not be up to Indigenous people to
constantly have to explain themselves—the responsibility
of learning to operate bi-culturally should also fall on nonIndigenous people. Our group is composed of “Whitey’s”
working with Indigenous people to (hopefully) help educate
non-Indigenous people and institutions.
We come from a wide variety of fields and from different
cultural backgrounds. Richard and Anna Lydia began
discussing the possibility of double perspective while Anna
Lydia was in Australia on a Dyason Fellowship at the
University of Melbourne, and brought together the rest of the
group specifically to expand on this concept. We decided that
it is important for us to write this article as a way of explaining
and mitigating the confusion and misunderstanding that we
have witnessed in cross-cultural communication between
Indigenous and non-Indigenous people. We will occasionally
return to the story of Shawn’s father’s visit to the hospital as
we further explain these concepts.
Background
The conceptualisation of cultural complexity and discontinuity has been an analytical as well as a theoretical
challenge that has generated a variety of concepts like
Bourdieu’s “habitus” (Rooksby & Hillier, 2005), Bernstein
and early linguistic “elaborated codes” and “restricted codes”
(Jones, 2013), Bradel’s “le long durée” (Armitage & Guldi,
2015) and Le Goff’s (1982) multiple temporalities
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Wilson et al.
“tidsuenlighet.” Models of inter-cultural relations include
working at the “cultural interface” (Nakata, 2007) and
“culturally appropriate care” (Williamson & Harrison, 2010).
As culture is a concept and area of study that has become
closer to home, not only medical anthropologists but also
folklorists, sociologists and historians of religions, more
and more tend to explore their own setting as culture, subculture or more post-modern reinvention of culture as a
plurality of coexisting cultures defined by socio-economic
groups, ethnic groups, groups related to age and popular
culture. We have also seen a cognitive turn, like when
anthropologist Victoria Burbank points out that culture is
something that stems from one’s relationship with the
family and should be conceptualised as something cognitive
and imbued with feeling. Cultural activities “feel good” in
a way that engaging with Western Institutions does not,
which has the potential to cause a great deal of tension and
miscommunication, as in the case of the child choosing
whether to attend school or a cultural event (Burbank,
2006). From an Indigenous studies perspective, culture is
tied to memories and experiences of past events, and is not
restricted to whether or not they felt good (Gaski, 1993). It
is understood as relevant by bringing insight into present or
future situations, if not directly so by an ability to transport
tools of relevance (Wilson, 2008).
In this particular text, we want to put forward the concept
of “double perspective” as a tool to understand how
Indigenous people negotiate and operationalise insider and
outsider perspectives. The concept is founded in Indigenous
experience, life and narratives. The aim is to gain a better
understanding of communication in settings where
Indigenous people interact with the Dominant culture, for
example in healthcare. A lack of recognition of the double
perspective generates situations that might be described as
acute in Indigenous health research and practice. When
health prevention or “close the gap” strategies fail, they have
the potential to create frustration, shame or even anger.
As we approach our material, and discuss particular
stories, our understanding of double perspective in
communication will follow two paths. Part of our focus will
be on culturally constituted and experienced worlds, and
another part of our focus will be on the way these worlds
are shaped by and in turn shape power relations and how
these generate harm. As being exposed to power relations is
a situation that affects people in a fundamental way, our
analysis will have application to other groups and
individuals. We’ll start by defining the concept of double
perspective. Subsequently, we will introduce examples by
telling some stories to visualise, and more precisely make
our theoretical point embodied by lived lives, both easier to
understand but most of all to show the contextual and
relational realities behind the concept.
What characterises a double
perspective?
Cultural analysis—as it has been conducted in anthropology,
folklore, history of religions, sociology, geography,
archaeology and other fields—has a long history of analysing
“the other.” Throughout the 20th century, at least back to the
fieldwork days of anthropologist Bronislaw Malinowski
(1926) and the missionary work of Bengt G. M. Sundkler
(Bowie, 2000), different strategies have been taken to
understand culture and cultural differences by emphasising
the value and autonomy of different cultures. Discussions of
“emic” and “etic” perspectives have been established as key
themes for securing high ethical standards in method and
analysis (Lincoln & Guba, 1986).
In the field of social work, “dual perspective” emphasises
viewing values, attitudes and behaviour from a client’s
family and community perspective, simultaneously with a
larger social system perspective (Norton, 1978). In a further
example, at PEALS in Newcastle, UK, the communication
between health institution professionals and patient groups
has been described as a cultural encounter, where both
parties need to be understood as representing their own
respective cultures (Chenhall et al., 2014). In this light,
cultural differences are perceived as different worldviews
(Beine, 2010; Carroll, 2010). It is implied that there is one
reality but different perceptions of this reality. The
differences will be tied to different symbolic universes
(myths) and practices (rites). It is taken for granted that we
share the same time and space, though we use it and
perceive it differently.
In this article we’ll take another stance, starting out from
various discourses in representations of Indigenous
experiences. Indigenous people have a repertoire of stories
that describe not two perceptions of the same world, but the
parallel existence of two (possibly overlapping) worlds at
the same time:
viewpoint
1
viewpoint
2
Reality
Two viewpoints.
RealityReality α
Double
perspecve
A double perspective.
Two worlds at the same time
Indigenous peoples are adept at working within systems
where different understandings of things such as art or
stories are dependent on a person’s status in society. An
example is the elaborate cross-hatched bark paintings of the
Yolgnu people of North East Arnhem Land. In these
paintings, a simple understanding of the representation may
4
be accessible to most people in the society (and even nonYolgnu, given a little help in interpreting symbols). But the
cross-hatching conceals, and reveals only to initiates, a
much more complex and secret level of the story (Morphy,
2001). What is being discussed here is the knowledge and
meaning of worlds or a reality that is exclusively knowable
to some, but not knowable to others.
It is also possible that this technique may equally
pertain to a comment on aspects of the Dominant culture
in that art forms may have one layer of meaning that is
easy to reach for most listeners, and (at least) one more
layer of meaning that carries implied meaning, not meant
to be understood by non-Indigenous authorities. This can
be exemplified by Sàmi jojk-texts (Gaski, 1993; Stoor,
2007; Svonni, 2015). These stories point towards a
situation where a person is living in a Dominant culture
and at the same time lives in a parallel world that is
consciously and cautiously hidden from the Dominant
culture as an action of protection.
At the same time as Indigenous musicians and singers
represent traditional ways of singing that are related to their
peoples’ daily life and ceremonies, they also have a long
history of being a part of the common popular culture.
Together, these artists represent a wide repertoire containing
their own particular instruments and songs as well as genres
from the wider society within which they live, perform and
where they cooperate with other musicians.
An Australian example is the song “Treaty”, which
arose out of a collaboration between the Indigenous band
Yothu Yindi, Midnight Oil and Paul Kelly. In his book
Reflections and Voices: exploring the music of Yothu Yindi
with Mandaway Yunupingu, Aaron Corn (2009) describes
how the song calls for the Australian government to
recognise Indigenous rights to land in the form of a treaty
in response to the Barunga Statement to which the then
Prime Minister of Australia promised a treaty by 1990.
This song, with its powerful political statement, rose to
being a number one hit and because it is sung in English,
the meaning was accessible to the Australian population.
The chorus of the song is, however, in Gumatj, and reveals
a more subtle story, but one that would resonate in the local
community. It tells the story of a grandfather instructing
his grandson how to dance a particular dance form,
djatpangarri, which had been popular in the 1930s. In
doing this, the song is reminding people in the community
about a time of fun, before White men, before mining and
before the need for a treaty. The grandfather urging his
grandson to “keep dancing” and “keep innovating,” could
be understood as an injunction to keep resisting pressure
from non-Aboriginal oppressors.
Indigenous peoples have long worked within Dominant
societies’ institutions; as lay men, politicians, administrative
leaders, priests, academics and teachers and other
occupations. In times of change and conflict, Indigenous
peoples have fought in wars and moved between nations.
Yet despite this, history tends to be written in a way that
Indigenous history is set apart, emphasising Indigenous
peoples’ history as being outside of Dominant society and
public institutions. From history to present time, Indigenous
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peoples’ stories combine inclusion and acceptance with
exclusion and double standards.
Time as politics
The perception of time is important in colonial ideology,
representing historic continuation and progress expressed
through worldly achievements, production, rationalisation
and accumulation of wealth. This colonial perception of
time and development is also an organising principle for
education and healthcare, dominated as they are by
schedules and appointments.
In Australia, non-Indigenous people joke about the
fluidity of “Aboriginal time”, but in fact the institutions they
represent have a far less relaxed view. When services are
only available occasionally (a doctor or dentist visiting a
community every 2 weeks), a missed appointment means a
long wait. The rigidity of schedules causes a great deal of
anxiety. For example, Senior (2003) wrote about an elderly
man who asked to use the phone every day to ring the doctor,
to check his appointment time. The Doctor in question
eventually became angry about the repeated calls when the
answer was always the same. However, to the man, this was
one way to negotiate a system which had little meaning—
one day the Doctor would say “your appointment is
tomorrow.” Ironically, the man chose this course of action
because he “didn’t want to make the Doctor angry.”
We think that time plays an essential part in the
differences between Dominant and Indigenous worldviews,
and is an essential quality in the double perspective. In the
Dominant culture, time is expressed, elaborated and thought
of as a chronology.1 It is a process with one direction (not
several) that is in need of governance and planning. When
related to an individual, in particular their health and wellbeing, the time defined as medically relevant will start at
this individual’s birth and progress in a unilinear fashion
through life stages ending with the present-day. Diagnostic
criteria include any deviation from this chronology and the
expected developmental stages of an individual’s life.
To achieve health and well-being, strategies are put in
place to make sure to straighten out any lost chronology
and reinforce direction. In the Dominant discourse of
modern society, the individual’s body carries a history that
is chronological, reduced to its own individual life, can be
changed by choices made by the individual alone, and stepby-step lead to progress. Chronic ill-health is thus a result
of the chronology of an individual’s bad life choices.
In a double perspective, this might look quite different.
In an Indigenous person’s life, history that is carried by
their body, integral to their life, might reflect a relationship
with Country way back in time and extends well into the
future. This expansive view is beyond linear time. Personal
history and narrative stretches back before colonial times
and reaches forward beyond an individual’s lifespan. A
person’s embodiment of health and well-being will include
incidents from the individual’s life and also incidents from
others that this person relates with. In contrast to the
Dominant culture and healthcare, time is tied to embodiment
of a world outside of the defined realities of Dominant
Wilson et al.
cultural understanding. This expanded time and inclusivity
of narrative over many generations may help to develop a
communal resilience, as stories of love, belonging and
survival imbue the culture.
However, narratives of bad “historical” experiences also
carry these experiences and memories. These experiences
are reinforced in situations where the experiences are
repeated or relived. Unfortunately, linear time may only
serve to further integrate and embody these experiences of
disempowerment and loss.
Embodiment, power and loss
Indigenous peoples’ colonial experiences are tied to
violation and abuse of power, loss of land, language,
livelihood, children, religion and traditions. In the Dominant
discourse, the violations are part of a story of the past. The
present is a new stage with its own challenges. Questions
and conflicts concerning land, language and culture are to
be solved by negotiations and cooperation between the
Dominant society and Indigenous peoples—all through
guidelines and sanctions defined and ratified by the
Dominant society (Wilson et al., 2019).
From an Indigenous position there is change, but not a
clear break or new phase that has led to a situation where the
past relations and experiences of violation have stopped. As
we saw in the story of Shawn’s father, the past clearly shapes
the perceptions of today. That the past is still present is
difficult to absorb or include in a linear historiography. Time
is supposed to be continually moving forward and thus
further and further away from what has happened in the past.
In Norway and Sweden the Indigenous people, the Sámi,
have their own parliament, good health and education.
However, the Dominant system and non-Indigenous people
are largely unaware of the past and present actual lives of
Sámi people. They have an awareness of the rights and
regulations of Indigenous peoples in general and have
established laws and strategies for dealing with them.
But the institutions and individual Scandinavians that
are to implement these strategies have very limited or no
knowledge about Sámi narratives and lives. This lack of
knowledge extends to those who are supposed to guard
Indigenous peoples’ rights and fulfil ratified obligations
and regulations (Svalastog, 2014; Svalastog & Fur, 2015).
In addition to an underlining lack of knowledge in the
population at large, Dominant discourse reproduces
clichéd stereotypes of Indigenous people in modern
society. For example, in Sweden you will find cartoons in
major daily newspapers and national television, comedies
caricaturing the Sámi as alcoholic. This is despite there
being less alcohol consumption in the Sámi population
than in the non-Sámi population (Lund et al., 2007). More
explicit violent actions are also taking place when dual
language road signs, written in both Sámi and a
Scandinavian language, have been shot at repeatedly to
erase the Sámi name (Riddu, 2001). General public
discussion about Sámi reindeer herding usually entails
critique and suspicion; criticising this traditional Sámi
livelihood as being built on principles unfair to non-Sámis,
5
or making accusations of insurance fraud. Just to push up
the blood pressure a little bit more, there has also been
much debated “unfairness” of Sámi rights regarding
fishing and hunting, which has been a particularly hot
theme in leisure time hunter and fishermen’s magazines.
During recent years, people have become aware of the
high suicide rate amongst young Sámi men, in particular
among reindeer herders. Research projects have been
launched to obtain a greater understanding of the issue
(Lund et al., 2007). But we question whether this is a matter
of general mental illness, or a failure or too great a gap in a
double perspective where economic success and social
acceptance struggles to overlap with Sámi life, so
integration between the double perspectives is too hard to
achieve? The notion of a successful Sámi individual is
ambiguous for others to understand if it is also attached to
relations with land (in a broad sense). Success is much
easier to understand if it is related to art, singing, writing,
film, directing and acting that can be either economically
rationalised or exoticised. For Sámi people success is too
often defined through a Dominant system lens, assuming
that Indigenous people share the same goals and want to
become more like non-Indigenous people.
Just a few years ago the wood-owners’ organisation of
Røros, a southern Sámi reindeer area, was quoted in the
local newspaper, saying that a local Sámi family ought to be
genetically tested because their intelligence quotients (IQs)
must be too high for them to really be Indigenous (Tønset,
2009). Of course this generated a large public and political
buzz (Larsen, 2009). The anger and demand for gene-testing
was directed at the Fjellheim family. Rune Fjellheim is the
present director of the Sámi parliament. The most famous
picture of Sámi phrenology is of Rune Fjellheim’s mother
watching his grandmother getting her skull measured
(Svalastog, 2013). For mainstream society, this event is long
forgotten and relegated to history, but for the Fjellheim
family it remains an active part of their consciousness and
identity. The affront caused by the newspaper article must
therefore be considered in the contemporary embodiment
of a continuing challenge to Sámi identity, rights and
personhood and the dignity of the family.
One of the political goals of a party that sat in government
in Norway for more than 6 years (2013–2020) is to shut
down the Norwegian Sámi Parliament. They argue that the
Sámi should not have special treatment because they are
integrated into the mainstream and they are cared for by the
nation state. A double perspective can capture what this
particular political party in Norway does not get; it is not a
question of whether the Sámi people are integrated into the
Dominant system, it is the way the state and Dominant
discourse has failed to understand or integrate Sámi lives
and reality as part of their society.
As civil rights movements developed during the 20th
century and the colonial project fell apart, a new, or at least
changed situation occurred in the former colonies, though
the post-colonial era did not ensure a new situation for
Indigenous people. Linda Tuhiwai Smith quotes Aboriginal
activist Bobbi Sykes, “What? Post-colonial? Have they
left?”(Smith, 1999, p. 24). Indigenous political awareness
6
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has developed within the field of native studies, and
formulates a distinction between post-colonial and
Indigenous studies, as the double perspective becomes
apparent within university and research settings, as seen in
this story by Heather Harris:
Well, Coyote went off to the city to the university because
that’s where Raven said adults go to school. In a few days
Coyote was back.
“Well my brother,” Raven inquired, “did you get your
education?”
“Not exactly,” Coyote replied, “education is as hard to get as a
welfare cheque. . .
When I got to the university they asked me what program I was
in. I didn’t know so they sent me to this guy who told me about
the programs. I kinda liked the idea of biology—if I learned
more about gophers maybe they’d be easier to catch. I liked the
idea of engineering—maybe I could invent a great rabbit trap.
But in the end I settled on Native Studies. Now that’s something
I can understand—I’ve known these guys for thousands of
years, even been one when it suited me.
So I went to my Introduction to Native Studies course and, can
you believe it, the teacher was a white guy? Now how much
sense does that make? I saw native people around town—any
one of ’em has got to know more about native people than
some white guy.
When I asked this guy what Indian told him the stuff he was
saying, he said none—he read it in a book. Then I asked who
the Indian was who wrote the book. And he said, it wasn’t an
Indian, it was a white guy. Then I asked him what Indian the
guy who wrote the book learned from and the teacher got mad
and told me to sit down.
The next day I went to my Indians of North America class. I
was really looking forward to meeting all those Indians. And
you know what? There was another white guy standing up
there and not an Indian in sight. I asked the teacher, “Are we
going to visit all the Indians?” He said, “No.” So I asked him,
“How are we going to learn about Indians then?” And he said,
just like the other guy, from a book written by a white guy. So
I asked him if I could talk to this guy who wrote the book and
the teacher said, “No, he’s dead.”
By then, I was getting pretty confused about this education
stuff but I went to my next class—Indian Religions. And guess
what? When I went in, there wasn’t another white guy standing
up at the front of the room—there was a white woman!
I sat down and I asked her, “Are we going to the sweatlodge?”
“No.” “Sundance?” “No.” “Yuwipi?” “No.” “Then how are we
going to learn—no wait, I know—from a book written by a
dead white guy! I’m starting to get the hang of this education
business.”
So then I go to my Research Methods class thinking I’ve got it
figured out. In this class the teacher (you’ve got it—another
white guy) said that our research must be ethical, that we must
follow the guidelines set out by the university for research on
human subjects. The rules are there, my teacher said, to protect
the Indians from unscrupulous researchers. Who made these
rules I asked—you guessed it—a bunch of white guys. They
decided we need protecting and that they were the ones to
decide how best to protect us from them. So I told my teacher
that I wanted to interview my father. The teacher said, you’ve
got to ask the ethics review committee for permission. What!
I’ve got to ask a bunch of white guys for permission to talk to
my own dad? That can’t be right. I was confused all over again.
So I sat down and thought about all this for a long time. Finally
I figured it out. If white guys teach all the courses about Indians
and they teach in the way white people think, then to find
Indians teaching the way Indians think, all I had to do was give
up Native Studies and join the White Studies program! (Harris,
2002, pp. 194–196)
Implications of the double
perspective in health
Up until they were officially recognised with the right to
vote by the Australian government in 1967, most rural
Aboriginal women were not allowed to give birth in the
same place as White Australian women. So most Aboriginal
women birthed on Country or on the veranda of the hospital.
If a birth required medical intervention beyond what was
able to be performed on the hospital veranda, Aboriginal
women were taken to the hospital mortuary for their care.
This early experience of racism and disrespect from the
health system was carried further by the forced removal of
many Aboriginal children from their parents’ care.
The prevalence of many chronic diseases in Aboriginal
Australian population is much higher than with nonAboriginal people. For example, end-stage kidney disease
is approximately eight times more common in Aboriginal
people, with the disease manifesting at a much younger age
(Health & Welfare, 2011). In recent interviews with
Aboriginal haemodialysis patients, one woman shared her
story of having a kidney infection when she was a child
(Rix et al., 2014). This infection could have easily been
treated with a course of antibiotics. However, a few years
previously her mother had taken her older sister in to the
local hospital with a minor illness. As she had an ill child,
the mother was, to the health system, obviously an un-fit
mother. Therefore, the elder sister was removed from the
family to be raised in state care. Interacting with the health
system became a matter of choosing between keeping your
child or seeking treatment for disease. So short of emergency
life-saving care, the system was to be avoided. Faced with
the prospect of losing another child, the mother decided not
to take her daughter in to be treated for her minor kidney
problems. Now in her early 40s, this woman must face
haemodialysis for 3–4 hr, three times a week for the rest of
her life (which on average will be many years less than
non-Aboriginal women born in her generation).
While the racism faced by Indigenous people in the
healthcare system is now slowly and sporadically being
addressed, Indigenous people carry memories of unjust
treatment. Going back to the opening story, it was
important to Shawn’s father to mention, “There was
7
Wilson et al.
someone from the Reserve there that came over and asked
if I needed help,” just as that was the first worry in
Shawn’s own mind. Both using the double perspective,
recognised that there are two different realities of how
people are treated by the health system. What might be
seen as historical mistreatment by the system was
definitely current in both their minds.
Understanding disease
The double perspective in conceptualising disease causation
is illustrated in the following song, by the Ngukurr Band
Broken English. Written in English, a level of understanding
is accessible to a non-Aboriginal person, and the listener
obtains the idea of some sort of potential threat arising as a
result of modernity. The author of this song, however, is
much more specific about its purpose, saying that it is a
song to warn his people about the threat of AIDS as a new
disease to the community: “I knew that disease was coming
and I wanted to warn my people.” The song describes a
foreign disease gathering its strength on a distant shore,
preparatory to travelling towards the community in which
the author lives and like so many things introduced to the
community, the disease will be hurled at it, with no chance
of escape from its ravages. The disease is likened to the
monsoonal rain, completely unpredictable and unstoppable.
From Distant Shores (Rogers, 1989, as cited in Senior,
2003):
You look to the east as the sun sinks to the west
Black clouds gathering in some distant shores
Then you feel the coming of the rain, so I can feel the
pain
Where the south wind blows nobody knows where it
goes
You look to the east and the sun sinks in the west
Where are all the people of this world, where are we
going?
Killing one another, destruction, pollution-the world has
its ways
Even though we tried our very best we must put it to an
end
Where the south wind blows nobody knows where it
goes
You look to the east and the sun sinks to the west.
The song is based around the yearly and daily cycles of life.
At the beginning the sun is setting, but at the same time as
the day is drawing to a close, another cycle is beginning as
black clouds herald the beginning of the wet season.
Although it is almost a certainty that it will rain during the
wet season, the place where the rain will hit is unpredictable,
especially at the beginning of the season. This encapsulates
two understandings of health which resonate within the
community, one that illness is arbitrary (in tune with local
sorcery beliefs it can strike people by accident) and two that
there is nothing that can be done to prevent it:
There is a worry that you can’t do much about this. It’s like you
can try to send the rain away and there are some old people
who can do this, but after a while they get tired and they can’t
do it anymore and the rain comes anyway. (Senior, 2003)
This view of AIDS as unpreventable, as being imposed
on a vulnerable population from outside, is contrary to nonIndigenous discourses of AIDS and the importance of
personal responsibility and prevention. It also encapsulates
and reminds listeners of a history of past injustices
experienced by the community as a result of their sometimes
tragic interactions with the Dominant society.
Another example, from the same community, examines
people’s apparent lack of concern about children’s skin
diseases: Towards the end of the dry season, young children
became covered in small boils. These were considered to
be a punishment for a person calling the name of their
“poison cousin.” Poison cousins are people who are in a
position to provide a husband or wife to an individual and
include potential and actual spouse’s mothers and spouse’s
mother’s brothers.
But because children were “silly” and did not
understand the restrictions, such boils were thought to be
natural and inevitable. Eventually, as the children become
knowledgeable about their place within the kinship system
and the restrictions on calling certain people’s names,
they would cease to be troubled by boils. Because of this,
these boils were not something that worried parents, they
were merely considered to be a stage in their child’s life,
which they would grow out of.
People’s understanding of this illness was embedded in
their understanding of appropriate kinship relationships. In
contrast is the focus of health professionals on the
importance of treating such conditions due to the association
between skin sores and rheumatic fever and vulnerability to
rheumatic heart disease (McDonald et al., 2004).
Sick houses
In northern Norway, the Sámi concept of “Sick houses” is
shared in Sámi communities amongst both Sámi and nonSámi people. The Sick house is tied to an understanding
that a dead person is causing, or is the sickness of the
House. This in turn makes the people living in the house
physically sick. A Sámi healer or Guvllár may be required
to carry out rituals that will make the house healthy again.
When Jens-Erik Nergård conducted fieldwork and
interviews in Northern Norway, the interviewees told him
how they could not go to the public healthcare system with
their worries about sick houses, because they would simply
be diagnosed as insane. For Jens-Eirik Nergård, the Sick
houses became a key to understand how the Sámi
perception, in this case, was completely and essentially
different from modern medicine and psychology. The Sámi
understanding was that the problem was outside of the
individual becoming sick, in contrast to modern medicine
and psychology that would identify, if confronted with the
8
problem, as a sickness inside (the mind of) the individual
person (Nergård, 2010).
Health policy
Health programmes and “bridging the gap” discourses,
based on social determinant analysis, presuppose one
shared reality that is hierarchical and where distribution of
goods and resources are unequal. The unequal distribution
of power results in health determinants that are stacked
against Indigenous people—they are over-represented in
those leaving school early, in unemployment figures, in
incidents of crime, incarceration and poverty. The incidence
of disease and early death result from this overrepresentation. Thus, the obvious solution is to provide
more education, employment, housing and income in order
to solve health inequity. If there is a failure to achieve
equity, then it is likely the fault of those receiving assistance.
Though, if there is more than one reality involved, the
solution is something other than shifting resources and
putting the marginalised at the centre of attention. Shifting
resources merely addresses the symptoms of colonialism
without doing anything to address the underlying problem.
In Australia, the “closing the gap” initiatives have been for
the most part unsuccessful (Department of the Prime
Minister and Cabinet, 2017). There is a growing recognition
that Indigenous culture needs to be incorporated into
programmes and service delivery in order to make any
significant change (Australian Institute of Health and
Welfare, 2011). Viewed from a double perspective, we can
see that it is actually the case that colonial reality is evident
in health policy that is over-represented in the lives of
Indigenous people.
Conclusion
A double perspective combines Indigenous people’s
understanding of the perspectives and lives held by the
Dominant culture as well as a particular Indigenous
understanding of history and the life it contains. In
particular, Indigenous people do not simply have a unique
perspective on reality, but a repertoire of stories that allow
for the representation of two different (but possibly
overlapping) realities. We hope that we have created an
awareness of inclusion and exclusion of Indigenous lives
and narratives in everyday life situations, such as healthcare.
The double perspective may be used by Indigenous
people as a form of protection from the injustices of the
colonial system. It can be utilised to hide insider knowledge,
while still transmitting that knowledge to others who have
the ability to read it. The double perspective encourages a
different view of time that is not unilinear. For Indigenous
people, the past and the future are always present and
embodied within our understandings and interactions with
the Dominant culture and institutions.
Importantly, an understanding that others are operating
with a double perspective can be used as a frame that public
institutions and their staff can use to start listening and
learning and to approach excluded Indigenous life stories
AlterNative 00(0)
and knowledge as important to include in health policy and
planning. The double perspective influences how disease is
understood and embodied for Indigenous people and will,
therefore, also impact on the social determinants of health
and healthcare provision.
If one’s perspective of time and history is too limited, and
only acknowledges the Dominant reality, then programmes
and initiatives will only be addressing the symptoms of
Indigenous ill-health and disease. Acknowledging a double
perspective and an additional Indigenous reality will allow
the underlying problems to be addressed. Indigenous people
in general already have a good ability to work with a double
perspective—perhaps actively encouraging this ability allows
the agency of Indigenous people to resolve some of the
wicked problems that the rest of society is currently facing.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship and/or publication of this article.
Funding
The author(s) received no financial support for the research,
authorship and/or publication of this article.
ORCID iD
Shawn Wilson
https://orcid.org/0000-0002-1123-0165
Note
1.
How individuals perceive time is more complex. Here,
we focus on Dominant culture in general. For more on the
relationship between temporality and colonisation, see
Rifkin (2017).
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