In healthcare, meaning is not always made in the clinical notes or the test results. It often happens in the moments in between: pauses, hesitations, silences, metaphors, side glances, shifts in the chair. These are the spaces where culture breathes, where identity shifts and where the human experience becomes unsteady. This is the space of liminality.

Liminality, from the Latin ‘limen’, meaning threshold, describes the state of being between two conditions. It is where the known ends and the unknown begins. Illness, grief, recovery, migration, puberty and aging, these are all liminal spaces. These are transitions, as well as disruptions of order and meaning. They are often where the deepest human truths emerge.

Culture as the Compass

When people enter liminal spaces, they reach instinctively for frameworks that help them orient. These frameworks are cultural. They provide the metaphors, rituals, stories and symbols that allow people to make sense of what otherwise feels chaotic. A cancer diagnosis may be interpreted as a battle, a test of faith, a spiritual case, a curse: the metaphor, the story, the symbolism change according to the cultural context.

Culture provides scripts but they are not fixed. The scripts are lived, adapted and improvised. One person might want to embrace family involvement in treatment, while another might seek privacy and solitude. One may see suffering as a kind of redemption, but another might see it as unjust and undeserved.

Understanding these responses when they apply across cultures requires more than just translation. It requires cultural humility: the willingness to learn from and be changed by the other.

Beyond the Checklist

Cultural competence often implies that culture can be mastered and reduced to categories. However, real care is relational. You do not have to know everything, but you do need to be open to what is unfolding. Cultural humility asks the clinician to notice what is under the surface of the person, the submerged iceberg of meaning, memory, trauma and hope of the culture of one.

It also means that recognising when patients are in liminal states: confused, suspended, transitioning. These states are often invisible in clinical tools like Clinical Outcome Assessments (COAs), which privilege clarity, measurement and resolution. But health is not always a linear path. It is a labyrinth sometimes.

The Sublime Within Liminality

Liminality is not just a transitional space. It is also an emotionally charged one. In healthcare, these threshold moments can carry a certain emotional magnitude:  a sense of awe, fear, disorientation or just a quiet revelation. This is where the sublime enters.

The sublime is not separate from liminality. It is what liminality feels like when it is at its most intense. It is the emotional and existential quality of standing between identities, between diagnoses, between worlds; when the ground beneath you has shifted and nothing familiar feels stable.

A patient who says “I don’t know who I am anymore” is not just experiencing a psychological reaction or a clinical symptom. They are encountering the sublime within the liminal, a vast, ungraspable shift in self and meaning. This is the depth and uncertainty that rise when people are suspended between what was and what is to be.

The Healthcare Professional as the Threshold Figure

To work in healthcare is to meet people at their thresholds. The thresholds between health and illness, life and death, coherence and collapse. Healthcare professionals are not just diagnosticians, prescribers or fixers. They are guides through uncertainty.

In this sense, the clinician resembles mythic threshold figures like Charon and Hermes. Charon, the ferryman of the dead in Greek mythology, accompanies souls across the River Styx. He does not judge or heal. He simply stays with them through a sacred transition. In healthcare, clinicians often do the same. They witness a patient’s crossing from one identity or state of being to another, even when the destination is unclear.

Hermes offers an even broader analogy. He moves freely between worlds: Olympus, Earth and the Underworld. He is not just a guide of souls, but a messenger, a translator, a boundary-crosser. Like Hermes, clinicians navigate between knowledge systems, between science and humanity, between the certainty of data and the ambiguity of emotion. They are interpreters of meaning as well as deliverers of treatment.

This reminds us that the healthcare professional’s role is relational, moral and mythic, in addition to clinical. It calls for deep listening, comfort with ambiguity and awe in the face of another person’s becoming. This is sublime too: contemplating the threshold role of the healthcare professional, as a witness to a patient’s crossing from one state to another gives me a sense of profound respect. It is holy ground.

Standing in the Doorway

Culture, the sublime and liminality are not abstract ideas, but real conditions under which healthcare happens. If healthcare professionals wish to honour the humanity of those in their care, they must learn to stand in the doorway with them; not rushing them through, not dragging them back, but remaining present. Quietly. Attentively. As each person becomes who they are becoming.

Thank you for reading,

Mark Gibson

Leeds, United Kingdom, May 2025