In healthcare, there is a push – rightfully so – towards clarity: clear diagnoses, clear protocols, clear communication. But a lot of what happens in the healthcare professional – patient encounter, especially in cross-cultural contexts, is anything but clear. It takes place in uncertain spaces, between what is known and what is still unfolding. It occurs between systems of belief, between roles and between decisions. This is a threshold from one state to another. This is the space of liminality.

Liminality is a concept in anthropology and philosophy to describe a threshold state in rituals: the moment when a person is no longer who they were, but not yet who they will become. A bride before the wedding. A patient waiting for a diagnosis. A refugee without a home. Waiting for Godot. Liminality is charged with vulnerability, ambiguity and ultimately, transformation.

In clinical care, especially when culture is involved, liminality is the norm, not the exception. The consultation room is not just a space for facts and prescriptions. It is also a site of negotiation, where people from different cultures and worldviews meet. It is a place where neither party – the healthcare professional or the patient – is often unsure of how to proceed, yet each is deeply aware that something important is at stake.

The Healthcare Professional in the Liminal Space

Healthcare professionals are taught to be decisive, but they are frequently pulled into liminal roles between:

·       institutional policy and patient emotion

·       scientific evidence and cultural belief

·       the roles of technician and witness, healer and moral agent.

Consider the moment a healthcare professional hears a patient explain their condition not in biomedical terms, but as punishment from ancestors or as a sign of spiritual imbalance. The clinicians cannot dismiss the belief, but neither can they fully endorse it. They are between comprehension and confrontation.

In these situations, the healthcare professional is not just a provider, but a participant in a rite. The consultation, already a kind of ritual, takes on another form: ambiguous and charged with friction. This is a place where multiple worldviews are held, but not always reconciled.

The Patient in the Liminal Space

Patients, too, inhabit these threshold states. Illness itself is inherently liminal:

·       It makes a departure from normal life, but the future is uncertain (biographical disruption)

·       The patient’s identity shifts: from parent, colleague, partner, to someone in need of care and redefinition.

·       In cross-cultural settings, the liminality is compounded by the feeling of being out of place in the system, of having to explain one’s logic, translate one’s pain or justify one’s beliefs.

A refugee unfamiliar with the healthcare system of a host country may wait too long to seek help. A religious mother may decline surgery for her daughter, while waiting for divine guidance. A teenager raised in a culturally traditional home may speak one way to the doctor and another to her parents – both potentially contradictory. These are examples of cultural liminality.

This Is Not a Problem to Solve

Western medicine is often uncomfortable with uncertainty. It tends to treat ambiguity as a problem to be resolved. However, liminality should not be seen as a bug in the system, but as a core feature of cultural and human experience.

When healthcare professionals mistake liminality for confusion or incompetence, the risk is that they may:

·       Misdiagnose symptoms expressed metaphorically or somatically.

·       Interpreting silence as denial, rather than as a culturally appropriate form of dignity.

·       Rushing decisions before the patient and the patient’s family have had time to catch up.

Instead of resisting liminality, healthcare professionals must learn to work within it. This means slowing down, asking better questions and listening more deeply.

The Sublime Lives in the Liminal

Now we return to the concept of the sublime, as the emotional experience of encountering something vast and overwhelming, as well as morally and intellectually disruptive. The sublime and the liminal are intimately connected. The sublime often arises within liminal spaces, when we reach the edge of our understanding and feel ourselves eclipsed by the enormity of another’s worldview or suffering.

A doctor who discovers signs of female genital mutilation (FGM) is plunged into a sublime-liminal moment: a collision between human rights, cultural beliefs and patient safeguarding.

A palliative care nurse listening to a patient explain death through dreams and ancestral visions is no longer simply collecting symptoms, they are standing at the threshold of two cosmologies

These kinds of scenarios are not footnotes to clinical care. They are clinical care.

The Liminal is also Internal

Liminality is not just out there in patient encounters. It lives within clinicians too:

·       The GP torn between cultural respect and child safeguarding.

·       The nurse working in a hospital Accident and Emergency department processing their own discomfort at a religious refusal of care,

·       The mental health professional feeling the inadequacy of their own framework when a patient speaks of spirit possession or generational curses.

These are instances where each healthcare professional is feeling the sublime and feeling it honestly.

Holding the Threshold

To work with liminality, the healthcare professional would need to reorient their practice, shifting from:

·       Solving to staying.

·       Explaining to asking.

·       Knowing to witnessing.

Above all, it means recognising that not all clinical moments have a resolution. Some remain open and some are navigated in pieces, bit-by-bit. And some never reach agreement but can still end in mutual respect.

Perhaps this could be a deeper form of care.

The Clinic as a Threshold

The clinic is not a place of certainty, in spite of the prime value that the biomedical model places on this. It is a portal, a liminal space where patients and healthcare professionals not only encounter each other, but themselves as well, only reflected in unfamiliar terms.

To stay in that space is to acknowledge that objective truth, healing and meaning are not always aligned. More often than not, they exist in tension. Sometimes, they are held like a paradox: together, but unresolved.

It is in those moments, between diagnosis and decision, between belief and biology, where the real work of caring begins.

Thank you for reading,

Mark Gibson

London, United Kingdom, May 2025