Sublime, as a word, has suffered a softening in its popular use. Today, it is more often used to describe refined pleasures like food, music or comfort, flattening its original intensity into something elegant or simply enjoyable. This shift mirrors the evolution of words like awesome, epic and terrific, which, like sublime, began with meanings tied to fear, grandeur or awe, but now serve as casual praise in everyday speech.

The sublime was once used to describe moments of existential rupture and overwhelming magnitude. In the minds of Burke, Kant and Schopenhauer, the concept of the sublime is not comforting, beautiful or polite.

The sublime is what we feel when we face something so vast, so unknowable, that it disorients us. It is awe tinged with fear. It is the moment when our mental frameworks falter. It is what we feel when we contemplate a volcanic eruption, a tsunami, Hiroshima or the distant certainty of rising sea levels that will one day swallow whole cities. Or AI, contemplating the power of AI. The sublime unsettles us not because it is alien, but because we recognise that it is beyond us. It is something we can name – the sea, for example – but not hold. It reminds us of our limits and our fragilities.

This article reclaims the sublime in its truest, most unsettling form, and begins to explore what it means for healthcare, especially in cross-cultural encounters. The sublime is not just something we witness in nature or art. It also appears in the clinic, in the encounter, in the confrontation with another’s worldview that resists, disrupts or overwhelms our own.

The Lineage of the Sublime

Edmund Burke, writing in the 18th century, defined the sublime as that which inspires “delightful horror”. It is the kind of reverent fear triggered by immensity, danger or power. Kant went further, arguing that the sublime arises when reason strives to grasp the infinite and fails. But, in failing, reason recognises its own dignity. Accordingly, it is not the mountain that is sublime, but our awareness of its scale compared to our own.

Then Schopenhauer darkened the concept further. For him, the sublime is not only something we fail to grasp, but it arises out of our confrontation with cosmic indifference: we realise that the universe is neither hostile nor benign: it is just there, infinite, neutral and has no concern for the individual or their suffering. The sublime is our individual realisation of this: that nature does not care, that suffering is not redemptive and that the meaning of life, the universe and everything in it is fragile and constructed. Here, the sublime is a glimpse into this machinery of existence and is beautiful only because it is terrifying – and real.

It is this richer view of the sublime – and not the softened version – that we must bring into cultural work within the health setting. This is especially so in a globalised, pluralised world where belief systems routinely collide.

The Sublime in Healthcare

Healthcare is full of rituals, systems and scientific uncertainties. Under the surface, though, it is also a theatre of vulnerability, fear, hope and cultural logic. Patients don’t just receive care, they bring their worldviews. And sometimes, these worldviews are vast and morally foreign.

Consider the following moments from real recent examples from the UK:

·       A patient in London, refuses life-saving treatment, convinced that their illness is a divine punishment.

·       A family in South Yorkshire insists that all medical and treatment decisions be made collectively, even when the law requires individual consent.

·       A parent in Lancashire brings a child to a healer first and not a doctor and, by the time the doctor sees the child, the child is critically ill.

·       A doctor in Leeds discovers signs of recent female genital mutilation (FGM) on a 6-year old patient during a routine exam and must choose how to proceed: with care, clarity but also with moral urgency.

These are not misunderstandings to be solved by cultural training modules – all they do is give you factoids and very limited cultural insights. These are encounters with the sublime, the deep and unseen aspects of culture that cultural training modules do not come close to even knowing about. Perhaps, within the climate of hypersensitivity around perceived cultural issues, training models would not even dare approach these topics. These are moments where the clinician faces a worldview that is complete, coherent and incompatible with their own.

The Deeper Significance

Too often, the language of “cultural competence” frames difference as something to be managed, translated or accommodated. Culture becomes a matter of traits, customs or taboos. These are quirks of language and aspects of the visible tip of the cultural iceberg that can be learned like a checklist.

But true clinical encounters are messier, deeper and destabilising.

The doctor who sits with a patient who believes that cancer is a spiritual test is not simply decoding a belief. They are facing the limits of the biomedical worldview. They are standing at a threshold – the liminal space – between systems of meaning.

This threshold is not always something you can cross. Sometimes, we do not merge worldviews. There is deep friction. Sometimes we have to act against them, as in cases of medical neglect or cultural practices that cause harm. But even then, the act must come from a place of recognising the scale, dignity and depth of what one is encountering. This is the true role of the sublime: not just to justify things, but to teach reverent confrontation.

A Reoriented View of The Cultural Encounter

The sublime, properly understood, could offer a new frame for cultural care:

·       Not: “How do I accommodate this belief?” But: “What is the scale of what I am encountering here?”

·       Not: “How do I fix this misunderstanding?” But: “What limits of my own understanding am I brushing up against?”

·       Not: “How can we agree?” But: “What do I do when agreement is not possible, but dignity still matters?”

Standing at the Edge

To reclaim the sublime from its softened popular meaning is to reclaim the ability to stand at the edge of knowledge, comfort and moral certainty and remain there long enough to act with care.

So, the sublime is not something to be admired. It is something to be endured, with humility, with clarity and sometimes with ethical force.

This is what healthcare professionals face when culture is not just different, but deep, vast and, yes, sometimes incompatible.

In these moments, the healthcare professional is not merely a provider, but a witness and a negotiator, a moral agent standing at a threshold, where the sublime reveals not just the patient’s truth, but their own limits.

Thank you for reading,

Mark Gibson

London, United Kingdom, May 2025