The past months have unearthed and amplified passionately opposing opinions about international events, in particular regarding Palestine and Israel. In addition to attending protests, calling my representatives, and having conversations with people I know, I’ve been publicly sharing my feelings about Palestine and Israel. While I stand firm in what I believe, my feelings around it are complex: I’m Jewish, and I’m anti-Zionist.
We encounter complex beliefs and feelings, many of which seem to contradict each other, all the time. We see them in national and international politics, in our places of work, and with our friends and family. What often happens, if we’re not intentional and careful, is that our different beliefs polarize us and make it nearly impossible to find commonality and work together.
As health care professionals, we’re trained to think that we should know all the answers. And when we don’t, or when a patient or a colleague challenges what we think is best, it can feel extremely uncomfortable. We might even get defensive or angry, which makes it even harder to stay open to other opinions and solutions.
One thing that has been very helpful for me in understanding my own feelings, as well as opening dialogue with others who may feel differently than me, is something called dialectics.
What is a dialectic?
“A dialectic is when two seemingly conflicting things are true at the same time. You might also see dialectics when in conflict with other people. Being more dialectical can help to reduce the emotional intensity that comes from unbalanced, all-or-nothing thinking or conflicts with other people. It reminds us that there is more than one way to see a problem and people are unique and have different points of view.” (Dr. Jillian Glasgow)
Dialectics are used in dialectical behavior therapy (DBT), which was pioneered to help people with borderline personality disorder. DBT can also be extremely helpful for all types of people, and dialectics can be used outside of the therapeutic milieu.
I wouldn’t be able to do anti-oppression work without dialectics. Holding space for more than one thing to be true at the same time, even if they seem to be conflicting.
A dialectical approach to the Middle East might look like this (these are just a few of many possible examples):
- I am Jewish and I support the liberation of Palestine.
- Jewish people are historically and currently oppressed, and Israel’s government is the oppressor.
- I oppose antisemitism and I oppose Islamophobia.
- Many Jewish people feel unsafe after the attacks of October 7, and the destruction of Gaza doesn’t make Jewish people any safer.
- The attacks of October 7 were horrifying, and Israel has been killing, kidnapping, and oppressing Palestinians for decades.
Dialectics can be helpful in the health equity space as well:
- I took an oath to “do no harm,” and the health care system harms patients from marginalized communities.
- Doctors often don’t see themselves as racist, and sometimes their actions harm their patients.
- Health equity work can be overwhelming, and it is absolutely necessary that we continue to fight for it.
- Patients look to doctors for help, and they also often mistrust the health care system.
Dialectics can also be used in health care in general:
- Hospitals are a place where people heal, and hospitals can be a place where people get sicker.
- Many academic doctors want to be promoted, and academia is a toxic, hierarchical system.
- I loved being a doctor, and I’m grateful for the opportunities I’ve had outside of health care.
- Being a doctor is a fulfilling career, and it often makes people feel trapped.
- Doctors are trained to heal people, and they don’t always know all the answers.
- Western medicine is extremely advanced, and there are many gaps in medical knowledge.
All of these things can be true. And until we give ourselves the space to hold all of these truths, what we perceive as conflicts will always feel like a zero-sum game. If we don’t open ourselves up to a reality beyond either/or thinking, even when it feels uncomfortable, we may never be able to recognize and honor each other’s humanity, which can lead to burnout, moral injury, and adverse outcomes for our patients.
Jill Wener is an internal medicine physician.