East is East, ...

I have lived in this country somewhat longer than in the country of my birth. There are times when I wonder, as is probably true of many expatriates, what I really am. Am I Indian, American, or some bastardized version that is neither? There is not very much in my behavior now that is completely Indian, at least to the casual observer. But at a deeper level, I realize that my reactions to many situations seem to be informed more by my cultural heritage, than by the culture in which I live. I think I had glimmerings of this perception many years ago when I was a graduate student. A group of us went to see the first episode of Star Wars. When we left the theater, one of my fellow graduate students remarked, in an awestruck tone, "I did not realize that the movie dealt with such classical themes." I looked at her quizzically, wondering what she could mean. She returned my look and said, "You know? Classical themes like the eternal struggle between Good and Evil?" As I thought about this over the next several days, I realized that this concept of an eternal fight between "good" and "evil" was not inherent in my view of the world. Indeed, the ideas that there are some entities that embody goodness and others that embody evil, that these exist in eternal conflict with each other, with the good almost inevitably winning at the end, were not ones that had been inculcated in me. I realize that even after all my years in the United States, surrounded by the Judeo-Christian schema of a dichotomous universe, I have remained uncomfortable with dualistic doctrines. Most Americans are probably familiar with the famous yin-yang icon of Chinese-Buddhist origin—a circle containing dark (yin) and light (yang) fish-like figures, forming a circular whole. Any radial line intersects both yin and yang, and the amount of whiteness or blackness depends on where one draws the line. In Hinduism as well, the concept of the continuum of good and evil, rather than categorical states, is inherent in the dominant philosophical school of advaita, literally nondualism. Unlike Judeo-Christian philosophy, there is no Satan figure in Hinduism. There are numerous characters who are evil, but no centralized figure who embodies evil and who is in dynamic opposition to the good that is God. There is no eternal struggle; instead, good and evil coexist in a less than perfect universe. The great conundrum that seems to occupy Judeo-Christian theologians—if God is perfectly good, why did he create Evil and permit its continued existence—does not puzzle Hindu philosophers at all. Since good and evil are two aspects of only one reality, neither has any existence apart from the other. It is perhaps not surprising that empirical science has developed and thrived primarily as a Western enterprise. Science studies and then divides phenomena into smaller and smaller entities, isolating them from the large, messier realities of life in order to understand them in their entirety. This reductionism brings in apparent dualisms, with which my Judeo-Christian colleagues seem comfortable. Take, for instance, the roles of insulin and glucagon. I remember being taught in medical school that insulin and glucagon were antithetical to each other, and this is indeed true—insulin causes a decrease in the blood glucose level, but glucagon increases it. However, from the perspective of the target cell whose function depends on obtaining appropriate amounts of glucose on demand, these two hormones actually work together—glucagon causes an increase in the release of glucose from the liver, whereas insulin helps the target cells import circulating glucose so that they can metabolize it. Their apparent antagonism, true while examined in a reductionist view, disappears in the "big picture." Perhaps nowhere does categorical dualism trouble me more than in my chosen field of infectious disease. Here, there are a number of instances where things seen as evil have important positive influences. Let us take, for instance, the case of nematode infections of childhood and young adulthood. Virtually every mammal living in the wild harbors at least one nematode species and one cestode species. In our own species, there is little doubt that our forefathers were often parasitized by roundworms and perhaps tapeworms as well. It is only with the emergence of improved sanitation conditions over the past century that these nematode and cestode parasites have disappeared from much of the developed world. Here then is a clear-cut example of the victory of good (read: we humans) over evil (read: worms). However, many researchers, including myself, have alerted the medical community to the striking correlation between the absence of nematode infections and the emergence of autoimmune and other immunological disorders. Many have raised the idea of a so-called hygiene hypothesis to explain autoimmunity. One researcher has recently shown that in patients with ulcerative colitis who were administered eggs of the pig parasite Ascaris suum, an infection that is self-limiting in humans, the patients dramatically improve as long as the infection persists; they then revert to their pretreatment state once the parasite is eliminated. To the best of my knowledge, this experimental protocol has not been repeated since its initial announcement but is deserving of further study. These deeply inculcated beliefs in the continuity of good and evil, the sense that the same entity can be good in certain circumstances and evil in others, may be the reasons for the overall lack of scientific and material progress in much of Asia. This ability to view phenomena in clean, neat, good vs. evil, black-and-white terms facilitates a resolute stance when one is confronted with a problem. The efficiency of Western cultures is a natural sequel to the clear-eyed ability to view individual people or entire cultures as friend or foe, good or evil; it makes them activist, forward-looking cultures. On the other hand, the culture of my birth and upbringing tends to equivocate and be paralyzed into inaction, not from laziness as many of my compatriots believe, but from a culturally based, philosophically guided inability to look at issues with a textured perspective, and a tendency to balk from decisive action even when such action is critical. As Shakespeare wrote (the text is from Quarto II and the spellings may be unfamiliar): Thus conscience dooes make cowards, And thus the natiue hiew of resolution Is sickled ore with the pale cast of thought, And enterprises of great pitch and moment, With this regard theyr currents turne awry, And loose the name of action. Chalk this up to yet another lack of a clear-cut, neat decision. Good and bad exist in both the Judeo-Christian and Hindu worldviews. One view makes it possible to discover profound empirical truths and achieve material gains that are the objects of envy for the rest of the world; the other makes it possible to have a nuanced view of phenomena. Can they be bridged, or, as Kipling said, can the twain never meet? T.V. Rajan, MD-PhD (rajan@neuron.uchc.edu), is chairman, department of pathology, University of Connecticut Health Center, Farmington, Conn.

East is East, ...

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