Questions and Conclusions – a Thanksgiving Post for my Daughter

Intially, we’ll frame our inquiry through an existential and poetic prism. To quote Eliot: “Do not ask what is it, Let us go and make our visit.”

Is the narrator telling us, or advising us, not to inquire as to identity of X in advance of experiencing X for ourselves? After the experience, after the visit, can we, should we, are we positioned to, answer the question “what is it”? Or does the very act of asking the question alter the answer? Does the question impair or influence an open-minded visit? But surely if, after we have experienced the subject of the question, experienced it however we do, experienced it with all that happens, however it happens, then the very process, to be understood, is the answer. How we describe our answer, how we act in response to it, reflects our answer, whether or not the words we use to do so do in fact so. In the acting we find new questions that in the act, and through the acting, we answer again.

The range of potential interpretations of Eliot’s lines extends from an oft-repeated cliche – Which came first? The chicken or the egg? – to the conundrum: how can we question “its” identity before or until we have engaged with, or visited, it? Yet, how will we know it when we see it if we have suspended our inquiry and reserved our conceptualization of what the “it” is?

We reframe our inquiry. Questions must be asked and each question entails an answer – or multiple or alternative answers – even if the answer (or each answer) is (or appears as) inability to answer the question. How will we know the answer when we have it? A question-answer loop. Or is it an endless linear series where, to quote Eliot again: “In a moment there is time, For decisions and revisions, Which a moment will reverse?” How can we know the answer from the question; and thus how can we know the question from the answer? Let’s visit and search for an answer.

We reframe our reframe: questions posed rest on, or emerge out of, answers given. The answers are the soil in which questions take root, these roots yield questions, blossom-like, that fertilize the soil in which new roots germinate. Cycling and recycling.

Has Frost gone on a visit: “Whose woods are these, I think I know, His house is in the village though……The woods are lovely, dark and deep…” Frost has “promises to keep.” His journey; his answers, tentative, his promises, whatever they are, are not our answers, are not our promises; our answers, tentative too, may resemble his but they are not his. Will our promises align? Overlap?

Let’s swivel: we are pragmatic. We have no choice. Conclusions must be reached, actions will be taken, with or without us. With us, we contribute; through us, we shape actions. We confront our responsibility. Will we acquit ourselves well? Only we can answer, and we will as we must.

And yet, at another level and in another direction: “It was as if she wanted him to name whatever it was they had, but if he did that he would kill that very same thing.” (Richard Flanagan, The Narrow Road to the Deep North)

Undetected (and Detectable) Shadows of Positions

Or should our title recognize positions of shadows rather than shadows of positions?

On any of the contentious issues of our day, we hear advocates for each of the contending positions engaging advocates for the alternative positions.  Each advocate presents the reasons for and against a given position, with whatever information, conviction and persuasive capabilities the advocate can bring to bear.

We listen to the advocates; we hear their dueling contentions; and we often are inclined to make up our minds by throwing up our hands. Inclined, yes. But dare we abandon our dignity and cede our responsibility to look with a cold eye, and gentle heart, at the facts and choices.  Dare we leave unexamined the prior choices that have constrained the choices we seemingly have, as if these prior choices are a knot with threads too tight and patterns too intertwined to ever unravel?  Dare we abdicate our individual responsibilities by conferring on the dueling and (occasionally) sincere advocates an expertise that stretches well beyond their expertise and lures us to accept their positions?

Let’s pause, for a moment, and consider whether all may not be as it seems.  Perhaps, just perhaps, the advocates of contending views adopt their respective stances on common ground.  Indeed, it would surely qualify as irony if the grounds claimed by each provided firmer terrain for the other.  And through our inspection, we seize our ground and own our responsibility to face the choices and their consequences, knowing they are ours, knowing that we must and (must continually) choose, and choose again. The moment of pause is not a moment of rest.

To be concrete, we’ll take the death penalty, a gruesome spectacle cloaked in sterile metaphor and shrouded in sanitized statistics, as an example.

The contenders on the death penalty, whether in support or opposition, invoke a variety of reasons, often prioritized and weighted differently, and commonly consisting of conclusions presented as reasons:

– the death penalty risks permanent injustice if we execute an innocent person.

– the death penalty is applied in a discriminatory (racial) manner.

– the death penalty brutalizes the society that legitimizes it (and brutalizes the doctors, nurses, wardens and other “administrators” that insert the syringe, pull the switch, unleash the guillotine, erect and dismantle the gallows, and “remove” the limp, disfigured carcass that once was a body).

– the botched execution is cruel and unusual.

– the death penalty is true justice – an eye for an eye.

– the death penalty is an effective deterrent against (certain?) crimes.

– the death penalty assures that the offender will not repeat his heinous crime.

– the visible spectacle of an execution gives expression to society’s rage and thereby dissipates impulses toward vigilante revenge.

The above is an incomplete list.  Many other reasons have been asserted in support of different positions. And, of course, we have not touched on side-issues that, sooner or later, take center stage: which crimes (if any) should merit the death penalty (if we were to have such a penalty); what should be the burden of proof for imposition of the death penalty; what should be the rights of appeal for a conviction; what are the permissible “techniques” for carrying out the death penalty; should there be a minimum age for eligibility to receive the death penalty; how should jurors be picked in capital cases? Further removed: who should decide the legitimacy of the death penalty?  Who is the “we” in the questions above?  Why should we legitimize objectionable actions (e.g., vigilante revenge) as a predicate (rhetorical or otherwise) to legitimizing the death penalty? If the death penalty violates human rights, should we seek a universal ban?  Or would pursuit of such a goal squander scarce resources better spent reforming our own judicial and penal systems?

But what if it were the case that those opposed to the death penalty actually have a greater desire for revenge and punishment than those who support the death penalty? How could this (paradox?) be?  One answer could be – although it may not in fact be – that those opposed to the death penalty think (feel? believe?) that locking a person in a secure cage for the rest of his life is a greater punishment. If we set aside how one measures the severities of different forms of punishment – is there a common denominator for measuring severity? – and whether the recipients (subjects) of the punishment (as well as the administrators of, and audience for, the punishment) share in their views as to severities – and what if they (or some of them?) don’t – and focus on the beliefs in and of themselves of the public contenders, then one may sense the grounds start to vibrate and shift.

Do we assume that achievement of the sought-after objective leaves all else unchanged?  As if change can be effected in a vacuum.  To overturn the death penalty and (thereby?) encourage increased impositions of, and increased severity of, other penalties would, one presumes, be an unintended consequence.  After all, it would be the rare opponent of the death penalty who would countenance a lower standard of proof or greater procedural bars to appeals of convictions.  Or so one would think. But do those of us who hold a particular view factor in the second and third level consequences?  Is the posing of this question asking too much?  Can our uncertainties in knowing the answers inhibit convictions in our positions?  Reader, read  Sarat’s Gruesome Spectacles, read the Federal bureau of statistics and then read more.

Shadows of positions? Positions of shadows?

That was Then (and Now): War, Poetry and Human Nature

History, as presented through historians, is the accumulation of selected data, woven into overlapping, contradictory, reinforcing, alternative, independent narratives. We animate the narratives through our individual, evolving, understandings. The scope of history is as broad as everything and as narrow as something (or someone). As students, we shape the shapes presented and represented by historians.

Akin to history, particularly the historical narrative of a participant in the events within the narration, poetry, a poem, kindles our imaginations, our imaging, of realities without images, without physical representations, other than those birthed out of our imagings. Through excursions through poems, composed through centuries, and across the globe, we can track unbroken threads, chords, that link descendants to ancestors, and that join, introduce, past to present.

All life is mortal and death is ubiquitous. But organized killing, sanctioned or not, by the state or by appeal to a higher (or lower) authority, if at times seemingly ubiquitous, is never inevitable. And, yet, killing runs unbroken from dawn to dusk.

Reading a recently published anthology of war poems, poems of, on, about, war, from the dawn of the printing press, or quill, ink and papyrus, to a dusk that eludes our grasp, we observe (no, we imagine, we image, we see, we feel, we hear) how some things, and each of us, “never change.” To paraphrase Norman Maclean, eventually all things merge into one and a poem runs through it.

Organic Apercus

In one of our earlier posts, “Savoring (Once Again) Alexander Pope,” we joined in (and enjoined) Pope’s sharp and funny skewering of the critic whose critical mastery consists in the easily-achieved expertise of alleging deficiencies in the contributions of others.

A defining feature of a brilliant observation (one that differentiates it from the banal, vapid, platitudinous) must be, if it is to warrant a glittering adjective, its seemingly effortless stimulation of refractions of itself, propelled by no more, or less, than our very attention to, and on, it.  And so with Pope’s lyrical “An Essay on Criticism,” with sparks ignited by our gaze, and its flames and flakes altered, flickering – alternating versions of Pope’s expressions:

In Poets as true Genius is but rare,
True Taste as seldom is the Critick’s Share;
Both must alike from Heav’n derive their Light,
These born to Judge, as well as those to Write.
Let such teach others who themselves excel,
And censure freely who have written well.

Nabokov must rank, on any scale, a master of inversions, the ingrained habit of flipping the apparent and viewing two sides of an object at once, as if metaphor’s challenge to physics.

In his recent review of Nabokov’s letters to Vera, Michael Wood highlights Nabokov’s talent for the comic inversion. We start with Tolstoy’s Anna Karenina “All happy families are alike; each unhappy family is unhappy in its own way.” Is the observation a fair characterization of families, or is the unstated proposition that unhappy families enrich dramatic plot more than do happy families?  Having framed the point, Wood then segues to Nabokov’s comic and “perfectly serious” counter-suggestion: “All happy families are more or less dissimilar; all unhappy families are more or less alike.”

Unless awareness that we are in the hands of a master tips us off to the dramatic tension that will circulate through Wood’s review, we proceed (with mind open) along with Wood into his biographical excursions of the life of Nabokov. Restless curiosity sets in even as we remain confident that the excursions are a purposeful diversion, a diversion that (we can expect) will pivot and revert to the point of origin, where, upon arrival, we find conversion, we are enveloped in the peak, climactic, ephemeral dramatic tension. The moment passes as we take its measure, leaving us breathless as we appreciate the alterations in our point of view, and our refreshed and expanded understanding.  All that remains, and all that we need, to restore our equilibrium is a worthy apercu, one that emerges organically from, and seals, the drama.

Wood does not leaving us wanting.

(See Michael Woods’ review of Nabokov’s Letters to Vera in the October 2014 edition of London Review of Books)

Mindless Rhetoric

As our regular followers know, we seek to enhance public discourse through questions, and questions about (and of) questions.

Fundamental to public discourse is sincerity, and positions espoused insincerely subvert trust, corrode cooperation and exact unmeasurable costs on those least able to afford the price. Whereas knowledge overcomes ignorance, insincerity is impervious to knowledge. Indeed, insincerity thrives on ignorance, which enables insincerity to pursue its prey.

A comment in yesterday’s Foreign Affairs should be required reading for those seeking election to office based on igniting and fanning fears of Ebola. The piece is titled “The Poor and the Sick” and a single quote within the piece from the co-director of the Yale Global Health Justice Partnership speaks volumes: “Exotic infections for Americans, often from far-away places, often Africa, strike fear into their hearts, but only once the pathogens have cleared customs.”

In a far more blunt way than my earlier piece (posted on this Blog on September 17, 2014 and available in the Archives section) on international reciprocity and the debt that we, as Americans, owe to Africa and Africans for our advances in infectious disease (a position I sourced to The New England Journal of Medicine), the piece in Foreign Affairs highlights the scourge of poverty and the reckonings of its disregard.

Humility and Brilliance: a Postscript

Having moved on to the activities of today, I was pleasantly struck by an Opinion piece in today’s Wall Street Journal.  Titled “A Nobel Economist’s Caution About Government,” the piece quotes from the great Hayek: “The curious task of economics is to demonstrate to men how little they really  know about what they imagine they can design.”

While I suspect the authors of the piece have not visited our Blog, the themes our readers have come to expect from us resonate in the articulation by the authors of the risks of certainty in an inherently uncertain world.

We close with (what else?) but a closing thought: Those who relegate poetry to the idlings of idiosyncratic daydreamers deprive themselves of the riches of ambiguity and expose themselves to a deceptive clarity that leads to unintended consequences and ossification.

Humility and Brilliance

Except when describing diamonds and freshly painted metals, except, that is, when used as a synonym for shining, brilliance is a metaphor used to indicate extreme intelligence. A quality that distinguishes the brilliant from the dull, the flat, the undifferentiated.

Whether used as noun, verb or adverb, humility and its derivatives and variants are, in their essence, animated solely through reference to the relationship of a person or the person’s activities to those of another. One is not humble before a rock. One is not humble (although one may be insecure or tentative) in private. One cannot humble herself before a mirror, although humility before another presupposes one’s prior gaze at, and into, the mirror and one’s reflection on the reflection. As water and oxygen promote germination of seeds, love promotes germination of humility, which takes root in one’s cognition and recognition of the views of others and the uncertainties that are fundamental, inescapable, impervious to shouts, no matter the volume.

Commentators who have endured through the ages, with universal appeal to our common qualities, have observed the inseparability of brilliance (as in extremely intelligent, differentiated from the crowd) and humility. Montaigne, translated loosely, captures the fusion through playful irony: “Nothing is so firmly believed as that which we know least.” Or, in the wit of Mark Twain: “It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt.” Or through the rhythm of Pope: “Much was Believ’d, but little understood, And to be dull was constru’d to be good…”

Now, hesitancy, tentativeness, may indeed reflect a dullard but it does not follow, in logic or experience, that unequivocal conviction reflects brilliance. Indeed, the history of thought has been an endless stream of visions and revisions, paradigm shifts, and adaptation to unforeseen (and often unforeseeable) consequences.

With the foregoing, paradoxically, being my firm conviction about the inherent flaws in and of firm convictions, one must marvel at the prominence we provide to, and the deference we display towards, those who are frequently wrong but never in doubt. My recommendation: beware of the man who holds the crystal ball, who loudly proclaims questions as if they were settled conclusions, who glibly dismisses counterpoints as beside the (i.e., his) point, who preaches his objectivity and neutrality, who uses his voice to stifle and his pen to censor, who confounds consensus and coercion.

We conclude with a quote from Alexander Pope in his Essay on Criticism:

“But where’s the Man, who Counsel can bestow,
Still pleas’d to teach, and not proud to know?
Unbiassed or by Favour or by Spite;
Not dully prepossest, nor blindly right;
Tho’ Learn’d well-bred; and tho’ well-bred, sincere;
Modestly bold, and Humanly severe?
Who to a Friend his Faults can freely show,
And gladly praise the Merit of a Foe?
Blest with a Taste exact, yet unconfin’d;
A Knowledge both of Books and Humankind;
Gen’rous Converse; a Sound exempt from Pride;
And Love to Praise, with Reason on his Side?”

 

Poetry and the End of Life

At deeper levels, conventional analytics and conventional wisdom are, at once, coercive and liberating. We’ll leave this apparent paradox for another day. But before we leave, let’s stake out a position: within, and outside of, the boundaries of the sciences and humanities and transcending (or indifferent to) the border between them resides poetic imagination: the imagination expressed in, and offered to us, by, through and in, our engagement with the poem.  The imagination planted by another and that kindles our own.  The imagination that takes optical microscopy into the nanodimension. What other human expression animates our imagination by inviting us, gently and with no expectation of reciprocity, and when our spirit moves us, when we stir, to engage and explore and bring what we find, in the introspection and through our self-inspection, to enrich our appreciation of ambiguity, frailty, insecurity, fear of the unknown and craving for sustenance in the face of our mortality. To displace our fears and harness the energy of displacement to foster and fortify resolve.

In a recent post we encouraged health care providers to develop, to practice, imaginative empathy. To minister to the patient with an acute awareness of, and compassion for, the person, the person who is, or will be, us, the person who has moved from the island of health to the island of illness. The person whose movement will soon have moved him to the past.

When the surgeon has left, when the lights have been dimmed, when the birds have flown, where will the dying find comfort?  How will the care-giver who has not looked deeply into himself, who has not explored and made peace with, death and the fear of dying, soothe the soul and fortify the spirits when fortification and sustenance are all that we ask for and what we need most?

More than Meets the Eye: Valuable Double-Takes

I was jolted out of my light reverie this morning while perusing the paper. A controversy in California had escaped my attention: a legal tussle over a law that would require more roaming room for egg-laying hens. Foregive me if my surprise reflects my inattention and if my amusement bespeaks my insensitivity. Surely in a world of competing sorrows we have better ways to spend time and money. Or do we?

Having seemingly moved on to other pressing articles in the paper raising profound issues of public policy, such as the sleeping habits of an advisor to NY City’s mayor, I found the article on hen-roaming continuing to peck at me. Before long, my free-floating reverie had become fixed on the Calornia hen-roaming law. I was experiencing a delayed double-take, wondering what was really going on. My speculations began to roam, comfortably unconstrained by any shortage of roaming room.

What indeed could explain the law?

1. Would hens with more roaming room lay higher-quality eggs? If yes, would the higher price justify the higher quality? Would the consumer forced to pay more for the higher quality egg receive his money’s-worth? Or would “society” benefit through a lower cost in its health care bill because higher quality eggs from roaming hens reduce cardiac stress?

2. Would it be cynical (or relevant) to inquire whether the hidden impetus for the law was a desire to promote a subset of the hen-raising industry, perhaps the subset that owns spacious turf to enable free-roaming? Or should I look elsewhere to find the money-trail?

3. Perhaps the motivation for the law is to ensure compassion to the fowl that provides us with daily bounty; perhaps, in other words, the law protects against any lapses in our ethical commitment to do the “right thing” by ensuring that the right thing will be done notwithstanding our frailties? In which case, three cheers to the wisdom of our law-makers for saving us from ourselves.

4. Might the law be designed to protect us against false advertisement and the scheming entrepreneur who purports to appeal to our better selves only to position herself to profit as we respond to the appeal?

Or have I misconceived the law altogether and engaged in a dialogue without foundation? Perhaps an exercise characteristic of subjective idealism (as in Bishop Berkely’s 18th century idealism)?

Although the article that prompted these observations (in the Wall Sreet Journal) did not explain the reasons for the law, other articles do. I found a few of these when I returned home and searched the Internet. As always, there is more than meets the eye. The challenge and opportunity lie in knowing when there is more, and we may fall short if we develop an unshakeable conviction that we have taken the full measure of the matter.

Imaginative Empathy

Many of our earlier pieces address, implicitly, the role of empathetic imagination in the enhancement of palliative care, broadly construed. Through our active imagination of the feelings of another (the other’s anxieties, aspirations, complacencies and frustrations) we enrich and deepen our responsive empathy, which in turn enables our provision of care tailored to the individual. And the individual’s recognition of the tailoring of the care animates and sustains the therapeutic benefits of the care.

With this in mind, we compliment The New England Journal for a piece in this week’s edition: “Becoming a Physician: Rethinking the Social History.” We cannot over-emphasize the value in the exhortation of the importance, in continuing medical education, of contextualization of patient care to promote satisfactory and satisfying health outcomes. The piece encourages, through illustration, an education that “elucidates how patients’ environments influence their attitudes and behaviors and how patients’ agency — the ability to act in accordance with their free choice — is constrained by challenging social environments.”

Whether or not we are physicians, we are social beings commonly called upon, by ourselves and by others, to provide palliative care in the broadest sense, and our cultivation of imaginative empathy in ourselves and our support for its cultivation in others hold prospects for increased well-being, with no harmful, and many helpful, side-effects for all concerned.