We’ve forgotten how to die

Modern faith in technology critically depends on the assumption that, as new problems result from our use of technology, solutions to those problems will also eventually present themselves. We assume that it is the nature of problems that they should be solvable.

But what if this isn’t true at all? Why couldn’t it be that pursuing some new direction in technology could take us into social territory where there are no solutions to the problems that it creates, where the old solutions no longer work and all attempts at new solutions at best do nothing and often make things worse than the problem they address?

According to Atul Gawande, we used to know how to deal with death, because death used to be a simple thing.

For all but our most recent history, dying was typically a brief process. Whether the cause was childhood infection, difficult childbirth, heart attack, or pneumonia, the interval between recognizing that you had a life-threatening ailment and death was often just a matter of days or weeks. Consider how our Presidents died before the modern era. George Washington developed a throat infection at home on December 13, 1799, that killed him by the next evening. John Quincy Adams, Millard Fillmore, and Andrew Johnson all succumbed to strokes, and died within two days. Rutherford Hayes had a heart attack and died three days later.

Some deadly illnesses took a longer course: James Monroe and Andrew Jackson died from the months-long consumptive process of what appears to have been tuberculosis; Ulysses Grant’s oral cancer took a year to kill him; and James Madison was bedridden for two years before dying of “old age.” But, as the end-of-life researcher Joanne Lynn has observed, people usually experienced life-threatening illness the way they experienced bad weather—as something that struck with little warning—and you either got through it or you didn’t. […]

But the wonders of modern medicine have turned the journey towards death into something that is prolonged, excruciating, of dubious worth to the sufferer, and uncertain in nature.

These days, swift catastrophic illness is the exception; for most people, death comes only after long medical struggle with an incurable condition—advanced cancer, progressive organ failure (usually the heart, kidney, or liver), or the multiple debilities of very old age. In all such cases, death is certain, but the timing isn’t. So everyone struggles with this uncertainty—with how, and when, to accept that the battle is lost.  […]

Medicine has made it almost impossible to be sure who the dying even are. Is someone with terminal cancer, dementia, incurable congestive heart failure dying, exactly?

Gawande offers an excellent of how difficult it is to answer this question.

I once cared for a woman in her sixties who had severe chest and abdominal pain from a bowel obstruction that had ruptured her colon, caused her to have a heart attack, and put her into septic shock and renal failure. I performed an emergency operation to remove the damaged length of colon and give her a colostomy. A cardiologist stented her coronary arteries. We put her on dialysis, a ventilator, and intravenous feeding, and stabilized her.

After a couple of weeks, though, it was clear that she was not going to get much better. The septic shock had left her with heart and respiratory failure as well as dry gangrene of her foot, which would have to be amputated. She had a large, open abdominal wound with leaking bowel contents, which would require twice-a-day cleaning and dressing for weeks in order to heal. She would not be able to eat. She would need a tracheotomy. Her kidneys were gone, and she would have to spend three days a week on a dialysis machine for the rest of her life.

She was unmarried and without children. So I sat with her sisters in the I.C.U. family room to talk about whether we should proceed with the amputation and the tracheotomy. “Is she dying?” one of the sisters asked me. I didn’t know how to answer the question. I wasn’t even sure what the word “dying” meant anymore. In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality, and created a new difficulty for mankind: how to die.

The last sentence above is not quite right. Mankind has always been faced with the difficulty of how to die. But until recently mankind has also been blessed by the fact that dying was almost always a short and uncomplicated process, and as a result socially manageable. The difficulty isn’t a new one, but our technological wizardry has turned it into something that people can no longer handle.

This is a discussion that we all will be engaging in soon, simply because we can only sustain our current state of denial by throwing money at the problem, and the money is fast running out. Unfortunately, the heart of the problem is still well obscured, and I doubt that the discussion will come anywhere close to penetrating it.

The cultural value of reportage

I don’t read much imaginative literature, i.e. fiction, not because I don’t like it, but because a little goes a very long way for me. I first read Joseph Conrad’s short novella Heart of Darkness nearly twenty years ago, and I am still working through the many fundamental lessons it taught me. I don’t see how it is possible to read a good work of fiction in any manageable period of time without out leaving most of its ideas unconsidered, much less explored. But that may be simply because I don’t absorb ideas quickly or easily.

In John Carey’s introduction to Eyewitness to History he claims that reportage is at least as culturally valuable as imaginative literature, possibly superior. That’s an argument I don’t care to engage in, and I leave it to the interested reader to go read for himself how Carey makes his case. Along the way, though, he makes some interesting points about the role that literature plays for the reader.

Imaginative literature habitually depends for its effect on a ‘willing suspension of disbelief’ in audience or reader, and this necessarily entails an element of game or collusion or self-deception. Reportage, by contrast, lays claim directly to the power of the real, which imaginative literature can approach only through make-believe.

It would be foolish, of course, to belittle imaginative literature on this score. The fact that it is not real—that its griefs, loves, and deaths are all a pretence, is one reason why it can sustain us. It is a dream from which we can awake when we wish, and so it gives us, among the obstinate urgencies of real life, a precious illusion of freedom. It allows us to use for pleasure passions and sympathies (anger, fear, pity, etc.) which in normal circumstances would arise only in situations of pain or distress. In this way it frees and extends our emotional life. [Emphasis added]

My only quibble here is that I think readers look to the passions and sympathies of imaginative literature as much for instruction as for pleasure. We want to know how other people tick, how they respond to extreme situations, not just to be entertained but to be instructed in how to behave, or how not to behave.

Carey points out that for most people these days this need is mostly filled by reportage.

It seems probable that much—or most—reportage is read as if it were fiction by a majority of its readers. Its panics and disasters do not affect them as real, but as belonging to a shadow world distinct from their own concerns, and without their pressing actuality. Because of this, reportage has been able to take the place of imaginative literature in most people. They read newspapers rather than books, and newspapers which might just as well be fictional.

The mixed blessing here is that both imaginative literature and reportage let us approach reality from a distance, with a certain critical detachment—a detachment that can be good, in that it allows us to look deeply into matters that would be intolerable in real life, or bad, in that it encourages us to trivialize and dismiss matters that are in fact weighty and significant. The same distance that spares us the pain of reality also puts us in a position to deny that the pain is there at all. When we read an account, fictional or reported, of a person who is suffering from the consequences of bad choices, it is difficult for us to appreciate the suffering and learn from it without lapsing into pious moralizing about how the suffering could have been avoided if only the right choices had been made—or, worse, smug satisfaction that we would never have chosen so badly.

Carey claims that good reportage avoids this shortcoming by slipping past the reader’s defenses to convey a situation in such a way that there is no denying its reality.

However enjoyable this is, it represents, of course, a flight from the real, as does imaginative literature, and good reportage is designed to make that flight impossible. It exiles us from fiction into the sharp terrain of truth. […]

When we read (to choose the most glaring example) accounts of the Holocaust by survivors and onlookers, some of which I have included in this book, we cannot comfort ourselves (as we can when distressed by accounts of suffering in realistic novels) by reminding ourselves that they are, after all, just stories. The facts presented demand our recognition, and require us to respond, though we do not know how to. We read the details—the Jews by the mass grave waiting to be shot; the father comforting his son and pointing to the sky; the grandmother amusing the baby—and we are possessed by our own inadequacy, by a ridiculous desire to help, by pity which is unappeasable and useless. [Emphasis added]

This I think is the real power of reportage. It takes us out of the realm of pat answers, reminding us that there is far more to the world than is encompassed by our philosophy, no matter how refined. Facts are stubborn things, and when we are confronted with one that we can’t explain—and when we find ourselves unable to deny its reality—then comes the opportunity to understand the world more deeply.

Or not quite useless, perhaps. For at this level (so one would like to hope) reportage may change its readers, may educate their sympathies, may extend—in both directions—their ideas about what it is to be a human being, may limit their capacity for the inhuman. These gains have traditionally been claimed for imaginative literature. But since reportage, unlike literature, lifts the screen from reality, its lessons are—and ought to be—more telling; and since it reaches millions untouched by literature, it has an incalculably greater potential.

I like this final paragraph because I think Carey points to the only sphere in which significant change is possible, namely the human heart. More and more I return to this famous observation by Aleksandr Solzhenitsyn:

Gradually it was disclosed to me that the line separating good and evil passes not through states, nor between classes, nor between political parties either, but right through every human heart, and through all human hearts. This line shifts. Inside us, it oscillates with the years. Even within hearts overwhlemed by evil, one small bridgehead of good is retained; and even in the best of all hearts, there remains a small corner of evil.

Another Russian, Leo Tolstoy, once lamented that “everyone thinks of changing the world, but no one thinks of changing himself.” And thus the world remains unchanged.

I want to know how people tick, that I might find ways to effectively adjust my own internal mechanisms. And so for awhile now I’ve spent my time studying the line Solzhenitsyn speaks of, sifting through accounts of how that line manifests itself in the lives of different people, treasuring especially the stories of how a select few have managed to shift the boundary within themselves.

The best of imaginative literature can certainly provide such accounts, but in the end those accounts are imagined, used by the writer to convey his own conclusions about the nature of reality. The advantage of solid reportage is that it provides us with the truth; the disadvantage is that, being unprocessed, we may not be able to grasp it.

News as an object of faith

The walls of the Kentucky Coffeetree Cafe are lined with shelves filled with high quality used books. One afternoon while Chris and I took a break between sets, I glanced at one shelf and saw a book called Eyewitness to History. It is a collection of excerpts from first person accounts written over the years, e.g. one fellow’s report of his dinner with Attila the Hun. The British title of the book was much better: The Faber Book of Reportage.

What caught my eye, though, was that the book was edited by John Carey, the fellow who wrote The Intellectuals and the Masses, a book I enjoyed and blogged about. Carey is very much a defender of mass culture against the disdain heaped upon it by the elite. His interest in reportage was partly spurred by this, since the explosion of news in the late nineteenth century was largely a phenomenon of mass culture, and one that was despised by those with more refined tastes. It all sounded promising, but since the Coffeetree copy was priced at $7.95 I cheaped out and ordered it through Better World Books, snagging an unread library hardback for just $4 including shipping.

I wasn’t surprised to find that the eight page introduction was more than worth the price of the book. You can read it at Google Books if you like, for free. In it, Carey points out that the news of the day is a very recent phenomenon, and represents a major change in how man views life.

Arguably the advent of mass communications represents the greatest change in human consciousness that has taken place in recorded history. The development, within a few decades, from a situation where most of the inhabitants of the globe would have no day-to-day knowledge of or curiosity about how most of the others were faring, to a situation where the ordinary person’s mental space is filled (and must be refilled daily or hourly, unless a feeling of disorientation is to ensue) with accurate reports about the doings of complete strangers, represents a revolution in mental activity which is incalculable in its effects.

To early-modern man the current situation would have been incomprehensible. Ben Jonson’s play The Staple of News (acted around 1626) turns on the self-evident absurdity of news-gathering as an activity. History has not supported Jonson’s judgment.

Carey then points out that the news has become such a fundamental part of our modern lives that we can barely imagine what people occupied themselves with before news came along. His answer is surprising.

It is hard for communication-age man to imagine what pre-communication-age man found to think about. But if we ask what took the place of reportage in the ages before it was made available to its millions of consumers, the likeliest answer seems to be religion.

Well, there’s a novel take on things! But Carey is not suggesting that before the news we all wandered around in a pious, godly haze, unconcerned with worldly things. Instead, he means that religion supplied at least three of man’s basic and pervasive needs.

Not, of course, that we should assume pre-communication-age man was deeply religious, in the main. There is plenty of evidence to suggest that he was not. But religion was the permanent backdrop to his existence, as reportage is for his modern counterpart. Reportage supplies modern man with a constant and reassuring sense of events going on beyond his immediate horizon (reassuring even, or particularly, when the events themselves are terrible, since they then contrast more comfortingly with the reader’s supposed safety). Reportage provides modern man, too, with a release from his trivial routines, and a habitual daily illusion of communication with a reality greater than himself. In all these ways religion suggests itself as the likeliest substitute pre-modern man could have found for reportage, at any rate in the West.

So, man needs to (1) know that reality is bigger than his immediate sphere of operations, (2) find relief from the mundane details of his own life, and (3) participate in matters of greater significance than his daily routine. The bigger, more important sphere of operations used to be heaven; now it is the world at large.

I found this idea helpful in understanding why modern Christianity has become so obsessed with worldly affairs, some to the point where they have decided that worldly affairs are exactly the business of heaven, and the proper work of a Christian is to bring governments and cultures into line with their reading of the Bible. Perhaps so. But this leaves unanswered the question of why God was content to leave his people puttering around aimlessly for so many years, only very recently giving them the go-ahead to get on with reconstructing the world.

Carey makes one other religion-related point, namely that both religion and reportage are profoundly focused on death.

When we view reportage as the natural successor to religion, it helps us to understand why it should be so profoundly taken up with the subject of death. Death, in its various forms of murder, massacre, accident, natural catastrophe, warfare, and so on, is the subject to which reportage naturally gravitates, and one difficulty in compiling an anthology of this kind is to stop it becoming just a string of slaughters. Religion has traditionally been mankind’s answer to death, allowing him to believe in various kinds of permanency which make his own extinction more tolerable, or even banish his fear of it altogether. The Christian belief in personal immortality is an obvious and extreme example of this. Reportage, taking religion’s place, endlessly feeds its reader with accounts of the deaths of other people, and therefore places him continually in the position of a survivor—one who has escaped the violent and terrible ends which, it graphically apprises him, others have come to. In this way reportage, like religion, gives the individual a comforting sense of his own immortality.

I think this is right, but I also think Carey’s reason for it stops too short. Looking at both the news and modern Christian thinking, the commonality is not just focused on mortality but actually covers the whole human condition, a cynical “There but for the grace of God go I …” sort of thinking. A central purpose of reportage is to reinforce our sense that we are better off than others in just about every way—smarter, richer, fatter, happier. And a central purpose of the modern Christian obsession with theological study is to reinforce our sense that we are closer to God than most, not just the heathens but also those who just don’t quite grasp doctrine and practice with the depth and subtlety that we’ve obtained for ourselves.

Carey has one other important thing to say about reportage, which I will cover in a later post.

Man of Constant Sorrow, by Ralph Stanley

Much to my surprise, this is a fine, fine book. Dr. Stanley decided to write it using his own dialect, a risky choice that adds significantly to the depth and warmth of the story. Ralph Stanley has remained a simple man all his life, even after the sudden fame that came to him at age 73 when the movie O Brother, Where Art Thou? was released. He tells his story simply, without flinching at the harder truths he encountered, and the resulting book is the best single account of life as a musician in the early years of bluegrass music.

This book was a gift to me and Chris, from our students at the recent jam camp in Owensboro. As I was chatting with some of them about bluegrass history, I mentioned that it was probably a very important addition to the canon, but we didn’t know yet because we couldn’t afford a copy. One fellow was inspired to go next door to the Bluegrass Museum, buy a copy, and have it signed by the folks who had been in our coaching groups. They presented it to us just before we all went onstage at the festival for the jam campers performance. That obviously meant more to us than the most enthusiastic evaluation form ever could.

We’ve read it since, and it definitely deserves a spot on the shelf next to the Bill Monroe and Carter Family biographies. And being one of the only first person accounts of bluegrass history makes it especially valuable.