Tag Archives: health humanities

Age as Illness, Illness as Tragedy

When my father was about my present age, he used to ask me whether I thought that old age was an illness. We went round on that question, which doesn’t admit an easy answer. Old age is heavily medicalized, and health care is organized around categories of pathology. In the last few weeks of caring for my father, and trying to arrange for others to care for him, one of my most consistent problems was that his ongoing need for professional care is not based on illness; he’s not sick. But on the threshold of turning one hundred, he is increasingly vulnerable and in need. At least in the United States, that puts him outside the categories that qualify a person for insurance and other benefits, or at least on the margin of qualification.

That raises a second question. Old age is not a tragedy, but rather it’s an expected stage of life. Not reaching old age is conventionally described as a tragedy. But I constantly felt the tragic dimension of my father’s situation. Now, the world is good in the sense that help comes to us when we need it, and on returning home, I began reading Simon Critchley’s Tragedy, The Greeks, and Us (2019). Critchley has written about topics that always interest me, but I admit never being able to connect with his earlier books. With Tragedy, it’s as if Critchley had been watching me for the last weeks and writing the commentary that I could not articulate without his help. That, I believe, is what health humanities ought to do: Give people words that articulate what they feel but cannot yet say for themselves. It’s the work that this blog tries to do.

Among the many voices that keep clamouring in my head from the last weeks, the most poignant is that of someone whom I never saw. When my father was in the hospital, we heard, all day and I gather most of the night, some lost soul who as far as I could tell was in a room diametrically opposite to my father, on the other side of the circular corridor of the hospital floor. I can’t imagine being a room closer to his. His main cry was “Help me”. He was too exhausted to scream it, but loud enough for the whole unit to hear him. Sometimes he would say a bit more, including calling out a woman’s name. My father claimed he simply tuned out that voice after a while, and I think he did. So, I think, did the medical staff. What I now want to ask is the cost of that tuning out. Because you don’t select one voice for tuning out; you tune out a category of unhearables. You tune out part of the reality around you, and you pay a price, because what you tune out you still hear, on some level. It’s still there.

Simon Critchley would call that voice lamentation. He tells us that ancient Greek had at least thirteen different nouns for grief, lamentation, mourning. Our language is comparatively impoverished. Critchley as a philosopher is interested in how the project of philosophy defined by Plato has been about silencing lamentation. Philosophy, he writes, “appears to be committed to the idea and ideal of a noncontradictory psychic life”. Where he writes philosophy, I read medicine. Medicine also is “premised on the exclusion of a range of experiences that we can call tragic”. As I watched so many different healthcare professionals interview my father and interact with him, only the lowest paid and least credentialed seemed able to recognize the fundamental sadness of his plight, which is being someone who does not fit.

Critchley articulates my father’s situation most perfectly when he writes that “tragedy is the art form of between times, usually between an old world that is passing away and a new world that is coming into being”. My father’s sense of how things should be–of rightness as I’ve used that term–is grounded in a world that was already passing away fifty years ago. He is being cared for according to the values and customs of a new world that is coming into being, although much of it was predicted by Marx and Weber with prescient accuracy, although they didn’t realize quite how far it would go. For my father as for Hamlet, time is out of joint. His lamentation is quieter than the fellow around the corridor, but he too is saying help me, and the terms in which help is conventionally offered don’t fit.

These weeks with my father took me back to where I started in this work in the late 1980s after my own illnesses. We need to witness what happens to people–how care is sometimes generous and how it is often indifferent or denied. We also need to change the parameters in which people construct and utilize categories such as illness and old age. We need a health care that dares to be tragic, to hear and to join with the voices of lamentation.

Shakespeare’s Lessons About Care

My travelling companion during the last couple of weeks was Marianne Novy’s 1984 book Love’s Argument: Gender Relations in Shakespeare. Novy has many insights into how Shakespeare positioned men and women in the comedies and the tragedies. She is especially sensitive to moments when one character acts as the audience to another’s performance. In the comedies, “characters of both sexes can be alternatively actors and audience, cooperating in a relationship of mutuality” (83). Mutuality is Novy’s ideal for gender relations; she reads the plays as forming a continuum from mutuality achieved to failed mutuality. The failures tend to occur in the tragedies; that failure is both a cause and an effect of things turning tragic.

In the comedies, the male heroes enjoy women being actors in the dual sense of both active agents and role players. In the tragedies, “The heroes’ suspicion of female pretense darkens their view of the women, whether the women actually pretend or not. The men’s own acting–whether deed or pretense–discourages female participation….Thus, the tragic women are often confined to being audience to the hero, mediating the offstage audience’s sympathy with their own, as Ophelia does for Hamlet, Desdemona for Othello, and even Lady Macbeth for Macbeth” (82).

All this is interesting enough, but it becomes especially relevant to vulnerable reading in Novey’s later comments. She quotes Stanley Cavell’s essay on Lear, in which he writes that in both tragedy in a theatre and tragedy in actuality, “people in pain are in our presence”. What, he asks, is the difference? Cavell then makes what I consider a crucial comment on the ethics of responding to suffering: “In actuality acknowledgement is incomplete … unless we put ourselves in their presence, reveal ourselves to them” (90). That’s where I start thinking of clinical professionals responding to their patients’ pain and also family members responding. Novy’s commentary on Cavell seems to speak directly to the dilemma of response for clinicians, maybe especially hospital workers: “For the theatre audience … no self-revelation to those they see suffering is expected or possible” (90). That last phrase resonates heavily in my experience of hospital care.

Clinical professionals care, often deeply. But here’s the problem: “Many of the examples of sympathy expressed by the women discussed previously have been more like that of a theatre audience–incomplete by the standards of actuality–because they have been expressed in the hero’s absence”, Novy writes (90). Again her examples are Ophelia and Lady Macbeth. Cordelia is a significant exception, because she does express herself directly to Lear in their reconciliation scene.

Care, that most over burdened word, involves both doing and expressing. Those who are cared for often experience the expressing to be as important as the doing, and health humanities is about pulling up the expressive side of clinical practice. I remember a moment in a hospital rounds that I was invited to attend. The discussion was about a patient who was making demands that were upsetting because, in my view, everyone knew they were fully legitimate was embarrassed by not being able to admit that. At one point, someone in audience said, in a tone I heard as indignant, “Doesn’t he know how much time has been spent talking about him?” That line sticks with me because it expresses so much of what patients experience as lacking in care, and how professionals don’t get the problem. That audience member self-positioned like one of the women in a Shakespearean tragedy or the theatre audience member who can only express sympathy in the hero’s absence. The “Nothing about us, without us” thing hadn’t registered. Or in this instance, maybe it should be: nothing for us, except to us.

Ophelia and Lady Macbeth end up mad, then dead. Cordelia ends up dead, but we believe that in her last moments, she felt the redemption of being where she had chosen to be, having said what she needed to say. Getting killed is not, in itself, a tragedy.

Clinical care, especially in hospitals, is all about the duality Novy identifies between acting-as-doing and acting-as-role-playing, and I understand what she calls pretense as a neutral description of an actor’s proper work. It’s not about dropping the pretense; that’s not the goal that Novy imagines for Shakespeare’s women or I imagine for clinicians. What it’s about is achieving the mutuality in clinical care that Novy seeks in gender relations. The comedies are lessons in achieving mutuality; Novy even manages to rescue Taming of the Shrew from the oblivion of irredeemable sexism. The tragedies are cautionary tales of what happens when mutuality fails.