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The Art of Medicine: W.H. Auden on What Makes a Great Physician and How He Influenced Oliver Sacks

“A doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist.”

The Art of Medicine: W.H. Auden on What Makes a Great Physician and How He Influenced Oliver Sacks

The poetry of W.H. Auden (February 21, 1907–September 29, 1973) was among Oliver Sacks’s formative books. When the two men eventually became friends in the final years of Auden’s life, Dr. Sacks was still a thirty-something neurologist with little more than a weightlifting record under his belt, a long way from becoming the Dante of medicine. Auden became an invaluable mentor as the young writer was honing the singular voice that would later render him the greatest science-storyteller of our time.

In the pages of A Certain World (public library) — Auden’s terrific commonplace book, that proto-Tumblr of fragmentary inspirations fomenting the poet’s imagination — I was delighted to discover the surprising seedbed of the kinship of spirit between these two otherwise rather different geniuses.

auden

Under the entry for Medicine, Auden writes:

I can remember my father, who was a physician, quoting to me when I was a young boy an aphorism by Sir William Osler: “Care more for the individual patient than for the special features of his disease.” In other words, a doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist.

[…]

It is precisely those members of the medical profession who make the bogus claim that they are “scientific” who are most likely to refuse to consider new evidence.

Radiating from this private reflection is the sudden illumination of why Dr. Sacks, that poetic humanist of modern medicine, was so enchanted by Auden’s work and the spirit from which it sprang. (In my own life, I have found that all of my close friendships with people whom I’ve first encountered through their work are based on something larger than aesthetic admiration for one another’s work — they are based, rather, on a certain resonant affinity for the spirit undergirding the work, of which the work is only a partial expression.)

Dr. Sacks on the set of the cinematic adaptation of his book Awakenings, with Robin Williams, 1989 (Courtesy of Oliver Sacks)

Writing shortly before the publication of Dr. Sacks’s groundbreaking Awakenings — the record of his miraculous work with patients frozen in a trance-like state by sleeping-sickness, brought back to life in large part by music — Auden offers a beautiful figurative counterpart to Dr. Sacks’s literal solution:

As Novalis wrote, “Every sickness is a musical problem; every cure a musical solution…” This means that in order to be a good doctor a man must also have a good character, that is to say, whatever weaknesses and foibles he may have, he must love his fellow human beings in the concrete and desire their good before his own. A doctor, like a politician, who loves other men only in the abstract or regards them simply as a source of income can, however clever, do nothing but harm.

In his magnificent autobiography, which remains one of the most rewarding and life-expanding books I’ve ever read, Dr. Sacks recounts the advice Auden gave him as he was writing Awakenings:

You’re going to have to go beyond the clinical… Be metaphorical, be mystical, be whatever you need.

How marvelous to uncover, buried amid the pages of his forgotten commonplace book, the seed of this wisdom, which helped Dr. Sacks write the book in such a way that Auden himself would later laud as a masterpiece.

Complement this particular fragment of Auden’s altogether wonderful A Certain World, which also gave us the poet on writing and the most important principle in making art, with the story of how Oliver Sacks once saved his own life with music.

BP

Speaking Truth to Power and the Value of Counterpoints: Madeleine Albright’s Surprising Commencement Address

“We should use our opinions to start discussions, not to end them.”

As I was preparing to deliver my Annenberg commencement address, restlessness of a very different kind and caliber was taking place on the other side of the country.

When Scripps Women’s College announced that former Secretary of State Madeleine Albright — a person with whom I disagree politically on many counts — was invited to deliver the 2016 commencement address, student protests broke out across campus. Some had hoped for a woman of color as the graduation speaker, some went as far as calling Albright a war criminal, and there was a general outrage centered around her politically charged remark that “there’s a special place in hell for women who don’t help each other.”

Unlike Villanova University, which sixteen years earlier had disinvited legendary journalist Anna Quindlen after students protested her liberal political views (with the result of Quindlen’s spectacular undelivered commencement address going “viral” long before social media), Scripps proceeded as planned. Albright traveled to campus early to meet with the students and faculty and hear out their dissent in order for them to accept her as a speaker. Even so, some of the faculty refused to participate in the ceremony.

On the morning of May 14, the day before her 79th birthday, Albright took the podium clad in cap and gown, tension and unrest still suffusing the air. She was greeted by a few tepid claps. Students wore buttons on their gowns bearing slogans like “Hell is Albright with me.” The class valedictorian prefacing the commencement address ended her speech with these words: “And if there’s a special place in hell for us, magical, radical, change-making us, then so be it.”

But what happened next — as relayed to me by my dear friend (and frequent collaborator) Wendy MacNaughton, who was in attendance as the cousin of a new graduate — is an astonishing lesson in courage, dignity, integrity, and transformation under the unlikeliest of circumstances.

Madeleine Albright by Wendy MacNaughton
Madeleine Albright by Wendy MacNaughton

After beginning by addressing the student directly with the warm response that “there is a special place in heaven for anyone who speaks truth to power,” Albright proceeded to speak about the perils of latching onto our preconceptions, the uncomfortable luxury of changing one’s mind, the importance of surrounding ourselves with counterpoints, and the vital distinction between information and wisdom in an age of instant, reactive opinions.

What emerges is a sublime addition to the greatest commencement addresses of all time and a testament to Ursula K. Le Guin’s assertion that “words are events [which] do things, change things… transform both speaker and hearer… feed energy back and forth and amplify it.”

At the end of the speech, something palpable had shifted — the few tepid claps had been transformed and amplified, erupting into a thunderous applause as Albright walked off the stage. Wendy watched one graduate remove the protest button from her gown. “Great speech, huh?” she said to the young woman, who rolled her eyes, then nodded.

Transcribed highlights below.

A generation after Adrienne Rich observed that “truth is not one thing, or even a system, [but] an increasing complexity,” Albright considers this growing complexity of truth’s multiplicity and mutability:

Truth can be a blunt instrument and, at times, a dangerous one. In some countries, even in our era, bearing witness to the abuse of authority can put truth-tellers in prison — or worse. It is also possible to be completely convinced that something is true and at the same time, completely wrong. There are people in our world today who are ready to die — or kill — for alleged truths that are grounded less on the validity of their insights than on the false certainty generated by their resentments and fears.

We have also learned through history that supposedly eternal truths can, in fact, go out of fashion. The Earth is flat; the Sun is a golden chariot; there are weapons of mass destruction in Iraq; Pluto is a planet; and women are the weaker sex.

So truth is a complex topic — but, for an educated person, it is an inescapable quest.

Here at Scripps, the alma mater talks about “searching and exploring the life of the mind.” You cannot do that without trying to separate what is true from what is not. But this mission begins with an important premise — that we do not already know everything there is to know.

That can be hard for many of us to admit.

Bertrand Russell called this “the will to doubt” and Albright illustrates it with the example of her own formative years as a college student in a distant cultural era “about halfway between the invention of the iPhone and the discovery of fire”:

At the time, I knew that I had much to gain from the words of my professors and from the books that they would assign, but I neither questioned nor doubted the fundamental values with which I had grown up. This is the way it is for most of us — after all, the only completely open mind is an empty one. We all have our opinions and prejudices, based on who we are, where we come from, what we have experienced, and how we have been taught.

The key to further education is not to put aside what we think we know, but to employ that knowledge as a platform for learning more.

This means that we should use our opinions to start discussions, not to end them.

Half a century after Eleanor Roosevelt’s clarion call for our individual role in social change, Albright turns to the litany of global problems facing us today — climate change, income inequality, genocides, wars, and the various monumental and subtle erosions of our dignity — and urges the next generation:

The principal challenges of the future are not going to be surmounted solely by any one country or small group — a new era of collaboration is required that will extend to every corner of the globe. And the responsibility for forging such a network does not belong to governments alone. Everyone must participate in solving shared problems — including corporations, academic institutions, religious leaders, civil society, and individual citizens.

A summons of this nature is easy enough to proclaim, but it cannot be answered without a healthy approach to truth, because we are not going to have the kind of cooperation we need if everyone insists on their own narrow version of reality.

To me, this is the great divide in the world today — not between liberal and conservative, rich and poor, or between any one race or creed and all the others, [but] between people who have the courage to listen and those who are convinced that they already know it all.

One of the great advantages of serving as Secretary of State was the perspective it brought — it was my responsibility to defend U.S. positions, but also to listen. And I can tell you that the way the world looks depends almost entirely on your vantage point.

For example, a resident of Claremont, California will ordinarily have a far more favorable view of the police than a democratic activist who is trying to avoid arrest in Cuba or an African American teenager in Cleveland. A child growing up in Pakistan will have a perception of history that varies widely from that of a boy or girl whose home is across the border in India. One’s sense of urgency about world hunger will be affected by whether one lives in a nation whose families can’t afford to buy bread or where diet books are best sellers.

The challenge for our leaders is not to eliminate the diversity of these perspectives — for that is not possible. The challenge is to manage them — and when necessary, moderate them — so that we are not defined primarily by what keeps us apart.

Albright ends by returning to the question of truth and the frame of mind most conducive to its clear-headed conquest:

I am not suggesting that [you] cast aside your own opinions or downgrade the value of your perspectives on life. I ask only that you make a real effort to keep learning more. And learning, by definition, means exploring areas of existence and opinion with which you are not already familiar.

Instead of choosing to read or to listen only to the people whose views make you the most comfortable — which is becoming easier and easier to do — choose instead to study those who make you the most upset. Instead of surrounding yourself with friends whose experiences are similar to yours, reach out to people whose life stories are unknown. Instead of repeating over and over again the opinions you have expressed in the past, stop venting for awhile, ask yourself why you believe as you do, and submit your own conceptions of truth to the rigorous standards of critical thinking.

Two millennia after the Buddha’s Charter of Free Inquiry and five centuries after scientific method founding father Francis Bacon’s insistence that we should “read not to contradict and confute; nor to believe and take for granted; nor to find talk and discourse; but to weigh and consider,” Albright concludes:

Above all, I ask you to understand that there is an enormous difference between entering into an argument for the purpose of proving how smart you already are — and engaging in research and discussion for the purpose of stretching your mind and giving free rein to your conscience.

One path may earn you a reputation for brilliance; but the other will lead you toward wisdom.

In saying all this, I am not conceding that all truth is relative or that every point of view is equal in merit. On the contrary, I am proposing that we place our greatest faith in principles that have proven themselves through decades of testing and struggle. These are principles that bring people together, instead of driving us apart; principles that challenge us to think not once but continually; principles that demand the best from each of us while honoring the rights of all. These principles include a commitment to justice, a belief in freedom, respect for the dignity of every human being, the capacity for forgiveness, and a desire to pursue the truth wherever that journey might lead.

Complement with Parker Palmer’s wise and wonderful Naropa University commencement address about the six pillars of the wholehearted life and Toni Morrison’s Wesleyan College commencement address about how to be your own story in a culture that constantly tries to tell you who you are.

BP

The Will to Doubt: Bertrand Russell on Free Thought and Our Only Effective Self-Defense Against Propaganda

“The protection of minorities is vitally important; and even the most orthodox of us may find himself in a minority some day, so that we all have an interest in restraining the tyranny of majorities.”

The Will to Doubt: Bertrand Russell on Free Thought and Our Only Effective Self-Defense Against Propaganda

“We must believe before we can doubt, and doubt before we can deny,” W.H. Auden observed in his commonplace book. Half a century earlier, Bertrand Russell (May 18, 1872–February 2, 1970), the great poet laureate of reason, addressed the central equation of free thinking in his 1922 Conway Memorial Lecture, later published as Free Thought and Official Propaganda (public library | free ebook) — a short and searing book charged with Russell’s characteristic intellectual electricity, the immense power of which melts an entire century into astonishing timeliness speaking directly to the present day.

bertrandrussell3

Three decades before he was awarded the Nobel Prize for “his varied and significant writings in which he champions humanitarian ideals and freedom of thought,” Russell writes:

When we speak of anything as “free,” our meaning is not definite unless we can say what it is free from. Whatever or whoever is “free” is not subject to some external compulsion, and to be precise we ought to say what this kind of compulsion is. Thus thought is “free” when it is free from certain kinds of outward control which are often present. Some of these kinds of control which must be absent if thought is to be “free” are obvious, but others are more subtle and elusive.

Writing three years after the magnificent Declaration of the Independence of the Mind, which he signed alongside luminaries like Albert Einstein and Jane Addams, Russell points to two primary meanings of “free thought” — the narrower sense of resisting traditional dogma and a broader sense that encompasses all forms of propaganda pervading public life. A patron saint of nonbelievers, Russell writes:

I am myself a dissenter from all known religions, and I hope that every kind of religious belief will die out. I do not believe that, on the balance, religious belief has been a force for good. Although I am prepared to admit that in certain times and places it has had some good effects, I regard it as belonging to the infancy of human reason, and to a stage of development which we are now outgrowing.

But there is also a wider sense of “free thought,” which I regard as of still greater importance. Indeed, the harm done by traditional religions seems chiefly traceable to the fact that they have prevented free thought in this wider sense.

He considers the three essential elements of this wider conception of free thought:

Thought is not “free” when legal penalties are incurred by the holding or not holding of certain opinions, or by giving expression to one’s belief or lack of belief on certain matters… The most elementary condition, if thought is to be free, is the absence of legal penalties for the expression of opinions.

[…]

Legal penalties are, however, in the modern world, the least of the obstacles to freedom of thoughts. The two great obstacles are economic penalties and distortion of evidence. It is clear that thought is not free if the profession of certain opinions makes it impossible to earn a living. It is clear also that thought is not free if all the arguments on one side of a controversy are perpetually presented as attractively as possible, while the arguments on the other side can only be discovered by diligent search.

Echoing the essence of Descartes’s twelve tenets of critical thinking, penned three centuries earlier, Russell returns to the centerpiece of free thought — the willingness to doubt:

William James used to preach the “will to believe.” For my part, I should wish to preach the “will to doubt.” None of our beliefs are quite true; all have at least a penumbra of vagueness and error. The methods of increasing the degree of truth in our beliefs are well known; they consist in hearing all sides, trying to ascertain all the relevant facts, controlling our own bias by discussion with people who have the opposite bias, and cultivating a readiness to discard any hypothesis which has proved inadequate.

Half a century before Richard Feynman’s terrific meditation on science vs. religion and why doubt is essential for morality, Russell extols science as the domain of human knowledge that best exemplifies the fruitfulness of this “will to doubt”:

Every man of science whose outlook is truly scientific is ready to admit that what passes for scientific knowledge at the moment is sure to require correction with the progress of discovery; nevertheless, it is near enough to the truth to serve for most practical purposes, though not for all. In science, where alone something approximating to genuine knowledge is to be found, men’s attitude is tentative and full of doubt.

In religion and politics, on the contrary, though there is as yet nothing approaching scientific knowledge, everybody considers it de rigueur to have a dogmatic opinion, to be backed up by inflicting starvation, prison, and war, and to be carefully guarded from argumentative competition with any different opinion. If only men could be brought into a tentatively agnostic frame of mind about these matters, nine-tenths of the evils of the modern world would be cured. War would become impossible, because each side would realize that both sides must be in the wrong. Persecution would cease. Education would aim at expanding the mind, not at narrowing it. Men would be chosen for jobs on account of fitness to do the work, not because they flattered the irrational dogmas of those in power.

He points Einstein and the relativity theory he had formulated just seven years earlier as an epitome of this disposition:

His theory upsets the whole theoretical framework of traditional physics; it is almost as damaging to orthodox dynamics as Darwin was to Genesis. Yet physicists everywhere have shown complete readiness to accept his theory as soon as it appeared that the evidence was in its favour. But none of them, least of all Einstein himself, would claim that he has said the last word… This critical undogmatic receptiveness is the true attitude of science.

Indeed, we have seen a supreme testament to this in the recent landmark detection of gravitational waves — something Einstein saw as a purely theoretical concept of unimaginable empirical corroboration.

Illustration by Vladimir Radunsky for On a Beam of Light: A Story of Albert Einstein by Jennifer Berne

Russell offers a disquieting thought experiment of sorts:

If Einstein had advanced something equally new in the sphere of religion or politics … the truth or falsehood of his doctrine would be decided on the battlefield, without the collection of any fresh evidence for or against it. This method is the logical outcome of William James’s will to believe. What is wanted is not the will to believe, but the wish to find out, which is its exact opposite.

He considers the core obstacles to this vital rational doubt:

A great deal of this is due to the inherent irrationality and credulity of average human nature. But this seed of intellectual original sin is nourished and fostered by other agencies, among which three play the chief part — namely, education, propaganda, and economic pressure.

Russell examines each of the three in turn, beginning with education — a subject he would come to consider closely four years later in his masterwork on education and the good life. Education’s formal institutions, he argues, are set up “to impart information without imparting intelligence” and designed “not to give true knowledge, but to make the people pliable to the will of their masters” — a seedbed of political and cultural propaganda that begins in elementary school, with the teaching of a history told by those in power, and results in the widespread manipulation of public opinion. Lamenting “the paradoxical fact that education has become one of the chief obstacles to intelligence and freedom of thought,” he envisions the remedy:

Education should have two objects: first, to give definite knowledge — reading and writing, languages and mathematics, and so on; secondly, to create those mental habits which will enable people to acquire knowledge and form sound judgments for themselves. The first of these we may call information, the second intelligence.

He then turns to propaganda — the concerted manipulation of public opinion by those in power. Having previously advocated for the blurring of the line between intuition and the intellect, he writes:

Too much fuss is sometimes made about the fact that propaganda appeals to emotion rather than reason. The line between emotion and reason is not so sharp as some people think.

[…]

The objection to propaganda is not only its appeal to unreason, but still more the unfair advantage which it gives to the rich and powerful. Equality of opportunity among opinions is essential if there is to be real freedom of thought; and equality of opportunity among opinions can only be secured by elaborate laws directed to that end, which there is no reason to expect to see enacted. The cure is not to be sought primarily in such laws, but in better education and a more sceptical public opinion.

Turning to the final impediment of free thought — the economic pressures of conformity, under which one is rewarded for siding with and adopting the dogmas of those in power — Russell writes:

There are two simple principles which, if they were adopted, would solve almost all social problems. The first is that education should have for one of its aims to teach people only to believe propositions when there is some reason to think that they are true. The second is that jobs should be given solely for fitness to do the work.

Nearly a century after Kierkegaard argued for the power of the minority and a generation before Hannah Arendt’s case for outsiderdom, Russell urges:

The protection of minorities is vitally important; and even the most orthodox of us may find himself in a minority some day, so that we all have an interest in restraining the tyranny of majorities. Nothing except public opinion can solve this problem.

It’s a sentiment of enormous poignancy and prescience, illustrating both how far we’ve come — Russell is writing more than three decades before the zenith of civil rights and the Equal Pay Act — and how far we have yet to go in a culture where, a century later, sexism and racism are far from gone and many workplaces are still systematically discriminating against minorities like Muslims and the LGBT community.

The cultivation of public opinion that advances equality and justice rather than upholding oppressive power structures has to do with the “will to doubt” at the heart of Russell’s case. He writes:

Some element of doubt is essential to the practice, though not to the theory, of toleration… If there is to be toleration in the world, one of the things taught in schools must be the habit of weighing evidence, and the practice of not giving full assent to propositions which there is no reason to believe true.

The role of the educator, he argues, is to teach young minds how to infer what actually happened “from the biased account of either side” and to instill in them the awareness that “everything in newspapers is more or less untrue” — a task all the more urgent today, when the old role of the newspapers has been largely taken over by incessant opinion-streams barraging us online and off with the certitude of their respective version of reality masquerading as truth.

Russell returns to the basic human predicament obstructing freedom of thought and envisions its only fruitful solution:

The evils of the world are due to moral defects quite as much as to lack of intelligence. But the human race has not hitherto discovered any method of eradicating moral defects; preaching and exhortation only add hypocrisy to the previous list of vices. Intelligence, on the contrary, is easily improved by methods known to every competent educator. Therefore, until some method of teaching virtue has been discovered, progress will have to be sought by improvement of intelligence rather than of morals. One of the chief obstacles to intelligence is credulity, and credulity could be enormously diminished by instruction as to the prevalent forms of mendacity.

Writing nearly a century ago, even before Walter Benjamin’s increasingly timely meditation on the challenge of extracting wisdom from the morass of (mis)information, Russell once again reveals his extraordinary prescience:

Credulity is a greater evil in the present day than it ever was before, because, owing to the growth of education, it is much easier than it used to be to spread misinformation, and, owing to democracy, the spread of misinformation is more important than in former times to the holders of power.

He concludes by considering what it would take for us to implement these two pillars of free thought — an education system that fosters critical thinking rather than conformity and a meritocratic workforce where jobs are earned based on acumen rather than ideological alignment with power structures:

It must be done by generating an enlightened public opinion. And an enlightened public opinion can only be generated by the efforts of those who desire that it should exist.

Complement the timelessly terrific Free Thought and Official Propaganda with Galileo on critical thinking and the folly of believing our preconceptions, Ursula K. Le Guin on power, oppression, and freedom of mind, and Carl Sagan’s indispensable Baloney Detection Kit, then revisit Russell on what “the good life” really means, why “fruitful monotony” is essential for happiness, the nature of time, and the four desires driving all human behavior.

BP

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