Learning How to be Human

I had my first interaction with a patient last week (I’ll call him John). He was a reticent and withdrawn teenager, who, when I first approached, was reclining on an arm chair with earbuds plugged, staring off into a corner of the sterile room. His grandfather, who had brought John to the hospital, looked equally disinterested. My task was to interview him, and my supervising physician would evaluate me on my interviewing skills – whether I asked the right questions, how well I was able to solicit answers, etc. I knew right away as I saw John that it was not going to be easy.

And it wasn’t. It felt like wading across a wide, swampy moat – a moat that John and his grandfather had dug even before I spoke a single word. John was at the hospital for a routine service, and as far as they were concerned, I was a disturber of their relative peace. As I introduced myself and explained to them why I wanted to talk to them, John’s grandfather sternly warned that our interaction better not last more than they needed to stay at the hospital for John’s visit. “No more than thirty minutes,” he said.

I began asking John questions about his illness, and the effect it’s had on his life. Yale’s patient interview curriculum – which prides itself in its radically patient-centered approach – had promised me that if I ask an open-ended question and shut up for 3 seconds, the patient would fill the silence with a lengthy response.  John, though, met all of my questions with a terse response and a sideways glance.

“How has having [your condition] been for you?”

“Just…normal. It’s just normal.”

After about 15 minutes, I started to ask about his family. I learned that he had previously lived with his mother, and visited his maternal grandmother every week (the grandfather he was with was his paternal grandfather). Nowadays, though, he lived with solely his grandmother. I asked him if he could tell me why. John’s grandfather, who had been listening the whole time, stepped in. “That’s getting personal.” I had crossed a boundary.

I gave up. There was no use in pursuing my agenda anymore, and as I let go, what surfaced was an apology. I told them that I was a first year medical student – naive, blundering, just learning to crawl in this medical profession; that I am sorry if I offended them. I was told by my teachers that I needed to treat patients as whole, and should ask about the lives they led beyond the hospital; I was just trying to understand who they were…

I asked John about the music he was listening to. He liked dubstep and electronic dance music.

“Dude, so you like beatdrops?”

And for the first time, he smiled.

We went on to chat about his schoolwork, and how he had starved himself of video games for 6 months for the sake of his grades. He had straight A’s. More smiles.

Donald Berwick, in his address to the graduating class of 2010 at Yale Medical School, noted that a good physician is not the one who readily dons the white coat (with its accompanying pedestal and power) but the one who readily gives it up.

Congratulations on your achievement today. Feel proud. You ought to. When you put on your white coat, my dear friends, you become a doctor.

But, now I will tell you a secret – a mystery. Those who suffer need you to be something more than a doctor; they need you to be a healer. And, to become a healer, you must do something even more difficult than putting your white coat on. You must take your white coat off. You must recover, embrace, and treasure the memory of your shared, frail humanity – of the dignity in each and every soul.

I wrote before about the phenomenon of ‘the bridge’ in medicine – that to become a doctor is to enter a world from which there is no returning. The irony is that becoming a healer precisely requires this return. I must learn, no less, to become human again.

The finding is in the giving-up… It is a principle that harkens me to the poetry and truth of Christ’s paradox: “Whosoever wants to save his life will lose it; and whoever loses his life for me shall gain eternal life.” So I gladly seek the place in which I become nothing – the place where I unmask all that I’ve toiled to put on to find that I am, in the end, simply Christ’s beloved. And in that place of nothing (which is the place of everything) I gain the vision to see John for as he really is: not as “a difficult patient,” but as fellow man, deserving of love.

This is the place where medicine transforms from a “giving to” or “fixing,” to “walking with.” It is where true ministry and healing is possible.

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The University Beyond Schooling

Many students, especially those who are poor, intuitively know what the schools do for them. They school them to confuse process and substance. Once these become blurred, a new logic is assumed: the more treatment there is, the better are the results; or, escalation leads to success. The pupil is thereby “schooled” to confuse teaching with learning, grade advancement with education, a diploma with competence, and fluency with the ability to say something new. His imagination is “schooled” to accept service in place of value. Medical treatment is mistaken for health care, social work for the improvement of community life, police protection for safety, military poise for national security, the rat race for productive work. Health, learning, dignity, independence, and creative endeavor are defined as little more than the performance of the institutions which claim to serve these ends, and their improvement is made to depend on allocating more resources to the management of hospitals, schools, and other agencies in question.

-Ivan Illich, Deschooling Society (1971)

I’ve spent quite a bit of time this past year thinking and reading about the history and meaning of the university, and one of the things that has increasingly struck me is the radical shift in the way universities have been conceptualized in the past couple of centuries. Although I’m still in the process of formulating my thoughts on this shift – and probably will be for quite a while yet – one particularly fruitful way of characterizing the change is to see institutions of higher learning as being caught up in a general movement to create a “scientific society”. This is, I would note, not the same thing as creating a “technological society” (for those already reaching for their Heidegger). Rather, it has a lot to do with the new normative social role that university practices were increasingly expected to play in shaping modern society – especially those associated with the new instrumental science that had reached new institutional heights with the incorporation of the “laboratory” into the university vocabulary. We have the German Idealists to thank for that.

We still live in the aftermath of that shift today, a shift that makes us take the things that a few isolated scientists making measurements through various instruments do and see as more determinative of what we consider to be reality than our common sense intuitions themselves. This table I’m sitting at? It certainly appears solid, but we know that it’s actually mostly empty space, populated by a neat lattice of protons, neutrons, and electrons arranged in such a way so as to produce the electrostatic repulsion that keeps my computer from falling through. How do we know? Science.

This is important for a number of reasons. Firstly, it crowds out the place that worship had at the center of the Christian conception of reality. What is most real about markets is not so much what various economists coming up with “scientific” theories of value say about the nature of distribution in the midst of scarcity, but the economy of gift and exchange that celebrated every Sunday in the liturgy as the church offers their sacrifice of thanksgiving in response to God’s gracious giving of his Son as an atoning sacrifice for our sins. What’s most real about humans and social relations is not the current dominant sociological theory (evolutionary, functionalist, structural, etc.), but the communion of the Holy Spirit which derives its life from Jesus Christ Himself. What’s at the center of reality is not quarks, gluons, photons, and Higgs bosons smashing into one another, but a Trinitarian god who has swept humanity up into the eternal perichoretic dance of self-giving love. This is not to say that there is no place for various academic theories about the nature of reality, but rather that they only truly find their place within the larger context of the liturgy. That is how the academic vocation can be understood as an aspect of a sinner’s response to the free grace of God.

Much more can be written on this topic, but I want to consider the second major implication of the scientific society as it has often been worked out – the displacement of the church from the center of society (indeed, the idea that society, or culture, or religion, or politics somehow has more reality than Christ or the Church is a product of this shift). Ostensibly, this puts the university at the center of society, but as any historian of the university would all-too-readily admit, the ideal of “academic freedom” has long remained illusive for all but the most fortunate of institutions. In the place of the church, the university has often been subordinated to the interests of state and, increasingly in our society, economics. It is in this context that one can understand the quote with which I opened this post.

Ivan Illich was a 20th century Catholic philosopher and priest who spent a good chunk of his time leveling a devastating critique of the ways in which the Vatican and Western nation-states were engaged in and complicit with modern theories of “development” and dealing with “global poverty”. In doing so, he heavily critiqued the ways in which the rhetoric of “equal opportunity” ended up becoming a new way of assigning social ranking by educational attainment in abstraction from one’s personal life history, constructing new definitions of “poverty” in its wake. “Equal educational opportunity,” he writes,

is, indeed, both a desirable and a feasible goal, but to equate this with obligatory schooling is to confuse salvation with the Church. School has become the world religion of a modernized proletariat, and makes futile promises of salvation to the poor of the technological age. The nation-state has adopted it, drafting all citizens into a graded curriculum leading to sequential diplomas not unlike the initiation rituals and hieratic promotions of former times.

In the place of mandatory schooling, Illich articulated the beginnings of what he termed “network education”, an approach that focused less on making sure that schools had enough money for “custodial care, indoctrination, and the selection of social roles” (i.e. “physical plants, curricula, teachers, and administrators”) and more on trying to use technology to connect people with skills with people who wanted to learn skills, one of the basic drives behind the MOOC (Massive Open Online Course) movement today.

A fuller evaluation of Illich’s project will have to wait for another day, but for now, it is enough for me to note the ways in which his diagnosis of the situation, though coming from a very different place, dovetails with my own interpretation. High-flying rhetoric aside, one finds in Illich the concern that “basic needs have been translated by society into scientifically produced commodities [so that] poverty is defined by standards which the technocrats can change at will.” Poverty, instead of being defined in terms of our universal condition towards God (with our social and economic needs a reflection and expression of that), is now defined by the new “priests” of society, the Ph.D. toting political scientist. What is most real is no longer the confession of the penitent and cry of the oppressed before God, but the “objective” evaluation of the academic. (Note: post-colonial theory has taken note of much of these critiques, but often falls to the trap of either uncritically affirming local traditions or failing to articulate coherent alternatives that escape the dialectic).

There are no easy solutions to the problems that I have tried to highlight. There are legitimate Christian reasons for wanting a scientific society. Indeed, a glance at the history of the development of a research ideal in the United States is intricately tied up with the history of Protestantism in the nation. There are also legitimate Christian reasons for seeking the (relative) freedom of the academy from the entanglements of church, state, and the business world.

I think it is safe to say, however, that the “science and religion at war” narrative is woefully insufficient for our needs. Ivan Illich, for one, gives a trenchant analysis of the kind of society that has resulted from positivist optimism about science. If the institutions of church and academy are to be distinct in our society, the relation between the two should not be that of replacement. But what should the relationship between the two of them be? And what might that mean for how universities engage the task of education?

Those of you who have followed thus far might already have sensed the spirit of Abraham Kuyper hovering over my words. In Kuyper, one finds a different path than the one that American society has trod – a separation of church and state that nevertheless has a role for the church to play in the rest of society without also having to dominate it, and a vision for scholarship in society that nevertheless finds its ultimate foundation in the divine decree.

As I have already hinted above, worship might play an important role in rethinking higher education such that it is not merely dominated by standards, curriculum, and degrees. For Christians, the communal pursuit of truth and sanctification that takes place at the university finds its ultimate grounding in the eucharistic worship of the church on the first day of the week. Communal. That brings up another key aspect that is often lost in the schooling-mindset that tends to dominate discussions of education today. Friendship plays a key role in the life of learning that tends to be ignored theoretically if not in practice.

Living faithfully in a scientific society, however, is not a task to be sneezed at. Shifts in our conception of history have affected the way we conceive of Scriptural authority. Theology, having been formally separated from philosophy, struggles to find its voice in-between the academy and church. Emphasis on objects and the pursuit of “objectivity” has left us trying to explain the organic in the terms of the inorganic. Statistics and probability have made the pursuit of “normalcy” normative. All these and more have radically changed the way that Christians approach living out the life of faith. Yet the reality at the center of it all remains the same: the love of God for his people, unchanging, unvarying, without limits, and without end.