Oliver Sacks

You mustn’t confuse the poem with the poet. Thom Gunn

Early this year I learned that Oliver Sacks had terminal cancer (Times, 1/19/15). On Sunday (8/30/15) Sacks died. He was 82 and had lived a remarkably varied life throughout those many years.

At once the news saddened me. In On the Move, his recently published memoir, he describes his early life in England during the War when he was sent away to a cruel private school in the country, his studies at Oxford, where he obtained his medical degree, his mother (surgeon) and father (general practitioner) and his Jewish Orthodox upbringing, his brothers, one of whom was schizophrenic and then his migration to this country where he wrote most of his memorable articles and books.

Sacks used to swim a mile every, broke weight lifting records on Santa Monica beach and for a period experimented with drugs, including LSD and amphetamines, which he became addicted to for a while. He used to drive his motorcycle for miles every day, sometimes all day to Las Vegas, Death Valley, the Grand Canyon and back again at night.

There is a direct union with oneself with a motorcycle, for it is so geared to one’s proprioception, one’s movements and postures, that it responds almost like part of one’s own body. Bike and rider become a single indivisible entity…

Sacks was a deeply empathetic clinician who emphasized the importance of case studies. He argued this was essential to understanding individual lives, finding it useful in treating and explaining the disorders he sought to explain--migraines, Tourette’s syndrome, color blindness, autism, sleeping sickness and Parkinson’s.

Sacks devoted his life and writing to narrative medicine on these problems, relevant to both lay readers and medical professionals. In On the Move he wrote, “All sorts of generalizations are made possible by dealing with populations, but one needs the concrete, the particular, the personal too.”

Sacks learned much from his literary friendships with Auden, Thom Gunn and Jonathan Miller and in several respects his essays and journal articles are stories that read like fictional explorations. He attributes his great desire to write directly to his parents:

My mother was a natural storyteller. She would tell medical stories to her colleagues, her students, her patients, her friends. And she had told us—my three brothers and me—medical stories from our earliest days, stories sometimes grim and terrifying but always evocative of the personal qualities, the special value and valor, of the patient. My father, too, was a grand medical storyteller, and my parents’ sense of wonder at the vagaries of life, their combination of a clinical and a narrative cast of mind, was transmitted with great force to all of us.

When he learned he had terminal cancer he said he wanted to live in the months remaining to him “in the richest, deepest, most productive way I can.” There is little doubt he was able to do that, writing every day, continuing to publish articles, and books visiting his friends, and loved ones.

The act of writing, when it goes well, give me a pleasure, a joy, unlike any other. It takes me to another place—irrespective of my subject—where I am totally absorbed and oblivious to distracting thoughts, worries, preoccupations or indeed the passage of time.

In a review of On the Move in the New York Review of Books (5/21/15), Jerome Groopman concluded “Oliver Sacks inspired my efforts as a physician-writer, as he has for so many others. I am, in a sense, one of his students. Now, in settings like my seminar, his work inspires the next generation to think and create. I will add On the Move to our reading list. His writing, like the light from a distant star, will continue to illuminate the lives of his readers, long after its source is extinguished.”

I was struck by Sacks predominant feelings when he learned that he had terminal cancer. It was “one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and written. I have had an intercourse with the world, the special intercourse of writers and readers.”

I must remember that sentiment for in every respect I share them--gratitude for long life, a life of learning and advantage for as long as I can remember.


Darkness Visible

“I’d feel the horror, like some poisonous fogbank, roll in upon my mind.” William Styron

For years I have pondered the mystery of my father’s alternating cycles of depression and elation that governed his life. I wondered what was at work to give rise to this strange and sad mix of horrible and wonderful days. I have read countless accounts of the various explanations for what is known now as bipolar disorder and the equally numerous treatments that attempt to alleviate it.

One of them was William Styron’s account in Darkness Visible of his battle with the storms of depression. The other day I noticed it on my bookshelf and decided to read it again. Styron describes his depression as “a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self—to the mediating intellect—as to verge close to being beyond description”

He begins with an account of a trip to Paris in the winter of 1985 when he realized that the melancholy that had dogged him for months was descending into a “siege” that rendered him practically speechless and socially inept.

After he returned to his home in Connecticut he became bedridden, unable to write, with suicidal thoughts and a degree of suffering that was indescribable. In time he was hospitalized where its seclusion and the support of his family and friends enabled him to recover.

In my father’s case, neither psychoanalytic therapy, the drugs available at that time, electroshock treatment, or the best private "rest homes" gave him any lasting relief. Would the newer drugs and treatments available today have made a difference? Perhaps they might have made it easier for him to manage the furies more effectively or put them at a greater distance.

However, I am not at all sure about this and I remain a skeptic about the current views of the brain mechanisms that may be responsible for bipolar disorder. Yes, he may have had some kind of chemical imbalance, but I saw the world in which he grew up, the way his mother and father treated him, and how he had to spend his working days in the family business. It was never a placid situation. There was no escaping the world he brought with him but neither could he escape the one he had to live through during each and every day of his relatively brief life.

Styron also attributes the source of his depression to his early years where his father battled “the gorgon for much of his lifetime, and was hospitalized …after a spiraling downward that in retrospect I saw perfectly resembled mine.”

After reading Darkness Visible, I asked myself if Styron’s account of his descent into madness helped me to better understand my father’s torments. I confess it didn’t, although many readers wrote to him to say how grateful they were for describing so clearly their own battles with depression.

The only thing that ever helped me was an experience I had as a young man, after having my wisdom teeth removed. He was with me when I was recovering from Sodium Pentothal (so-called truth serum), the anesthetic used then.

Its aftereffects led to a period of uncontrollable crying that I was fully aware of but could do nothing to stop. I said to him then that I finally understood why he couldn’t do anything about the demons that descended upon him.

But that was an atypical experience as Sodium Pentothal is rarely used today. And yet it taught me why it is so difficult to grasp the essence of this illness that plagues so many people today. As Styron notes, “To most of those who have experienced it, the horror of depression is so overwhelming as to be quite beyond expression.“


The Attack

We are only the children of a ravaged, despised people, fighting with whatever means we can to recover our homeland and out dignity. Nothing more, nothing less.

In Yasmina Khadra's novel, The Attack, there is a suicide bombing at a child’s birthday party in Tel Aviv. Nineteen people are killed, including many of the children. Sihem, the wife of a highly respected Arab surgeon (Amin Jaafari) is identified as the bomber.

Amin cannot believe his much-loved wife was the culprit. He spends days and sleepless nights trying to find out why and how she did it. His life turns into a nightmare of drink and struggle.

Eventually he comes to accept it but that calls into question every assumption he had about his wife and the work he is doing as an Israeli citizen.

And once you’re flat on your back, you realize that your life, your whole life—with its ups and downs, its pains and pleasures, its promises and failures—hangs and has always hung by a thread as flimsy and imperceptible as the threads in a spider’s web.

We are frequently reminded of what Israel has done to his homeland, their brutality, inhumane violence, total destructiveness.

We’re in a world where people tear one another to pieces every day that God sends. We spend our evenings gathering our dead and our mornings burying them. Our homeland is violated right and left, our children can’t remember that the word school means…Our cities are being buried by machines on caterpillar tracks.

Possessing nothing more to hope for Amin returns to the hospital with his convictions as his only allies.

We could spend months and years striving for mutual understanding, and neither of us would ever be willing to listen to the other.…the only battle I believe in, the only one that really deserves bleeding for, is the battle the surgeon fights which consists in re-creating life in the place where death has chosen to conduct its maneuvers.


Black Dogs

Turning points are the inventions of storytellers and dramatists, a necessary mechanism when a life is reduced to, traduced by a plot, when a morality must be distilled from a sequence of actions, when an audience must be sent home with something unforgettable to mark a character’s growth. Ian McEwan

On their honeymoon is the south of France June and Bernard Tremaine set out on a walk in the countryside. Both are devout Communists, agree on most everything and much in love. While Bernard stops to look closely at some caterpillars, June continues on her way.

Soon thereafter, two large, black dogs confront her. We learn later that the Germans left them to terrorize the villagers. June managed to ward off the dogs, but the encounter changed her life.

It became a mystical experience, turned her away from Communism and acquired a somewhat religious epiphany. In spite of their love for one another, June and Bernard never lived together again. June settled in a bergerie in the south of France; Bernard returned to England and ran successfully for Parliament.

McEwan’s tale is narrated by their adoptive son, Jeremy, who spoke frequently with both of them. The novel recounts their now-differing views on science, religion, and politics.

I believe McEwan intended June’s encounter with the black dogs as a metaphor for a fundamental feature of the human condition. He sums it up at the end:

I came face to face with evil. I didn’t quite know it at the time, but I sensed it in my fear—these animals were the creations of debased imaginations, of perverted spirits no amount of social theory could account for. The evil I’m talking about lives in all of us. It takes hold in an individual, in private lives, within a family, and then it’s children who suffer most. And then, when the conditions are right, in different countries, at different times, a terrible cruelty, a viciousness against life erupts, and everyone is surprised by the depth of hatred within himself. Then it sinks back and waits. It’s something in our hearts.


The Nightingale

If I have learned anything in this long life of mine, it is this: In love we find out who we want to be; in war we find out who we are

Once I started Kristin Hannah’s The Nightingale I couldn’t put it down. It was one of those books you chance upon once in a while. The book surprised me. I had no idea who Kristin Hannah was, although she has apparently written over a dozen books. A friend picked it up at the bookstore, I started reading it, and at once decided to download it.

The book is about two sisters and their father in France during World War II. Those horrible years in France--how the French survived, the resistance some of them displayed and the role of collaborators--has always fascinated me, as have the inescapable moral issues.

Vianne, the oldest of the two sisters, lives with her husband, Antoine, and daughter in a village south of Paris. She is quiet, reserved, hard-working. Isabelle is impetuous, short tempered, a rebel. When their shell-shocked father returns from World War 1, everything changes. He is no longer the kind, serious scholar. Now he is angry, prone to drink, and harsh.

After his wife dies, he kicks his two daughters out of their apartment and sends them away to a Catholic school. Isabelle escapes from one school after another. Antoine is drafted into the Army and in time is captured, sent to a camp. Vianne struggles to get by in their country home.

Her clothing was as worn and ragged as that of most Parisians, and the clatter of wooden soles rang out. No one had leather anymore. She bypassed long queues of housewives and hollow-faced children standing outside of boulangeries and boucheries. Rations had been cut again and again and again….

Food is scarce, there is no heat, a German solider comes to occupy their home, then another after Vianne accidentally kills the first one. The second soldier is mean, lusts for her. Meanwhile, Isabelle joins the Resistance and becomes a hero after escorting downed English and American pilots across the Pyrenees numerous times.

On this cool October morning, her life would change. From the morning she boarded this train…she would no longer be the girl in the bookshop…From now on she was Juliette Gervaise, code name the Nightingale.

Later Vianne gains the cooperation of a Catholic nun to save children in the Sister’s school. The War goes on, the hardships increase, finally the Americans arrive, the Nazis are driven back, Antoine escapes from the camp, Isabelle is captured, somehow manages to survive and both Antoine and Isabelle return to their home when the War is over.

Those are the major occurrences in an otherwise rich and beautifully written novel. Hannah has that rare story telling gift.

In reading The Nightingale, I came to realize that fictional depictions of World War II are far more revealing than the non-fiction books I’ve read. The experiences, dangers, thoughts and emotions of the people seem to me much truer to what the experience must have been like.

I am reminded of a statement George Eliot wrote, “Art is the nearest thing to life; it is a mode of amplifying experience and extending our contact with our fellow man beyond the bounds of our personal lot.”


Gravity Payments

Perhaps the most striking illustration of economic inequality in this country is the pay gap between C.E.O.s and workers at their company. Gretchen Morgenson writes (Times 4/10/15) that despite federal regulations most companies fail to report this measure.

She cites an academic study that reported the C.E.O pay as a multiple of the average worker ‘s pay increased “from an average of 20 times in 1965 to 295.9 in 2013!”

Acknowledging that their estimates are imprecise, two labor economists, Dean Baker and Nicholas Buffie, have nevertheless calculated pay gaps in specific companies. They found that the Walt Disney had the widest pay gap in 2014. Their CEO received $43.7 million last year, while the median worker received $19,530, a C.E.O. worker ratio of 2,238!

Microsoft was next on the list. Their C.E.O. pay package last year was $84.3 million, 2,012 times the estimated median employee earnings of $41,900 at Microsoft.

And so it goes, down the list of enormous compensation for C.E.O.s and comparatively modest salaries for their employees. Is it any wonder public companies fail to report the C.E.O. pay ratio comparison with their workers. While efforts have been made to require them to do so, not surprisingly the rule met an avalanche of opposition.

Occasionally you read about a company that significantly increases the salary of the people who work there. The most recent example is the decision of Dan Price, the founder of Gravity Payments, a credit-card processing firm, to raise the salary of even the lowest-paid clerk to a minimum of $70,000.

A company spokesman said the salary of 30 of the 70 employees will double. The average salary at the company is $48,000 a year. So with one exception, the salaries of all the employees will increase. The exception is the salary of Dan Price who will pay for the wage increases by reducing his own salary from nearly one million to $70,000.

How many other C.E.O.s would be willing to follow suit? Clearly there aren’t many, a sad commentary on the state of capitalism in this country.

So who would have believed that Dan Price’s policy of guaranteeing each of his employees a minimum salary of $70,000 would cause the backlash it has? At least, I never imagined the controversy it has produced as described in Patricia Cohen’s article in the Times (7/31/15).

First, several long time clients withdrew their business because they didn’t agree with Price’s new policy. Others left because they anticipated a fee increase, in spite of assurances there wouldn’t be one. In addition, other companies in the Seattle area complained it made them look stingy.

Then employees started to leave because long serving staff members only received small or no raise. A few others left because of burnout, they simply didn’t much like Price or because it shackled high performers at the expense of less motivated staff.

Worst of all, Price’s older brother and Gravity co-founder filed a legal suit that threatened the company’s existence. Price simply didn’t have the money to pay the eventual legal fees. So he would had to scramble or consider borrowing heavily.

Even though the new minimum $70,000 salary plan generated many new clients, a great deal of publicity, and thousands of job applications, the effort to deal with all this was exhausting and distracting.

Price’s original goal had simply been to take a stand against income inequality in the only way he could. He had no idea of the brouhaha it would give rise to or that it would affect his personal life and financial condition so greatly.

Note: Dan Bertolini is the only other C.E.O. that I know about who has taken a somewhat similar action. I quote his example from an essay I wrote on economic inequality.

“It was a breath of fresh air to read that Mark Bertolini, Aetna’s C.E.O, announced (New Yorker, 2/2/15) that his lowest paid workers would receive a substantial raise, as well as improved medical coverage.

Even more remarkable was the reason he gave for the decision. He framed it in terms of the growing economic inequality in this country, mentioning Thomas Piketty’s influential Capital in the Twenty-First Century and that he had given a copy to each of his top executives.

Bertolini also said it wasn’t “fair” for a company as successful as Aetna for its employees to be struggling to get by, while his senior personnel were paid lavishly.

Companies are not just moneymaking machines. For the good of the social order, these are the kinds of investments we should be willing to make.

I suspect that an employee who is paid more will work harder, remain in the company longer, be absent from work less often, and, in turn, that the company’s productivity and profits will increase. Bertolini’s decision is an investment with an immediate and highly beneficial outcome for his company, as well as its many workers.



Many years ago I saw David Hare’s Skylight on the stage and more recently read the script. The play brings together two former lovers, Tom, now a relatively wealthy restaurateur and Kyra, a teacher of children in a lower class London school.

They had been lovers for several years until Tom’s wife learned about their affair, whereupon Kyra ended the liaison. Tom’s wife has recently died of cancer and he finds that he wants to see Kyra again. One night he unexpectedly arrives at her apartment.

Tom: You think I haven’t wanted to? My God, you think I haven’t wanted to call? To pick up the telephone? You think I haven’t wanted to jump in the car and bust my way through that bloody door?

Kyra I wish you’d take off your fucking coat. Her directness suddenly speaks of a whole past between them.

Tom Well, I would. Of course. If you’d get central heating. Then of course I’d take off my coat. But since you’ve made a style choice to live in Outer Siberia, I think for the moment I’ll keep my coat on.

There’s a genuine familiarity in their dialogue, they are glad to see one another, they battle like any lovers do. Tom wants Kyra to give up teaching, move to a nicer apartment, resume their relationship.

Krya: You started to lecture me. “Don’t waste you time on higher education, it’s only a way of postponing real life.”
However, Kyra is devoted to teaching, finds the business world repellent and Tom’s display of his wealth unattractive.

Kyra: I spend my time among very different people. People who often have nothing at all. And I find in them one great virtue at least: unlike the rich, they have no illusions that they must once have done something right! Nor do they suffer from delicate feelings.

At the end of the first act, they embrace, Kyra begins to cry, they take each other in their arms and Tom says, Kyra, I’m back.

In the second act their disagreements continue, nothing is resolved, and the play ends as Tom quietly leaves.

Tom and Kyra are bound together by a shared memory of love, but divided by income and belief. Theirs is an impossible love, a tragic one. In the present era of gross economic inequalities and class differences, I find the play even more compelling than when I first saw in it in the 90s.

Equally important is the personal resonance the play has for me in light of my own brief relationship with a young woman as different from me in income and status as Kyra and Tom.

Every now and then I wonder about what happened to her or if I would ever see her again. At times I have thought about e-mailing her. But why? What is the point? There isn’t any.


James Salter

James Salter died yesterday; he was 90 years old. Salter was and continues to be one of my favorite writers. I’ve written about him often. Have a look: http://marksinthemargin.blogspot.it/search/label/James%20Salter

Many other have as well. Here is a profile from the New Yorker: http://www.newyorker.com/magazine/2013/04/15/the-last-book . And an interview in the Paris Review: http://www.theparisreview.org/interviews/1930/the-art-of-fiction-no-133-james-salter .

While I will miss another of his novels or short stores, there’s always the great pleasure of rereading them again.


Best Book of The Year

It’s the time of the year when readers write about their favorite book(s) of the year. All told it’s been a good year for both fiction and non-fiction books. Anyone who doubts this need only have a look at the large group mentioned on two Guardian pages here and here, as well as two in the Times here and here.

My favorite book of the year, In the Light of What We Know by Zia Haider Rahman, an impressive philosophical novel was mentioned a couple of times. I wrote about it here and will read it again once the paperback version becomes available.

Joyce Carol Oates also gave the novel high marks recently in her review in The New York Review of Books (10/24/14).

What struck me about Oates’ two-page review was that none of the topics she dealt with were discussed in my review. For example, Rahman’s novel often reminded her of others. She felt the mordant tone of Conrad’s Heart of Darkness throughout the novel.

It also reminded her of Fitzgerald’s The Great Gatsby, the novels of dislocation and inquiry of Graham Greene and W. G Sebald and in the “suspense of its espionage-driven conclusion, the spy novels of John le Carre.”

I read the novel without such a literary background, a background that I never acquired in the first place. My reading was that of a naïve individual drawn to such a novel by its truths based on my study of epistemology as an undergraduate major in philosophy.

My only reference to another novel was to Pascal Mercier’s discussion in Night Train to Lisbon of how it might be possible to better understanding yourself by studying the life of another person, as the narrator of Rahman’s novel studies the life of his friend Zafar.

Oates continues in this view by noting the many ideas cited in the novel, reminded her of Mann’s Magic Mountain. Yet she doesn’t mention which of the ideas had this effect.

She does unfold the story of Zafar’s life, from his birth in Bangladesh to his arrival in Oxford, study of mathematics, work as a derivatives trader, doomed love affair with the temptress Emily Hampton-Wyvern and work with an NGO in Afghanistan. Oates’ emphasis in her account dwells on the class differences that continue to rule much of English life. She writes:

“In vain we wait for Zafar to consider that his infatuation with a member of the English aristocracy is a narcissistic projection of his own: a willful attempt to appropriate a person, and a family of a social class perceived as higher than his own, thus more desirable.”

While I was aware of the importance of this difference and the way it contributed to Zafar’s deep anger and scorn of the English aristocracy, ruling class, and the international aid programs in Afghanistan, it was not a subject I wrote about in my review.

Toward the end of the novel the narrator says his friend appears to him now as several Zafars--the Zafar of their college days together, the bedraggled Zafar who reappeared at his front door one day, and the Zafar revealed by the fragmented stories he tells the narrator and those he wrote in the pages of his notebook.

In like fashion, most readers of this novel view it from their own background, mine from a philosophical perspective, while Oates from her literary/writing tradition. Nevertheless, we both agree that In the Light of What We Know is a powerful novel, a rather unusual work of fiction in this day and age, with a great deal of insight about human relationships.

To view a BBC Interview with Rahman go here:


Economic Inequality: What Can Be Done?

The question of what can be done about the enormous economic inequalities in this country will conclude my discussion of this topic.

No sooner had I posted my first blog on the subject than Nicholas Kristof wrote a short note, “An Idiot’s Guide to Inequality,” in the Times. He reminds us that economic inequality has become increasingly worse in this country, impeding economic growth and creating large “fissures” in our society between the very rich and very poor. Moreover, the very wealthy have gained increasing control of the electoral process and reduced job opportunities for countless individuals.

Kristof concludes: “Inequality and lack of opportunity today constitute a national infirmity and vulnerability—and there are policy tools that can make a difference.”

This leaves wide open just what these policy tools are and, even more uncertain, just how they are ever going to be implemented.

The very next day, echoing the theme of my blog, Eduardo Porto wrote a note, “Why Voters Aren’t Angrier About Economic Inequality,” also in Times. He believes there are several reasons for the public’s passivity.

1. The poor vote less than the rich and they don’t necessarily vote on the basis of their economic interests.

2. Like Kristof, he says the rich have far more political power.

3. And he reviews another study (this one in Germany), reporting that individuals don’t grasp the magnitude of inequality. “Evidently, nobody has a clue.” He claims people in the United States not only seem to accept one of the largest gaps in the developed world but our government ranks among the “stingiest” in doing anything about it.

Two days latter the Russell Sage Foundation reported that the average U.S. household experienced a significant decline in net worth in the ten years ending in 2013. Then it was reported that 35% of U.S. individuals have credit card debts and unpaid bills large enough to be reported to collection agencies. As Caroline Radcliffe of the Urban Institute said, "Roughly, every third person you pass on the street is going to have debt in collections.”

But what can be done, what can realistically be done given the equally large political polarization in this country? Why is this question so rarely asked?

Perhaps it’s because all too many people believe the poor deserve to be poor and those who are rich have earned it. Or they believe we are focusing on the wrong problem, with the real problem slow growth, or education, or that “thwarting the people at the top” will have no effect on the people at the bottom, other than worsening their condition with as the economy comes tumbling down.

Meanwhile, in a bold post on the New Yorker Web site (1/28/14) John Cassidy did make ten proposals that Obama should mention in his State of the Union address delivered earlier this year, if he is genuinely serious about reducing economic inequality. Among the ten, five deal with taxes.

1. Abolish the payroll tax
2. Raise the top rate of income tax
3. Introduce a consumption tax
4. Tax wealth properly
5. Introduce a financial-transaction tax

In my view, each of these changes is desirable. Obama didn’t mention any of them and, even if he had, this Congress will never approve a single one, nor can the President issue an executive order to implement them.

Would they narrow the gap between the 1% and the 99%, if he could? Not everyone is convinced they will. The Nobel laureate Robert Solow commented at a seminar on inequality,

“I am very pessimistic about the capacity of the American political system to redistribute income within a reasonable period of time…I simply don’t think that legislation either to support the safety net or to tax high incomes stands a chance in Congress.”

In a word, income disparity between the rich and the poor in this country will continue, perhaps even deepen, until the Democrats or progressives of one ilk or another gain control of both houses of the Congress. But even then, it’s not a sure thing.

The other five of Cassidy’s proposals include:

1. Establish a guaranteed minimum wage
2. Give “ordinary Americans” grants to spend as desired
3. Nationalize the public education system
4. Expand technical education
5. Abolish private schools and legacy admissions to private universities

Like the Cassidy’s tax proposals, these additional five seem rather fanciful given the current political realities in this country. But what I find most remarkable about his post is how rarely we hear about any concrete proposals for narrowing the Great Divide(s) in this country.

Eduardo Porter asks (Times 11/4/2014) “Are we condemned then to largely futile efforts to reduce the widening gap?” He wonders if there are better tools that government redistribution to reduce inequality—education, increasing the minimum wage, reducing tax benefits for corporations and the wealthy. At present we have no data to determine their effectiveness. My hunch is that if we ever do, it will be a long time in coming.

Instead, we hear only one description after another about the growing economic gap between the rich and poor. Some accounts try to explain this, drawing on historical and political trends, as well as social policy comparisons with other nations. But more than anything, we hear the rhetoric.

Tom Perkins is one of the 1%, probably the.01%, one of the founders of a large venture capital firm. When asked recently what should be done to improve the lives of the 99%, he replied:

“I think the solution is less interference, lower taxes, let the rich do what the rich do—which is get richer, and along the way they bring everybody else along with them, when the system is working.”

There you have it, in a single, breathtaking sentence.


Plato at the Googleplex

What makes life worth living? When was the last time you heard this question? When was the last time you thought about it? Perhaps you don’t think it’s a question worth thinking about. Or, that it’s one of those perennial, unanswerable philosophical questions that only philosophers mull over.

Rebecca Goldstein ponders the question a great deal in her new book, Plato at the Googleplex: Why Philosophy Won’t Go Away.

Like Plato, she says that we really have to exert ourselves to make a life worth living. And the way to do so is to pursue philosophy in the way Plato viewed it. That means considering the questions of morality that we are confronted with almost each day—namely, what makes the specific actions and choices we make right or wrong?

The process of reasoning about these questions is distinctly philosophical. Such a life is exhausting, uncommon, and easily ignored. We don’t learn how to do this as young students or even in college unless you take a course in moral philosophy or read some of the Platonic dialogues. And even if you do, its relevance to ordinary life isn’t always clear. Goldstein writes:

The thing about Plato is that he rarely presented himself as giving us the final answers. What he insisted upon was the recalcitrance of the questions in the face of shallow attempts to make them go away. His genius for formulating counter-reductive arguments is at one with the genius that allowed him to raise up the field of philosophy as we know it.

Few people think that a life of reasoning in that distinctly philosophical way constitutes a life worth living. Some, like Nietzsche and Schopenhauer claim there really isn’t anything that does. Others believe that religion is the only place where they find meaning in life. I suppose the majority believe that finding happiness is the true measure of a life worth living. And there are those who believe being generous and charitable to others is the only kind of life worth living.

I know that a person’s answer to this question is a highly individual matter. In my case, when I think back on my long life, I know that I would never had been satisfied had I not been able to live a life of reasoning in the way Goldstein describes Plato’s life. It was a stroke of luck that I enrolled in a course on Plato as a sophomore in college. More than anything it open my eyes for the very first time to the path I wanted to pursue for the rest of my life.

When I think about all this I am always reminded of some remarks of an English historian, Keith Thomas, that he delivered in 2001 on the occasion of Fifth British Academy Lecture:

Finally, the life of learning still has an exemplary morality to offer. Where else, save in other forms of academic inquiry, can we find the same scrupulous concern for truth, the same requirement that all propositions which are not self-evidently true should be documented, the same conviction that getting things right is more important than a quick fix, the same acceptance of the complexity of things and the same refusal to contemplate any dumbing down? And where else is hard-won knowledge freely imparted, without hope of financial recompense? So long as these qualities remain in evidence, those who follow the life of learning have no reason to be ashamed of their calling.



“As much as we hate to admit it, patients are a commodity.”

Not long ago I had occasion to visit a new doctor, as the one I usually saw was out of town. At the time I was experiencing a rather intense back pain. He stood at his computer taking notes on what I was saying, rarely looked at me, did not examine the location of my pain and quickly ordered an MRI.

I was in his office for not much more than 10 minutes and thought I had been treated almost dismissively.

As documented in Sandeep Jauhar’s Doctored: The Disillusionment of an American Physician, the current pressures upon doctors explain why this is not an uncommon experience. The way managed care operates, insurance companies exert enormous control over medical practices. It is the new reality of medicine in this country today.

Insurance companies don’t reimburse doctors a great deal for spending time with patients. But they do for ordering stress tests, MRIs and CT scans (X-rays from several angles). This often leads to unnecessary testing, spending less time with patients and seeing as many as possible.

Are the tests worth the cost? Consider the evidence. The United States ranks 45th in life expectancy, near the last in infant mortality, and “in last place in terms of health care quality, access, and efficiency among major industrialized countries.”

Jauhar laments: How limited our interactions with patients, I thought. We see them for a few minutes, then pen a quick summary and leave directions for the nurses to follow. To whom are we speaking in these inky chart drizzles? Doctors, patients, a phantom lawyer?

Medical lapses and fear of lawsuits from diagnostic error requires doctors to take out medical malpractice insurance. The cost of these policies is prohibitive. Then there is all the paperwork doctors must complete each day. Jauhar writes:

American doctors spend almost an hour on average each day, and $83,000 per year—four times their Canadian counterparts—dealing with the paperwork of insurance companies); fear of lawsuits; runaway malpractice liability premiums; and finally, the loss of professional autonomy that has led many physicians to view themselves as pawns in a battle between insurers and the government

To compensate for his relatively stagnant income Jauhar begins to take on outside jobs. He speaks in behalf of a pharmaceutical company that makes a heart medication he prescribes and moonlights on weekends and evenings reading medically unnecessary cardiac stress and cardiogram tests for a “shady” physician.

The extra money helps to pay the rent for his apartment, schooling for his son, and needs of his pregnant wife. All this takes a toll on his family, to say nothing of Jauhar himself. He notes he was trained to be a caregiver and not a businessman “The constant intrusion of the marketplace has created serious and deepening anxiety in our profession.”

Burnout is an increasingly frequent response to this situation, with approximately a third of physicians surveyed admitting feeling that way, while others are giving up their practice entirely. Jauhar also comments that only 6% of physicians reported “positive moral” in a 2008 survey. In another study, 30 to 40 percent of practicing physicians said they would not choose to enter the medical profession if they were deciding on a career now.

Jauhar doesn’t offer many solutions to these fee-for-service problems. His one suggestion is to hire doctors as employees as they do at the Mayo and Cleveland Clinics. He believes this will take away the financial incentives to overtest.

After reading Doctored, I don’t think I will ever view the relationship I have with my doctor the same way. Is the test he is ordering necessary? Is the medication he is prescribing going to benefit me? Why has he spent so little time with me?

As I look back on some of the tests and medications he has ordered, I view them in a new light. The tests revealed nothing abnormal, the drugs sometimes did more harm than good. I wonder why he ever ordered them in the first place and I am not sure.

When I was a young boy, my doctor always made a house call when I was sick. Today that is almost unheard of. In 1930 40% of all doctor-patient visits were house calls. Today the proportion has dwindled to less that 1%.

Now the encounters I have with my doctor, often take place online or mediated through his nurse and it often takes weeks and sometimes a month to actually arrange an appointment with him.

Jauhar concludes: Most of us went into medicine to help people, not to follow corporate directives or to maximize income. We want to practice medicine the right way, but too many forces today are propelling us away from the bench or the bedside. No one ever goes into medicine to do unnecessary testing. However, this sort of behavior is rampant.


Let's Go to the Movies

Just a Sigh

They glimpse one another on the train. They are traveling from Calais to Paris. He is a literature teacher from England going to a funeral. She is an actress going to audition for an Ibsen play.

Their eyes frequently meet during the trip. As they leave the station, she overhears him asking directions to the Basilica of Ste. Clotilde.

Emmanuele Devos, 39, plays Alix, Gabriel Byrne, 63, plays Douglas. The chemistry between them is vivid and believable. After her audition, with much uncertainly and without much cash, she finds herself going to the church where the funeral is being held. Douglas is one of the mourners.

After the service, they exchange a few awkward words. Thereafter, they stroll through Paris, spend the rest of the day and night getting to know one another. We learn their history, heartbreaks, and fragilities.

It cannot last, they must depart, neither wants to. He asks her to come to England with him. She would like to. But she is pregnant and has a boyfriend in Paris. We sigh, they sigh, “Just a Sigh,” a beautiful film and touching story.

Queen to Play

I first saw Queen to Play (Joueuse) about five years ago. It is a French film about talent, about discovering your talent and how it often occurs by chance. Helene (Sandrine Bonnaire) works as a chambermaid at a posh hotel on the island of Corsica. One day she notices a young couple playing chess on the balcony, flirting with every move. It is a seductive scene that leads Helene to try to revive her marriage by giving her husband a chess set for his birthday.

He has no interest in the game and so Helene begins to teach herself how to play. In the afternoon she also has a part-time job cleaning the home of a Dr. Kroger (Kevin Kline), where she notices a chess set is prominently displayed. She volunteers to clean his home, without pay, if he will give her chess lessons.

They start to play and eventually she begins to beat him. Meanwhile, in her obsession with the game she plays constantly—at home in the middle of the night, at the hotel mopping the black and white tile floors, on a chessboard in her mind’s eye.

Dr. Kroger tells her she has a rare gift for the game, a natural talent that can’t be taught, that a few people have and most don’t. He encourages her to enter a local contest. She hesitates, finally enters, and ends up winning the tournament. The film ends as she is taking the boat from Corsica on her way to Paris to enter the French national championship.

Queen to Play is a charming, amusing fairy tale, thoroughly refreshing in a season of utterly tasteless films.

Wendy and Lucy

She is walking by railroad tracks with her dog. She is Wendy (Michelle Williams), the dog is Lucy and together they are the subjects of the film, Wendy and Lucy. They meet a group of vagabonds who appear to be slightly drunk. They ride the trains once in a while.

Other than that, we know nothing about Wendy except that she is heading in her old Honda to Alaska. She doesn’t have much money, goes into a small market in a small Oregon town, stuffs a doughnut in her pocket and is caught by a young clerk. Taken to the manager’s office, Wendy apologizes, then hauled off to jail for a few days.

Lucy had been tied to a post outside the market and when Wendy is released from jail she returns to find her missing. Her car can’t start. Across the street is a mechanic who tells her what it will cost to fix everything wrong with the car. When it’s completed, she can’t afford to pay for it and walks away from the car.

The rest of the film she searches for Lucy, walking everywhere, visits the pound day after day or calling them. A friendly police officer sees her comings and goings, offers her the use his phone. Eventually the pound calls to tell her where Lucy is.

She walks over to the house, sees Lucy in a fenced yard, they greet each other gleefully, tears begin to roll down Wendy’s face, as she realizes what she must do. She leaves, walks away, and hops aboard an open boxcar on the train passing by.

This is the story of Wendy and Lucy. Nothing more, but Wendy’s expressive face, even if it’s rarely expresses much of anything. The tale is heartbreaking, a film I will never forget.

Wendy hasn’t dropped out of life, but life has given her nothing but grief. She doesn’t have a friend, loses the only thing she loved, doesn’t have a job, doesn’t search for one, all she wants to do is get to Alaska where there is money in the salmon canning factories.

We very much want her to, it’s too late to turn back, but we sense her wish is a pipe dream. Luck rarely comes to the Wendys of the world, Wendys who begin with nothing and spend the rest of their life trying to find just a little something.


Calories on Menus

Perhaps you read earlier this week that late next year the Food and Drug Administration will require calories on menus in many restaurants, movie theaters, convenience stores and amusement parks. The intent is to lead consumers to choose lower calorie items and be a “major weapon” in reducing obesity.

But will it have those effects? The evidence is far from clear. While some research indicates a slight influence, the bulk of the research does not.

One investigator noted: “upper middle-class people making menu-labeling policy often have little insight into how the lower-middle-class people whom the policy was aimed at would use the information. Just getting consumers to understand what the numbers means his hard…the people who most need the information don’t know how to use it.”

Several years ago New York City required fast-food chains to post the caloric content of their items. Simultaneously a study tracked food choices at four fast-food chains—McDonalds, Wendy’s Burger King and Kentucky Friend Chicken—where customers were informed or the calorie content of food items.

The outcome of the study should not be surprising to anyone familiar with the long line of previous field studies of the effects on information on modifying behavior. Research as far back as the energy crisis of the 70s and 80s demonstrated over and over again that posting requests to save energy or informing people of their actual consumption with and without cost feedback did not turn them into energy conservers. Still we continue to rely on information techniques in trying to regulate or change behavior

Evidence from the recent study in New York found that about half the customers noticed the posted calories associated with particular items of food. About a quarter (28%) of those who noticed claimed the information had influenced what they ordered while almost 90% said it had led them to make less caloric choices

But when the investigators analyzed the receipts (during a four week test period), they found that slightly more calories were ordered than the subjects in the control condition where customer choices were measured during a two week baseline period before the law went into effect—a common control condition in field studies.

The research was carried out in what were said to be “poor neighborhoods” where there are high rates of obesity. “One advocate of calorie posting suggested that low-income people were more interested in price than in calories.”

I laughed when I read this knowing full well that while those more financially endowed are probably less concerned about price, they are just as likely as anyone else to ignore the information and let their taste buds govern their choices.

Since information approaches are not costly and can be easily implemented, the more central issue is how to make them more effective. Simply posting information or passing out a leaflet doesn’t guarantee by any means that it will be translated into action. Several suggestions have been made on how to overcome this limitation.

• Vivid and highly concrete information should be employed: Instead of posting caloric values, show a symbol of a clogged artery.

• Take account of the motivation of the target population: If you are working in an area where price is important, offer an incentive, say a free low calorie item for every nine ordered, as many coffee shops do for coffee purchases.

• Emphasize the trustworthiness of the message: Pair the information with respectable physician, hospital of government agency rather than McDonald’s or Burger King

• Personalize the information as much as possible: Instead of posting the caloric information, arrange to have the manager hand out a colorful card with the same information to each patron with a few words of encouragement.


On Evidence and Belief

Maybe you can’t change the world, but at least you can change the way you look at things and how they affect you. Zia Rahman

What do we do when our beliefs conflict with the facts? For example, when our belief in evolution conflicts with our religious convictions? Or when our belief in a free market economy meets head-on the increasing economic inequalities in this country?

Do we stick with the facts and if they are contrary to our beliefs and then modify them? What a dreamer! No, most people tend to discount or reject the evidence in these kinds of situations, especially for deeply held beliefs. Weakly held beliefs may be less resistant to contrary evidence, but given our predilection for selective perception, we are unlikely to know about it.

In the Times (7/5/2014) a while ago, Brendan Nyhan cited evidence from a Pew Research Center study that found 33 percent of the public believes “Humans and other living things have existed in the present form since the beginning of time.” In the same study 26 percent don’t believe there is convincing evidence that the average temperature on earth has been increasing in the past few decades.

Even more striking was his report that individuals are sharply divided along political lines on such issues. “For instance, 46 percent of Republicans said there is no solid evidence for global warming, compared with 11 percent of Democrats.” This suggests that knowing more, being more aware of the evidence tends to increase the polarization between proponents of different belief systems.

So what can be done to bring a person’s beliefs into conformity with the facts? Nylan suggests that we need to break the bond between a person’s political and cultural views and beliefs. That means, for example, dissociating the evidence for global warming from being a conservative or a Republican. Let the facts speak loudest. Understand that you can still be a conservative and believe in global warming. Again, dream on.

Is there any realistic way belief and evidence can be brought into closer agreement? Nothing in the research on changing behavior indicates that any technique, direct or indirect, modest or forceful can do this. Individuals need to find their own reasons for altering a deeply held belief and that will rarely, if ever, come from external influence

But there are times when we change a strong belief or habit. How does that happen? Consider Bertold Brecht’s short story, The Unseemly Old Lady. A respectable seventy-two year old grandmother, who managed a household of five children in a small town in Germany, is suddenly transformed after the death of her husband.

She begins going to the cinema, something she never did before her husband died. Then she starts spending a good deal of time at a nearby cobbler’s workshop located “in a poor and even slightly notorious alley, frequented by all manner of disreputable characters.” During the summer, she would often rise very early, around 3 am, and walk about the deserted streets of the town by herself.

“When you come to think of it, she lived two lives in succession. The first one as daughter, wife and mother; the second simply as Mrs. B, an unattached person without responsibilities and with modest but sufficient means.” Brecht concludes, “She had savoured to the full the long years of servitude and the short years of freedom and consumed the bread of life to the last crumb.”

I view Brecht’s tale as metaphor for how significant changes in belief/behavior can occur quite naturally. They occur after a major change in one’s life, the circumstances in which individuals find themselves.

Her grandmother’s metamorphosis is not an entirely unknown reaction following the death of a spouse. A divorce, job layoff, a personal or spiritual crises, a physical illness, a family inheritance, even a good book, etc. can often set the occasion for striking out on a totally new path.

These are not the kind of conditions that can be induced by an agent of change or, for example, a communication campaign or incentive program. But when they occur naturally, they can exert a powerful effect. They are also relatively infrequent and, as a result, do not often induce a major transformation in one’s life.


Greg Baxter's Novels

There isn’t a great deal to say about The Apartment by Greg Baxter. There isn’t much that happens. The tale takes place in a single day in an unnamed city, during a month of snow and extreme cold. The unnamed American narrator has come there to live for reasons that are somewhat puzzling. “They asked me why I’d come and I said, I didn’t know”

In a museum he meets a woman, Saskia, and together they spend much of the day searching for an apartment for the American. They walk everywhere, sometimes take a bus or subway, meet a friend occasionally, and spend a fair amount of time talking. They speak of Dante, Mozart, artists and writers.

Their relationship for now is a platonic one. We have fallen into a swift intimacy of pure circumstance…Our relationship probably could not bear any conflict at all. The force that stabilizes the intimacy is politeness.

It takes them forever to reach the apartment Saskia has found for him, they wander in and out of cafes, department stores, coffee shops, all the while the unnamed narrator is recalling his days in Iraq, first in the military, then as an independent contractor. We get a hint of the terrible scenes he has witnessed and those he has committed or in which he was implicated.

One might wonder if he has come to this bitterly cold, unknown city to expiate the bloody crimes of that war. It has led him to a hatred of America and all that it stands for and, in turn, a hatred of himself for the crimes he committed while there.

The narrator says it is “the eve of a life that I hoped would represent the entombment of the violence I have witnessed or imposed upon the world.”

Eventually he finds an apartment he likes and continues his wanderings about the city, sometimes alone, sometimes with Saskia, but always ruminating about his past, himself, and a world in which violence is everywhere. And then the novel ends, the same way it begins, without a clear idea about where it is headed or why.

I hate myself today; I hate the whole human race. I am coursing with rage at the thought of every man and woman alive. Greg Baxter

I read Greg Baxter’s A Preparation for Death on the basis of his first novel, The Apartment. Don’t ask me why. This book appears to be a memoir of a few years of Baxter’s life. He moves to Dublin from Texas, then to Vienna, and returns to Texas from time to time to visit his mother. Throughout he wallows in his own misery.

He meets one woman after another, has sex with all of them, wild sex described in detail and ad nauseaum, spends sleepless days and nights drinking. He teaches writing to students he cares little about, tries to write with results that appall him. He is ambivalent about every thought and experience.

I am never content, but I approach contentment through longing, through disappointment.” “…life was meaningless without impact. I believed that I could alter society. How pathetic that seems to me now.” “Sometimes when I remember the unhappiness I felt at twenty-five, I can’t imagine why I didn’t kill myself. I sensed that I was an outcast everywhere. My characters were all exiles, and I hated them.”

On and on this way. The novel is little more than reveling in despair and venom, while worshiping both.

What can I say? I’m a reader. I read novels. Some are better than others. Some days are better than others. That’s life.


Does it Matter?

In the film 1,000 Times Goodnight a war photographer is dedicated to carrying her cameras into the heart of ongoing war zones. In E-Team, a Neflix produced film, a group of emergency investigators for Human Rights Watch report on their visits to warn-torn battlefields of Syria and Libya.

In both films there are scenes of total destruction, weeping survivors, unexpected onslaughts of bombing attacks or marauding warriors. Photographers take their pictures, investigators write their reports.

I ask what does it all matter? Do the photographs affect anyone? Do the reports decrease the frequency of human rights violations? Where is the evidence that either have any influence? Wars continue. Human rights violations continue. Whistleblowers come forward. Nothing seems to change.

The courageous chroniclers return to their glamorous homes, devoted husbands and children. Then they head out again to the war zones. Are these people heroic communicators or danger addicts? Do they even measure the impact of their work?

Or are they under no illusions about the difference they make? Perhaps they view their task as making public what the perpetrators seek to keep secret. They judge their work in terms of newspaper reports, blog hits, tweets, and minutes on the nightly news.

I am continually asking the same questions of others form of communication—television, newspapers, literature. Consider the influence of reading literature on an individuals beliefs or behavior?

Perhaps reading a book or set of them might change the behavior of some individuals, but for others, perhaps the majority of readers, it has little or no effect. Even some writers lament how little influence their work has. Within a day or two of each other, I read the following confessions:

“Although I’ve spent much of my life writing and speaking in opposition to the corrupting influence of money on medicine, I find doing so increasingly pointless because it seems futile.” Marcia Angell

“[Barbara] Garson has similar doubt about the value of her work. Talking in a restaurant booth with Alice Epps, who is bravely fighting foreclosure, she suddenly gets up, goes around to sit down beside the woman, and begins to cry, because my books never do anyone any good.”

A while ago, this issue became the question of the moment on the Web. It was initiated by Susan Elderkin and Ella Berthoud’s new book, The Novel Cure. They write about how reading novels can overcome a variety of mental ills, suggesting novels for depression, anorexia, bulimia, obsessive-compulsive disorders, etc.

The novels they recommend are designed for adolescents, the middle-and-old age. Elderkin and Berthoud are widely read, the novels they discuss are among the best and most well known. However, they don’t provide any evidence for the effectiveness of reading them.

Not long after The Novel Cure was published, the results two studies one in the US and the other in the Netherlands provided some relevant data. The methodology in both studies was roughly the same. The results indicated that individuals who were asked to read from literary works of fiction (Chekhov, Munro, DeLillo etc) for only three to five minutes scored higher on measures of empathy than those who were asked to read “popular fiction” or nonfiction books.

The authors suggest that reading fiction exposes us to the perspective and emotions of individuals who may be quite different from ourselves, at least for a short period. This leaves open the duration of this effect or how a longer reading period, including a lifetime of reading literary fiction influences empathy.

But I do know that reading literary fiction or an appreciation of the arts in general does not guarantee a strong sense of empathy. One only need look to wartime Europe for evidence that well educated individuals who appreciate Beethoven or Goethe can be entirely indifferent to the suffering of others.


Executive Salaries

Last year the Times published a table showing the 2012 pay of the chief executives of public corporations with revenues of at least one billion. It is fascinating and depressing.

The median compensation, including salary, bonuses and other perks was $14 million. You are reading that correctly, $14,000,000 last year. Of course, many CEOs received much more. At some of these corporations those who were not the chief executive also received more.

Larry Ellison the CEO of Oracle was the highest paid: $78.4 million, more than six times the median. What has he done to justify this shocking sum? Has he done that much more than the workers who produce or design his products?

CEO total compensation for last year was about 3% higher than it was the year before. Base pay increased by 16% over the previous year. Did your salary increase by that amount?

Consider what 3% means on a meager $1 million: $30,000. It is $420,000 for the median CEO compensation. Are you earning that much more this year? Why not? As George Packer writes on the New Yorker website, There must be a social or economic theory somewhere that explains why all this is necessary and just. The well-informed Packer doesn’t know what it is. I sure don’t either. I wonder if Ellison or the top paid CEOs do?

The chief executive of JPMorgan Chase, Jamie Dimon, was awarded $20 million in compensation for 2013. That’s a $20,000,000 bonus for a year in which the company was assessed stiff ($13 billion) penalties for what is referred to as “soured mortgage securities.” And, mind you, that’s in addition to his yearly salary of $1.5 million.

It is said that it is the innovators, the creative types, the job creators who deserve to earn the most. But what about all those hedge fund managers who rake in those multimillion dollar salaries year after year? The 25 highest paid hedge fund managers took in a total of $21.15 billion in 2013 according to Institutional Investors. And that was a year in which most hedge funds fell short of market returns.

David Tepper, the founder of Appalossa Management earned $3.5 billion last year. Hard to believe, isn’t it? According to Paul Krugman (Times 5/8/14) “Last year, those 25 hedge fund managers made more than twice as much as all the kindergarten teachers in America combined.”

They don’t create jobs or useful innovations. They are in the business of financial investment, of increasing the wealth of the already rich shareholders, including themselves, of course.

So why is the American worker, indeed, the general public, so passive in the face of these enormous instances of financial inequality? Where are the groups that are expressing outrage or seeking legislative remedies? Sure, the chances for any change are close to zero. But that is often true of most large-scale protest movements.

Perhaps Americans don’t fully appreciate the magnitude of the enormous gap between the rich, including the very rich, and the poor. If they did, maybe there would be less silence and more outrage. To find out Michael Norton and Dan Ariely undertook a study (Perspectives on Psychological Science, 6, 2011) of popular beliefs and the distribution of wealth in this country.

They asked a nationally representative sample of 5,222 individuals, equally divided between males and females, to estimate the current distribution of wealth in the US and then their ideal level of inequality. Before beginning the survey they asked each person to read the following definition of wealth:

“Wealth, also known as net worth, is defined as the total value of everything someone owns minus any debt that he or she owes. A person’s net worth includes his or her bank account savings plus the value of other things such as property, stocks, bonds, art, collections, etc., minus the value of things like loans and mortgages.”

The individuals in the study vastly underestimated the actual level of wealth believing that the wealthiest “quintile” held 59% of the wealth when the actual number is closer to 84%. It may very well be that this widely divergent perception from reality accounts for the lack of widespread public objections to the large and growing economic inequalities in this country.

Norton and Ariey also asked their subjects to state their ideal distribution of wealth in the US. They found a slight preference for some inequality, rather than perfect equality, but by no means close the degree currently present in the US.

When given examples of the distributions in other countries, they expressed a preference for the distribution that most closely resembled Sweden’s, where the top wealth quintile holds 36% of that countries wealth and the lowest 11%.

Finally, Norton and Ariely noted there was a considerable, and to them surprising, consensus among different demographic groups in this country--gender, income level, voting history, etc. in both their estimates of actual and ideal wealth distribution in this country.

These findings were recently confirmed (Perspectives on Psychological Science, Vol. 9, 2014) in data from 16 countries that revealed that people dramatically underestimate actual pay inequality. This was also true regardless of demographic group and political beliefs.

The study also reported that underestimation was particularly pronounced in the US. The actual pay ratio of CEOs to unskilled workers (354:1) far exceeded the estimated ratio (30:1), which in turn exceeded the ideal ratio (7:1).


Rachel Cusk's Outline

I found Part IV, the final section of Rachel Cusk’s serialized novel the least interesting of the four published in the Paris Review. There is scarcely any word from the unknown narrator who, when she does speak, sounds in many ways like the very Rachel Cusk herself.

You may remember in the first installment, an English writer travels to Greece in the summer to teach a month-long writing course. Seated next to her on the flight is an older Greek man who describes the failure of his two marriages and other family misfortunes. He invites her to take a boating excursion with him the next day.

Part II begins as they drive to a small boat harbor outside Athens. They continue their dialogue that, at times, is both amusing and stimulating. She swims far out to sea, all the while ruminating.

She notes that people can never change completely. Rather she believes whatever changes occur are latent, “had lain dormant, waiting to be evoked by circumstance.”

In the evening, after their boating trip, they meet for dinner in Athens with another writer. The talk is lively, serious, interesting. They talk about the meaning of the self, a person’s identity. And Cusk has the narrator say to my delight: “I thought the whole idea of a “real” self might be illusory: you might feel, in other words, as though there were some separate, autonomous self with you, but perhaps that self didn’t actually exist.”

In the third segment of, Outline, Cusk writes about how often we are deceived in judging another person on the basis of their appearance. Knowing about the pitfalls of this bias does not prevent us from succumbing to it. But perhaps Cusk’s descriptions will keep us from falling prey to it as often as we usually do. It isn’t easy, except perhaps by ignoring physical appearance completely or learning to pause for a moment or two before you judge another person.

She also dwells at length on how individuals react to the same experience quite differently. Each person views the experience in the light of their own history and because each person’s history is unique, they are bound to attach a different meaning to the same experience. She describes the reactions of a woman, who had hoped to become a professional musician, as she was passing by an open window and recognized a piece of music she had always loved.

And instead of appreciating the beauty of the Bach piece, she felt an extraordinary sense of loss. The music she once loved no longer belonged to her and instead was possessed by someone else or so she felt.

Cusk gives generalities like this a life, she places them in concrete situations, situations that we may find ourselves experiencing. By doing this, I think she makes them far more memorable, with much greater impact than reading about a research study of the same phenomena.

Part IV opens with the students in her class commenting on an assignment she had given them. Each student speaks about how difficult it was to follow the teacher’s instructions to place an animal in his or her story. And as they do so, we come to learn about the emotional life of the student’s life.

The account shifts to a story told by the fellow writer who has come to replace the narrator at the end of her one-month teaching stint. Her replacement describes what her neighbor said on the plane flying to Athens. Again, Cusk resorts to the unknown person sitting next to someone on a flight to engage in a dialogue on a serious issue

As he unfolded his story, the replacement realizes he was describing what she herself was not: in everything he said about himself, she found in her own nature a corresponding negative…Yet this shape, even while its content remained unknown gave her, for the first time since the incident [rape] a sense of who she was now.

While the novel is difficult to summarize, certain themes seem to be evident in the encounters the narrator has with the people she meets – marriage and separation, the ties of parenthood, the struggles of reconciling them with one's identity and freedom. Each one of them draws upon Cusk’s personal experiences as reflected in her most recent novels.

The complete version of Outline will be published in this country on January 13, 2015. It was nominated for this year’s Goldsmith Prize which is designed “to reward a book that is deemed genuinely novel and which embodies the spirit of invention that characterizes the genre at its best”


Old Masters

The Times recently published portraits of what they called Old Masters. It was drawn from an essay that Lewis Lapham wrote for Lapham’s Quarterly. The fifteen portraits are of men and women in their 80s and 90s with substantial and well-known careers. They were each asked five or six questions about how being old affected their work.

Virtually all reported that they were still doing pretty much the same things they always did. While they continued to learn from their experience, they were still working in the same area they started out in.

For example, the filmmaker Frederick Wiseman, 84, said: I think I’ve learned more about how to make a movie. [but] The basic approach hasn’t changed.

T. Bone Pickens, 86, the American financier and business magnate, more or less summed up the view of all of the Old Masters. “I don’t consider myself to be old. I just go to work like I did 10, 20, 30, 40 years ago. I work the same hours. I haven’t semiretired or slowed down.”

Many reported they stayed in shape and tried to keep fit. Tony Bennett, now 88, plays tennis, Ginette Bedard, 81, long-distance runner keeps running marathons (“I’m going to do this until destiny takes me away.”), T. Bonnes Pickens has a personal trainer, and Supreme Court Judge, Ruth Bader Ginsburg, 81, works out at the gym each day.

The actor Christopher Plummer, 84, also said it’s important to stay in shape but added, “And so is doing the work. It uplifts you. The idea that you’re doing what you love. It’s very important.”

At the same time, it is sad that so many people who are not especially happy with their job can’t wait to retire. And when they do, they have no idea what to do… “They sit and home and watch television. And that is death.”

The Old Masters never retire, they keep doing what they’ve always done. Plummer said he would simply like to drop dead on the stage. “That would be a nice theatrical way to go.”

For most of these individuals, it hardly seemed to matter how old they are. No one reported about their aches and pains, they didn’t feel any different, and that age isn’t so much chronological as your way of being. They are the fortunate ones.

Aging varies so much among individuals. I suspect most people in their 80s and 90s do begin to feel their age, in all the ways we hear about these days. Perhaps the Old Masters devotion to their work kept the inevitable effects of old age at bay. As Hemingway once wrote, “Isn’t it pretty to think so.”


Reading Diaries and Letters

The daily practice, compulsory or near compulsory, of setting down one’s ideas and the day’s events in a diary allows a virtual autodidact like myself to learn how to reflect, how to exercise the memory by focusing deliberately rather than randomly on images.... Robert Bolano The Third Reich, Part I

I am not one for reading personal diaries or letters. Both seem disjointed, without a central theme or story line. If you are a biographer, they may provide essential information. Or if you like to know about a well-known person, you might find them interesting.

However, diaries do provide a personal view of the past, a view that is often representative of a wide segment of the population. They may also document more general trends in a country at the time they were written. And a great many diaries and letters have been best sellers for many years.

Clearly, I am in the minority on the pleasure of reading such collections.

Yes, the letters and diaries of writers and historical figures interest a great many people—Ann Frank, Virginia Woolf, David Foster Wallace, Hemingway, Fitzgerald, Bellow, Orwell, Jefferson, John Quincy Adams, Washington, Lincoln, etc. etc.

But what about the rest of us, the life of ordinary people? So many have of us have set down our life stories on paper. What is to become of these accounts?

Of course, you can publish them yourself or through the services of self-publishing companies.

The Life Writing Connection (LWC) is an alternative that publishes the journals, diaries, letters, and memoirs written by 20th century Americans. Its goal is to publish online the writings of individuals that might otherwise remain unknown or more likely lost or destroyed. However, not many individuals have submitted their writings to the LWC.

A somewhat similar archive, National Diary Archive but not restricted to the 20th Century, has been far more successful in Italy. To date, 7000 journals and letters of ordinary Italians have been added to the Archive.

The city of Pieve Santo Stefano, a small town in Tuscany, has become the repository for these letters and diaries. It may have started there because a resident of the town offered a prize (1000 Euros or $1,332) for the most “compelling” submission. Anyone can compete for the prize that is given each year. Winner or not, all entries become a part of the archive.

According to the Times (8/19/14), “Some were brought here by their authors, who range from frustrated homemakers to unrepentant bank robbers; other by heirs of the diarists. Yet others were found in attics or at flea markets, then turned in because their story struck a chord with their readers. The earliest diaries date to the 18th century, but most from the 20th century.”

Would such an archive be successful in this country with success measured in terms of number of submissions and how often they are read? First there is the matter of funding the archive, then marketing it and publicizing it widely. Perhaps an annual prize would also promote submissions, as well as an easily accessible website.

As long as the submission process is not complicated, I have every reason to believe that a US National Diary Archive would be equally popular in this country. Countless individuals keep a journal or diary and some even write letters. As long as they have no desire to keep them private, they may be quite willing to post them on the Archive.

Who knows, there is always a chance of winning that prize.


Booklover's Dream

One night recently I went down to the university library in Portland hoping to find some recent journal articles that I couldn’t locate on the Web. I arrived about 7 pm. The place seemed empty.

I went down to the basement to locate the first journal. I had been misinformed. The library didn't have it. Most of the lights were out. It seemed very dark. I thought there had been a power outage or an electrical problem.

I hiked up to the fifth floor to find the next journal. The volume I wanted was missing. The lights were out up there, as well. Down to the second floor for the last one. It wasn't on the shelf either. But I found another with an interesting report.

Down to the first floor to copy it. No. The copy room was closed. Eventually I realized that the entire library was closed. It had been closed all the while I was there.

They were about to lock up the place, so I managed to get out. Yet, how delightful, I thought, to be locked up in the library with all those books and journals all night.

I was reminded of all this by a recent report about a US tourist who was locked inside a Waterstones bookstore in London one night. While that also sounds like a lark, it didn’t seem that way to the American tourist.

Unlike my experience, he had his digital arsenal with him and began tweeting his dilemma on Twitter. A little after 10, he posted a photo of the shuttered door, along with a message that he was trapped inside. He wrote:

“This is me locked inside a Waterstones bookstore in London. I was upstairs for 15 minutes and came down to all the outs out and door locked. Been here over an hour now.”

At about 11 he tweeted another message that he had not been released. It was after midnight that he wrote that he had finally been released. This was confirmed on Waterstones Twitter feed.

Being locked in a library or bookstore for a night might seem like a booklover's dream, assuming of course that was enough light to read and soft carpet to sleep. I don’t know how you feel about it, but I think it would be a lot of fun.

Apparently so did many others who had tweeted that the US tourist’s situation was a dream, with one saying, “I would kill to be locked up in a bookstore.” Waterstones decided to capitalize on the clamor by organizing a sleepover at its Piccadilly store. From hundreds of applicants, they chose 19 “guests” to spend the night locked up in the bookstore.

Most planned to browse, read and eventually get some sleep. The Guardian (10/25/14) reported: “…the lights were dimmed. It was time to do what they all came here for. Books were read, chess was played, tweets were sent and quiet conversations had until the early hours.”


Being Mortal

Over and over, we in medicine inflict deep gouges at the end of people’s lives and then stand oblivious to the harm done. Atul Gawande

We may fear it, deny it, or avoid thinking about it, but in time it will come to all of us. No matter how alive we feel now, eventually we will come to the end of the line. What kind of ending do we hope for?

Unless you carefully express yourself on the matter, it is likely you will end up in a hospital hooked up to a collection of tubes and monitoring machines. Is that what you want? Medicine’s focus is on prolonging your life, repairing the breakdown of your bodies, using its technical arsenal to extend your life.

In Being Mortal: Medicine and What Matters in the End, Atul Gawande, says this approach has failed. It has failed because it neglects the quality of life at its endpoint.

We are living longer, healthier lives but our body eventually breaks down. Medicine’s model is to fix the broken parts, usually by hospitalizing you, where you are stripped of control of your life and subject to treatments that more often than not only increase your pain.

The story begins with the breakdown of teeth, bone density declines, lung capacity decreases, the brain shrinks, working memory and judgment are impaired. Old age is a continuous series of losses. Eventually these losses accumulate to the point where daily life becomes more than we can physically or mentally manage on our own.

This was not a problem when individuals lived in a multigenerational home where one or more of their children could assist them. In contemporary society this type of household is rare. Very few of individuals in their 70s or 80s live with their children, in fact, most live completely alone.

“There remains one problem with this way of living. Our reverence for independence takes no account of the reality of what happens in life: sooner or later, independence will become impossible. Serious illness or infirmity will strike. It is as inevitable as sunset.”

The consequence is that doctors try to extend life for as long as possible, dosing people with mind-numbing drugs, shocking their hearts back in action, delivering painful chemotherapy with unknown effects. He cites data that 25 percent of all Medicare spending is for the five percent of patients who are in their last year of life and that most of that money goes for care in the last couple of months that is of little apparent benefit.

Gawande reports that medical interventions for people in this stage of life cause more harm and suffering that doing nothing. “…terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions or admitted near death to intensive care had substantially worse quality of life in their last week that those who received no such interventions.”

Being Mortal describes several alternatives to medical treatment at the end of life. Gawande considers nursing homes, most of which have a checkered history and explores the benefits and drawbacks of assisted living centers, hospice and palliative care. There are enormous variations in the quality of care in each of these settings.

He asks readers to discuss the type of life they want at its end with their doctor. Is there anything that makes this stage of life worthwhile? Each of us probably has our own answer. Many want to be at home, others with their family. He describes one program that brought children, plants, and various animals into a senior housing setting. Compared to the period before this intervention, the director reported that drug costs fell by 38 percent and deaths declined by 15 percent.

Most people fail to discuss their end of life care with their physician, leaving them at the mercy of hospital treatment. In the event that happens, it is important to make clear your answers to four crucial questions:

1. Do you want to be resuscitated if your heart stops?
2. Do you want aggressive treatments such as intubation and mechanical ventilation?
3. Do you want antibiotics?
4. Do you want tube or intravenous feeding if you can’t eat on your own?

Ideally you should also give you doctor a notarized Advance Directive Form that is legally binding in your state.

Toward the end of Being Mortal, Gawande briefly discusses euthanasia. He critiques the end-of-life policy in the Netherlands in the belief that as a doctor “our ultimate goal is not a good death but a good life to the very end.”

The book is liberally sprinkled with case histories that document Gawande’s central themes.

“I never expected that among the most meaningful experiences I’d have as a doctor—and, really, as a human being-would come from helping others deal with what medicine cannot do as well as what it can…When to shift from pushing against limits to making the best of them is not often readily apparent. But it is clear there are times when the cost of pushing exceeds it value.”

Being Mortal is a difficult book to read, some will find it irrelevant to their life, others will find it quite timely. Most likely it depends on your age. But its difficulty is more than outweighed by the quality of Gawande’s writing and his honesty in discussing mortality.