Medicine and Literature

John Updike once wrote, “Life is a very strange thing, in a way, compared to life in a novel. People in novels rather rarely eat; their health is not often of concern to them; earning money isn’t nearly as important to them as it is to those of us in the real world.”

Virginia Woolf also expresses this view in her well-known essay “Short of Breath” that has been reprinted as a slim volume On Being Ill. It begins with a memorable paragraph.

“Considering how common illness is, how tremendous, the spiritual change that is brings, how astonishing, when the lights of health go down, the undiscovered countries that are then disclosed, what wastes and deserts of the soul a slight attack of influenza brings to view, what precipices and lawns sprinkled with bright flowers a little rise of temperature reveals, …when we think of this, as we are so frequently forced to think of it, it becomes strange indeed, that illness has not taken its place with love and battle and jealousy among the prime themes of literature.”

Even though she spent most of her life battling depression and debilitating physical symptoms, she never wrote about them. She wonders why illness has not been as popular a subject for literature as love. Why has the “daily drama of the body” not been recognized by writers?

She admits it might simply be due to the poverty of language. “English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver and the headache.” Her essay was written in 1926; in the eighty-four years since then, much has changed.

Late last year the first Wellcome Trust book prize was awarded for “outstanding works of fiction and non-fiction on the theme of health, illness or medicine.” The winning book was Keeper, Andrea Gillies memoir of caring for a relative with Alzheimer’s that apparently had not been publically reviewed. In writing about this award Chris Powers discusses other works of literature that treat medical themes.

He discusses Ken Kesey’s One Flew Over the Cuckoo’s Nest and Thomas Mann’s The Magic Mountain, Oliver Sacks The Man Who Mistook His Wife for a Hat, and Ian McEwan’s Saturday. He mentions writers who were trained as doctors—Chekhov, William Carlos Williams, Somerset Maugham, Walker Percy, a topic about which I have previously blogged.

I think of books I’ve read about individuals with Alzheimer’s, a topic that is being written about with increasing frequency these days. There is Still Alice by Lisa Genova a novel that describes the experience from the point of view of an individual diagnosed with early onset Alzheimer’s. Much earlier there was Elegy for Iris, John Bayley’s moving account his wife, Iris Murdock’s, descent into Alzheimer’s.

…Iris’s inability to summon the words she seemed to want. Her delivery had always been slow and thoughtful and a little hesitant, and at first I was not perturbed, sure that she would recover in a few minutes, when she got the feel of the gather. It was hard to say how conscious she was of her own difficulty, but the effect soon became paralyzing, for the listener as well as for her.

Alzheimer’s is, in fact, like an insidious fog, barely noticeable until everything around has disappeared. After that, it is no longer possible to believe that a world outside fog exists. First, we saw our own friendly, harassed GP, who asked Iris who the prime minister was. She had no idea but said to him with a smile that it surely didn’t matter.

More and more fiction and non-fiction books are being written about old age and the infirmities of growing old. I think of Jean-Dominique Bauby’s The Diving Bell and the Butterfly, a memoir that documents the author’s struggle to cope with the effects of a massive stroke that left him totally paralyzed with the exception of his left eye-lid that allowed him to communicate. I think David Rieff’s Swimming in a Sea of Death about his mother, Susan Sontag that portrays her persistent, but always painful, struggles to overcome three bouts of cancer. And then there are two recent works of Philip Roth, Everyman and Exist Ghost that depict in agonizing detail the “massacre” that is old age.

It is clearly no longer correct to say, as Virginia Woolf and John Updike did, that literature has ignored illness and matters of health. To the contrary, it now appears we are being inundated with more and more volumes of literary works that treat these issues in considerable detail. I sense we have only seen the beginning.

Econ 101

The Nobel Prize winning economist Paul Krugman is growing increasingly pessimistic about the chances for recovery from the current recession. In her March 1st New Yorker profile Larissa MacFarquhar states that Krugman “pulled out of the stock market ten years ago never went back.”

Krugman believes that stocks at their current price earnings ratios are currently overpriced. “They were a good deal when the average price earnings ratio …was thirteen or fourteen, but now, except at the very bottoms of recent swings, its been over twenty.”

The stock market is a fairly reliable, although imperfect, predictor of future economic conditions. So any investor might want to take his views seriously. The same holds for anyone planning a major expenditure based on their current financial condition or that of the economy.

Should I buy a house now? Will interests rates continue to be so low? Are we about to see another bust in the housing market? Krugman also believes that being a highly developed industrial country is no guarantee against the forces that give rise to major economic downturns. “Finland and Sweden…suffered slumps as long as Indonesia’s.” So did Japan the long recession of the 90s.

Yet he is the first to admit he doesn’t always get it right. “The extent of corporate fraud, the financial malfeasance, the sheer viciousness of the political scene—those are all things that, ten years ago, I didn’t see.”

As Krugman has noted over and over again in his column in the New York Times, the Obama administration bailout plan does not go far enough. He believes much more needs to be injected into the economy to produce a sustained, stable return to better economic times and avoid a much more serious recession with the potential to develop into major depression-like crisis. (Reflecting an increasingly heard concern, David Leonhardt, in yesterday’s Times, asks, “Could the economy be at risk of a double-dip?)

Krugman is a busy man. He writes for the Times, teaches at Princeton, has conducted several landmark research studies, and written a good many books, and in collaboration with his wife, Robin Wells, also an economist, an introductory economic textbook.

Krugman also faults Obama for not being as forceful in moving forward on his agenda, particularly on health care. (Perhaps he would think otherwise in light of Obama’s latest proposals.) He believes given the current political makeup of Congress, it is hopeless to expect there will ever be any consensus on the difficult issues that the nation confronts today. Anyone who expects he can “…achieve real change without bitter confrontation is living in a fantasy world.”

It has been many years since he has been able to do the kind of serious research that led to his Nobel Prize. Yet he worries that “I guess doing the really creative academic work does require a state of mind that’s hard to maintain throughout your whole life. When I was younger, when I figured something out there was this sense of the heavens parting and the choirs singing that I don’t get now. And that’s life.”

The increase in financial inequality in the US is one of the problems Krugman would like to look more deeply into now. “…he believes that the increase in inequality in the U.S. since the sixties is a product less of economic factors—the development of technology, say, leading to the greater importance of skills and education—than of political decisions about taxation and unions.”

He is also interested in problems associated with economic geography, why for instance “…were cars produced in Detroit, carpets in Dalton, Georgia, jewelry in Providence, and chips in Silicon Valley.” Chance, history, geography, or something else?

MacFarquhar concludes her profile with a sentence that I think would characterize most, if not all scholars who devote themselves to a life of research and study. “If there is a sadness in him at all, I think it is a tiny core of profound sadness of the kind that the Buddha understood—that we probably can’t use human rationality to make the world all better and it would be really nice if we were able to.”

A Cento

A cento is a form of writing that is created from the works of other writers. It can be a poem, series of statements, an interview and, in principle, a book-length volume. The word cento is based on the Latin word for patches, as in a patchwork quilt or collage.

In its purest form it consists entirely of lines from other works of literature. I first encountered the term in doing research on commonplace books that are also a remix of quotations from other books, periodicals, poems, speeches, etc. It is said that early examples of centos can be found in the works of Homer and Virgil and other writings from antiquity.

The staff of the American Academy of American Poets has composed the following cento composed of lines written by Charles Wright, Marie Ponsot, Emily Dickinson, Sylvia Plath, and Samuel Beckett:

"In the Kingdom of the Past, the Brown-Eyed Man is King
Brute. Spy. I trusted you. Now you reel & brawl.
After great pain, a formal feeling comes--
A vulturous boredom pinned me in this tree
Day after day, I become of less use to myself,
The hours after you are gone are so leaden."

Does that make any sense? I suppose about as much as many contemporary works of poetry. Patrick Kurp once wrote a cento on his blog Anecdotal Evidence, “A Noble Part of the Joy of Life,” in the form of a Q and A about the relationship between life and literature. I found it quite amusing.

In its less pure forms the cento has recently become an extremely controversial subject. The issue concerns the extent to which it is legitimate for a writer to use the work of other writers in their own work. It ranges on the one hand from outright plagiarism, to occasional appropriation from other sources, both acknowledged and unacknowledged, to a subtle blending of quotations into a larger body of writing.

Consider the following examples: David Shields has written a novel, Reality Hunger, that presents a collage of ideas and quotations deliberately drawn from other writers that according to one reviewer “casts new light on ideas of ownership, appropriation, and reality.”

Helene Hegermann, a teenage German novelist, is embroiled in a controversy over her novel about the Berlin club scene that she admits incorporates a fair amount of writing from another novelist’s work. She says it was her plan all along to incorporate passages from other books in her own work. “There’s no such thing as originality anyway, just authenticity,” she said.

Andre Aciman acknowledges he has done a little bit of remixing in his recent novel, Eight White Nights. In a letter responding to a brief review in The New Yorker, Aciman admits that, “…quotations frequently crop up in my novel whenever the narrator tries to grasp what is happening to him. Because this is more or less standard procedure in my novel, I wouldn’t want knowledgeable readers of your magazine to be under any misguided impressions about my work when they pick up snatches s from William Wordsworth, Paul Verlaine, Matthew Arnold, William Butler Yeats, James Joyce, or Stevie Smith.”

However, it is unclear from Aciman’s letter if these passages are acknowledged or not, whereas in Shield’s novel, the quotations from other works are apparently cited in a detailed Appendix.

Isn’t this remixing much like the commonplace books of antiquity where individuals collected the notable writings of others into a manuscript that they could use in their own speeches, writings, and instruction? Indeed, isn’t this collage-like practice also necessary for investigators in any discipline that builds upon the work of previous writers and researchers and draws upon it in guiding their own inquires, as well as supporting its findings? Quoting Isaac Newton, “If I have seen further it is only by standing on the shoulders of giants.”

Try writing a cento sometime. It is a bit like playing Scrabble, only instead of letters, a sentence or series of short passages from other authors are combined to create a poem or paragraph(s) of your own. It isn’t exactly the easiest thing to do and I am confident it isn’t going to replace Scrabble as the board game of choice for the linguistically nimble.

On Depression

Could depression be an adaptive response to painful life stressors? You might wonder how anyone might think anything as unpleasant could be the least bit adaptive. However, if you think the question makes little sense, consider the fact that 1 in 18 or 14.4 million people in USA are estimated to become seriously depressed during their life.

What possible function could such distress or even mild suffering have? This is the question Jonah Lehrer considers in his article “Depression’s Upside” in this week’s New York Times Magazine. The question emerges within an evolutionary psychology framework that tries to account for human thought and action in terms of natural selection processes.

Darwin himself suffered from periodic bouts of depression that he came to believe allowed him to focus on his work. Lehrer quotes Darwin: “Work is the only thing which makes life endurable to me.” And later sadness “…leads an animal to pursue that course of action which is most beneficial.” “The darkness was a kind of light.”

The light it might shed has been taken up by a psychiatrist, Paul Andrews and an evolutionary psychologist, J. Thomson in their controversial paper “The bright side of being blue: Depression as an adaptation for analyzing complex problems.” According to Lehrer they began by focusing on rumination, one of the dominant thought processes of a depressed person. They wondered what purpose rumination might serve.

Andrews and Thomson claim there are real benefits to be derived from ruminative thinking even though it occurs while a person is suffering. They are the insights gained in thinking analytically about their depression. They call their view the “Analytic Rumination Hypothesis.

“The analytical rumination (AR) hypothesis proposes that depression is an adaptation that evolved as a response to complex problems and whose function is to minimize disruption of rumination and sustain analysis of complex problems.”

Andrews and Thomson respond to the many critics of their view by admitting depression cannot be so easily encapsulated into a single formulation, that it is a highly variable phenomena that takes many forms, often without any discernable benefits and that it has numerous alternative theoretical accounts. “To say that depression can be useful doesn’t mean it’s always going to be useful.”

I am sympathetic to Thomson’s view of the critical test for the AR Hypothesis, namely, “Do these ideas help me in my practice?” To find out he began cutting back on anti-depressive medications in the belief that they were actually making it harder for individuals to resolve their dilemmas. He relates the response of one patient who, when asked if her anti-depressants were working, said, “Yes their working great. I feel much better. But I’m still married to the same alcoholic son of a bitch. It’s just now he’s tolerable.”

Lehrer proceeds to discuss the mounting evidence that anti-depressants do not lead to lasting improvement and that the relapse rates for those on them is as high as 76 percent, whereas for those receiving the increasingly popular cognitive therapy it is 36 percent. In addition, he discusses recent research on the effects of negative moods (a sad video, gray/rainy days, negative performance feedback, etc.) that often lead to better decision-making and improved writing.

In one study he showed that unhappy writers write better than happy ones. This is consistent with the large body of research assembled by Kay Redfield Jamison in Touched with Fire that creative achievement in the arts is often associated with depression or manic-depressive illness.

The relationship between depression and improved writing skills seems like a paradoxical quirk of evolution. In an experiment he conducted on abstract-reasoning Andrews found that, “Depressed affect made people think better.” At least it did for some depressed individuals. A seriously ill depressed psychotic is clearly not going to think better or show any benefit from ruminating about their misery.

Lehrer concludes, “The challenge, of course, is persuading people to accept their misery, to embrace the tonic of despair. To say that depression has a purpose or that sadness makes us smarter says nothing about its awfulness….even if our pain is useful, the urge to escape from the pain remains the most powerful instinct of all.”

Telling someone then to embrace the tonic of their despair is easy. Getting them to do that is another matter. Perhaps one way writers try to escape from their despair is by writing about it. Since that rarely works for very long, is it any wonder our bookshelves are filled with so many unhappy novels and memoirs.

William Styron

Soon after it began publishing, the Paris Review interviewed William Styron who was then living in Paris. The interview was conducted in early autumn on a sunny afternoon at a cafe on the boulevard du Montparnasse—parfait. The interviewer begins by asking Styron if he enjoys writing.

“I certainly don’t. I get a fine, warm feeling when I’m doing well, but that pleasure is pretty much negated by the pain of getting started each day. Let’s face it, writing is hell.” This is spoken by the author of Sophie’s Choice, Lie Down in Darkness, The Confessions of Nat Turner and Darkness Visible: A Memoir of Madness that describes Styron’s battle to overcome depression.

Styron’s account of his struggle to write should give some consolation to all those aspiring writers who are about to abandon ship. But like Roth, who said every writer needs his “poisons,” Styron also thought of writing as somewhat therapeutic for “people who are perpetually scared of nameless threats as I am most of the time.”

While admitting his work has been influenced by the notables—Joyce, Flaubert, Dos Passos and Fitzgerald, “the strongest influences are out of the past—the Bible, Marlow, Blake, Shakespeare.” Again, this leaves unanswered the question of how the work of one writer can influence another. No doubt, it is a matter of considerable subtlety and may be nothing very specific, but rather a vague, indefinite form of learning without awareness.

Styron is then asked about his view of the critics, of which he had many. He replies, “From the writers point of view, critics should be ignored, although it’s hard not to do what they suggest.” He then notes how hard it is to have critics who are also your friends. He reads their reviews…but they don’t really help him much, at least in ways that he can pinpoint.

“Look there’s only one person a writer should listen to, pay attention to. It’s not any dam critic. It’s the reader….The writer must criticize his own work as a reader. Every day I pick up the story or whatever it is I’ve been working on and read it through. If I enjoy it as a reader then I know I’m getting along all right.”

What do I expect to learn or find in reading a critics review of a book? It is really one and only one thing—I want to find out if I might enjoy reading the book. I am far less interested in placing the book in the context of other works by the writer or much of anything about his or her life.

Nor am I the least bit interested in what the book reviewer thought about its literary excellence—its structural or post-modern features. Rather, I want to know what the book meant to the critic and how it might have affected him. I look for the experience the reviewer had in reading the book, what insights it gave him, if it led him to identify with any of the characters or their situations and the significance that might have had for the reviewer.

In short, I want to know if it is worth my time to read the novel and head down to the bookstore to buy it. I confess, I rarely get this kind of information from most reviewers. Like Styron, I have to start reading the book and if I like what I read in the beginning, it is likely that I’ll enjoy the rest of it.

As a totally unrelated but profoundly relevant footnote, I would like to cite a passage from the interview with Paul Auster that is also included in Volume IV of the Paris Review Interviews. It was conducted in 2003 when Auster was then 56. Even at that relatively young age he could say,

“Time begins slipping away, and simple arithmetic tells you there are more years behind you than ahead of you—many more. Your body starts breaking down, you have aches and pains that weren’t there before, and little by little the people you love begin to die. By the age of fifty, most of us are haunted by ghosts. They live inside us and we spend as much time talking to the dead as to the living. It’s hard for a young person to understand this. It’s not that a twenty year old doesn’t know he’s going to die, but it’s the loss of others that so profoundly affects an older person—and you can’t know what the accumulation of losses is going to do to you until you experience it yourself.”

Physicality of a Book

A book is more that the words on the page, the story that is told, and the way it is written. A book is also possessed of sheer physicality. How heavy is it, how thick, or how many pages, what is the cover like, does the paper have a distinctive odor, is there room in the margin for comments, what is the typeface, etc?

Of course, these features, as well as other ancillary features of reading a book are relatively minor compared to the real reasons we read a book, although they cannot be entirely discounted. Recently there has been some discussion of these matters on the various Web sites I visit.

Dust Jacket
There is the matter of dust jackets. Some books have them, some books don’t. Are they necessary? I am reading two books now, neither of which has one. What purpose do they serve? Can they be met without a dust jacket? Some dedicated readers believe one of the major downsides of the new e-books is the absence of a dust jacket or a book cover.

Deckle Edge
Then there is the matter of the edge of the page—rough, smooth, or deckle edge (uncut). I remember returning from France a long time ago with a load of deckle edge books. A knife was required to cut open the pages; there was something rather special about these books, as if they were in someway more authentic than their smooth edged counterparts.

Sustainable Highlighting
For those who don’t like to write in their books, there is now a way to avoid doing so by placing a “verdant sticky” next to passage you would normally underline or highlight. Simply place one of these Japanese designed stickies next to the passage and later remove it to reuse again after you’ve added the passage to your collection.

Bookshelves
How do you arrange the books on your bookshelf--randomly, alphabetically by author, color of cover, fiction, biography, poetry, culinary, etc? Lately, I simply add the book to whatever open space I can find. And when I search for a previously read book, I am more often than not able to find it simply by the color and design of the book cover.

Dollars and Cents
There is the cost of a book, a matter that cannot be easily dismissed these days. Shall I wait for the paperback edition? Or hold off until one comes into the library? Or planning ahead, why not buy a Kindle or a Nook, or the forthcoming iPad and start downloading them “in less than a minute” for $9.99 or, in an increasingly number of cases, for nothing.

Roth on Roth

I’ve been reading Volume IV of the always intriguing Paris Review Interviews with writers—poets, playwrights, novelists, essayists, journalists and critics. In the introduction to this volume Salman Rushdie calls the set “the finest available inquiry into the how of literature.” They began over fifty years ago in the first issue of the periodical (1953) with an interview of E. M. Forster. A year later an interview was conducted with William Styron, then only 27, who was one of the Paris Review’s founders.

Volume IV includes an interview of Philip Roth conducted in 1984 when Roth, then 51, was well into his writing life, having recently published Portnoy’s Complaint and in 1983, The Anatomy Lesson. The interview begins with Roth describing his writing day and what he goes through each time he starts a new novel. He says he works almost every day, all day, morning and afternoon. “If I sit there like that for two or three years, at the end I have a book.”

Every writer knows that the beginning, sometimes simply the first sentence, is usually the hardest part of writing a new work. Even for Roth, a writer who has published countless works of fiction and non-fiction, it is a bit of an ordeal. He says, “I often have to write a hundred pages or more before there’s a paragraph that’s alive…that has some life in it.”

This is a tale told by many writers—those first hundred pages often end up in the recycling basket. I imagine that is an impossibly difficult thing for any writer. To be utterly frank, more than once I have thought of doing the same.

But there is another far more difficult struggle that Roth goes through when he embarks on a new book. That is the struggle for a problem, a dilemma, a predicament that makes for compelling fiction. When he begins, he claims he hasn’t the slightest idea what that will be. “What matters most isn’t there at all.”

He says the central character in his novels have to be going through a major transformation or “radical displacement” in their life. And to create this kind of person, Roth says he needs to be going a little bit crazy. He comments, “…a writer has to be driven crazy to help him see. A writer needs his poisons. The antidote to his poisons is often a book.” Does this suggest the novels he writes are Roth’s way of getting in a little writing therapy?

Roth has always downplayed the power of literature to bring about social or personal change. He reiterates his position in the interview: “I don’t believe that, in my society, novels effect serious changes in anyone other than the handful of people who are writers, whose own novels are of course seriously affected by other novelists’ novels. I can’t see anything like that happening to the ordinary reader, nor would I expect to.”

Here he leaves unanswered the question of just how one writer’s work influences another. Writers often say they have been influenced by one writer after another, by Tolstoy or Chekhov or Fitzgerald or Hemingway. I always wonder in what way. They may have greatly admired their work, but how was that admiration translated into their own work?

Roth’s view about the effects of literature on the ordinary reader is contrary to the abundant evidence, in some cases anecdotal in others empirical, that suggest otherwise. See, for example, Goethe's Sorrows of Young Werther, the fascinating answers given by many well-known individuals to the question “What book did you read when you were young that most influenced your life?" at The Academy of Achievement Web site, the life-changing accounts given in Jack Canfield and Gay Hendrick's volume, You’ve Got to Read This Book: 55 People Tell the Story of the Book That Changed Their Life, Gordon and Patricia Sabine’s Books That Made the Difference, the “Changing Lives Through Literature Program,” etc.

The interviewer, Hermione Lee, who has written a study of Roth’s work, then asks him, “What do novels do then for the ordinary reader?” Roth replies as if he had not earlier said they don’t. “At their best writers change the way readers read. That seems to me the only realistic expectation. It also seems to me quite enough. Reading novels is a deep and singular pleasure, a gripping and mysterious human activity…”

Here we have Roth saying a novel does sometimes give rise of a reader’s pleasure and change the way they read, whatever he means by that. In this sense he does acknowledge the “power of the pen” to influence a person and if he is willing to admit these not insignificant effects, surely it is conceivable for a work of literature to have an even greater impact on some readers, if only to cause them to think more seriously about an issue or, in the most extreme, but far from unknown case, of changing the course of their life.

On Napping

Earlier this week a report was circulating on the Web about the benefits of napping. Since I am a serious napper, I read it with keen interest. It appears naps are good for the mind or as the BBC report headlined “Nap boosts brain learning power.” The study reported that 39 individuals who were allowed to snooze for a while after taking a “hard learning task” in the morning outperformed those who had to get through the day without a siesta.

However, we are not told how large the difference was or given much information about the process that led to the performance improvement. Dr. Matthew Walker of UC Berkeley who conducted the study said: “Sleep not only rights the wrong of prolonged wakefulness, but, at the neurocognitive level, it moves you beyond where you were before you took a nap.” This doesn’t seem to help me much.

A few years before, Dr. Martha Mednick reported similar findings in a study in which a nap that included REM (Rapid Eye Movement) sleep led to nearly a “40 percent improvement compared to the pre-nap performance on a word-association test. Individuals who didn’t experience REM sleep improved slightly, but their pre-and-post nap differences were modest and not statistically significant

These results also agree with my many years of napping experience. Since I rise early, a nap has become a bit of a necessity. I am totally refreshed after a short, mid-day nap. When I do really conk out for even a very short time, I actually feel much better after the nap than I did in the morning after a full night of sleep.

In a way, a mid-day nap really creates two separate days for me. There is the morning day and then the afternoon day and perhaps yet another evening day if I can manage that, something I’ve never really been able to achieve even when I needed to.

After I read the BBC report, I recall reading a delightful essay by Joseph Epstein on “The Art of Napping.” I searched without success for a copy in my files and I searched for copy on the Web, again without any luck. In doing so, I learned that the essay was included in book of Epstein’s essays, Narcissus Leaves the Pool.

I could order the book from Amazon but it would take weeks to arrive. Or I could walk a few blocks down to Powell’s to buy their one remaining copy. But it was rather too cold for me to venture out and besides the book would cost a fair amount and my bookshelf was running out of space anyway. What was I to do?

Lo and behold, Google Books came to my rescue. The complete essay is there and while I couldn’t print a copy or copy any passages, I could separately take notes while I read it, one page at a time. Doing that wasn’t so bad, at least it wasn’t reading the essay on my computer where note taking is easy. All this surprised me. Thank you Sergey and Larry. Perhaps one day it will be just as nice with some of the new e-readers that are currently making deep inroads on the reading experience.

Some well known individuals have been excellent nappers. Thomas Edison was said to be a superb napper and attributes much of his inventive energy to them. So was former President Bill Clinton, who was also known to be a voracious reader. No doubt, he also took advantage of his napping time to read for a while, as I do. Sometimes I think that is one of the reasons napping is such a treat for me

Other first-class nappers include Ronald Reagan, who seemed to be napping most of the day. Leonardo DaVinci for other much valued reasons also napped on and off during the day, but hardly slept at all at night. John D. Rockefeller also took a daily nap and for all I know may have regarded the experience as the royal road to wealth.

In his charming essay Epstein discusses the various ways napping affects his life. He recalls, “At the University of Chicago, I slept through the better part of the Italian Renaissance, or at any rate through a course in the history of art. As a teacher myself, I am now being justly repaid by having students fall asleep in my own classes.”

He also mentions some of the works of literature where it plays a lesser role. He cites Prince Bolkonsky’s comment in Tolstoy’s War and Peace, “A nap after dinner was silver, a nap before dinner golden.”

On Fragments

In the beginning was the fragment, and the fragment cast a shadow, and the shadow became the word.
—Carlos V. Reyes

Olivia Dresher, writer, publisher of Impassio Press, and director of the Life Writing Connection has also established an online magazine of fragmentary writing that publishes “…excerpts from journals, diaries and notebooks; vignettes; aphorisms; micro essays and notes; excerpts from letters; and various nontraditional short forms.” Her recent book, In Pieces: An Anthology of Fragmentary Writing, seeks to establish fragmentary writing as an independent genre.

At her suggestion, I’ve have been reading Fernando Pessoa’s The Book of Disquiet to find out what the experience of reading fragments is like. It has taken forever to get past the first quarter of this volume. This by no means diminishes it greatness for it is a fascinating book to read. But it is without narrative or direction or momentum and so I read it for a while and then put it down in order to get into the next gripping novel that is going to take command of my life

Olivia and I have had periodic exchanges about the nature of fragmentary writing of which the following is representative:

To Olivia: Here is my concern about texting, tweets, and facebooking, and even short fragments. These forms of expression may discourage writers from formulating reasoned, well supported, and comprehensive statements about an issue or a question. Especially among the young, although not restricted to them, learning how to do this, and it does require a lot of learning, will take a back seat to shorter forms of expression. You really have to practice, practice, practice, writing a coherent statement in order to do it well.

Without abundant opportunities for such practice, it will become a thing of the past. It will also fail to be recognized as extremely important and valuable in its own right. I admit my view is simply a concern without any empirical evidence. But we do hear a lot of anecdotal evidence these days about poor writing among the young and their inability to sustain an interest in reading for very long. No doubt there are exceptions and no doubt I overgeneralize. But still I worry. I guess I worry about many things. Worry comes to me quite naturally.

From Olivia: I hope you don't think that I see them [fragments] as a substitute for other kinds of writing. I just want to help them develop a place that can be respected, especially since they don't really have a place. I want to explore their dimensions and possibilities.

I'm very interested in form, and I like all forms of literature. I happen to, personally, be drawn to short forms (I always have been). A lot of people don't know how to appreciate or write short forms. And perhaps people, in general, have leanings to write short or long forms rather than both, and perhaps it isn't just a matter of training, practice, and education. I'm glad that there are writers of novels AND writers of haiku. I also value traditional writing AND experimental writing. Both.

In the Introduction to In Pieces Olivia writes, “One quality of fragmentary writing is the lack of a traditional beginning or end. Instead, the two are merged into a brief and concentrated middle. A fragment is a “slice of life,” a short expression or description of a thought, memory, insight, mood, perception, image, or experience.”

She notes that journals, diaries, and notebooks are forms of fragmentary writing. Clearly then there are millions of us of all ages who really are fragment writers. Much of what we write is personal, usually written in the first person, and most often they are works of non-fiction.

Olivia concludes her introduction by saying, “It is my feeling that the fragmentary form, more than any other form, gives writers the opportunity to travel as far away from the boundaries of traditional genres as they feel they must in order to express their truths.”

Here are some fragments on fragments that Olivia has composed:

Fragments: because it's the very nature of perception to be fragmentary.

Fragments: the less there is, the more that's left to the imagination.

Our contemporary lives are fragmented...the fragmented form is a reflection of the way we think and live...

A fragment doesn't explain...it just is...it can be a few words or several pages long... It can exist by itself or in a series... It can be whatever the writer wants it to be... There are no rules...

"Stupid Little Checklists"

Did you ever go to the market only to find you left your shopping list at home? Who hasn’t? Who hasn’t made far more serious mistakes? Doctors make them all the time, airline pilots do on occasion, construction engineers are known to make them too.

Dr. Atul Gawande’s latest book, The Checklist Manifesto: How to Get Things Right, is a study of mistakes, about making and preventing them and how to do so quickly and effectively, at least how to make a start in that direction. Gawande is a surgeon, a staff writer for the New Yorker, a professor at Harvard, and a MacArthur fellow. It is a mistake not to listen to him.

Early in the book he writes, “…the volume and complexity of what we know has exceeded our individual ability deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.”

Consider the enormously complex situation an airline pilot faces as he sits in the cockpit getting reading to fly a massive 358,000 lb (that’s empty) Boeing 747 crammed with 545 passengers several thousand miles across the sea. At least a thousand things could go wrong causing the death of the passengers to say nothing of himself and his 33-member crew. How does he avoid making a potentially horrible mistake—a single one could be fatal--in a situation where countless things that could go wrong?

What he does is to start going over, one by one, a set of really simple checklists. There are the checklists he goes over as he inspects the outside of the plane, and those that he reviews before turning on the engines, and another set before pulling away from the gate, plus those before taxiing out to the runway, etc.

He also has a sizable notebook consisting of the “non-normal” checklists “covering every conceivable emergency situation a pilot might run into: smoke in the cockpit, different warning lights turning on, a dead radio, a copilot becoming disabled, and engine failure, to name just a few.” Gawande dramatically describes instances when a careful review of one of these checklists avoided a crash and a few when they weren’t looked at carefully that ended in a tragedy.

Gawande admits doctors don’t much like those “stupid little checklists,” that they aren’t much fun, and that physicians are often reluctant to employ them, largely because they raise doubts about their competence. Against this reluctance, he marshals one study after another to demonstrate how effective checklists are in reducing the alarming number of medical errors.

In one study the introduction of a checklist reduced infections when an intravenous line is inserted into patents in intensive care units (I.C.U.) to zero from its normal rate of 11 percent. Two years after the checklist was introduced it was estimated that it had prevented 43 infections, avoid 8 I.C.U deaths, and saved the hospital in which it was studied approximately $2 million.

Another study for the World Health Organization examined the effects of introducing checklists in surgical care at eight hospitals in both developed and undeveloped countries. “The rate of major complications for surgical patients in all eight hospitals fell by 36 percent after the introduction of the checklist. Deaths fell 47 percent. …Overall in this group of nearly 4,000 patients, 435 would have been expected to develop serious complications based on our earlier observation data. But instead just 277 did. Using the checklist had spared more than 150 people from harm—and 27 of them from death.”

The checklist may seem like a minor, relatively innocuous tool to employ in order to avoid making mistakes. The evidence that Gawande assembles from medical, construction, and aviation situations suggests otherwise. It is another mistake not to take these findings seriously.

Errors will continue to be made, accidents will occur, mental lapses are inevitable, but the use of a checklist will help overcome some of them. They are a start and only a start in confronting the fallibility of the human judgment in the face of the increasing complexity of modern life.

Isaiah Berlin

…he made readers appreciate “the charisma of the intellect. Nicholas Kristof

A few years ago I took an online course on the philosopher Isaiah Berlin offered by an Oxford University instructor. As a former philosophy student, Berlin had always interested me. I also took the course to get an idea of what online instruction was like and how it compared to taking a class in person.

The course consisted of a collection of Berlin’s writings and periodic discussions with the instructor and other students (N = 6). The readings were terrific; the online discussions were very strange, a series of rather awkward written comments, with none of the spontaneity of a classroom discussion and a maddening delay responding to a comment you or another student might have made a couple of minutes ago.

I haven’t taken another online course but I have continued to read about Isaiah Berlin and from time to time one of works. On the occasion of the recent publication of Berlin’s Enlightening: Letters 1946-1960, Nicholas Kristof writes about Berlin in the February 25th issue of The New York Review of Books.

Berlin was born in Russia, the only child of a wealthy Jewish family that eventually migrated to England. He was educated at Oxford, during the era of analytic philosophy, and remained there for the rest of his life. I cannot begin to do justice to the range of topics he wrote and spoke about (he was uniformly regarded as an utterly charming conversationalist, witty, effervescent, scholarly)—political theory, concepts of liberty, epistemology, the history of ideas, ethical thought and values, etc. Instead, I will note a couple of ideas touched on by Kristof who befriended Berlin when he was at Oxford as a law student.

Berlin never thought of himself as a philosopher claiming that its lack of progress “led him to move away from philosophy to become a historian of ideas.” In reality, what that meant was that he was never part of the analytic philosophy tradition that conceived the discipline as primarily concerned with language and logic.

Kristof then asks, “What exactly is Berlin’s legacy in philosophy? To me, it is his emphasis on the “pluralism of values,” a concept that suggests a non-ideological pragmatic way of navigating an untidy world.”

That is also why Berlin finds a sympathetic ear with me. He was skeptical of the grand theories, the single generalization, the paramount value, arguing instead for the acceptance and tolerance of a pluralism of values, values that are often times competing and incompatible with each other.

Kristof wonderfully compares Berlin’s view to a Chinese metaphor, mozhe shitout guo he, that is roughly translated as “as fording a river by feeling for the stones with your feet.” Kristof later describes this programmatic approach to problem solving as “a matter of feeling for the next stone and finding what feels comfortable, honest and just. That entails recognizing that there may not be a single best place to ford the river, and that others may prefer different stones—yet that tolerance should not extend to the ruler who tries to cross by building a bridge of corpses.”

Berlin argued that one has to recognize the one is often wrong, that most situations are complex and that mistakes are often made in groping our way through the these complexities. What is important is to make the mistakes as quickly as possible, “without letting appreciation of nuance emasculate one’s capacity to make strong moral judgments.”

Kristof finds Berlin’s approach a philosophy for adults in today’s uncertain world and concludes that “Berlin’s world view is that we are fated to grope our way along, making constant compromises, revising priorities, living with contradictions, trying to reduce suffering where we can.”

Reading Briefs

An E-book Convert
Charlie Brooker reports he’s an e-book convert mostly because “…no one can see what you're reading. You can mourn the loss of book covers all you want, but once again I say to you: no one can see what you're reading. This is a giant leap forward, one that frees you up to read whatever you want without being judged by the person sitting opposite you on the tube. OK, so right now they'll judge you simply for using an ebook – because you will look like a showoff early-adopter techno-nob if you use one on public transport until at least some time circa 2012 – but at least they're not sneering at you for enjoying The Rats by James Herbert.”

Dictating Notable Passages
Dan Greco may be unique in the way he collect passages for his commonplace book. “When I find particularly memorable passages in the book that I'm reading I dictate those passages (and my comments relating to them) into a Microsoft Word file utilizing Dragon NaturallySpeaking voice recognition software, with a separate Microsoft Word file for each book. Then later I use word indexing software to create word searchable index of the database of all those Microsoft Word files. I can then at a later date with a word or phrase search quickly identify all of the books for which I prepared abstracts and comments pertaining to the words or subjects that I'm searching for.”

Comparing Paper and On-Line Reading
Kenton O’Hara and Abigail Sellen report a laboratory study that compares reading from paper to reading the same document on-line. “Critical differences have to do with the major advantages paper offers in supporting annotation while reading, quick navigation, and flexibility of spatial layout. These, in turn, allow readers to deepen their understanding of the text, extract a sense of its structure, create a plan for writing, cross-refer to other documents, and interleave reading and writing.” Case closed.

Hero of American Justice
In reviewing Melvin Urofsky’s Louis D, Brandeis: A Life, Anthony Lewis writes that “We see him now as a great mind, perhaps the most brilliant of all Supreme Court justices; as a crusader against oversized institutions; and as a luminously eloquent exponent of free speech and privacy—the right to be let alone.”

He concludes by quoting Dean Acheson’s remarks following Brandeis’ death in 1941: “Truth was less than truth to him unless it was expounded so that the people could understand and believe. During these years of retreat from reason, his faith in the human mind and in the will and capacity of people to understand and grasp the truth never waivered or tired….He handed on the great tradition of faith in the mind and spirit of man which is the faith of the prophets and poets, of Socrates, of Lincoln.”

Commonplace Books in the Classroom
From the very beginning commonplace books were conceived as an essential educational tool to collect and organize knowledge. Even today they can be used in guiding students to a more disciplined method of reading and as an aid in recalling more of what they have read. In her blog, Self Made Scholar Jamie Littlefield outlines a plan for creating a commonplace book in classroom settings. She cites Susan Wise Bauer on the process of using commonplace books while reading:

“The journal used for self-education should model itself after this extended type of commonplace book. It is neither an unadorned collection of facts, nor an entirely inward account of what’s going on in your heart and soul. Rather, the journal is the place where the reader takes external information and records it (through the use of quotes, as in the commonplace book); appropriates it through a summary, written in the reader’s own words; and then evaluates it through reflection and personal thought. As you read, you should follow this three-part process: jot own specific phrases, sentences, an paragraphs as you come across them; when you’ve finished your reading, go back and write a brief summary of what you’ve learned; and then write your own reflections, questions, and thoughts.”

Discovery or Creation

As the winter drags on for month after month and the sun vanishes from view, my thoughts turn more and more to Italy and to those times when I have been basking in the warm sun of Tuscany and Umbria. So I am likely to devour any book or film about these places.

William Trevor published My House in Umbria in 1991. I don’t know how I could have missed it until I chanced upon it only a few months ago. And I followed it soon thereafter with the film version based on Trevor’s novel that is transcribed to the screen virtually unaltered and, given the magic of cinematography, is even more vivid.

After escaping a childhood of sexual abuse in England, followed by “career” as a prostitute in an African brothel, middle aged Emily Delahunty settles in a villa somewhere in the Umbrian countryside. We learn that she achieved some fame as a writer of romance novels that are difficult to distinguish from one another. And we learn she occasionally takes in tourists at her Italian residenza. Her days in Italy are familiar to every traveler:

“There are beautiful moments hidden away in corners. I have seen, near the Scala in Milan, a stout little opera singer practicing as he strolled to a café. I have seen a wedding in the cathedral at Orvieto, when the great doors were thrown wide open and the bride and groom walked out into the sunshine.”

During a train trip to Milan, a bomb goes off in the car Delahunty is traveling in. While she survives, the only other survivors are a young German, Otmar, whose lover is killed, a retired English general whose daughter and son-in-law are killed, and an eight-year old American girl, Aimee, who has lost her entire family. Emily Delahunty invites them to her home to recover.

Aimee does not speak after being traumatized by the attack and much of the story centers on her recovery. The general and Otmar undertake their own recovery by planting a garden on the on the villa’s run-down grounds. Meanwhile, Delahunty begins to weave her own, illusory stories about each of them, including Aimee’s uncle, Thomas Riversmith, who arrives to take her back to his family in America.

Trevor writes, “…we are all inside a story that is being composed as each day passes.” And Emily Delahunty’s a master at composing tales of her guests that are little else but fabrications. It is around Riversmith that Delahaunty weaves her wildest tale and whom she pathetically pursues.

Does it matter if our life differs from the stories we make up about it? Is there really a difference between what is true and what is false in these stories? These are the questions I think Trevor wishes us to consider in My House in Umbria.

Mrs. Delahunty doesn’t seem the least bit concerned about the fictions she creates of her own life or those of her guests. She says, “there’s not much to me” and that she is “not a woman of the world” both of which are patently false, if we can believe Trevor’s description of her previous life.

Trevor never tells us why Delahunty engages in such fictions. She was a romance novelist, after all. Perhaps more importantly, she too may have been traumatized by the terrorist attack, as well as the experiences she had before settling in the Umbrian countryside. Her fictional inventions then may have given her the resources to overcome her own traumas and reach some peace with her past—fiction therapy in a work of imaginative fiction, if you will.

Paraphrasing a comment in Pascal Mercier’s Night Train to Lisbon, understanding yourself may be just as much a discovery as a creation.

A Bookstore Like No Other

"Who says the traditional bookshop is dead? In this age of chain superstores and online selling, it often seems that the days of the old-style independent dealer are numbered. But one American bookseller, at least, refuses to believe that." The Independent (London), September 6, 1998

I went to Powell’s bookstore on the weekend and was floored by the number of people there. Yes, it was a rainy afternoon in Portland, Oregon. Perfectly normal day. And it was the day before Valentine’s Day but I can’t imagine that many booklovers were giving their lover a book. And they don’t sell candy at Powell’s. What they sell is an incredible number of new and used books.

There was not a free table in the room where you can get coffee and read for a while. Elsewhere the aisles were filled with serious looking people searching intently for their next acquisition. Many devoted readers were sitting on the floor, pouring over the books they had pulled from the shelf.

Upstairs a large group had gathered for a poetry reading. There were long lines at the two checkout stands, one upstairs on the main floor, the other downstairs on the lower level. It just felt really good to be there on that a dreary Saturday afternoon. And whenever I walk into Powell’s when it is as jammed as it was that day, I break out in a big smile.

Let me tell you a little about Powell’s that many claim is the world’s largest bookstore. I remember when it opened in a run-down warehouse and sold only used books, mostly beat--up paperbacks. Then one day they started to sell new books. After that, the store seem to take off. It now occupies a full block at that same location in a part of town that has become rather gentrified of late.

But still the store has that same dusty-musty warehouse feeling and is but one of several other branches—a couple of stores at the airport, a technical bookstore a down the street a ways, one in the suburbs, and two on the other side of town, one of which specializes in books for home and garden. It also has a widely visited Web site that I am sure is a major source of its revenue. And it has become a must-visit for the increasing number of travelers who come to Portland. No doubt many come primarily to stock up on books at Powell’s.

Powell’s has nine rooms on four floors of one city block. It seems immense. Each room is known by a different color—go to the green and blue rooms for literature, reference, and poetry, the gold room for mysteries and science fiction, the orange room for cooking, crafts, and gardening, the red room for young readers, games and sciences, the purple room for social sciences, history and ethnic studies, the red room for religion, travel and foreign language, and the pearl room for art, drama, music and dance.

During a period when one bookstore after another is closing and when it is reported that two bookstores close every week in England, even Powell’s has been affected by the current economic crisis. Sales have declined somewhat perhaps most notably in online store purchases and plans to expand the store by adding yet a new floor, have been abandoned. I confess, you’d never imagine that was possible after visiting last Saturday afternoon and no doubt the day after either.

It is easy to get lost in Powell’s and I have a hunch more than one booklover has ended up spending the night there after the store had closed. Indeed, as it says on the stores brochure, The City of Books, “Once you visit you won’t want to leave.”

To those of you who fear for the future of the book, take heart, and come to Powell’s any weekend afternoon. Your fears will vanish the moment you walk in the door.

Presidential Commonplace Books

On President’s Day this year, I was led to wonder about the commonplace book activity of any past or present U.S. Presidents. We know a little about the reading habits of Presidents—Obama was recently seen with a copy of Fareed Zakaria’s The Post-American World and on another occasion clutching a copy of Joseph O’Neil’s Netherland, while Clinton was known as a voracious reader.

But do Presidents keep a record of some of the notable passages they come across in the books or periodicals they read? Perhaps they might wish to invoke them in a meeting, speech, or future writing. To my knowledge Thomas Jefferson was the only President who kept a commonplace book. In fact, as a youth, he kept two, the first devoted to matters of government and politics, the second, the earlier of the two, to literature and poetry

In addition to collecting passages, Jefferson also did a good deal of annotating at the time he wrote the passage in his commonplace book. The practice of annotating is rarely engaged in by those who keep a commonplace book and is even less likely to occur at the time the entries are made. On her commonplace book page, Lucia Knoles cites the following Jeffersonian procedure:

"He would synopsize and capture the key points of his readings and add his own reflections, recording them in a journal which he called his 'commonplace book.' One of his biographers quoted Jefferson as saying 'I was in the habit of abridging and commonplacing what I read meriting it, and of sometimes mixing my own reflections on the subject.' His tutor, James Maury, commended the practice as a means 'to reflect, and remark on, and digest what you read.”

Jefferson’s commonplace book on government also anticipates many of the ideas he later expressed in the Declaration of Independence.

“Stanyan says that the first kinds of Greece were elected by the free consent of the people.” “All men are, by nature, equal and free: No one has the right to any authority over another without his consent: All lawful government is founded on the consent of those, who are subject to it.”

It also includes passages that deal with policy issues we confront today. For example, here is a representative passage on gun control from Cesare, Marquis of Beccaria:

"Laws that forbid the carrying of arms ... disarm only those who are neither inclined nor determined to commit crimes ... Such laws make things worse for the assaulted and better for the assailants; they serve rather to encourage than to prevent homicides, for an unarmed man may be attacked with greater confidence than an armed man.”

The descendents of Thomas Jefferson withheld publication of his literary commonplace book until 1928. According to Douglas Wilson, who edited a 1988 edition of the work, Jefferson maintained it from the age of about fifteen to thirty and because it is the most personal of the two, provides a rare glimpse of Jefferson’s formative years and the considerable influence of literature in the development of his personality.

The collection includes about four hundred passages that Jefferson copied by hand. Many of the entries were written by Jefferson in their original Latin, Greek, or French, and appear to be selected because of their philosophical and moral content. Wilson indicates that 339 of the entries are poetry, and 35 of the 45 authors quoted are poets. Homer, Horace, Pope, Milton, Shakespeare and Euripides are among the most frequently cited.

In noting some of the similarities between Jefferson’s and Milton’s commonplace books, Ruth Mohl suggests both men selected passages not only for their literary merit but also as “sources of inspiration and practical wisdom.” Later she concludes that like Milton’s, Jefferson’s literary commonplace book is alive with:

"Themes of courage, self-reliance, freedom, equality, the necessity of wisdom combined with strength, and faith in God…along with those on the brevity of life, death and the fatal beauty of women. In them the personality of Jefferson is strikingly revealed—as if in his own words he was recording his philosophy of life.”

May-December Romance

Lost in Translation is far and away my favorite May-December romance written for the screen. None of the countless others come close. There is no lust in Lost in Translation. There is none of the awkwardness that usually characterizes most depictions of a couple like this. She is young, about twenty; he is almost three decades older in his fifties. In spite of this difference, they find themselves at loose ends and similar mind at the swanking Park Hyatt in Tokyo. They never talk about their age difference, although early on she says he must be going through a “mid-life crisis.” I thought it was the only false moment in the film.

The fact that these two people, at opposite ends of their lives are drawn to one another is the heart of the film. They banter, they jest, or simply gaze at one another. There is never any hint that he can’t keep up with her or that he is uncomfortable playing around with her friends. He is as young as they are. Sofia Coppola, the film’s author and director, put it this way: “But I think that, you know, that early 20s kind of 'what am I going to do with my life?' crisis I felt was similar to the guy having a mid-life crisis. I just related to his character and allowed them to both be kind of going through similar things, but from other ends of the spectrum.”

Yet I didn’t think it was necessarily a younger woman older man crisis. It is a crisis that any two individuals can have at any time in their lives. The connection between Bob and Charlotte is startling. I kept wondering what could they ever do? What kind of a relationship could they possible have? I wanted them to have a future. And yet I knew that was impossible. At the end Bob says he doesn’t want to leave. Charlotte replies, well don’t. We’ll start a jazz band. Age is so irrelevant. And yet it colors everything. She is newly married and unhappily so. He has been married 25 years and finds it is growing tedious. The emotional torpor of their separate lives is the springboard of their relationship.

I often find myself puzzled why the characters depicted in contemporary films act the way they do. They may be indecisive or ambivalent or violent or they may feel strongly about another person. But it isn’t clear why. And so they are less compelling than they might be. None of this is the case for Lost in Translation. I knew why Charlotte and Bob were there, why they were at loose ends. I understood them and thought about them for days. One night they entered my dreams.

Charlotte is luminous, totally unadorned. There is nothing racy or pretentious about her. She is quiet, inquisitive, reflective. He learns she was a philosophy major at Yale and so there is a reason for her doubts and curiosity. There is also a sweetness about her, a sweet and melancholy wistfulness. She is thoroughly irresistible. She speaks softly. She is quiet. While she doesn’t say much, when she does, it is smart, clear, and to the point. She seems years older than her age. The rhythm and tone of her words is lovely.

Bob is detached, bemused, and full of hilarious wit and innocuous nonsense. She approaches him in the bar and asks him what he’s up to. He says he is planning a prison break and asks if she is in or out. When she tells him she studied philosophy, he tells her there must be a “good buck in that racket.”

What is it that he sees in her? Is it her youth? The good times they have together? The escape from his sleeplessness and boredom? Or a trifling fling far away from home? The depth of their apparent feeling argues against those possibilities. Yet, I wonder if they would have been drawn to one another had they not been geographically removed from their spouses.

The ending is wrenching. They depart from the Park Hyatt rather clumsily. On the drive to the airport Bob sees Charlotte walking down a crowded street. He tells the driver to stop and races after her. They embrace and with tears in her eyes and maybe his too, they finally kiss for a heartbreaking moment. He whispers something to her. And then, as they must, they go their separate ways.

On Writing Well

A few years ago I enrolled in a workshop on writing memoirs and essays. It taught me a lot about what I should try to be doing when I try to write just about anything, including a memoir or essay. And what I learned really wasn’t much different than what I knew about writing peer-reviewed articles for research journals. The course was described this way:

Personal narrative shares with fiction writing the obligation to lift from the raw material of life a tale that will shape experience, transform event, and deliver a bit of wisdom. But whereas a fictional "I" can be, and often is, an unreliable narrator, in nonfiction the reader must always be persuaded that the narrator is speaking truth. How does the memoir/essayist pull from oneself the truth-speaker who alone can tell the story that needs to be told? Personal memoir becomes literature when it is shaped, shaped by a form. Ask what is the form that surrounds this memoir?

I took a great deal of notes at the workshop. Some deserve to be remembered, as well as communicated, and so I will pass along a few of the ideas I took note of during the two-week session.


A personal memoir should attempt to understand an experience that you have had, to know what it means. The understanding or your attempt to understand it becomes the form.

Try to achieve a wisdom beyond yourself, ask what is the organizing principle of the essay? It need only to apply to yourself; don't worry about it's generality.

For example, the instructor’s essay on letter writing tried to use her own experience to explain why people don't write letters any more.

In reading essays, consider the following questions:

1 Can you see the larger picture?
2 What is understood?
3 What is the essay about?
4 How to make some sense of what has happened to you?

A personal essay needs also to be going somewhere, to be in motion, to answer a question, to solve a problem, to provide some insight, to make some sense of your experience.

A mood piece must have a revelation to be an example of a personal essay. Revelation develops from a cumulative building of incident after incident until clarity or insight is apparent or the revelation emerges.

The writer should be different at the end of the essay than they were at the beginning. They are different because of the revelation. If you write about your migraines, understanding what they are and what brings them on should deepened.

The charge is to inquire more deeply or to try. To work through, in a step-by-step fashion, a self-inspection, to introspect about the situation(s) you are describing.

Page after page of feelings is not a journey. Simply exposing yourself is not literature. You need to be going somewhere and be a different person when you get there than you were when you started, even if you don't fully understand the situation.

The workshop was taught by Vivian Gornick whose work, The Situation and the Story: The Art of the Personal Narrative, expands upon many of workshop themes. If you find a few of the workshop notes at all instructive, I encourage you to read her volume on the difficult art of writing about personal experience.

On Writing in Books

In Library Looking Glass, David Cecil wonders if writing in books is a bad practice. This is an issue about which many readers have firm convictions. Cecil admits it is certainly the wrong thing to do if a book is a “precious object, elegantly bound and on fine expensive paper.” But when it comes to the regular books we read, there is much to be said for it. Cecil says, “It helps to make a book seem more one’s own; and, unless what is written insults its author, it is a compliment to him. It treats him as a living man, with whom one wants, as it were, to converse.”

It is startling to read how similar Cecil’s routine is to mine: “In particular when anything in the text has especially struck me, I have noted on the end-paper the number of the page where this has occurred. Sometimes my note simply indicated admiration; but more often admiration of a special and personal kind. The passage referred to was beautiful or comical or well-written in ways that had a peculiar appeal to my own taste, or it stated a view which I found especially illuminating; or it stimulated in me a fruitful train of thought.”

However, I take two additional steps that Cecil apparently didn’t. When I have finished the book or however much I want to read, I copy each of the passages I have marked in a Word document. Following that, I insert them following those I have already collected in my Commonplace Book for the year. And at year’s end, I add the year’s collection to those I have been saving since 1988. In part, I do all this because the computer makes it so easy, maybe too easy. When Cecil started writing in his books, the computer was a distant dream, if that. Would he be saving his passages in electronic form today? My hunch is he would.

Of course, Cecil is talking about his own books, not those he obtained in the library. I am sure he would agree that making marks in a library book is inexcusable. But even worse is “defacing” your own books in a way that apparently Toby Lichtig does with abandon:

“…in my library anything goes: doodles, numbers, addresses, lists, recipes and the ensuing food stains.”…the marks and scrawls help me to recall the text—and crucially, the person I was when red it: how I was feeling, where I was sitting, whom I was with.”

Stephanie Hollmichel, the blogger at “So Many Books,” and a diligent keeper of a commonplace book, employs a much more civilized approach, indeed, although she marks her notable passages, it is one that doesn’t leave any marks in the book and is far more selective than the my procedure. Here is how she described her routine to me:

“When I read I keep a tin of page nibs by my side … and stick them on the pages at passages that particularly catch my attention. When I am done with the book I go back through it looking at all the passages I marked and take out the page nibs that mark passages that no longer seem all that interesting. Then I let the book sit for a day or two and go back and look at the still marked passages and make a final decision about which ones really speak to me and copy those out into my commonplace book.”

I don’t think any of these readers are going to get too excited about the iPad or any of the other e-book readers either. None of them make marking or collecting their favorite passages very straightforward. Indeed, Lichig remarks “…I intend to carry on reading as I always have: with an object I can physically alter; something I can damage with impunity. Ever-primed for action, my pen hovers restlessly just above the page.”

Mine does too, but I am certainly not going to scrawl anything across the page or leave coffee stains on it either.

Who Knows Best?

Jerome Groopman’s essay, “Health Care: Who Knows “Best”?” in the February 11th New York Review of Books isn’t going to help pass the moribund legislation before Congress. Groopman argues that there are serious problems in relying on studies of comparative effectiveness to improve the quality of care--one of the central components of both the House and Senate bills.

Obama often says, Let’s study and figure out what works and what doesn’t. And let’s encourage doctors and patients to get what works. Let’s discourage what doesn’t.

According to Groopman, it’s not quite that simple. The findings of comparative effectiveness research are always open to further testing and ultimate refutation or qualification. What is true today is often false tomorrow.

Groopman cites several examples: “Best practices” research once demonstrated that blood sugar levels should be tightly controlled in critically patients in intensive care. Later research showed that this practice was not only shown to be wrong but resulted in a high likelihood of death when compared with measures allowing a more flexible treatment and higher blood sugar.”

He points to another failure in treating hip and knee replacement by orthopedic surgeons. In this case, conforming to or deviating from the “best practice” procedures based on comparative research had no effect on the rate of complications from the operation or the outcome of the treated individuals.

Groopman claims physicians are growing increasingly dubious of efforts to standardize clinical practice based on comparative effectiveness studies.

“…clinical trials yield averages that often do not reflect the real world of individual patients, particularly those with multiple medical conditions. Nor do current findings on best practices take into account changes in an illness as it evolves over time. Tight control of blood sugar made help some diabetics, but not others.”

As our knowledge of the disease process grows, the care and treatment of patients has become overwhelming complex. So it is not surprising that the clinical application of the best practices model is fraught with difficulties. As Groopman points out, the findings fail to distinguish between those patients where it works and those where it doesn’t.

To add to this complexity, Groopman develops further the role of cognitive biases in medical decision making and the pitfalls of human reasoning in situations where an easily made error can end a person’s life. He takes special note of the following potential sources of error

• Overconfidence Bias—over estimating the importance of his own work and analytical skills

• Confirmation Bias—the tendency to ignore and discount contradictory evidence

• Focusing Illusion—basing a decision on a single patient change that is mistakenly employed in predicting the effects on the overall condition.

Groopman’s essay calls into question one of the basic tenants of Obama’s health care proposal. He concludes: “The care of patients is complex and choices about treatments involve difficult tradeoffs. That the uncertainties can be erased by mandates from experts is a misconceived panacea, a focusing illusion.”

This does not imply comparative effectiveness research should be disregard. To the contrary, it means there is much more that has to be taken into account in medical decision making-- the history and state of the individual patient, the boundary conditions of the research findings, the experience of the physician in dealing with the patient’s problem and the numerous value judgments that both the physician and the patient will want to consider.

Omnibus

The Game is finally over I am thinking what is the big deal after all? I am told that even the commercials this year were “horrible” and, to some, “offensive.” The Game is one of the most important days of the year, the main event until the one next year. It is surely the most widely watched television program in this country (an estimated 106 million viewers this year, about a third of the total US population) and perhaps the world, too. I suppose I should have simply relaxed, stopped grousing, and enjoyed the day for a change.

I remember when the first Super Bowl was played. It was late January in 1967 on my son’s first birthday and so before the game was the moved further and further into the year, I was always able to remember his age. We were living in a university town up the coast from Los Angeles and had invited a big crowd to our home to watch the thing, as it was blacked out L.A where the game was held that year. Several rows of folding chairs were set up before the television set and, along with an estimated sixty million other viewers, we watched the Green Bay Packers beat the Kansas City Chiefs—are they still in business?

I tend to think of television events like this in terms of what they could be or what they once were. And so I recall what we used to do each Sunday afternoon in the early days of television. Then it was those remarkable programs of the Omnibus Television series. Week after week Omnibus brought drama, dance, music, science, art, history and opera to our living room for two incredible hours. The program was hosted by the always learned and witty British journalist Alistair Cooke and was shown on one of the major networks, that’s CBS, NBC, and ABC, mind you, from 1952 to 1961.

I recall the first program was a live performance, as were most of its programs, of Henry VIII. It also included a reading by William Saroyan of his short story, “The Bad Men,” and an analysis of the human digestive system. On subsequent programs Orson Wells stared in an adaptation of King Lear, Peter Ustinov performed as Samuel Johnson, William Faulkner took us on a tour of Oxford, Mississippi and James Agee wrote a five-part docudrama of the life of Abraham Lincoln with a script written by Carl Sandburg and music by Aaron Copeland. Can you believe that all of this was actually on Sunday afternoon television?

Wait, that is not all. I’ll never forget remarkable musical series that began with Leopold Stokowski and Benjamin Britten’s “Young Person’s Guide to the Orchestra” that was eventually taken over by Leonard Bernstein who “single-handedly enlarged the possibilities of music analysis and performance on television.” He taught me much of what I “know” about music and he did that with his unique style of passion and excitement.

Surely that was the Golden Age of Television. Whatever happened to the spirit of enlightenment that made those programs possible? The show appeared in the early days of black and white television. Is there not an even greater audience for such programming in the new millennium?

Today I vainly search for something to watch on TV, surfing the channels, trying to find something to view for a while. The array of choices is mind-boggling--quiz shows, wrestling matches, shouting matches, sitcoms, cop shows, soap operas, crime and more crime investigations. And oh, yes, professional football games. It is hopeless.

“Fifty seven channels and nothin’s on.” Add two hundred, the result is the same. No doubt I expect too much. Omnibus was free. Cable TV had not been imagined. But would I pay for a channel to see Omnibus again? The answer should be clear and I wouldn’t mind paying a goodly sum. I can’t imagine I am the only one either.