A Sign
(Eds. Note: I was working very hard on Thanksgiving, and when I finally decided to take a break the break took the form of me crashing on the couch and watching tv. The best thing on was a House marathon, so I stepped in to the exciting and misanthropic world of diagnosis for a couple of hours. Here are some of my thoughts, on second look rather disjointed as they may be.)
House is an effective base for a story because of the puzzle that diagnosis presents doctors. These puzzles have been at the heart of medicine since its founding in ancient times. It struck me how some things remain completely unchanged by time and technological improvements; no matter how advanced the tests get, the basic strategy remains the same; interpret the signs the body gives you and treat the illness that best fits the sign. In fact, the etymology of our word "sign" is derived from the Greek Seme, which was a derivation of medical signs.
Of course, medicine is not the only area which deals with interpreting signs. Seme gave its name to semiotics, which is a set modern philosophical disciplines looking at the way communication works. Umberto Eco, in his monumental Theory of Signs, outlines some of the uses of semiotics: studies of musical codes, of formalized languages, of code breaking, of visual, olfactory, and tactile non-linguistic communication. Among his list he includes medical semiotics. The drama of House is increased because all of the episodes are focused on issues of life and death (not to mention the personal issues of the main characters) and so the interpretation of the signs becomes top priority and is generally very urgent. House and his team are shown to be brilliant because of the way they know diagnoses instantly, the same way our comprehension of language is tested in how fast we read or in our understanding of rapid speech.
But the function of the doctors on House seems to be a little different from our interpreting a book. It becomes more complicated as symptoms seem to contradict other symptoms. Occasionally having every symptom of a disease leads to the idea that something else is happening - since it is rare that every symptom will ever be shown. What we seem to have, then, is a language (the set of diseases) that is known fairly well (there are no new diseases that show up on House; otherwise diagnostics would have no place) but the expression of that language is fuzzy or indistinct.
It is somewhat similar to when I try to read Japanese poetry. If I try to read printed Japanese, I can get a little ways. Often, I'll have no clue about context or specifics but given my knowledge and the ease of getting general ideas from Japanese characters, I can get the gist of the text. More to the point, if there are characters I am unfamiliar with, I can look them up in a dictionary, something most diagnosticians outside of television surely avail themselves of. But Japanese poetry, written by hand, generally uses calligraphic script. The characters, while more beautiful, become almost illegible, at least to me. Not only do I have to decipher the meaning I have to decide what part of the squiggles that I am seeing are meaningful and which are not. Similar instances occur when listening to Gregorian chant or Japanese chant - trying to interpret a foreign language that is then given in an unfamilar way.
Given this difficulty in interpretation, any correct diagnosis seems incredible; the odds seem monstrous. Fortunately we have several things on our side: twenty five centuries of medical history to draw upon, and the fact that there is a relatively small pool of common diseases that make it easier to diagnose. On House, of course, these two aspects are shooed away: the medical history is suppressed by the genius of the doctors, since they never consult books or anything else to help aid their memories; and the small pool, since the drama is heightened by the exotic diseases or circumstances used.
The drama is also elevated by the strategy of having some patients die. Here the difference between television and reality must certainly step in. Most people survive on House. Surely, most people with the diseases presented on House die in real life. But let's leave the difference aside for a moment. Assume that a single case happens in real life the way it happens on television - the same race against time, the same difficulties in diagnosis, and eventually, the same victory. What does that say about humanity?
Pascal said that a man is a reed, weaker than anything in the universe, but that he is a thinking reed, which makes him better than the whole universe. We are cut down by so much, but we have learned nearly as much as we have lost. Our mistakes, on certain fronts, become fewer and less severe as time goes on and we learn from them. It's true that we will never be able to solve every problem, but it is enlightening, when we despair of solving anything, to look back and see how much we have solved.
On Pain
The existence of pain and suffering is a fundamental question for all. A time of grief or despair is one of the few instances where individuals almost universally come to grasp questions that they may have previously scorned. Why did this have to happen? Why does this happen to me? These searches for reason in what, to an objective eye, seems to be chaos is often the first steps to philosophy or religion. But for religion itself it poses a problem: the objection from time immemorial against theology: if God existed, is good, and is supremely powerful, why is there evil in the world? And, related, why is there suffering?
This question drives
The Problem of Pain, one of the most memorable books penned by C.S. Lewis. It is a book that has often given me questions to grapple with, because in the end no answer satisfies. Hume pointed it out reasonably. We have three positions: God is all-beneficent; God is willing to intervene for the good; and evil exists in the world. Logically we cannot hold all three positions, and so either our idea of God needs to be altered or God does not exist. Evil is far too prevalent to consider the other alternative seriously. Hume, not being well read in the history of philosophy, missed out on Augustine's theodical answer to this problem. First, evil is privation and cannot be said to
exist in the proper sense. Second, God can be willing to act but still refrain from doing so if he has an sufficient moral reason for holding back. For Augustine, this reason is free will; God would be violating our autonomy if He were to directly prevent evil from happening.
These arguments are related to but not connected to the problem of suffering. Evil is theologically important for all who are not salvational universalists. The existence (or persistence) of evil is a prerequisite for the idea that some humans or angels may not reach paradise. Suffering does not have this theological importance. Where the thought argument of a created world without evil is impossible to conceive, the idea of a world without pain is relatively easy. One could imagine a world without pain to still have evil. Why, then, we ask the author of theodicy, did and does God allow suffering?
C.S. Lewis answers, in a nutshell, that suffering is necessary in order to stimulate humans to maturity. Pain is a learning experience. This has always come across two ways in my mind. Sometimes it seems eminently plausible. Other times, it seems like a cheap cop-out. I waver between thinking that pain can actually cause one to mature and thinking that suffering merely dulls the spirit and mind. Here, I think it is quite legitimate to ask: surely God could have come up with something better to teach us with? Surely there is some other way of becoming the type of person we need to be? Perhaps one could argue the same way as utilized against the equivalent problem of evil: any other learning mechanism, at least any other that was more effective, would violate our free will again. God is determined to hide, it seems, as frustrating as it may seem to some of us.
There is an old story that came up from the Cabbalist tradition. Two rabbis, one young and impetuous, the other old and seasoned, begin debating some theological matter. For hours their arguments are considered and attacked, and as a crowd gathers it seems like both of them have an equal grasp on the situation, both of them have the scriptural knowledge to face any objection. Finally, though, the elder draws his trump card. "May God bring lightning if my position is correct." And God answers with lightning. As the crowd begins to realize the significance, the younger rabbi remains unperterbed. "Is it not written," he asks, "that no one shall interupt two rabbis while in discussion of the scriptures?" And a voice from heaven cries out that the young rabbi is in the right.
The idea is that God is not looking for slavish, passive worshippers. As C.S. Lewis writes in the
Screwtape Letters, He wants saints, gods like himself. Is hiding away and prodding us with random bouts of suffering the best way to bring this across?
Sometimes I think that I finally have something that I understand. It usually does not take much to have that happy, naive view come tumbling down around me. But understanding is not a prerequisite for obedience, whether you believe it to be obedience to God's wishes or obedience to your own conscience, striving to make you a better person. And obedience to others does bring about changes, which does require some measure of pain: think of the value of boot camp, or more poetically the fire which cooks the clay into a meaningful form. Pain comes when we have to give up something which we hold dear to ourselves, something we think we own. The idea of ownership is one of the most corrosive and dangerous ideas morality has to face down. Reason, spirituality, or common sense experience all tell us that we can never own anything permanently. Everything can be taken from us. Relinquishing this idea of ownership, this conception that
X is mine empties places where pain can take hold. This is the polar opposite of becoming numb, cutting oneself off from feeling. It is something far greater: losing our fragile ego in order to become something more.
I will miss you, friend.
