{"id":115,"date":"2019-07-02T20:42:13","date_gmt":"2019-07-02T20:42:13","guid":{"rendered":"http:\/\/www.heartlandspiritinc.org\/?p=115"},"modified":"2019-11-11T15:33:35","modified_gmt":"2019-11-11T15:33:35","slug":"health-is-membership","status":"publish","type":"post","link":"https:\/\/www.heartlandspiritinc.org\/?p=115","title":{"rendered":"Health Is Membership"},"content":{"rendered":"\n

Health is Membership
\nby Wendell Berry <\/strong><\/p>\n\n\n\n


\nDelivered as a speech at a conference, “Spirituality and Healing”, at\nLouisville, Kentucky, on October 17, 1994
\n
\nFrom our constant and increasing concerns about health, you can tell how\nseriously diseased we are. Health, as we may remember from at least some of the\ndays of our youth, is at once wholeness and a kind of unconsciousness. Disease\n(dis-ease), on the contrary, makes us conscious not only of the state of our\nhealth but of the division of our bodies and our world into parts.
\n
\nThe word “health,” in fact, comes from the same Indo-European root as\n“heal,” “whole,” and “holy” To be healthy is\nliterally to be whole; to heal is to make whole. I don’t think mortal healers\nshould be credited with the power to make holy. But I have no doubt that such\nhealers are properly obliged to acknowledge and respect the holiness embodied\nin all creatures, or that our healing involves the preservation in us of the\nspirit and the breath of God.
\n
\nIf we were lucky enough as children to be surrounded by grown-ups who loved us,\nthen our sense of wholeness is not just the sense of completeness in ourselves\nbut also is the sense of belonging to others and to our place; it is an\nunconscious awareness of community, of having in common. It may be that this\ndouble sense of singular integrity and of communal belonging is our personal\nstandard of health for as long as we live. Anyhow, we seem to know\ninstinctively that health is not divided.
\n
\nOf course, growing up and growing older as fallen creatures in a fallen world\ncan only instruct us painfully in division and disintegration. This is the\nstuff of consciousness and experience. But if our culture works in us as it\nshould, then we do not age merely into disintegration and division, but that\nvery experience begins our education, leading us into knowledge of wholeness\nand of holiness. I am describing here the story of Job, of Lazarus, of the lame\nman at the pool of Bethesda, of Milton’s Samson, of King Lear. If our culture\nworks in us as it should, our experience is balanced by education; we are led\nout of our lonely suffering and are made whole.
\n
\nIn the present age of the world, disintegration and division, isolation and suffering\nseem to have overwhelmed us. The balance between experience and education has\nbeen overthrown, we are lost in experience, and so-called education is leading\nus nowhere. We have diseases aplenty. As if that were not enough, we are\nsuffering an almost universal hypochondria. Half the energy of the medical\nindustry, one suspects, may now be devoted to “examinations” or\n“tests”-to see if, though apparently well, we may not be latently or\ninsidiously diseased.
\n
\nIf you are going to deal with the issue of health in the modern world, you are\ngoing to have to deal with much absurdity. It is not clear, for example, why\ndeath should increasingly be looked upon as a curable disease, an abnormality,\nby a society that increasingly looks upon life as insupportably painful and\/or\nmeaningless. Even more startling is the realization that the modern medical\nindustry faithfully imitates disease in the way that it isolates us and parcels\nus out. If, for example, intense and persistent pain causes you to pay\nattention only to your stomach, then you must leave home, community, and family\nand go to a sometimes distant clinic or hospital, where you will be cared for\nby a specialist who will pay attention only to your stomach.
\n
\nOr consider the announcement by the Associated Press on February 9, 1994, that\n“the incidence of cancer is up among all ages, and researchers speculated\nthat environmental exposure to cancer-causing substances other than cigarettes\nmay be partly to blame.” This bit of news is offered as a surprise, never\nmind that the environment (so called) has been known to be polluted and toxic\nfor many years. The blame obviously falls on that idiotic term “the\nenvironment,” which refers to a world that surrounds us but is presumably\ndifferent from us and distant from us. Our laboratories have proved long ago\nthat cigarette smoke gets inside us, but if “the environment”\nsurrounds us, how does it wind up inside us? So much for division as a working\nprinciple of health.
\n
\nThis, plainly, is a view of health that is severely reductive. It is, to begin\nwith, almost fanatically individualistic. The body is seen as a detective or\npotentially defective machine, singular, solitary, and displaced, without love,\nsolace, or pleasure. Its health excludes unhealthy cigarettes but does not\nexclude unhealthy food, water, and air. One may presumably be healthy in a\ndisintegrated family or community or in a destroyed or poisoned ecosystem.
\n
\nWe speak now of “spirituality and healing” as if the only way to\nrender a proper religious respect to the body is somehow to treat it\n“spiritually.” It could be argued just as appropriately (and perhaps\nless dangerously) that the way to respect the body fully is to honor fully its\nmateriality. In saying this, I intend no reduction. I do not doubt the reality\nof the experience and knowledge we call “spiritual” any more than I\ndoubt the reality of so-called physical experience and knowledge; I recognize\nthe rough utility of these terms. But I strongly doubt the advantage, and even\nthe possibility, of separating these two realities.
\n
\nWhat I’m arguing against here is not complexity or mystery but dualism. I would\nlike to purge my own mind and language of such terms as “spiritual,”\n“physical,” “metaphysical,” and “transcendental”-all\nof which imply that the Creation is divided into “levels” that can\nreadily be peeled apart and judged by human beings. I believe that the Creation\nis one continuous fabric comprehending simultaneously what we mean by\n“spirit” and what we mean by “matter.”
\n
\nOur bodies are involved in the world. Their needs and desires and pleasures are\nphysical. Our bodies hunger and thirst, yearn toward other bodies, grow tired\nand seek rest, rise up rested, eager to exert themselves. All these desires may\nbe satisfied with honor to the body and its maker, but only if much else\nbesides the individual body is brought into consideration. We have long known\nthat individual desires must not be made the standard of their own satisfaction.\nWe must consider the body’s manifold connections to other bodies and to the\nworld. The body, “fearfully and wonderfully made,” is ultimately\nmysterious both in itself and in its dependences. Our bodies live, the Bible\nsays, by the spirit and the breath of God, but it does not say how this is so.\nWe are not going to know about this.
\n
\nThe distinction between the physical and the spiritual is, I believe, false. A\nmuch more valid distinction, and one that we need urgently to learn to make, is\nthat between the organic and the mechanical. To argue this-as I am going to\ndo-puts me in the minority, I know, but it does not make me unique. In The Idea\nOf A Christian Society, T S Eliot wrote, “We may say that religion, as\ndistinguished from modern paganism, implies a life in conformity with nature.\nIt may be observed that the natural life and the supernatural life have a\nconformity to each other which neither has with the mechanistic life.”
\n
\nStill, l wonder if our persistent wish to deal spiritulally with physical things\ndoes not come either from the feeling that physical things are “low”\nand unworthy or from the fear, especially when speaking of affection, that\n“physical” will be taken to mean “sexual.”The New York Review\nof Books of February 3, 1994, for example, carried a review of the\ncorrespondence of William and Henry James along with a photograph of the two\nbrothers standing together with William’s arm around Henry’s shoulders. Apropos\nof this picture, the reviewer, John Bayley, wrote that “their closeness of\naffection was undoubted and even took on occasion a quasi-physical form.”\nIt is Mr. Bayley’s qualifier, “quasi-physical,” that sticks in one’s\nmind. What can he have meant by it? Is this prurience masquerading as\nsqueamishness, or vice versa? Does Mr. Bayley feel a need to assure his\npsychologically sophisticated readers that even though these brothers touched\none another familiarly, they were not homosexual lovers?
\n
\nThe phrase involves at least some version of the old dualism of spirit and body\nor mind and body that has caused us so much suffering and trouble and that\nraises such troubling questions for anybody who is interested in health. If you\nlove your brother and if you and your brother are living creatures, how could\nyour love for him not be physical? Not spiritual or mental only, not\n“quasi-physical,” but physical. How could you not take a simple\npleasure in putting your arm around him?
\n
\nOut of the same dualism comes our confusion about the body’s proper involvement\nin the world. People seriously interested in health will finally have to\nquestion our society’s long-standing goals of convenience and effortlessness.\nWhat is the point of “labor saving” if by making work effortless we\nmake it poor, and if by doing poor work we weaken our bodies and lose conviviality\nand health?
\n
\nWe are now pretty clearly involved in a crisis of health, one of the wonders of\nwhich is its immense profitability both to those who cause it and to those who\npropose to cure it. That the illness may prove incurable, except by catastrophe,\nis suggested by our economic dependence on it. Think, for example, of how\nreadily our solutions become problems and our cures pollutants. To cure one\ndisease, we need another. The causes, of course, are numerous and complicated,\nbut all of them, I think, can be traced back to the old idea that our bodies\nare not very important except when they give us pleasure (usually, now, to\nsomebody’s profit) or when they hurt (now, almost invariably, to somebody’s\nprofit).
\n
\nThis dualism inevitably reduces physical reality, and it does so by removing\nits mystery from it, by dividing it absolutely from what dualistic thinkers\nhave understood as spiritual or mental reality.
\n
\nA reduction that is merely theoretical might be harmless enough, I suppose, but\ntheories find ways of getting into action. The theory of the relative\nunimportance of physical reality has put itself into action by means of a\nmetaphor by which the body (along with the world itself ) is understood as a\nmachine. According to this metaphor-which is now in constant general use-the\nhuman heart, for example, is no longer understood as the center of our\nemotional life or even as an organ that pumps; it is understood as “a\npump,” having somewhat the same function as a fuel pump in an\nautomobile.If the body is a machine for living and working, then it must follow\nthat the mind is a machine for thinking. The “progress” here is the\nreduction of mind to brain and then of brain to computer. This reduction\nimplies and requires the reduction of knowledge to “information.” It\nrequires, in fact, the reduction of everything to numbers and mathematical\noperations.
\n
\nThis metaphor of the machine bears heavily upon the question of what we mean by\nhealth and by healing. The problem is that like any metaphor, it is accurate only\nin some respects. A girl is only in some respects like a red rose; a heart is\nonly in some respects like a pump. This means that a metaphor must be\ncontrolled by a sort of humorous intelligence, always mindful of the exact\nlimits within which the comparison is meaningful. When a metaphor begins to\ncontrol intelligence, as this one of the machine has done for a long time, then\nwe must look for costly distortions and absurdities. Of course, the body in\nmost ways is not at all like a machine. Like all living creatures and unlike a\nmachine, the body is not formally self-contained; its boundaries and out-lines\nare not so exactly fixed. The body alone is not, properly speaking, a body.\nDivided from its sources of air, food, drink, clothing, shelter, and companionship,\na body is, properly speaking, a cadaver, whereas a machine by itself, shut down\nor out of fuel, is still a machine. Merely as an organism (leaving aside issues\nof mind and spirit) the body lives and moves and has its being, minute by\nminute, by an interinvolvement with other bodies and other creatures, living\nand unliving, that is too complex to diagram or describe. It is, moreover,\nunder the influence of thought and feeling. It does not live by\n“fuel” alone.
\n
\nA mind, probably, is even less like a computer than a body is like a machine.\nAs far as I am able to understand it, a mind is not even much like a brain.\nInsofar as it is usable for thought, for the association of thought with\nfeeling, for the association of thoughts and feelings with words, for the\nconnections between words and things, words and acts, thought and memory, a\nmind seems to be in constant need of reminding. A mind unreminded would be no\nmind at all. This phenomenon of reminding shows the extensiveness of mind-how\nintricately it is involved with sensation, emotion, memory, tradition, communal\nlife, known landscapes, and so on. How you could locate a mind within its full\nextent, among all its subjects and necessities, I don’t know, bur obviously it\ncannot be located within a brain or a computer.
\n
\nTo see better what a mind is (or is not), we might consider the difference\nbetween what we mean by knowledge and what the computer now requires us to mean\nby “information.” Knowledge refers to the ability to do or say the\nright thing at the right time; we would not speak of somebody who does the\nwrong thing at the wrong time as “knowledgeable.” People who perform\nwell as musicians, athletes, teachers, or farmers are people of knowledge. And\nsuch examples tell us much about the nature of knowledge. Knowledge is formal,\nand it informs speech and action. It is instantaneous; it is present and\navailable when and where it is needed.
\n
\n“Information,” which once meant that which forms or fashions from\nwithin, now means merely “data.” However organized this data may be,\nit is not shapely or formal or in the true sense in-forming. It is not present\nwhere it is needed; if you have to “access” it, you don’t have it.\nWhereas knowledge moves and forms acts, information is inert. You cannot\nimagine a debater or a quarterback or a musician performing by “accessing\ninformation.” A computer chock full of such information is no more\nadmirable than a head or a book chock full of it.
\n
\nThe difference, then, between information and knowledge is something like the\ndifference between a dictionary and somebody’s language.
\n
\nWhere the art and science of healing are concerned, the machine metaphor works\nto enforce a division that falsifies the process of healing because it\nfalsifies the nature of the creature needing to be healed. If the body is a\nmachine, then its diseases can be healed by a sort of mechanical tinkering,\nwithout reference to anything outside the body itself. This applies, with\nobvious differences, to the mind; people are assumed to be individually sane or\ninsane. And so we return to the utter anomaly of a creature that is healthy\nwithin itself.
\n
\nThe modem hospital, where most of us receive our strictest lessons in the\nnature of industrial medicine, undoubtedly does well at surgery and other\nprocedures that permit the body and its parts to be treated as separate things.\nBut when you try to think of it as a place of healing-of reconnecting and\nmaking whole-then the hospital reveals the disarray of the medical industry’s\nthinking about health.
\n
\nIn healing, the body is restored to itself. It begins to live again by its own\npowers and instincts, to the extent that it can do so. To the extent that it\ncan do so, it goes free of drugs and mechanical helps. Its appetites return. It\nrelishes food and rest. The patient is restored to family and friends, home and\ncommunity and work.
\n
\nThis process has a certain naturalness and inevitability, like that by which a\nchild grows up, but industrial medicine seems to grasp it only tentatively and\nawkwardly. For example, any ordinary person would assume that a place of\nhealing would put a premium upon rest, but hospitals are notoriously difficult\nto sleep in. They are noisy all night, and the routine interventions go on\nrelentlessly. The body is treated as a machine that does nor need to rest.
\n
\nYou would think also that a place dedicated to healing and health would make\nmuch of food. But here is where the disconnections of the industrial system and\nthe displacement of industrial humanity are most radical. Sir Albert Howard saw\naccurately that the issue of human health is inseparable from the health of the\nsoil, and he saw too that we humans much responsibly occupy our place in the\ncycle of birth, growth, maturity, death, and decay, which is the health of the\nworld. Aside from our own mortal involvement, food is our fundamental\nconnection to that cycle. But probably most of the complaints you hear about\nhospitals have to do with the food, which, according to the testimony I have\nheard, tends to range from unappetizing to sickening. Food is treated as\nanother unpleasant substance to inject. And this is a shame. For in addition to\nthe obvious nutritional link between food and health, food can be a pleasure.\nPeople who are sick are often troubled or depressed, and mealtimes offer three\nopportunities a day when patients could easily be offered something to look\nforward to. Nothing is more pleasing or heartening than a plate of nourishing,\ntasty, beautiful food artfully and lovingly prepared.
\n
\nAnything less is unhealthy, as well as a desecration.Why should rest and food\nand ecological health not be the basic principles of our art and science of\nhealing? Is it because the basic principles already are technology and drugs?\nAre we confronting some fundamental incompatibility between mechanical effciency\nand organic health? I don’t know. I only know that sleeping in a hospital is\nlike sleeping in a factory and that the medical industry makes only the most\ntenuous connection between health and food and no connection between health and\nthe soil. Industrial medicine is as little interested in ecological health as\nis industrial agriculture.
\n
\nA further problem, and an equally serious one, is that illness, in addition to\nbeing a bodily disaster, is now also an economic disaster. This is so whether\nor not the patient is insured. It is a disaster for us all, all the time, because\nwe all know that personally or collectively, we cannot continue to pay for\ncures that continue to get more expensive. The economic disturbance that now\ninundates the problem of illness may turn out to be the profoundest illness of\nall. How can we get well if we are worried sick about money?
\n
\nI wish it were not the fate of this essay to be filled with questions, but\nquestions now seem the inescapable end of any line of thought about health and\nhealing. Here are several more:
\n1. Can our present medical industry produce an adequate definition of health?\nMy own guess is that it cannot do so. Like industrial agriculture, industrial\nmedicine has depended increasingly on specialist methodology, mechanical\ntechnology, and chemicals; thus, its point of reference has become more and\nmore its own technical prowess and less and less the health of creatures and\nhabitats. I don’t expect this problem to be solved in the universities, which\nhave never addressed, much less solved, the problem of health in agriculture. And\nI don’t expect it to be solved by the government.
\n2. How can cheapness be included in the criteria of medical experimentation and\nperformance? And why has it not been included before now? I believe that the\nproblem here is again that of the medical industry’s fixation on\nspecialization, technology, and chemistry. As a result, the modern “health\ncare system” has become a way of marketing industrial products, exactly\nlike modern agriculture, impoverishing those who pay and enriching those who\nare paid. It is, in other words, an industry such as industries have always\nbeen.
\n3. Why is it that medical strictures and recommendations so often work in favor\nof food processors and against food producers? Why, for example, do we so\nstrongly favor the pasteurization of milk to health and cleanliness in milk\nproduction? (Gene Logsdon correctly says that the motive here “is\nmonopoly, not consumer’s health.”)
\n4. Why do we so strongly prefer a fat-free or gem-free diet to a chemical-free\ndiet? Why does the medicine industry strenuously oppose the use of tobacco, yet\ncomplacently accept the massive use of antibiotics and other drugs in meat\nanimals and of poison on food crops? How much longer can it cling to the\nsuperstition of bodily health in a polluted world?
\n5. How can adequate medical and health care, including disease prevention, be\nincluded in the structure and economy of a community? How, for example can a\ncommunity and its doctors be included in the same culture, the same knowledge\nand the same fate, so that they will live as fellow citizens, sharers in the\ncommon wealth, members of one another?<\/p>\n\n\n\n

II<\/strong><\/p>\n\n\n\n

It is clear by now that this\nessay cannot hope to be complete; the problems are too large and my knowledge\ntoo small. What I have to offer is an association of thoughts and questions\nwandering somewhat at random and somewhat lost within the experience of modem\ndiseases and the often bewildering industry that undertakes to cure them. In my\nignorance and bewilderment, I am fairly representative of those who go, or go\nwith loved ones, to doctors’ offices and hospitals. What I have written so far\ncomes from my various efforts to make as much sense as I can of that\nexperience. But now I had better turn to the experience itself.
\n
\nOn January 3,1994, my brother John had a severe heart attack while he was out\nby himself on his farm, moving a feed trough. He managed to get to the house\nand telephone a friend, who sent the emergency rescue squad.
\n
\nThe rescue squad and the emergency room staff at a local hospital certainly\nsaved my brother’s life. He was later moved to a hospital in Louisville, where\na surgeon performed a double-bypass operation on his heart. After three weeks\nJohn returned home. He still has a life to live and work to do. He has been\nrestored to himself and to the world.
\n
\nHe and those who love him have a considerable debt to the medical industry, as\nrepresented by two hospitals, several doctors and nurses, many drugs and many\nmachines. This is a debt that I cheerfully acknowledge. But I am obliged to say\nalso that my experience of the hospital during John’s stay was troubled by much\nconflict of feeling and a good many unresolved questions, and I know that I am\nnot alone in this.
\n
\nIn the hospital what I will call the world of love meets the world of\nefficiency-the world, that is, of specialization, machinery, and abstract\nprocedure. Or, rather, I should say that these two worlds come together in the\nhospital but do not meet. During those weeks when John was in the hospital, it\nseemed to me that he had come from the world of love and that the family\nmembers, neighbors, and friends who at various times were there with him came\nthere to represent that world and to preserve his connection with it. It seemed\nto me that the hospital was another kind of world altogether.
\n
\nWhen I said early in this essay that we live in a world that was created and\nexists and is redeemable by love, I did not mean to sentimentalize it. For this\nis also a fallen world. It involves error and disease, ignorance and\npartiality, sin and death. If this world is a place where we may learn of our\ninvolvement in immortal love, as I believe it is, still such learning is only\npossible here because that love involves us so inescapably in the limits,\nsufferings, and sorrows of mortality.
\n
\nLike divine love, earthly love seeks plenitude; it longs for the full\nmembership to be present and to be joined. Unlike divine love, earthly love\ndoes not have the power, the knowledge, or the will to achieve what it longs\nfor. The story of human love on this earth is a story by which this love\nreveals and even validates itself by its failures to be complete and\ncomprehensive and effective enough. When this love enters a hospital, it brings\nwith it a terrifying history of defeat, but it comes nevertheless confident of\nitself, for its existence and the power of its longing have been proved over\nand over again even by its defeat. In the face of illness, the threat of death,\nand death itself, it insists unabashedly on its own presence, understanding by\nits persistence through defeat that it is superior to whatever happens.
\n
\nThe world of efficiency ignores both loves, earthly and divine, because by\ndefinition it must reduce experience to computation, particularity to abstraction,\nand mystery to a small comprehensibility. Efficiency, in our present sense of\nthe word, allies itself inevitably with machinery, as Neil Postman demonstrates\nin his useful book, Technopoly. “Machines,” he says, “eliminate\ncomplexity, doubt, and ambiguity. They work swiftly, they are standardized, and\nthey provide us with numbers that you can see and calculate with.” To\nreason, the advantages are obvious, and probably no reasonable person would\nwish to reject them out of hand.
\n
\nAnd yet love obstinately answers that no loved one is standardized. A body,\nlove insists, is neither a spirit nor a machine; it is not a picture, a\ndiagram, a chart, a graph, an anatomy; it is not an explanation; it is not a\nlaw. It is precisely and uniquely what it is. It belongs to the world of love,\nwhich is a world of living creatures, natural orders and cycles, many small,\nfragile lights in the dark.
\n
\nIn dealing with problems of agriculture, I had thought much about the\ndifference between creatures and machines. But I had never so clearly\nunderstood and felt that difference as when John was in recovery after his\nheart surgery, when he was attached to many machines and was dependent for\nbreath on a respirator. It was impossible then not to see that the breathing of\na machine, like all machine work, is unvarying, an oblivious regularity, whereas\nthe breathing of a creature is ever changing, exquisitely responsive to events\nboth inside and outside the body, to thoughts and emotions. A machine makes\nbreaths as a machine makes buttons, all the same, but every breath of a\ncreature is itself a creature, like no other, inestimably precious.
\n
\nLogically, in plenitude some things ought to be expendable. Industrial\neconomics has always believed this: abundance justifies waste. This is one of\nthe dominant superstitions of American history-and of the history of\ncolonialism everywhere. Expendability is also an assumption of the world of\nefficiency, which is why that world deals so compulsively in percentages of\nefficacy and safety.
\n
\nBut this sort of logic is absolutely alien to the world of love. To the claim\nthat a certain drug or procedure would save 99 percent of all cancer patients\nor that a certain pollutant would be safe for 99 percent of a population, love,\nunembarrassed, would respond, “What about the one percent?”
\n
\nThere is nothing rational or perhaps even defensible about this, but it is\nnonetheless one of the strongest strands of our religious tradition-it is\nprobably the most essential strand-according to which a shepherd, owning a\nhundred sheep and having lost one, does not say, “I have saved 99 percent\nof my sheep,” but rather, “I have lost one,” and he goes and\nsearches for the one. And if the sheep in that parable may seem to be only a\nmetaphor, then go on to the Gospel of Luke, where the principle is flatly set\nforth again and where the sparrows stand not for human beings but for all\ncreatures: “Are not five sparrows sold for two farthings, and not one of\nthem is forgotten before God?” And John Donne had in mind a sort of equation\nand not a mere metaphor when he wrote, “If a clod be washed away by the\nsea, Europe is the less, as well as if a promontory were, as well as if a manor\nof thy friends or of thine own were. Any man’s death diminishes me.”
\n
\nIt is reassuring to see ecology moving toward a similar idea of the order of\nthings. If an ecosystem loses one of its native species, we now know that we\ncannot speak of it as itself minus one species. An ecosystem minus one species\nis a different ecosystem. Just so, each of us is made by-or, one might better\nsay, made as-a set of unique associations with unique persons, places, and\nthings. The world of love does not admit the principle of the\ninterchangeability of parts.
\n
\nWhen John was in intensive care after his surgery, his wife, Carol, was\nstanding by his bed, grieving and afraid. Wanting to reassure her, the nurse\nsaid, “Nothing is happening to him that doesn’t happen to everybody.”
\nAnd Carol replied, “I’m not everybody’s wife.”
\n
\nIn the world of love, things separated by efficiency and specialization strive\nto come back together. And yet love must confront death, and accept it, and\nlearn from it. Only in confronting death can earthly love learn its true\nextent, its immortality. Any definition of health that is not silly must include\ndeath. The world of love includes death, suffers it, and triumphs over it. The\nworld of efficiency is defeated by death; at death, all its instruments and\nprocedures stop. The world of love continues, and of this grief is the proof.
\n
\nIn the hospital, love cannot forget death. But like love, death is in the\nhospital but not of it. Like love, fear and grief feel out of place in the\nhospital. How could they be included in its efficient procedures and\nmechanisms? Where a clear, small order is fervently maintained, tear and grief\nbring the threat of large disorder.
\n
\nAnd so these two incompatible worlds might also be designated by the terms\n“amateur” and “professional”-amateur, in the literal sense\nof lover, one who participates for love; and professional in the modern sense\nof one who performs highly specialized or technical procedures for pay. The\namateur is excluded from the professional “field.”
\n
\nFor the amateur, in the hospital or in almost any other encounter with the\nmedical industry, the overriding experience is that of being excluded from\nknowledge of being unable, in other words, to make or participate in anything\nresembling an “informed decision.” Of course, whether doctors make\ninformed decisions in the hospital is a matter of debate. For in the hospital\neven the professionals are involved in experience; experimentation has been\nleft far behind. Experience, as all amateurs know, is not predictable, and in\nexperience there are no replications or “controls”; there is nothing\nwith which to compare the result. Once one decision has been made, we have\ndestroyed the opportunity to know what would have happened if another decision\nhad been made. That is to say that medicine is an exact science until applied;\napplication involves intuition, a sense of probability, “gut feeling,\n” guesswork, and error.
\n
\nIn medicine, as in many modern disciplines, the amateur is divided from the\nprofessional by perhaps unbridgeable differences of knowledge and of language.\nAn “informed decision” is really not even imaginable for most medical\npatients and their families, who have no competent understanding of either the\npatients illness or the recommended medical or surgical procedure. Moreover,\npatients and their families are not likely to know the doctor, the surgeon, or\nany of the other people on whom the patient’s life will depend. In the hospital,\namateurs are more than likely to be proceeding entirely upon faith-and this is\na peculiar and scary faith, for it must be placed not in a god but in mere\npeople, mere procedures, mere chemicals, and mere machines.
\n
\nIt was only after my brother had been taken into surgery, I think, that the\nfamily understood the extremity of this deed of faith. We had decided – or John\nhad decided and we had concurred on the basis of the best advice available. But\nonce he was separated from us, we felt the burden of our ignorance. We had not\nknown what we were doing, and one of our difficulties now was the feeling that\nwe had utterly given him up to what we did not know. John himself spoke out of\nthis sense of abandonment and helplessness in the intensive care unit, when he\nsaid, “I don’t know what they’re going to do to me or for me or with\nme.”
\n
\nAs we waited and reports came at long intervals from the operating room, other\nrealizations followed. We realized that under the circumstances, we could not\nbe told the truth. We would not know, ever, the worries and surprises that came\nto the surgeon during his work. We would not know the critical moments or the\nfears. lf the surgeon did any part of his work ineptly or made a mistake, we\nwould not know it. We realized, moreover, that if we were told the truth, we\nwould have no way of knowing that the truth was what it was.
\n
\nWe realized that when the emissaries from the operating room assured us that\neverything was ‘”normal” or “routine,” they were referring\nto the procedure and not the patient. Even as amateurs – perhaps<\/em> because\nwe were amateurs-we knew that what was happening was not normal or routine for\nJohn or for us.
\n
\nThat these two worlds are so radically divided does not mean that people cannot\ncross between them. I do not know how an amateur can cross over into the\nprofessional world; that does not seem very probable. But that professional\npeople can cross back into the amateur world, I know from much evidence. During\nJohn’s stay in the hospital there were many moments in which doctors and nurses\n– especially nurses! – allowed or caused the professional relationship to\nbecome a meeting between two human beings, and these moments were invariably\nmoving.
\n
\nThe most moving, to me, happened in the waiting room during John’s surgery.\nFrom time to time a nurse from the operating room would come in to tell Carol\nwhat was happening. Carol, from politeness or bravery or both, always stood to\nreceive the news, which always left us somewhat encouraged and somewhat\ndoubtful. Carol’s difficulty was that she had to suffer the ordeal not only as\na wife but as one who had been a trained nurse. She knew, from her own\neducation and experience, in how limited a sense open-heart surgery could be\nsaid to be normal or – routine.
\n
\nFinally, toward the end of our wait, two nurses came in. The operation, they\nsaid, had been a success. They explained again what had been done. And then\nthey said that after the completion of the bypasses, the surgeon had found it\nnecessary to insert a “balloon pump” into the aorta to assist the\nheart. This possibility had never been mentioned, nobody was prepared for it,\nand Carol was sorely disappointed and upset. The two young women attempted to\nreassure her, mainly by repeating things they had already said. And then there\nwas a long moment when they just looked at her. It was such a look as parents\nsometimes give to a sick or suffering child, when they themselves have begun to\nneed the comfort they are trying to give.
\n
\nAnd then one of the nurses said, “Do you need a hug?”
\n“Yes,” Carol said.
\nAnd the nurse gave her a hug.
\nWhich brings us to a starting place.
\n
\n
\n
\n
\nWendell Berry is the author of thirty two books of fiction, poetry. and essays,\nincluding Sabbaths; Sex, Economy, Freedom, & Community<\/em>; and What\nAre People For?<\/em> He has farmed a hillside in his native Henry County,\nKentucky, for thirty years. A former professor of English at the University of\nKentucky, he has received numerous awards for his work, including most recentdy\nthe T S. Eliot Award, The Aiken Taylor Award for Poetry, the John Hay Award of\nthe Orion Society, and The Chnstian Century’s<\/em> Award for Excellence in\nPoetry. <\/p>\n\n\n\n

Return to North Glen<\/a>\nor Reading List<\/a>\nor Credo<\/a>
\nAnother Turn of the\nCrank<\/a><\/strong><\/p>\n\n\n\n\n\n

visitors since Jan 8th 1999<\/p>\n","protected":false},"excerpt":{"rendered":"

Health is Membership by Wendell Berry Delivered as a speech at a conference, “Spirituality and Healing”, at Louisville, Kentucky, on October 17, 1994 From our constant and increasing concerns about health, you can tell how seriously diseased we are. Health, as we may remember from at least some of the days of our youth, is … Continue reading Health Is Membership<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-115","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"aioseo_notices":[],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/www.heartlandspiritinc.org\/index.php?rest_route=\/wp\/v2\/posts\/115","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.heartlandspiritinc.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.heartlandspiritinc.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.heartlandspiritinc.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heartlandspiritinc.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=115"}],"version-history":[{"count":1,"href":"https:\/\/www.heartlandspiritinc.org\/index.php?rest_route=\/wp\/v2\/posts\/115\/revisions"}],"predecessor-version":[{"id":116,"href":"https:\/\/www.heartlandspiritinc.org\/index.php?rest_route=\/wp\/v2\/posts\/115\/revisions\/116"}],"wp:attachment":[{"href":"https:\/\/www.heartlandspiritinc.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=115"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.heartlandspiritinc.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=115"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.heartlandspiritinc.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=115"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}