by John Berger
It is the same in life. A man’s death makes everything certain about him. Of course, secrets may die with him. And of course, a hundred years later somebody looking through some papers may discover a fact which throws a totally different light on his life and of which all the people who attended his funeral were ignorant. Death changes the facts qualitatively but not quantitatively. One does not know more facts about a man because he is dead. But what one already knows hardens and becomes definite. We cannot hope for ambiguities to be clarified, we cannot hope for further change, we cannot hope for more. We are now the protagonists and we have to make up our minds.
And so if Sassall were dead, I would have written an essay which risked far less speculation. Partly because I would have wanted to write a more precise memoir of him, to preserve his likeness. But also because when writing about him I would not have been aware – as I am now and have been every moment of writing – of the process of his life continuing – unfixed, mysterious, only half conscious of its own ends. If he were dead, I would conclude this essay as death concluded his life. Without sentimentality and without religious intimations, I would have wanted him to rest, at least on these final pages, in peace.
As it is, Sassall is alive and working, and my speculations have paralleled the process of his continuing life – anxious to see the maximum possible, but inevitably half-blind, like an owl in bright daylight. Too blind to see the conclusion for certain, aware only of the alternatives.
There is another factor which makes it almost impossible to conclude this essay. It is hard to write about it without making sweeping generalizations about our society and then having to justify these generalizations so that finally one is led too far from the subject in hand.
I must try to be simple. There are such things as national or social crises of such an order that they test all those who live through them. They are moments of truth in which, not everything, but a great deal is revealed about individuals, classes, institutions, leaders. The world at large does not usually appreciate or understand these revelations: but for all those who belong to the society or country in question their importance and meaning are quite clear. Even those who as a result of the crisis find themselves in total and lasting opposition to one another will nevertheless agree that what was revealed in the moment of truth was undeniable.
The word moments should not be taken too literally. The crisis may last for days, weeks, occasionally years. It was like this in Dublin in 1916.
MacDonagh and MacBride
And Connolly and Pearse
Now and in time to be,
Whenever green is worn,
Are changed, changed utterly:
A terrible beauty is born.7
It was like this in France in 1940 after the capitulation, in Budapest in 1956, in Algeria during the war of liberation, in Cuba when Castro landed for the second time in 1959.
If one were writing about a man who had lived through such a crisis and been illuminated by it, it would be much easier to see at least part of his life in perspective, to recognize his historic role. If one’s readers had lived through the same crisis, it would also be very much easier for them to understand the value ascribed to this role. To say to a Frenchman who lived through the Occupation that X was in the Resistance or was friendly to the Resistance, or that Y was a collaborateur, is to say something about the meaning of X’s or Y’s whole life.
Sassall has lived through no such crisis. He fought in the war. But for Britain the Second World War did not constitute a crisis of this order. In a crisis that reveals and tests in the way I am suggesting, every man has to choose for himself. By choosing for himself he is then unequivocally committed with all the others who have chosen likewise. It is as though at a given moment each individual were waylaid by the historical process of which he is a part and forced to declare himself. In Britain in the Second World War, we only had to endorse a choice which had been officially made, and was daily justified officially, on our behalf.
Since the war, during the last twenty years, we have lived through a period which must be reckoned as an exact and prolonged antithesis to a moment of truth. We have exercised no choice at all. Certain fundamental political decisions have been taken in our name – without ever being presented to us as a matter of choice. We have accepted them as inevitable or with marginal protest. The Opposition in Parliament is only an opposition about details: fundamentally the two effective political parties are agreed. We have been spared the obligation to commit ourselves to a choice concerning any of the issues which occupy three-quarters of the world as matters of life and death: such issues as racial equality, the right to national and economic independence, the ending of class exploitation, the struggle for freedom (and survival) in a police state, the abolition of famine, etc. We have our opinions, but these count for little even as between ourselves.
Unaccustomed to choosing, unaccustomed to witnessing the choices of others, we find ourselves without a scale of standards for judging or assessing one another. The only standard which remains is that of personal liking – or its commercial variant, which is Personality.
Many will say that this is our good fortune. I doubt it. Our exemption from having to make choices has been so far at the price of the constant deferment of problems – basically economic ones – which vitally affect our future. We will probably continue to defer them until it is too late. Then we shall suffer our crisis – perhaps in Sassall’s lifetime.
I am aware of most of Sassall’s opinions. I think I can imagine how he might choose in any foreseeable situation. But whether I imagine rightly or wrongly, or whether all the possible situations are foreseeable or not, the point is that any standards for assessing the choice I believe he would make – the choice which may confirm the purpose of his life – are bound at this moment to be subjective, formulating themselves as intimations rather than proper measurements. They are bound to be subjective in this way because in the present situation of exemption and deferment it is only by a personal act of faith and imagination that they can be kept alive at all. Some pay lip-service to a set of objective standards by which historic choices can be judged anywhere in the world: but such people, with wild staring eyes at the window, are all sheltering in various academies of unfelt, dogmatic certainty. By contrast, my intimations, which are felt, can as yet convince nobody – and understandably so. We await the conclusion of the long overture.
Readers who have followed me thus far – to the furthest outskirts of the subject – may now argue: The future has to be problematic: conclude by drawing up the account to date: let it be an admittedly incomplete conclusion.
But here we come to another difficulty. Sassall has practised medicine for twenty-five years. To date he must have treated well over 100,000 cases. This would seem a ‘good’ record. Would it be a less ‘good’ record if he had only treated 10,000? Supposing he is an intelligent but careless doctor – how much must he forfeit from his record for treating one case, ten cases, a hundred cases carelessly? Supposing that he is an intelligent and unusually dedicated doctor, how much must be added to his record? What would his bonus be?
Such accounting seems absurd. Then let us ask: What is the social value of a pain eased? What is the value of a life saved? How does the cure of a serious illness compare in value with one of the better poems of a minor poet? How does making a correct but extremely difficult diagnosis compare with painting a great canvas? Obviously the comparative method is equally absurd.
Should a doctor be judged professionally – by the consistent level of his professional skill? This would seem to make sense in the case of a surgeon, because his tasks, however complex, are limited. They have a beginning and an end and can be checked. A technique, however fine, is always within known bounds. It would be very much more difficult to judge a doctor like Sassall. However, I do not want to complicate the issue. Let us assume that the consistent level of Sassall’s performance as a doctor can be measured as a technique. He can then be grade
d as a technician. Since with his technique he treats illness, and illness requires treatment, his grading as a technician should be able to determine the value of his work.
But could this satisfy us? The value of his capacity rather than the value of what he has really achieved?
Here I imagine readers interrupting: Of course it could not. But the limitation or absurdity of the answers is the result of the way you pose the questions. You cannot expect to evaluate a man’s life’s work as though it were stock in a warehouse. There is no scale of measurement possible.
It is true that my questions cannot be answered satisfactorily. But I was asking them to try to lead you to the point of realizing that we in our society do not know how to acknowledge, to measure the contribution of an ordinary working doctor. By measure I do not mean calculate according to a fixed scale, but, rather, take the measure of. It is not a question of comparing the doctor with the artist or with the airline pilot or with the lawyer or with the political stooge and then arranging them in a winning order. It is a question of comparing them so that in the light of the other examples we can better appreciate what the doctor is (or is not) doing.
When we hear of a team of doctors or biochemists discovering a new cure, we can acknowledge their achievement easily. A new cure contributes to ‘the advance of medicine’. The acknowledgement is easy because the promise of the discovery remains abstract. It can be subsumed under ‘science’ or ‘progress’.
It is a very different matter when we imaginatively try to take the measure of a man doing no more and no less than easing – and occasionally saving – the lives of a few thousand of our contemporaries. Naturally we count it, in principle, a good thing. But fully to take the measure of it, we have to come to some conclusion about the value of these lives to us now.
The doctor is a popular hero: you have only to consider how frequently and easily he is presented as such on television. If his training were not so long and expensive, every mother would be happy for her son to become a doctor. It is the most idealized of all the professions. Yet it is idealized abstractly. Some of the young who decide to become doctors are at first influenced by this ideal. But I would suggest that one of the fundamental reasons why so many doctors become cynical and disillusioned is precisely because, when the abstract idealism has worn thin, they are uncertain about the value of the actual lives of the patients they are treating. This is not because they are callous or personally inhuman: it is because they live in and accept a society which is incapable of knowing what a human life is worth.
It cannot afford to. If it did, it would either have to dismiss this knowledge and with it dismiss all its pretences to democracy and so become totalitarian: or it would have to take account of this knowledge and revolutionize itself. Either way it would be transformed.
Let me be quite clear. I do not claim to know what a human life is worth. There can be no final or personal answer – unless you are prepared to accept the medieval religious one, surviving from the past. The question is social. An individual cannot answer it for himself. The answer resides within the totality of relations which can exist within a certain social structure at a certain time. Finally man’s worth to himself is expressed by his treatment of himself.
But since social development is dialectical and there is always a contradiction between the existing social relations and what is becoming possible, one can sometimes perceive that the existing answer is inadequate for questions raised by certain new developments of activity or thought.
I have never forgotten a paragraph in an essay of Gramsci’s which I first read years ago. He wrote the essay in prison in about 1930.
Thus the problem of what man is is always posed as the problem of so-called ‘human nature’, or of ‘man in general’, the attempt to create a science of man – a philosophy – whose point of departure is primarily based on a ‘unitary idea’, on an abstraction designed to contain all that is ‘human’. But is ‘humanity’, as a reality and as an idea, a point of departure – or a point of arrival?8
Is humanity as a reality and as an idea a point of departure or a point of arrival?
I do not claim to know what a human life is worth – the question cannot be answered by word but only by action, by the creation of a more human society.
All that I do know is that our present society wastes and, by the slow draining process of enforced hypocrisy, empties most of the lives which it does not destroy: and that, within its own terms, a doctor who has surpassed the stage of selling cures, either directly to the patient or through the agency of a state service, is unassessable.
The conclusion is inconclusive and simple. Sassall practises medicine. His practice perhaps corresponds a little to my description of it. Since we have as yet scarcely begun to establish a society which can assess his contribution socially, since we can only judge him, at best, by empirical standards of convenience, I can only end by quoting the logic by which he himself has to work, a logic which for all its stoicism has in it the seed of a great affirmative vision: ‘Whenever I am reminded of death – and it happens every day – I think of my own, and this makes me try to work harder.’
1 I do not attempt in this essay to discuss the role of Sassall’s wife or his children. My concern is his professional life.
2 For the philosophical implication of early medicine see first two volumes of Henry Sigerist’s History of Medicine: vol. I, Primitive and Archaic Medicine (New York: O. U. P., 1951); vol. 2, Early Greek, Hindu, and Persian Medicine (New York: O. U. P., 1961).
3 For a full study of the subject see Michael Balint’s brilliant book The Doctor, His Patient and The Illness (London: Pitman, 1964).
4 My novel Corker’s Freedom (New York: Vintage International, 1995) attempts to illuminate this situation.
5 Nausea. Jean-Paul Sartre (translated by Robert Baldick) (London: Penguin, 2000). The novel was first published in France in 1938.
6 See Jean Piaget, Language and Thought of the Child: 3rd edn (London: Routledge & Kegan Paul, 1959).
7 W. B. Yeats’s poem ‘Easter 1916’.
8 Antonio Gramsci, The Modern Prince and Other Writings (New York: International Publishers).
Afterword
When I wrote the preceding pages – and I’m thinking particularly of the last ones which speak of the impossibility of summing up Sassall’s life and work – I did not know that 15 years later he was going to shoot himself.
Our instant-hedonist culture tends to believe that a deliberate suicide is a negative comment. What went wrong? It naively asks. Yet suicide does not necessarily constitute a criticism of the life being ended; it may belong to that life’s destiny. This was the tragic Greek view.
John the man I loved killed himself. And, yes, his death has changed the story of his life. It has made it more mysterious. Not darker. I see as much light there as before. And standing before him, I do not search for what I might have foreseen and didn’t – as if the essential was missing from what passed between us; rather I now begin with his violent death, and, from it, look back with increased tenderness on what he set out to do and what he offered to others, for as long as he could endure.
1999
