Mortality, Autonomy, and Craft

I have been reading two books lately about two very different topics that engage the same basic question: How can we act as genuine individuals in a society that treats us all as interchangeable consumers of goods and services? One, that spoke directly to themes in Sawdust and Soul, was The World Beyond Your Head: On Becoming an Individual in an Age of Distraction, by Matthew Crawford. His earlier book, Shop Class as Soul Craft had caught my imagination and I wanted to follow up on that theme. The other was Being Mortal: Medicine and What Matters in the End, by Atul Gawande, a surgeon and medical writer in Boston, whose earlier pieces in The New Yorker evinced great wisdom and insight. Besides, my wife and reading companion Sylvia had recommended it to me.

Crawford is a philosopher and a motorcycle mechanic in Virginia. I’m not sure which of those things he does at night and which is his day job. They are probably churned together. Most of his academic conversation partners swim in the currents of German philosophy—Kant, Hegel, Heidegger and the like. But his boat seems to be constructed more out of the traditions of American pragmatism with an admixture of Michael Polyani’s insights. But don’t worry about that. What he is trying to say is that our own fetish of individualism has been based in a wrong-headed notion that we had to detach from the world around us and from traditions of work and action in order to become truly free individuals who act according to our own will and reason. However, what we need is not this detachment but engagement in the practices of the great craft traditions that demand the movement of our body as well as our mind. We are embodied selves who learn and think most fully and uniquely when we are engaged in practical activity that relates us to a whole community enduring over generations, whether that be carpentry, sailing, organ-building, or, yes, cooking.

All of this is built up with an argument that takes us into the insidious manipulations of the gambling (not “gaming”) industry as well as the fascinating and resurgent craft of building organs. It is a rich itinerary, indeed. I was struck, of course, with the parallels with what John and I were trying to get at in Sawdust and Soul. “Mindful meditation,” as I put it, is a way of engaging mind and hands with wood in order to find a kind of transcendence in the real-world particular. Just as John and I found a re-anchoring of our lives in this practical activity with natural materials, so Crawford is finding a more generous lever to get at the destructive forces of consumer culture as well as the liberating possibilities opened up by commitment to the craft traditions.

What has this to do with the reflections of a surgeon? A lot, it turns out. Gawande opens his exploration with a chapter on “The Independent Self,” in which he shows how most contemporary medicine approaches us as customers and the physician as a vendor who describes the various options and then asks us to choose among them out of our relative ignorance. This vendor-customer model was meant to replace the paternalism of “the doctor knows best” that pervaded medicine in an earlier age and still does in many rural areas. However, this notion of the individual as consumer, with its assumption that prolonging the life of the individual’s body is the main goal of medicine, is also a mistaken understanding of who we are as persons. For Gawande, we want to be authors of a coherent life story that makes sense within a community of memory and hope. Crawford is saying much the same thing in a different context. What we need is a guiding, informed conversation with physicians and medical care-givers about the meaning and purpose of our life. What goals and values do we want to pursue as our options for physical mobility and mental acuity diminish with age or impairment? Within this framework, then, doctor and patient can work together to maximize those goals and values.

This model of conversation and personally-tailored care also is emerging in the institutional models for living out our later years—a matter of increasing interest to people like me, for sure. Do we want to be “institutionalized” and fit into the routines and requirements of a “nursing home,” “retirement village,” or other large-scale “continuous care” facility? Or are there other options that enable each of us to maximize the specific goals and values we have for our lives? Gawande weaves his argument for new approaches through a number of case studies rather than forays into academic philosophy, although he picks up on Josiah Royce, one of my favorites in my college and graduate school years. Through his stories, we can try on some different scenarios to get a feel for their pain or their possibility.

In both books, then, the authors are calling for a new, embodied, way to author our identity, to live out our story in the most imaginative way we know. To do this, we will have to live against the grain of our society and find ways to remold it to enable each of us to live in conversation with our bodies, our natural world, and the communities that have shaped us and that we hope will receive our memory. It’s worth talking about. You can start with these partners, for sure.

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1 Response to Mortality, Autonomy, and Craft

  1. claire stoeckel says:

    Oh Bill, my favorite topic after having the privilege of working at the bedside of the dying, through Hospice. Most unfortunately, I heard on PBS this week that physicians are not being paid by Medicare when they do engage in the the conversation, so most just don’t. Cannot believe our society is going directly backwards in this respect. Medicare pays out more in the last 20 days of life than the whole time a person has Medicare, just in order to do “everything”. I’ll have the talk with anybody as it gives most a huge relief! Thank you for this opportunity….

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