Russell Saunders

The Duties of Downton Abbey

by Russell Saunders on February 15, 2012

[Over at Blinded Trials, my co-blogger Rose wrote the following post about Downton Abbey, with further reflection on the duties of art.  Several commenters indicated it deserved a bit more attention, and would be a good addition to recent main-page conversations along similar lines.  As Rose does not yet enjoy front-page posting privileges, I am posting this on her behalf.]

by Rose Woodhouse

If you are currently a film studies scholar, writing a paper arguing for the artistic merits of a film is probably a non-starter. It is completely obvious (to most in the field) that aesthetic preferences are merely expressions of political power. So any kind of critique of a film is always ultimately a cultural critique. Films are discussed as cultural objects, not as aesthetic objects. A film’s value is discussed only in terms of whether it criticizes the dominant ideology (good!) or reinforces the dominant ideology (bad!).

Let’s set aside the question of whether aesthetic value only ever amounts to the preferences of those in charge. A topic for another post! The question I want to ask is this: are films and television only valuable insofar as they criticize culture?

This kind of view often trickles its way into the popular press. I just finished watching Season 2 of Downton Abbey and (full disclosure) I was quite fond of it. (Season 1 more than season 2, but still really good.) To some, however, the show is problematic. The aristocratic class is portrayed sympathetically. Many of the lower classes are depicted as being pretty much okay with their lot, and approving of the class structure. So it needs to be explained why a liberal could love it. Going one step further, Simon Schama considers the show “cultural necrophilia.” He relates his biases:

But this unassuageable American craving for the British country house is bound to get on my nerves, having grown up in the 1950s and ’60s with a Jacobinical rage against the moth-eaten haughtiness of the toffs. They still knew how to put One in One’s Place. I’d barely crossed the threshold of one such establishment before its Carson had delicately knocked at the door of my room wondering when he could collect my trousers. He had not asked of course but assumed I’d want them Properly Pressed. I still remember the look on his face as he carried them off between thumb and forefinger as if removing a mysterious object in an advanced form of contaminated decay. Before “retiring,” I was asked by another servant whether I would prefer to be woken with tea or coffee. “Ah,” I said, “how nice. Tea if that’s all right.” “Milk or lemon?” he pressed on. “Oh, gosh, thanks, milk.” “The Jersey or the Guernsey herd, sir?”

I am indeed terribly sorry he had to go through that.

Then he goes on to argue the show is a disservice to the public.

In the current series, historical reality is supposed to bite at Downton in the form of the Great War. The abbey’s conversion into convalescent quarters did indeed happen in some of the statelies. But if Fellowes were really interested in the true drama attending the port and partridge classes—more accurately and brilliantly related in Evelyn Waugh’s Brideshead Revisited and Isabel Colegate’s wonderful The Shooting Party—the story on our TV would be quite different. Instead of being an occasional suffragette, Sibyl would have turned into a full-on militant, carving, while incarcerated in prison, a “V” for “votes” on her breast with a piece of broken glass. Lord Robert, whose income from land and rents would have collapsed with the long agricultural depression, would be unable to service his mortgage and, subject to the estate duties imposed to pay for old-age pensions, would have to sell the place to a wheat baron from Alberta. And Matthew would be one of the 750,000 dead.

Too much of a downer for Downton? Probably. Sorry, but history’s meant to be a bummer, not a stroll down memory lane. Done right, it delivers the tonic of tragedy, not the bromide of romance. But then that wouldn’t get the high ratings, would it?

This is the story of a specific family. Do you, or your family, exemplify your times in every way? Are you never an exception to your era, your class, your ethnic group? How dreary the fiction that always deals only with the generals, and not the particulars – always only with broad social movements, and never with the microsocial happenings in workplaces and families.

If you reject a film or show because it does not adequately critique its culture, you are basically saying that art should reflect your own social views. But why? You already have those views. You don’t need to be convinced. So art is…not for you? Really?

Art is then a lesson for those who don’t already agree with you. This strikes me as not only fundamentally condescending, but an proscribed understanding of art. Like so many wonders of life, like sex and love and marriage and children and friendship, it seems ridiculously limiting to claim that art serves only one function. And it seems especially to suck the joy out of art to insist it be only for educating others until they have as dark a view as can be mustered of rigid class structures and history.

I am not saying that there is nothing wrong with a system of landed gentry. Or that World War I was a walk in the park, or that women who wanted the vote did not go suffer to earn that right. I do question whether it is the sole job of every single work of fiction set in that time and place to educate people as to those facts. In addition to an education about broad social issues, art can also educate about interpersonal issues, about moral issues. And, dare I say it, some of the functions of art may not be educational at all.

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Patient BW, DOB 2/16/1971

by Russell Saunders on November 14, 2011

[By special request]

Patient: Wayne, Bruce

DOB: 2/16/1971

Occupation: Industrialist

Insurance: Self-pay

Emergency Contact: Dick Grayson, XXX-269-9637 [click to continue…]

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Bachmann, Perry and HPV

by Russell Saunders on September 15, 2011

Let me begin by dispensing with the easiest parts first. Michele Bachmann is an idiot.

“I’m offended for all the little girls and parents that didn’t have a choice,” [Bachmann] said. (Actually, any parent can opt out on a child’s behalf.) She said that girls who were harmed by the vaccine don’t get “a mulligan.” Later, the offended Bachmann ventured deeper into scientific illiteracy, telling Fox News that a woman had approached her after the debate and told her that she had a daughter who had “suffered mental retardation as a result of that vaccine.”

To say that I am extremely skeptical about Bachmann’s story is to be charitable. I do not believe a single word of a story about a child suffering any kind of cognitive deficit following HPV vaccination, which reads as unmitigated bullshit to me. At one point there was concern that a relatively rare neurological condition called Guillain-Barre Syndrome may occur with greater frequency following vaccination with the HPV vaccine Gardasil, but that connection has been investigated and rejected. There is zero evidence to suggest any possible connection between mental retardation and HPV vaccination (or the appropriate use of any other vaccine, for that matter). Bachmann’s demagoguery is social conservatism dressed up with the usual anti-science vaccination hysteria, a combination I find unpalatable in the extreme.

In fact, I don’t imagine the Tea Party’s own Jenny McCarthy would care about this issue at all were it not a way to take aim at an ascendant Rick Perry, who is drawing fire for trying to make HPV vaccination mandatory in Texas. As much as I find Rick Perry wholly unappealing as a politician, and would vote for a shaved ape before I cast a vote for him, on this one issue I think he was trying to do right by the kids in his state in defiance of political expediency. He has my grudging admiration in this isolated case.

That being said, I do not support mandatory HPV vaccination. [click to continue…]

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Recollection

by Russell Saunders on September 10, 2011

At the hospitals where I did my residency in New York City, the pediatrics department had its Grand Rounds every Tuesday morning.  One of my favorite attending physicians was delivering a talk on hematopoietic stem cells on the morning of September 11, 2001, so in contrast to my usual habit of sleeping quietly in the back during the often dry, abstruse presentations I was actually awake and paying attention.  On my way out of the conference room I stopped to check the sign-in sheet to make sure I’d get credit for attending the presentation, and I bumped into one of my fellow senior residents on her way in.  She asked if I’d heard that a plane had struck one of the towers of the World Trade Center.  I hadn’t.

It seems almost obligatory when describing that day to note that the weather was gorgeous.  The sun was shining and the air was fine and clear as I walked from the building at the medical school where the talk had been held back to the hospital where I was the senior resident on the inpatient pediatric service that month.  I told the junior resident and the interns to go up to the pediatric ward and start getting ready for rounds.  That hospital has a pediatric emergency department, and I thought I would just swing by to see if they needed any extra help for what I assumed would be a relatively small problem.  When my friend told me about the plane, I had pictured a small private aircraft of some kind hitting the building through pilot error.  I didn’t imagine that there would be much going on in the emergency department or anything for me to do, but it seemed like a good idea to check.

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Knock this off

by Russell Saunders on July 18, 2011

June Thomas at Slate thinks that Dan Savage is behaving like a bully toward Marcus Bachmann.  Bachmann, the husband of right-wing firebrand, Rep. Michele Bachmann, and is a proponent of reparative therapy to “fix” homosexuality.  Writes Thomas:

This week, though, [Savage's] podcast started with an attack on Marcus Bachmann’s masculinity. After a short preamble about the accuracy of gaydar (with a scientific citation, no less), Savage—whom I respect tremendously—played a tape of Michele’s* husband’s speaking voice. Bachmann has a tiny bit of a lisp—though it’s barely perceptible—and he slurs his words slightly. To Savage’s ears, it was a gay accent. Savage played the tape over and over, and reprised it several times throughout the podcast. He even did his own Bachmann impression, exaggerating the lisp and camping it up.

In other words, the man who launched the “It Gets Better Project,” an effort to stop the bullying of gay teens, was acting like a big bully. As Savage always notes, the kind of smear-the-queer taunts that can cause so much pain to young people aren’t aimed only at kids who are gay, they’re often aimed at boys who don’t live up to some mythical standard of masculinity and girls who just aren’t girly enough. I can only imagine how listeners who happen to have the kind of lisping, effeminate speech and affect that Savage was ridiculing felt upon hearing the attack.

I don’t know that I agree that Savage’s attacks on Bachmann amount to bullying per se.  Bachmann has chosen to promulgate beliefs that many find odious and harmful, myself included.  Further, those same beliefs have been the basis for the stigmatization of gay and lesbian people, and provide ammunition for those who would keep us marginalized and hidden.  I understand Savage’s anger.  Bachmann’s wife has also thrown her hat into the presidential ring, and with that decision comes all manner of scrutiny and criticism for her spouse.  Much of it will be unfair and cruel (just ask Michelle Obama or Hillary Clinton), but it comes with the territory.

That doesn’t make it seemly, however.  Thomas makes a sound point about the dissonance between Savage’s humane and compassionate crusade to give hope to isolated, depressed LGBT youth and his trafficking in the very same anti-gay stereotypes when the target suits his purposes.  The power of Savage’s message is diluted when it combines with hypocrisy.  As for Bachmann, if he really is a closeted gay man at war with his own nature, my primary response is one of pity.  As poisonous as the results may be, it’s an awful way to live.

Regardless, it profits us nothing to sneer at our opposition.  Whose approval will this win?  For those inclined to agree with Bachmann’s viewpoint, the mockery from Dan Savage or (heaven help us) Cher will only feed the ressentiment from the social conservative faction that considers itself the victim of contempt from the liberal elite.  That ressentiment is what’s driving his wife’s campaign in the first place.  If anything, this episode will redound to her political favor.

Finally, this ad hominen attack against Bachmann should be unnecessary.  Would we consider his ideas more compelling if he swaggered around like Steve McQueen redux?  Would we be forced to take him more seriously?  I would hope not.  His take on homosexuality and its potential to be “cured” has long been discredited and abandoned by the mental health community, and represents an attitude falling out of favor even within Republican circles.  The message is dying, and we merely distract ourselves with childish snipes at the messenger.

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Department of Sardonic Understatement

by Russell Saunders on July 15, 2011

In an excellent piece about the judicious pace the Don’t Ask, Don’t Tell repeal is taking, Capt. Adrian Bonenberger writes:

The vocal minority asked whether soldiers could be compelled to serve alongside people whose lifestyles they believed were immoral. They felt that the terms of their commitment to the Army had been changed — that they would not have joined if they had known they might be serving alongside gays. There was also a great deal of concern about the decision not to make separate showers or living quarters. This group did not sympathize with the logic behind the repeal. I was careful to emphasize that being angry about something outside one’s control is not fruitful, and, instead, encouraged reluctant or resistant soldiers to view the change as beneficial for the country in the same tradition as desegregation or empowering women. Frank discussions of post-enlightenment social momentum, and the importance of sympathy and humanism bore limited fruit. [emphasis added]

Yes, I imagine the fruit was limited indeed.  One can only imagine how those “frank discussions” played out in real time.

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Because you said so

by Russell Saunders on June 27, 2011

When I meet new people and tell them I’m a pediatrician, there are a handful of common responses I get. There’s usually a remark about how much I must love kids. (Most of the time.) Sometimes people ask if it’s hard to take care of sick children. (Yes, but that’s part of the bargain.) And frequently my interlocutor will comment about how the hardest part must be dealing with the parents. (It is.) This last often comes with a self-deprecatory laugh on the part of admittedly neurotic parents who know they drive their kids’ own pediatricians crazy.

If ever I have read any true thing about parenting in America today, it is this article by Lori Gottlieb in the current issue of The Atlantic. (Via Andrew Sullivan.) So much of what she says is so true to my own experience that I scarcely know where to begin. In describing the myriad ways well-intentioned parents coddle and cosset their kids, thus depriving them of a true notion of the world and their place in it, she pinpoints the problems with what I see day in and day out.

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Apostasy: an open thread

by Russell Saunders on June 19, 2011

I see that the Southern Baptists have re-affirmed their belief in hell as “an eternal, conscious punishment,” following views to the contrary expressed by a pastor in Michigan.

When I abandoned the fundamentalist Christianity of my youth (watch the movie “Jesus Camp” and, mutatis mutandis, you’ve got my childhood), one of the first bits of doctrine to be jettisoned was that of any kind of hell.  Punishing even the rankest of sinners with an eternity of material torment was utterly impossible to square with belief in a God of love or justice, let alone mercy.  As I met more and more non-Christians, many of whom were far more pious, moral or godly than me, it became even more impossible to believe that heaven would be accessible to Christians only.  I cannot imagine now why anyone would want to worship a God that would dictate otherwise.

It was a liberating thing, to shed so much of what I had once believed with such fervor.  It’s left me very wary of any kind of ideological rigidity as an adult.  I like to think it’s made me a better person, but perhaps I’m just prone to diffidence and moral indecision.

One of the things I admire about the community here at LOOG is its philosophical inclusivity, its small-C catholicism and panoply of perspectives.  So, I’m curious — what may you once have believed, truly and sincerely, that you have since repudiated?  Was the process of changing your perspective something that informs your perspectives now?  Do you feel better for it, or was it a loss you still regret?

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Insufficient evidence

by Russell Saunders on June 14, 2011

A friend brought this opinion piece in the New York Times to my attention yesterday.  Dr. Karen Sibert, a stridently proud full-time anesthesiologist, argues that women who choose to work as part-time physicians are short-changing their patients and the country.  I’ve been meaning to write something about the changing relationship between physicians and their careers for some time, and so this may as well serve as my first post on the subject.

Suffice it to say at the outset that the column makes all kinds of claims that it does not support, and that its author seems to me to be the kind of doctor who views her own experience as illustrative of how things ought to be for everyone.  These are cut from the same cloth as doctors who had the tar ground out of them during residency, and so think that every new doctor should have a similarly grueling experience because that’s just what doctors go through in their training.  This tendency to romanticize a negative runs strong in my profession.  There’s usually some kind of bluster about how it instills a sense of commitment, an immersive dedication to the practice of medicine, which I happen to think is so much hooey.

Begins Dr. Sibert:

I’M a doctor and a mother of four, and I’ve always practiced medicine full time. When I took my board exams in 1987, female doctors were still uncommon, and we were determined to work as hard as any of the men.

Today, however, increasing numbers of doctors — mostly women — decide to work part time or leave the profession. Since 2005 the part-time physician workforce has expanded by 62 percent, according to recent survey data from the American Medical Group Association, with nearly 4 in 10 female doctors between the ages of 35 and 44 reporting in 2010 that they worked part time.

This may seem like a personal decision, but it has serious consequences for patients and the public.

Medical education is supported by federal and state tax money both at the university level — student tuition doesn’t come close to covering the schools’ costs — and at the teaching hospitals where residents are trained. So if doctors aren’t making full use of their training, taxpayers are losing their investment. With a growing shortage of doctors in America, we can no longer afford to continue training doctors who don’t spend their careers in the full-time practice of medicine.

Dr. Sibert does not actually support these assertions with any numbers.  I don’t know many practice hours per provider per year are necessary for taxpayers to recoup their investment, and she doesn’t tell us.  Who knows if a part-time career gives back enough to make the investment in the doctor’s career worthwhile.  I suspect its hard to quantify, but am skeptical that part-time physicians are providing insufficient benefit to make their educations not worth the money.

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On death and dying

by Russell Saunders on June 3, 2011

Jack Kevorkian has died.  From the obituary in the New York Times.

From June 1990, when he assisted in the first suicide, until March 1999, when he was sentenced to serve 10 to 25 years in a maximum security prison, Dr. Kevorkian was a controversial figure. But his critics and supporters generally agree on this: As a result of his stubborn and often intemperate advocacy for the right of the terminally ill to choose how they die, hospice care has boomed in the United States, and physicians have become more sympathetic to their pain and more willing to prescribe medication to relieve it.

I’m really not in a position to pronounce on how much credit Dr. Kevorkian should receive for the rise in hospice care.  As the most vocal advocate for the rights of the terminally ill to die on their own terms, he certainly put a visible face on the issue and kept it in the news.  Changing the attitudes of the medical community regarding how our patients die was his goal, and insofar as they have changed he seems to have accomplished it to a great degree.

There were many, many reasons for my becoming a pediatrician.  I like kids.  They’re fun to take care of, and I interact well with them.  I like being a formative part of my patients’ lives, and helping them create positive impressions of going to see the doctor and taking care of themselves.  And I really like that the vast majority of my patients will either remain in good health while under my care, or will return to it with appropriate treatment.  It’s nice to have a patient population that will almost always get better.

However, the truth that every medical provider must face is that some of our patients will die while under our care.  None of us are wonder-working wizards that can cure everything, and there are some diseases that have no cure and proceed ineluctably toward death.  It is humbling and frustrating and heart-breaking when one has to face this, but face it we must from time to time.  I have myself, all too recently.  We do no service to ourselves or to our patients if we try to deny it or hide from it.

Decisions about when to withhold or withdraw care require honesty and courage.  Too often the culture in medicine is (or, perhaps, has been) that every death is a defeat or a failure, something that could have been forestalled if only there had been some small change in management.  It’s us vs. the disease.  But patients die of their diseases every minute of every day, and preparing for it properly allows patients and medical providers alike the option of setting the best terms possible.  A death free of pain and in the setting that offers the most comfort should be available to every patient, so far as circumstances allow.

We now have the capacity to preserve the function of numerous organ systems long after the organs themselves have failed.  We can mechanically ventilate patients, give them dialysis and parenteral nutrition, and turn them in their beds to keep their skin intact.  But just because we can doesn’t mean we always should.  Prolonging the metabolic lives of those who have otherwise long since died because of an inability to face the truth that our patients will die, or because we never dealt honestly with it while they were still in a position to make their wishes known, is a failure on our parts.  To the extent that Dr. Kevorkian reminded us of this, he deserves a degree of gratitude.

(Cross-posted at Blinded Trials.)

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