El objetivo legítimo del representante farmacéutico, en las sociedades capitalistas ,es aumentar los beneficios y esta es su motivación en la interacción médico-reptresentante
Las compañías farmacéuticas tienen derecho a anunciar su producto y saben que la utilización de esta cara vía publicitaria persona a persona obtiene resultados. Esto justifica la utilización de representantes, normalmente, agradables, bien formados y que pasan largas horas viajando solo para ver a un puñado de médicos cada día.
La firma de este compromiso no implica que usted piense que esta práctica de las empresas farmacéuticas realizada por los representantes, no es ética o es inmoral. Nosotros no estamos pidiendo algún tipo de prohibición, ni siquiera exigir a las empresas farmacéuticas que reduzcan el número de representantes: mientras todas las compañías tengan representantes, esto es poco probable que ocurra. Lo que nos preocupa es el papel del médico y a ellos apelamos para que reduzcan (a cero, si es posible) su interacción con los representantes de todas las compañías. Esto no pretende en modo alguno ser un insulto a los representantes que después de todo no hace sino cumplir con lo que se les pide.
El papel del médico contrasta marcadamente con el papel del representante. El trabajo del médico es proporcionar el tratamiento más apropiado para su paciente. Éticamente, el médico debe tomar todas las medidas razonables para asegurarse de que su decisión en relación con la prescripción de medicamentos se basa en las mejores pruebas científicas existentes. El médico, por lo general e idealmente, no tiene ninguna ganancia o pérdida con esta decisión pero está dirigiendo el dinero del paciente y de los contribuyentes hacia la compra de unos medicamentos en particular. Dada la fuerza de la evidencia que muestra que los representantes influyen en la prescripción del médico, es más seguro y más ético que un médico no los atienda. Toda la información y pruebas que el representante ofrece está disponible en otros lugares y, por lo general, a partir de fuentes con intereses menos personales en el aumento de las ventas.
Que el representante llame a la puerta no significa que haya que atenderlo. Sugerimos un educado 'No hay publicidad, por favor. "
Hay una diferencia muy grande entre, el silencio y la mudez. Las sociedades de hoy están más amenazadas que nunca por hacer enmudecer al individuo"
R. A mí me pasa que en según qué compañía el yo enmudece, me quedo sin palabras. Es cuando ha llegado el momento de desaparecer y buscar un lugar silencioso —no tiene que ser el baño—, con algún pretexto, pues allí vuela el habla. Ahí estaba el punto de energía del libro: tienes que apartarte de la sociedad para volver a ser sociable, para que vuelva el lenguaje. Para que puedas hablar contigo mismo. Es muy importante que un hombre pueda hablar consigo mismo. Cuántas veces me ha pasado esto, nada más cerrar una puerta detrás de mí y en mi interior algo empezaba a hablar. Mientras antes, en medio de la gente, estaba sumido en la más absoluta mudez. Hay una diferencia muy grande entre, el silencio y la mudez. Las sociedades de hoy están más amenazadas que nunca por hacer enmudecer al individuo.
How We Grieve: Meghan O’Rourke on the Messiness of Mourning and Learning to Live with Loss
“The people we most love do become a physical part of us, ingrained in our synapses, in the pathways where memories are created.”
BY MARIA POPOVA
John Updikewrote in his memoir,“Each day, we wake slightly altered, and the person we were yesterday is dead. So why, one could say, be afraid of death, when death comes all the time?”And yet even if we were to somehow make peace withour own mortality, a primal and soul-shattering fear rips through whenever we think about losing those we love most dearly — a fear that metastasizes into all-consuming grief when loss does come. InThe Long Goodbye(public library), her magnificent memoir of grieving her mother’s death,Meghan O’Rourkecrafts a masterwork of remembrance and reflection woven of extraordinary emotional intelligence. A poet, essayist, literary critic, and one of the youngest editors theNew Yorkerhas ever had, she tells a story that is deeply personal in its details yet richly resonant in its larger humanity, making tangible the messy and often ineffable complexities that anyone who has ever lost a loved one knows all too intimately, all too anguishingly. What makes her writing — her mind, really — particularly enchanting is that she brings to this paralyzingly difficult subject a poet’s emotional precision, an essayist’s intellectual expansiveness, and a voracious reader’s gift for apt, exquisitely placed allusions to such luminaries of language and life as Whitman, Longfellow, Tennyson, Swift, and Dickinson (“the supreme poet of grief”).
O’Rourke writes:
When we are learning the world, we know things we cannot say how we know. When we are relearning the world in the aftermath of a loss, we feel things we had almost forgotten, old things, beneath the seat of reason.
[…]
Nothing prepared me for the loss of my mother. Even knowing that she would die did not prepare me. A mother, after all, is your entry into the world. She is the shell in which you divide and become a life. Waking up in a world without her is like waking up in a world without sky: unimaginable.
[…]
When we talk about love, we go back to the start, to pinpoint the moment of free fall. But this story is the story of an ending, of death, and it has no beginning. A mother is beyond any notion of a beginning. That’s what makes her a mother: you cannot start the story.
In the days following her mother’s death, as O’Rourke faces the loneliness she anticipated and the sense of being lost that engulfed her unawares, she contemplates the paradoxes of loss: Ours is a culture that treats grief — a process of profound emotional upheaval — with a grotesquely mismatched rational prescription. On the one hand, society seems to operate by a set of unspoken shoulds for how we ought to feel and behave in the face of sorrow; on the other, she observes, “we have so few rituals for observing and externalizing loss.” Without a coping strategy, she finds herself shutting down emotionally and going “dead inside” — a feeling psychologists call “numbing out” — and describes the disconnect between her intellectual awareness of sadness and its inaccessible emotional manifestation:
It was like when you stay in cold water too long. You know something is off but don’t start shivering for ten minutes.
But at least as harrowing as the aftermath of loss is the anticipatory bereavement in the months and weeks and days leading up to the inevitable — a particularly cruel reality of terminal cancer. O’Rourke writes:
So much of dealing with a disease is waiting. Waiting for appointments, for tests, for “procedures.” And waiting, more broadly, for it—for the thing itself, for the other shoe to drop.
The hallmark of this anticipatory loss seems to be a tapestry of inner contradictions. O’Rourke notes with exquisite self-awareness her resentment for the mundanity of it all — there is her mother, sipping soda in front of the TV on one of those final days — coupled with weighty, crushing compassion for the sacred humanity of death:
Time doesn’t obey our commands. You cannot make it holy just because it is disappearing.
Then there was the question of the body — the object of so much social and personal anxiety in real life, suddenly stripped of control in the surreal experience of impending death. Reflecting on the initially disorienting experience of helping her mother on and off the toilet and how quickly it became normalized, O’Rourke writes:
It was what she had done for us, back before we became private and civilized about our bodies. In some ways I liked it. A level of anxiety about the body had been stripped away, and we were left with the simple reality: Here it was.
I heard a lot about the idea of dying “with dignity” while my mother was sick. It was only near her very end that I gave much thought to what this idea meant. I didn’t actually feel it was undignified for my mother’s body to fail — that was the human condition. Having to help my mother on and off the toilet was difficult, but it was natural. The real indignity, it seemed, was dying where no one cared for you the way your family did, dying where it was hard for your whole family to be with you and where excessive measures might be taken to keep you alive past a moment that called for letting go. I didn’t want that for my mother. I wanted her to be able to go home. I didn’t want to pretend she wasn’t going to die.
Among the most painful realities of witnessing death — one particularly exasperating for type-A personalities — is how swiftly it severs the direct correlation between effort and outcome around which we build our lives. Though the notion might seem rational on the surface — especially in a culture that fetishizes work ethic and“grit” as the key to success— an underbelly of magical thinking lurks beneath, which comes to light as we behold the helplessness and injustice of premature death. Noting that “the mourner’s mind is superstitious, looking for signs and wonders,” O’Rourke captures this paradox:
One of the ideas I’ve clung to most of my life is that if I just try hard enough it will work out. If I work hard, I will be spared, and I will get what I desire, finding the cave opening over and over again, thieving life from the abyss. This sturdy belief system has a sidecar in which superstition rides. Until recently, I half believed that if a certain song came on the radio just as I thought of it, it meant that all would be well. What did I mean? I preferred not to answer that question. To look too closely was to prick the balloon of possibility.
But our very capacity for the irrational — for the magic of magical thinking — also turns out to be essential for our spiritual survival. Without the capacity to discern from life’s senseless sound a meaningful melody, we would be consumed by the noise. In fact, one of O’Rourke’s most poetic passages recounts her struggle to find a transcendent meaning on an average day, amid the average hospital noises:
I could hear the coughing man whose family talked about sports and sitcoms every time they visited, sitting politely around his bed as if you couldn’t see the death knobs that were his knees poking through the blanket, but as they left they would hug him and say, We love you, and We’ll be back soon, and in their voices and in mine and in the nurse who was so gentle with my mother, tucking cool white sheets over her with a twist of her wrist, I could hear love, love that sounded like a rope, and I began to see a flickering electric current everywhere I looked as I went up and down the halls, flagging nurses, little flecks of light dotting the air in sinewy lines, and I leaned on these lines like guy ropes when I was so tired I couldn’t walk anymore and a voice in my head said:Do you see this love? And do you still not believe?
I couldn’t deny the voice.
Now I think: That was exhaustion.
But at the time the love, the love, it was like ropes around me, cables that could carry us up into the higher floors away from our predicament and out onto the roof and across the empty spaces above the hospital to the sky where we could gaze down upon all the people driving, eating, having sex, watching TV, angry people, tired people, happy people, all doing, all being —
In the weeks following her mother’s death, melancholy — “the black sorrow, bilious, angry, a slick in my chest” — comes coupled with another intense emotion, a parallel longing for a different branch of that-which-no-longer-is:
I experienced an acute nostalgia. This longing for a lost time was so intense I thought it might split me in two, like a tree hit by lightning. I was — as the expression goes — flooded by memories. It was a submersion in the past that threatened to overwhelm any “rational” experience of the present, water coming up around my branches, rising higher. I did not care much about work I had to do. I was consumed by memories of seemingly trivial things.
But the embodied presence of the loss is far from trivial. O’Rourke, citing a psychiatrist whose words had stayed with her, captures it with harrowing precision:
The people we most love do become a physical part of us, ingrained in our synapses, in the pathways where memories are created.
In another breathtaking passage, O’Rourke conveys the largeness of grief as it emanates out of our pores and into the world that surrounds us:
In February, there was a two-day snowstorm in New York. For hours I lay on my couch, reading, watching the snow drift down through the large elm outside … the sky going gray, then eerie violet, the night breaking around us, snow like flakes of ash. A white mantle covered trees, cars, lintels, and windows. It was like one of grief’s moods: melancholic; estranged from the normal; in touch with the longing that reminds us that we are being-toward-death, as Heidegger puts it. Loss is our atmosphere; we, like the snow, are always falling toward the ground, and most of the time we forget it.
Because grief seeps into the external world as the inner experience bleeds into the outer, it’s understandable — it’s hopelessly human — that we’d also project the very object of our grief onto the external world. One of the most common experiences, O’Rourke notes, is for the grieving to try to bring back the dead — not literally, but by seeing, seeking, signs of them in the landscape of life, symbolism in the everyday. The mind, after all, is a pattern-recognition machine and when the mind’s eye is as heavily clouded with a particular object as it is when we grieve a loved one, we begin to manufacture patterns. Recounting a day when she found inside a library book handwriting that seemed to be her mother’s, O’Rourke writes:
The idea that the dead might not be utterly gone has an irresistible magnetism. I’d read something that described what I had been experiencing. Many people go through what psychologists call a period of “animism,” in which you see the dead person in objects and animals around you, and you construct your false reality, the reality where she is just hiding, or absent. This was the mourner’s secret position, it seemed to me:I have to say this person is dead, but I don’t have to believe it.
[…]
Acceptance isn’t necessarily something you can choose off a menu, like eggs instead of French toast. Instead, researchers now think that some people are inherently primed to accept their own death with “integrity” (their word, not mine), while others are primed for “despair.” Most of us, though, are somewhere in the middle, and one question researchers are now focusing on is: How might more of those in the middle learn to accept their deaths? The answer has real consequences for both the dying and the bereaved.
O’Rourke considers the psychology and physiology of grief:
When you lose someone you were close to, you have to reassess your picture of the world and your place in it. The more your identity is wrapped up with the deceased, the more difficult the mental work.
The first systematic survey of grief, I read, was conducted by Erich Lindemann. Having studied 101 people, many of them related to the victims of the Cocoanut Grove fire of 1942, he defined grief as “sensations of somatic distress occurring in waves lasting from twenty minutes to an hour at a time, a feeling of tightness in the throat, choking with shortness of breath, need for sighing, and an empty feeling in the abdomen, lack of muscular power, and an intensive subjective distress described as tension or mental pain.”
Tracing the history of studying grief, including Elisabeth Kübler-Ross’s famous and often criticized 1969 “stage theory” outlining a simple sequence of Denial, Anger, Bargaining, Depression, and Acceptance, O’Rourke notes that most people experience grief not as sequential stages but as ebbing and flowing states that recur at various points throughout the process. She writes:
Researchers now believe there are two kinds of grief: “normal grief” and “complicated grief” (also called “prolonged grief”). “Normal grief” is a term for what most bereaved people experience. It peaks within the first six months and then begins to dissipate. “Complicated grief” does not, and often requires medication or therapy. But even “normal grief” … is hardly gentle. Its symptoms include insomnia or other sleep disorders, difficulty breathing, auditory or visual hallucinations, appetite problems, and dryness of mouth.
One of the most persistent psychiatric ideas about grief, O’Rourke notes, is the notion that one ought to “let go” in order to “move on” — a proposition plentiful even in the casual advice of her friends in the weeks following her mother’s death. And yet it isn’t necessarily the right coping strategy for everyone, let alone the only one, as our culture seems to suggest. Unwilling to “let go,” O’Rourke finds solace in anthropological alternatives:
Studies have shown that some mourners hold on to a relationship with the deceased with no notable ill effects. In China, for instance, mourners regularly speak to dead ancestors, and one study demonstrated that the bereaved there “recovered more quickly from loss” than bereaved Americans do.
I wasn’t living in China, though, and in those weeks after my mother’s death, I felt that the world expected me to absorb the loss and move forward, like some kind of emotional warrior. One night I heard a character on 24—the president of the United States—announce that grief was a “luxury” she couldn’t “afford right now.” This model represents an old American ethic of muscling through pain by throwing yourself into work; embedded in it is a desire to avoid looking at death. We’ve adopted a sort of “Ask, don’t tell” policy. The question “How are you?” is an expression of concern, but as my dad had said, the mourner quickly figures out that it shouldn’t always be taken for an actual inquiry… A mourner’s experience of time isn’t like everyone else’s. Grief that lasts longer than a few weeks may look like self-indulgence to those around you. But if you’re in mourning, three months seems like nothing — [according to some] research, three months might well find you approaching the height of sorrow.
Another Western hegemony in the culture of grief, O’Rourke notes, is its privatization — the unspoken rule that mourning is something we do in the privacy of our inner lives, alone, away from the public eye. Though for centuries private grief was externalized as public mourning, modernity has left us bereft of rituals to help us deal with our grief:
The disappearance of mourning rituals affects everyone, not just the mourner. One of the reasons many people are unsure about how to act around a loss is that they lack rules or meaningful conventions, and they fear making a mistake. Rituals used to help the community by giving everyone a sense of what to do or say. Now, we’re at sea.
[…]
Such rituals … aren’t just about the individual; they are about the community.
Craving “a formalization of grief, one that might externalize it,” O’Rourke plunges into the existing literature:
The British anthropologist Geoffrey Gorer, the author ofDeath, Grief, and Mourning, argues that, at least in Britain, the First World War played a huge role in changing the way people mourned. Communities were so overwhelmed by the sheer number of dead that the practice of ritualized mourning for the individual eroded. Other changes were less obvious but no less important. More people, including women, began working outside the home; in the absence of caretakers, death increasingly took place in the quarantining swaddle of the hospital. The rise of psychoanalysis shifted attention from the communal to the individual experience. In 1917, only two years after Émile Durkheim wrote about mourning as an essential social process, Freud’s “Mourning and Melancholia” defined it as something essentially private and individual, internalizing the work of mourning. Within a few generations, I read, the experience of grief had fundamentally changed. Death and mourning had been largely removed from the public realm. By the 1960s, Gorer could write that many people believed that “sensible, rational men and women can keep their mourning under complete control by strength of will and character, so that it need be given no public expression, and indulged, if at all, in private, as furtively as . . . masturbation.” Today, our only public mourning takes the form of watching the funerals of celebrities and statesmen. It’s common to mock such grief as false or voyeuristic (“crocodile tears,” one commentator called mourners’ distress at Princess Diana’s funeral), and yet it serves an important social function. It’s a more mediated version, Leader suggests, of a practice that goes all the way back to soldiers inThe Iliadmourning with Achilles for the fallen Patroclus.
I found myself nodding in recognition at Gorer’s conclusions. “If mourning is denied outlet, the result will be suffering,” Gorer wrote. “At the moment our society is signally failing to give this support and assistance. . . . The cost of this failure in misery, loneliness, despair and maladaptive behavior is very high.” Maybe it’s not a coincidence that in Western countries with fewer mourning rituals, the bereaved report more physical ailments in the year following a death.
Illustration from ‘The Iliad and the Odyssey: A Giant Golden Book’ by Alice and Martin Provensen. Click image for details.
The otherworldliness of loss was so intense that at times I had to believe it was a singular passage, a privilege of some kind, even if all it left me with was a clearer grasp of our human predicament. It was why I kept finding myself drawn to the remote desert: I wanted to be reminded of how the numinous impinges on ordinary life.
Reflecting on her struggle to accept her mother’s loss — her absence, “an absence that becomes a presence” — O’Rourke writes:
If children learn through exposure to new experiences, mournersunlearn through exposure to absence in new contexts. Grief requires acquainting yourself with the world again and again; each “first” causes a break that must be reset… And so you always feel suspense, a queer dread—you never know what occasion will break the loss freshly open.
She later adds:
After a loss, you have to learn to believe the dead one is dead. It doesn’t come naturally.
Among the most chilling effects of grief is how it reorients us toward ourselves as it surfaces ourmortality paradoxand the dawning awareness of our own impermanence. O’Rourke’s words ring with the profound discomfort of our shared existential bind:
The dread of death is so primal, it overtakes me on a molecular level. In the lowest moments, it produces nihilism. If I am going to die, why not get it over with? Why live in this agony of anticipation?
[…]
I was unable to push these questions aside: What are we to do with the knowledge that we die? What bargain do you make in your mind so as not to go crazy with fear of the predicament, a predicament none of us knowingly chose to enter? You can believe in God and heaven, if you have the capacity for faith. Or, if you don’t, you can do what a stoic like Seneca did, and push away the awfulness by noting that if death is indeed extinction, it won’t hurt, for we won’t experience it. “It would be dreadful could it remain with you; but of necessity either it does not arrive or else it departs,” he wrote.
If this logic fails to comfort, you can decide, as Plato and Jonathan Swift did, that since death is natural, and the gods must exist, it cannot be a bad thing. As Swift said, “It is impossible that anything so natural, so necessary, and so universal as death, should ever have been designed by Providence as an evil to mankind.” And Socrates: “I am quite ready to admit … that I ought to be grieved at death, if I were not persuaded in the first place that I am going to other gods who are wise and good.” But this is poor comfort to those of us who have no gods to turn to. If you love this world, how can you look forward to departing it? Rousseau wrote, “He who pretends to look on death without fear lies. All men are afraid of dying, this is the great law of sentient beings, without which the entire human species would soon be destroyed.”
Without death our lives would lose their shape: “Death is the mother of beauty,” Wallace Stevens wrote. Or as a character in Don DeLillo’sWhite Noisesays, “I think it’s a mistake to lose one’s sense of death, even one’s fear of death. Isn’t death the boundary we need?” It’s not clear that DeLillo means us to agree, but I think I do. I love the world more because it is transient.
[…]
One would think that living so proximately to the provisional would ruin life, and at times it did make it hard. But at other times I experienced the world with less fear and more clarity. It didn’t matter if I was in line for an extra two minutes. I could take in the sensations of color, sound, life. How strange that we should live on this planet and make cereal boxes, and shopping carts, and gum! That we should renovate stately old banks and replace them with Trader Joe’s! We were ants in a sugar bowl, and one day the bowl would empty.
A Perseid meteor over Joshua Tree National Park (Image: Joe Westerberg / NASA)
This awareness of our transience, our minuteness, and the paradoxical enlargement of our aliveness that it produces seems to be the sole solace from grief’s grip, though we all arrive at it differently. O’Rourke’s father approached it from another angle. Recounting a conversation with him one autumn night — one can’t help but notice the beautiful, if inadvertent, echo ofCarl Sagan’s memorable words— O’Rourke writes:
“The Perseid meteor showers are here,” he told me. “And I’ve been eating dinner outside and then lying in the lounge chairs watching the stars like your mother and I used to” — at some point he stopped calling her Mom — “and that helps. It might sound strange, but I was sitting there, looking up at the sky, and I thought, ‘You are but a mote of dust. And your troubles and travails are just a mote of a mote of dust.’ And it helped me. I have allowed myself to think about things I had been scared to think about and feel. And it allowed me to be there — to be present. Whatever my life is, whatever my loss is, it’s small in the face of all that existence… The meteor shower changed something. I was looking the other way through a telescope before: I was just looking at what was not there. Now I look at what is there.”
O’Rourke goes on to reflect on this ground-shifting quality of loss:
It’s not a question of getting over it or healing. No; it’s a question of learning to live with this transformation. For the loss is transformative, in good ways and bad, a tangle of change that cannot be threaded into the usual narrative spools. It is too central for that. It’s not an emergence from the cocoon, but a tree growing around an obstruction.
Before we scattered the ashes, I had an eerie experience. I went for a short run. I hate running in the cold, but after so much time indoors in the dead of winter I was filled with exuberance. I ran lightly through the stripped, bare woods, past my favorite house, poised on a high hill, and turned back, flying up the road, turning left. In the last stretch I picked up the pace, the air crisp, and I felt myself float up off the ground. The world became greenish. The brightness of the snow and the trees intensified. I was almost giddy. Behind the bright flat horizon of the treescape, I understood, were worlds beyond our everyday perceptions. My mother was out there, inaccessible to me, but indelible. The blood moved along my veins and the snow and trees shimmered in greenish light. Suffused with joy, I stopped stock-still in the road, feeling like a player in a drama I didn’t understand and didn’t need to. Then I sprinted up the driveway and opened the door and as the heat rushed out the clarity dropped away.
I’d had an intuition like this once before, as a child in Vermont. I was walking from the house to open the gate to the driveway. It was fall. As I put my hand on the gate, the world went ablaze, as bright as the autumn leaves, and I lifted out of myself and understood that I was part of a magnificent book. What I knew as “life” was a thin version of something larger, the pages of which had all been written. What I would do, how I would live — it was already known. I stood there with a kind of peace humming in my blood.
A non-believer who had prayed for the first time in her life when her mother died, O’Rourke quotes Virginia Woolf’sluminous meditation on the spiritand writes:
This is the closest description I have ever come across to what I feel to be my experience. I suspect a pattern behind the wool, even the wool of grief; the pattern may not lead to heaven or the survival of my consciousness — frankly I don’t think it does — but that it istheresomehow in our neurons and synapses is evident to me. We are not transparent to ourselves. Our longings are like thick curtains stirring in the wind. We give them names. What I do not know is this: Does that otherness — that sense of an impossibly real universe larger than our ability to understand it — mean that there is meaning around us?
[…]
I have learned a lot about how humans think about death. But it hasn’t necessarily taught me more about my dead, where she is, what she is. When I held her body in my hands and it was just black ash, I felt no connection to it, but I tell myself perhaps it is enough to still be matter, to go into the ground and be “remixed” into some new part of the living culture, a new organic matter. Perhaps there is some solace in this continued existence.
[…]
I think about my mother every day, but not as concertedly as I used to. She crosses my mind like a spring cardinal that flies past the edge of your eye: startling, luminous, lovely, gone.
"The Stinker", the official mascot of the Ig Nobel Prizes.
The Ig Nobel Prizes honor achievements that make people LAUGH, and then THINK. The prizes are intended to celebrate the unusual, honor the imaginative — and spur people's interest in science, medicine, and technology.
Every September, in a gala ceremony in Harvard's Sanders Theatre, 1100 splendidly eccentric spectators watch the new winners step forward to accept their Prizes. These are physically handed out by genuinely bemused genuine Nobel Laureates. Thousands more, around the world, watch our live online broadcast.
CEREMONY: The 29th First Annual Ig Nobel Prize ceremony will happen in September, 2019, at Sanders Theatre, Harvard University, Cambridge, Massachusetts, USA.
"Last, but not least, there are the Ig Nobel awards. These come with little cash, but much cachet, and reward those research projects that 'first make people laugh, and then make them think'" — Nature
"It's like the weirdest f-ing thing that you'll ever go to... it's a collection of, like, actual Nobel Prize winners giving away prizes to real scientists for doing f'd-up things... it's awesome."— Amanda Palmer
Soy una persona anticuada que cree que leer libros es el pasatiempo mas hermoso que la humanidad ha creado . El homo ludens baila , canta , realiza gestos significativos , adopta posturas, se acicala , organiza fiestas y celebra refinadas ceremonias . Para nada desprecio la importancia de estas diversiones ; sin ellas , la vida humana pasaría sumida en una monotonía inimaginable y , probablemente , la dispersión . Sin embargo , son actividades en grupo sobre las que se eleva un mayor o menor tufillo de instrucción colectiva . El homo ludens con un libro es libre .
Al menos tan libre como él mismo sea capaz de serlo . Él fija las reglas de juego , subordinado únicamente a su propia curiosidad .
Hepburn le espetó a un periodista: «Yo soy atea y eso es todo. Creo que no hay nada que podamos saber excepto que debemos ser amables con los demás y hacer lo que podamos por otras personas»
How We Grieve: Meghan O’Rourke on the Messiness of Mourning and Learning to Live with Loss
“The people we most love do become a physical part of us, ingrained in our synapses, in the pathways where memories are created.”
BY MARIA POPOVA
John Updikewrote in his memoir,“Each day, we wake slightly altered, and the person we were yesterday is dead. So why, one could say, be afraid of death, when death comes all the time?”And yet even if we were to somehow make peace withour own mortality, a primal and soul-shattering fear rips through whenever we think about losing those we love most dearly — a fear that metastasizes into all-consuming grief when loss does come. InThe Long Goodbye(public library), her magnificent memoir of grieving her mother’s death,Meghan O’Rourkecrafts a masterwork of remembrance and reflection woven of extraordinary emotional intelligence. A poet, essayist, literary critic, and one of the youngest editors theNew Yorkerhas ever had, she tells a story that is deeply personal in its details yet richly resonant in its larger humanity, making tangible the messy and often ineffable complexities that anyone who has ever lost a loved one knows all too intimately, all too anguishingly. What makes her writing — her mind, really — particularly enchanting is that she brings to this paralyzingly difficult subject a poet’s emotional precision, an essayist’s intellectual expansiveness, and a voracious reader’s gift for apt, exquisitely placed allusions to such luminaries of language and life as Whitman, Longfellow, Tennyson, Swift, and Dickinson (“the supreme poet of grief”).
O’Rourke writes:
When we are learning the world, we know things we cannot say how we know. When we are relearning the world in the aftermath of a loss, we feel things we had almost forgotten, old things, beneath the seat of reason.
[…]
Nothing prepared me for the loss of my mother. Even knowing that she would die did not prepare me. A mother, after all, is your entry into the world. She is the shell in which you divide and become a life. Waking up in a world without her is like waking up in a world without sky: unimaginable.
[…]
When we talk about love, we go back to the start, to pinpoint the moment of free fall. But this story is the story of an ending, of death, and it has no beginning. A mother is beyond any notion of a beginning. That’s what makes her a mother: you cannot start the story.
In the days following her mother’s death, as O’Rourke faces the loneliness she anticipated and the sense of being lost that engulfed her unawares, she contemplates the paradoxes of loss: Ours is a culture that treats grief — a process of profound emotional upheaval — with a grotesquely mismatched rational prescription. On the one hand, society seems to operate by a set of unspoken shoulds for how we ought to feel and behave in the face of sorrow; on the other, she observes, “we have so few rituals for observing and externalizing loss.” Without a coping strategy, she finds herself shutting down emotionally and going “dead inside” — a feeling psychologists call “numbing out” — and describes the disconnect between her intellectual awareness of sadness and its inaccessible emotional manifestation:
It was like when you stay in cold water too long. You know something is off but don’t start shivering for ten minutes.
But at least as harrowing as the aftermath of loss is the anticipatory bereavement in the months and weeks and days leading up to the inevitable — a particularly cruel reality of terminal cancer. O’Rourke writes:
So much of dealing with a disease is waiting. Waiting for appointments, for tests, for “procedures.” And waiting, more broadly, for it—for the thing itself, for the other shoe to drop.
The hallmark of this anticipatory loss seems to be a tapestry of inner contradictions. O’Rourke notes with exquisite self-awareness her resentment for the mundanity of it all — there is her mother, sipping soda in front of the TV on one of those final days — coupled with weighty, crushing compassion for the sacred humanity of death:
Time doesn’t obey our commands. You cannot make it holy just because it is disappearing.
Then there was the question of the body — the object of so much social and personal anxiety in real life, suddenly stripped of control in the surreal experience of impending death. Reflecting on the initially disorienting experience of helping her mother on and off the toilet and how quickly it became normalized, O’Rourke writes:
It was what she had done for us, back before we became private and civilized about our bodies. In some ways I liked it. A level of anxiety about the body had been stripped away, and we were left with the simple reality: Here it was.
I heard a lot about the idea of dying “with dignity” while my mother was sick. It was only near her very end that I gave much thought to what this idea meant. I didn’t actually feel it was undignified for my mother’s body to fail — that was the human condition. Having to help my mother on and off the toilet was difficult, but it was natural. The real indignity, it seemed, was dying where no one cared for you the way your family did, dying where it was hard for your whole family to be with you and where excessive measures might be taken to keep you alive past a moment that called for letting go. I didn’t want that for my mother. I wanted her to be able to go home. I didn’t want to pretend she wasn’t going to die.
Among the most painful realities of witnessing death — one particularly exasperating for type-A personalities — is how swiftly it severs the direct correlation between effort and outcome around which we build our lives. Though the notion might seem rational on the surface — especially in a culture that fetishizes work ethic and“grit” as the key to success— an underbelly of magical thinking lurks beneath, which comes to light as we behold the helplessness and injustice of premature death. Noting that “the mourner’s mind is superstitious, looking for signs and wonders,” O’Rourke captures this paradox:
One of the ideas I’ve clung to most of my life is that if I just try hard enough it will work out. If I work hard, I will be spared, and I will get what I desire, finding the cave opening over and over again, thieving life from the abyss. This sturdy belief system has a sidecar in which superstition rides. Until recently, I half believed that if a certain song came on the radio just as I thought of it, it meant that all would be well. What did I mean? I preferred not to answer that question. To look too closely was to prick the balloon of possibility.
But our very capacity for the irrational — for the magic of magical thinking — also turns out to be essential for our spiritual survival. Without the capacity to discern from life’s senseless sound a meaningful melody, we would be consumed by the noise. In fact, one of O’Rourke’s most poetic passages recounts her struggle to find a transcendent meaning on an average day, amid the average hospital noises:
I could hear the coughing man whose family talked about sports and sitcoms every time they visited, sitting politely around his bed as if you couldn’t see the death knobs that were his knees poking through the blanket, but as they left they would hug him and say, We love you, and We’ll be back soon, and in their voices and in mine and in the nurse who was so gentle with my mother, tucking cool white sheets over her with a twist of her wrist, I could hear love, love that sounded like a rope, and I began to see a flickering electric current everywhere I looked as I went up and down the halls, flagging nurses, little flecks of light dotting the air in sinewy lines, and I leaned on these lines like guy ropes when I was so tired I couldn’t walk anymore and a voice in my head said:Do you see this love? And do you still not believe?
I couldn’t deny the voice.
Now I think: That was exhaustion.
But at the time the love, the love, it was like ropes around me, cables that could carry us up into the higher floors away from our predicament and out onto the roof and across the empty spaces above the hospital to the sky where we could gaze down upon all the people driving, eating, having sex, watching TV, angry people, tired people, happy people, all doing, all being —
In the weeks following her mother’s death, melancholy — “the black sorrow, bilious, angry, a slick in my chest” — comes coupled with another intense emotion, a parallel longing for a different branch of that-which-no-longer-is:
I experienced an acute nostalgia. This longing for a lost time was so intense I thought it might split me in two, like a tree hit by lightning. I was — as the expression goes — flooded by memories. It was a submersion in the past that threatened to overwhelm any “rational” experience of the present, water coming up around my branches, rising higher. I did not care much about work I had to do. I was consumed by memories of seemingly trivial things.
But the embodied presence of the loss is far from trivial. O’Rourke, citing a psychiatrist whose words had stayed with her, captures it with harrowing precision:
The people we most love do become a physical part of us, ingrained in our synapses, in the pathways where memories are created.
In another breathtaking passage, O’Rourke conveys the largeness of grief as it emanates out of our pores and into the world that surrounds us:
In February, there was a two-day snowstorm in New York. For hours I lay on my couch, reading, watching the snow drift down through the large elm outside … the sky going gray, then eerie violet, the night breaking around us, snow like flakes of ash. A white mantle covered trees, cars, lintels, and windows. It was like one of grief’s moods: melancholic; estranged from the normal; in touch with the longing that reminds us that we are being-toward-death, as Heidegger puts it. Loss is our atmosphere; we, like the snow, are always falling toward the ground, and most of the time we forget it.
Because grief seeps into the external world as the inner experience bleeds into the outer, it’s understandable — it’s hopelessly human — that we’d also project the very object of our grief onto the external world. One of the most common experiences, O’Rourke notes, is for the grieving to try to bring back the dead — not literally, but by seeing, seeking, signs of them in the landscape of life, symbolism in the everyday. The mind, after all, is a pattern-recognition machine and when the mind’s eye is as heavily clouded with a particular object as it is when we grieve a loved one, we begin to manufacture patterns. Recounting a day when she found inside a library book handwriting that seemed to be her mother’s, O’Rourke writes:
The idea that the dead might not be utterly gone has an irresistible magnetism. I’d read something that described what I had been experiencing. Many people go through what psychologists call a period of “animism,” in which you see the dead person in objects and animals around you, and you construct your false reality, the reality where she is just hiding, or absent. This was the mourner’s secret position, it seemed to me:I have to say this person is dead, but I don’t have to believe it.
[…]
Acceptance isn’t necessarily something you can choose off a menu, like eggs instead of French toast. Instead, researchers now think that some people are inherently primed to accept their own death with “integrity” (their word, not mine), while others are primed for “despair.” Most of us, though, are somewhere in the middle, and one question researchers are now focusing on is: How might more of those in the middle learn to accept their deaths? The answer has real consequences for both the dying and the bereaved.
O’Rourke considers the psychology and physiology of grief:
When you lose someone you were close to, you have to reassess your picture of the world and your place in it. The more your identity is wrapped up with the deceased, the more difficult the mental work.
The first systematic survey of grief, I read, was conducted by Erich Lindemann. Having studied 101 people, many of them related to the victims of the Cocoanut Grove fire of 1942, he defined grief as “sensations of somatic distress occurring in waves lasting from twenty minutes to an hour at a time, a feeling of tightness in the throat, choking with shortness of breath, need for sighing, and an empty feeling in the abdomen, lack of muscular power, and an intensive subjective distress described as tension or mental pain.”
Tracing the history of studying grief, including Elisabeth Kübler-Ross’s famous and often criticized 1969 “stage theory” outlining a simple sequence of Denial, Anger, Bargaining, Depression, and Acceptance, O’Rourke notes that most people experience grief not as sequential stages but as ebbing and flowing states that recur at various points throughout the process. She writes:
Researchers now believe there are two kinds of grief: “normal grief” and “complicated grief” (also called “prolonged grief”). “Normal grief” is a term for what most bereaved people experience. It peaks within the first six months and then begins to dissipate. “Complicated grief” does not, and often requires medication or therapy. But even “normal grief” … is hardly gentle. Its symptoms include insomnia or other sleep disorders, difficulty breathing, auditory or visual hallucinations, appetite problems, and dryness of mouth.
One of the most persistent psychiatric ideas about grief, O’Rourke notes, is the notion that one ought to “let go” in order to “move on” — a proposition plentiful even in the casual advice of her friends in the weeks following her mother’s death. And yet it isn’t necessarily the right coping strategy for everyone, let alone the only one, as our culture seems to suggest. Unwilling to “let go,” O’Rourke finds solace in anthropological alternatives:
Studies have shown that some mourners hold on to a relationship with the deceased with no notable ill effects. In China, for instance, mourners regularly speak to dead ancestors, and one study demonstrated that the bereaved there “recovered more quickly from loss” than bereaved Americans do.
I wasn’t living in China, though, and in those weeks after my mother’s death, I felt that the world expected me to absorb the loss and move forward, like some kind of emotional warrior. One night I heard a character on 24—the president of the United States—announce that grief was a “luxury” she couldn’t “afford right now.” This model represents an old American ethic of muscling through pain by throwing yourself into work; embedded in it is a desire to avoid looking at death. We’ve adopted a sort of “Ask, don’t tell” policy. The question “How are you?” is an expression of concern, but as my dad had said, the mourner quickly figures out that it shouldn’t always be taken for an actual inquiry… A mourner’s experience of time isn’t like everyone else’s. Grief that lasts longer than a few weeks may look like self-indulgence to those around you. But if you’re in mourning, three months seems like nothing — [according to some] research, three months might well find you approaching the height of sorrow.
Another Western hegemony in the culture of grief, O’Rourke notes, is its privatization — the unspoken rule that mourning is something we do in the privacy of our inner lives, alone, away from the public eye. Though for centuries private grief was externalized as public mourning, modernity has left us bereft of rituals to help us deal with our grief:
The disappearance of mourning rituals affects everyone, not just the mourner. One of the reasons many people are unsure about how to act around a loss is that they lack rules or meaningful conventions, and they fear making a mistake. Rituals used to help the community by giving everyone a sense of what to do or say. Now, we’re at sea.
[…]
Such rituals … aren’t just about the individual; they are about the community.
Craving “a formalization of grief, one that might externalize it,” O’Rourke plunges into the existing literature:
The British anthropologist Geoffrey Gorer, the author ofDeath, Grief, and Mourning, argues that, at least in Britain, the First World War played a huge role in changing the way people mourned. Communities were so overwhelmed by the sheer number of dead that the practice of ritualized mourning for the individual eroded. Other changes were less obvious but no less important. More people, including women, began working outside the home; in the absence of caretakers, death increasingly took place in the quarantining swaddle of the hospital. The rise of psychoanalysis shifted attention from the communal to the individual experience. In 1917, only two years after Émile Durkheim wrote about mourning as an essential social process, Freud’s “Mourning and Melancholia” defined it as something essentially private and individual, internalizing the work of mourning. Within a few generations, I read, the experience of grief had fundamentally changed. Death and mourning had been largely removed from the public realm. By the 1960s, Gorer could write that many people believed that “sensible, rational men and women can keep their mourning under complete control by strength of will and character, so that it need be given no public expression, and indulged, if at all, in private, as furtively as . . . masturbation.” Today, our only public mourning takes the form of watching the funerals of celebrities and statesmen. It’s common to mock such grief as false or voyeuristic (“crocodile tears,” one commentator called mourners’ distress at Princess Diana’s funeral), and yet it serves an important social function. It’s a more mediated version, Leader suggests, of a practice that goes all the way back to soldiers inThe Iliadmourning with Achilles for the fallen Patroclus.
I found myself nodding in recognition at Gorer’s conclusions. “If mourning is denied outlet, the result will be suffering,” Gorer wrote. “At the moment our society is signally failing to give this support and assistance. . . . The cost of this failure in misery, loneliness, despair and maladaptive behavior is very high.” Maybe it’s not a coincidence that in Western countries with fewer mourning rituals, the bereaved report more physical ailments in the year following a death.
Illustration from ‘The Iliad and the Odyssey: A Giant Golden Book’ by Alice and Martin Provensen. Click image for details.
The otherworldliness of loss was so intense that at times I had to believe it was a singular passage, a privilege of some kind, even if all it left me with was a clearer grasp of our human predicament. It was why I kept finding myself drawn to the remote desert: I wanted to be reminded of how the numinous impinges on ordinary life.
Reflecting on her struggle to accept her mother’s loss — her absence, “an absence that becomes a presence” — O’Rourke writes:
If children learn through exposure to new experiences, mournersunlearn through exposure to absence in new contexts. Grief requires acquainting yourself with the world again and again; each “first” causes a break that must be reset… And so you always feel suspense, a queer dread—you never know what occasion will break the loss freshly open.
She later adds:
After a loss, you have to learn to believe the dead one is dead. It doesn’t come naturally.
Among the most chilling effects of grief is how it reorients us toward ourselves as it surfaces ourmortality paradoxand the dawning awareness of our own impermanence. O’Rourke’s words ring with the profound discomfort of our shared existential bind:
The dread of death is so primal, it overtakes me on a molecular level. In the lowest moments, it produces nihilism. If I am going to die, why not get it over with? Why live in this agony of anticipation?
[…]
I was unable to push these questions aside: What are we to do with the knowledge that we die? What bargain do you make in your mind so as not to go crazy with fear of the predicament, a predicament none of us knowingly chose to enter? You can believe in God and heaven, if you have the capacity for faith. Or, if you don’t, you can do what a stoic like Seneca did, and push away the awfulness by noting that if death is indeed extinction, it won’t hurt, for we won’t experience it. “It would be dreadful could it remain with you; but of necessity either it does not arrive or else it departs,” he wrote.
If this logic fails to comfort, you can decide, as Plato and Jonathan Swift did, that since death is natural, and the gods must exist, it cannot be a bad thing. As Swift said, “It is impossible that anything so natural, so necessary, and so universal as death, should ever have been designed by Providence as an evil to mankind.” And Socrates: “I am quite ready to admit … that I ought to be grieved at death, if I were not persuaded in the first place that I am going to other gods who are wise and good.” But this is poor comfort to those of us who have no gods to turn to. If you love this world, how can you look forward to departing it? Rousseau wrote, “He who pretends to look on death without fear lies. All men are afraid of dying, this is the great law of sentient beings, without which the entire human species would soon be destroyed.”
Without death our lives would lose their shape: “Death is the mother of beauty,” Wallace Stevens wrote. Or as a character in Don DeLillo’sWhite Noisesays, “I think it’s a mistake to lose one’s sense of death, even one’s fear of death. Isn’t death the boundary we need?” It’s not clear that DeLillo means us to agree, but I think I do. I love the world more because it is transient.
[…]
One would think that living so proximately to the provisional would ruin life, and at times it did make it hard. But at other times I experienced the world with less fear and more clarity. It didn’t matter if I was in line for an extra two minutes. I could take in the sensations of color, sound, life. How strange that we should live on this planet and make cereal boxes, and shopping carts, and gum! That we should renovate stately old banks and replace them with Trader Joe’s! We were ants in a sugar bowl, and one day the bowl would empty.
A Perseid meteor over Joshua Tree National Park (Image: Joe Westerberg / NASA)
This awareness of our transience, our minuteness, and the paradoxical enlargement of our aliveness that it produces seems to be the sole solace from grief’s grip, though we all arrive at it differently. O’Rourke’s father approached it from another angle. Recounting a conversation with him one autumn night — one can’t help but notice the beautiful, if inadvertent, echo ofCarl Sagan’s memorable words— O’Rourke writes:
“The Perseid meteor showers are here,” he told me. “And I’ve been eating dinner outside and then lying in the lounge chairs watching the stars like your mother and I used to” — at some point he stopped calling her Mom — “and that helps. It might sound strange, but I was sitting there, looking up at the sky, and I thought, ‘You are but a mote of dust. And your troubles and travails are just a mote of a mote of dust.’ And it helped me. I have allowed myself to think about things I had been scared to think about and feel. And it allowed me to be there — to be present. Whatever my life is, whatever my loss is, it’s small in the face of all that existence… The meteor shower changed something. I was looking the other way through a telescope before: I was just looking at what was not there. Now I look at what is there.”
O’Rourke goes on to reflect on this ground-shifting quality of loss:
It’s not a question of getting over it or healing. No; it’s a question of learning to live with this transformation. For the loss is transformative, in good ways and bad, a tangle of change that cannot be threaded into the usual narrative spools. It is too central for that. It’s not an emergence from the cocoon, but a tree growing around an obstruction.
Before we scattered the ashes, I had an eerie experience. I went for a short run. I hate running in the cold, but after so much time indoors in the dead of winter I was filled with exuberance. I ran lightly through the stripped, bare woods, past my favorite house, poised on a high hill, and turned back, flying up the road, turning left. In the last stretch I picked up the pace, the air crisp, and I felt myself float up off the ground. The world became greenish. The brightness of the snow and the trees intensified. I was almost giddy. Behind the bright flat horizon of the treescape, I understood, were worlds beyond our everyday perceptions. My mother was out there, inaccessible to me, but indelible. The blood moved along my veins and the snow and trees shimmered in greenish light. Suffused with joy, I stopped stock-still in the road, feeling like a player in a drama I didn’t understand and didn’t need to. Then I sprinted up the driveway and opened the door and as the heat rushed out the clarity dropped away.
I’d had an intuition like this once before, as a child in Vermont. I was walking from the house to open the gate to the driveway. It was fall. As I put my hand on the gate, the world went ablaze, as bright as the autumn leaves, and I lifted out of myself and understood that I was part of a magnificent book. What I knew as “life” was a thin version of something larger, the pages of which had all been written. What I would do, how I would live — it was already known. I stood there with a kind of peace humming in my blood.
A non-believer who had prayed for the first time in her life when her mother died, O’Rourke quotes Virginia Woolf’sluminous meditation on the spiritand writes:
This is the closest description I have ever come across to what I feel to be my experience. I suspect a pattern behind the wool, even the wool of grief; the pattern may not lead to heaven or the survival of my consciousness — frankly I don’t think it does — but that it istheresomehow in our neurons and synapses is evident to me. We are not transparent to ourselves. Our longings are like thick curtains stirring in the wind. We give them names. What I do not know is this: Does that otherness — that sense of an impossibly real universe larger than our ability to understand it — mean that there is meaning around us?
[…]
I have learned a lot about how humans think about death. But it hasn’t necessarily taught me more about my dead, where she is, what she is. When I held her body in my hands and it was just black ash, I felt no connection to it, but I tell myself perhaps it is enough to still be matter, to go into the ground and be “remixed” into some new part of the living culture, a new organic matter. Perhaps there is some solace in this continued existence.
[…]
I think about my mother every day, but not as concertedly as I used to. She crosses my mind like a spring cardinal that flies past the edge of your eye: startling, luminous, lovely, gone.
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