What's Wrong with His Argument?

What’s wrong with his argument?

In the midst of his commencement address to the graduating class of Harvard Medical School, Dr. Atul Gawande offered the following:

“The doctors of former generations lament what medicine has become. If they could start over, the surveys tell us, they wouldn’t choose the profession today. They recall a simpler past without insurance-company hassles, government regulations, malpractice litigation, not to mention nurses and doctors bearing tattoos and talking of wanting “balance” in their lives. These are not the cause of their unease, however. They are symptoms of a deeper condition—which is the reality that medicine’s complexity has exceeded our individual capabilities as doctors.” Link here.

Actually, there’s a lot that’s wrong with this argument.

To be fair, one thing that is not wrong is Gawande’s observation that today’s medicine is far more complex than yesterday’s. Medical treatment today is more often delivered by a team of professionals than by a solo practitioner. The era of Marcus Welby is over.

So far, so good.

Yet, Gawande is rudely suggesting that when older physicians talk about their experience, they don’t know what they are talking about.

He thinks that they have mistaken the symptom for the cause.

Thereby, Gawande has disrespected the group of physicians who are increasingly choosing to retire young.

More significantly, he dismisses the intrusions of outside forces on the practice of medicine. Surely, most physicians today feel stifled under the weight of “insurance company hassles, government regulations, malpractice litigation...” 

I will leave it to others to ascertain how much they are irritated by tatooed interns seeking work/life balance.


As it happens, regulations and malpractice laws are more burdensome in some states than in others. Currently, there is a migration of physicians to Texas, largely to escape bureaucratic regulation and malpractice litigation.

Physicians are moving to Texas because they want to spend more time practicing medicine and less time doing paperwork and navigating a bureaucracy. Can you blame them?

By making this an either/or question Gawande, perhaps unconsciously, sides with those extra-medical professionals who have invaded his profession and are driving young people away from the profession while they drive older physicians out of it.

His rhetorical sleight of hand gives the impression that he feels that we need not reform malpractice laws or streamline bureaucratic regulation.

It’s not an either/or question. It’s a both/and issue. If bureaucracies and lawsuits have made it that much more difficult to practice individual medicine, they must make it more difficult to practice medicine in a group.

Outside supervision and control, to say nothing of threats of lawsuits, does not enhance teamwork. It undermines it. When faced with threats most people, even most physicians, start functioning as though it's every physician for him or herself.

Get Over Yourself

It’s become part of the ritual. As it hands out college diplomas, a college will feel obliged to season the entree with a sprinkling of very bad advice.

Yesterday, I took Jonathan Franzen to task for offering some exceptionally bad advice.

Today, I am more than happy to open with some great advice. it comes from David Brooks, and it’s even better than “Wear Sunscreen.”

Brooks advises recent graduates to learn that: “It’s Not About You.” Link here.

Upon graduation college students should be told that it’s time to get over their self-involved, self-centered world view. Above all else they need to get over themselves.

It’s an ugly world out there. Graduates who try to deal with it by following the bromides that commencement speakers are offering will be at a decided disadvantaget.

Brooks makes a number of important and salient points. Let’s review them and give them their due.

He believes that the young generation has been supervised and tutored to within an inch of its mental capacity. Now, we are inviting these same young people to enter a world where there are no clear guidelines and where the standard life track no longer seems to exist.

Brooks may be right that the young generation has been subjected to exceptionally strict adult supervision, but I suspect that if this were true, they would all have been brought up by Tiger Moms.

If the vicious debate about Amy Chua’s book told us anything, it revealed that far too many children receive insufficient supervision and suffer from diminished parental expectations.

Brooks feels that children who were brought up in highly structured environments will have difficulty adapting to free-wheeling unstructured uncertain situations. Certainly, it makes sense. One set of social skills will not always work in an alien environment.

However, I suspect that a child who has been trained to be disciplined and hard-working will do better in today’s world because he or she does not need a very structured environment.

If you can bring your own discipline and organization with you, you will do better in a world that no longer forces discipline and organization on you.

If you did not learn discipline and organization and good values at home or in school, you will do better in a highly structured environment, like the military or a corporation.

Brooks is right to see that the world that the boomers are leaving to the young generation is nothing like the world in which the boomers grew up.

Past college graduates had their future mapped out for them. They could get a job, get married, raise a family, get promoted, and so on. Some of them went to graduate school, got jobs, got married, raised families, got promoted, and so on.

The life track was fairly clear and well laid out. Such is no longer the case.

Allow Brooks to describe it: “Yet upon graduation they will enter a world that is unprecedentedly wide open and unstructured. Most of them will not quickly get married, buy a home and have kids, as previous generations did. Instead, they will confront amazingly diverse job markets, social landscapes and lifestyle niches. Most will spend a decade wandering from job to job and clique to clique, searching for a role.”

The worst part,  in my view, is that these new graduates are being bombarded with bad advice from what I would call the therapy culture. I have often written about the ravages of the therapy culture, so I am happy to see Brooks offering a similar perspective.

Brooks does not use the term therapy culture, but the values he sees running amok at college graduations, and presumably, in college courses, owe their existence and survival to it.

Brooks describes it well: “Worst of all, they are sent off into this world with the whole baby-boomer theology ringing in their ears. If you sample some of the commencement addresses being broadcast on C-Span these days, you see that many graduates are told to: Follow your passion, chart your own course, march to the beat of your own drummer, follow your dreams and find yourself. This is the litany of expressive individualism, which is still the dominant note in American culture.”

He continues: “College grads are often sent out into the world amid rapturous talk of limitless possibilities. But this talk is of no help to the central business of adulthood, finding serious things to tie yourself down to. The successful young adult is beginning to make sacred commitments — to a spouse, a community and calling — yet mostly hears about freedom and autonomy.

“Today’s graduates are also told to find their passion and then pursue their dreams. The implication is that they should find themselves first and then go off and live their quest. But, of course, very few people at age 22 or 24 can take an inward journey and come out having discovered a developed self.”

Well explained and well presented. In these paragraphs Brooks articulates everything that is wrong and misleading about the therapy culture approach to life.

Commencement speakers should not be telling everyone to pursue happiness. They should, as Aristotle had it, tell  them to pursue excellence.

Brooks writes: “The graduates are also told to pursue happiness and joy. But, of course, when you read a biography of someone you admire, it’s rarely the things that made them happy that compel your admiration. It’s the things they did to court unhappiness — the things they did that were arduous and miserable, which sometimes cost them friends and aroused hatred. It’s excellence, not happiness, that we admire most.”

The meaning of life does not lie in self-actualization; it lies, Brooks explains, in a job well done: “Today’s grads enter a cultural climate that preaches the self as the center of a life. But, of course, as they age, they’ll discover that the tasks of a life are at the center. Fulfillment is a byproduct of how people engage their tasks, and can’t be pursued directly.”

Allow me to offer a couple of examples, ripped from the headlines.

This morning Jennifer Rubin drew a great moral lesson from Memorial Day. Link here. She shows us that it’s not just commencement speakers who are peddling bad values.

Reflecting on the politicians who announce that they are not going to run for office because they place the good of their family above their duty to the country, Rubin writes: “Who’s more noble: the pol who decides not to run for the White House or the soldier, marine or sailor who goes overseas no matter how much he loves his family?”

Obviously, she is talking about Indiana Governor Mitch Daniels and Mississippi Governor Haley Barbour.

Rubin continues: “If a pol believes his country needs him, is the family dislocation — which involves no personal danger, comes with many perks, permits weekends and vacations with the family, and allows (if they so desire) relocating the family to Washington — justification for not serving? Patriotism, the extraordinary courage and everyday stress borne by our military and their families are something to admire. Many of us could not imagine undertaking it. So if a pol can’t tolerate a far more minor inconvenience, perhaps he should keep it to himself, lest the rest of us think worse of him.”

Her point is well taken. Even if his family has vetoed his presidential run, a politician would set a better example and retain some of his self-respect and kept it to himself.

The therapy culture tells us all to share. Our self-respect tells us to learn to keep more to ourselves.

While we are talking about politicians ducking the presidential race for reasons that have more to do with the therapy culture than with their duty to the country, I would add New Jersey Gov. Chris Christie.

As I wrote last week, the Christie dodge, namely that he does not feel ready to run for the presidency, is misses the point. Do you believe that the soldiers who go off to war should wait until they feel that they are ready?

Chris Christie needs to get over himself; he needs to figure out that it’s not all about him. It’s about the nation’s future, his duty to his country, and his place in history.

Ignore Jonathan Franzen

I wasn’t invited to deliver any commencement addresses this year, so I have not been giving too much though to the kind of advice I would offer to newly-minted college graduates.

If I were to do so, I might consult past commencement addresses, to see what the world’s luminaries have been able to offer.

Then, I would be confronted with the fact that the most famous piece of commencement wisdom appeared in a fake speech, attributed to the late Kurt Vonnegut, but not written by him. You probably recall it: Wear sunscreen.

Practical advice it was. You cannot go wrong by wearing sunscreen. The notion that four years of college and a mountain of debt would make you apt to embrace such good advice is, at least, somewhat heartening.

Alas, you cannot go peddling someone’s old advice as your own. The first piece of new advice that popped into mind was this: Floss.

While this is also unimpeachably good advice, it feels a bit derivative, and besides, college students being college students, it is likely that their first thought would have related dental floss to a certain style of swimsuit.

There I was, stuck for a pithy piece of wisdom, when I chanced on Jonathan Franzen’s commencement address to last week’s Kenyon College graduates. Link here.

I read it. Which is more than I can say about Franzen’s fictional output. I read it with an increasing feeling of horror. Franzen had managed, as was his wont, to load up his essay with a mix of mindless banality, utter stupidity, and godawful advice.

You might consider this to be a literary achievement of the highest order. It told me that the next time I am asked to give a commencement address, I am going to say: Ignore Jonathan Franzen.

You remember Jonathan Franzen. A favorite of the New York literary elite, he wrote a book called The Corrections. Widely proclaimed to be a masterpiece-- it wasn’t-- the book was having a fairly good run... until Oprah Winfrey chose it as a book club selection.

Being chosen for Oprah’s Book Club was a gift from the gods, manna from Heaven. Sales of the book shot up from the tens of thousands to the hundreds of thousands.

Authors, publishers, editors, and publicists would have sold their souls to have a book chosen by Oprah.

Not so Jonathan Franzen. The new star of the New York literary scene went into tantrum mode. He was not honored to be selected; he felt it was demeaning, beneath the aesthetic greatness of his novel.

If I may interrupt myself here, I will tell you that if you, as a writer, have to proclaim the greatness of your fiction, then you are saying that your novel cannot do it on its own.

Anyway, Franzen did not just believe that being selected for Oprah’s Book Club compromised his literary seriousness. He also declared that he feared that people would now mistake his book for a girly exercise, not quite up to the more manly novelists in whose company he sought to place himself.

As it happened, The Corrections is a domestic tragicomedy. It is not really a guy’s book. Domesticity, the inner workings of a family, these belong to the genre of advanced chick lit.

Perhaps Franzen thought that his efforts at jejune social commentary would raise his book to the ranks of Dickens and DeLillo. It didn’t.

As I explained in a prior post, I found the book to be boring beyond endurance. I stopped reading at the quarter pole. I will mention in passing that I used to teach English literature in college. I am not an amateur consumer of literary fiction.

Franzen was not done ranting against Oprah. Cringing in anguish,  Franzen declared that now, each book jacket was going to sport the Oprah seal of approval. Too corporatist, said Franzen, whose book was being published by an American branch of a German conglomerate.

If he wasn’t going to be a great novelist, Franzen seemed to be trying to compete for the title of the world’s most ungrateful cur. He told the world that he had never stooped to watch Oprah’s show, that the segments he had taped for it were bogus, and so on.

You cannot get very much more offensive. One must wonder what kind of world Franzen lives in, where such behavior might be considered to be clever and cool.

Anyway, Oprah was sufficiently put off to cancel Franzen’s appearance on her show.

I don’t know for a fact, but I do not imagine Franzen’s reputation suffered from his emotional incontinence. He might even have been expressing elite opinion in the New York publishing world.

However clever they are, and many of them are extremely clever, no matter how much effort they put into selling books, some editors and publishers must have rankled at the fact that the greatest marketer of books was this African-American woman on a daytime television show in Chicago.

I have no idea why people care about what a man with such an obvious character deficiency thinks about anything, but Kenyon College invited Franzen to deliver its commencement speech. The speech was reprinted in the New York Times, so it is going to receive some serious exposure.

Franzen begins with a metaphor. It’s not a very good metaphor, but, what did you expect?

He starts out by recounting his passion for a hand-held device. Which hand-held device might that be? Why, his BlackBerry. You weren’t thinking of something else, were you?

Apparently, Franzen was. Infatuated with his own cleverness he goes on to talk about how, when you use an iPhone, you can enlarge the image by spreading your fingers.

Getting the picture?

Franzen himself is trying to explain to these college graduates that you can have a love affair with these hand-held devices, and that they treat you better than real women do when you throw them out.

From there Franzen offers a reflection about Facebook.

It’s worth quoting in full, not because it is an exemplary prose passage, but because it’s so poorly reasoned. And besides, we should allow Franzen to speak for himself.

In his words: “A related phenomenon is the transformation, courtesy of Facebook, of the verb ‘to like’ from a state of mind to an action that you perform with your computer mouse, from a feeling to an assertion of consumer choice. And liking, in general, is commercial culture’s substitute for loving. The striking thing about all consumer products — and none more so than electronic devices and applications — is that they’re designed to be immensely likable. This is, in fact, the definition of a consumer product, in contrast to the product that is simply itself and whose makers aren’t fixated on your liking it. (I’m thinking here of jet engines, laboratory equipment, serious art and literature.)

“But if you consider this in human terms, and you imagine a person defined by a desperation to be liked, what do you see? You see a person without integrity, without a center. In more pathological cases, you see a narcissist — a person who can’t tolerate the tarnishing of his or her self-image that not being liked represents, and who therefore either withdraws from human contact or goes to extreme, integrity-sacrificing lengths to be likable.”

Where to begin....

Franzen is arguing that it is bad to be likable because it makes you less lovable. He wants young people to live their lives with wild gusto, to engage in mindless passions, because being madly in love is better than getting along with other people, fitting in with the group, and living as a functioning member of a community.

After opening his talk with a slew of erotic images about his relationship  with hand-held devices, he now tells us that these gadgets are more on the side of like than lust.

Not only does Franzen’s lecture have a special place in the annals of bad advice, but he himself has certainly qualified as a charter member of the gang that couldn’t think straight.

It is simply idiotic to say that Facebook has changed the meaning of the word: like.

Franzen claims that people who want to be liked have no integrity, thus, no character, that they are narcissists,  and that they merely want to keep up appearances in order to be liked by others.

But isn’t Franzen himself a monster of self-centered narcissistic preening, a man so thoroughly lacking in integrity that he is capable of insulting and demeaning the woman who is most responsible for his financial success and security.

Narcissist, heal thyself!

Narcissism involves a failure to respect the feelings of others. Only someone as confused as Jonathan Franzen could say that a narcissist is someone who tries to like other people and to be liked by them.

Because likability simply means having friends and acquaintances, colleagues and associates, and getting along with them in order to engage in productive enterprise.

You cannot accomplish any of those without showing tact and consideration. You cannot be a narcissist and be tactful at the same time. You can do as Franzen does and be tactless and narcissistic at the same time.

People who have a close and expanding circle of friends are not desperate to be liked. Quite the contrary. A person without friends is going to feel desperate to find the kind of true passionate love that Franzen prescribes.

If you have isolated yourself from other people, if you feel like a misfit, you might follow Franzen’s bad advice and attempt to cure it all by finding true romantic love.

You will not succeed. No single person should ever be expected to compensate for your failure to sustain good relationships with a large variety of people.

A mad passionate love affair is not a substitute for a social life. If you try to make it into one, you will soon discover why the poets declared this kind of love to be a type of madness.

As Franzen explains it: “The simple fact of the matter is that trying to be perfectly likable is incompatible with loving relationships. Sooner or later, for example, you’re going to find yourself in a hideous, screaming fight, and you’ll hear coming out of your mouth things that you yourself don’t like at all, things that shatter your self-image as a fair, kind, cool, attractive, in-control, funny, likable person. Something realer than likability has come out in you, and suddenly you’re having an actual life.”

Again, this is idiotic. If you not have a goodly number of friends, people who like you but are not in love with you, then your love affairs will be desperate, frantic, and frenetic.

You can love someone without liking them, but such passions usually burn out rather quickly and violently.

If you do not have friends who you like and toward whom you make every effort to be charming, tactful, courteous, and considerate, you will, as does Franzen, find yourself saddled with the kind of bad character and emotional incontinence that turns your adventure in true love into a “hideous, screaming fight.”

Franzen rails against being a consumer-- which he somehow associates with likability-- but he fails to notice that he is recommending that these young people become desperate to the point where they allow themselves to be consumed by some mindless passion.

As you might imagine, following Franzen’s formula is not going to make you very many friends. It is also not going to get you involved in very many sustainable love affairs.

Given that failure is built into the system, Franzen needs a fallback lover. He finds one in birds: “But, no less important, whenever I looked at a bird, any bird, even a pigeon or a robin, I could feel my heart overflow with love. And love, as I’ve been trying to say today, is where our troubles begin.”

His heart overflows with love... who is he trying to kid? If this were not risible, it would be pathetic.

Of course, birds, like other handheld devices, do not get into screaming fights with you. If you decide to drop them, they simply fly off. They do not expect you to like them. They do not much care.

Is there a better definition of narcissism than this injunction to abandon human companionship and to fall in love with pigeons?

The Two Conformities

Generally speaking, conformity is better than deformity.

That’s why people who prize their independence consider themselves to be non-conformists. It’s a lot better than declaring yourself to be  deformed.

At the least, there are two ways to conform, outer- and inner-directed.

By outer-directed conformity, I mean our tendency to follow dress codes, table manners, etiquette, decorum, and propriety.

Good behavior involves conforming to social norms and customs. The more you conform the more you feel like you belong to the group. The more you conform the more your interactions with other members of the group will be harmonious.

Conformity lubricates social intercourse. It is the foundation for cooperative enterprise.

As with any virtue, too much conformity is as bad as too little. When the crowd has been whipped into a frenzy, consumed by an irrational emotion, it is not good to conform.

Many people are telling you that you should not conform to society’s imperious demands.

True enough a few people can function in society while ignoring societal norms.

Regardless of how creative you are, it is nearly always better to do as others do, especially when it comes to behavior that is on public display.

We know-- because Confucius told us-- that group cohesion requires ritual and ceremony. It also requires conformity. If people did not conform to social customs, no one would ever know who was a friend and who was an enemy.

In my view, outer-directed conformity is more important than its inner-directed reflection, mostly because it is clear to any objective observer. You can fake sympathy or belief; you cannot fake good table manners or proper attire.

Inner conformity, that is,  conformity of thought and feeling, is not as solid a social foundation. Once we start making reference to private thoughts and feelings, you are relying on subjective impressions and guesswork.

Perhaps this is why mental conformity, groupthink, is such a difficult issue.

Take the most famous philosophical attempt to promote groupthink, Jean Jacques Rousseau’s concept of the general will.

Rousseau conceived of a state where a wise and benevolent leader would know and express what people really thought and felt, even if they do not know it themselves.

As you know, this is a formula for tyranny. It is the reason why the worst tyrannies pretend to express the will of the people and why they say that theirs are democratic governments.

More immediately, we all tend to align our thoughts and feelings with those of our friends and neighbors because we seem to want to live in spiritual harmony.

And we also try to avoid conflict.

Most issues are not really worth arguing about. When you have to choose between social harmony, on the one hand, and a disruptive fight over whether the Packers deserved to win the Super Bowl, most people, unless they have a strong vested interest in the question, are likely to go along in order to get along.

Often enough, we form opinions that are consonant with those of important figures. If we need to make up our minds about a matter on which we are not very well informed, we are likely to take on the opinions of the person with the strongest convictions.

Lecturers, and certainly politicians, know that if they sound completely sure of themselves, they are likely to gain more adherents than if they sound uncertain and hesitant.

It would seem that the person with the strongest conviction is least likely to compromise and more likely to fight anyone who disputes his opinion.

We also tend to agree with the person who has the most impressive credentials. If we do, we might be wrong, but we will be in good company, and besides, no one is going to say that we are stupid.

Yesterday, Jonah Lehrer explored another angle on the question of conformity: if everyone believes something, is it more or less likely to be true? Link here.

Research has shown that if you ask individuals separately to guess the number of jelly beans there are in a jar, they will do a fairly good job. When they are informed of other people’s opinions, they tend to get carried away by the need to conform.

Beyond showing that we are subject to the crowd’s influence, this also reflects the way the human mind works when nothing of importance is at stake,. At that point,  we place more value on thinking like others.

But, what happens when something important is at stake? Can we, for example, trust the judgment delivered by the markets.

In principle, the market knows more than any of us knows individually. But, the markets do not present us with a view of the general will. They show us the opinions of participants. In this sense they are not democratic.

Of course, the market may well get consumed by the madness of crowds. There are market bubbles and market manias. In fairness, the market always corrects its own excesses, and does not really care who gets hurt in the process.

When the crowd goes mad, when it is whipped into a frenzy, conformity reaches an extreme. You might call it the triumph of emotion over reason.