I was struck recently by the concluding sentences of an article written by Nathaniel Morris, a Harvard Medical School student. Note his final words. “. . . health care providers must discern when to apply the powerful instruments at their disposal and when to carefully hold back. It often just comes down to clinical judgment, a skill I’ve yet to learn but I’m hoping to find in my education.”
Here is a student at the beginning of his career, recognizing something he calls judgment, a palpable skill he hopes to discover not in school, if we take him literally, but in his education. It seems obvious that what young Mr. Morris perceives as a need represents a strain of wisdom that comes only with age and experience, a perspective that one’s culture may teach, although ours often fails in this one respect. Our mantra “If it’s new it’s good” derives from a society worshipping the young, albeit ambivalently, and the constant pressure to consume. Inevitably a culture of this sort also tends to worship science over art, and perhaps too, numbers over letters. It is a culture preferring rationalism over intuition, alleged fact over sensibility, and accomplishment and status over experience.
For a young doctor, these distinctions are captured in the two worlds that will forever constitute his medical education and ultimate career: The science of his discipline, and the art of the discipline, a portion of which we too casually label “bedside manner,” the latter representing all of the human experiences that go into those moments when the life of our doctor (or teacher) affects us, even heals us as profoundly as the pure knowledge upon that he or she draws.
Only naturally I see some of my own concerns in Mr. Morris’s concluding sentences; why else would I linger with them. I fail to understand why our culture so regularly seeks to rid its institutions of elderly people, the very people, many of them, leaning less on their glorious scientific training and more on, well, their experiences of just having lived, and watched, and heard, and touched. And learned. Perhaps we underestimate what goes into what some call “the attitude” of the experienced teacher or clinician, the lived experience that upholds the approach one assumes, and the utterances one makes. In his book The Analytic Attitude, psychoanalyst Roy Schafer spoke of attitude as being part of the drama of interaction, of teaching or clinical work that goes on “behind the scenes.” But it may be that the act of judgment is quintessentially a temporal drama, and hence “behind the scenes” refers more to maturity and experience than “pure” knowledge and professional training. Attitude also may refer to humility, another dividend, perhaps, of lived experience.
Two dear friends, both in their late sixties, both with chaired professorships in a very prominent school within a very prominent university, are being pressured to retire. Combined the two of them probably have written thirty-five books and received honorary degrees from fifty prestigious universities. They are known nationally and internationally, and from what one hears from their present and former students, they are loved and admired. One of these professors wrote me recently that he recognizes that those of us of a certain age belong to what John Kenneth Galbraith called the “Still At Generation.” “Professor Galbraith, you’re still at it?”
But isn’t the work they are still at, the very work Mr. Morris requires as part of his education? And isn’t the operative word here “still?” Are these two renowned scholars not invaluable participants in the essential conversation of education and judgment and the development and education of the mind? Of course systematic studies in their respective fields must be performed, in the manner that these two performed such studies decades ago. No one doubts this assertion, assuming that it is good science one practices and not merely science that one practices. Are these not the very people, moreover, Kierkegaard had in mind when he advanced that “Life can only be understood backwards, but it must be lived forwards.” These are the “backward understanders” who the “forward livers” require in order to develop that skill called judgment. Once upon a time they were the forward livers enriched by the “Still At” mentoring seniors of their day. Shakespeare said it all (in Two Gentlemen of Verona):
“Experience is by industry achieved,
And perfected by the swift course of time.”
Maybe I am the character in Alan Lightman’s Song of TwoWorlds, searching for something to believe in. Then again, perhaps what troubles me, namely the paucity of truly caring communities, what Erich Fromm called loving communities, is not necessarily a concern shared by everyone. I suppose one could design a scientific study and determine the demographics and personality characteristics of the “Still At Generation” that correlate with such a concern or world view, but I doubt we wish to waste valuable resources on such an investigation. Better perhaps to keep an eye on the perils of old fashioned institutional ageism, root for the marriage (okay, the co-habiting) of science and art to endure, and retain some of those old folks so that people like Nathaniel Morris can be assured that someday he will be making the sort of judgments that both honor and heal his patients. And his profession.
Thomas J. Cottle, 76, is Professor of Education at Boston University. His latest book is Drawing Life: Narratives and the Sense of Self.