The book Disease, Pain and Sacrifice, by David Bakan, is a work that I did not fully appreciate upon a first reading. I discovered a copy about a year ago among a stack of discarded books at the college where I teach, and the title alone was enough to catch my attention, but I also gleefully savored the reactions of people who would ask me about it. “Well, that sounds like some light, uplifting material!,” was a common, sarcastic response. Usually such comments would be followed by an uncomfortable laugh and then a quick change of subject. It was no big surprise that most people prefered to avoid dwelling on such dark subjects!
When I first read the book, it wasn’t the grim subject matter that put me off, but rather the author’s integration of scientific medical findings into a work that otherwise leans heavily on literary theory, biblical analysis and psychoanalytic interpretations. Originally published in 1968, the book draws on studies going back as far as the 1930’s, and due to the ever-changing nature of science, I was naturally skeptical about the continued relevance of such material. It makes me suspicious when a philosopher makes too many appeals to science in order to buttress interpretive claims. While such appeals might be superficially interesting, I tend to think that they generally distract from the underlying issues at hand. What count as the latest scientific findings of today quickly become the outdated speculations of yesterday, and so authors always run the risk of making their writings seem outdated and irrelevant when they put too much confidence in the current state of scientific research. Additionally, when non-scientists make appeals to science, the result can sometimes turn into a kind of pseudo-science, further undermining a reader’s confidence.
Upon a second reading however, I have come to see the book as a kind of artwork in-itself, the beauty of which partly depends on appreciating how all of its various pieces intertwine in order to produce a unique and profound reflection on the nature of human finitude. The author describes the book as a “triptych”: a description that now seems very apt and revealing to me. The point of the book, thus, is not to focus on a literal set of facts, but to give expression to a distinctive human experience: the reality of suffering and the aspiration toward its alleviation. What I find especially refreshing about Bakan’s treatment of this theme is his clear-eyed insistence that human life is a paradox in which suffering and extinction are presuppositions even as we strive toward their overcoming. There is no way to overcome our finitude, in other words, and so the human experience is one in which we struggle and strive toward something that is ultimately impossible. As the author puts it:
Pain and mortality make up the tragedy of man. Within these he squirms around. (p. 91)
Without calling himself a nihilist, Bakan here nonetheless eloquently expresses what I understand to be the “truth” of nihilism. We are destined to “squirm around,” doing one thing after another as we attempt to convince ourselves that all of this is not in vain. We subject ourselves to strain, stress and suffering in the attempt to overcome strain, stress and suffering. In the end, we die, which is the only thing that can halt our incessant “squirming.” This is dark stuff, but it is also hopeful in the sense that Bakan argues we are capable of understanding this process and, through the cultivation of that understanding, come to terms with our situation.
I’m not so sure of the last point myself. In my experience, the confrontation with disease, suffering and death is always accompanied by a sublime and terrible awe that exceeds my own capacity to feel reconciled or content with the nature of the world. I would note here that I’m not even referring to my own disease, suffering and death, but to that of the people around me and with whom I am close. When I stop to reflect on the inevitability that there will be a point in time when I personally will be visited by these evils, I tremble. Though intellectually I understand the day will come when terminal disease or some other bodily assault will strike and I will finally face oblivion, existentially I remain in state of awe-filled dread.
I can report that I have also seen what appears like this same fearful incomprehension in the eyes of others; for instance when I am in public with aging and physically fragile relatives. Strangers on the street are generally kind, but behind the kindness I often detect a shudder. They, like me, see their own destiny when they encounter old folks. There is, thus, an unusual solemnity that occurs in the presence of the elderly, and especially the elderly who are infirm, fragile and vulnerable. It is something like the “fear and trembling” described by Kierkegaard in reference to Abraham’s encounter with God when he had to surrender his will to the Holy. All of us, by virtue of being human, must eventually surrender our will to live when death arrives.
Bakan expresses these sentiments, and yet he also seems confident that our intellect can save us from utter despair in the face of oblivion. He ends his book with the suggestion that if we stop “lusting” after eternal life, then we can become “comfortable” with the reality of old age, disease and death; something that I myself am not currently capable of doing. Maybe some day I’ll get it.
The “tryptich” of Disease, Suffering and Sacrifice is constructed out of the three themes that appear in the book’s title. Like the panels of a three-sectioned art piece, each part echoes and develops the ideas in the other sections, weaving together a whole that is more than simply the sum of the parts.
The first “panel” focuses on disease, characterizing it as the result of what the author calls “telic decentralization.” Contrary to the conventional “Darwin-influenced” view of life as a battle for individual survival, Bakan makes the (Freud-influenced) claim that individual life itself is internally endowed with a drive toward extinction, and that “the goal of all life is death.” (p. 26) If biological organisms are conceived of as consisting of parts (like cells and organs), which must subsume their own individual purposes to the goals (or teloi) of the whole, and if the goals of the whole organism at times differ from the goals of the parts, then there will inevitably during the life of the organism emerge points of internal conflict during which either the parts must sacrifice themselves for the whole or the whole must sacrifice itself for the parts. Disease, argues Bakan, occurs when when the parts of an organism start to pursue their own purposes without being subservient to the higher order purposes of the whole. “…disease is to be conceived of as decentralization of this higher telos of the organism, and its loss of dominance over the lower teleoi.” (p. 32) This is what happens with cancer, for instance, when individual cells multiply uncontrollably and thus interfere with the normal functioning of the entire body and its systems. The paradox for multi-cellular creatures is that on the one hand, their growth depends on the complex nature of their bodily organization while on the other, it is this same complex organization that leads to eventual disease and death.
In the second “panel,” Bakan addresses the nature of suffering and pain. He points out that the existence of pain “forces the question of its meaning.” (p. 58) When we experience pain and suffering, in other words, it is natural and automatic to ask why we are in distress. What is the reason for our pain? Bakan’s contention is that pain is the manner in which telic decentralization becomes manifest to human consciousness. It is a mental indicator for when a bodily part is not playing its subservient role in the overall purposes of the organism. Psychologically, this experience encourages us to view the out-of-control part of ourselves as “not us.” We mentally separate our overall identity from that of the troublesome part, and thus prepare the way for the sacrifice of that part in service of the whole. For instance, a tumor, which is made of the cells in a person’s own body, is experienced mentally as a painful intruder that needs to be removed for the benefit of the rest of the body. It becomes “the tumor” that is a attacking “me.” A separation thus emerges internally between the “I” and the “not-I” as a preliminary step toward the elimination of a part that was originally a part of the “I.” (This same process, by the way, is implicated in the logic of fascism. Hannah Arendt, in her classic book The Origins of Totalitarianism, suggests that in the Nazi state, “undesirables” like jews, slavs, communists, capitalists, etc. were viewed as “other” as a preliminary step toward their extermination. It is fitting, accordingly, that the Nazis used the language of disease in order to characterize those elements within their society that they sought to eliminate.)
The third and final panel focuses on sacrifice, and it is here that Bakan engages in an utterly fascinating interpretation of the Book of Job from the Bible. The story of Job is one in which a pious man, Job, becomes the subject of a bet between God and the Devil. The Devil suggests to God that Job’s piety is merely due to the fact that he has never experienced enough suffering to make him question God’s goodness. God knows that this is not the case and so He challenges the Devil to make Job suffer in the most terrible ways in order to demonstrate that nothing will make him lose his faith. Consequently, Job’s livestock and his family are killed and yet it is not until Job himself is struck with a horribly painful skin disease that he truly begins to express dejection. For Job, it is ultimately his own physical suffering, and not that of others, that forces him to question the meaning of this ordeal. Bakan argues that before Job, Old Testament figures like Abraham and Moses were willing to sacrifice themselves for the good of the tribe, family and race. But with Job, a psychological change occurs. With him we find a man more motivated by the desire for personal survival than by the desire for the survival of his progeny. The death of his livestock and his family are nowhere near as powerful a motivating factor as is his own personal pain. Job, the author claims, is thus one of the few Old Testament heroes to make a distinction between himself and “other.” Here we have a man who has experienced a telic decentralization of his own “self” from the community as a whole.
Bakan reads this story as an allegory indicating how disease and personal, physical suffering are implicated in sacrifice. Psychologically, Job is a figure who, like Abraham before him, has a child’s trust in his father (God). However, unlike Abraham, Job does not seem to be at all concerned with the legacy of his own children. Whereas Abraham agrees to sacrifice his own son Issac in order to ensure that the members of his family and tribe will be rewarded with a “promised land,” Job is concerned primarily with the alleviation of his own suffering, and he seems to put his own children and family on the same par with his livestock and his private property. In fact, the “happy ending” of the story has it that Job is rewarded for his continued faith with new livestock, a new farm and a new set of children; as if there was nothing all that unique or special about his own kids! Job is the head of a family, but his concern with his own goals and health are more important to him than the goals and health of his family. Abraham was willing to sacrifice his son for the good of the rest of his family and his tribe. Job is not. As the cells in his body undergo a telic decentralization, producing painful disease, Job himself becomes telic-ly decentralized from his community. He becomes an individual.
Bakan argues that the final biblical development of Job’s way of thinking becomes manifest in Christianity where, through bodily suffering, Jesus overcomes death once and for all, living forever at God’s “right hand.” The message here is that if one is an obedient son to the father, punishment in the form of suffering and personal death can be overcome. This, Bakan claims, is “one of the major defects of the Judeo-Christian tradition, the tendency to subsume death under punishment, to leave out the possibility of death which is not punishment.” (p. 126) His point is that personal sacrifice in the pursuit of personal immortality is a lie. It is an infantile wish. Life just is a “squirming” around between life, suffering and death. Suffering and disease are not punishments from “the father,” but brute facts that derive from the very constitution of our biological makeup. The second to last paragraph in Bakan’s book sums up the message of the entire work:
There are two major points in life which are beyond the scope of the individual will. One is conception; the other is death. Between these, but not including them, the will of the individual has its proper sphere. To fancy one’s self one’s own creator, or to place death within the power of the will, are the real sins of mankind. This Job understands. And this, I believe, Freud understood when he stressed the fantasy of presence and witness to the primal scene, on the one hand, and the death instinct, on the other. (p. 128)
Because we are biological creatures, we must all be born and we must all die. There is nothing that can be done about these facts. As the existentialists say, we are all “thrown” into the world, and once we are here we are are all “beings-toward-death.” While we are here, we can engage in projects. We can “squirm around” for a short period of time. All of these are things that I agree with. What I find hard to come to terms with is the idea that all of this is good. I still wish things were otherwise.