Max Lerner … On the Universe of Ill

GUEST: Max Lerner
VTR: 7/22/1990

I’m Richard Heffner, your host on THE OPEN MIND. Now, whenever he appeared on this program in the 1950s and 60s and 70s and80s, my guest today seemed always to me to be the most intellectually energetic and adventuresome man I’d ever met. Even his wonderfully positive characterization of himself one day at this table as a “possibilist” conveyed his unlimited optimism about what we could make of ourselves individually and as a people, whether we ever would or not. This was true even as into his own 80s he experienced – by the way, for him, a far more descriptive word than “suffered” – two cancers and a heart attack. And now W.W. Morton has published Max Lerner’s new book, Wrestling with the Angel: A Memoir of My Triumph Over Illness. And today I want this extraordinary journalist, historian, and commentator on civilization generally to share with us its insights. Perhaps the most doleful of those insights is that we don’t know what health is until we fall ill and lose it. Well, Max Lerner’s awareness that understandably there is a smell of taboo around life-threatening maladies since a society tribally tries to protect its integrity and see s a stricken person as a threat to the well-being of all. We inure our sick in hospitals, but we also invent ingenious ways of moving them off-stage, banishing them from life’s center, making their healing and self-healing more difficult. But I want to begin by asking Mr. Lerner whether he hasn’t turned just a bit too mellow in writing, “Understandably, there is a smell of taboo about life-threatening maladies”? Max, you’re very generous about understandably there is such a taboo.

Lerner: Well, understandably in the sense that every society has taboos, and these happen to be among our taboos. Understandably in that sense. I have yet to study a society that hasn’t’ had some pretty bad taboos. This one I have fought against through my years. And in the book, I’m still fighting against it, but I understand why a society seeks to protect itself against what it regards as rather strange and outlandish creatures like myself.

Heffner: But do you think of it as protection? Is it really protection?

Lerner: No, I don’t think it is. But it is perceived as protective. They feel insecure. And because they feel insecure, therefore they reach out to put us away, get us off the stage of life.

Heffner: And do you think that will continue to be the case as we all grow older and obviously more infirm, though you’re not a very good demonstration of infirmity?

Lerner: It will be less so. I think as a culture we are learning, and we are changing. As a matter of fact, every year I find changes within the culture, within its perception of the ill and the aging and so on. And perceptions which I wouldn’t have expected 10, 15, 20 years ago.

Heffner: Those perceptions, people say they have always been with us, the taboo (if we want to call it that) about the aging. And yet I do remember, max, and I go back a long time too, I remember.

Lerner: You’re a youngster.

Heffner: Well, let’s say just comparatively, which does not make me jump up and dance around. (Laughter)

Lerner: (Laughter)

Heffner: But I seem to remember that there was a great acceptance of infirmity in each, shall I say, nuclear family. There were those who were infirm, those who were going through tough times. They came out of them, they didn’t. But there seemed to be a great willingness to assume within the family circle.

Lerner: I think there’s greater awareness now of what we call life-threatening illnesses, mortal illnesses, a great awareness, we read about them in print or we watch them on television constantly. So they’ve penetrated our consciousness. And as they penetrate our consciousness, two things happen. And they both are there. One is that we get more scared as we apply it to ourselves. The other is they become more familiar, and we become more tolerant. And the other two are now locked in an embrace, fighting it out.

Heffner: You see to think you know who will win, or which will win that battle.

Lerner: I think I do. I think we’re going to win, the forces of life affirmation rather than life denial.

Heffner: Yeah, but now, is this more of my old friend Max Lerner the possibilist, the optimist?

Lerner: I don’t think so. I don’t think so. One of the things I’ve had to learn less during this last decade or so in which there’s been a certain amount of struggle I’ve been involved in, I’ve had to learn to face the gorgon head of reality, and really face it. And not only face it in my own life, but face it even more in the society, culture around me.

Heffner: What then – I know this is a question that’s asked on very different shows than this – what then led you to write this book?

Lerner: Oh, why did I write it? I wrote it…

Heffner: Therapy?

Lerner: Partly, yes. I needed to purge myself. Partly, I wanted to express myself. I’m a writing man. I don’t feel as if I’ve experienced anything, really fully experienced I until I’ve written it down. And I was like the ancient mariner. I wanted to tell my story to whoever was willing to listen to it. But in pat also because I thought there are a lot of people out there, a lot of families, who were also involved with cancers and heart attacks and all kinds of things, and that what I’d experienced might in some small way be useful.

Heffner: What’s the essential message then?

Lerner: The message is that this body we inherit is – we inhabit, rather – is a frail tenement, very frail. But that we can evoke some kind of spirit with strength and tenacity to cope with the frailty.

Heffner: Max, you know, I know that that’s your message, and I question it, because i wonder – and you’re going to say yes or not – whether we’re not talking about a certain kind of person. That’s why I talk about what I’ve always known about you and what I’ve always sensed about you, and whether that optimism, that sense of action, that indomitable spirit, without that whether you…

Lerner: I’m grateful to you for your description, but I’m not that unique. One of the things that really good doctors have discovered, doctors who work with the potential of hope and affirmation in people, one of the things they’ve discovered are that there are a lot of patients of this kind. Albert Schweitzer learned it long ago in Africa, working with primitives, when he said that there is a shaman within every person, a doctor within every person. And he said every person. And one of the wonderful things about Schweitzer that makes him so universal was that he didn’t distinguish between levels of people in that sense. There is a potential doctor in each of us. And in that sense I don’t think this is optimism on my part.

Heffner: Well, if Norman Cousins, our mutual friend, were sitting here, I would say the same to him about what I always knew about him as what I’ve always known about you. And the Schweitzer metaphor, of course, is quite telling with Norman.

Lerner: Many people who have read both Norman and me feel that Norman is more optimistic on the whole than I am. He writes about the biology of hope. Hope is one element in what I’ve written about. But to face the mask of reality, a mask that can freeze you, to be willing to faced it and to know that it represents a struggle. You know, the epigram that I use for the book as a whole, from Exodus, about Jacob. Jacob was left alone and there came a man into his tent and wrestled with him all night. And when he left, Jacob found that he had a wound on his thigh. And it wasn’t a man, it was the angel, it was god himself. And it ended by Jacob saying “I’ve seen god, and my life is preserved”. Now, it’s that wrestling which is not a matter of just hope, and it’s not optimism. It is grim wrestling. And one of the things that I tried to convey along with my sense of the potential within each of us to evoke some kind of spirit of affirmation, but one of the things I tried to say is that this is night. And I have a chapter called “Don’t Take My Night Away”. Because the presence of night, the fact of night, the fact of darkness is one of the things that evokes, by the startling contrast, evokes light. And I see no reason why I have to choose, in these polar opposites, I have to choose the optimistic one, the light. They’re both there, and they’re both part of each other.

Heffner: And the medical community?

Lerner: The medical community is split. A very good part of the medical community might well feel that what I’ve written in this book is for the birds. But there is a growing part o the medical community, even those that practice traditional medicine with very considerable rationality and willingness to face reality, I think a very considerable part of that medical community, and a growing part, is willing to understand the element of the – the what? – it isn’t just the mind/body connection . that’s part of it, it’s the connection with the body of the body, of the mind, the spirit, the outlook, the whole life way, the whole lifestyle that we have, the way in which we live, which affects the organism. And that understanding is beginning to move into the medical community at a quite impressive rate.

Heffner: You know, your thought about the doctor within the patient, most of the doctors I know would embrace that idea, in fact do embrace that idea. But they don’t have the time for it.

Lerner: Yes, that’s true. And they’re dealing with patients who all their lives haven’t had time to deal with the doctor within them actually until something strikes them. I call it “The news”. When we hear the news, whatever, of a cancer or a stroke or whatever it may be. We haven’t had time either. I go back to Moses and to David, who didn’t want to face the angel of Death because they didn’t have time. We always say that we don’t have time. And the very doctors who are so busy – and I think many of them make the mistake of allowing their business to overcome the shaman within them – but many of these doctors who are so busy are understanding that they have to find time for this shaman within them.

Heffner: But you quote, is it Hobbes who wrote that, “When two ride the same horse, one must lead him”?

Lerner: Yes, that’s right. It’s Hobbes.

Heffner: And how does one lead when two ride?

Lerner: Yeah, and one must ride in the front.

Heffner: Which one?

Lerner: Well, in this case, it was the doctor within me, the shaman within me. And in terms of my doctors, it was the shaman within them that rode in front. That’s right. I think Hobbes was a little wrong on that. He was talking of sovereignty. And what he was saying was that you cannot really share sovereignty. And what he was saying was that you cannot really share sovereignty. I talk about polarities, when I speak of the life/death polarity. And there it isn’t a question of who will ride in front. It’s a question of each embracing the other and being part of the other.

Heffner: but I meant more, I was referring really not to the darkness/lightness dichotomy, but to the patient/doctor dichotomy.

Lerner: Ah. On that, that’s another matter. There I’d never have any question. The centrality of the patient. We’ve always gone along with the basic schema of the centrality of the doctor. The doctor is the authority. He knows. And everything radiates around him, including the patient. And I don’t know whether I started with that or not. I was skeptical to begin with. But I had to learn through bitter experience that I was, as a patient, I was ultimately the one who, as a patient, I knew my organism best. As a patient, I had only one patient, that was myself. The doctor has hundreds. And as a patient, I had ultimately, while I had input from as many doctors and people as I could, ultimately i had to take command and make the decisions.

Heffner: But of course, Max, you’re a sophisticated, highly educated person.

Lerner: Thank you again.

Heffner: Well, I’m not simply saying that. You know what your body is. You know better than most of us. And you learned more.

Lerner: I know very simple people who have not had your education nor mine who know what their body is. Very much so. They have a kind of wisdom of the body. Far more than they may have a wisdom of the mind. Now, there are many people who are not so much simple or educated. There are many educated people, and I’ve known them, who in their own field were authorities and would never brook any challenge to that authority, who nevertheless, when they confront an illness and then control the doctor, surrender totally to the authority of the doctor and feel that there’s nothing they can do. I quote one actually who had surgery, castration for his prostate, when the doctor could have told him that there were other ways than castration. Nevertheless, he felt, “Who was I”, he says, “to question my doctors”? Now, that is different from education, he was a highly educated man.

Heffner: Yes, but we began this program with my asking why you are so generous with this word “Understandably”, referring to the taboos of our society. Now I would ask you the counterpart of that. If we are to be understanding, mustn’t we understand that the traditional view of the patient’s relationship to the doctor came out of some real felt need, that it is your example of the authoritative businessman who, in the presence of his doctor, in the presence of illness, turns immediately to a doctor. We have done that. It must be for some visceral, internal reason.

Lerner: Well, it came out of respect for specialization. Many people are specializing what they do. And when they find they’re confronted by disease, they feel they have to go to a specialist. I feel, by the way, that while I recognize many specialties in medicine, I like my doctors to be generalists. I like also, I would like myself to be a generalist so far as I can. I do not know medicine as well as the doctors do, but I know myself.

Heffner: But let me come back to the question of whether you are not expecting too much of mortal men and women to take your experience and – not to impose it, because you never would – but to suggest that it might be a guide for others.

Lerner: It might be. It might be a guide. I hope it will be a guide. There will be many who may well feel, “Look, it’s true of that guy, but it isn’t true of me”. But more and more I think may well say, “If it worked for him, and while he’s had a different education and so on, he isn’t that special”. I don’t have that sense of being that special. Every individual, by the way, is special. They may well say, “It may work for me too”. At any rate, as I said, one reason I wrote the book was that I thought it might be somewhat helpful.

Heffner: Do you think, Max, that…do you see a movement? Do you see an understanding, an increasing understanding on the part of physicians.

Lerner: Very much.

Heffner: …maybe not the time?

Lerner: Very much, and on the part of patients. This is why there are more and more illness narratives by patients. It’s getting to be a genre because more and more patients are beginning to understand that they are involved with their illness, they need to take command of it, and then they tell the story of that illness.

Heffner: Do you think that’s the reason for your book, for Norman’s, and for many others?

Lerner: For many, many patients. Of course, Norman has become a real authority on these things. This one book I wrote, I’m not going to write any more about it. I want to go back to other things now. But I did feel like the ancient mariner, that I had to find someone who would listen to me. And now I’ve gotten rid of it.

Heffner: Is there any sense on your part that medical schools themselves recognize the shaman within us and are helping younger physicians become more attuned to that idea?

Lerner: Norman tells me – he’s out of medical school – he tells me that’s so. My son, Michael Lerner, who is out of medical school, tells me also that that’s so. Yes, a number of people do.

Heffner: And that we then can anticipate that there will be a more sympathetic understanding of the approach you took in your illnesses?

Lerner: I think so. I sense this in the current around me. I may not be as sensitive as I should be, but I do sense this very much. And this isn’t simply being a possibilist. I think it’s being fairly objective.

Heffner: You are taking what I had said to heart.

Lerner: Yes.

Heffner: But I find it difficult to separate that bouncy enthusiasm with which I associate you, I associate Norman Cousins.

Lerner: Yes.

Heffner: And it doesn’t seem strange to me that the two of you should have written these books.

Lerner: I’ve known many non-bouncy people who have also written books like that (Laughter).

Heffner: Well, send them to me, because I’m looking for some…

Lerner: You want a non-bouncy illness narrative? (Laughter)

Heffner: Shaman within us. Right, I want to get to that concept of the doctor within us. You said this wasn’t just a matter of the mind/body.

Lerner: There’s more involved than the mind, as I say. There’s the question of a whole lifestyle. My friend Dean Ornish, who has now done a study of heart patients, by trying to change the whole lifestyle, their diet, their stress, everything else, feels that there can be reversibility in whatever has been happening to them in terms of potential heart attack, and in some cases, real heart attack. And these studies that have recently gotten a good deal of publicity, I think, indicate that this is quite possible.

Heffner: Max, where does that lead us as a society then? If you talk about reversibility, and we talk about, in our society now, the incredible problems associated with numbers and a growing sense of smaller and smaller resources.

Lerner: Yes. Well, this has been raised by Daniel Callahan in several very important and very good books. I happen to disagree with him when he says, “Where there are people who are very old and have got a lot of things wrong with them and so on, let’s not spend too much money with expense of medical technology on them; let’s use that money for other things”. I say that as long as…I think this is the wrong people making the decisions.

Heffner: What do you mean?

Lerner: I think that’s the kind of decision that should be made by the individual.

Heffner: But it’s not really a decision that you make, is it? Because the society about you is footing the bill.

Lerner: They’re footing the bill, I understand. And what I’m saying is that, as an individual, I’m fighting for that society not to discard people who want to fight for their lives, who are sound of mind, who know what they’re about, and who do not want to be discarded.

Heffner: I spoke with Dan about this…

Lerner: I call myself a “medical populist” in that sense.

Heffner: And I love that. I was going to come to that, because I love that phrase. And tell me what you mean by that.

Lerner: Well, I mean just as a political populist is one who identifies with the large numbers of people in fighting the entrenched authorities, so a medical populist is one who identifies similarly with those that want access to whatever technology there is, whatever health help there may be, and ought not to e discriminated against for whatever reason, whether it’s color or gender or age or degree of frailty.

Heffner: But Max, is it discrimination against, or is it choice of resources?

Lerner: I do not believe in social engineering. I have never believed in social engineering, whether fascists, communist, o under the name of democracy. Social engineering is when a small elite decides that it has the right to figure out what shall happen to groups of people. And my plan is that this is something that ought not to be a matter of social engineering.

Heffner: But isn’t that engineering taking place right at this moment, and must it not, since we are indeed in a situation where we’re talking about transplants or any of the modern technology?

Lerner: We are in the situation of great urgencies in terms of what is available to spend. I’m still fighting for minimal amounts of social engineering, of discarding whole groups of people because we cannot afford in some way to give them a chance to live.

Heffner: Well, you say, “Because we cannot afford”. You don’t see that as an absolute then?

Lerner: I do not see it as an absolute. We have spent money for many, many things, including death-dealing things. These are life-affirming things.

Heffner: It’s interesting to me to hear you say this, because so m any of our recent programs together over the past decade, you have been enthusiastic, you were in the Reagan years, enthusiastic about our defense posture.

Lerner: Yes.

Heffner: And you can’t have it all ways.

Lerner: Defense is fine when it’s relevant. Defense is becoming less relevant now. But at any rate, if I have to choose between life and defense things, I think I would choose life at this point. Now, perhaps my experience has tended me that way. But on the whole, I think that we are able thus far, we have been able thus far to do the defense without discarding the need for life affirmation.

Heffner: How do you relate this to what the British do, for instance, in their determination that there is a limit to dialysis, for instance, people over a certain age do not have it available to them, and that’s it? Not an uncivilized people.

Lerner: They’re not uncivilized. The Germans, by the way, were not uncivilized, and look at what happened. And we’re at the present time debating to what extent the Germans having really gotten rid of their whole past between 1914 and 1945. No, it’s quite possible for a civilized people – and the British are very civilized people – to adopt social policies which I do not believe in. and I have to say that.

Heffner: Let me ask another question now. We have one minute left, I see. What way do you think we will go?

Lerner: In terms of what? The issue that Callahan raises?

Heffner: Yes.

Lerner: I think Callahan probably has the course of history on his side. But I’m going to keep on fighting against that course anyway.

Heffner: What do you mean, “Course of history”?

Lerner: Well, I think the very things that you’ve talked about.

Heffner: Dollars?

Lerner: The growing number of…well, the scarcity of dollars, and the growing number of the old and the frail, the fragile and so on. Given all that, I think the course of history is likely to go against the kind of medical populism that I stand for.

Heffner: You know, Max, in the final analysis, I really wanted you to find a way out of that. I wanted you to help me, make me a little more optimistic by finding a way out of that.

Lerner: No, I’m not optimistic when the circumstances don’t’ warrant it.

Heffner: Come back next year and the year after, as you always do, and we’ll see whether they warrant it or not. Max Lerner, thank you so much for joining me again.

Lerner: Thank you.

Heffner: And thanks, too, to you in the audience. I hope you’ll join us again next time. And if you care to share your thoughts about today’s program, please write to THE OPEN MIND, P.O. Box 7977, FDR Station, New York, NY 10150. For transcripts send $2.00 in check or money order. Meanwhile, as another old friend used to say, “Good night and good luck.”