Carl Reisman on the water

Dave Kopacz near the water

This is part II in a discussion between Dave Kopacz and Carl Reisman, part I can be found in the previous blog, below…

Dave:

Why do you think that machine-think, machine-medicine, machine-models of service and interaction have become more attractive than more human interactions? This brings up the question, following on from above, what is the difference between machine and human?

Carl:

To whom?  The business model prefers efficiency and short-term gain, externalizing costs.  This has been the dominant approach in the West at least since the Industrial Revolution and seems to be a new  world religion.  Machines are the new slaves.  I remember a David Sedaris essay where his brother refers to the TV remote as “a nigger.”  Humans are lazy, and it is wonderful to have work done magically for us without taking responsibility for the suffering it causes another.  It’s a Utopian dream to have a world where we all are rich and robots serve us.  If they do, though, what are people for?  Wendell Berry wrote an essay with this title, and it is a good question.

It’s tempting to say that the difference between humans and machines is that humans have spirits or souls and machines don’t.  I would say that is unproven.  I go back to what I said before, that humans are the models for machines.  Even if machines eventually can create new machines, or learn to crack jokes, or feel love, they are still our creations.  Machines are our way of playing God.

More thoughts:

As far as we know, machines don’t have a sense of self awareness.  They don’t have a culture that is independent of human culture.  They aren’t aware of their own mortality.

Being fully human means being a member of human culture.  It’s impossible to be fully human as an isolated individual.  A baby is fully human.  We can all aspire to follow their model for participation, direct communication, and ability to grow.

If we are honest with ourselves we need to own up our debt to machines and the people who imagine, build, maintain, and scrap them.  They are a part of human culture and should be honored as members, from jet planes to pepper mills.

Dave:

I like what you say about being human means being part of something larger than the individual, being part of culture (this echoes your earlier statement that being human is being aware of larger ecological interconnection. In my book, I equate holistic medicine with connection – connection within one’s self (between body, emotions, mind, spirit) and connection between people (particularly doctor/patient). I contrast this connection-based interaction with a mentality that values efficiency and technique more than human connection. While these may or may not be mutually exclusive in theory, in the practice of contemporary medicine, efficiency and standardization are valued over connection (Amit Goswami, author of The Quantum Activist and The Quantum Doctor, writes, that this should be called “machine medicine”). Partly this is because in our materialistic society, “things” that can be turned into “numbers” are valued more than feelings or states of interaction. I think the complaints that patients and doctors have about contemporary health care delivery systems is that they are de-humanizing.

Carl:

The Marxists have been talking about this problem for over 150 years.  Doctors have just become workers in a new factory.  It’s the same language and logic as was used in earlier forms of industrial production.  We are steeped in this culture, and it is very difficult to free ourselves from it.  The film, The Matrix, dealt with this anxiety that we are slaves in a system  that we don’t understand and that is committed to our remaining asleep.

While it sounds innocent to talk about humanizing health care, it is placing oneself firmly against the tide.  Certainly, the industrial health care system can pay lip service to being more humane without facing its deep-seated de-humanizing, profit-driven values.  It can offer up birthing rooms but not make home births legal, for instance.  Like all revolutions, this one will come from the people, not the owners–i.e., the patients, who demand more than they system wants to give.  So, doctors who want to become more humane need to listen to their patients and find out what they really want and need.

Dave:

Peter Salgo, a physician, wrote in a NYT piece that it is up to the people (patients) to demand that medicine change, because doctors “have felt powerless to change things.” While I am all for grass roots movements, I think we also have to appeal to professionalism and the contract between doctor and patient. Can it really be true that an educated and privileged class of professionals are really “powerless to change things?” What I argue in my book is that the same dehumanization that patients feel in the medical system is the linked to the dehumanization of the doctor through a rigid adoption of the scientific persona of the technician, which not only treats the body as a machine to be “fixed,” but also leads physicians to believe that they are simply machinists of the soul.

I speak about the Quality Revolution in medicine, which is a movement driven by multiple motivations from different sectors, which calls for more efficiency, safety and less variation in treatment and outcomes. I also acknowledge that there is another growing movement, a Compassion Revolution, which calls for enhanced human connection and treating people as people while treating them as patients. These two revolutions are not necessarily at odds with each other, but I think they function best as a dialectic or a pair of inter-balancing movements. The exclusive triumph of one at the expense of the other would not be good medicine.

Is it possible for a doctor to say, “I will treat you exactly how I treat everyone else, as a unique human being?”

Carl:

It’s cruel to doctors to hold them to a standard of treating everyone the same way. Doctors are human and humans have favorites.

Besides, if a patient comes into the room and the doctor thinks, “I am going to treat this man as a unique human being,” they have already lost an opportunity to see who they actually are.  We all need a beginner’s mind when we encounter the world, and it’s especially hard for experts to have this sense of open curiosity, since experts have been trained to quickly establish authority and sense of control in each new situation.

Doctors can aspire to be better listeners and let their treatment lightly follow what they hear from their patients, as learned from their histories, a review of their medical records, and their own knowledge and intuition.  They need to be vulnerable, working with open minds and hearts.  They need to at times admit that they don’t know what is going on or how to help, despite their best efforts, and admit to their patients when they are wrong.  Sometimes they need to just sit there and witness another person suffering and dying.   Sometimes they need to smile at a patient’s return to health, because or in spite of the doctor’s advice.   That can be quality medicine, too.

Dave:

Carl, what are your thoughts about these topics as they pertain to your practice of law? I have always referred to you as a “holistic” counselor. This idea of a “counselor” is relevant in both law and medicine and I suspect that the roots of the term lead back to some kind of spiritual guidance in antiquity.

Carl:

When you say, “holistic” what do you mean?

It makes me think of how we create firewalls in ourselves to protect ourselves from all sorts of threats.  When we go to a professional school we are given a new suit of armor.  The armor insulates us from those who might doubt our competence or authority but also isolate us.  In a holistic practice we sometimes wear the armor or sometimes not, as we see fit.  The armor has its place and needs to be polished, oiled, and deeply appreciated.  But we also need to know when it is a terrible trap.

Dave:

Thanks for the question, when I say “holistic” I mean being able to shift between multiple perspectives. Perhaps that means to have multiple suits of armor? I suppose another way to reformulate some of our original questions is: is it possible to be a professional and also to not be wearing a suit of armor? Or, maybe how does one appreciate when one needs the armor and when to remove it?

I define holistic as a state of being. Technically, I envision this as something like the chakra system, an interlocking system of sub-systems with different rules and strengths. Is each chakra a suit of armor? Or a “body?” In that sense, one would be embodying different conceptions or states of being and recognizing that each of these states is one language or musical note or instrument that is part of a larger whole. To be “holistic” is to be continually shifting perspectives while realizing that it is impossible not to have a perspective. Is that true? I am not sure. What if I said that to be “holistic” means to always be focusing on the between of different paradigms and perspectives?

Carl:

When I went back to law school nine years after dropping out I hand-painted my own ID.  I was afraid that I would lose my sense of self when I went through the professionalization process of law school.

It reminds me of a conversation I had last week, too, with a singer song writer who said that she was afraid if she learned how to read music that she would lose her way as a musician.

I think the word holistic points towards being able to shed some of these fears and move with a certain confident vulnerability.

In my own practice I exclusively help clients who have suffered injuries, most at work.  I have the luxury of being able to take time with each client.  I don’t have a paralegal or secretary.  If a client comes in my office or calls the office phone, it’s just me.

I am not sure if this is a holistic practice, but it has worked for me for nine years, since my partnership broke up and I took up residence in an old gas station in Urbana, Illinois.

Clients come to lawyers with expectations that they have powers, perhaps arcane or diabolical, to fix things for their benefit.  It’s similar to why they come to doctors.  They seem to have similar roots in wizardry, sorcery, alchemy, or shamanism.  A person is under some sort of dark spell and they want help.

So, like a doctor I have to try to be a good listener.  I need to take a history, learn something about the person who comes into my office.  I have the luxury of time that few doctors have any more.  Like a doctor, I review their medical records.  Again, because I have so much time, and am a generalist, sometimes I see things that doctors miss, and I can help the client with their problem in that way.  I used to see myself as a hero, a warrior for my client, but I dropped those fantasies years ago.  Now, I feel like the hard work of recovering from their injury is theirs to do, and I am just along to help in the modest ways that I can.  That is also similar to a doctor, and I imagine that doctors must go through a similar process of shedding their grandiose fantasies and accepting the limitations of what they can accomplish.  Perhaps, also like a doctor, I’ve come to understand what a privilege it is to get to know people when they are at their most vulnerable, their most tender, their most human.

Lawyers and doctors both seem to feel trapped by their professions.  Lawyers talk about the “golden handcuffs”—their inability to leave high paying jobs that they hate.  Doctors lament the cost of medical school and the corporatization of medicine.

It’s always easier to blame others for one’s own choices than to take responsibility for one being stuck.  Every doctor and lawyer can do simple things to make their profession better, and it starts by listening to the people who come to them for help.

Dave:

Let’s go back to our topic of humans and machines. How about pondering why we have come to value machine-thought and machine-being over human process? Why elevate the created over the creator?

Carl:

Our culture values highly human cultural production over machine processes in many ways.  Just look at prices for original oil paintings by Picasso compared to machine made reproductions.  This sort of appreciation for the small, the human made, the artisan-produced, is found in countless products–it’s why there is a premium paid at the farmers market, for the bowl thrown by the potter, for the hand-stitched quilt.  It is a luxury afforded to the rich and a necessity for the poor, who survive by their hands and wits.

Humans also crave order and predictability.  If we buy a jar of Jiffy peanut butter, we want it to taste exactly the same next week, next year, and twenty years from now.  That is the implicit promise of brands–order, stability, uniformity, the known.

When we are dealing with novel situations, whether we are on a strange highway far from home looking for lunch or in a hospital, facing surgery, there is comfort in knowing that there is something familiar that will reassure us, that we can surrender our defensiveness and put ourselves in the hands of someone who will take care of our needs.  We turn in to the McDonalds and order a burger, and it tastes like the burger we ate last year in our hometown.  The doctor comes into our room, and uses the same sort of language as our family doctor did ten years ago.

The same desire for order created machines, a refinement of tools.  Tools, by their nature, do not produce uniformity.  A chisel in my hands with a block of wood will result in something very different then the same chisel and block of wood put in your hands.  But if we make a lathe, there is a pretty good chance that we can produce something pretty consistent, whether you use it or I use it.

So, our appreciation for the unique is a kind of nostalgia for the old order of things, when we worked with tools.  We are creatures, though, of a machine culture and machine thought, gravitating towards order and predictability.  We prefer standardization to surprise, security to joy.

Dave:

Could it be that our nostalgia for the unique is also that illusive kernel of what makes us fully human? We have ranged across a discussion in which “human” is part of a unique identity, that it is attained through transcending or contextualizing the human in a larger realm (which seems to have a sense of being “more than” human, but also being human through our connection and care for that which is “less than” human). We humans seem to sometimes want to just accept ourselves as we are, to sometimes try to be more than we are, and also to have a drive to be less than we are. For instance, Philip K. Dick speaks of a form of dehumanization when human beings become like androids, particularly when their behavior is always “predictable.”  Carl, please leave us with some inspiring words to spark off the Human Revolution!

Carl:

When I think about the products of the human imagination, how an idea becomes a thing, and the thing changes us, I think about the wheel.  There is the prayer wheel of Tibetan monks, the clay cylinders of scribes, the wheels of ox carts, the medieval concept of the wheel of fortune, the tires of our cars, the wheels of our lives.

We talk about the need for a revolution, but what is it that revolves?  It’s the wheel, going around, our innate creativity, industry, and restlessness taking us as humans to new places.  Any revolution that is going to mean something needs to start with individuals who wake up.  They need to find their own wheel.  Thanks to culture, they don’t have to invent it, but culture only goes so far.  We all still have our work to do and places to go.