Happiness that Money Can’t Buy

Edwin Arlington Robinson
Edwin Arlington Robinson

I think we’ve all read E. A. Robinson’s masterful “Richard Cory” poem about a wealthy man, much admired, perhaps envied for his living the good life, who commits suicide.

Whenever Richard Cory went down town,
We people on the pavement looked at him:
He was a gentleman from sole to crown,
Clean favored, and imperially slim.

And he was always quietly arrayed,
And he was always human when he talked;
But still he fluttered pulses when he said,
“Good-morning,” and he glittered when he walked.

And he was rich – yes, richer than a king –
And admirably schooled in every grace:
In fine, we thought that he was everything
To make us wish that we were in his place.

So on we worked, and waited for the light,
And went without the meat, and cursed the bread;
And Richard Cory, one calm summer night,
Went home and put a bullet through his head.

In keeping with the poem’s theme, I recently came across a Federal study published in 2002  that showed that rich neighborhoods have higher rates of suicides than less affluent neighborhoods. This finding may come as a surprise to most people who, like those in the poem, equate wealth with contentment.

The obvious question to ask is why money, possessions, fame and power don’t assure us happiness? The answer is that they fall short in the staying power of simpler values, found largely in ourselves, not things subject to life’s vicissitudes and often paid for with daily stress.

Ironically, having money and all it buys may mask an insecurity, or need for validation,  compounding one’s misery.

According to Solberg, Diener, and Robinson, “Why Are Materialists Less Satisfied?” (2004), those values that truly sustain come down to a relative few:

Personal health.

Security.

Having goals.

Enjoying a rich relationship with others.

I’d even contend that the four can be reduced to just one, security. Defining security more specifically, what we want most is freedom from anxiety in a world of flux. As Freud might have told us, we’re all children crying in the night. Let’s face it: As human beings we’re possessed by egos that generate our desires and foster our insecurities.

This, of course, may help explain the increasing popularity of meditation to relieve our stress or, better, our fright.

I think Tolstoy, that most moral of writers, gets at the truth in his short story, How Much Land Does a Man Need?:

I would not change my way of life for yours,” said she [to her well off sister]. “We may live roughly, but at least we are free from anxiety. You live in better style than we do, but though you often earn more than you need, you are very likely to lose all you have. You know the proverb, ‘Loss and gain are brothers twain.’ It often happens that people who are wealthy one day are begging their bread the next. Our way is safer. Though a peasant’s life is not a fat one, it is a long one. We shall never grow rich, but we shall always have enough to eat.

Recently I saw Hardy’s magnificent Far From the Madding Crowd at the movies and reread the classic. Observing the reenactment of an agrarian tapestry of defined roles amid resplendent, on locale filming in Dorset, Somersetshire and Oxfordshire (Hardy’s Wessex), I couldn’t help remembering Hardy’s nostalgia for a fast fading bucolic way of life providing security, communal intimacy, and defined roles.

In our own time, in contrast, one only has to read sociologist George Packer’s The Unwinding: An Inner History of the New America (2013) to see the carnage of our free-fall from those nets of safety intrinsic to daily life.

If you were born around 1960 or afterward, you have spent your adult life in the vertigo of that unwinding. You watched structures that had been in place before your birth collapse like pillars of salt across the vast visible landscape—the farms of the Carolina Piedmont, the factories of the Mahoning Valley, Florida subdivisions, California schools. And other things, harder to see but no less vital in supporting” the order of everyday life, changed beyond recognition (pp. 12-13).

How much better the simpler life, free of complication with its inherent risk of loss, lived honestly, even if frugally, ample in the extraordinary goodness of family and friends and the joy of pursuing one’s passion.

Ok, so I’m a sentimentalist, I still hold that those times, lived in the plentitude of the simple values I enumerated earlier, provided far more in the way of genuine happiness than today’s stressful, materialistic world that increasingly marginalizes each of us and holds our contentment hostage.

–rj

Being Mortal

gawandeI’ve just finished reading Being Mortal: What Matters in the End by Dr. Atul Gawande.

I had read his previous Complications about life as a surgeon several years ago, greatly impressed.

Both books have been highly praised, with the present book listed by the New York Times as among must reads of 2014.

As a surgeon at Massachusetts General Hospital, Gawande knows what he’s writing about.

And he writes well, often movingly, in layman’s language, of death scenarios with their accompanying challenges that need to be individualized, since we’re all different.

I suspect many readers will opt to avoid a seemingly morbid subject, but that’s a mistake, for   mortality knows no exceptions and our best approach is one that, through knowledge, provides us with options.

And Gawande, a writer for the prestigious New Yorker as well as a physician, delivers–deftly, compassionately, and always with eloquence, on a difficult subject.

Moreover, his book preeminently addresses the medical community, often committed to treatment paradigms that work against the patient’s welfare.

Physicians are trained to see themselves as enhancers of health and survival. They are not taught how to handle lingering illness devoid of remedy:

…within a few years, when I came to experience surgical training and practice, I encountered patients forced to confront the realities of decline and mortality, and it did not take long to realize how unready I was to help them (3).

If your problem is fixable, we know just what to do.  But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity, and extraordinary suffering (8).

What’s the point, anyway, of continuing chemotherapy, radiation, and surgery in terminal cases when such methodologies may involve great risk and, often, increase duress?

When, in short, should doctors, not just patients, let go?

Patients cling to hope and doctors knowingly feed into this, when frequently no regimen can procure that miracle of restoring health and dignity.

Or as Gawande vividly makes clear in his allusion to Tolstoy’s powerful tale, The Death of Ivan Ilyitch:

What tormented Ivan Ilyitch most was the deception, the lie, which for some reason they all accepted, that he was not dying but was simply ill, and he only need keep quiet and undergo a treatment and then something very good would result (2).

The ultimate challenge for physicians is to accept the restraints of biology and assist their patients to come to terms when that moment arrives

Otherwise, they can inflict considerable, even barbaric, suffering.

Doctors need to be patient-centered, addressing the patient’s best interests, and sometimes the greatest kindness entails being candid..

Ultimately, it’s about providing patients with options that preserve dignity, lessen suffering, and are in accord with the patient’s priorities.

We’ve made some progress in the now universal acceptance of Advanced Directives, though initially contested. But what about options for the terminal patient, still conscious, who lingers, often in great pain, and with perhaps even greater to come?

Gawande says that there are two dominating physician protocols: the one patronizing (this is what you should do); the other, informative (here are your scenarios).

Doctors do better when they ask the right questions of their patients in such contexts:

Whenever serious sickness or injury strikes and your body breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make or not willing to make? And what is the course of action that best serves this understanding? (259)

Palliative care, for example, may well be a better option to further surgery, chemotherapy and radiation when the outcome may make matters worse.

On the other hand, indulging patient fantasy may invoke “a prolonged and terrible death” (4).

Gawande carries out what he advocates. For me, his account of his father’s lingering passage into mortality is deeply moving, which I think many of us can identify with in our own wrestlings with the demise of those we love.

In addition to all of you, I wish every medical practitioner would read this book.

Death isn’t an enemy, but the natural order of things.

How much better it would be in our final moments to have someone like Gawande attending–a physician, with compassion, listening and helping us discern those best options that enhance our dignity and lessen our suffering.

–rj

 

 

 

 

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