While reading Un’altra pratica della cura. Tra due sponde by Sandro Spinsanti, one embarks on a brief yet intense journey—cultured, light, and rich in irony—through some common clichés of the healthcare world and of patients and caregivers.
On the side of doctors and volunteering, which is rooted in philanthropy, a question arises: how philanthropic can we be without receiving gratitude in return, without being seen by the other—as Paul Ricœur would say—without falling into the opposite excess, that of pursuing money alone and becoming money-devouring machines of cosmetic surgery?
It is pleasant to read the passages in which one becomes kinder, learning that even something as simple as the smell of a warm brioche can make us more generous when a beggar asks for alms, as the philosopher Ruwen Ogien recounts in Del profumo dei croissants caldi e delle sue conseguenze sulla bontà umana. Thus we discover that aesthetic perception is fundamental in making people more pleasant, and therefore kinder, while environments lacking beauty tend to make people harsher.
Spinsanti—somewhat in the manner of Howard Gardner, who speaks of multiple intelligences—does not describe a single posture of the physician, but presents five different professional attitudes. Just as intelligent people do not stop at the singular, Spinsanti does not stop at the stereotype of a single posture.
Among these we find the scientistic posture, that of the fan of Evidence-Based Medicine who considers it full of absolute certainties rather than probabilities; the vitalistic posture, that of those who want to keep a patient alive at all costs—as told by Marco Venturino in the novel Cosa sognano i pesci rossi—because one must not fail, one must not lose a patient; the philanthropic posture, on which he reflects when speaking of the “human” doctor as distinct from the professional one—but is not the professional doctor also human?; and finally the conversational or narrative posture, where the various aspects—perhaps deliberately caricatured—are balanced.
He also discusses ethics committees, noting that translating ethics committee as “comitato etico” (ethical committee) is inappropriate, since it actually means “committee for ethics.” Saying “ethical committee” almost implies that the committee will behave ethically by definition.
I would like to add a postscript: Spinsanti speaks of ethics committees in end-of-life decisions, but I would also like to introduce the issue of when an ethics committee is called upon to evaluate studies in narrative medicine and does not wish to classify them as observational studies. Yet, if observation is the first element of narrative medicine, we may deduce that there is still limited awareness of it within ethics committees. Perhaps this happens because the Evidence-Based Medicine posture prevails, with standardized clinical protocols. But how much can a human being truly be standardized?
On the other side are patients and caregivers. Here the social critique is strong: Spinsanti reminds us how many people must give up their own self-realization to care for a loved one, and how this can become an enormous burden on families. Chronic illness has brought wonderful progress, but it has also revealed the limits of the burden imposed by the sheer quantity of life.
If Aeneas, the hero of pietas, was young and carried an elderly man—perhaps fifty years old—on his shoulders and led a child by the hand, today we instead see sixty-year-olds carrying ninety-year-old parents on their shoulders, with grown children, and perhaps also caring for their grandchildren. Pietas has its limits among non-heroes.
And what about the patient? The classification of different attitudes toward illness is interesting, as it adds, beyond the misery report, the tension toward normalization, the recovery of lost health—what Arthur W. Frank called the “restitution narrative.” Then there is maintenance: given a chronic illness, I know I must live with it, and only by recognizing my responsibility for its maintenance can I begin to seek the “Great Health” of Friedrich Nietzsche, based on existential health—the quest, as Frank would say: the search.
All of this includes the art of smiling and laughing, of not taking oneself too seriously, because otherwise we run short of endorphins—and therefore of energy. And I smile thinking of the association that came to mind while reading Between Two Shores: it echoed the song dedicated to our river of resistance flowing between beloved banks.
Once again, thanks to Sandro Spinsanti for this life lesson in the form of an essay
