PALLIATIVE AESTHETICS: FINDING OUR WAY INTO THE EYE OF THE BEHOLDER BJ Miller, MD I want to feel alive more than I want to be alive. My patients and their families do too. Let this longing be what fills the space between us, the subjects and the objects of care. This essay is directed at the human being in each of us, whether we’re playing the role of patient or doctor. If you ask me, all physicians are palliative physicians at heart and by oath. As a palliative physician, per se, my job is to see patients in all manner of anguish. Suffering is the beginning. We start with feet that have gone numb or tingly. Or maybe nausea. Fatigue is probably most common of all. Or maybe the patient is feeling mostly fine, but the family is burning out. There is always something for us to do. Eventually we get underneath the angst to its source, where the bigger issues lie. Connection, appreciation, realization, and everything else meaningful that can go lacking when you’re distracted. But down here, we have our opening: where in your day do you feel the slightest bit OK? When do you feel right with the world, even for a moment? What’s happening then? Illness is discombobulating to the point where it can be hard to find the ground. Answering these questions helps light a way. For many, it’s time with family or friends. A certain activity: the movies, music, their art studio, driving, swimming, being in their garden. Maybe it’s at work where they finally drop in for a moment. Almost invariably, people’s answers to these questions have two things in common. One, they comprise a sensation. More than just the garden or the movies, what registers is how they feel being in the garden or at the movies. The emotional and the physical. Second, these sensations always hold their own significance for the patient, regardless of any other purpose the activities might serve. Purpose is good, but it’s not necessary. Here is where means and ends meet. In other words, these questions and answers bring us into the realm of aesthetics. Does that register with you? It might not. That word ‘aesthetics’ has gone wonky. White teeth, smooth skin, Italian art, sunsets when the clouds are just so. The word ‘aesthetic’ is more typically reserved for these sorts of things. Something subjective and of a particular taste: exotic, special, arty. Furthermore, to use a word like ‘aesthetic’, you might presume you need special glasses, like graduate degrees or secret pass codes. But here’s the real secret: you don’t. You don’t even need to think. WWW.SFMMS.ORG
As a force for breaking through, illness is helpful, shredding layers of shellac that build up over time, obscuring a person. The gum and goo of expectations, roles we think we must take on to be recognized, all the while suffocating our real core: the thing of us that receives more than it sticks out. Illness is also a foil. It dials up the contrast, so that beauty and the other bits of ease can pop. But let’s not give illness too much glory. You don’t need to be amidst loss to appreciate something. You don’t need to exaggerate the contrast. Nor do you have to be ill to fall apart. Modern life will give you a luxurious number of opportunities to do so. In other words, you don’t need an excuse to be affected. You just need a little courage or a shove. From what we see with people at the edge of their lives, being affected by life is one of the finest ways to prepare for it to end. Regret tends to pool around the unmoved bits. For all our lurchings, our charge is the same as it ever was: to feel with this body while we can. To do so, all you need is one of the following: sight, sound, smell, taste, touch, or intuition. The world has much more to offer than a small selection of pretty things, and, as long every bit of us is welcome, we humans have so much more capacity to handle it all than perhaps we realize. In the realm of aesthetics, we’re freer than we think. The aesthetic is generous and inclusive: anything that intensifies the immediate sense of living. That’s how John Dewey, philosopher, psychologist, and educator defined it. There’s no time required, and no memory either. Just a direct sensation piquing life in you. Or, to be even more inclusive, take Frank Zappa’s definition of the aesthetic: anything, anytime, anywhere. Gaps so easily widen between the world we have and the one we wish for. This is the price we pay for having imagination. That pain is nothing new, but nowadays we have a gap that’s only widening and at an accelerating pace. The times are at once so challenging and so promising. Ever more seems possible—virtual realities, intimacies from afar, instantaneousness, simultaneousness—but it turns out ever more isn’t really possible after all. Surely, all these new developments have their aesthetic potential too. But for most of us, they arrive faster than we’re able to make the receptors required to experience them. The tonnage is overwhelming to the point of anesthesia. It gets harder to know what we have, and harder to feel in time.
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