Saturday, January 10, 2004


I've been thinking "soon I'll rejoin the world," but then I thought a better way of saying it is "soon I will repatriate." I've never really left the world. Only my relationship to it has been altered. Is there a word rematriate ? I have not left my motherland. It seems a fatherland from which I have been absent.

Since the beginning, the part of my world that's given over to medicine has always seemed a patriarchy. From my dear father Raul Stanati's early and unsubtle insistence that I become a doctor, through my own later impudent characterization of my field as "stern master medicine," medicine has always seemed a province whose influence over me is classically paternal: strict, exacting, anxiety-provoking, hierarchical. Replete with rules and obligations, precisely marshalled rewards and punishments. The image of a puppet occurs to me: of limbs precisely controlled by an external agency. Not a dance erupting, flowering from within.

Practicing medicine, I have felt like Persephone in the underworld. Like Jonah in the whale. Alienated, kidnapped, imprisoned, punished, inwardly rebelling, fleeing. Controlled by, possessed by a stranger. At its worst, it entrains feelings of terrible inauthenticity and fear. Of being pecked at by a flock of hungry birds. Most of the time there's just a small fume of dysphoria to clinical dailiness and caring for patients.

And a longing for Demeter's house. And for Demeter.

The existential analysts (does anyone ever think about these folks anymore ?) delineated three lived, experiential "worlds" that they called the umwelt, the mitwelt and the eigenwelt. The umwelt is the surrounding physical world, the environment. The mitwelt is the world of relationship. The eigenwelt is one's relationship to oneself and to the world through oneself. Rollo May writes in his 1958 introduction to Existence that the eigenwelt an "unexplored fronteir of psychotherapeutic theory" and that the "self knowing self" is "closer to us than our breathing." Investigating this world -- which is both "inner" and "outer" -- is, of course, the province of meditation. The eigenwelt IS meditation.

My own personal crisis has been in the mitwelt. I understand it well enough -- a biological substrate of shyness, passivity and timidity, a psychodynamic tendency to relate to people as if they were fathers -- and I simply do not think there is a "cure" for such a fundamental way of being in the world, any more than there is a cure for "blue" or "wet."

The problem, the dissonance, arises when the world begins making demands that go against the grain of one's abilities and proclivities.

I just finished reading The Curious Incident of the Dog in the Night Time, a story with an autistic narrator. I felt immense sympathy for the narrator. His special abilities and proclivities made being in the world enormously difficult for him -- in the spheres of understanding and relating to other people, of interpreting emotional and epistemological nuance. He develops strategies for navigating the world, which, given the world's intolerance for difference, don't always work. But he sets out bravely, and pursues what he needs. His fantasy of paradise is being alone in a bathysphere at the ocean's bottom, or being the last survivor after a plague wipes out humanity.

On some level, it's the same for all of us: we find that we are strangers, outsiders; that the world is knocking uncomfortably at our skin with either too-open, too-vacant spaces or with jostling, impinging throngs.

I'm trying to imagine myself into the opposite of me: someone who is gregarious, exuberant, active, bold, in a profession that imposes quietude, reflection, obedience and isolation. Bill Clinton, say, in a Carthusian hermitage ?

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