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Johnny Temple plays bass guitar in the rock bands Girls Against Boys and New Wet Kojak and is the publisher of Akashic Books (www.akashicbooks.com).
I offer these brief remarks today as a prayer for our country, with love
of democracy, as a celebration of our country. With love for our country.
With hope for our country.
The legendary Surrealist exhibitions of the late 1930s and early 1940s were Surrealist in spirit and secondarily Surrealist in content. In 1942, for example, an exhibition called "The First Papers of Surrealism" was installed at the Whitelaw Reid mansion on Madison Avenue in New York, and those that attended it were far more likely to remember the show itself than any of the works on display. It was designed by Marcel Duchamp, using one mile of string to weave a sort of spider's web from floor to walls to ceiling, which visitors had to climb through to look at the art hung on temporary display panels. Moreover, they had to put up with a crowd of schoolchildren, boisterously playing ball or skipping rope or chasing one another through the show. The children were instructed to say that Mr. Duchamp said it was OK for them to play there, if anyone raised the question. It was an ideal way to subvert any propensity to seek a rich aesthetic experience in contemplating the art, and by indirection to demonstrate that it was not the point of Surrealist art to be an object of aesthetic contemplation in the first place. Duchamp disdained aesthetic response--"That retinal shudder!" as he dismissed it in a late interview.
Duchamp had also installed the legendary International Exposition of Surrealism at the Galerie Beaux-Arts in Paris four years earlier. There he arranged to have the ceiling hung with 1,200 coal sacks that, though empty, showered residual coal dust on the throngs below, who were supplied with flashlights to see the paintings hung in shadows. Upon entering the show, visitors encountered Rainy Taxi by Salvador Dali--an ancient taxicab on which water poured down from the ceiling. The driver and passenger were both mannequins, the former equipped with a shark's head and wearing goggles, the latter a frump covered with escargots, and both placed on a bed of lettuce.
These exhibitions achieved the same shock of incongruity that was intended to characterize what one might think of as Surrealist experience in general, as expressed in one of their favorite paradigms from a text by Isidore Ducasse, a k a le Comte de Lautréamont: "The chance meeting on a dissecting table of a sewing machine and an umbrella." There is a 1920 photograph by Man Ray of a mysterious object, wrapped in a heavy blanket and bound with rope. It was used as the frontispiece of the first issue of a magazine, La Révolution surréaliste, the readers of which would immediately have inferred from its title--"The Enigma of Isidore Ducasse"--that the wrapped object must be a sewing machine. Visitors to non-Surrealist exhibitions of Surrealist art--such as "Surrealism: Desire Unbound," on view at New York's Metropolitan Museum of Art through May 12--might be let in on the secret by a wall label reading: "sewing machine, wood, fabric, card." But without knowing the identity of Ducasse or the text alluded to, the point of the work would be lost on them.
Surrealism was essentially a literary movement, whose primary products were books, magazines, poems, letters and manifestoes. These in fact form a considerable part of "Desire Unbound," which, together with the many aging snapshots of groups of smiling Surrealists, could with equal suitability have made up a show at the Morgan Library or some comparable venue. Art itself was largely peripheral to the movement, serving, like Man Ray's photograph, to illustrate the essentially philosophical ideas of the writers, who were chiefly poets and what one might term aesthetic ideologists, tirelessly taken up with defining what we might term "Surrealist correctness." At least in the early stages of the movement, one of their questions was whether painting was even a Surrealist possibility. Ironically, the writers have become the subject of scholarly specialization, while Surrealism itself is widely identified with a body of paintings, pre-eminently those of Dali--desert landscapes in acute perspective, on the floor of which various objects, often teeming with ants, cast sharp shadows. It was Dali who designed the dream sequence in Alfred Hitchcock's film Spellbound--and it is his idiom that has been universally appropriated for the representation of dreams.
It is with reference to dreams that Surrealism was initially formulated in André Breton's First Surrealist Manifesto of 1924. What excited Breton about dreams was the fact that what happens in them defies reason and certainly common sense. But for just the reason that dreams cannot be captured in the discourse we use in our waking lives, they were, until Freud, relegated to parentheses that we felt no need to incorporate into the narrative of our lives. Breton was convinced that this was, in effect, throwing away something of inestimable value, and in the Manifesto he described a method of writing that makes the dream accessible to our waking consciousness. This, in effect, is a kind of automatic writing--writing that as far as possible is uncontrolled by our critical faculties. The resulting pages will be impossible to appreciate in the ways in which ordinary writing is appreciated. "Poetically speaking," Breton says, "they are especially endowed with a high degree of immediate absurdity." Nevertheless, what we have done has somehow brought the dream before our conscious minds, and what we have is at once reality and dream, hence a kind of "absolute reality." Surrealism is then the method through which this absolute or "sur-" reality is made available to us as a resource to be used. Here is Breton's definition:
SURREALISM, noun, masc. Pure psychic automatism by which it is intended to express, either verbally or in writing, the true function of thought. Thought dictated in the absence of all control exerted by reason, and outside all aesthetic or moral preoccupations.
I have italicized "either verbally or in writing" to emphasize that Breton does not mention either singing or playing, or drawing or painting. There is little if any Surrealist music, though one might think that jazz would exemplify psychic automatism to perfection. Breton thought Surrealist music was impossible, probably because music lacks the dimension of realism that is a precondition for sur-realism--an objection that would be overcome in the case of opera, and indeed my musical informant, Lydia Goehr, has told me of a Surrealist opera, Julietta, by a Czech composer. Painting, on the other hand, met the criterion of realism, but as far as the Surrealists were concerned, it lacked the spontaneity of writing or speech. Dali painted like an old master, using perspective and chiaroscuro, building up glazes, creating illusions. There is no way it could have been done automatically, or without rational control. So by definition, his painting cannot be Surrealist. It would be like transcribing a dream in rhymed verse. The most that can be said is that he illustrates strange conjunctions and encounters, directed, as it were, by a strong artistic will.
One might say that the visual arts became admitted to Surrealism only when artists found ways of working more fluidly. Max Ernst's marvelous collage narratives, in which he clipped and pasted images from old engravings, recommended themselves to the Surrealists. Miró, who actually used writing in his paintings together with images, was also accepted. When Breton encountered the sculpture of Giacometti, it was as though he at last found someone who seemed to dream while awake, in the medium of clay and plaster.
In truth, it was mainly the painter Matta who found a way of drawing automatically and hence surrealistically. And Matta taught the New York painters--especially Pollock and Motherwell--how to do this. Psychic automatism evolved spectacularly into what we now think of as Abstract Expressionism, and it was through the chance encounter of Right Bank Poets and rednecks like Pollock on the dissecting table of Manhattan that American artists were able to produce work that Motherwell describes as "plastic, mysterious, and sublime"--adding that "no Parisian is a sublime painter, nor a monumental one, not even Miró." But Abstract Expression was never "Surrealist" in the sense in which Dali's images were. It was as though there were two dimensions to Surrealism--psychic automatism and absurdity. The latter does not figure in Breton's definition, but it certainly figures in what we might call Surrealist sensibility.
I learned a certain amount about what it would have been like to be a Surrealist from Robert Motherwell, who as a young artist in New York in the early 1940s became a kind of guide to Breton and a cadre of other Surrealists, then in exile in New York, where they endeavored so far as possible to re-create the form of life they'd lived in Paris. Twice a week they would gather for lunch at Larre's, an inexpensive French bistro on West 55th Street, and proceed afterward to Third Avenue, at that time lined with all sorts of secondhand stores and antiques shops. The activity for the afternoon was to decide which of the objects on display were Surrealist and which were not. It was a fairly serious matter to be wrong about this. Matta would have been disgraced when he misidentified as Surrealist a certain gargoyle head--until Duchamp intervened, saying that maybe he had a point. Duchamp, listed as Generateur-Arbitre (producer and arbitrator) in the catalogue for the 1938 exhibition, was not officially a Surrealist, but Breton regarded him as having perfect pitch when it came to what possessed surreality and what did not.
A famous such object was a curious wooden spoon Breton and Giacometti had found at the flea market in Paris. A little shoe was carved just under the spoon's handle. It struck Breton that the whole spoon could be seen as itself a shoe, with the little shoe as its heel. He then imagined the possibility that its heel was another shoe, with a heel of its own, which itself was a shoe...and that this could go on to infinity. The spoon he saw as an example of "convulsive beauty" in the sense that it revealed through its structure a state of mind, which consisted in a desire for love. There is a photograph, again by Man Ray, of this found object with the descriptive title "From the height of a little slipper making a body with it..." which was published in Breton's book L'Amour fou. There would be no way of telling from the photograph--or from the spoon itself--that it had convulsive beauty, or the evasive property of surreality. And I am uncertain whether it has either of these intrinsically, or only for the individual to whom it reveals, the way a verbal lapse does in Freud's The Psychopathology of Everyday Life, a state of mind that would otherwise have remained unconscious. At the very least, some fairly elaborate chain of interpretation--as again in the The Psychopathology of Everyday Life--has to be supplied. Surrealism was a taxing and fully absorbing form of mental activity.
In the First Surrealist Manifesto, Breton mentions having become aware of a certain "bizarre sentence" that came to him "bearing no trace of the events with which I was involved at the time." He was unable to remember the exact wording, but it generated the writing he subsequently identified as Surrealist. The little spoon, as it happens, helped unpack a different such phrase, one that had been obsessively running through his mind--"Cendrier-Cendrillon"--which means "Ashtray-Cinderella." Breton refused to learn English, not so much, I believe, out of the vanity that is threatened when we lose the fluency of our native tongue but because we dream in our own language. The terms "ashtray" and "Cinderella" have no obvious connection, but "cendrier" and "Cendrillon" have a common root--the French word for cinders or ashes, which enables them to be conjoined in free association. Breton went so far as to ask Giacometti to make an ashtray in the form of Cinderella's slipper. But he remained baffled by "Cendrier-Cendrillon," and somehow the slipper spoon helped clarify the emotional state that expressed itself through the conjunction. But you have to read L'amour fou to find out how.
L'amour fou brings us to "Desire Unbound"--since unbound desire is exactly what L'amour fou is. Desire--and in particular erotic desire--is the theme of the Metropolitan exhibition. With qualifications, everything in the show possesses surreality--or convulsive beauty--providing we understand how to unlock it. The most helpful thing to understand is that aesthetics was never a central Surrealist preoccupation, so looking for an aesthetic experience here will not get you to first base. You have to look at the exhibits the way those displaced Surrealists looked at the objects on view in shop windows sixty years ago, trying to decide which were the Surrealist objects. Motherwell told me that his problem in playing that game lay in the fact that he had been brought up to look at antiques aesthetically. His mother was an antiques collector. But he got a kind of education surréaliste in those afternoons spent peering through dusty shop windows, tutored by Breton and Duchamp. With a sigh of what I felt was despair, he said, on one occasion, that the whole world was beginning to look surrealistic to him. But that, as he of course knew very deeply, was a metaphorical truth. The world seemed pretty crazy when the International Exposition of Surrealism took place in Paris in 1938. France was falling apart, German planes were bombing Barcelona, Germany was poised for conquest. The Surrealists were not aiming for the kind of experience that could be had from reading the headlines.
But neither did they think that the creation of the surrealistic was their unique contribution to art. The surrealistic existed avant la lettre. The Surrealists found it present throughout the history of art--in Hieronymus Bosch and in Hans Baldung Grien for obvious reasons, in Seurat's La Grande Jatte for less obvious ones. The first gallery in the show is given over toGiorgio de Chirico, whom the Surrealists took as a predecessor, and the second one to Dada, many of whose members, especially Max Ernst and Marcel Duchamp, were to make substantial contributions to Surrealism when it emerged as a movement in the 1920s. But the first object one encounters in entering the show--Venus aux tiroirs, 1936--a plaster Venus in whose torso Dali had placed a number of small drawers, as in a jewelry case, each with a fur-covered knob--is self-consciously Surrealist. Fur seemed by itself to confer surreality when adjoined to any object, the use of which seemed to rule fur out as a material--like a teacup, for example. No survey of Surrealism would be complete without Meret Oppenheim's 1936 fur-lined teacup, which somehow is like a dream object rendered concrete. One can see why. The last thing one expects, lifting a teacup to take a sip, would be the feeling of fur on one's lips. It happens only in dreams, where it would seem to disguise an obvious reference and a no-less-obvious repressed wish. Oppenheim had a genius for finding ways to express genital references through everyday objects, and much of Surrealism was taken up with such disclosures. There is a photograph by Man Ray of an unidentified woman, her head thrown back so that we see the lines of her jaw from below. But then, with the irresistibility of an optical illusion, the neck convulses into the shaft of a thick penis, with the jaw becoming the glans--and the image looks like a huge penis coming out of a woman's shoulders. Surrealist objects are displacements of the objects of desire with which the world around and within us abounds--though a lot of good it does us so far as the gratification of desire is concerned. Perhaps that is why it seems to constitute the constant preoccupation of mental life, which surfaces distortedly in our dream life.
The great emblem of unfulfilled and perhaps unfulfillable desire is Duchamp's 1915 masterpiece The Bride Stripped Bare by Her Bachelors, Even, usually referred to as The Large Glass. A display case here holds notations and sketches for the work, and there is a painting of the bride in Duchamp's Cubist manner. The stripping has gone so far that the flesh has been taken away, and what we see looks like her reproductive system, including a schematized uterus. She is suspended in an upper chamber, separated by a glass shelf from her "bachelors"--a chorus of "malic forms" in the lower chamber. The two chambers are united and separated by an erotic desire that leaves everyone at once unsatisfied and inseparable. Duchamp, as is well-known, took a female identity for himself as Rrose Sélavy--Eros, c'est la vie--and was photographed wearing a woman's hat, makeup and furs by--who else?--Man Ray. In one of his most famous works--a postcard of the Mona Lisa on which he drew a mustache and goatee--Duchamp sought a reverse transgendrification. Magritte showed the female torso as a readymade pun on a male face, with the nipples as goggle eyes, and the pubis as beard. In Surrealist thought, male and female are often transcriptions of each other, as in the myth of Aristophanes that once upon a time we were a single being, male and female at once, and that ever since we have longed, in futility, for our other half. In Surrealism, though, the split was not clean--each of us bears something that belongs to our sexually opposite number.
The Surrealists did have robust love lives, and the heart of the show--no pun intended--exhibits the cat's cradle of their relationships: Gala with Paul Eluard, Man Ray and finally Dali; Max Ernst with Leonora Carrington and Dorothea Tanning; Eluard with Nusch; Man Ray with Meret Oppenheim and Lee Miller; Louis Aragon with Elsa Triolet; Breton with Nadja and Jacqueline Lamba. And there were plenty of secondary loves as well. Many of the women were artists in their own right, and it is a merit of the show that a lot of their work is shown. I'll end with one of my favorite lines from a Surrealist poet, Robert Desnos, bound to two women--Yvonne George and Youki Foujita--by l'amour fou: J'ai tant rêvé de toi que tu perds ta réalité. ("I have dreamt of you so much that you have lost your reality.") The line is logically equivalent to: "I have dreamt of you so much that you have gained surreality." The beauty of the objects of Surrealist desire became convulsive through dreams. May this become true for us all!
Pat Buchanan surely holds the record for the greatest impact on a presidential election with the fewest votes. With less than 0.43 percent of the tally nationally, he still managed to decide the 2000 election. But for the thousands of votes mistakenly cast for Buchanan in Palm Beach because of the infamously confusing "butterfly" ballot, Al Gore would be President today and George W. Bush would be the Republican Michael Dukakis.
Buchanan's pernicious influence, however, did not end with the 2000 election. He's now picking up where he left off with his infamous "cultural war" speech to the 1992 Republican convention, a speech, as Molly Ivins quipped, that "sounded better in the original German." Well, Buchanan's been translating from Deutsch again, this time with The Death of the West: How Dying Populations and Immigrant Invasions Imperil Our Country and Civilization, his new book. The Death of the West harks back to the xenophobic jeremiads of the early twentieth century, such as Madison Grant's The Passing of the Great Race, Lothrop Stoddard's The Rising Tide of Color, Houston Stewart Chamberlain's The Foundations of the Nineteenth Century and Oswald Spengler's The Decline of the West.
Indeed, enterprising journalists and historians looking to expose the next Stephen Ambrose or Doris Kearns Goodwin should consider comparing Buchanan's book side by side with these others. In addition to revising Spengler's title, Buchanan shares Stoddard's love of watery metaphors--both books gush with rising tides, surging oceans and flooding rivers of nonwhites, all of which push inexorably against the ever more precarious dams and dikes around the white world. The two authors also share a predilection for quoting Rudyard Kipling, the poet laureate of the "white man's burden."
Each of these earlier books shares the same simple theme: It's Us against Them, and with fewer and fewer of Us and more and more of Them, things look grim for Us. Buchanan readily accepts the "demography is destiny" argument: "As a growing population has long been a mark of healthy nations and rising civilizations, falling populations have been a sign of nations and civilizations in decline." Buchanan's data clearly put the West into the latter category. "In 1960, people of European ancestry were one-fourth of the world's population; in 2000, they were one-sixth, in 2050, they will be one-tenth. These are the statistics of a vanishing race."
And who's responsible for this disappearance? For Buchanan, women bear most of the blame. Liberated by technological and cultural changes, he argues, Western women have abandoned their true calling as designated racial breeders. "Only the mass reconversion of Western women to an idea that they seem to have given up--that the good life lies in bearing and raising children and sending them out into the world to continue the family and nation--can prevent the Death of the West."
Faced with declining birthrates, the only alternative available to Western nations if they wish to maintain themselves is massive immigration from the burgeoning populations of Asia, Africa and the Middle East. But for Buchanan, this medicine is worse than the disease, since immigration on this scale entails the introduction of too many nonwhite non-Christians. Regarding Europe, he writes: "And as the millions pour into Europe from North Africa and the Middle East, they will bring their Arab and Islamic culture, traditions, loyalties, and faith, and create replicas of their homelands in the heartland of the West. Will they assimilate, or will they endure as indigestible parts of Africa and Arabia in the base camp of what was once Christendom?" Clearly he thinks the latter. The United States faces a similar danger, he warns: "Uncontrolled immigration threatens to deconstruct the nation we grew up in and convert America into a conglomeration of peoples with almost nothing in common--not history, heroes, language, culture, faith, or ancestors. Balkanization beckons."
Buchanan must know that many have rung this tocsin before him, and each time it has been a false alarm. The West's population has probably declined relative to the rest of the world ever since the Western world defined itself as such. For example, when Stoddard wrote in 1922, he sounded the alarm because Western nations had declined to only one-third of the world's population. By 1960, as Buchanan points out, the Western share of the world's population had fallen to one-fourth. Despite this relative decline in population, he considers 1960 as the height of Western power and influence. Furthermore, most evidence suggests that Western nations are at least as powerful now as in 1960, even with the decline in population.
Buchanan's warnings about the United States ring just as hollow. Of the 30 million foreign-born residents, he claims, "Even the Great Wave of immigration from 1890 to 1920 was nothing like this." He's right--that wave surpassed the current one. Today, foreign-born residents make up about 11 percent of the US population, but from the 1870s to the 1920s, that number fluctuated between 13 percent and 15 percent.
Buchanan, however, also argues that today's immigrants are fundamentally different from earlier generations of newcomers; but again, there's no evidence for this. America was hardly more familiar to a Southern Italian peasant who came to New York City in 1900 than it is to an immigrant today from Nigeria or the Philippines. If anything, the spread of global markets and American popular culture has made recent immigrants more attuned to the ways of their new home than their predecessors of a century ago. Furthermore, the bulk of contemporary immigrants come from Latin America, and thus possess the Christian faith that Buchanan views as central to any definition of America. Indeed, the vast majority of Latin American immigrants share Buchanan's Catholicism. Nonetheless, these immigrants "not only come from another culture, but millions are of another race," making it difficult if not impossible for them to assimilate into US society. While Buchanan might consider Latinos as his brothers in Christ, he draws the line at having them as neighbors or fellow citizens.
September 11, Buchanan argues, painfully exposed the threat from contemporary immigrants: "Suddenly, we awoke to the realization that among our millions of foreign-born, a third are here illegally, tens of thousands are loyal to regimes with which we could be at war, and some are trained terrorists sent here to murder Americans." But the past is full of similar warnings about the enemy within. During World War II, anti-Japanese prejudices combined with national security concerns to result in the internment of thousands of US citizens. During World War I, "unhyphenated" Americans saw German-Americans as the Kaiser's minions, engaging in sedition and sabotage to aid the cause of the Fatherland. Yet as these instances demonstrate, the real threat, then as now, existed largely in fevered nativist minds.
This selective and myopic view of American nativism runs throughout The Death of the West. On the one hand, Buchanan refers to nativist statements by such people as Benjamin Franklin, Theodore Roosevelt and Calvin Coolidge to support his assertion that concerns over immigration are not un-American. On the other hand, while he is correct that nativism has always been one of America's multiple political traditions, Buchanan has nary a mention of how pervasive, inaccurate and pernicious such sentiments have been. Of the Know-Nothings, he knows nothing. He quotes Al Smith, the first Catholic nominated for the presidency by a major party, but includes no mention that anti-Catholic prejudices made a major contribution to his landslide defeat in the 1928 election, as he was vigorously opposed by Protestant leaders and groups such as the Ku Klux Klan. (After the election, the joke went, Smith sent a one-word telegram to the Pope: "Unpack.") To Buchanan, it seems, anti-Catholic sentiment is a recent development and limited to left-wing intellectuals. Overall, he chooses to ignore the fact that nearly every immigrant to this country confronted nativists who argued that their race, religion, ethnicity or culture made them unfit to become full American citizens. Furthermore, if these previous nativists had had their way, they would have excluded the ancestors of most current American citizens, including Buchanan's.
Buchanan recognizes that he's in a minefield with this subject, and he makes some efforts to tread lightly. To rebut accusations that he's an anti-Semite, he sheds crocodile tears over the danger to Israel from a growing Arab population and occasionally (but not consistently) refers to America's Judeo-Christian values. But like Dr. Strangelove's hand, Buchanan's anti-Semitism refuses to stay under control. As examples of conservative leaders who have failed to fight the culture wars with sufficient zeal, he singles out Irving Kristol, Gertrude Himmelfarb and Norman Podhoretz. One might well ask why these three when one could level similar charges against Jack Kemp, Bob Dole, John McCain and even George W. Bush.
By the end of the book Buchanan has dropped all pretenses, declaring America to be a Christian nation. His racism is equally apparent. For example, in addition to warning that many current immigrants are of a different--that is, nonwhite--race, he includes a lengthy discussion of black crime rates. Given that most blacks can trace their American ancestry back further than most white Americans, it's clear that Buchanan defines America not by "history, heroes, language, culture, faith, or ancestors" but by race.
If Buchanan's diagnosis of the problem is objectionable, his solution is even worse. For him, democracy, a shared culture and even a common race offer no defense against the West's impending doom. Rather, he argues, "If the West expects a long life, it had best recapture the fighting faith of its youth." And what were these youthful characteristics? "Protestant monarchs and Catholic kings alike did not flinch at burning heretics or drawing and quartering them at the Tyburn tree. The Christianity that conquered the world was not a milquetoast faith, and the custodians of that faith did not believe all religions were equal. One was true; all the rest were false." To believe otherwise invites disaster, "For it is in the nature of things that nations and religions rule or are ruled."
Buchanan's right-wing nativism is nothing new, so it might be tempting to dismiss him and his book as inconsequential. After all, didn't the 2000 election prove that Buchanan had only marginal electoral support and that even the Republican Party considers his views too extreme? But votes don't always measure influence, and The Death of the West has clearly struck a responsive chord. Not only does it stand near the top of the New York Times bestseller list, but its author remains a prominent fixture on the TV talk-show circuit. Indeed, it's interesting to contrast the reception of The Death of the West with that of Buchanan's previous book, A Republic, Not an Empire. The latter set off a firestorm of criticism, especially among Republicans and conservatives, when Buchanan argued that Hitler had not threatened the United States. If anything, The Death of the West is even worse, since Buchanan moves beyond minimizing the danger of Hitler to the open espousal of many of his doctrines. Yet this time around, the conservative commentators have not been nearly as critical. Then, of course, Buchanan was in the middle of bolting the GOP, potentially splitting the conservative vote and throwing the election to the Democrats. None of this came to pass, with Buchanan even helping Bush to win Florida. But the lesson seems clear: Conservatives are more than willing to tolerate Buchanan's racism and xenophobia, so long as he doesn't pose a direct threat to their political interests.
Even more disturbing than Buchanan's kid-gloves treatment by the media and the right is that the book's popularity stems from and seems likely to reinforce the upsurge in nativist sentiments after September 11. For many Americans, those tragic events gave even more reason to see the world in manichean terms and to divide Americans along lines of race, religion and ethnicity. Consequently, relatively open immigration policies came under attack. In Congress, a House caucus devoted to immigration restriction doubled in membership after September 11. Representative James Traficant, Democrat of Ohio, spoke for many of those members when he asked, "How do you defend your home if your front and back doors are unlocked? What do we stand for if we can't secure our borders? How many more Americans will die?... If 300,000 illegal immigrants can gain access to America every year, trying to find a better life, do not doubt for one moment that a larger contingent of people with evil intentions could gain entry into America and continue to kill American citizens."
Thankfully, such sentiments have not gained much headway in the ensuing months. Although the Bush Administration has backed off its proposal for granting amnesty to illegal immigrants from Mexico, it has shown few signs of embracing significant immigration restrictions in response to September 11 and has even agreed to restore food-stamp eligibility to legal immigrants. In Congress, immigration opponents have failed even to gain a formal hearing for their proposals. Yet the popularity of The Death of the West shows that nativist attitudes have not disappeared, and Buchanan's diatribe will undoubtedly help reinforce such views. Furthermore, both opponents and supporters of open immigration recognize that another incident of terrorism is perhaps all that is needed to turn The Death of the West from polemic to policy.
For a while I thought about designing a flag. Something bigger, blurrier than "nation." I imagined a hovering planet on a field of blue, and "United We Stand" could be written under that--which felt good. I mentioned my idea to a few visual artists, who smiled and said I know what you mean, though some felt the American flag was fine and did stand for "something." Though no one could say what that something was, except maybe a desire to feel safe, together. Nonetheless, it kept happening. The war got sold on TV right in front of us. First, "Attack on America," then "America Strikes Back," then "America at War." It felt like a gradual poem coming across the TV screen in the same way a news story keeps adding one tiny little detail every hour on the hour. A poetry of repetition, so very American. We do understand the selling of a thing. Patriotism is, of course, a language system; a reality is getting constructed, just like "sobriety" exists as it does because of AA and the success of its endless repetitions ("it works if you work it!"), because, as Fredric Jameson says, conviction is related to the amount of redundancy in the message. But what about a flag for that other us? If there is another country, or many of them, in North America, or even in the world, how shall we know ourselves? Or shall we just darkly slide into the abyss under Gertrude Stein's ominous words: "Each civilization insisted in its own way, until it went away."
Long before September 11, I received countless e-mail petitions, still do, concerning the inhumane treatment of women in Afghanistan, though at dinner parties one hears the "good news" about the war--that windows in Afghanistan have been flung open, TV stations are coming back on and women are abandoning their burqas, going back to work. Suddenly, the US military has become the liberator of Afghan women. Yet this cheeriness is complicated by the story of Lieut. Col. Martha McSally, the highest-ranking female jet pilot in the Air Force, stationed in Saudi Arabia, who was, until recently, bizarrely forced to wear restrictive clothing--a black head-to-foot robe called an abaya, female Muslim attire, for her own protection whenever she was off base. Also, she was required to sit in the back seat of the car, as Saudi women do. (The Pentagon recently declared the black head-to-toe robe is now "not mandatory but strongly recommended" as off-base dress code. And McSally was reassigned to Arizona in what didn't sound like a promotion.) So while women were being liberated in Afghanistan, McSally's experience seemed like a recapitulation of the same oppression in mini-form, as if Muslim culture and the entire incident afforded the US military an opportunity to restrain women within its own ranks--obviously a goal. Because no one would ever suggest that a man in the military wear a dress for any reason. It would get him thrown out--so the masculine "out" is the feminine "in." Clearly, the patriotic have lots of work to do to change this pattern. Perhaps the war is "our" opportunity. We really need a flag.
In recent months I've read some radically female books that use poetics to promote a sexy and beguiling peace. Lisa Robertson, a Canadian writer, has written a small but epochal collection of poemlike prose passages and intermittent poems called The Weather. Once you crack the cover of this incidentally stunning-looking book--three floating white spheres in an azure sky--a folded turquoise sheet tumbles out, a press release it seems, from "The Office for Soft Architecture." It pronounces in boldface, "We think of the design and construction of these weather descriptions as important decorative work," and it wonders grandly, "How should we adorn mortality now?" This is a serious political question, since, it explains, "sincerity's eroticism is different from wit's." I suspect "sincerity's eroticism" is the condition of that "other America" that put Colonel McSally in an abaya. Lisa Robertson embarked on The Weather during a residency at the University of Cambridge, where she began an intense yet eccentric research in the "rhetorical structure in English meteorological descriptions." Referring to these weather descriptions, the Office for Soft Architecture temptingly promises, "They sculpt what rhythmed peace could be." The Office for Soft Architecture is a poet's fiction, a poet's dream--utopia, what used to be called a manifesto. Robertson's trope is exactly what we need to see whapping in the air, and, as the vastness of her international conceit reminds us, it is the air. In this so-often-impersonal book (which is no small crime for a female writer) she lets the landscape narrate, and from this newly constructed body politic, a collective tells the tale. The writing of the weather descriptions (which, I must admit, instantly changed mine) is incantatory. The Weather is a work of dazzling surface divided up into the days of the week, each "day" being rhythmic prose with a pendant poem at its end.
"Sunday" opens like a stick being thrust in the ground. "About here. All along here. All along here...." Later on it grows more dramatic: "Here a streak of light, here and there a house...." She continues: "Here is a system. Time pours from its mouth. We design it a flickering. Here is its desolation. Here it crosses. Here it falls at last...." The perspective is so deliberately precise and unclear, and so lovingly guided, that we follow it like a beautiful film, one quivering between art and politics, and the classic calm of her narration slides us over to a meditation on the State. Her text is a Virgil who would lead us humming through our mutating atmosphere. "Monday" begins with this suggestion: "First all belief is paradise." She shifts readily into the philosophic realm because she was never absent from it, and as the payoff for her constant mutation--just as swiftly she shifts out. The flickering ground of her book is all exits.
"Wednesday" is, among other things, a litany of female saints. She plops them into her landscape like paratroopers. These are military girls, leaders. "Days heap upon us. Where is our anger. And the shades darker than the plain part and darker at the top than the bottom. But darker at bottom than top. Days heap upon us. Where is Ti-Grace. But darker at the bottom than the top. Days heap upon us. Where is Valerie. Pulling the hard air into her lung." The effect of her naming and moving over the schematic, flickering landscapes is a cumulatively emotional one. "Days heap upon us. Where is Olympe. Going without rest. The polis crumbles open." When she quickens the pace of her unfolding, by shifting the scale, drawing her terms closer to one another, it sexualizes: "When monogamous, besieged. When no perception, doing warning. When none would, a pip of wet, stillness, a runnel." As each sentence opens with a poised "when," and as the gaps shorten, the field is suddenly jarring, exciting: "When the plan, a purse, optical." The rhythm of the collapse is a way of focusing, containing, then pulling back. This single practice, this excision of space and time, becomes a manner of speech itself. If all is weather dividing into week, week made of days, days of moments and letters, then the whole is a reference to a continuous surface of enlightenment in language, in being. It's exalted, even patriotic to me. We see the words that remain, and our selves reflected in it. In this fragment, the poem after "Friday," her work almost done, she speaks keenly of her utopia:
I make a little muscle
to disallow each part; a collar clamped against the cold, a nail against the rock. Sometimes, just what I praise, I believe.
Dodie Bellamy in Cunt-Ups uses overtly sexual texts, her own and ones written by others. She arranged her pages whole cloth, cut 'em into quarters and re-arranged them like tiles. She smoothed the resulting page out till it seemed right. The "cunt-ups" of the title refer to William Burroughs's famed cut-up technique. I think there's a deliberate air of domesticity (like working-class moms making dresses from patterns) to how she describes her project--this female riffing on the historic practice of the quintessential "outsider" man. Especially when I think of Burroughs's prophetic railing against the corporate monstrosity, while taking into account the irony of his being the scion of a huge corporate family; and when I recall how much Burroughs hated women, calling them (us) "two-holed monsters," and how he shot his wife (allegedly a lifelong sorrow for Burroughs, yet still how much worse for her!). There's something horribly fitting that Dodie Bellamy, who incidentally comes from a Midwestern, no-privilege background, would construct a small book of endless romps like:
I contact either myself or you, I recall being involved at this time when I moved our hand across my body and I felt like I had one of those small water pistols. You were dripping instead of shooting your victims, you were living in your stomach penis and balls. I fuck you in a garage, I fuck you as if you'll be recovered like a sledgehammer in a garage, like you'll eat my brains. I get all stirred up, I was still half asleep and started flopping about, I was shown to have my right hand cupped around the sledgehammer's base, I used to break up the bones to reach your balls, kneeling before you, here, a sledgehammer will be placed on inventory, your cunt is comfortable, that and your tits, orgasm, after orgasm, but I can't shake wanting to plant myself inside you, gray handle, my hips spreading across the chair, feeling me over. I just want to suck on your nipples.
In a way Burroughs could say anything--he couldn't be thrown out of anything, could he?--being a man, being on a small trust fund, living at the end of the world. Already killed his wife. What's to lose? I think about how Bellamy's appropriation of his method is not unlike Kathy Acker's, but Kathy was also a trust-fund kid, and was personally safer being bad--because the upper classes are entitled to transgress for us all. I applaud this dedicated act of replacement, the joyfully willful construction of a Frankenstein text, one where the genitals are all confused in a timeless flow--all present, as a particularly ballsy female accomplishment. Going one further than Bill, the avant-garde's Dubelyew, in taking this sublime stab at pleasure, the rearrangement of hundreds of cunts and clits and dicks and pussies: The exhausted "I just want to suck on your nipples" has tremendous immanence, all gesture, a mad kind of one-time power.
Honor Moore's Darling is in many ways the most ambivalent creature of the lot. Its cover is a photo that looks like a painting; the whole question of artifice abounds in this book. It's conventionally poetic in some ways, but the ground is unstable, the largest tease in Darling being its title. A female nude leans into her position, gazing at flowers, and so many of the poems in the book are about love; sometimes the lovers are female, sometimes male. It's truly a midlife book about love and relationships, but the "Darling" of the title is not the woman gazing on the cover or one of the lovers or all of them. Instead, there's a dream of a funeral in an eponymous poem toward the end of the book; it's a family funeral, I guess. And there the dream's narrator saw her first gay man kiss another. After which he calls him "Darling." It puts a spin on all the poems, making this trickster aspect of love be the star. Which love? The woman on the cover thinks: Hell, what's he gonna do now. Love is unfathomable, this poet knows.
Stylistically, Moore does not speak in excision. It's an older ear. I'm thinking that a material everything hovers in her view, and the poems feel selected from that. We're moving through the fullness of a world, and memory. The surprises, the replacements, are conducted almost by sleight of hand. Like Bellamy's, this is also a poetry of class. I mean, what poetry isn't, but here I'm thinking upper class, and the poems are full of the aches of privacy; figuratively it starts in the dark and it returns. In the book's first poem, "Bucharest, 1989," a painter yearns for white, but the color is unavailable. The whole of this book is richly dark. It's hard to imagine most readers not approaching this world without a certain covetousness. In the same way that the name Robert Lowell was part of that poet's poetry, so is "Honor Moore." Her name approaches allegory, and even when you know she's being daily, it's a rarefied daily and it sings differently. A poem called "In the Dark," however, approaches a Djuna Barnes or a Hart Crane wildness: "A goat strays/through my dreams, Doctor, a crazy dove,/and from Pontormo, a woman struck/blind, her arms raised against the stranger." It's a medallion of chaos, but emotionally it's as stamped as a coin, like an old dream that clangs long after its images are gone. I'm glad for the mystery here. The house of the book is huge, and it sheds light on the unknown. History is a place, after all, a very real and glamorous one, where strange things occur. In "Citizenship" she states: "I wake to cars raging north up a rise, a truck/banging south." There's a loneliness to the notation.
My sense of the real time of the book comes out of these matter-of-fact lines. The poet wakes up and you feel she is ready to move, while still swarming with dreams. You feel the pause before the gesture, and the effect is quietly awesome. In "Undertow" a woman is described: "She liked to wear bright/colors, used the word 'sweetie,'" then a line later you realize it's the poet's mother. There's a movie star quality to the description: "I'm tiny in her arms, as if/flat against a steep mountain." Even as we read the lines, the poet is fading into the distance--no one is bred for this experience. The poet endures her own pathos: "Understand, I don't/believe this will ever change." "Hollow Hill" is a swatch of prose that is not a "prose poem" but a tiny memoir of a child in a big house, where people have "old rooms," as in "my father's old room." On a planet where many people spend their lives moving constantly, on "Hollow Hill" not only is the poet's own childhood stable but her father's is too. Her parents sleep in "the Modern Room." The reality of this family life is uncanny, museumlike, and the child iterates herself theatrically: "They don't let me keep the doll. I gallop back...but I will never undress her or untie the red ribbons under her chin." How I understand this book has to do with what seems disallowed in this very ornate, very conditioned reality. So much undoing is not visibly possible. I understand, for instance, how our sense of the Gothic springs out of exactly this imaginary of old, dark ancestral houses, even beautiful places where things don't change much. Just deepen.
To be alive in these places one would become a reader of codes and elsewhere seek one's own undoing. That "undoing" being passion, which is the subject of this book. Passion being, I hate to say, so poetically, the most necessary flag. Lines slap us in the face, almost jumping out of the poems that hold them: "Nothing heals/like that hand," she utters in "Resonance," which I think is the finest poem in Darling. The moment of the line is followed by a sort of rejection: "We don't have a life/together," she says, "face toward/the child, window, the child running...." It's a heartbreaking reply, yet the power of the moment remains with the narrator. It resounds with a very female frankness that cuts across class in terms of knowing what one has made, has done.
Perhaps he's right about the cup.
You dig the clay or purchase it.
You cover it, keep it wet. One day
The clay calls you to model the cup
And what you've lived, every cup
To your lips, moves through your hands.
As a reader these new books make me feel that so much good is already on its way to us. Like Lisa Robertson says: First of all belief is paradise. The right to assemble a moment of presence--a poem, this flickering banner of passion is ours.
A historian questions whether he led a slave revolt, but his heroism still stands.
It's one thing to have Somali groups protesting Black Hawk Down for what they say is an inaccurate and racist portrayal of Somalis.
It's the largest profession in healthcare. It's the largest female profession in America. But despite its tremendous importance and impact, most people know very little about contemporary nursing. Public ignorance of the present-day profession, however, pales in comparison with ignorance of nursing's history. How many of us know that the development of nursing as the first secular profession for respectable women was a major feminist achievement? Or that Florence Nightingale was not, in fact, the "founder" of modern nursing? Or that nurses played a key role in developing the American hospital system, as nursing historian Sioban Nelson has documented in her recent book Say Little, Do Much? How many of us know about the role of nursing in the development of public health and care of the chronically ill and poor? Most important, how many of us recognize that society's persistent devaluation of nursing--reflected today in the prejudices of many newly liberated female physicians, health policy experts and journalists--is a legacy of longstanding, socially enforced subordination to medicine?
Katrin Schultheiss, an assistant professor of history and women's studies at the University of Illinois, Chicago, is one of a handful of non-nurses who understand what the profession has to teach us about the complex process of female emancipation, as well as about the development of modern healthcare systems. She recounts the tortuous history of how the "professionalization" of nursing in France coincided with anticlericalism and the secularization of the field. Although her story focuses on the forty-year period from 1880 to 1922 and takes place in one country, the gender dilemmas Schultheiss explores have hampered nurses' ability to care for patients in healthcare systems around the globe, including in the United States.
Her tale begins with the advent of France's Third Republic and follows political reformers who attacked clerical authority as they tried to modernize the healthcare system. Until that time, nursing outside the home was typically provided by convent-trained nuns. Modern hospital reformers recognized that nursing required more nurses with more systematic education, but therein lay the problem. Since knowledge is power, the acquisition of knowledge was inevitably a challenge to authority.
Physicians, as men, did not welcome women on their terrain. As members of a developing profession--one that did not then command the prestige it enjoys today--doctors were also adamant about defending their field "from irregular or illegal practitioners."
Even doctors who recognized the need for a more educated nursing work force and who wanted to laicize the care of the sick would not countenance the education of nurses if, in the process, nurses attained the kind of knowledge and stature that would allow them to demand greater authority and autonomy in both the workplace and society. So even lay nursing had to be constructed in altruistic terms that stressed not nurses' knowledge but their virtue. As Schultheiss writes, "As long as nursing was clearly understood to be a custodial, maternal, or charitable occupation, and as long as nurses were regarded as the social, economic, and educational peers of the patients, rather than the doctors, there would be no ambiguity about who held medical authority within the hospital."
In Paris, nursing nuns, while obedient and devoted, presented a problem to medical reformers. "The very existence of an autonomous community of women called into question the hierarchy of power within municipal institutions," Schultheiss notes. Happily, secular authorities found lay nurses, as one reformer commented, to be "infinitely more subordinate than the religious nurses and more scrupulous in the strict execution of doctors' orders."
While anticlerical reformers touted the benefit of lay nurses, the French public was attached to the nuns who had provided what out-of-home nursing care had existed since the seventeenth century, and even before. Of course, Schultheiss points out, even support for religious nurses was cast in gendered terms. Proponents of the nuns insisted that nursing should be left to a special group of religious women because it would corrupt lay women for their real work--which was mothering. "A woman is either a bad mother or a bad nurse," was their motto. To convince the public to support secularization, reformers had to "feminize nursing--to turn nursing into a general feminine virtue that all women could possess."
Schultheiss's story also introduces us to a peculiar hybrid form of religious nurse--the "hospitalières" of the Hospices Civils of Lyons. These women were secular nuns, congregationist sisters "who undertook a lifelong commitment to serve the sick and poor under harsh physical conditions and with virtually no monetary compensation, but who remained under the direct authority of the secular administration." According to Schultheiss, laicizers supported them because they were easily controllable and because their sense of devotion was easily manipulated by civil administrators who didn't want to pay the real cost of nursing care.
In this section of the book, class also enters the story: If civil administrators were to get nursing care for little or nothing, women's educational standards--and thus their salaries--had to be low. Whether they were secularizers or not, reformers recognized that more highly educated women of a better class would eventually demand more pay, and more say.
Finally, Schultheiss takes us to Bordeaux, where we meet Anna Hamilton, a reformer and devotee of Florence Nightingale. With connections to the international nursing reform movement, Hamilton wanted to open a nursing school that would produce a "new nurse," recruited from the so-called better classes. This new nurse, she insisted, would deliver better patient care than nursing nuns. Hamilton's critique of the nuns, Schultheiss explains, was not based on anticlericalism. Rather, Hamilton argued that the nuns had "distanced themselves from direct patient care" while creating obstacles to the creation of "a single medical hierarchy grounded on universal principles of hygiene and scientific health care."
Hamilton was able to gain support for her project from Paul-Louis Lande, a physician who became mayor of Bordeaux, because she firmly linked the "professionalization and feminization of nursing." Doctors in Bordeaux, Schultheiss writes, recognized "the need for improving the training of hospital nurses, but rejected all aspects of reform that expanded the nurses' autonomy or authority beyond the narrowest limits."
Hamilton accepted these limits, asserting that "it is extremely ridiculous for a nurse who possesses neither the knowledge nor the rights nor the sex of the doctor to try to imitate his way of interacting with the patient and to try to use his language." Thus, in France, as in England and the United States, the nurse-doctor game began with the acceptance of the notion that nurses could not--or should not--possess medical knowledge and that they therefore could not--and should not--use medical language.
Schultheiss ends her story after the First World War. The war produced such a huge need for nurses that the debate over the virtues of lay versus religious nurses effectively ended. When more than 100,000 nurses culled from every social class enlisted to serve "la Patrie," this "demonstrated that women's special aptitudes could be attached fruitfully to the state." However, even during this period and afterward, nursing was valued not for its knowledge but for its virtue. It had become, the author concludes, "a twentieth-century version of republican motherhood."
French nursing carries that legacy to this day. Last year, when I was strolling down the Boulevard St. Germaine in Paris, a book displayed in the window of a children's bookstore caught my eye. It was called Je Sais Qui Me Soigne ("I Know Who Takes Care of Me") and is part of a series on citizenship and the professions. Nurses make a brief appearance in the book--as doctors' servants who have, as the text reads, "just enough schooling to follow doctors' orders."
For nurses struggling to put their education to use for patients, rather than for physicians, the ability to escape, at least temporarily, medical domination has always made home care attractive. Which brings us to Karen Buhler-Wilkerson's part of the story. In No Place Like Home, Buhler-Wilkerson, a professor of community health and director of the Center for the Study of the History of Nursing at the University of Pennsylvania School of Nursing, traces the development of home care from the opening of the first US home-care agency--the Ladies Benevolent Society, founded in 1813 in Charleston, South Carolina--through the present.
In Charleston, as elsewhere, respectable society ladies started home-care agencies because they felt "obligated to improve the conditions of and provide for the comfort of the poor," who were, in turn, "expected to manifest their gratitude to the rich," who established these agencies. But they did not deliver the care. Nurses did.
No Place Like Home does a great service to these ordinary nurses who are often dismissed as know-nothings by some nursing elites today. Buhler-Wilkerson details the complexity of caring for victims of tuberculosis or managing patients during typhoid epidemics. She also documents the persistence of the issues with which home-care agencies still struggle today: how to navigate doctor-nurse relationships; how to choose appropriate patients for home-care services; how to deal with gender, race and class prejudice; and how to secure long-term services for the chronically ill.
From the early days of home care, doctors were concerned about nurses invading their territory. In Boston, for example, doctors "confided to lady managers that 'the constant danger with trained nurses is that they shall usurp the doctors' position and prescribe for patients.'"
At the turn of the twentieth century, with the founding of the Henry Street Settlement on the Lower East Side of Manhattan, Lillian Wald and her colleagues developed public health nursing--"to improve standards of living" of the poor. One of the great innovations of the Henry Street Settlement was the establishment of a "First Aid Room." This was a kind of community clinic where immigrants could gain easy access to nursing care for routine health problems. Doctors, however, soon complained that "nurses were carrying ointments and even giving pills outside the strict control of physicians." Even outspoken nurses like Wald's colleague, socialist Lavinia Dock, feared a confrontation with powerful physicians. By 1911 questionable cases were no longer treated in the First Aid Room. "Later publications," Buhler-Wilkerson writes, assured the public that "the real Henry Street Settlement nurse will make the doctor feel that she is exerting every effort to have his treatment, not hers, intelligently followed."
An equally fascinating subject tackled by Buhler-Wilkerson is the impact of racial prejudice on nurse-patient and nurse-doctor relationships. In both the North and the South, lady managers as well as nurses fretted about whether it was appropriate for white nurses to care for black patients or black nurses for white patients. When insurers, notably Metropolitan Life, entered the field at the turn of the last century, managers considered the same imponderables. Race invariably trumped the needs of care and even of doctor domination of the nurse-physician relationship. For example, Buhler-Wilkerson tells us that the respectable ladies of Richmond, Virginia, who ran home care in that city, decided it was "'eminently' satisfactory for white nurses to care for black patients on the 'same footing' as white patients--but drew the line at white nurses 'taking orders from colored physicians.'"
The advent of health insurance also had a critical impact on the home-care agencies. Wald convinced Metropolitan Life to cover home-care services in 1909. Met Life wanted to reduce the high mortality rate of black life insurance subscribers--thus delaying payments on their life insurance policies. Home-care nursing's preventive approach initially seemed to make good business sense. By the 1950s, public health nursing and medical advances had paid off: Fewer people were dying of infectious diseases, and more acute illnesses were treated in the hospital. This meant that the bulk of home-care patients were chronically ill. To reward public health nursing for its success, Met Life curtailed its home-care program. "Providing care for those who failed to recover quickly was, from an insurance perspective, a poor investment," Buhler-Wilkerson states bluntly.
Since the fate of nursing is tied to the fate of the patients nurses serve, the situation has not improved much, as first Medicare and Medicaid and now managed care have "rediscovered" home care. Indeed, today the promise of the home as a place where nurses and their patients can escape the negative consequences of medical paternalism and give or receive higher-quality care has remained largely unfulfilled.
In Devices & Desires, Margarete Sandelowski uses a different lens--the world of medical technology--to explore the issue of gender and nursing. This brilliant book shows just how much the "charitable, devotional and altruistic" image of the nurse conceals. From the discovery of the thermometer to the development of intensive heart and fetal monitoring, Sandelowski documents doctors' dependence on nurses for their reputation for scientific and technical mastery. As Sandelowski shows, nurses have been critical in administering medical technology, monitoring the information it provides and interpreting that information to physicians, not to mention "educating patients about new devices, getting patients to accept and comply with their use, and alleviating patients' fears about them."
An eye-opening segment describes the use of the first thermometer, rather than the hand, as a diagnostic tool in the mid-nineteenth century. In it, we learn that the thermometer we take for granted today was originally an unwieldy, dangerous instrument that had to be carefully manipulated so as not to injure the patient. Because diagnosis and treatment involved taking the patient's temperature numerous times a day, busy physicians assigned the task to nurses. This involved, however, far more than simply recording data. The nurse, Sandelowski writes, "had to know what caused various temperatures to occur and the nursing measures that would lower or raise temperature to normal levels."
While physicians were the ones to insert the first unwieldy and equally dangerous intravenous devices, nurses were the ones to make sure the patient's arm remained immobile and that the patient could tolerate the discomfort of IV therapy. Nurses are the ones who developed the intensive-care unit--to provide intensive nursing care--and who track and interpret data from fetal monitors. As the primary users of much medical machinery, nurses are often more knowledgeable about equipment than doctors. Indeed, "the benefits of machine monitoring could not be fully harnessed without nurses who understood and could act immediately on the information monitors generated." While the public does not recognize this fact, the author tells us that medical equipment manufacturers certainly do. This is why nurses continually work with physicians and manufacturers to create design improvements and to insure that "expensive machinery [is] fully utilized."
What is amazing about this story is how little nurses have benefited from their technological mastery. Sandelowski shrewdly diagnoses a classic Catch-22. While it is true that nurses' status is somewhat enhanced by their technical proficiency, the recognition they receive does not match their actual accomplishments. That's because physicians quickly label the technical activities nurses engage in as "simple enough" for a nurse to perform.
No matter how much nurses participate in the diagnostic process, of course, physicians have maintained a legal and linguistic stranglehold on "medical" diagnosis. Even as "physicians were increasingly expecting them to perform de facto acts of diagnosis," Sandelowski writes, "nurses were in the bizarre position of having to be mindful of symptoms without speaking their mind about them."
Nurses were supposed to be able to distinguish between normal and abnormal conditions and to look for reasons for any abnormal findings. But nurses were never to use the words "normal" or "abnormal" in reporting or recording patient conditions, and they were to refrain from offering their opinions on etiology or diagnosis.... Nurses were to say (report and record) only what they saw, unlike physicians, who maintained the right to say what they knew.
This has produced the peculiar phenomenon--even today--of the nurse who recognizes that a cancer patient has diarrhea or a mentally ill patient is hallucinating, but who is not allowed to use the actual medical word because that would suggest that she, or he, is making a "medical diagnosis."
As she describes these phenomena, Sandelowski never paints nurses as innocent victims of nasty, overbearing physicians. In their perennial attempt to find "a socially valued place and distinctive identity," Sandelowski argues, many members of the profession have, albeit unwittingly, adopted common gender stereotypes that perpetuate the oppression of nurses.
One segment of the profession, Sandelowski contends, has bought into the notion that the complex practical, technical work that ordinary nurses perform is indeed simple and know-nothing.
Typically conceived of as nothing more than the physician's hand, and persistently caught in the Western cultural dichotomy between merely manual and highly prized mental, or intellectual, work, nurses have struggled to show that nursing is largely brain work. In the process, however, they have inadvertently complied with the prevailing cultural practice of denigrating the very "body-knowledge" that is the forte of the nurse.
This is particularly evident in the nurse-practitioner movement, which so many elite nurses now promote. "The key factor differentiating nurse practitioners from other nurses," she writes, "is both the use of medical instruments and the use of instruments in ways previously denied nurses." But, she points out, in our bottom-line-driven healthcare system "the role emerges as largely economically and 'medically-driven'.... The traditional image is maintained of nurses as the extra hands and eyes of physicians willingly and cheaply filling voids and bridging gaps in health care."
Other segments of the profession, Sandelowski argues, have opposed nurses' emotional and social work to their technological activities, arguing that technology is somehow an inauthentic nursing activity, while "caring" is both authentic and an essential "antidote to technology." Sandelowski shrewdly insists that in opposing "nursing/touch and technology," the profession has been "identified both with and against technology and thus, in an ironic way, with and against itself."
While it is not the purpose of these books to offer advice about dealing with the many problems nursing confronts, they implicitly point to one incontrovertible solution: We can appreciate what nurses do in the present only if we understand how their work has been constructed in the past and what they have contributed--and can contribute--to our healthcare system.
Understanding and analyzing nursing's decades-long struggle for "a socially valued place and distinctive identity" is not an academic exercise. It is central to reversing the chronic underfunding of the nursing services most of us will eventually depend on in hospitals and other healthcare institutions, and also the undereducation of the nursing work force at almost all levels of practice. And it is critical to any solution to the severe nursing shortage, which, if not quickly and effectively addressed, will have disastrous consequences as the population grows older and sicker.
On East Capitol Street a few years ago, I was in a taxi when a car pulled suddenly and dangerously across our bow. My driver was white, with a hunter's cap and earmuffs and an indefinable rosy hue about his neck. The offending motorist was black. Both vehicles had to stop sharply. My driver did not, to my relief, say what I thought he might have been about to say.
Frederick Wiseman has spent a lifetime piecing together sounds and images captured from the daily flow.
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