Ades & Oakes’s Shakespeare; Keenleyside’s Prospero: at the Met DH Opera

Simon Keenleyside as Prospero

Dear friends and readers,

Lest it be thought I’ve gone over-the-top in my praise of so many of these Met Operas transmitted by HB, my reaction to the first act of Ades’s and Oakes’s Tempest was it’s so still, and “there’s nothing doing.” I didn’t like the (to me) screetch-y high notes of Ariel, nor the lack of long melodic arias. The costumes were trying too hard. Keenleyside with his skin tattoos, feathers on his head, was still not US Indian-like; Ariel in pink fluff with ludicrously heavy-make-up – all green eyes; the lovers far too well-fed and smooth, he like something out of When Knighthood was in Flower, she like some fairy tale maiden in the Blue Fairy Book. Robert LePage’s re-building of aspects of La Scala on stage could have made for a disconnect, it added nothing.

What took time to emerge was the focus on an ethical-psychological relationship between Caliban and Prospero: when Prospero loses Ariel, he’s left without consolatory dreams. Ares really gave us an adaptation, serious interpretation of Shakespeare’s play (Enchanted Island was more Dryden/Davenant).

Audrey Luna as Ariel

The play-story does not depart from any of the hinge points of Shakespeare’s; Meredith Oakes’s script brought over to operatic music Shakespeare’s austere visionary core with its intimations of dream aspiration and realities of brute animal creatures and vicious envious evil (Caliban and the Milanese apart from Ferdinand). The young lovers were appropriately innocent for their short beautiful songs and their and all the music was like Debussy (Pelleas et Melisande) — ever there quietly beautiful. After a while the set also turn of the century, with its conceit the people are in an opera house grew tiresome. Yes there was a computer island, soft sea, and we began to see the slow emergence of Prospero’s character as regretful, remorseful, bitter yet in act willing to forgive began. That’s part of the play’s naturalistic miracles.

The last part or act was so moving to me. Keenleyside showed how well he can act: I identified with him as the older person having to give over, to let go, and I liked the presentation of Caliban as an aspect of the solitary Prospero. None of the really powerful lines were omitted, and Prospero’s response to Miranda’s “O brave new world,” was plangently disillusioned.

Alan Oates as Caliban

I’d like to see it again so I could enter into Act 1 from the perspective of what is to come.

As to the interviews, Deborah Voight can carry these off. To some extent she asks real questions about singing technique. You could see in Ades’s eyes a moment’s oh I wish I didn’t have to do this hype but he managed and gave eloquent interviews where he spoke more simply and directly about writing and putting on the opera and his relationships with the singers. He said that he saw himself as their support.

Some reviews: this review particularly insightful and with good photos and stills. See New York Times review. Another review.

Ellen

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John Riddle’s Eve’s Herbs: A history of contraception and abortion in the west

New Yorker Cartoon

The right to privacy encompasses a woman’s decision whether or not to terminate her pregnancy [but] a woman’s right to terminate her pregnancy is not absolute … Roe v Wade, 410 US, p 154

Dear friends and readers,

This morning I read a thoughtful questioning blog by a friend who maintains a journal of her reading online: Margaret Sanger and the Planned Parenthood Rally. I got all fired up, felt strong emotion as I have before when it’s pointed out that, hard as it seems to believe, a sufficiently large percentage of the population in the US is against letting people have the liberty to buy and use contraception to vote in congressmen who will fight to pass laws to destroy women’s health organizations, specifically and most notoriously (see the name) Planned Parenthood, in order to stop the women from having access to safe contraception.

I wrote about this on my blog once before when I had a sudden insight into this apparently destructive aim: after all who would force on families endless children, the enormous work, the inability to care for children individually, the dire poverty, the exhaustion of a woman’s body and a man’s ability to support her and the family that would result: The woman from Planned Parenthood: what is hated is a woman’s access to contraception:

I’ve noticed in mainstream media the determination to de-fund Planned Parenthood has not been treated with any clarity or truthfulness. What has been repeated is the mantra of the Republican group refusing to sign the budget is the objection to Planned Parenthood is they support abortion and do abortions. The reality is a tiny percentage of Planned Parenthood’s efforts are about abortion (different figures are quoted, one that’s repeated is 3%).

The real animus against Planned Parenthood is they enable women to have sex without getting pregnant. The whole thrust of the organization (as seen in its name) is to spread contraception, to give women control of their bodies — and inexpensively. It’s a legacy of Margaret Sanger. The real objection of the republicans is such places enable women to have sex without anxiety.

As I wrote my friend in my comment I’ve gone beyond this insight I had (Katha Pollit saw it too) as I’ve watched and listened to the public media’s reporting of this anti-contraceptive care movement. I still see that republicans and their quiescent allies want to prevent women from having control over their reproductive functions. By stopping access to contraceptives, they also make sex risky so the woman can no longer have an adult sex life of her own choosing.

But the reasoning goes beyond this. They want to subject women to men who they think have the right to demand of a woman they have a relationship with that she produce a child, preferably a son for them — to prove or act out their “manliness.” Romney’s nomination and all he stands for, now coupled with Ryan enforces this lesson: the people heading this movement don’t want to pay any taxes for anyone else’s need. Yes they know very well that Planned Parenthood also provides cheaply for women’s health care in other areas: for antibiotics, for psychological help, for operations (say if you have endometriosis). But every one must be on their own, everyone keep every penny he or she earns except for the minimum of taxes to have wars and say build sidewalks and roads. Poor people deserve whatever happens to them; they are meted out discipline and punishment this way.

The last part of the agenda (not to pay anything for anyone, not to share and take responsibility for anyone but yourself and only pay into what you get an equivalent out of) is not in John Riddle’s Eve’s Herbs. But the rest of the agenda emerges as he tells the history of contraception and abortion in the west.

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Riddle opens his book with the quotation that heads my blog and a full account of the Roe v Wade decision which he says troubled him because not only the were the judge’s arguments but much of even the intelligent discourse around it was riddled (pun intended) anachronistic misconceptions of the previous history of abortion, for example, that the Hippocratic oath implied a physician could prohibit or refuse to help a woman produce an abortion, that the idea that a human life begins with conception is an ancient widespread one, that scientific studies were central to women and their physician’s decisions about how she should go about treating her reproductive system. Says Riddle in the first chapter (with witnesses in print to demonstrate this) many ancients accepted not only abortion but suicide, not condone but accept.

He decided he would write a book which would demonstrate clearly that until the 19th century in Europe and the cultures the spread from Europe (through emigration) it was acceptable to abort a fetus before quickening, and that few believed a human being was created at the time of conception. I wish he could have proved all that he set out to prove. Alas, he does not. It is true but only generally speaking that until the later 18th century until quickening a woman could obtain an abortion and not be punished or ostracized as long as she kept her act private — as she would most of her sex life. But very early on (3rd century conferences and their publications like the Bible) the church’s hostility to sex and to women demonstrated a strong disposition to stop any control of reproductive functions by either men or women, and there emerged the corollary idea that a human life or soul began at conception. And even earlier than Christianity, from Roman times on we see the persistent idea that a man has a right to have children, especially a son, and that such a right trumped the woman’s right to abort the fetus in her body. In fact much of the discourse that got into court when cases involving marriage, children, pregnancy outside marriage, stillborn babies (with accusations of murder often flung at a woman) was about how a man had been deprived of a possible heir (a son was wanted).

But along the way, about 2/3s of the book demonstrates something as important to the contraception, abortion debates — and let us include here debates and a lack of real common knowledge about miscarriage, stillborn and deformed fetuses and babies, artificial insemination and technologically-induced pregnancies, induced parturition (bringing on childbirth before the full term or 9th month), and choosing a child’s sex. From the beginning of recorded time women have wanted to control their reproductive functions to protect themselves and control their destiny and, together in earlier times with midwives and “healing” women, done everything they could to help themselves in these areas. Riddle has a hugely long chapter where he lists and describes all the herbs and concoctions used (as far as we can tell) from medieval to later 18th century time to bring about fertility, prevent contraception, or cause termination (abortion) or early birth, or somehow control and aid a woman who seemed to be sick because of the pregnancy. Riddle keeps saying many of these did work, some were also toxic, and of course some probably had little effect at all.

So for centuries women were left alone to deal with their pregnancies and reproductive functions more or less. If it was not at all acknowledged as her right to chose, because much was invisible, not mapped publicly, she could exercise her own judgement and follow her desires insofar as herbs could help. They did all they could for themselves. The strongest motive for control was a man’s right to have a child by his wife.

A group of men, an iconic copy of Roland of Parma’s Surgery depicting a context in which surgery is not simply professionalizing but masculinizing quite thoroughly.

It’s important to know that medicine was seen as a woman’s province until the later 17th century when it became part of medical science and began to be a paying licensed profession. Groups of women together. Barbara Ehrenreich and Deirdre English argue in a their Witches, Midwives and Nurses that a large majority of women burnt as witches were women who practiced medicine, and that some of this stemmed from the animus of men who wanted to repress them. It’s no coincidence that the largest number of such burnings took place in the 17th century too. It also came from fear as if a woman is granted this power to heal, she is blamed if something goes wrong (and who better to blame than an aged ugly old woman, an easy scapegoat). Riddle concurs that midwives were subject to ostracizing and anathematized and burnt (together with, as Doris Lessing and Stevie Smith say, their helpless hapless cats).

He also demonstrates that until the 19th century laws ignored this fraught and important part of women’s lives, and that attitudes across many levels of society about when you could abort and when human life began were multiple and flexible and endlessly ambivalent. He shows that the recourse to “science” as a rational or explanation for what a woman chose to do only began in the mid-20th century,and then (as science often is used) only those parts of scientific explanation were brought forward which enforced a particular group’s previously held cultural beliefs or agenda.

19th century photo: doctor in charge, nurse his servant, and woman patient subject to them

The last third of the book is the most troubling. We see how easy it is to lose knowledge. Riddle demonstrates that the rise of evangelicism and Victorian determination to control sexuality itself led to the repression of earlier traditional knowledge about herbs. Middle class women no longer had access to or handed down knowledge of herbs. Physicians also did all they could to ridicule and stigmatize as silly or dangerous all means of self-medication that they did not themselves invent or see as scientific. Women’s wombs become a sort of public territory — women had never managed to have the right to control the space about their bodies and their right not to be searched or invaded bodily by members of the community if they have transgressed sexually. Now their reproductive functions were seen as producing important commodities: children. This is another version of men wanting children, but now with the growing understanding of conception, development of fetuses, and physicians’ apparent right to bring babies into the world using socially approved of methods, one could make laws about conception, and childbirth and enforce them by punishments.

Riddle cites new kinds of bills, like Lord Ellenborough’s 1803 omnibus bill which covered various kinds of murder, and this law included a demand that a court determine whether a child who was born dead or alive, to see whether the mother should be accused of murdering it if it died soon after and she had not told anyone it had been born (this hit at women who had babies outside wedlock). It included language like:

It is a crime of murder for anyone to unlawfully administer to, or cause to be administered to or taken by any of his Majesty’s subjects any deadly poison, or other noxious or destructive substance or thing, with intent [for] … his Majesty’s subject or subjects thereby to murder, or thereby to cause and produce the miscarriage of any woman, then being quick with child.

There may still be glimpsed the assumption that no human life or baby is there until quickening, but someone who understood these words or act would be foolhardy to administer any herbs at all, lest she be accused of having done it after the quickening. Quickening is ambiguous and occurs differently for different women and not at exactly the same time.

The last chapter takes us back to modern America, and we find a melange of extraordinary punitive and repressive laws, including attempts to stop women from using any drug that is not prescribed by a certified physician, attempts to prevent women from regulating their menses, prohibitions against the sale of contraception or any drug for female use only. We have arrived at the time of Griswold v Connecticut when the US Supreme court invalidated a Connecticut law that forbade the sale of contraceptions on the grounds of a right to privacy. (Scaglia thinks this hilarious, this right to contraceptive privacy, does not find it in the Constitution.)

At the same time women continued to, albeit quietly, hiddenly, secretly (and thus with shame and fear and anxiety) avail themselves of what help they could get outside the medical profession (and inside when it came to by then illegal abortion). Among popular medications supported by women’s groups was Lydia Pinkham’s Vegetable Compound, advertised as a “blood purifier” but actually known (as herbs once were known) to have anti-fertility properties so sold as a means of birth control. There were attempts to take it off the market, its ingredients were investigated and changed (fenugreek seed was removed), vitamins were added. It is still sold today. The AMA has of course been tireless in damning such bottles as quack and charlatan stuff.

As Riddle shows all along, one text discussing this preparation is probably partly right when it suggests that abortifacients like this could also be placed in “a volume on toxology.” Drugs that terminate pregnancies are often toxic. The Republican congressmen who likened the product of rape to a product of sex outside marriage and said US people should consider the cases as parallel and consider the feelings or rights of the father takes us right back to the age-old assumption that a woman’s body is only a container for a man to have children through. Plus ca change, moins ca change.

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Jill Townsend as Elizabeth in very bad pain after inducing a premature birth, Michael Cadman as Dwight Enys, the doctor (Poldark 1977-78)

I read this book because I wanted to answer a question I had about a key incident in the Poldark novels. In the fourth novel Ross Poldark rapes Elizabeth Chynoweth Poldark in order to assert his right over her body and stop her from marrying George Warleggan. Events and feelings transpire such that she goes ahead and marries Warleggan and gives birth to a baby 7-8 months afterward and claims it was premature. But it was not, it was full term baby, the child was Ross’s. Warleggan is told that the child was not born prematurely, and his savage jealousies are aroused; he torments her and the boy and when she becomes pregnant again (by him), after a terrible scene of his corrosive bullying, she takes a herb compound a London physician has given her to induce an early birth. She wants to persuade Warleggan that she naturally gives birth early so that he will accept the son. She is told the herb or drug is dangerous and should call a physician immediately upon bad cramps. But she does not call a doctor immediately and by the time a doctor is on the scene who recognizes a smell from her increasingly rigid and cold body as gangrene-like it is too late to save her. I wanted to know if there was a compound from herbs which could prompt early parturition, but then kill the person by causing gangrene. Riddle does not descend to that level of detail.

Lest my reader find this story melodramatic, I should say that Charlotte Smith’s Romance of Real Life includes court cases where a woman has a child prematurely and the husband accuses her of trying to foist another man’s child on him. Jim suggested that if the trajectory here is probable, perhaps the specification of gangrene-like is fantasy.

But if I did not have my question answered, I learned about an aspect of women’s history far more important generally. From a book I reviewed Josephine McDonagh’s Child Murder and British Culture, 1720- 1900, I did know that women were routinely accused of infanticide when their babies were born dead, especially if they were poor, powerless, or unwed, that laws were written which made them guilty until they could prove themselves innocent and that as late as the 1980s one can find a case of a girl prosecuted for murder when she was found to have hidden her pregnancy and the baby was stillborn. Well, now I have the larger picture and I have shared it with all who read my blog.

Another New Yorker cartoon on behalf of women

Ellen

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My mother’s death

Those who are left are different people trying to live the same lives — Winston Graham speaking as Demelza, Warleggan

Give sorrow words — Shakespeare, Much Ado About Nothing

William John Garbus (1944? age 23), my father

Evelyn Garbus (1943? age 21?), my mother

Dear friends and readers,

My mother died this past Friday afternoon, between 4 and 5 in the afternoon in a room in what was once called Booth Memorial Hospital, now New York hospital, located in eastern Queens county, NYC. My mother’s younger sister, my Aunt Barbara (77); me (65) & Jim (63); Barbara’s two sons (my mother’s nephews), Paul and Mark (in their early 50s); Paul’s wife, Kathy (straight from the airport by cab); and my mother’s paid home-companion-attendant, Neli, were in the room. The nurse came in and said “We are unable to find a heartbeat.” I asked, “Does that mean she’s dead?” The nurse replied that we must wait for the doctor to come in and see and he was on his way. He came in and said yes (the exact wording escapes me) and proceeded to direct a set of questions to me as the “next of kin.” My mother would have been 91 this November.

More than a month before (mid-July), six of us, this time my aunt, her husband, Erwin (78), Paul & Mark, Jim & me had met in my mother’s apartment to discuss whether she would like to go into assisted living. The next Saturday Paul had driven my mother to a place called Bear Creek to see the buildings, living quarters, costs, activities. My mother had appeared to be delighted with the place. We all made plans to help her re-settle, expecting her to live for several more years. Paul thought she might begin to thrive in a place with a social life with people like herself. In the event, about a week and a half before (August 8th?), when I called to ask my mother when she was going (so as to figure out when Jim and I could go see the place, which was not far from my aunt), my mother asserted that she did not know what was happening (something she had said before), and then when I pressed, that she did not want to change her arrangement of living in a largish rent-stabilized apartment with Neli to care for and companion her 24/7. She was unwilling to explain further (I should call my aunt), but appeared determined, & was going with Neli to sign a lease for another year in her apartment (!). They had reached a new understanding. They had not been getting along: my mother hated paying the large sum 24/7 care cost, Neli had been paying someone else to work for the weekend in order to keep a secondary job as back-up, but now my mother agreed to be pleasanter and Neli to stay all 7 days & nights. So I called my aunt, told her what my mother had said, and we left it I would now be the one to phone my mother and cope. My aunt would send me the paperwork I needed.

Then sometime this past Thursday (the afternoon of the 18th), I phoned my mother thinking to be on the phone briefly and be told all was fine. But no, she was breathless, bewildered and said she had been in pain for two weeks. She could not keep in her mind who I was. I asked if she had phoned my aunt and she asserted they phone every day. I asked for Neli to get on the phone, and Neli said, this was not so, but the pain only started the day before and was the result of diarrhea, and (as usual) my mother would not eat, this time not even rice which would help. (Neli later said my mother had stopped taking her vitamins since the last time I called — on grounds of expense.) I stayed on the phone with my mother for a while and felt something was profoundly wrong, but didn’t know what to conclude was happening as her stories didn’t make sense. I began to think I would phone my aunt the next morning after 11 am after all.

I get up early and at 7 my aunt phoned me. It seemed Neli had become badly frightened around 3 am (my mother often had bad nights) and phoned my aunt (as Neli often did), and both my aunt and uncle said “Call an ambulance.” My mother was taken to the hospital, and the people there said she’d die within the hour if they did not put a tube down her to make her breath and perform other resuscitation measures. My mother had signed a Do Not Resuscitate order long ago, but they needed someone to confirm. My aunt and uncle both were unwilling to confirm the DNR alone so they phoned me. I have spent literally years teaching a course called Advanced Composition in the Natural Sciences & Technology and devoted 1/3 of it to the practice of medicine today, read many books & essays about what happens to a person when the breathing tube is put in (it’s very painful and they must be under continual heavy sedation to endure it), the violence of real resuscitation. I know what happened to my father who endured this as the climax of his dying at 68 (his heart wall’s crumbled), remembered Wiseman’s Near Death, Mike Nichols & Emma Thompson’s Wit, and they were telling me about how frail she was, and her various systems shutting down. I confirmed.

Tellingly my aunt called back, saying the hospital was asking us to re-confirm. Were we sure? We were told that an oxygen mask was on her, she was now in an ordinary ward (not ICU), and sleeping. I reconfirmed. Then my aunt said that Paul, who lived the closest, was going to the hospital to see what’s happening. She began to make funeral arrangements and we began to call back and forth, with me talking on the phone to a cousin of mine, Carol, my father’s niece. My mother had made plans to be buried next to my father and Carole had the name of the funeral home, and cemetery. A little while later, my aunt Barbara called again, and Paul’s news was my mother had rallied soon after she arrived in the hospital and when he first saw her. Blood tests had turned up nothing, no reason for all this, and they were doing more tests. I asked Barbara would she re-open her talks with the woman at Assisted Living, and she replied she had beat me to this idea. She’d phoned the AL lady about 10 minutes ago.

I got off the phone and remembered this was a group of people who probably never saw my mother before in their lives, and thought to myself, maybe she’ll end up going home with Neli at the end of the day. Too many times I’ve seen and read of medical people wanting to do something now and proposing all sorts of technical solutions (injections whose power lasts a year) to someone they’d talked to for 10 minutes. (I recently met a psychologist of the new socially coercive pill-administering school who after 20 minutes talked absurdly to me in knee-jerk textbook fashion.) But I phoned again (I forget why) and then asked my aunt if I should come, and she thought I should this weekend, so after securing a room at the Princeton for one night, Jim and I set out for a 6 hour drive. Perhaps if I saw her, I could withstand the panicked nagging with a calmer conscience.

In the event when I got there, my aunt and Mark and Paul’s wife were there (something I didn’t expect) and my mother looked unconscious. She was also every bad color (discolored, yellow, all shrivelled), and Paul began to talk the way I’d heard people in Wiseman’s Near Death talk. I can’t remember the spiel, but it seemed her lactic acid was up very high, her kidneys shutting down, criteria about her breathing alarming (he has a degree which makes him partly a physician, an MD and Ph.D. in psychology too) and after he finished his technical talk, he looked at me and said awkwardly style, “She’s not doing so well.”

I walked over to her and tried to make contact but all I could see what one eye looked a bit open, slit, I told her I was there, who I was, tried to hug her a bit, but no response. I got closer but no response. I went over to the other side of the (small) room area where my aunt and the others were. Jim told me to notice the machine was breathing for her and making her chest move up and down. Her neck was not moving. So I asked Paul some more questions and got the same kind of response, and then I asked, “Are we watching her dying?” Well, he wasn’t sure, he couldn’t say, but then he said, “yes, probably.”

And so it was.

A nurse had come in to ask us questions as if she was going to take care of my mother. She asked me if she should take the catheter out. I didn’t know. She asked again, and after she said maybe my mother would be more comfortable, I said yes, but then Paul said he thought that was a bad idea since she could soil herself. So I agreed with him. I asked the nurse if my mother was dying. The nurse said she was not God. I replied I knew that but from her expertise in natural happenings, what were the probabilities. She said something to the effect it could turn around. She couldn’t say. She asked me what should she do. I said I had no idea. She was the nurse. She said it was up to me. I repeated I didn’t know what she should do. Meanwhile other nurses and technicians appeared to come and go and do things with the IV and machine and listen. At one point Paul’s wife left and we began to talk about how long we would stay that night and when we’d return tomorrow. I asked if the oxygen mask was prolonging this. Paul said, no, it made no difference. It just made it easier for her to breathe when she tried. (So it was a comfort measure.)

Around then the nurse came in with her comment that they were unable to find a heart beat. (Not that it had stopped. How careful all the language was throughout.) But then when the doctor came and left, the machines were turned off, things disconnected and tossed about, and we knew. The changes in her corpse were an unnerving sight (as had my father’s embalmed remains when I had seen them 23 years ago). A dry wizened body, a frozen face, expressionless. Look down and see what death is doing.

We didn’t very much. We all went in and out of the room, discussing the funeral arrangements which my aunt said we should do on Sunday. We would have a Jewish ritual, a rabbi. She and Paul got on the phone using the numbers my cousin, Carol, gave us, and since Paul again lived nearest (he lives on Long Island and the cemetary and funeral home are in Wading River, near Riverhead, Suffolk), he would go discuss what we’d do and what would be the cost face-to-face, but keep in continual contact by phone with my husband, Jim. I phoned my older daughter, Laura, to ask for her and my younger daughter, Isobel, to come tomorrow.

Neli began to cry. She had had a hard year (though well-paid) and was in shock. On Tuesday she and my mother had gone for a walk, dressed up, all seemed well.

A doctor came in and talked and told us the body would be taken down to the morgue within an hour. I asked him “What did she die of physically?” He said the tests showed she had had a viral infection, and because of her age and weak state, the infection had overwhelmed her.

What did she die of, how did she come to this beyond age? A year ago her handbag had been grabbed from her as she stood outside her apartment house. She had (in character this) chased after the man, yelling at him, but was no match in speed or strength. When she came upstairs to her apartment, unnerved, she fell off a stool. She broke some part of her ankle but not badly. But when she was taken to a hospital and told she could go home that night with a boot on the ankle, she refused. Suddenly after 22 years of living alone (from the time my father died), apparently fearlessly, going to spas, to colleges for adult ed classes, at first traveling to see cousins, and now at least staying lively (shopping even driving), something welled up within, an intense sense of vulnerability, loneliness and she refused to go home alone. The only way she could stay was to have her leg put in a cast. Alas, she decided on that and was put into a rehabilitation home for six weeks. She began to lose a lot of weight.

When she came out, she was too weak to walk, needed physical therapy, help at night (really care 24/7 — someone to cook for her, dress her, clean for her); the cleaning lady who had come 4 times a week was dismissed (my aunt and mother did this) and Neli found, hired 24/7. She never accepted Neli as a companion (in my presence called Neli “the aid”), but sat in a corner of the room, not watching TV or listening to the radio with Neli (claiming Neli did not understand it when she did, enough at any rate). She would not turn it on. She did not like the two options (home companion or assisted living), she obsessed over her money and what things cost her, gave my aunt migraine headaches and Jim and I frantic conversations in which he’d demonstrate to her she had tons of money. Sometimes she did seem better physically but basically over the course of the year she would say she was depressed & just continually declined & deteriorated. And so the thing went on until she made the recent decision she found she couldn’t live with.

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Photo take by Laura with her ipad

The funeral. I had been to this place before, 23 years ago to be precise: when my father died (aged 68). Again the death had been unexpected if you looked at it from an immediate standpoint or long over-expected, in his case at least since he was 62 when he had experienced cardiac arrest, been advised to have open heart surgery and refused. The surprise was not that he had died, but that he had been enabled to live so long with a heart that beat irregularly since he was 47, and 20 years of gradually accumulating symptoms, each one worsening the other, and medicines that themselves caused multiple problems. I do not mean to imply he made the wrong decision when he decided against the surgery; he had too much imagination to live with the statistics which he said were near 50% death on the table or soon afterward.

Again an aunt (this time my father’s eldest sister) had taken charge. My aunt Helen had arranged for a Catholic ceremony of sorts for him. She said that if she didn’t, the relatives would not be satisfied, and as for cremation (which my mother to give her credit here brought up), it was out of the question. No one would come. Later my mother regretted the amounts of money she had been led to spend, feeling her sense of shame had been exploited for absurd things like “eternal care” and inner steel in the casket. We had discussed Jessica Mitford and she said she knew all that about the American way of death and yet could not help herself somehow. It was apparently a somewhat shorn or short one since he had not been in a church since an adolescent. He had been an atheist and so some things were lacking that were used in the ceremonies.

I had been traumatized by grief and unable to take in what I was seeing, but I had vivid memories of little bits. I had not been in control and at one point during the ceremonies inside the funeral home, got up and just talked plainly about how much I and others had valued my father and recited a litany of all the generous and good things he had done for others in his life and I described a little of what he was. I just could not stand the ritual which did not seem to talk about him as a person or our missing him at all.

At graveside I was much worse. It was a freezing cold day in December and the ground could not be dug up. A large crowd of people seemed to be there, but not much was said and the funeral director said (rightly enough), that it was so cold we should go back. But when I saw the others turn to leave, I lost it. I cried out, crazily, “We’re not going to leave him here, like this!” I made hysterical gestures, but the funeral director (I realized later) must have been watching me and was prepared. First he handed me this gold cross and said, my father wasn’t there. I didn’t insult the man or the other people around me, held the cross (in law silence is construed as consent) in my hand, but while I was perhaps thinking of something to say against this object and hand it back, there was Bobby, my father’s youngest sister’s youngest son, coming over, hugging me, and saying something or other, and putting his arm around me to pull me away. The funeral director had somehow found out something of my relationship with my cousin. He couldn’t know that I had slept in a crib with Bobby as a baby, and my father, fond of Bobby, helped Bobby now and again over the years, and would joke “let’s go rescue Bobby” when Bobby would arrive at the airport. But he had found out enough from someone. My uncle Erwin said something sensible too, was on the other side of me, and I did walk away.

This time I was determined to do better. I asked Laura to bring Tennyson’s poems but upon looking at “Crossing the Bar,” I decided against it: the feeling was right, but the words mushy, and it ended with religion. Stanzas from In Memoriam were too particularized. And then I thought of the poem R.L. Stevenson had engraved on his gravestone and Jim found it using his ipad, I wrote it out and practiced it and decided I’d read it before or after (or at some time during) the rabbi’s speech. I’d be careful to ask first and make sure it was understood I’d do this by the rabbi. After all I was paying for this ($8260). Unlike my mother I didn’t and don’t regret the money; I was doing it for everyone else as the daughter, providing this, sort of a minimum I could do as I knew and know there is much I couldn’t do and others had done in my stead. It was understood (or thought) I would inherit ample to cover it. Still American-like I was paying and indeed the Rabbi asked me several times what I wanted, and I kept saying, do what my aunt would want and as he seemed to be dissatisfied with this, I told him, I was an atheist and my aunt Jewish and he should do all the Jewish things regularly done, which she would want. I added that for she was central to was my prime motivation at this ceremony.

But this time I did want to say something appropriate for my father which I had not last time, and I knew, know my mother was not a practicing Jew; though she was a Jewish person in culture and shared many American Jewish attitudes, I never in all my life saw her do any ritual that could be called religious. She never claimed to pray. She told me that once when she and my father thought I was near death after giving birth to Isobel, she asked him if she should pray. He said something about the uselessness of such behaviors, and so she didn’t.

The rabbi did leave an interval for me to say the poem. I got up and said that my mother and father were buried in one grave appropriately as they had shaped one another’s existences since the time they married (in November 1945 about a year or more after the photos at the head of this blog were taken). I didn’t say for better or worse (though I meant this to be understood). I did say it was short, strong, and they would probably find lines in it familiar:

UNDER the wide and starry sky
    Dig the grave and let me lie:
Glad did I live and gladly die,
    And I laid me down with a will.

This be the verse you ‘grave for me:
    Here he lies where he long’d to be;
Home is the sailor, home from the sea,
    And the hunter home from the hill.

Continued in the comments. See also my description of our walk in High Line Park and Sondheim’s Into the Woods.

E.M.

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Watch what these primates do: Frederick Wiseman — with framing from Trollope, Agree, Montgomery

Dear friends and readers,

I have been given pause what we should call ourselves. Last night I watched the most horrifying film I’ve ever seen and I’ve seen some horror. It’s a 1974 Frederick Wiseman film called Primate where he filmed the people or scientists who “do” science at Yerkes Regional Primate Research Center in Atlanta. (I hate to call them that but that’s why they would call themselves and would probably be granted that definition because of their methods of documentation) The daily cruelty inflicted on a group of apes unluckily caught and enslaved in cages is terrifying as you watch them do the meanest, most absurd, brutal, exploitation, and useless experiments on these animals. Researching these animals’ sexuality under conditions of extreme imprisonment, drugging, imprisonment inside various kinds of harnesses, versions of chains, includes forcing a chimp to ejaculate while you feed him grape juice; you keep him in cage, starve him so he is hungry and will come to the front and you put your hand in and do this to him. This is minor. I saw one gibbon beheaded slowly. The people wear doctors’ outfits. They are doing science, continually writing down every thing these animals are coerced into doing in these cages

I then read an chapter printed in a 1989 book by Thomas Benson and Carolyn Anderson, Reality Fictions, where I learned as of that year the Yerkes institute was still performing these acts.

To my surprise I discovered it began with Anthony Trollope’s description of his realistic method IN CYFH? where he discussed self-reflexively how he put his “facts” on a page, what he meant to do in his novels: to make us see and face the real details of the world and see their relations and consequences quite apart from what the characters claim these are.

This is what Wiseman does. Benson and Anderson then quoted and discussed James Agee documentary book on sharecroppers in the depression where a similar point is made about political discourse and how to be effective.

Of course the Yerkes and its supporters have attacked Wiseman as unfair, gross, skewing the evidence. They say their talk was not included, their justifications. In fact they partly are. But these are irrelevant.

Look at what people do. I cannot better Benson and Anderson’s straight descriptions and evaluations:

Primate is 105 minutes long-feature length-and contains, according to an analysis by Liz Ellsworth, 569 shots.8 That works out to an average of eleven seconds per shot for Primate, approximately half of the average shot length of twenty-three seconds in Wiseman’s High School, and a third of the average shot length of thirty-two seconds in Titicut Follies. The unusually large number of shots in Primate is not simply a fact, but a clue, both to the rhythm of the film and to its method of building meanings.

The film opens with a long series of shots in which we may first notice the ambiguity of the film’s title, which applies equally well to men and apes. We see a large composite photograph, with portraits of eminent scientists, hanging, presumably, on a wall at the Yerkes Center. Wiseman cuts from the composite portrait to a series of eight individual portraits, in series, then to a sign identifying Yerkes Regional Primate Re­search Center, a bust of a man on a pedestal, an exterior shot of the center, and then a series of four shots of apes in their cages. The comparison is
obvious, though not particularly forceful, and it depends for its meaning both upon the structure Wiseman has chosen to use-at least he does not intercut the apes and the portraits-and upon our own predictable surprise at noticing how human the apes look.
Slightly later in the film, still very near the beginning, a pair of sequences occur that are crucial to how we will experience the rest of the film. Research­ers are watching and recording the birth of an orangutan. The descriptive language is objective, but not altogether free of anthropomorphism: for exam­ple, it is hard not to refer to the female giving birth as the “mother.”

Immediately following the birth sequence, we watch women in nursing gowns mothering infant apes: the apparatus of American babyhood is evi­dent-plastic toys, baby bottles, diapers, baby scales, and a rocking chair. To reinforce the comparison, we hear the women speaking to the infant apes. “Here. Here. Take it. Take it. Come on,” says the first woman, offering a toy to an infant ape. Then another woman enters the nursery, also dressed in gown and mask. “Good morning, darlings. Good morning. Mama’s babies? You gonna be good boys and girls for Mommy?” A moment later she contin­ues, “Mama take your temperature. Come on, we’ll take your temperature. It’s all right. It’s all right. It’s all right. It’s all right.” Then a man enters and hands cups to the infants. He says, “Come on. Come on. Here’s yours.”

The rhetorical effect of this scene is to reinforce our sentimental identifica­tion with the apes. And this scene, by comparison, makes even more frighten­ing a scene that follows close upon it, in which a small monkey is taken from its cage, screaming, as a man with protective gloves pins its arms behind its back and clamps his other hand around its neck.

After these scenes, every image in the film invites us to continue enacting comparisons, as part of the process by which we actively make meanings out of the images.

Wiseman establishes a dialectic between acts that we are likely to perceive as kindness to the apes and acts that we are likely to perceive as cruelty. Do the acts of kindness balance the acts of cruelty? Is there a journalistic attempt at fairness here? Not really. We understand that in this institution, the apes are subject to human domination, mutilation, and termination. In such a situation, the acts of kindness do not balance the acts of heartless research. Rather, kindness is reduced to hypocrisy, a lie told to ease the consciences of the scientists and to keep the apes under control. Far from balancing the harshness of the research scenes, the scenes of kindness turn the research into a cruelty and a betrayal.

Let us examine briefly another sequence in Primate. It is the climactic sequence of the film, a little over twenty minutes and over one hundred shots long. In it, researchers remove a gibbon from its cage, anesthetize it, drill a hole in its skull, insert a needle, then open its chest cavity, decapitate it, crack open its skull, and slice the brain for microscope slides. It is a harrowing sequence. From a structural standpoint, Wiseman uses the techniques we have noticed earlier. The images are often highly condensed, with close-ups of needles, drills, scalpels, the tiny beating heart, the gibbon’s terrified face, scissors, jars, vises, dials, and so on.

We are invited to engage in our continued work of making comparison and metaphors: the gibbon is easy to identify with, in its terror of these silent and terminal medical procedures. We are the gibbon, and we are the surgeons. At another level, we see the gibbons’ cages as a sort of death row and call upon our memories of prison movies when we see the helpless fellow gibbons crying out from their cages as the victim is placed back into its cage for a twenty-five-minute pause in the vivisection.

Wiseman has carefully controlled progression and continuity in this section of the film, first by placing the sequence near the end of the film, so that it becomes the climax of the preceding comedy, and then by controlling its internal structure for maximum effect. The sequence is governed by the rules of both fiction and documentary. We do not know until almost the very last second that the gibbon is certainly going to die. Earlier in the film we have seen monkeys with electrodes planted in their brains, so we are able to hope that the gibbon will survive. We keep hoping that it will live, but as the operation becomes more and more destructive of the animal, we must doubt our hopes. And then, with terrible suddenness, and with only a few seconds’ warning, the surgeon cuts off the gibbon’s head. We feel a terrible despair that it has come to this. But the sequence continues through the meticulous, mechanical process of preparing slides of the brain. Finally we see the researchers sitting at the microscope to examine the slides for which the gibbon’s life has been sacrificed. And for us, as viewers, the discovery ought to be important if it is to redeem this death. The two researchers talk:

FIRST SCIENTIST: Oh, here’s a whole cluster of them. Here, look at this. SECOND SCIENTIST: Yeah. My gosh, that is beautiful.
FIRST SCIENTIST: By golly, and see how localized. No fuzzing out. SECOND SCIENTIST: For sure it does not look like dirt, or-
FIRST SCIENTIST: No, no, it’s much too regular.
SECOND SCIENTIST: I think we are on our way.
FIRST SCIENTIST: Yeah. That’s sort of interesting.

The whole operation, which viewers are invited to experience as pitiable and frightening, seems to have been indulged in for the merest idle curiosity, and, if the scientists cannot distinguish brains from dirt, at the lowest possible level of competence. Our suspicions are confirmed a few minutes later when a group of researchers seated at a meeting reassure each other that pure research is always justified, even if it seems to be the pursuit of useless knowledge.

We have already mentioned the sound-image relationships in this se­quence in discussing the structural uses of comparison and continuity. But let us point to some special issues that relate to Wiseman’s use of sound. At many places in the film, people talk to apes, creating a dramatic fiction that the apes can understand and respond to human speech. But in the vivisection sequence, no word is spoken to the victim. This silence is almost as disturbing as the operation itself, because a bond of identification offered earlier is now denied.

The distortion of sexual behavior, in the name of understanding sexual behavior, sometimes reduces sexuality to mechanics, as in the many scenes where apes are stimulated to erection and ejaculation by means of electrodes implanted in their brains, or the scene in which a technician masturbates an ape with a plastic tube in one hand while distracting the ape with a bottle of grape juice in the other. At other times, the scientists seem gossipy, as they sit and whisper about sex outside a row of cages. The effect of the sex scenes is comic and undermines the dignity of the presumably scientific enterprise we are watching.

But along with the comedy, there is an undercurrent of horror, at times straightforward, at times almost surrealistic. Sometimes the horror occurs in small moments: a technician tries to remove a small monkey from its wire cage. He reaches inside the door of the cage and grasps the monkey, which tries to evade capture by clinging to the front of the cage next to the door, an angle that makes it difficult for the technician to maneuver it out of the door. The technician reaches up with his other hand and releases another catch, revealing that the whole front of the cage is hinged. The front of the cage swings open, and the technician grasps the clinging monkey from be­hind, as our momentary pleasure at the comedy of the impasse gives way to a small despair: there is no escape.

Benson and Anderson found the snipping of the gibbon’s head off the moment the film most made them shudder; for me the cruelty of these people was felt most when Wiseman photographed one of the apes operated on and we see him from the back with no clothes, no fur, just shuddering and not a thing is done to soothe, comfort, protect him. And again when the ape operated on so horrifyingly is brought back to his cell, and just dumped there, and the camera catches the creatures intensely distress confused eyes as he lays on the cement floor, and the keeper locks the door on him and walks away.

Oh the film is rightly called Primate. The creatures in charge in their white coats doing these deeds are primates just as surely as the creatures they torture.

This film more than any other shows the wisdom and decency of Sy Montgomery and the “Woman who walked with apes” (Goodall, Fossey, and Gildikas) whose methods are called “unscientific.” They watched the apes in their real habitat, did not attempt to control or change or manipulate them, took into account the apes’ subjective life and studied them from within as a culture. Theirs is the real way to discover truths about these animals.

Birute Gildikas and an orangutan she is genuinely getting to know and understand

Ellen

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Maggie Mahar’s Money-Driven Medicine: First, make a profit! the new Hippocrates’ oath

Dear friends and readers,

A final blog of notes and links on an important book I read with my students this term: Mahar’s Money-Driven Medicine. This remarkable book should be required reading for all adult Americans.

Preface: Her achieved goal to tell the story of health care in the US through the eyes of doctors, patients, hospital administrators, health care executives, economists and Wall Street analysts. She wants to reach uninformed people and does; to show us that competition far from making medicine better and cheaper makes it far more expensive than it need be and deforms the system to the point where it’s dangerous. She teaches us about the messy realities of a world of medicine where a commercial marketplace is a primal motivating force, and show that all its parts and people are driven (or are here to) make a big profit as possible, not to keep people well and enable those who have genuinely become sick become well.

She begins with two maps: who is paying, what are we paying for? and shows that 7.1 per cent of the US gross national product is involved in health care; and increasingly US worker and employers cannot afford the premiums. 1 in 3 households making over $50,000 cannot afford the premium. You are not safe if you are insured because often what you think is covered is not: Michael Moore’s film Sicko was about this: people fooled to think they are covered, when after all they have paid, they are underinsured. Employers are gouged too so that the movement of jobs outside the US to countries where there is national health care is partly the result of not having to pay such health care bills. We are said not to ration care; but we do, it’s rationed by who can afford it; why is there the cost? more treatments? We get shorter stays if more intense care. It’s said malpractice suits are at fault:: they account for 0.5 per cent of spending; costs of defensive medicine impossible to calculate. In this area of life competition and the need to make a profit makes the system much worse: we pay much higher prices for same services; we have much higher administrative costs; we perform far more of complex dangerous specialized procedures than are needed.

The competitive system makes the health care delivered to individuals much worse: the competition makes it wasteful. Why: aggressive duplicate sales and very high high profit margins. The aim of corporations who involve themselves in the area is to make money for stockholders and they do what makes the most profit. One of 3 health care dollars spent on unnecessary unproven procedures, over-priced drugs, devices no better than inexpensive ones they replaced

She asks, What if individuals are being mistreated, over-charged, is this a personal or society’ responsibility? Yes because we cannot exist apart from one another and what others do affects us immediately in the area of health care. We are not individual automatons doing things that don’t affect one another in the area of health care because it is so central to our lives and we cannot do without it. When a for profit hospital lures customer with false advertising non-profit hospitals who are dependent on the money they bring in must change their ways and lure people. Many many people do know this. In 2004 a national coalition of businesses, unions, provider groups, insurers, called for price controls, national health insurance, restricting increases in insurance premiums. We cannot get reform because the system’s lobbyists pay huge sums to politicians to enable them to get into office, and once they need and have taken that money, they dare not vote in the interests of their constituencies.

There is also a film made from book and it too shows how a profit-hungry medical-industrial complex has turned health care into a system that squanders millions of dollars on unnecessary tests, unproven and sometimes unwanted procedures and overpriced prescription drugs; see the interview too.

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Chapter 1: The Road to Corporate Health care: how did we get here? this chapter includes history

This is a story about how power trumped reason and ethics: like Gawande, she opens on the problem of uncertainty, how we cannot know the outcome of a visit or medicine, how doctors themselves operate uncertainly; the patient must buy blindly, and recovery unpredictable. Ironically in this system a well person is someone you can’t make a profit on. Medicine is not a commodity like buying a jar of coffee or car; the relationship is one which has to rely on trust and needs the doctor to put the patient’s interests first. If the product will do you more harm than good, you have still to pay for it. In a capitalist driven system doctors and hospitals are not paid to keep people well but treat them when they are sick. A pill or operation is a sale.

She tells the story of now in the later 19th and early 20th century physicians banded together (the AMA) to create autonomy for themselves. They control who gets what medicine, keep the number of schools limited, price high and their authority supreme and fight transparency (p. 4). In most other professions individuals do not remain independent; she thinks the way they did that was just this need for a relationship between a doctor and patient – and the relationship is needed and must be based on trust and honesty. What they did then was took their cultural authority and strategic position to make themselves gate-keepers to everything you might want or need for real.

Insurers stepped in to help pay the rapidly rising costs and that opened the door to endless price inflation; the only check was the patient’s ability to pay; now it’s the employer’s. he AMA allowed Blue Shield/Blue Cross to come in because they did not interfere with the doctor: doctors not required to charge patients controlled fees; they paid hospitals on basis of costs and let hospitals say what these costs were. The pre-deducted sum from the paycheck of the employer the final enabler. In the 1960s medicare, medicaid were brought in to fund the aged and poor; but the problem here is the gov’t pocketbook is open to be fleeced and was and is.

Meanwhile in world of scientific medicine and profit, you saw the rise of the specialist, and the entry of enterpreneurs who saw a world awash with sums if only they could get their hands on these: hospitals began to compete like hotels, and individual uninformed egos and profit motives allowed to control what is on offer and what people can choose.

By the 1970s this invented marketplace was in crisis. The earliest solutions were smaller groups within the system like HMOs: they would rationalize their groups within and apart. They learned they could not exist apart. Paul Starr has written two important books: one on the social transformation of American medicine and the other on how given the present political system, how we cannot change the bad results. He shows in the latter how the HMOs are too small and not in control; the goal is return on investments as corporations began to buy these entities (HMOs, hospitals, drug companies) whose business is one of selling false ideas about what medicine is and can do.

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Chapter 2: The Cost of competition

WE have a Hobbesian system where all the players are pitted against one another and the aim of managed competition was not to deliver better care so much as to keep costs within the present system down: the idea was the insurance companies would dictate what a doctor could order for the patient and this would stop.

To save money you have to pay slow careful attention to the processes, and discover ways to really improve the care of individuals first, ask yourself what kinds of basic care are really effective. Medicine because it goes on between a doctor and patient is a cottage industry: doctors practice episodic medicine and if they don’t share what they are doing with one another, a patient ends up the recipient of mistakes.

She shows how hospital are pitted against hospitals; obtain lavish technology which others have because others have it; speciality hospitals take patients from community hospitals (p. 39). If we look at how she treats each individual area we see Gawande omitted important parts of explanations. He says we do so badly with pneumonia becasue no one cares enough for the average adult; Mahar show that that huge margins of profit are there for open-heart surgeries, while only small ones in for pneumonia care (which demands immediate tried antibiotics (p 40). Yet our population has little immediate need for heart-surgery programs (p 40): our real problems are smoking and bad eating habits. She goes over the ordeal of by-pass surgery and how it’s pushed on people (p 43) who have no watch-dog to help them.

Then there’s doctors versus hospitals (p 45): they have to pay unscrupulous doctors what they demand or they go to another hospital

Doctors want to be in control (p 47) and conflicts break out everywhere: the value system is so askew (p 49): drug-maker v drug-maker, insurer v insurer. The knowledge a physician needs to decide whether or not to give someone an operation, the problems and complications, the medicine, are called “trade secrets” and they cannot find out whether what they are doing is helpful or safe.

We see where whistle-blowers and patients are caught in cross-fire and trampled down, basically punished for being active on their own behalf (p 59). It’s a story with occasional decent people (heroes and heroines): Dench and Powers who blew whistle on doctors overseeing more than one surgery (pp. 59-79). The story of Diane Powers (pp. 63-69) — since it’s normal for patients to die people overlook the causes and increasingly autopsies are not done because they are not profit-making.

Still from Bill Moyer’s Journal: discussing movie from book

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Chapter 3: The for profit hospital

For profit hospitals lead to higher prices, well, duh, of course they do; study after study shows this (p 127)

This chapter includes a central revealing history of three pirate companies: National Medical Enterprises, Tenet and Health South. It was run by CEOs who she describes as inherently sociopathic types: these are people good at guessing others motives and manipulating that. Three took away huge sums with impunity: Richard Eamer, a story of billing fraud at psychiatric hospitals (p. 87)); he was replaced by Jefferey Barbakow (p. 93); whole centers set up to obtain and gouge customers was Redding’s contribution (p. 102, 104); Trevor Fetter (p. 114); Dr Tommy Frist a dangerous man because he was himself a respected physician, he worked as a front (p 119) and used his position to enrichen his family fantastically (p. 122); Richard M. Scrushy (p. 125) another “empire” builder. Most of these have gotten out with huge sums. Wall street applauds, (p 101).

Outlier payments: the way they gamed the system was to take the patients whose so-called costs were outrageous and actually bill for these (p 100). In reality no one pays these sums; they are notional except when the patient has no insurance. What happens is the institution figures out how much he or she needs to get to make a big profit and then divvies up the costs for individual items so they add up to that price. It’s also a kickback game (p 115) where settlements are a form of coverup (p. 112).

Shanghaii-ing Patients: I’ve seen this kind of grabbing mentally and socially troubled wreaking of people’s lives when parents of disabled children and young adults mistakenly put them in institutions (p 86); you are in absolute danger (p 89). Victims’ stories include John David Deaner, p 69, Christy Scheck (p. 90); Tony Ginocchio (p. 102); Shirley Wooten (p. 103). The psychiatric industry exists within a a climate of pervasive fraud.

Here and there a quiet hero: the new editor of New England Journal of Medicine, Arnold Relman (p 97), an editor; Jim Moriarity, an attorney (p. 90) and his brother-in-law (p. 108); Louis Parisi (p. 96); Robert F. Stuckey (p. 96); Skolnick Sheryl, pp 106-109

An institution that started life as charity ends an irresponsible investment opportunity wrung dry by ruthless operators (p 131); historically hospitals (like schools) were unprofitable institutions (p 132). Problems includes those who work to game the technology; instill fear in patients and an over-confidence in technology; it’s revealing to see a stock market exuberance characterized early phases of “for profit” hospitals

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Chapter 4: Not-for-Profit hospitals driven to change their act so they make a profit. Their original mission is lost.

She begins this chapter with an advertising campaign in a hospital to attract patients as if it were a hotel (pp 139-40). They are not emphasizing safety and not setting up what happens with safety criteria in mind, but rather luring patients in. Academic medical centers also need to be scrutinized because increasingly they are operated with a central aim of bringing in money too.

During the first half of 20th century, hospitals not expected to be self-supporting; paid for by progressive taxes. Boards saw themselves as providing a social service; they were not a crew of savvy entrepreneurs, but pillars of the community. There is always a gap between ideal and real, but now it’s exacerbated and central.

Today not-for-profts rely on borrowed money and what they can bring in for themselves. They are (like churches) still exempt from property and corporate taxes. They do provide charity; they must stabilize patients before ejecting them, only we discover that often they do not do this.

Some results: only 20 per cent of community hospitals invest in palliative care; 4 brand new hospitals in one area where wealthy people live; the hospital has to offer handsome bonuses to keep doctors (p 146). A race on to lure well-insured; high-margin services to cardiac patients (p 148); proliferation of Neo-Natal units p 149: yet infant mortality rates no lower; infants with less serious disease put into ICUs. Ironically, the plans set up for people cost more and provide less (to make this profit).

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Chapter 5: When More Care is Not Better Care

She begins with the story of Maureen Silverman who made the mistake of calling an ambulance for her father who was again seriously ill (p 156): he had had many operations and he didn’t want dialysis. The family was told this is what we do; this kind of medicine; the doctors were not interested in what Silverman himself wanted. Instead of hugely expensive painful technology, an IV should have been put in the man. In the middle of the night the old man died and escape them all.

There is no business case for learning how to do less: system stubborn, set up to do more even if all is uncertain (p 174): no capacity or teams of people hired to study what truly works; too much thrown at people (pp 176-77). Too many drugs, and people die from therapy — one of 8 stories in Near Death; you are told it’s your only hope for survival when no one knows if treatment actually works (p 177).

The Insured often receive too much care in the forms of newly-patented medicine and expensive technology: 65 billion is spent in overtreatment; but those with this kind of lavish care do not do any better. By not talking about price we don’t discuss why we do what we do: excess capacity then governs (p 170)

The regional variations: Gawande has a long article in the New Yorker on this too: Manhattan and Miami people receive far more and aggressive care than counterparts in Minneapolis and Missouri, Montana (p 159). Underlying competitive and price gouging system accounts for 1/4 of cost. Geography becomes destiny because the values and types of doctors who exist in one place don’t exist in the other: with more intensity of care, the outcomes are often worse: you are being cut up, so you have greater risk of complications or medical errors; hospitals are dangerous places if you don’t have to be there.

Speciality hospitals syphon off expensive patients and leave longterm care to community hospitals. Often the high-tech treatment is worse for the person (like bone marrow treatment plus chemotherapy often kills instead of saves). Non-invasive treatments reap less profits so doctors do more operations and hospitals participate in this over-sale and attempt to make money.

High tech distracts by from going little things that work and that count (p 165) to big things that may not and are dangerous and painful: antibiotics must be immediately to pneumonia patients, beta blockers to people with heart attacks. Patients expect more care; an ago-old instinct is to want to see something done and not understand that sometimes nothing can be done but palliative help (p 173) and comfort.

Story of Dr Donald Berwick whose wife was several times nearly badly harmed and suffered unnecessarily (he comes up in Gawande’s “Bell Curve”). Ann: we see continual mistakes, continual errors, no one caring for her, no one watching to see what others are doing; she experienced long waits with no attention paid to her – and this is the wife of a big doctor in the best institutions (pp. 182-89).

In End of life care: doctors not trained to listen, not paid to listen; team comes to tell you your options; not paid to do that. The ICU; Meier makes $100 an hour to talk; cardiologist brings in $1000; Hsaio’s famous formula leaves out usefulness (p 193). Technology is defining the patient; no one paid to listen; talking to families major part of what’s done in ICU physicians trained to treat specific illness not whole person

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Chapter 6: Too Little Too late

So who is uninsured? 1 in 8 children for a start. Veterans. States decide how to allocate money that is given them by the federal gov’t, and when programs are set up without funds, the states respond by making it difficult for individuals to get health care (p 199). When they are forced to give out immediately, they sharply limit future enrollments. They get rid of the list that tells who is not insured.

Who is at risk: 47 million plus: when uninsured you pay gross bills which insurance companies do not pay (see outlier payments); they receive no preventive care and less or no immediate care (p 201). They do turn people away (p 203); screen them, (p 205); hospitals shun and dun people ruthlessly (p 208); no cash, no cure, no research. We see the capricious access to specialists

People in hospitals made gate-keepers who have forced of character not to take you in unless you have the money (p 202), and sometimes not then. Poignant stories of Martin Martinez and Buddy Rich. Mr North (pp 216-22): the terrible suffering of a working man reveals why in political arenas people get so bitter. They or relatives and friends have been badly mistreated.

Shunning and dunning. Hospitals overprice services to the poor and uninsured: first they refuse to treat you if you are uninsured unless you bring money up front; then they charge you the literal unreal price they send the insurance companies. These are the prices they have to get from a procedure based on cost and profit, not what each thing really costs. Then they sell the debt to a collector. So the person experiences ludicrously high costs, is shunned and then dunned. He or she does not return to the hospital.

Finally, the high costs to taxpayers and the system in general of not treating uninsured and the irrational ways things are cut (p 222-224).

For last part of book, see comments. And see also Gawande’s Complications and essays; Marcia Angell on privatizing medical knowledge: harm spreads through globe; Frederick Wiseman’s Hospital.

Ellen

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Atul Gawande: realities of medicine hidden and mostly misunderstood

Dear friends and readers,

Another blog where I’m turning my lecture notes into a blog for my students and in the hope other readers involved in some aspect of medicine (and which of us is not?) will find them of interest.

I begin with Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science, his introduction, a summary and exemplification of his book’s major arguments: Medicine is a strange and disturbing business: it is messy, uncertain and surprizing. Is that true of other sciences? Yes. Are there other applied uses of science where what happens is very often unpredictable? We have had one this term: the NASA shuttle. John Harrison’s invention of watch that could tell what longitude a shiop is at. We see him aboard ship showing how hard it is to cope with knowing this abstract placement.

Gawande opens with anecdote (pp. 3-5). The doctors were frightened, meant to help a young man shot through the buttocks, cut him open, what damage was done was done by them; they couldn’t explain how it happened. Then the case of boy in danger of death. He, Gawande, had to guess. They didn’t know how gravity would affect what they were doing (p. 6). Lee Tran. They guessed right.

Medicine is an imperfect science, diagnosis and offering medication are ways of investigating what’s wrong with someone (p. 7). The stories in a sense all exemplify this idea. Book’s sections organized thematically to highlight sub-points he wants to make: doctors are fallible: they have to learn and on patients and they “go bad.” Much mystery and many unknowns in medicine and struggles of what to do about these (back pain with no physical explanation that drives a person wild; nausea won’t go away and is literally killing her): we see that evolution has made a creature at odds with the demands of our modern lives and society. Then uncertainty itself driving the whole experience, shaping it.

The major flaw in book: “While people continue to bear the high cost of medical care, negligence and over-commercialization, Gawanade offers analysis of intangible though important dimensions dimensions through stories and leaves out of his discussion any ethical burden on the above issues affecting the nation and society: our attitudes towards one another because of race, sex, ethnicity, and the kind of illness we show up with.” “He prefers to throw dust away from medical profession by called medical science ‘imperfect’.” It could be called a distraction.

The candid stories conceal a biased and conciliatory analysis that favors a gainful status quo of practitioners; the way medicine is practiced today (in the US and elsewhere) where good health benefits are distributed like cookies to certain high incomes and luckily placed people and age groups.”

On the other hand they are candid and for many they open up cracks in our own attitudes towards medicine and doctors that are unreal and dangerous. He is smart, learned, and gives us a chance to think. What medicine is despite the plethora of programs remains mostly hidden and misunderstood.

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Part 1: Fallibility

Atul Gawande

Essay 1: Education of the Knife (pp. 11-34): it’s people doctors must practice upon.

He is frank about how hard it is to learn. I’ve read this kind of thing where the doctor/nurse/medical technician shows him or herself trying to put in an IV. What makes this different is he shows himself trying to put in a scalpel, in the center of someone’s body. The reader pays attention.

What are the motives of someone who does this? Enjoyment of power. Darwin was originally going to be a doctor; his father sent him to one of the best medical schools on the earth at the time, at the University of Edinburgh (also good were Paris, some in Italy). He shuddered in horror: no anesthesia; he found it particularly hard to take how the poor were treated and also children, particularly the children of the poor. Gawande gaps in awe (p 15), exhilarating the power (p 16)

Real experience daily is of ordinary things all the time: someone gets a screw in her leg from a chair and can’t wrest herself free, (p 18)

He doesn’t tend to see hand-eye coordination genes per se as central. What you need is the ability to practice, practice, practice. The genius or talent is the one which leads you to practice (pp. 18-21)

It is hard to talk to patients about this (p 23) People won’t let you learn on their family or friends if they know about it (pp. 29-30). He didn’t let a resident learn on his child. Truth is the wealthy and well-connected wriggle out; he’s for setting up a system insofar as you can, where choices are offered or born equally (p. 33) How much should trainees be allowed to participate? (Is there anyone in the classroom who feels or knows that a physician-in-training did something and the result, while not fatal, is not so good?)

Introduces important theme or insight which carries throughout the book: the way to eliminate errors is not to demonize individuals; it’s to study a system, a practice, a habit, a group and see what patterns of errors happen and then see how to eliminate them. Everyone makes mistakes, everyone. No matter how hard you try not to. Gawande shows they tend to be of the same kind: like misreading the machine which puts someone under anesthesia because the companies put the controls on the front differently; like copying out prescriptions.

What to do? Get after the companies; make doctors use preset prescriptions in computers (that is shown to work better because then they are not misread, another systemic problem). We want to believe in some hero and then we sue him; he’s just another “flawed human” being in a team, in a subculture.

We see the team that learns quicker and does better, is one where people cooperate, are not competitive or domineering, and we see why: they are really a team (p 29): trust, getting people to do their best in security.

It is hard for someone to adjust to and face your own fallibility.

Essay 2: The Computer and the Hernia Factory (pp. 35-46): what makes for needed excellence

Gawande begins with examples of how approaching medicine from a systemic point of view, relying on machines can help eliminate certain kinds of errors. The problem: people are mistakenly discharged; one reason is misreading the computer printout. Machine is better at it (p. 37).

Well, there are hospitals where doctors do nothing but hernias. They get good at it. Repetition changes the way you think. Is that to be better? Depends, maybe in the case of this sort of operation. Doctors do rely on intuition too; a lot of doctoring is sizing you up. Do we eyeball our groceries to determine how much they should cost us?

The problem in the book of celebrating technical virtuosity. Is Gawande too much into this technical virtuosity? Our films (Wit, The Doctor) stress the need for humanity. Jason a technique freak; so too Kelekian; alas so too was Vivian Bearing when she taught poetry. All avoiding the human. The human is so painful and so uncertain. It’s hard to make friends. I’m one of those who goes to the library and finds books as friend.

Essay 3: When Doctors Make Mistakes (pp 47-74): again doctors must learn on people and how to bring down the number of mistakes

Gawande is concerned to show us that medical error is not fundamentally a problem of bad or crooked or inadequate or corrupt doctors. He tells the story of his bad judgement is one that has been excerpted again and again. It’s brave of him; it also probably precludes some other person getting very mad at him (he can’t make enemies telling of his own failure).

I talk a lot to my dentist. Dentists are doctors. For about 15 years, maybe a bit more I’ve had very bad troubles with my teeth. He’s a nice man, honest, a good dentist. When I told him about this book and quoted the line, “It was a clean kill” (p. 61), he said to me people he knows have said this to him. One surgeon says you are unlikely to carry on through a life doing surgery without killing someone. I said, “is that true, do you think?” Well, he said, he’s lost people’s teeth when they didn’t need to lose them. He feels bad when people lose their teeth unnecessarily.

Gawande’s pride was at stake. He wanted to do it himself

While I don’t think suit prevents errors, and agree that fear of suit can make errors, I disagree with the inference some may take away from this chapter that we ought not to have suit (pp. 55-58).

It’s the only place we as patients have to fight a lack of autonomy. It’s a crude highly fallible mechanism which is screwed up by the adversarial court system (and you get money for pain and injury, not from mistakes; juries award much bigger sums when outcome back regardless of whether there was a mistake or some egregious misconduct as in the stories Gawande tells in the essay called “When Good Doctors Go Bad.”

I lived in England for a time where you can’t sue; patients have less rights in custom; custom and norms are more significant in determining how people behave than law. Laws forbid things; they don’t tell us what to do, but what not to do. The language is sometimes phrased as the law allows you this or that, but it’s felt as what is not permitted. Scotland you have to prove a tort; here only pain and injury.

Would they discuss their errors if we didn’t have lawsuits? I don’t think so (p 58). Nonetheless, I agree demonizing errors is a bad idea. As doctors are not gods, so they are not demons.

M&M: Mortality and Morbidity: with all its evasions, it’s what they have and it needs to be protected. Let us remember lawyers make money from suits. He agrees it’s inadequate and shabby. The individuals don’t take responsibility; the doctor does not want to see himself as part of team or system. There’s the problem of collegiality and the problem that you fear someone will accuse you of bad or poor practice. But they do look into errors; the person is known to have made it, and his or her career is on the line.

Probably the most important part of this book is the argument that “people err frequently and in predictable patterned ways.” We know this but do not act upon it except when something seems singularly risky: like airplane flight. People don’t have wings. He tells the case of anesthesiology where error was brought down to a tiny percentage of what it had been when the systems and patterns of behaviors were studied (pp 64-67).

I notice that one cause of the young woman’s death can be said to be an unwillingness to spend money on new machines that make no money. It cost to replace the monitors with better ones (p 67). That takes money out of the budget which individuals can glom up. City of Alexandria is always very unwilling to replace a stop sign with a red/green light. They say people don’t like red/green lights, but they also often add the $90,000 bill or so these things cost. Only after a number of accidents at bad corners, do you see a red/green light go up.

Doctors should still work to utter capacity; bodily harm at stake. Effort makes; diligence, attention, care (p 73).

Gawande did err; he did not make the most of the hand of cards he’d been dealt with. Not always easy to see what is the best thing to do.

Essay 4: Nine Thousand Surgeons (pp. 75-86): people go to conferences to be with their tribe.

A considerably lighter essay. Time our for a little humor that teaches us something. What do professionals go to conferences for? A good question. Feynman distrusts conferences. He says they are mostly for display, political networking, personal aggrandizement. There are things sold which are worthless; little original research or ideas for real anywhere. Maybe so. Still people go and he went too. Anyone here ever gone to a convention or conference of people engaged in the same endeavor or having the same interests?

You go to be validated; to talk to people in your community like you. To share feelings and thoughts. The conversations on the bus. You are among your particular tribe. A tribe not linked by genes or biology. If nothing original, a lot of development. You are in for conning of course and have to figure out what’s valuable and what hype, what personal aggrandizement sheerly and what interesting.

You can experience the occasional illuminating or just so moment: the telling paper, film, procedure, encounter. For him it was the man with the real books of thought (pp. 81-82) in the midst of frivolous nonsensical gadgets and freebee give-aways.

Essay 5: When Good Doctors Go Bad (pp. 88-106): the problem of inadequate means to stop bad doctors from practicing; the lack of help for them.

Story of Hank Goodman is memorable: he began as intensely caring and ambitious and became “burned out.” Had had enough.Surprisingly common and no one with the power to do anything acted (p. 95). Gawande says there is an honorable reason: “they don’t have the heart.” Well what about the patients. He does not include how people fear for themselves. He says the intentions of everyone are good. Are they? (p. 95). Goodman was depressed. Most whitewashing moment in the book.

People just beneath this doctor in the best position to know (p. 96). Some brave enough to steer patient away.

But it’s brave and decent of Gawande to bring this up; to tell this story and how the man who started this effective clinic could not get monetary support. We should look to what someone does and not what they didn’t do altogether.

He names 4 types of abusive behavior, p 100: persistent poor anger control or abusive behavior; bizarre or erratic behavior (which people get away with when in high positions); transgression of proper professional boundaries (ditto — mostly having to do with sex); and the familiar marker or sign of a disproportionate number of lawsuits or complaints.

What we really are: 32 percent of general population has some serious mental disorder (1/3) be it depression, mania, panic, psychosis or addiction.

Gawande would like readers to stop being ready to view doctors as sociopaths; they are struggling human beings too. I wonder if we are able to look at ourselves.

Do you think people prefer a system of don’t ask, don’t tell? Well which people. Doctors may prefer it, but do patients? (P. 103) There are people who don’t want to know about their sickness, who don’t want to be asked to participate in the decision-making process for real. I don’t prefer don’t ask, don’t tell. But this is a character trait with me. I want to know. I feel stability and safety can only rely on truth. I may be wrong. In life I’ve seen where I have been.

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Part 2: Mystery

Essay 6: Full Moon Friday the Thirteenth (pp. 109-114): our intuitive thinking wrong

People see patterns and meanings where there is none; do a study and discover that our intuition is wrong. There is no connection, but as we experience the misery or trauma, we persist in remembering the previous time we experienced it and its details and trying to find some pattern.

Essay 7: The Pain Perplex (pp. 115-129): suffering because and out of things outside our control.

Have you ever had a pain and everyone said “it’s in your head”? Gawande is here to agree it’s in your head but that does not make it any the less real. Have you ever had a pain and no one could find an explanation for it and dismissed your pain? Gawande writes of the common condition of ” a patient who has chronic pain without physical findings to account for it.”

It’s common for doctors to dismiss them as cranks, not real, needing psychiatric care (“whinging”). Such people go to acupuncturist and alternative medicine.

Gawande is here to believe you and say there are some other scientifically medical people who will try to help you. The story of Rowland Scott Quinlan (pp. 115-118). Story not atypical but common.

Theoretically the problem is the mechanistic theory we adhere to about medicine. We have to find a physical agent to push something
before we will believe it’s been pushed. Gawande leaves out psychology: people don’t want to allow this; it’s inconvenient; they only want to take seriously what is physically there.

Underlying this story is an argument that psyche is as real and significant as soma, e.g., panic disorder. It’s real. But it gets no respect. It’s hard to get an etiology. Gawande is for resorting to drugs if they work — and also operations. After all, he’s a surgeon. Health is a complicated state. People aren’t faking it if misery in the job or marriage or wherever is giving them acute pain (P. 128).

Gate-control theory of pain has been replaced by a new theory which seems to be accurate: the brain is not a bell you pull with a string, and the idea of to stop the bell from reacting to the pull (that is find distractions and other things to make you ignore pain, though it’s true that people in certain professions and situations will ignore pain longer: ballet dancers and men who escaped with their lives from battle even with terrible maiming injuries.

Pain comes from the brain, and it doesn’t need a physical stimulus necessarily. This makes pain political because it demonstrates the source is social arrangements. If we want to eliminate the pain, we need to change the social arrangements.

Essay 8: A Queasy Feeling (pp. 130-145): the uses of nausea.

A woman friend has told me that there are people who “don’t believe” in this condition of a woman during pregnancy; they deny that near fatal vomiting can occur in some pregnancies.

Parents have an adversarial as well as supportive relationship with children. There is a conflict between the interests of the mother and child when it comes to childbirth. Nature does not care for the individual but species. Until 20th century childbirth was often fatal; it’s still dangerous. Explanation comes from evolution: pelvus we walk on is not quite big enough to accommodate large brain which developed a little later. We are claptrap machine. Horses have trouble too.

So here is a place where natural selection has developed erratically: some foods safe for adults are unsafe for embryos; pregnancy sickness may be evolved to reduce an embryo’s exposure to natural toxins. Common morning sickness does usually end by the end of the first trimester. It’s said that women who are pregnant naturally prefer bland foods; I can say that when I was pregnant the second time I stopped drinking wine – and other liquors. I couldn’t. They just made me sick. This unhappy state ended upon giving birth.

I don’t know that motion sickness is relevant here; he does not want to go into the adversarial nature of the symbiosis.

Story of how woman endured this killing pregnancy: she did have someone to care for her; she had money and health care; many women would not and many would not endure this. They’d have an abortion. It was advised but she said she was Catholic. The doctors also attached her to a device that made her hear a heartbeat much louder than it really was. I wonder if the nurse did that voluntarily or was it imposed on this woman (p 139)

Gawande goes into the phenomena of nausea and tries to explain why people dislike it so. Our understanding of this is primitive. Pharmaceutical companies make millions of dollars selling drugs. Best way to cope is start treating the condition when it’s mild. So habit comes in here

Larger interesting issue about suffering Do we do enough about suffering? The problem is when we see someone suffering we look at it as something to test and then look to see if there is a practical thing we can do. Instead of trying to cope with the suffering. Nausea is one condition where we are forced to deal with the suffering itself because people really dislike nausea.

Essay 9: “Crimson Tide” (pp. 146-161): the blush

This one interesting because physiology is clearly intertwined with someone’s character. They are not separate facets of existence which people might tend to think. Blushing useful. You signal you are embarrassed, you self-deprecate; you are kowtowing to group, confessing anxiety.

Essay 10: The Man who Couldn’t Stop Eating (pp. 162-183): eating disorders.

I. The story of Vincent Caselli and his Roux-en-Y gastric-bypass operation. This one too has evolutionary implications. All of the essays in this section do: be it the one about blushing or how we impose patterns on things (which we are skipping) we have evolved in reaction. So our bodies work hard to keep our calories going safely in our bodies.

Story of Caselli includes much detail which tells you he is working class: the way it’s done makes me a wee bit uncomfortable: it’s stigmatizing. Both he and wife good at business: he construction, she assisted-living. He ate a lot, big portions and everything on his plate. We eat out of habit too: it’s time so we eat.

So history of weight-loss one of unremitting failure (pp. 169-70). We are built to survive starvation, not deal with abundance. If you diet, your metabolism goes slower to compensate. So it can be a terrible battle to lose weight.

People who have this operation seems mostly to chose not to overeat anymore, to eat less. Though not all. Alas Vincent is eating less because he is forced to, not because of operation. He is not a thoughtful fellow and it may be it’s hard to sink in that this operation has endangered him so that if he overeats he’s at risk. Gets rid of diabetes.

I’m glad to see this emphasis on weight problems through this operation: most of the time you get stories about anorexic women which show little sympathy and less understanding (p. 182): “how can you let yourself look like that?” (see “Girls Want out” by Hilary Mantel, at London Review of Books)

I’m glad to see that Gawande expresses concern at merely plump people opting for this serious operation.

Very recently a study was published which showed our awareness that we are overweight can be attributed to strong advertising on the part of the weight-losing industry. The claim is that some of this distaste for the least fat on women in commercials and films is a product of advertising. Some of the “worry” about obese children in particular may be a construct of advertising campaigns.

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Part 3: Uncertainty

Essay 11: Final Cut (pp. 187-202): the need for autopsies to continue.

An intelligent argument on behalf of autopsy. He thinks its decline is due to doctor hubris — not money or distaste of families of dead patients who give in if pressured. He says that people have always protested autopsy so that it’s unlikely that a new religious motive is coming in here.

How do others feel about autopsy? Why is it in decline? You don’t have to be religious to be emotionally attached to the corpse of the person. Perhaps also a distrust and dislike of hospitals and doctors. Don’t want the body cut up. Final cut.

Gawande shows long history of medicine demonstrates the importance of autopsy in learning about the human body. A corpse can be treated more aggressively. He felt he didn’t need to do autopsies until he discovered a bad mistake.

A long history of misdiagnosis continues (pp. 197ff): 40% in 1998 and not getting better. Why? the nature of fallibility. The tests shows accurate results, but the physician doesn’t call for the right test. People are somewhere between being like hurricanes and ice cubes. Remarkable that he thinks he can come up with what’s wrong with Charlotte Duveen.

Essay 13: Whose Body Is It, Anyway (pp. 208-27) autonomy and having to choose

This essay revolves around the question of asking the patient for their input? Gawande seems to think our communities have begun asking too much of patients to hand them the responsibility?

This is a complete switch-around from earlier practice: much hidden and patient not consulted; treated like a child or someone of a lower class. Gawande says the current medical orthodoxy says let the patient decide.

Is that your experience? Mine is the mildly dominating doctor with a pretense of consulting me.

Case of man who chooses badly (Lazarus, symbolic name) because he can’t face that they don’t have life to offer him but continued near death and misery and yet more misery to sustain that (p 215)

Gawande makes a strong case that patients are themselves emotional, confused, don’t know enough, can’t hear: exhausted, irritable, shattered or despondent (p 222). Gawande preferred to have decision made for him; Dr K saved the life of the man who didn’t want “another machine.”

What is really needed is kindness. That’s the real task (p. 222). Autonomy is but one value among others, but it is an important one. He’s not saying don’t get a second opinion, don’t ask questions, but that ethicists have gone overboard. But Gawande too strong on the side of the doctor deciding. Just about all his stories have patients succumbing to doctors and ending up better off. As usual, he forgets corrupt, indifferent, and bad-choosing doctors.

To sum up: There’s a direct conflict of interest between the pregnant female and the fetus in the sense that childbirth endangers her life and her body; there is the problem that people cannot always hear the truth about anything and make bad decisions, a result of naivety, misinformation and inability to take in the hard reality.

I suggest the man who chose the horrific operation because he couldn’t accept there was nothing doctors could do for him and the woman who had naive ideas about childbirth (knew nothing of history) may be taken as conflicts of interest. We don’t treat suffering itself; we go after what we think we are supposed to care so much about yet do we care about it?

Essay 14: The Case of the Red Leg (pp. 228-52).

Gawande falls into sensational mode: here are these heroic doctors cutting cutting cutting to save. Here we see how Gawande falls into technical virtuosity. Is Gawande too much into this do you think?

Our films, Wit and The doctor stress the need for humanity. Jason a technique freak; so too Kelekian; alas so too was Vivian Bearing when she taught poetry. All avoiding the human. The human is so painful and so uncertain. Wit is about the human condition seen through the prism of illness: how hard to make contact with one another.

For Gawande’s later essays, see comments: Bell Curve; The Score; The Way We Age Now.

Atul Gawande recently withd Jack Cochran, a high official at Kaiser Permanente

Ellen

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Books in art and science (Sharp 4): Fairy books; Medical books, outsiders, & handbooks as territorial struggles; Keepsakes, Alice in Wonderland and Pitman sten

The Blue Fairy Book, compiled (and written by) Andrew Lang

Alice in Wonderland — in translation

Dear friends and readers,

I am come to the fourth and last blog on this conference. Today topics included the fantastical and imaginative (fairy books and math and Alice in Wonderland), just its seeming opposite, medical memoirs, and large handbooks whose entries and publication are fought over tirelessly because such huge amounts of money can be made by a few if the organizations can keep preventing universal non-profit medicine from going into effect. In effect the social targets for fantastical and fairy books brought before the listener how it was supposed children and their middle class parents were interacting with books, while medical books and the institutions which ignored, published or supported them showed us how an interested profession used books to fight over their territory and promote themselves, their science agenda, their careers.

A Sunday story. There was hardly any traffic on the way in, at noon the park outside the Dillon center was filled with people doing all sorts of things and the carousel nearby crowded with children.

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“The Bronze Ring” from The Blue Fairy Book

Sunday morning I might be said to have fitted in two sessions each period since in both cases, I left 2/3s the way through one session and arrived at the second session where there was still 2/3s to go. In both cases the questions were good enough to elicit re-explanations of the papers. So I heard twice as much.

At 9:00 I went to “Utopia, Fantasy and Prophecy,” and heard a paper by Jennifer Gundry on how print culture (books, thoughtful high-minded doings) were regarded with suspicion and distrust in a selection of Utopias. The critics and reviewers (rightly) assault advertising, find slipping literary standards at each new technology or innovation; they indict the low quality of the new productions. Print has failed 19th and 20th century society. It would seem the only printed object valued is money. Sara Hines described the unexpected huge success of Andrew Lang’s series of “colored” fairy books; here there is a stronger nostalgic pull. With the success of the Blue Fairy book, Lang went on to compile (and write) the nostalgic notes. Critical writing and studies of folklore and fairy tales enables us today to understand him. (Probably translation studies ought to be brought in). Green came next, then a rainbow, then violet. Lang were first intended for the Christmas market; eventually they functioned as a poet manque for family rituals, gathering and creating time together.

I hurried out to a session on scientific and medical publishing. Sounds boring? Think again: Darwin is a central tract; so too Humboldt. I spend 1/3 of my course reading serious books on how medicine is practiced today. Jim Conor’s paper on “The Editing and Publishing History of Rural and Medical Care (1948) was of direct relevance to the essays I read with my students. This was not a how to book: name a condition and then offer treatments. Rather it is a book which describe and defines disease and has essays on aspects of the profession and its author was strongly for socialized medicine. Mr Conor told a story of a man who had continually to fight to get his book published, then respected, then distributed. Eventually it became enormously influential in Canada, in US minus the politics which (if I understood him correctly) were cut out. Jennifer Conor’s paper on a specific medical memoir by Gordon Murray enabled me to see how the medical establishment viewed the kind of scientific medical memoirs I’ve been assigning students for years. With respect. The specific one she discussed had problems that were never resolved, especially balancing autobiography and telling an appealing story with explaining technical cases in difficult language.

The interest of the Health Guide is how it became a lightning rod for political issues. The AMA and other powerful physician organizations were vigilant against anything smacking of socialism, and defining illness in ways that insurance companies want to control was seen as strongly socialist behavior. The AMA fought to suppress the book. Now its definitions are used by our local day coffee bar place. As to memoirs, they can teach ethical norms, and do well when they are beautifully written, like Atul Gawande’s Complications), and can reach a large layman audience. Jennifer Conor said a president of a respected college had had to resign recently because it was discovered he plagiarised his goodbye speech from Gawande’s Complications. The students had read Gawande and recognized the passage by checking the texts on their computers.

I got myself a coffee and then went to the mid-morning sessions. Marie-Claude Felton’s paper was “‘Je ne suis pas fou’: The Self-publishing journey of poorly-estimated scholars in the 19th century was a general history of statistics; she showed far more scientists managed to spread their work by self-publishing than is realized. Johanna Lilja told of an “indefatigible botanist” who persisted in the face of neglect, ridicule and misery; institutional norms destroyed him personally though much later in life he was done justice to. The paper was very sympathetic towards the institution and its problems and showed how it learned from this experience to cope with non-conformity. Susan Pickford began her paper by telling of what she called with any specific definition or defense “insane” scientists; she was going to talk about “outsider literature,” but I felt the use of such a blanket derogatory term (“insane”) unacceptable (like the use of “idiot” in Victorian literature for mentally disabled people) in scientific, medical (or humane) senses so quickly left.

I found I had just time to listen to two papers and heard a third discussed afterward from another session, “Play and Politics.” Manuela Mouraco and Margaret Stetz argued the children’s books he described were made with parents’ ideas and desires in mind; they taught children to fit in; encouraged certain kinds of socialization and interest in subjects that are career-worthy. Mouraco and Adam Trammell agreed the Keepsake and other annuals were intended to build an identity for the people buying them; they are books with a strong middle class bias and show nostalgia for the past.

In this session and an earlier one on librarians helping children to form reading groups in libraries, the idea was endorsed in the discussion time afterward that in a classroom socialization is as or more important than the topic taught. So that if math is being taught, the children should be made to do it in group settings. This reminded me of how the whole conference seems to value how books function socially for people, what intellectual stance they enable people to feel they belong to (or do). But what about the child who learns best alone and would learn far more about the topic if left to do so alone. He or she will be straitjacketed into first enacting a set of general social skills or be made to feel bad if he or she can’t (and perhaps graded on social capability rather thabn math). This set of values makes learning very hard for the disabled (e.g., autistic children). And it’s not just the autistic that such tactics in a classroom would stmy but many non-outward people. We do have inward growth as we learn academic subjects sheerly for themselves.

For lunch I sat with Elizabeth Starr on a bench in a lovely shaded area and we shared a sandwich, memories and goals. We hope to keep contact up. She has a student working on a biography of Jane Austen for younger readers and perhaps I could help.

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The Mad Hatter’s Tea Party, illustration by John Tenniel

The last session I attended was unexpected fun for me. It was on translating Carroll’s Alice in Wonderland. Clare and August Imholtz, a married couple of independent scholars and book collectors gave papers on different translations of Alice. Clare went over many kinds across the globe, and August concentrated on those just in Russian. Statistics of how many translations and where are impressive. Of course translation is bad at puns, and some of the word play and games that provide the experience we have of the text. They named particularly good ones (a Spanish one); August took us into the realms and suppositions of a Russian child.

Catherine Parisian then got up to tell us the history of Alice in Wonderland translated into Gregg and Pitman. How many Pitman’s, how many Gregg’s. It seems this was a way of teaching girls to read and to use phonetics. She knew I was in the audience and could read Pitman stenography and I did come up to the front to declare this text was Pitman and did not use vowels or the three line approach and the other was written precisely following the conventions. Stenography by hand is associated with women working in offices and we find it spread as soon as jobs were created: 1872 in the UK it’s said 6 women knew Pitman, in 1893 6000. Gregg grew exponentially from 1901 -1915. Alice was published in 4 systems: Callenders (1899, the 7th, Mad Tea Party chapter), Pitman (1908 and 1909), Gregg (1915) and Pitman again (1979, Chapter 7).

We discussed stenography as well as why the Alice books appeal so. We also discussed the real gender faultline in the uses of hand stenography in the first 3/4s of the 20th century. I offered my memory that in my high school class in 1963 there were not boys learning shorthand, though you could find boys learning to type. Only girls learnt sten so there was a strong taboo of shame involved. But when machine stenography spread and began to be used by court reporters, men went in for the training in great numbers in post-secondary school.

I was charmed with the notion that stenography had been taught this way. In Richmond Hill High School where I was first taught Pitman stenography I was never encouraged to respect it as a system. I did that later when I studied languages in college. I should say here that all the blogs I’ve written since I started going to conferences and blogging are the result of my use of stenography. While recently I can no longer cover pages of my sten pages in pure Pitman, and must use English spelling and abbreviated words, when I am really trying to get down specific wording there’s nothing comes near using Pitman sten.

A table of short forms within Pitman

It’s a 19th century invention.

There was again much more to the conference in the later afternoon. A Plenary panel, a general meeting, and finally an African American Literary Walking Tour, with Toast. I could not do any of it. This was the last night of the Capital Fringe Festival: we had tickets for La Belle Parricide, a play by a community of women on Beatrice Cenci so my conference ended on Alice in Pitman. Many people appeared to be leaving around the same time.

As I came out of the building, the sun seemed so bright and the air very hot. I threaded into the quiet justle of people going down the escalator. The trains to and from into Alexandria were running on just one track (not two) so there seemed to be a mass of people waiting to get on as they were thus running slowly (taking turns). I got home in plenty of time.

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This is the first conference I’ve written about in this extensive way in quite a while. I had heard a diverse number of excellent papers which took positions which did teach about how books can be or are made to function socially. Countless individuals have largely idiosyncratic or personal responses to books that these large social perspectives ignore or sweep by and these are important for the individuals and for their communities too — making for finer disinterested ideals from the sympathetic imagination which can cross all borders. Yet people do choose a book because they are part of a particular sophisticated or political world, and read as part of that (often class-based) world. About this group of people at the conference, I came away feeling the generality might have at one time really loved books for themselves (as on some level I still do a fine, beautiful or wise and good and great book), for their texts (ditto), and that’s why they cared about books materially and how they function as social instruments, commodities and social capital.

See Sharp 1, Sharp 2, and Sharp 3.

Ellen

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Harm spreading across the globe: privatizing medical knowledge

Wit (directed by Mike Nichols, screenplay by Emma Thompson based on Margaret Edson’s play): Jason, the resident (Jonathan Woodward) has disregarded Miss Bearing (Emma Thompson), the patient’s request to be DNR on the grounds “she’s research!” Suzie, her nurse (Audra McDonald), is protecting the space around Miss Bearing.

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine” (Marcia Angell, “Drug Companies & Doctors: A story of corruption”, NYRB, Jan 15, 2009)

The “commercialization of science” in universities, gov’t agencies and organizations has led to “research supported by for-profit entities [that] will yield results consistent with the financial interests of those entities … “the push to commercialize the university”, “a planned coordinated effort” “had been one of the biggest Ponzi schemes this side of Bernie Madoff and Allen Standford” (Sheldon Krimsky, reviewing Philp Morowski’s Science-Mart: Privatizing American Science in The American Scientist, 99 (2011):330-32).

The Doctor (directed by Randa Haines, screenplay Robert Caswell from Ed Rosenbaum’s memoir, A Taste of My Own Medicine): Jack McKee (William Hurt) is comforted by his wife, Ann (Christine Lahti) after Jack suffered an enforced barium enema, administered by mistake (indifference and carelessness led to it, and there’s hardly any apology at all).

First, do no harm. Cure seldom, relieve often, comfort always.

Dear friends and readers,

Among Helen Epstein’s many important essays published in the New York Review of Books is “Flu Warning: Beware the Drug Companies” where she carefully shows how various drug companies, the doctors and researchers they pay, and distributors and advertisers they use so skewed research in the area of flu vaccine that it is not possible to get past the conflicts of interest, unacknowledged biased behavior and results to see that the strongly probabilities of flu epidemics and need for flu vaccine was partly manufactured by the drug companies. Epstein concludes:

Six years ago, John Ioannidis, a professor of epidemiology at the University of Ioannina School of Medicine in Greece, found that nearly half of published articles in scientific journals contained findings that were false, in the sense that independent researchers couldn’t replicate them. The problem is particularly widespread in medical research, where peer-reviewed articles in medical journals can be crucial in influencing multimillion- and sometimes multibillion-dollar spending decisions. It would be surprising if conflicts of interest did not sometimes compromise editorial neutrality, and in the case of medical research, the sources of bias are obvious.

The pervasiveness of overt and covert corruption in the medical establishment is hard for ordinary citizens to credit. They are surrounded by such expert propaganda ceaselessly poured out on TV, in movies, and in creditable print. It is nonetheless true. It not only is destroying scientific knowledge in the US; it constitutes a present danger to consumers who may be led to take drugs whic do not help them, might and do do them harm and cost them hugely.

No where is this more common than in the area of mental health where the terrain for diagnosis is partly subjective and where social problems and distresses in our competitive brutal environments in schools, universities and the job market lead to people desperately seeking solutions for success where it is so hard to achieve. One way they relieve their mental troubles and try to help their children in the newly relentless networking environment is to medicalize the problem. Insurance companies collude by offering money if the condition identified can be found described in the Diagnostic and Statistical Manual of Mental Disorders, which has become, an Angell and others have shown,

“the product of a complex of academic politics, personal ambition, ideology, and, perhaps most important, the influence of the pharmaceutical industry.”

Two recent articles by her in the NYRB dwell just on the area of mental health. The arguments in “The Epidemic of Mental Illness” (NYRB, June 23, 2011) and “The Illusions of Psychiatry” (NYRB, July 14, 2011), are fundamentally accurate, though the second article has a significant flaw in its lack of compassion for the real increase in mental illnesses across the board in patient-consumers today, its failure to acknowledge that increase in diagnosis has led to progressive empathy and understanding of mental and social stresses and help for people, as well as its repetition of ill-informed gossip which (very like Reagan on mythical Welfare queens) exaggerate the amount of help mentally disabled people get (for adults hardly anything at all). Still, she is fundamentally correct: she shows the harm that the substitution and erasure of the talk cure in favor of handing out drugs is ill-advised, a move that makes profit for the drug companies and saves doctors and the medical establishment money and having to help people for real.

So, flawed as is part of Angell’s second article, all else she writes in both articles is frighteningly sound, and, as Sheldon Krimsky shows, the direct result of commercialization of science everywhere in the US so that universities are directly dependent on private companies for funds for basic research.

About the serious issue of what causes depression and mental illness, Angell is concerned to show the fundamental flaws in the argument that a lack of certain chemical causes depression. She tried to show (or said the books under review showed) that we cannot prove these prescription drugs sold at high prices do what they are said to do. In the first case she showed the tautology of the thinking: the drug companies are in effect saying we have discovered that aspirin gets rid of headache; there is no aspirin in people’s bodies, hence it must be a lack of aspirin in the body itself that is causing the headache. So we will go out and invent new and improved versions of aspirin for you to shoot yourself up with. The side effects of these new and improved drugs are dangerous, not well-understood. She shows that in both that the research conducted by these companies is so shot through with techniques designed to prove the drugs are needed, good for people, you can’t believe what is published. The placebo tests are flawed and when they don’t produce the results wanted phony (by suppression of evidence).

She didn’t deny that the drugs calm people, children too and relieves symptoms of depression, anxiety, rage; she is aware that these results are partly why the drugs are taken by millions of people. She said we don’t know what the result of taking these drugs for decades will one for many; one result for some is addiction; for others high weight gain (bad for you). I can understand how someone who has used these drugs and feels they have helped him to survive would be taken by the pragmatic arguments that they help control one’s symptoms. I take 2 240 milligram tablets of surfak (docusate calcium) every day, and have been doing this for 30 years. I’d be desperate if they were taken away. They are needed stool softeners for me, I trust they have no bad side effects and think they do help me for my bad constipation.

Her review is just a review nothing more. She doesn’t go into what she thinks of the “talking cure” beyond suggesting such session are useful and that the dropping of them is wrong because they are another important way of helping people. I don’t think she is interested in this issue in itself nor just the medicine invented for mental troubles and illness but as these are aspects, symptoms, instances of what the article you pointed to is true: the total corruption of the drug and medical establishment in the US. It’s that she is endlessly writing about, trying to expose. The whole enterprise is filled with rottenness. She wants sweeping and fundamental changes in the FDA, the NIH (watch dogs and research institutes), the way medicine is delivered, and strong controls on the way these companies do business.

The primitive personal or honest question is, Do I agree or think that my own depression, anxiety, troubles are chemical or physiological as well as psychological. Yes. Is this because something is wrong with me or it’s in my nature to be melancholy, my physiology. Both are different ways of saying the same thing. Some people have a tendency to be cheerful, aggressive; others the opposite, and these natures we are born with are exacerbated or countered by what happened to us as we grew up and later in school and life. So I had two parents who were very ill suited and on some level hated one another. My mother should not have had any children as she is cold, indifferent, selfish, obtuse — of course the world is filled with people like this who have children. My father was made miserable about his job, his life, a frustrated thwarted man who never developed intellectually as he could have. He turned to me and should not have. Both of them were (Larkin’s phrase) fucked up and they fucked me up too.

But if I agree that it’s partly physiological, chemical, that does not mean that these drugs these companies sell are based on a reasonably logical theory which can then be used to prove their efficacy. Far from it.

Titicut Follies (Frederick Wiseman, 1965)

On Angell’s article Part 2: yes, the more I have been thinking about it the more at long last (after a number of important wholly sound articles), she does show her privileged life. The article had a glaring heartlessness. She took gossip about SSI and wrote about how Aspergers people are getting sums of money equivalent to welfare (as if that had been a loadstone). She did not take into account that while the Manual might reify diseases (make diseases exist by definition) and be a political document, that does not mean that mental trouble/illness is not widespread in the society. Atul Gawande’s Complications quoted and substantiates 33% or more of Americans have major depressive episodes over the course of their lives. In his book he shows that pain, both physical and psychological, is a social problem of real seriousness, one that needs to be addressed medically, by talk cures, and by government and social reforms of our daily lives and the norms we live by. That’s the implication of his “The Pain Perplex.”

So, that while it’s true the drug companies have faulty logic (=you get depressed because you don’t have X [say aspirin]in your system when they find giving X makes you cheerful so that means aspirin is what your system lacks); and it is true that their tests for drugs are corrupt (dismissive of evidence that shows they don’t work or do harm); nevertheless, that does not mean many many US people are not in trouble and need help. They do. This is insufficiently recognized in her part 2. Especially bad is the implication that Aspergers people are living high off gov’t money. She is so absorbed in the corruption here and now she forgets there has been progress.

On this a friend wrote me as follows:

“I was thinking of the Angell articles when I was watching The Kennedys the other night (it has only just arrived here) – I had not realised that the horrific Joe had one of his daughters lobotomized – I had to leave the room when it showed the effects; as I commented before however ineffective or indeed misdirected medicalization may be when one considers that 50 years ago this barbaric practice (mainly on women as far as I can see) was still a medical commonplace there has been progress. The historical perspective – institutionalizsation, lobotomy, ECT – must be kept in mind. Certainly things are still a long way off good but at least I have never been in danger of having a chunk of my brain cut out.”

Having acknowledged this, I want to provide a short review of Angell’s other articles so that this flaw will be seen in the larger perspective. In “Body Hunters” (NYRB, 51:12, October 6, 2005), a review of Fernando Mereilles’s film adaptation of John Le Carre’s The Constant Gardener, she demonstrated that although the murder of Tessa Quayle and Arnold Bluhm is improbable, much else that we find in the book is not just probable, but everyday business in testing drugs for phamaceuticals.

For example (the incident which lies behind the film), in 1996 Pfizer, the American pharmaceutical giant, opened a clinic in Kano, Nigeria, during a meningitis outbreak in order to test the drug Trovan, which had yet to be approved for use on children. There is no Tessa Quayle in this story, but there are doctors from the humanitarian group Medecins sans frontieres. There were no formal ethics-approval protocols in place for the tests, nor were the patients properly advised that they were participating in an experiment, nor was proper long-term follow-up implemented. Consequently, of 200 children treated, eleven died, while others suffered serious meningitis-related symptoms, such as deafness, lameness, blindness, seizures, and disorientation. Patients deteriorating on Trovan were not taken off it and given another antibiotic. Children given higher doses of deftriaxone to make the contrast look better yet it made for more pain. While I was at a Wagner conference, a man who used to be the Ambassador to Kenya was there, and he saw me with this novel (endlessly rereading you see), and confirmed that testing is done as a prerequisite for other care and the people don’t know what they are taking.

Further,

In 1997, Trovan was approved by the FDA to treat certain infections, but not for children and not for epidemic meningitis. The FDA found dozens of discrepancies in the documents from Nigeria. Trovan quickly became a highly profitable antibiotic widely used against a variety of infections. However, after less than two years on the market, there were over a hundred reports that the drug produced liver toxicity, causing several deaths. It is no longer sold.

The Constant Gardener (based on LeCarre’s book, directed by Fernando Mereilles, produced by Simon Channing-Williams, screenplay Jeffrey Caine): Justin Quayle (Ralph Fiennes) tries to decipher Tessa’s computer files (see Todd Hoffman, “The Constant Writer: LeCarre Spies a New Villain”, Queen’s Quarterly, Spring 2001)

A second incident:

Thousands of HIV infected women were given a placebo while another group given a course of AZT very strong dosage for shorter time. They should have compared women being given drug as normal and at a usual rate; instead they consigned babies to HIV/AIDS and women to quicker death. The argument made was just that of LeCarre’s villain: the women in a pregnancy test would have died anyway. A Pfizer doctor contests this view, and argues that the mortality rate in his clinic was as low as, or lower than, at the MSF clinic. But this falls to respond to the ethical question of giving children an untested drug and the choices made about how to treat individuals once they are on it. The Pfizer attitude resembles that of Sandy Woodrow regarding Dypraxa, “We’re not killing people who wouldn’t otherwise die. I mean, Christ, look at the death rate in this place. Not that anybody’s counting”

Near Death (Frederick Wiseman, 1989): What Wiseman does is find the people with power in an institution and he films them for hours: here we listen to a chief of staff discussing what to do about certain patients with other medical personnel

Most of the time the trials run in these 3rd world countries are for diseases that afflict wealthy societies (arthritis, obesity, cholesterol, cancer). Research should not be done in the third world unless it concerns diseases that are virtually confined to those regions. And regulations governing research in poor countries should be every bit as stringent—and enforced just as vigilantly as in well-to-do countries. There is no justification for the present situation in which the standards are looser precisely where human subjects are most vulnerable.

Generally, there’s no question that the US and other rich countries have been conducting more and more clinical research in Africa and other parts of the third world. Although exact figures are hard to come by, it is likely that tens of thousands of studies sponsored by first-world drug companies and governments are now underway in Africa, parts of Latin America and Asia, and the former Soviet Union. Most of this research is intended to find new treatments for use in well-to-do countries. Standards are low or non existent.

These companies, called contract research organizations, or CROs, hire local doctors to find people who will take part in clinical trials, and while the payments to the doctors per patient are lower than in first-world studies, by local standards they are munificent. Doctors can multiply their income tenfold or more.

Patients, too, are readily enticed by small amounts of money and promises of free care. In fact, as in LeCarré’s story, enrolling in a trial may be the only way they can get any care at all.

Hospital (Frederick Wiseman, 1970): Wiseman also seeks out unusually candid and articulate people and films them

Finally, in “Your Dangerous Drugstore” (NYRB, 51:10, June 8, 2005), Angell makes visible the corruption found along the entire system of developing, testing and using prescription drugs. She goes over trials and shows all the problems were known and shoved under rug. Clinical trials are dropped or argued against while money spent on advertising.

The FDA has on its boards people who were or are in the pay of drug companies or affiliates. They get to decide what comes to market. At best you get a mild warning on packet.

Startlingly obviously bad is the “user fee:” the part of the FDA doing evaluating gets its funding from drug companies who they are evaluating!

Taking people’s testimonials is highly problematical. People want to believe they are different and in their case this is helping. All long for magic miracle drug.

Angell does suggest that the US public said to be growing sceptical of drug companies’ claimed disinterest: we see escalating prices; we see government bills intended to stop agencies acting for us from negotiating lower prices; we see that most research for new drugs done in university and government labs. That companies often go for “me-too” drugs.

The value of Epstein’s article is she uses a case where people are inclined to believe drug companies because flu can be a killer and vaccination can prevent illness and death. She shows how difficult it is to catch these people are their lies, pretenses, skewing of evidence.

Finally, Krimsky’s review (unfortunately, not online) shows that the very structuring of American medicine since the 1980s by neo-liberal voodoo economics has created this dire situation. How to stop it? Nothing short of universities monitoring its professors and laboratory technicians’ research for real, and firing anyone who is found to falsify results, take personal bribes, or allow his or her name to appear on research he or she did not do. In an atmosphere where all that is cared about is getting grants from companies for funding this is not about to happen tomorrow. A wholescale cleaning out of these be-shitted stables is called for.

A man in a wheelchair, left in the corridor of Metropolitan Hospital (Frederick Wiseman’s Hospital):

I can confirm the accuracy of Wiseman’s portrait. In 1989 I spent a week in Metropolitan Hospital (the place he filmed for Hospital) after I was in an automobile accident. It was like a crowded bus station everywhere. When I came in I had a fractured knee with no cast or anything on it for hours. There was that weekend one man in the whole hospital doing x-rays. Jim, my husband, promptly called him “The bottleneck.” He was not gentle doing x-rays; he was in a hurry you see.

Ellen

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Winston Graham’s v Alfred Hitchcock’s Marnie

Marnie (Tippi Hedren) all distress and the caring tender Mark (Sean Connery) from Hitchcock’s 1960s Marnie)

Dear friends and readers,

I’ve not given up on Winston Graham because his 8th Poldark novel, The Stranger from the Sea, revealed a precipitious falling off. A series of 7 remarkable historical novels set in the 18th century is not to be dismissed. What I’m doing is reading a few more novels by him which are not historical novels, reading good books on historical novels (among them Jerome de Groot’s The Historical Novel) and trying a couple of historical novels set in the 18th century by other people: one I’ve begun which I’m thus far enjoying is Emma Donoghue’s Life Mask. Donoghue’s is the first type in Graham’s typology: most of the characters really did once live and she is in effect doing history imaginatively.

Marnie (Tippie Hedren) stealing thousands from firm’s safe

The burden of the song: Like Graham’s other novels this one delves unusually into sexual unhappiness in marriage (including another rape); Hitchcock turned it silly Freudianism. It might be said that Hitchcock’s movie is an absurd travesty of Graham’s novel, but I’m not sure Graham’s novel is itself really sheds any humane light on sexual and psychological distress — especially in his attitude towards Marnie’s mother. He does calls attention to “the rough deal women have” (his words). That’s a start.

One source for his book was an incident of infanticide that from my reading I know is not uncommon:

while he lived in Cornwall during war a mother with 3 young children came to live there as an evacuee. Graham presents her as simply promiscuous; she’d let men in her bedroom and throw her children out while a man was there. She got pregnant and, fearing ostracism, exile, loss of her own children, she hid the pregnancy and when she gave birth, strangled her newborn in a newspaper.
A neighbor had assisted in the labor, and unfortunately this woman began to hemmorrhage so the dead baby was found. She was acquitted on grounds of insanity. As we shall see, this is a version of what happened to Marnie’s mother.

I’m beginning to think that Wayne Booth’s Rhetoric of Fiction condemned more than hard-boiled detective stories with women-hating males at the center, more than the deluded use of irony which allows so many books to have evil narrators at the center, more than the hardening of readers such reading encourages: he was pointing out how a whole slew of modern books may be regarded as documents showing the sicknesses of our society. Graham’s book by substituting a woman for the central figure and not asking us to read the book ironically does this in spades.

A second core of Graham’s novel was a real young woman he once came across: It’s based on a young girl who was hired to take care of young children as a nanny. Gradually it emerges she was psychologically disturbed. She would take baths three times a day, and had an inordinate love of horses, loved to ride, and hated men. He says he read a letter she wrote to her mother showing this. He then says she was let go and he heard later on committed suicide.

Oddly the moral lesson he draws is be careful who you hire to take care of your children, with the implication you should do it yourself – meaning women should. Nothing about the woman or her suicide. Nothing to ask himself where such a hatred could come from. Nor in the original (as far as he tells us) was the problem the girl was liar or stole things. Nothing of her behavior beyond the above is told. What he did was account for the babysitter’s behavior by making into into one of the children whose mother had gotten pregnant, killed the infant and was imprisoned. What Hitchcock did was substitute the story of the woman who let men into her room and shoved the children out as an explanation for Marnie.

This topic is of interest because the movie at least continues to be famous and no one discusses the book which does have a marital rape (if not at the center at any rate there) nor the portrait of a mother. It is counterproductive feminism because there’s no understanding of the causes of a girl’s psychological distress. When you’ve read this one and go back to Graham’s historical novels you see them differently: why he chose to set his novels in the 18th century is perhaps that 18th century novels do examine sexuality centrally

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Marnie centers on a supposedly helplessly sociopath liar and thief who is a woman. In both film and book here is the central character and conceit (so to speak): this the story of a young woman who when we meet her is busy changing her identity, looks, serial numbers (identity cards), clothes & hair color too. She is stashing away a huge amount of cash she has stolen. She then visits her mother with a story about Mr Pemberton who is her husband which the mother doesn’t investigate. She is supporting this mother. In the book we learn little of the mother until the back story emerges. In the movie the mother (called Bernice and played by Louise Latham) is presented as a neurotic bigot who teases Marnie by preferring another small child and clearly dominates her. Marnie though does not depend on her mother or live with her; she leaves (escapes) after the visit and gets another job. Apparently this is what she does: get a job, steal a huge amount of cash, flees, change her identity, gives most of the money to her mother to support her, and and gets another job — all the while lying to her mother by pretending she’s married and her husband just does not want to visit.

This is what is presented in both movie and book.

It could thus be a misogynistic book, but I really think it’s another of Graham’s curious works of instinctive feminism. I didn’t read it that carefully because I grow very impatient with hard-boiled detective fiction — I’ve hardly tried any or gotten through any — but I know from those I’ve opened and Wayne Booth’s Rhetoric of Fiction (justly famous) these often have these cruel misogynistic males at the center, Mickey Spillane and irony is a cover (as in Lolita) for offering up delectable exercises in raping, torturing, murdering, bad-mouthing women. Most of the time they are mindless: the protagonist’s name is put in agreement with verbs. The real impulse behind Booth’s famous book is his detestation of this popular form. Booth shows that the ironies supposedly used here are a cover-up to allow male readership (and female perhaps) to read cruel trash and tell themselves what they are reading is really reprehended by the author and themselves. The Rhetoric of Fiction was written during the 1950s when this kind of fiction had had a supreme embodiment in the hypocritical Lolita where Nabokov has it both ways: he gets to masturbate in front of the reader and flatters himself and the reader they really detest what they are doing in the person of Humbert Humbert and anyone Lolita is a total tramp and deserves to be used, exploited, her mother killed &c&c.

In Graham’s book at first Marnie seems as hard and mindless as the usual detective story, but as we progress we find that although she never does give us subtle psychological meditations (only Le Carre and tremendously successful writers in this vogue dare that and not too often), by the end we have a fascinating portrait of a woman twisted by her society.

It includes a motif I’ve come to expect of Graham: the marital rape. As in the Poldark novels, the rape itself is not described in any details, only enough suggested to feel a terrible violation of Marnie.

Marnie is told in the first person and as an incessant stream of conciousness that gradually widens out. I found it a kind of page-turner at times, and then again was bored by being asked to keep track of minutiae of facts (endemic to this type). I also find the conventions of hard-boiled not-telling inner truths directly or keeping the mind of the central figure semi-blank or not understanding herself irritating.

In the original book Mark is a businessman, not (as in the movie) upper class. Graham’s Mark is high in the last firm in the book Marnie tries to fleece. He falls in love with Marnie because she is beautiful and strange and he does sleuth successfully to discover her previous position and catches her at a new theft and attempt at a new appearance. He demands she marry him and then he’ll protect her. He discovers she seems terrified of sex, won’t let him near her, and he rapes her that first ight. After that unlike Sean Connery he is does not attack her again. There is another male in the company, one Terry, who is also attracted to her and she to him, a much less moral man. Mark brings Marnie back to the firm after himself replacing the money. Then he says he has married her so naturally she will not work anymore but stay home. He says they have an invitation to Mark’s house to gamble and he does not want to go. Marnie does so she concocts a story about a girlfriend which Mark appears to believe and then Marnie goes to gamble each Saturday night — lying to Mark about it.

Alas, it’s somewhat justified for the man, Mark, is not just married to her and wants to help her and by the end she returns to him and begins what might be a decent life — we can’t tell. He has (I rush to say) not done that again, not forced himself on her again.

One of the fallacies of the book is how she gets away with lying. It’s just improbable. Now in the book gradually Marnie comes to like, trust Mark and when she is found out further (an old employer comes to a party) and Mark finds out a great deal and wants to go to the police, she decides to flee again. This time though guilt assails her, she puts the money back, and visits her mother, stalling for time. She arrive to find her mother dead, and her uncle and an aunt who brought her up there. She goes into the mothers papers and discovers the book’s back story. Graham’s novel is a gothic.

It is structured like a gothic for at long last we get to a back story, and what is it, but of Marnie’s mother — whom Marnie has been lying about and protecting and stealing for for years. Turns out Marnie’s mother murdered a baby son she gave birth to. A while back I reviewed two books which made a strong impression on me: the first, McDonagh, Child Murder and British Culture, demonstrated that infanticide is 1) omnipresent in many books; and 2) central to social stability throughout history (killing unwanted infants) and 3) most of the time suspected in such books and in the real world of societies too the woman is suspected and is blamed for killing the baby when most of the time she didn’t do it (shades of false accusations of rape) but either the child died in a miscarriage, was still born, from the horrors of childbirth before the 20th century; or she is often driven to it because she has gotten pregnant out of wedlock and will be shamed, ostracized, her life ruined in the community.

The third is the case here: Marnie’s mother in Graham’s book murdered the neonate after denying she was pregnant in the last trimester in order to hide it from all those who would despise and throw her off. Her husband had fought in WW2 and the way she supported herself was to be a prostitute. Not uncommon. If she were pregnant when he came home or had a baby, he’d know. Some time after he returned, he died, but she was suspected and accused of killing the baby. She went to prison and then was later released (exonerated). She then spent the rest of her life hiding this after she was exonerated by a court: — that is improbable, but then this is a novel. This woman in the book brought Marnie up to hate and fear sex for (among other things) the way the woman supported herself and Marnie was through quiet prostitution along with a menial job — not uncommon for women in history.

Marnie’s mother (Louise Latham) in Hitchcock’s movie: she often has just that irritated smirk on her face

This story as I’ve told it speaks for itself I should say. I ordered the movie from Netlfix and it arrived two days ago and I watched the movie for the first time last night. I also have a book called The Making of Marnie– by Tone Lee Moral, a very early film study — of the type so familiar today but not when it was done. I chose to read the book because of my interest in Graham’s Poldark novels, desire maybe to write a paper on historical fiction set in the 18th century and growing love of things Cornish, books and films (yesterday I watched one made out of Trollope’s “Malachi’s Cove” about abysmally impoverish people who make their living gather seaweed to sell it for manure on the dangerous cliffs).

In the movie much of this is changed, and in the movie Hitchcock said the central issue is Marnie doesn’t want to have sex with Mark. (Graham never said Marnie’s dread of sex was the real crux of the book.)

Why in Hitchcock’s movie did the mother teach Marnie to hate sex. It seems that either the father died or disappeared and to support herself the mother went in for prostitution. The child was forced out of the bed where she slept with the mother and had to allow the man in. She had to sleep outside in the outside room. One night she cried too much, the young man came out and tried to soothe her, grew irritated, started to shake her, the mother defended her and before you know it a brutal incident emerges and the child grabs an iron stick for stirring a fire and hits and kills him. The mother “takes” the “rap;” says she did it and ever after lied about it.

A very different story from the one in GRaham’s novel where a woman gets pregnant and is driven to kill the neonate (rather than be exposed as a prostitute and ostracized) and then is accused, goes to jail for it, and hides that.

At the heart of Hitchcock’s movie is Marnie’s refusal to have sex with Mark. This is what seems to be the great problem to Hitchcock. Mark looks upon this as her tremendous illness and what she has got to get over: poor thing. And of course long-suffering noble Mark — except that one instance of rape which is presented so discreetly if you blink you’ll miss it and seems to have not much effect on Marnie afterward in the movie (nor to be fair in the book). She just carries on.

This rape scene was very controversial in the movie it’s said. Oh the film was the one which clinched Sean Connery’s career (as OxBow Incident began Anthony Quinn’s) and he was Mark. I mention The Oxbow Incident because it was a genuine success d’estime (and deserved it) and was a financial flop. Not only was Hitchcock’s movie a financial flop, it was ridiculed. Only years later did it come to be seen to be worth studying, fascinating, to some a “great” movie.

In Graham’s book the marriage is coerced strongly (as it is in the movie), but it’s not done with violence. Mark discovers Marnie is a thief of a high order: stealing vast amounts of cash and threatens to turn her in except they marry. She thinks to herself (in the book) that this will prevent him testifying against her. So there is a sort of bargain.

Promotional shot of Marnie on horseback (Forio)

Then what happens in the book is Mark insists that Marnie see a psychiatrist. (The first script for the movie by Joseph Stefano included the psychiatrist of the book.) We read of weekly long sessions in Graham’s book where Marnie lies, makes up stories, but, after she learns her mother’s back story, is broken down to tell the psychiatrist what we have known all along: her father died when she was young, mother remained alive and supported them on a menial job. Marnie was was brought up by a kindly aunt who lived with and on the mother, Lucy Nye. Marnie as soon as she grew up herself supported her mother by stealing, thus sparing her mother the awful office jobs she had had to endure.

In Graham’s novel, Marnie has been followed by Terry who urges her to return, instead she returns to her house and goes on a hunt. Mark shows up; in the book she lures Mark into a bad accident and her feelings afterward and thoughts (at long last) about her mother and all she has said to the psychiatrist and past bring her to a realization Mark is her great friend and she is last seen returning to him.

I’ve discovered a theme of intense loneliness is important for Graham — Graham’s Marnie is intensely lonely and Graham’s central hero for his Poldark novels, Ross remains a renegade, a man apart, ever traveling and keeping to himself, bitter within, seeing how unjust and awful are society’s arrangements, sickened by them The ending of several of the Poldark novels were Ross comes home to Demelza, stands outside watching her and feels comforted he has this place of order, stability, peace to return to is just the way Marnie ends, only it’s the woman who has been a radical criminal type and now finds her way back to a dependable kind partner.

The movie changes much of this. In the movie absurdly Mark is not only upper class but Philadelphian (with a Scottish accent as Connery’s is still there). We have this upper class milieu which is fake utterly, which includes a tender loving father-in-law dressed absurdly (not in the book where there is prosaic sort of mother who lives off her son’s business.) There is a promotional still where we see Marnie talking to her father-in-law. Shades of La Traviata.

In the movie all is done that counts by the powerful Sean Connery. It’s he who finds out about her mother, he who takes her there, he who is kindly overlooking the mother’s story (but deeply disapproving), he who focuses on Marnie’s dislike of sex. Not that the book Mark likes this but he does not see it as so central, and anyway he is in rivalry with Terry.

In the movie, Marnie does not nearly kill Mark but herself gets into an accident which appears not to hurt her at all except emotionally. She does bang her horse, Fornio into a wall. Fornio is so badly hurt he must die. She runs for a gun and hysterical shoots this horse. In both novel and movie , we are asked to believe that during Marnie’s childhood the one creature she really loved who loved her was this horse, that she had the money to keep and ride it. (Maybe this is why Hitchcock made Mark upper class so when they visited the horse it would not seem improbable to a British audience). It’s after this that in in the movie Mark takes Marnie to visit her mother.

Hitchcock regarded Graham’s book as fodder with which to make a very different story, one with a strong hero (not in original); a previous screenplay by a Evans Hunter kept the transposition and did not include the rape but this was rejected. Jay Presson Allen wrote the play we now have; in the feature she comes across as not caring about the improbabilities and saying the rape was not really a rape. (The usual way of justifying rapes.)

In Graham’s book Marnie does ride and she does damage Mark, come near killing him in a hunt towards the end of the book as I said. So we could say it’s partly a woman’s film, one third of the triumvirate was a woman. But the truth is the first play was writen by Evan Hunter who was fired because he balked at writing the rape scene in the way Hitchcock wanted it changed. The Heart of Me- a misogynistic take on Lehman’s book had a woman playright, but the director was a male.

The great climax of the movie is how Mark breaks down Marnie’s carapace, she relives the incident where she was put out of her mother’s room, the man came into the room when she cried, violence ensued and she killed the man. Marnie breaks up into whimpering and a kind of crazed monologue. We are to believe this releases her, and when she returns home with Mark they will now begin to have a “normal” life together: she will have sex with Mark. Mark of course will continue to support the mother who is left there after herself confessing how she has ruined Marnie’s life by bringing her up to hate men and sex. But she did not mean this. So we are allowed to feel for her.

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Some thoughts on the book as part of Graham’s oeuvre. Graham’s novel is not one of your respected high status books so you may have to buy a cheap copy on the Net. I found one which is part of an omnibus book of Graham’s “best” mysteries. It seems that highly unusually Graham really repeatedly delves the problem of unhappiness in sex in married life. He again and again presents marital rape in his Poldark books; he repeatedly shows married couples unhappy because of an unhappy sex life. He shows men raping women, men murdering women out of jealousy (or their lover) or from too much alcohol (that’s what happened to Verity’s husband years ago we are told, and naturally she forgives him for it’s years later.)

The first instance is the rape of Elizabeth Poldark by Ross Poldark in Graham’s novel of the same name, life just goes on. For Marnie she goes about her business the next day, breakfast &c. And he rapes her no more, only a couple of times trying to seduce or soften or be suggestive but she does not let him near her. At the end of the book when she returns to him (after she has had a sort of revenge by luring him into hunting and then into doing something beyond his capacity so he broke bones and was almost killed) we may guess eventually gradually now she’ll learn maybe to accept and even like sex.

This is what presumably happens to the second woman in Graham’s Poldark novels. Morwena experiences marital rape nightly and it’s sufficiently suggestively describe a few times that we know the man is sadistic, a foot fetishist. She begins to lose her firmness of stance, become shattered psychologically and she is impregnated. Finally she has a hard birth and he is made to understand by a doctor he must leave her alone; after a while he does start up again. Our author (Graham) is kind and this husband-rapist is murdered. She flees her wretched family who coerced her into the marriage and to a young man she loved. He see she cannot bear sex and is tender and loving and leaves her be. We see them marry and it’s implied no sex yet. Book ends. The next book opens and we hear she had a child. Presumably like Marnie she began to trust, then bear and then like it. But alas, we are not shown what happened at all.

This kind of thing though one sees was of interest to Graham. This trajectory of the woman coming to trust or learn or change was not to Hitchcock. Instead she breaks out of her shell by him making her hear and tell the tale in front of him and her mother. But there is this peculiar man’s point of view that in both cases (book and movie) we begin with a rape. The author wants to have the woman broken down some more first.

I’m interested in the subject of rape, how it’s presented (which is usually rare in mainstream novels and almost never of marital rape)

Of interest is that Mark in the book is really an ordinary law-abiding person, perfectly conventional, not at all pathological and not a rapist type at all. (Graham’s favorite heroes are not violent men: Dwight Enys, a sensitive doctor; Ross normally is not violent to women at all, but loving and kind even if a strong man. Strength does not issue in physical violence against others in Graham except when someone is attacked.) People watching the movie say there is something awry in the Mark character: perhaps they can’t believe he would live with a woman without sex — or are embarrassed to think so so something must be wrong. In the feature that goes with movie, some people opined Mark is enjoying his role, titillated by it.

The most common promotional still shows Marnie on her horse: see above and this too;

In the movie she goes off and kills her horse; she does not do this in the book

This is an archetypal image of the femme fatale: the woman on a horse (the horse is phallic power, something outright denied Victorian women during the worst repressive phase of the era, when it was not done even to ice-skate). The woman with the gun. The woman on a horse is seen in cover illustrations of Mary Braddon’s Wilkie Collins’s books – and DuMaurier’s Rebecca. Remember Hitchcock made a version of Rebecca. All evil, when DuMaurier said she was partly on Rebecca’s side, and Max de Winter was a murderer.

Well Marnie (book and film) made me think more about the way rape is and is not treated in the Poldark books — sexual experience is open and central to 18th century novels the way it is not in the 19th century. In Graham’s Marnie the transgressive heroine (twisted by her society and childhood) is coerced into marriage, but it’s not done with violence. Mark (as I’ve said) discovers Marnie is a thief of a high order: stealing vast amounts of cash and threatens to turn her in except they marry. She thinks to herself (in the book) that this will prevent him testifying against her. So there is a sort of bargain.

Two, he insists on sex the first night. So he rapes her — not presented in the book after the initial suggestive sentence just the way it’s one in Warleggan between Elizabeth and Ross — and then afterward nothing happens. There are no fatal consequences — except to Ross and Demelza’s marriage and later to Elizabeth’s with George because she conceives a child he can’t endure. As in the rape of Elizabeth Poldark by Ross Poldark in Graham’s novel of the second name, life otherwise just goes on. For Marnie she goes about her business the next day, breakfast &c. And he rapes her no more, only a couple of times trying to seduce or soften or be suggestive but she does not let him near her. At the end of the book when she returns to him (after she has had a sort of revenge by luring him into hunting and then into doing something beyond his capacity so he broke bones and was almost killed) we may guess eventually gradually now she’ll learn maybe to accept and even like sex.

This is what presumably happens to the second woman in Graham’s Poldark novels. Morwena experiences marital rape nightly in Graham’s Black Moon and Four Swans and it’s sufficiently suggestively describe a few times that we know the man is sadistic, a foot fetishist. She begins to lose her firmness of stance, become shattered psychologically and she is impregnanted. Finally she has a hard birth and he is made to understand by a doctor he must leave her alone; after a while he does start up again. Our author (Graham) is kind and this husband-rapist is murdered. She flees her wretched family who coerced her into the marriage and to a young man she loved. He see she cannot bear sex and is tender and loving and leaves her be. We see them marry and it’s implied no sex yet. Book ends. The next book opens and we hear she had a child. Presumably like Marnie she began to trust, then bear and then like it. But alas, we are not shown what happened at all.

The first episode of Poldark movies brings home to me how Graham is unusually frank and interested in marital sex — the dissatisfaction between Enys and Caroline is not just a matter of diet and exercise. How it fails and creates terrible miseries for people. Another couple is presented as having fraught difficulties because of sexual life does not cohere to supposed norms.

This bothers me. There is this peculiar man’s point of view that in both cases we begin with a rape. The author wants to have the woman broken down and does not always punish the males who do this but at times justifies them (Ross in his behavior to Elizabeth, Blamey to his wife, Mark Daniels to his — the latter two murdered their wives).

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Now comments on the movie as movie: Several issues are at the heart of a comparison of the film with its source — which is what interest me. The first is easiest to deal with — swiftly. The mise-en-scene and cinematography of the movie was dated when it was filmed. Lee (and the people in the feature to the movie, some famous, which is part of the modern DVD) justify the refusal to film on location at all and the various symbolic techniques which break naturalism (the screen goes red when Marnie is deeply distressed about her past) are instances of German expressionism. Perhaps the film would be better in black-and-white — as it seems to have been originally filmed. In color it’s all conventional pastels. The use of painted backdrops, of people not on real horses but wooden something-or-others with countryside behind, does detract. The studio rooms with the action as a drama on stage is fine once you accept this is an older style movie.

As for the inner life of the novel (first person personating a woman in an incessant stream of consciousness with story going forward interpersed with memories), what Hitchcock puts in its place seemed to me didn’t work. He is fascinated as were so many by Freudianism and when the “back story” of the mother — driven of course by Mark who is the big he-man presence of the film, acting, knowing, doing everything (but except once apparently fucking his wife, Marnie) — is finally presented we get this sudden dissolving of Hedren as an actress to a whimpering kind of neuroticism. It’s hard acting. We are to pity her. Why? Because you see she had this mother who hated sex and taught her to hate sex.

To me it’s remarkable all the respect Hitchcock gets. Yes he brings up intense important issues of great violence and terror and misery between men and women, but then he most of the time just shows them at their most sensational and improbable and then walks away.

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I am bothered by the way the character, Marnie in the movie is discussed. The discourse endlessly begins with how she’s a “liar.” This word has a powerful dishonoring connotation, so powerful that even today one must not call someone else a liar even when you and they know the person has been lying. In fact lying is so common and when people protest against a lie, it’s usually not the lying but the content they can’t stand and don’t want to admit to disliking.

In the book we gradually see Marnie’s is a defensive lying; she has to lie a lot because she’s getting away with a lot — so to speak.

Ellen

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Winston Graham’s Warleggan: Unabiding renegade; Sexual Possession;the power of death and memory (Poldark novel 4, Cornwall 1792-93)

Those who are left are different people trying to lead the same lives … Demelza to Captain MacNeil who attempted to console her for death of infant Julia (Bk 1, ch 4, p 55)

There’s no to-morrow. It doesn’t come. Life’s an illusion. Didn’t you know. Let us make the most of the shadows … Ross to Elizabeth, before raping her (Bk 3, Ch 5, p. 314(

Final shots of Season 1: Film ends with Trenwith burned down, Mark Daniel killed, all money and hopes lost, Ross to go abroad as soldier, leaving Demelza with Jeremy (very different from book here)

Dear friends and readers,

Ross Poldark, jacobin landowner, in the film an unabiding renegade who rapes Elizabeth in order (he tells himself) to try to prevent her from marrying George Warleggan, capitalist villain, ruthless, malevolent. Demelza, refusing to accept this situation, hating herself for not retaliating by going to bed with the hard but fair Captain who tried to capture Ross et alia as smugglers. Caroline, strong woman brought out of 18th century gay witty lady, Enys as disillusioned as Ross. The hard capitalist (new world, our world) Warleggans. How I love these novels. Naturally another blog.

Here am I to relive with a you a little of the experience of this fourth of Winston Graham’s marvelous Poldark novels: Warleggan. We’ve had Ross Poldark, Revenant, Demelza: Mistress Poldark, Herstory, Jeremy Poldark, the midst of life. Warleggan is the name of a family enemy to the Poldarks since their grandfathers’ time, and this novel ends with George (Ralph Bates) taking possession not just of Elizabeth Chynoweth Poldark (Jill Townsend), Francis’s widow, Ross’s ex (as he thought until the end of the last book) beloved, but also of Trenwith, the family home.

An important theme in this novel is death: early on Demelza tells Captain MacNeil who tries to suggest that Jeremy has replaced Julia that ” “those who are left are different people trying to live the same lives” (p. 55): the death of Francis screws up the lives of three of the principles (Ross, Demelza and Elizabeth) by giving George Warleggan a chance to buy, seduce Elizabeth who in effect makes a second bad marriage. Her disloyalty to Ross leads to his raping her and (as emerges in Black Moon), Elizabeth’s pregnancy, the birth of Valentine, and Elizabeth’s death eventually.

The ending of the filmic Warleggan (Episode 16) differs startlingly from the ending of the novel as the opening of the mini-series (Episode 1) and ending of the first novel (Episode 4) differed from Graham’s Ross Poldark so the themes of the two works emerge quite differently.

What happens in the film is the theme of possession in the novel dominates the close: it’s true that central thematic matter in this novel also includes sexual possession, very much an 18th century theme too: towards the end of Warleggan Ross tells Demelza that he has been possessed by Elizabeth in the sense Lafayette’s La Princess de Cleves is possessed by Nemours (the man who would not mind committing adultery with her). Ross has been erotically enthralled by Elizabeth, and was awakened to his feelings the previous Xmas before Francis died. Ross asserts he is no longer, but we can see that while the grip of this “possession” has been broken during a long night of his ambiguous rape of Elizabeth, it is not altogether gone.

Demelza may be said to be possessed by Ross: she could not get herself to fuck with Captain (prevention man) McNeil (Donald Douglas) in retaliation, because she felt she belonged to or was part of Ross; but she is also possessed by Ross in law, when she’s pregnant with his child, and beholden to him for the respect she gets, her place in society, her name (as it’s put in the book).

The phrase may be used of non-erotic states and bodies: a person may feel he or she is possessed by evil and dark thoughts (the devil); you can be possessed by some pursuit that becomes an obsession. Both Mark Daniels and Dr Enys (Richard Morant) were possessed by Daniels’ wife, Keren (Demelza) in mad self-destructive way. By having the film end in a conflagration and abandonment of all the film emphasizes the destructiveness of this erotic possession and jealousy (George’s of Ross) and hatred (George’s of the community that despised him and he seeks to punish).

It is very easy to become confused between book and film so this time I preface each of the four sections with a summary of Graham’s book; and will make put a summary of 1 Poldark Part 16 in the comments to this blog (the filmic equivalent of the parts of Warleggan which differ radically from the book).
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Book One: April-May 1792

The set for the 1975 Poldark mini-series: we see Nampara

This is the first of the books to try to reset the reader into the world of Cornwall: in so doing it reminds me of Trollope’s Dr Thorne: the first two Barsetshire novels were written w/o an aim to make a series, but by the third Trollope knew he had created a world and would be filling it with characters and begins to develop the setting at length.

This is not fictional in the way of Trollope’s: it is meant to be historical places but Graham doing the same thing: he really sketches the area but it’s not wooden or dull as it’s done from the viewpoint of our main characters who have been invited to and are reluctant to go to a party at one of the six gentleman’s houses in the area. Ross and Demelza’s is the smallest, least pretentious, indeed most poverty stricken of the group.

A summary of the book:

Chapter 1: The six houses, Demelza at home with Jeremy, to her Francis, Ross arrives, they discuss return of Caroline; Trenwith George’s (false) courting of Elizabeth and its success; he and Aunt Agatha’s first ugly clash

Chapter 2: Francis home to Elizabeth; Elizabeth’s obtuseness about George; George meets and tries to seduce Enys to his side, fails; Dwight at the Hoblyns, his wandering about moors at night

Chapter 3: Begins with Ross and Demelza’s arrival at Place House, owned by Trevaunances, evening of 24 May 1792 . Dinner party with all major characters at table; major blindness of Trevaunance to invite both Ross and George; flirting of MacNeil with Demelza; charged conversations of Elizabeth with Ross (he loves her), of Elizabeth with Francis (she made serious mistake marrying him); deterioration of conversation when men leave. Four riding home together, Demelza feels something new afoot, Ross declares Caroline “wrong wife for Dwight .. [she will] wipe her feet on him” (p. 43)

Chapter 4: Dwight’s custom growing (Ellery’s death), his wooing of Caroline. MacNeil of Demelza who tells him of death of Julia: “those who are left are different people trying to live the same lives” (anticipates what will happen after Francis’s death too, p 55). Ross home, MacNeil leaves; Ross and Demelza discuss Mark Daniels’ possible find, Ross to Trencom to plan; Trencom aware an informer about and he has to move operation to another cove and keep his stolen goods at Nampara (the hole in the library floor made).

Chapter 5: Dwight visits Hoblyns and finds Kempthorne’s house remarkably improved; Dwight and Caroline’s strained courting.

Chapter 6: Trencom carries on, exchange of witty rebarbative letters between Dwight and Caroline; Pascoe’s letter sounding warning about his selling that note; Francis and Demezla’s important conversation where he tells her how much she means to the family and how lucky they are to get her; and also of his part in betrayal and she cannot forgive (a theme in book); Francis drowning, the child playing at Trenwith

Chapter 7: Ross home to Demelza withi news that the note was passed to Pascoe; the hunt for Francis and realization when they get to the mine he’s drowned, the body

The power of the opening four chapters is a direct development of the five characters at length and from within and in dialogue. It is here that Ross’s love for Elizabeth (Francis, Ross’s cousin’s wife) is brought out more clearly for the first time, both from his desiring point of view and the past they knew; from within. Now she has been so disappointed in Francis (she has not been out of her house in 4 years more times than she can count on one hand) and is bored. She is letting Ross know she’s available. Demelza intuitively sees this and is very hurt.

George Warleggan begins to be central as a presence. We see his spite in the way he insults Aunt Agatha, wishes for her death, calls her ugly in front of her because she’s deaf. She’s pathetic and narrow but not a bad woman, and has nowhere to live but with Francis and Elizabeth. Francis is wry and ironic but not unkind. We see how hard he is trying to support Ross; Francis warns Ross not to participate in the smuggling, even if the money is so desperately needed — as Warleggan is Ross’s enemy and has liens on the authorities.

Dr Enys is among the faithful decent. Alas, partly because of this he is not doing well. He cannot cure people magically and when they die, he’s blamed.

Breaking of sexual norms:

The character of Caroline Penvenen; far from a Gainsborough heroine, like Elizabeth, she is a woman who breaks sentimental norms. Another strong woman emerges: Caroline Penvenen. She’s an important character: in archetype she’s the gay witty lady of Restoration and 18th century comic drama: I can see Anne Oldfield doing her to perfection.

This is from Season 2 where there are scenes capturing this aspect of Caroline; in Season 1 she is much more like the elusive lady of Gainsborough 1940s movies, mischievous, non-serious

IN the book, what Winston Graham did was take this character and make her a proto feminist: she is pro-active and aggressive in her love affair with Dr Enys. He would have shrunk from her because of his lower station background, his lack of money, his sensitivity and gravity as a personality; his past history of having been taken over by another woman’s erotic enthrallment (in which he more than acquiesced) and her murder by her husband, Mark Daniels (still a fugitive in France, helped to get there by Ross Poldark) all in the way. She overcomes this by her wit, determination (Bk 1, ch 5 67-75, Bk 2, ch 2, 115-22). In Jeremy Poldark she had showed her understanding and kindness in the romance of the oranges I described.

In the film and book Enys is in love with her and she knows it; she refuses the older man her uncle wants her to marry. A good set of implicit social scenes does this. Ross is ever shown as intelligent (so too Demelza) and his remark on the relationship of Enys and Caroline rings a dark ominous note: “I certainly think she is the wrong wife for Dwight. She would wipe her feet on him” (ch 3, p 43). Nonetheless, when Warleggan tries to bully Enys into coming on his side, Enys refuses pointblank and is frank in discourtesy.

In both Francis (in Jeremy Poldark he tried to commit suicide; he drinks to drown depression, assumes ironical stance towards life) and Enys (the idealistic doctor who will not kowtow but is susceptible to affection from women) Graham breaks masculinity norms.

The film series does try to do justice to some of this, e.g.,

In the opening segment of season 2: after in the film Ross rescues Enys and Enys and Caroline marry, Caroline in the film lets Demelza know that after his long imprisonment & shattering experience Enys is still impotent but it does not come off sympathetic to him so much as about her frustration, the actress has not much feel for this, or maybe the writer and director (both men).

Finally, McNeil brought back — a Scots customs officer who had warned Ross in the end of Demelza about not getting too far away from law. He is well played in the series by Donald Douglas. He is interested in Demelza and she responsive — partly from her own frustrations. In Captain McNeil, the customs officer’s conversation with Demelza, he expresses regret at the death of Julie to which Demelza replies: “Those who are left are different people trying to live the same lives” (p 55).

It seems a strong remark about a 1 1/2 year old child, but not about the death of Francis. For now Elizabeth the frail widow who Ross knows is willing, Ross, now genuinely grieving yet aware how futile and stupid was Francis’s act (there was nothing there probably), has to take over Francis’s duties, supply the other half of the firm; his absence hurts Demelza’s self-confidence and and growing place. Because he’s not there their roles must be different in law and custom.

Francis’s death (Chapter 6): I can’t speak too highly of the power and effect of the way this is done. Francis having tried so hard to make up for his dereliction in allowing himself to be bribed and pressured to give away who (Ross) was starting up the Copper company, with last intimate talk to Demelza, returns to the mine to see if he can find this ore level Mark Daniels had seen. He goes too far in, slips, falls, and drowns.

That’s what’s seen in the film. In the book we are with this man during the hours he waits to be rescued. In Jeremy Poldark he had tried to kill himself in Dr Enys’s room before the trial, but now he has thought better of it, is going in the direction of a life he wants, with respect for himself (his father never gave) him and wants to live. We are with him as he sinks, as he finds there is no ladder, as he holds onto that nail for three hours and then as the wall crumbles. His thoughts, his frantic shouts. A long sequence, not overdone but each moment felt as the man is there waiting, slipping, frantic and gone. We have heard so many stories of late about miners thrown away (unions useless now), and out infrastructure let go and so many dying this way. 9/11 managed to retrieve only a few and who ultimately brought on that blast? who has profited from it?

And then the silence and narrative returns to Elizabeth waiting for him patiently as yet.

A theme in the book: when an individual dies it matters. Ellery dies, Rosalie Hobyns doesn’t and that changes Enys’s life. Harris Peascoe passes the promissory note Ross originally signed for the first loan to Cary Warleggan. Charles, the old man, now dead and Cary ruthless.

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Book Two, Mid-November 1792:

Botallack Mine, Cornwall

A summary of the book:

Chapter 1: That terrible year (mist, cold), Ross walking meets Caroline in coach, Ross she means to have Dwight and in Ross’s thoughts the renewal of the relationship with Elizabeth, now frail and clinging to him (so he thinks) — he’s like a man with two wives. Dwight visits Demelza who tells him she does not want to be like “Elizabeth and Geoffrey Charles” (p. 110); Ross arrives to tell of return again of Caroline, and talks with them “Events do what they like with us, and such — such temporary freedom as we have only fosters an illusion … Look at Francis Was there ever a more sorrier or end … To drown like a dog in a well for nothing .. the wantonness …the useless waste” (P. 113), and Demelza trying to look forward …

Chapter 2: November a bad month for secret assignments out of doors but we have meeting of Caroline and Dwight and at long last agreed upon engagement; she agrees he the most noble but she does see he does not like her Bath plan … (patients need him)

Chapter 3: One of Ross’s weekly visits to Elizabeth; does she know how much he feels responsibility; when he leaves we see she is thinking of saying yes to George’s proposal as solving her problems; Ross to Demelza, about their desperation, talk of how much more of Trencom they will need; she wants to borrow, he does not, dark hours

Chapter 4: Mr Penvenen and Dwight’s clash over Caroline — very like a Catherine de Bourgh and Elizabeth scene; Caroline’s visit to Pascoe and her determination to provide needed 2000 pounds

Chapter 5: Pascoe tells Ross the good news, Ross’s return to Demelza who we see with dog, with child, with cat, good news, how they will prosper, the presents he means to give her, the love-making

“that odd fusion of desire and affection for which there is no substitute … They stayed for a while hardly moving. His hands were cool on her legs. Remember this, she thought. In the times of jealousy and neglect, remember this” (p. 159). “so you are not to be rid of me my love …”

Chapter 6: Another Christmas, now 1792: they were all to go to Verity (who had taken Francis’s death hard), last moment Elizabeth decides to go to mother (Cusargne); instead she goes to Cardew which makes Trenwith look like country house, and Cusargne an empty barn, the tension among the Warleggans, Nicholas not keen for Poldark widow as a daughter-in-law; Ross’s quixotic gesture; now Ross determined to pay his debt to Francis for mine: to give Elizabeth the 600 pounds and take useless mine from her; Dwight and Caroline’s compromise (he does not want to go but feels he ought, still guilty over Keren); Ross gives Elizabeth the 600 without admitting it’s him; she is all smiles and brilliance, talks of her “dislike to think I was being false to our friendship” (p.175). He is intensely aware of her tight narrow body. We are to guess she has half accepted George.

Chapter 7: Henshawe with new troubles, Ross now has only 75, Henshawe regrets how Ross has spent needed money; could Ross go see Mark, price coming down; Ross tells Demelza he will go find Mark; Dwight among the Hoblyns (we have this thread to remind us of informer as well as Dwight’s work), ends again on a woman, Caroline this time, how she intends to live her life her own way

“I intend to live my life in my own way and shall not be bribed by them into remaining their domestic tabby. It will do me good, Dwight, to stand on my own feet, and I want you to help me.” He says perhaps we shall have to help one another” – p 187

Chapter 8: January 1793, the execution of the king, known by Jan 24th; Ross spends last 75 pounds on purchase of coal (p. 189). Dwight comes to tell Ross he is leaving; he will be home first of February; so Dwight tells her but not about Caroline and leaves her feeling lonelier than ever; Ross in old clothes seeking Daniel on the island, uncle tells Caroline better to leave Friday, Caroline refuses to leave before Sunday; Ross now brought ashore on Thursday

Chapter 9: The meeting between Mark and Ross; Mark white haired, aged; Ross realizes that Mark saw the same vein of apparent copper that Francis did, promises to put up a stone for Keren “by building so much on the chance utterances of a man crazed with rage and grief, he had brought himself to the present pass’ (p. 201). No by giving his money away to Elizabeth. Dwight giving up on seeing Ross; meanwhile MacNeil and Vercoe making their plans; Dwight waiting until midnight, one last call to Rosina’s whose knee is gone again; goes to Hoblyns, hears Kempthorne’s lie and recognizes it, realizes what is occurring and goes to Kempthorne before trying to meet Caroline

Chapter 10: Uncle Ray Penvenen goes to bed at half ten; Caroline and maid sneak out, Dwight exposes Kempthorne to Hoblyns; Dwight and Kempthorne’s struggle; now Lottie cries out that her life is being ruined at this exposure, father hurt in struggle and Dwight flees, Lottie’s grief

Chapter 11: MacNeil come to Nampara to await Ross’s return, Demelza almost tells him but some native caution stops her and they sit waiting; Dwight rushes to the top of the hill and lights the fires of warning

Chapter 12: Ross coming ashore, his talk with Mark’s brother, Paul; they see the gaugers and military and prevention men in time; Ross begins to flee; Ross home and hidden, Demelza tries to prevent Vercoe from coming in; on the beach a terrific struggle ensuing; they examine the floor, go the cache, but it is empty

Chapter 13: Caroline’s goodbye letter to Dwight, letter dated February 3, 1793; he didn’t want to come; the men out to hunt for Kempthorne; hours after the military leave Ross emerges from his hiding place.

Commentary: Things have become desperate for Ross. Harris Pascoe has sold the promissory note to Cary Warleggan — another treachery, and Ross can do nothing about it. Cary demands full payment by December. The loss of their very land looms over Demelza and Ross.

Caroline to the rescue. She goes to Harris and offers to buy the promissory note herself. This is a scene which would startle and feel meaningful to any reader of Trollope: when women try to use money on their own, men won’t listen. At first Pascoe doubts she has the money, then the control of it, and then he says Ross would not accept money from a woman. At each count she persuades him otherwise. When at the last he downright refuses as he is uncomfortable, she asks who else runs a bank here, and is leaving. It reminded me of buying a car from a car dealer. You need to be willing to walk. He caves in and the scene closes. We don’t need to know the negotiations once she has gotten over this hump of being a woman (Bk 2, ch 4, p 144-48, in fact juxtaposed to Enys standing up to Caroline’s uncles).

What makes for the complexity also is she is given the rightist rhetoric: not as a validation but to explain why an heiress would think Tory like thoughts.

Graham is unwilling though to have his hero not be sufficiently manly so he has Enys confront Caroline’s uncle in a scene where the two men rehearse the scene between Lady Catherine de Bourgh v Elizabeth: in this one Enys stands up to all the counts of inappropriateness, future misery because they will not be accepted, the unimportance of love, sneers at his profession, learning, insistence that Caroline does not know her mind. It’s this scene (as in P&P) that persuades Caroline that Enys does love her. It’s hard not to believe Graham had P&P in mind and is reversing the sexes (bk 2, ch 4, 134-44).

That this is a quietly feminist vein is reinforced by Caroline’s riding a horse. She rides dangerously according to her uncle; she insists on riding publicly twice a week with Enys well before the uncle and he have their scene together.

The Ross-Demelza-Elizabeth triangle:

Ross is called over and at first astounded to be told the money is now paid, then perplexed, and then wonders where some treachery lies. He almost walks out but Harris Pascoe (despite his having been squeezed to sell the note) is an old friend and says on his word, this is good and Ross signs the new note. Now he is free for a long time to come (Bk 2, Ch 5, pp 149-52).

Meanwhile though money desperation and the intervention of McNeil and the prevention men has led Trencomb to ask Ross to allow them to store their smuggled goods in his house. He bends to pressure despite Demelza’s concern. Comically or ironically they use the library. We watch the scene (pp. 132-33) and from our visit to the Hoblyns with Enys where Enys’s success in curing the daughter’s broken knee, has made him get customers, begin to suspect Charles Kempthorne is not altogether above board about something. It’s impossible to keep secrets as it takes people to do things is what Graham wants us to see.

Ross’s first act is to re-buy things for the house and to bring Demelza precious presents, including things for her hair. We see and she does how he loves her tenderly despite the attraction (love or lust and a certain congeniality in their amorality) for Elizabeth still. He has had to visit Elizabeth since Francis’s death and they have come closer together — or so he thinks.

I just loved how the scene of the presents ended. Jeremy is there, natch and the dog, Garrick, chasing the cat. He kneels down to her while she sits in a chair and we are told puts his hands on her thighs. She thinks to herself that she wants to remember these moments for a long time, especially when she is feeling not valued or remembers his love for Elizabeth and then they speak:

He said: ‘So you are not to be rid of me my love.’
‘I am not to be rid of you, my love.
Over in the corner by the door Jeremy thumped down and began methodically to pull off his gloves (Book 2, ch 5, pp 158-59)

Life moves on relentlessly or quietly as it does in these novels. Next chapter, Christmas and now they can take up Verity’s invitation to Blamey’s for Christmas: they have clothes and things to bring, can hold up their heads.

We are told that Elizabeth was to come (Ross had urged her) and had planned to go to her parents but does not: We surmise she in fact went to the Warleggans, in effect to George who also has been visiting regularly: been so good to not pull in the debt Francis owed him, has bought her boy presents (pp; 158-159). She (we know) unlike Demelza but like Caroline values things over people, she wants social admiration over cherished private life (which is what matters to Demelza — and to me).

On the one hand, Ross goes to the island of St Mary’s where Mark Daniels is waiting for him. This is his last ditch attempt to be told where Daniels saw this lode of copper in the mine. Ross is shocked at how Daniels looks: decades older, white hair, wild and desperate, not quite right in his mind any more. Daniels has been living as an outcast, fugitive from the law (for murder of his wife, Keren) and has hired himself out to fight in France. It comes home to Ross how tenuous is Daniels’s memory and how foolish and self-deluded he had been to believe this story. It is improbable it appears that Daniels saw anything. And on this he had invested his last large sum, Francis’s loan, that Francis had lost his life seeking out desperately.

We see this desire was natural and Francis fell for it too because he wanted too. Earlier in the book there’s a long monologue by Ross about how life can be so meaningless and people die just for nothing — this in reference to Francis’s death by drowning.

It’s on his way home to Nampara by sea that Ross confronts this scene at the cove of unloading the goods and is almost captured by Vercoe, and actually fights him bodily, is seen and throws Vercoe off and flees home successfully to hide in a cache behind a cache in the family home’s unused (a quiet joke by Graham) library.

How did Ross manage to escape in time and why were not all the smugglers taken?

Dr Enys. As above, Enys has succombed to Caroline’s pressuring and has agreed to flee with her from her uncle’s home and go to live with her in Bath. A fait accompli. She is an heiress and apparently thinks they can live on her income, but if Enys is so determined to practice his medicine, he can set up there very well. We are told in an earlier book (it comes out in the trial scene of Ross in Jeremy Poldark) that Enys is one of those who benefited from the slight glimmerings of a meritocracy, and although from poor middling parents, was recognized for gifts and educated as a genuine physician and we see how much he cares about his patients.

He tells Demelza in an unconscious slip when he is telling her of his and Caroline’s plans, that the going off is a “grief.” It is. We remember Ross’s words about Caroline: she may wipe up the floor with Enys (I suppose like Rosamund Vincy does with Lydgate in Middlemarch though on different grounds and from different psychological/sociological causes).

That night they are to meet at 11. She insists she must not tell her uncle for he will thwart her ferociously (the class system is very real in this book) but will accept a fait accompli after a while. We get a double small interweave here. Caroline trying to say goodbye to the uncle who gains a sense something is afoot and will not go to bed. He goes well after 10 and she arrives with her luggage at the carriage late, to find no Enys.

He too was waiting and there came to him a last emergency: Rosina Hoblyns’s knee is acting up again. He is sitting there waiting for the 11 o’clock time to come near and he figures he’s better off spending the last half hour with a patient whose good health he has gained credit for. When there, he is told that Charlie Kempthorne will not be with the men that night. Why not? Kempthorne is ill and he hears a lie about himself. That he advised Kempthorne to stay in. Now we do have a novelistic providential trick: he suddenly puts together his noticing (which he had) the better condition of Kempthorne’s cottage (as doctor he visits them) and partly because he does not want to meet Caroline, heads for Kempthorne’s cottage.

A confrontation scene of some power ensues. Enys is rarely not soft-spoken and cooperative. He suddenly accused Kempthorne of being the informer and Kempthorne loses it. He is frightened himself, a fight ensues and Kempthorne tries to disable Enys (with a knife) but Enys escapes. The children are frightened by all this and anxious.

Enys then runs high on the hill and sets up a bonfire. A bonfire is an old symbol that something is wrong. He has a gun and when the men begin to land he lights the fire and attempts alerts them. Not only him but some of the smugglers have seen one of McNeil’s men and another figure at a point on a fence they usually use to get the stuff to the library.

Ross is coming onto the beach just around that time, a little tiny bit later and sees the cargo being thrown overboard, sees the first scuffle and is himself beset by Vercoe. He shoots to keep people away and either kills or wounds someone and keeps running home.

Meanwhile Demelza is waiting too — she too is up that night waiting, for Ross. We had a moving scene between them when he went off to find Daniels. We are told little things about Ross’s appearance by this time. Pascoe (his banker) sees he has taken on a wolvish appearance. He insists he must see Daniels and that he will make his way there and back (it’s 1792 and France is dangerous too). She knows this is a night for smuggling and bringing the cargo to the library.

Comes to her house to quarantine it and hold her there McNeil and his men. McNeil has been alerted that his men are seen and he wants to prevent Ross from getting home. He knows from a sub-textual conversation with Ross after the trial that Ross is involved in the smuggling. Demelza for a moment thinks to hint to McNeil the truth for McNeil is decent, has warned Ross friendly-like and would go to bed with her if she acceded. But she looks in his eye and knows there’s no mercy there.

So she sticks to her story, Ross is at St Ives and will be back tomorrow or late tonight. Her house is surrounded. The men won’t let her go upstairs but she insists on seeing her boy. She gets herself out the window, jumps three feet and is off to the beach where she meets Ross coming from it. She warns him and he goes into the library by another entrance than the front of the house. She has no way of climbing back up to her boy’s window and braves the group by just walking in.

A half hour or less later McNeil is there furious, wounded, they look everywhere for Ross, including the library. Demelza can see there’s been an informer for they know to lift part of the library floor where cargo sometimes is. No cargo tonight.

In the film a superbly well-done, tightly knit, expertly interwoven yet sprawling near-disaster. Ross and the “free trade” men he is allowing to land at Nampara cove are informed against by Charlie Kempthorne; they are lit upon by the prevention-men, Captain McNeil, the customs officer and his men, the local government man, Vercoe and 7 smugglers captured, 2 killed and one wounded. McNeil is among those wounded on the other side. The rest of the smugglers escape out to sea with most of their cargo intact. They will be back on another dawn.

This early dawn on the shore does not end Book 2, for its final chapter is a search for Charlie Kempthorne by a group of self-appointed men from the neighborhood. But he has fled, and while a first impulse is to burn the cottage and beat his children, better impulses prevail and the children are simply sent to an aunt and then the cottage burnt (where Kempthorne had been gathering very nice furniture and other hitherto unexplained quietly put-in signs of prosperity for quite a long time).

In the film we see the men throw Kempthorne off a cliff. A group of men seek out Charlie Kempthorne and after a while find him. It’s an ill wind that does no body any good. Kempthorne had made a deal with Rosina’s father to marry her and the father had been willing to beat her into it. Kempthorne is much older than she, brings two children; he would provide a decent home, but she is not sure he is a character she will be treated kindly by. Well, now she need not worry.

A letter from Caroline to Enys ends Book 2. A bitter one about how she has left with her uncle the next morning at 10, and does not expect to return again. She says she was aware how loathe Enys was to leave his practice and friends too at Cornwall.

As I’ve said all this is deepened by the reality of the reading experience of subjectivized narratives for 4 books now and each of the important characters is alive in the reader’s mind as a real presence.
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Book Three, begins a week later, still February 1793

Prelude to Rape scene: Ross climbs the walls (Part 15, Episode 5)

The confrontation: he says he will stop her

A summary of the book:

Chapter 1: Trencom takes care of his friends, alibis for all, Dwight’s unease, some loss of custom and increase of admiration from people around as a group. His thoughts: “Far better bitter disappointment now than the humiliation and misery of a lifelong mesalliance” (p 258); Demelza and Ross’s talk, he has to admit he sold Leisure for 675 and discharged a debt of honor with the 600, she says she’s heard George Warleggan very obliging to Elizabeth so maybe not so much in need; Ross’s jealousy over Bodrugan deflects this; he and Henshawe go down Grambler, and feel despair.

Chapter 2: George Warleggan outwits Elizabeth in effect: “streak of hazard blending with good fortune” on Warleggan’s side; he pressures her into a public wedding, says that he’ll repair Trenwith; he will help her with her boy; at the close of the chapters George exults that he had “dealt what he knew would be the deadliest of blows at his bitter enemy” (p. 277)

Chapter 3: Now tin found at Gambler; Demelza to Verity, limit on what you can ask; “if you believe in him,then you’ve no excuse for asking for proofs all the time” (p. 282). Verity to have baby (October due date — so 1793). Demelza thinking, off to do what she can for Bodrugan, meets MacNeil on the way, genuine conversation (man is in his own terms decent) at Bodrugan learns of match of Elizabeth and George

Chapter 4: Large political scene sketched in (counter revolution, war in Europe, Paris open to taker), May 2, 1793 Charlie Kempthorne’s body found floating in sea; Rosina come to Dwight; moving talk; he has no one to talk to; Dwight and Ross rush to where accident; Ross had not spent enough money on mining equipment and bad accident: 2 men killed by fall, 3 seriously injured, work stops

Chapter 5: Failure coming very hard; he comes home to Demelza; odd tone, Elizabeth’s letter dated 9 May 1793 (so the rape is 9 May 1793), he goes dark in mind and heart; goes there, intense conversation which rehearses all the previous backstory history (which is dramatized in melodramatic ways in mini-series, episodes 1-4). They quarrel over his intention to stop her and her refusal to acquiesce; no escape she knows; he insists she is making another mistake; his insistence makes him hateful to her, she now needles him with her love for George and it leads to rape and his staying the night. She: “Tomorrow …:. He: “There’s no tomorrow. It doesn’t come. Life’s an illustion, Didn’t you know. Let us make the most of the shadows” (p. 314)

Chapter 6: Ross comes home to Demelza and Jeremy; terrible scene, “joint betrayal destroyed the basis of their life”; “frightening blazing anger” alive in her and she goes out; the relationship destroyed it seems, they meet at meals, the invitation to Sir Hugh Bodrugan’s party, Demelza will go alone.

Chapter 7: Demelza at party; “desolation” in her heart, the will to retaliate, but not the object; she can’t bear Bodrugan; MacNeil turns up, at heart she feel “lost, irretrievably lost” (p. 333)

Chapter 8: Demelza does lead MacNeil on, a bedroom scene which is counterpart to rape scene; MacNeil a bit too aggressive, and she punts; he will not force himself on her, she feels she must adhere to the one man; she feels debased; MacNeil’s words of interest for they do not blame Demelza by a cliched morality: “When admiration turns to contempt [what he feels for her now] it is time to go” (p. 346). She’d like to die.

Chapter 9: Comical fight of Treneglos and Bodugran outside her door; Bodrugna breaks in and finds her gone, and then thinks of Margaret (not pleasant person in the book at all).

Chapter 10: Ross at Looe on business; Demelza thinks he will leave her; he cannot get himself to go to Elizabeth (p. 356); he was sure of his love for Demelza but cannot speak or talk of it or justify himself; she would have felt better had she yielded to MacNeil. Then Elizabeth and George: Elixabeth attempts to weasel out, then to gain a delay, only manages that; real anger is that Ross had not been near her, had he come she would have reacted differently. As she yields passively to George the lines are: “God, I am in a cage! Lost for ever (why did Ross come, she hates him for coming, despise, only enmity between them, she shall be George’s faithful wife and again) “Why did he have to come? god, I am in a cage. I am lost forever” (p. 367).

So matter of this book is trial aftermath; Crash of Mine; Ross’s night with Elizabeth and its dire results for him and Demelza and for Elizabeth too.

Reading on in Smuggling on Cornwall and Devon: as far as I can tell quietly, unobtrusively, Graham continually accurate in offhand references and suggestive scenes.

The aftermath of the near capture of the smugglers, is a series of trials where the authorities get nowhere. Mary Waugh in her Smuggling in Devon and Cornwall, 1700-1850 says despite draconian legislation and punishment throughout the coastline of the British Isles starting around mid-17th century (to drag tax out of people), in some areas local populations persistently refused to convict and gradually punishments were softened so that you could get off by volunteering for military service (especially if you could bring someone with you).

Well, Trencom the man who runs this smuggling does not forget his friends. He has someone in court stand up with an alibi for Ross; he pays people’s fines. A few do have to pay by the horrors of some years at transportation or a year in prison. The prevention people go off to France to fight – they are eager for this we are told (with some irony in the narrator’s voice). A rare leftist point of view depicts Paris as under siege from the counterrevolutionary and emigrant armies. Graham also shows how the interests of the judges are distinctly against the smugglers for personal gain and stature and out of whack with the locals. Not as history but as realized personalities. The informer’s body, is found drowned some weeks later; the girl who was to have married him is somewhat saddened because after all she would have had an establishment and he showed admiration and affection but now she has the trouble of getting people to believe she knew nothing. She did know nothing.

Graham’s fiction stands out as superior to Daphne Dumaurier’s I now realize for he offers a full sociological feel of smuggling, including how it took organization, money, was a full fledged business operation outside the law. In her books it is all vague romance outside the adventure sequences.

A second set of scenes concerns finding a tin lode. They do find one, but alas, Ross has given back the 600 pounds Francis lent him, seeing (he thinks for a long time to come) Elizabeth’s poverty. He feels terrible over the death of Francis. He also does love Elizabeth too and visits and begins to feel he is an important presence in her house. But she does not consult or go to him because that would interfere with Demelza and they stop at a certain point from too much intimacy.

What happens to the tin lode is Ross mines it dangerously, He does not spend because he does not have the money to set up a careful operation which would preclude a sudden crash within and that is what happens. His men (friends) are wounded badly and the operation must cease now. I say this briefly and swiftly but in the book it is fully dramatized, including scenes of Ross with his money lender and the builders. Of course our hero goes down in the mine for hours to try to save people and does help bring two more men out, one Will Nanfan who I remember accompanies Ross to France to rescue Enys from a French prison in a later book (it’s in Season 2 of the films).

So I come to the sections that most engage me and at a deep level: Elizabeth’s decision to marry George Warleggan, Ross’s arch enemy.

Suffice to say it is not presented simply as a sudden burst of intense passion and revenge hatred, self-satisfaction by a hero who has within him an abiding renegade but a night of harsh love-making which causes a terrible break and tension between Ross and Demelza as she knows about it as he does not hide it — because he can’t get himself too. So as with the marriage and first pregnancy of Demelza, the films turned into something far more melodramatic and simple a sequence of adult experience.

The point I want to make about Ross’s one night with Elizabeth is its ruthlessness as an action, and ambiguity as a non-ethical violent act, however made understandable and mitigated by the past, present circumstances, and how it’s presented. As a reader who sympathizes even intensely with Ross (and equally Demelza), I want to exculpate him, and know that in my presentation of his heading the riot on the beach (for in some sense he did and it’s not clear he didn’t start it) where he and other men seized two incoming ships, fleeced them, and reveled in the exhilaration of the moment, I had an urge to make his role less instigating, dominant, and (as in the courtroom his defense attorney did) kept alive in my narrative how when he saw the action turning into wanton destruction and murder, he turned round to invite the militia (then in danger) to his house. All the while he let everything started up take its course, and even if new groups of men had come in (miners mostly) who he could not have controlled, his hospitality and later return to as benevolent landowner was an evasion.

So too here. In the film, Ross receives Elizabeth’s letter and is so enraged, he flees his house, finds a horse, makes his way to Trenwith, and upon finding the house locked for the night, climbs onto the roof, across the siding and into a window, and without much more ado than an initial face-to-face shot, rapes her. Or so we are to understand. The screen goes dark and he is next seen in the morning returning home to a Demelza who knows where he has been, as much because he then sleeps downstairs, does not go up to their room where she’s laying, baby Jeremy not far off.

That is an accurate outline of what happens — except the letter Elizabeth sends is much more apologetic in the novel. In the film she lashes out at conventions and says she is marrying George for money and power; she has been and continues to be selfish; she did not marry Ross because he had nothing and Francis was the heir to a gainful property at the time, and refuses explicitly to make moral excuses about her son. We know she dreams of going to London for she says so to George who plays along (pretends he is considering it). I doubt she’s have done that realistically . It’s an anachronism like having Demelza pregnant before marriage in the film (not so in the book) and having her claim she doesn’t know who the father is and not be judged harshly adversely as she would certainly have been.

IN the letter in the novel Elizabeth details what we have seen happening towards the end of Jeremy Poldark and the first 3/4s of this novel. In 5 years she’s been out barely 5 times; she is now living in poverty even if the 600 was returned to her (by Ross); she is beset by creditors, by the trouble of keeping up this huge house, by the problem of what to do about Geoffrey Charles’s education, by all sorts of hard-to-do even impossible to do stuff. And we see in the novel she is fooled by thinking that George is marrying her just for herself, does not know he does it to revenge himself ultimately on Ross: as her husband, he becomes the head of Trenwith, takes over Francis’s place. Graham makes this hypocrisy burningly evident in the narrator’s discourse.

Plus three different long conversations are omitted. Ross does indeed climb into Elizabeth’s room, but then they proceed to talk. This talk taking us back to her original motivations for marrying Francis, her boredom and despair, that she didn’t love him and he knew it (part of his reason for wanting to kill himself), and these long 5 years of an abyss of anything to do, anyone to talk to but Aunt Agatha, makes her marriage understandable to us and even to Ross, but it does not make up for his drive to possess her sexually and his intense frustration. He did think by giving her that 600 he would be a kind of alternative husband. He tells her she should have come to him for all these troubles and he would have helped her find another husband. The novel doesn’t make any or much of his motivations explicit (because they are not conscious with him) but we doubt he’d have found her another husband.

What the film series did was take this long talk turn it into a series of scenes which are interwoven in Season 1 throughout. In Season 1 Ross’s love and lust or urge for Elizabeth begins quite early in his marriage and carries on until this night together. In the novels, it is not evident until he and Demelza visit Francis and Charles on the second Xmas when Elizabeth makes it clear for the first time she would perhaps be willing to go to bed with Ross (over the dishes near midnight) and he responds and would have done “it” there on the floor with her, but that she held back, backed off, fled the room (in Jeremey Poldark). By threading this material throughout the film series, that makes the film series far more coherent, dramatic, psychologically modern, for Demelza knows, is hurt, feels herself someone who was simply felt sorry for and is a barrier. In the novels Ross and Poldark have a period of real euphoria, and his marrying her, giving her his name, is part of his rebellion against his class, and rank and is felt that way — not in the series (which reflects 1970s attitudes).

This reminds me of how long inset histories in novels are often taken to make scenes much earlier in film adaptations nowadays so socially unacceptable materials kept as back-stories in the older books become front stories in the films.

While this conversation cuts against the idea of that the man just went in there and raped this woman as a revenge on her, on George, and on the world for not giving him what he wanted, it is still (I think) a rape because Ross is forcing himself on Elizabeth as far as the scene goes, for as he begins to see she is not going to be persuaded not to marry George, he grows very angry, and he begins to become sexually aggressive in a cruel way, and she tells him he is “contemptible”. As he carries on, and it goes back and forth, she says as she can’t help marrying George, so

‘I can’t help this either.’ He kissed her. She turned her face away but could not get it far enough round to avoid him.
When he lifted his head, her eyes were lit with anger. He’d never seen her like it before, and he found pleasure in it.
‘This is – contemptible! I shouldn’t have believed it of you! To force yourself … To insult me when – when I have no one …
‘I don’t like this marriage to George, Elizabeth. I don’t like it! I should be glad of your assurance that you’ll not go through with it.’
‘I’d be surprised if you believed me if I gave it you! You called me a liar! Well, at least I do not go back on my promises! I love George to distraction and shall marry him next week-’
He caught her again, and this time began to kiss her with intense passion to which anger had given an extra relish, before anger was lost. Her hair began to fall in plaited tangles. She got her hand up to his mouth, but he brushed it away. Then she smacked his face, so he pinioned her arm …
She suddenly found herself for a brief second nearly free. ‘You treat me -like a slut-’ ‘It’s time you were so treated-’
‘Let me go, Ross! You’re hateful — horrible! If George –’
‘Shall you marry him?’
‘Don’t! I’ll scream! Oh, God, Ross … Please .. .’
‘Whatever you say, I don’t think I can believe you now. Isn’t that so?’
‘Tomorrow-’
‘There’s no tomorrow,’ he said. ‘It doesn’t come. Life is an illusion. Didn’t you know? Let us make the most of the shadows.’
‘Ross, you can’t intend … Stop! Stop, I tell you.’
But he took no further notice of the words she spoke. He lifted her in his arms and carried her to the bed.

Curtain down. This idea men have “it’s time you were so treated,” as if they are doing the woman a favor by abasing and punishing her.

The next scenes take place at Ross’s house and we are in Demelza’s mind as she watches him. She does misunderstand. She thinks he does not love her, she worries he is thinking of leaving her. He is unwilling to talk about what has happened, and tries to pretend nothing important has. She won’t let this happen and asks him, “‘It won’t be the last time, will it?’ He didn’t speak, but looked down at his pate and pushed it away.” (p. 318). “‘Is their [George and Elizabeth's] wedding to go on?’ ‘I don’t know …” His scar is “noticeable this morning” She asks if Ross will see Elizabeth again, “‘I don’t know.’” What time did he get back? Around 5. He then tries small talk about ribbons for Jeremy, his plans for the day, political news. She spills her tea. “Blazing frightening” anger is what she feels; she wants to kill Elizabeth.

Demelza agrees to go to a party she knows he’d never go to: local landlords, the upper class, one Elizabeth and George will be at: given by one of the men chasing her, Sir Hugh Bodrugan, there is no danger of her taking up with him (old, stupid, lecherous), but once she is ensconced in her bedroom, the music of the dance playing, we are told is “Coming along the path towards the house was Malcolm Neil of the Scots Greys.” McNeil had told since returning to the area after the trial that he did take his men off watching the house less than 18 hours later — he could have kept them there, that would have caught Ross is what he is saying, and he did it for her.

In the fiction (not anachronistic in an obvious way like the film) she does still intensely love Ross: we are told because he took her in at age 13, was “one step more than husband to her … represented a kind of nobility, not of birth, but of character, a person whose standards of behavior always were, and always would be, slightly better, surer than hers” (p. 316). That no longer holds, quite, but his rank and her place do. Still she is incensed, and has become unsure of what is to come, what is what.

Ross does not appear to think about what happened at the ball to Demelza (if she went to bed with McNeil) but she does. He just doesn’t think about her world view except as his wife. In the 1950s/60s way she despises herself for not having gone to bed with McNeil. She sees herself as having reneged on him, having played games with this man when she didn’t mean to, but she also didn’t mean to become his lover or mistress. She is angry with herself for her tie to Ross.

******************
Book Four, June 20, 1793 (date of George and Elizabeth’s wedding)

Ross and George Warleggan’s last confrontation: George needles Ross with the fine madeira in the house (Trenwith) of which he is now master (1 Poldark, Part 16, Episode 4)

Ross has accused Warleggan of destroying the old community with his enclosures, firings, rentracking, and Warleggan counters with accusing Ross of fleecing Geoffrey Charles, using Ross’s taking of the old mine when he gave Elizabeth the 600 pounds

Summary of Book:

Chapter 1: The wedding and George does not at all keep his word in any way. The allied armies have not yet taken Paris. Ross and Demelza not sleeping together. September 1793 George and Elizabeth move to Trenwith and he undertakes extensive repairs. Verity’s letter: the wedding, how much money spent, and Elizabeth is with child. He cannot bear the idea of them living there, it comes out the Wheal Leisure mine has much more of a lode than they dreamed. Riches. Of course the fairy tale must help now. Dr Sylvane calls in Dwight to help with Ray Penvenen.

Chapter 2: Dwight finds Penvenen creating a relationship; George and Ross’s exchange of letters; the scene where George accuses Ross of deliberately buying Wheal Leisure as a rich mine to grab it from a helpless widow when it was that he gave the 600 he needed so desperately. Warleggan will contest the ownership of the now rich mine. With Mr Chynoweth there, they accuse Ross of cheating his ward (Geoffrey Charles). George insults Ross once too often: “Go back to your scullery maid.”

Chapter 3: Jeremy needs to be near Demelza to thrive; Ross home with wounds, he and George fought so hard they almost destroyed the parlor itself, certainly many things in it; Elizabeth upstairs all the while. But he will not give up this mine; George has taken too much from him already. He looks about their house and decides it’s time to make it not so poverty-stricken. A fortnight passes. We are probably in October.

Ross to Pascoe to talk about repaying money and discovers patroness was Caroline. They go shopping, happy trip, ride back together, Demelza says he should repay Caroline by trying to get her and Dwight together, home, affection growing, of course she care; he feels he could go to bed with her, but there is that amount of resistance he decides to put it off, but she has strong feeling in her again for him

Chapter 4: Dwight’s appointment aboard a ship as surgeon (like Jeremy goes to military service). Ross to London, execution of Marie Antoinette (Oct 16, 1793) . Caroline looks ravaged; they grow as people alike who understand one another on class and personal level; talk of what happened, she felt Dwight looked upon what he was doing as shameful; Keren to her was someone in the past; does Ross know what it’s like “when your anger and bitterness are so great that you can only hurt yourself — and go on hurting yourself for ever and ever, so that it seems there’s no escape” (p. 426)? Just the case of Ross and Elizabeth. She says she will not go back; he says she has until Thursday.

Chapter 5: Demelza and Garrick on Trenwith land are accosted by Warleggan’s henchman and she could have been killed, the dog is hurt and she nearly so. In London Ross sees Dwight, Ross brings them together, Caroline does say “the people who come off worst are the people who draw back at the last moment and spend their whole lives regretting it” (p. 439). And yet she walks out again.

Chapter 6: Christmas Wednesday; Ross still not back the next Tuesday (7 days later), January 1, 1794. The story of Garrick and the trespass told him. Then we move to Trenwith and Elizabeth and George: she does not love him, he treats her as a prize possession. She finds she cannot handle or understand him as she did Francis. Ross shows up to demand they be careful of hurting his wife and actually start some reconciliation but discovers that Elizabeth now hates him and it is too late from the ninth of Mary when he had left the situation as it was. And indeed he did desert her, a pregnant woman.

Chapter 7: The quiet close. Dwight and Caroline now there together, he saying she “disguises her goodness as if ashamed of it.” The last talk between Ross and Demelza. She is talking of Elizabeth from a woman’s point of view; he says he does not want to discuss his adultery; they try to talk of it and fall to quarreling (does he want her to get MacNeil for her?). It’s the 7th Christmas of their marriage (married June 24, 1787) It does not help to talk we discover; we will rediscover this when she has her liaison with Hugh Armitage. The novel ends in a moment of truce.

There is a problem in responding to the book the way we are intended to. It’s both too close to us in time (1953) and too far (more half a century ago as I type this).
By cutting off the rape scene from our regard (in the way of middle class novels of the era), what happened is not shown. But as the story progresses, we see that while it’s clear Ross is not leaving Demelza, had he been able to get himself to visit Elizabeth on the next day or a couple of days thereafter there might have been no marriage to George. Elizabeth is waiting for him to return but too proud to call for her or send any kind of sign. So Elizabeth did acquiesce later in the night. But Ross never meant to leave Demelza. He wants both women and cannot have that.

He cannot see that Demelza has become distrustful of him, and only Elizabeth’s marriage to George and then time begins to persuade her that Ross loves her and wants the marriage to continue and supports it utterly.

In the next scene with George (dramatized after Ross and Demelza’s first morning after his night with Elizabeth and their conversation whose motives I just characterized above), Elizabeth tries to weasle out of the marriage. She wants a postponement. She too is hampered by conventions: she would have to break the engagement and admit to this man something of the reason why, and he intuivitely immediately leaps to the idea it’s Ross. He wants to marry her precisely because he thinks Ross is his rival. He manages to first soothe her (which Ross doesn’t do for anyone much, including himself), then fool her, and get her to agree to a marriage a month later. He promises a tiny affair. In fact we see he begins to renege on all his promises. It’s a huge affair. He said they would live at Cardew, his house, when he moves into Trenwith, the Poldark residence. This infuriates Ross as much as his taking Elizabeth. It’s a matter of his status, family place, pride, something not middle class or bourgeois, but stemming from an older aristocratic heritage: it was this that ruined Francis to some extent, and stands in Ross’s way again and again. We know that Aunt Agatha is not in for a good time, for we have seen how spiteful George can be to her.

I called this Ross’s rage because in some real sense the night with Elizabeth was rape as it emerged from rage, and this rage erupts again. I did love how in the scene with Elizabeth in the book Ross said: ‘It doesn’t come. Life is an illusion. Didn’t you know? Let us make the most of the shadows.’ Francis’s life thrown away; the money given to Elizabeth and the money Francis gave him all lost to no good purpose, and the events of the past nights and days (including the ones with Elizabeth and the ones without Demelza) embittering.

This time after the marriage, George sends a letter by attorney to Ross asking him to come and discuss financial matters. Ross has to come to Trenwith. There is a repeat of this in Season 2 (perhaps from Black Moon). When Ross gets there, Elizabeth does not come down although Ross wanted to deal with her. George has taken over and sends a message from Elizabeth she wants to see Ross no more. This is believable: she does dread Ross for he tells hard truths too. The scene in Season 1 from Warleggan that ensues is George needling Ross when he discovers the 600 Ross gave Elizabeth back, and his attempting to cheat Ross once more. Ross’s tin lode is beginning to produce money and George is a cutthroat capitalist. The two begin to argue and George sneers at him to go “back to his scullery maid.” Meaning Demelza.

Ross loses it, and there ensues a physical fight where the new fancy furniture (Ross noticed) in the room and two windows are badly damaged. So too George and Ross until hired men come and throw Ross out.

He then returns home, to Demelza, and what the late chapters in Book 4 show is them gradually coming together again, very slowly. She rushes to him to help him as he is badly wounded and hurt. And they get into a talk. They don’t exactly discuss their motives directly but through discussing Enys’s failed romance with the upper class Caroline. We have a scene where they go shopping together with the new found money — yes you could say begin to become middle class, but it’s more out of personal pride. These are probably modern feelings put into a historical fiction but they resonate with modern readers. They feel good bringing home their stuff. They talk again. Does he want her to stay? yes. She wants to stay. A visit to Pascoe had brought out the information it’s been Caroline Penvenen who gave them the important loan which enabled them to continue. So they agree he should go alone to her to talk of what to do now — in London.

When he returns he and Demelza have another talk. In this one they quarrel first: she is looking at the night’s sex from a woman’s point of view; he as the man who does not want his intimate life undignified. He grows angry and jealous when she brings up MacNeil. They are getting angry and getting nowhere and stop this talk.

The scene ends thus: He says again she should come to London; he would show her London, she could stay in the inn:

‘You could stay at the inn while I went to see her.’ ‘No. This time I’d rather not.’
He had moved a little closer to her. ‘Demelza.’ ‘Yes.’
‘There have been a lot of unhappy things between us in these last months. Not said – but felt. I should be glad to think they are all forgotten.’
‘Of course, Ross. I feel nothing now.’
He put his face against her hair. ‘It is not nothing that I want you to feel.’
‘I’m sorry .. .’
They stayed thus for a moment more. Although unable to feel any tautness within her, he knew it was there. He had not removed it, he had not defeated it. He knew he could take her if he wanted, and her resistance would only be token; yet the token was there, and while it existed the reconciliation would be ashes.
He kissed her abruptly on the hair, released her, went across to the north window, and pulled aside the curtain to look out. Her eyes followed him.
He said: ‘Perhaps you’re right; we don’t ever regain
what we lightly lose.’
‘I don’t think ’twas lightly lost on either side.’ ‘But lost,’
‘Well .. .’
It was so dark outside he could hardly see the sea.
‘And lost to no good purpose,’ he said, half speaking to himself.
‘That I don’t know.’
‘Oh, there was a purpose, a good purpose served, if you come to think of it; though perhaps you would not agree. I don’t know … I have not wanted to talk of it.’
She stood by the cot watching him.
‘Perhaps sometime it will have to be talked of,’ he said. ‘if we are ever to straighten this out between us. Yet I have a prejudice, a feeling that it is a bad thing .. .’
‘What is a bad thing, Ross?’
He turned from the window, let the curtain fall from his long fingers, said wryly: ‘I think there is an etiquette even in adultery, and I cannot bring myself to discuss one woman with another, even when the second happens to be my wife.’ .
‘You don’t suppose 1 should want to hear it?’ ‘Yet it might not displease you.’
‘I can’t see how it would be likely to please me.’ ‘Then you are less perceptive than I suppose.’
“Tis very likely.’ .
There was another pause. Ross came slowly back from the window and after a moment’s hesitation bent and kissed her on the lips.
‘Yes, it is very likely,’ he said, and went out.
She did not move for a time. Jeremy’s breathing was a. little more hurried now, as if he were dreaming. She turned him over expertly, firmly; as if knowing the touch of the familiar hand, he settled more comfortably after it.
She straightened up and went to the window herself There were movements of warmth in her heart where she had not expected to have feeling again.

In fact her trip to London (which she finally undertakes in the end of the trilogy is a failure for her and him (see Angry Tide).

Ellen

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