Wearing Life but as the fashion of a hat

Every once in a while I find that I am confronted by an idea which, even were I to have thought of it first, I would have put aside as of little relevance -or worse, of little consequence.

Clothing, has always been one of those for me: it’s something you wear, not something you are. And despite the desperate claims by Fashionistas that it reflects an inner self -or at least would, if you let it- I’ve always found the argument largely specious, and to reword Samuel Johnson’s quip about marriage, is a triumph of hope over expenditure.

And yet, I was drawn into an essay about clothes -albeit reluctantly- written by Shahida Bari, a lecturer in Romanticism at Queen Mary University of London, for Aeon. https://aeon.co/essays/why-does-philosophy-hold-clothes-in-such-low-regard?

I have to admit the article was not at all what I expected: I was neither deluged with praise for couture, nor subjected to shaming for my sartorial insouciance. At first, I was merely confused by her fascinating ruminations about clothes: ‘Ideas, we languidly suppose, are to be found in books and poems, visualised in buildings and paintings, exposited in philosophical propositions and mathematical deductions. They are taught in classrooms; expressed in language, number and diagram. Much trickier to accept is that clothes might also be understood as forms of thought, reflections and meditations as articulate as any poem or equation. What if the world could open up to us with the tug of a thread, its mysteries disentangling like a frayed hemline?’ What an utterly fascinating thought that what we wear is not merely a passive display, but has a voice of its own.

‘What if clothes were not simply reflective of personality, indicative of our banal preferences for grey over green, but more deeply imprinted with the ways that human beings have lived: a material record of our experiences and an expression of our ambition? What if we could understand the world in the perfect geometry of a notched lapel, the orderly measures of a pleated skirt, the stilled, skin-warmed perfection of a circlet of pearls?’

Do you see why I kept reading? The very idea that clothes have agency in and of themselves is powerful. She goes on to observe that ‘clothes are freighted with memory and meaning… In clothes, we are connected to other people and other places in complicated, powerful and unyielding ways, expressed in an idiom that is found everywhere, if only we care to read it.’

Bari seems to understand that ‘for all the abstract and elevated formulations of selfhood and the soul, our interior life is so often clothed… The garments we wear bear our secrets and betray us at every turn, revealing more than we can know or intend.’

But we cannot hide in clothes -as the poet Kahlil Gibran observes, ‘Your clothes conceal much of your beauty, yet they hide not the unbeautiful’. And Bari goes on to suggest that ‘to entrust to clothes the keeping of our secrets is a seduction in itself.’ I would have thought that this alone would have been fodder for the Philosophers, but as she goes on to explain, ‘the discipline of philosophy has rarely deigned to notice the knowledge to which dress makes claim, preferring instead to dwell on its associations with disguise and concealment.’

She seems to think that Plato had something to do with Philosophy’s aversion to treating clothes as a worthy adversary. ‘Haunted by Plato’s anxiety over how to distinguish truth from its ‘appearance’, and niggled by his injunction to see beyond an illusory ‘cave of shadows’ to a reality to which our back is turned, philosophy’s concept of truth is intractably aligned to ideas of light, revelation and disclosure.’

Still, in fairness, she turns her spotlight on various other philosophers and notes that although appearance has always been a fair topic for discussion, it has rarely concerned itself about physical appearance or dress. And yet, after a tedious, albeit poetically expressed, litany of the views on clothes of characters, both fictional and academic, she concludes with a one sentence précis that I think might have made her point much sooner: ‘Philosophy might have forgotten dress, but all that language cannot articulate – the life of the mind, the vagaries of the body – is there, ready to be read, waiting to be worn.’

I did enjoy her metaphors and evocative language, and I have to admit that, until the latter half of the journey, I was swept along quite contentedly in the current of her thoughts. It reminded me of a recent conversation of two women, both laden with large cloth bags who plonked themselves down beside me on a couch that break-watered the teeming throng of shoppers in a downtown mall. Both were middle-aged, and both spread themselves out as if I wasn’t there.

I’m not keen on being jostled on a seat, and was about to launch myself into the chaotic tide of passing elbows when I saw the woman next to me pull some garish fabric partly out of her bag to show it to her friend.

“What d’ya think Jesse?” she asked, stuffing whatever it was back in her bag once Jesse had seen it.

Jesse looked frazzled by the crowds, and her once-coiffed, greying hair floated in little strands from her head while her eyes stayed anchored on her face. “Colour’s interesting, Paula…” she said, after a noticeable pause.

“It’s a statement, Jess…” She relaxed her buxom frame further into the couch and settled an elbow into my rib without seeming to notice the infringement. “I think it’s time people noticed me.”

Jesse blinked and a weak smile surfaced on her lips for a moment. “I don’t think you need the hat, dear,” she added, as tactfully as the situation allowed.

I could see Paula’s eyes harden, and then the pressure on my rib cage lessened briefly as her hand searched for a pocket in her incredibly wrinkled ankle length coat for a Kleenex. She blew her nose untidily and then tried to stuff what was left of the tissue back in the coat somewhere, and her elbow back into my side. “What are you saying, mirror-child?” she shot back. Clearly they were both tired, but I was beginning to enjoy the exchange.

“Just that you don’t have to wear a sign to attract attention…”

Paula’s face somehow retracted further into itself and her eyes peered out through the bars of their lashes like caged animals. And then, just as suddenly, her expression softened, and she shifted the position of her elbow again. “Oh, you mean that blouse, I bought…?” A smile darted onto her lips and stayed there like a runner that had made it safely to second base. “It’s really more me, isn’t it?”

Jesse’s eyes twinkled mischievously as she nodded. “But I don’t think you should wear them together, do you…?”

I could feel, as well as see Paula sigh. “You’re right, dear,” she said, as they both struggled to their feet. “I’m someone else with the hat on, aren’t I?” Another smile surfaced briefly, like a seal. “But it’s always nice to have a choice, Jess,” Paula added, hefting her bag onto her shoulder. Then pulling her friend with her free hand, they both stepped into the ever-passing flood like branches falling together in a river and were swept away.

I think you learn a lot about philosophy in malls if you’re patient…

Let No One Put Asunder

At my age, I suppose I should have learned to expect the unexpected, to revel in the entrepreneurism of a new and alien generation, and to wonder at its ability to see opportunity in the predicaments of others. But then again, why not? Isn’t that what lawyers are all about? And doctors…? Where would we be without predicaments?

Alright, I accept that the approach may seem cheeky, or even downright calculating, but I have to say I sometimes admire the attempt –a Swedish hotel chain is ‘offering a refund to couples who get divorced within a year of staying at one of its places.’ http://www.bbc.com/news/blogs-news-from-elsewhere-39382059 The idea being, apparently, ‘to encourage spouses to spend time together and work on their relationship’. And so, ‘It’s offering a “relationship guarantee” on mini-breaks at its hotels, so if things subsequently don’t work out and the marriage ends within a year, then the chain says it will reimburse the cost of a two-night stay’.

Of course, they’re not fools; nobody wants to be taken to the cleaners -they’re out to make a profit and, perhaps naively, figure that those who decide to vacation together for a while might not be that close to the brink. And, naturally, ‘There is some fine print: couples must be already married, stay in the same room and reference the relationship guarantee when booking. If they subsequently divorce and want to claim a refund, they have to submit court documents as evidence’.

I don’t know… At first glance, it might seem that they’re either very naïve, or really convinced they have an effective therapy -I mean, the divorce to marriage ratio in Sweden (2010, at least) was 47%. On second glance, however, the marriage rate in Sweden according to Eurostat Demographic Statistics –OECD Family Database (2014)- was only around 6 per 1000. So who, exactly, is sufficiently wide-eyed not to notice they may be on to something? I’m reminded of most private insurance agencies who offer great deals as long as you are low risk and have no major ongoing disabilities.

But it speaks to something larger, I think: the institute of marriage itself. Marriage is something which is incredibly difficult to define. In its simplest form, it is an officially sanctioned union between two people that affords legitimacy to any offspring and entails certain rights and responsibilities -and these vary from one society to another. In Western cultures it has been the religious –or secular (usually governmental)- authorities that are required to sanction and guarantee those issues. But in other societies, families, traditions, and deeply held beliefs often prescribe the boundaries, duties, and also the rights of each person in the relationship. Hence the cross-cultural misunderstandings and misgivings. We tend to ascribe the most legitimacy to that of the society in which we were raised.

Guilt, is not imposed, by and large, it is acquired -usually at a very early age- by deviating from the expectations of those we love and trust: our family, and immediate friends, bonds that link intimately with cultural and, often, religious beliefs. Sexual mores and intimacy are no exception -in fact, they are often the incentives offered by matrimony.

But marriage is becoming more popular recently, even in Sweden, with the ongoing influx of migrants from other cultures who were raised with different familial and religious obligations to which they feel they must adhere -obligations which may not be as easily dissolved, or as readily ignored as in the host country. After all, ‘Marriage is a matter of more worth than to be dealt in by attorneyship’ according to Shakespeare.

So is the hotel chain actually reading those trends, too? And are there other conditions –loopholes- that are not immediately apparent in their advertisements? Fine print? Exceptions? I don’t know, but I certainly wish them well. It’s a gamble on their part, to be sure… But I think I’d put my money in real estate, frankly.

Perhaps I’m just being far too cynical, though. Far too… divorced –there, I said it- but I’m willing to bet that they haven’t read the famous definition of how realistic are the expectations of marriage by none other than George Bernard Shaw in his preface to ‘Getting Married,’ 1908: ‘[W]hen two people are under the influence of the most violent, most insane, most delusive, and most transient of passions, they are required to swear that they will remain in that excited, abnormal, and exhausting condition until death do them part’.

Pick your side on divorce and marriage, but they do seem to follow each other around and around like a tail the dog. I have to say, part of me is tempted to quote Samuel Johnston’s sarcasm (out of context) on the hotel chain’s promise -that it’s ‘The triumph of hope over experience’. And yet, when I stop to think of it, why not credit them with the courage of their conviction? Why not Alexander Pope’s ‘Hope springs eternal in the human breast’…?  After all, that’s what they’re trying to accomplish in those couples who stay with them… And that’s what we all hope for, isn’t it?

 

 

The Caesarian Path

The Caesarian section has a fascinating, if largely apocryphal history. In all likelihood it was probably a procedure of last resort to save the unborn child when its mother was already dead or near death. That the famous Julius Caesar –like Shakespeare’s MacDuff- was ‘from his mother’s womb untimely ripped’ seems unlikely, however appealing the etymology. In fact, the name may well derive from the Latin verb ‘caedere’ –to cut- and hence the cognomen (originally a nickname). Pliny the Elder, according to Wikipedia, ‘refers to a certain Julius Caesar (an ancestor of the famous Roman statesman) as ab utero caeso, “cut from the womb” giving this as an explanation for the cognomen “Caesar” which was then carried by his descendants.’

At any rate, before the days of appropriate antisepsis let alone adequate analgesia, the survival rate for both the mother and baby would have been dismally low. And despite isolated reports of its use throughout recorded history in such diverse countries as India, China, and even Babylon, it was always a procedure of desperation. A triumph, as Samuel Johnson once wrote in another context, ‘of hope over experience.’

Unfortunately it has now become merely a triumph of experience -a default position assumed at what seems to be the slightest provocation. The fact that it is an operation that can be booked in advance under some circumstances, and therefore superimpose a degree of predictability on the scaffolding of the anticipated chaos of labor, has been seen as desirable in some quarters. And in fairness, there are those for whom labor carries undue risks for either mother or baby and its avoidance would be prudent if not lifesaving. The issue, I think, is in the interpretation of risk.

The other, perhaps more problematic concern, is that of choice. At least in a system of limited resources, or one in which the public purse is providing medical coverage, one could ask whether an elective Caesarian section for no other compelling obstetrical reason than patient choice, is a sustainable option. Or even a desirable one.

So, what about in a user-pay system? Is it merely a matter of supply and demand: build more hospitals to accommodate the needs and whims of those who can afford them? Is that an efficient use of their resources? Is it even an ethically defensible position? The matter has finally prompted the Brazilian government to wade in, as an article in the July 7/15 BBC news reports: http://www.bbc.com/news/world-latin-america-33421376

Of course, there are many reasons for elective Caesarian sections –some of which are the result of previous and unsuccessful attempts at vaginal delivery that necessitated Caesarian deliveries at that time. The desire to avoid a similar and frustrating trial of vaginal delivery is certainly understandable –if not always necessary- under those circumstances. These are the so-called elective repeat Caesarians. Others, as I indicated, are obstetrically mandated because of developing or pre-existing risk factors –once again, hard to argue against. There is an interesting and informative article that attempts to put the Canadian experience (2007-2011) into perspective –a classification system (the Robson Classification System) that can be used to make international comparisons in Caesarian section rates: http://www.jogc.com/abstracts/full/201303_Obstetrics_1.pdf

But getting back to the situation in Brazil. As the BBC article suggests, ‘Eighty-five per cent of all births in Brazilian private hospitals are caesareans and in public hospitals the figure is 45%’. And the new government rules ‘…oblige doctors to inform women about the risks and ask them to sign a consent form before performing a caesarean. Doctors will also have to justify why a caesarean was necessary. They will have to fill in a complete record of how the labour and birth developed and explain their actions.’ That they may not have been doing this routinely before is troubling, to say the least.

Also, ‘Each pregnant woman will now be assigned medical notes which record the history of her pregnancy, which she can take with her if she changes doctors.’ I would have thought this practice would have been universal and intuitive -without the need for a government fiat.

But, as worrisome as all of this seems, there is another, perhaps more subtle pressure on the woman to opt for a Caesarian delivery in Brazil: ‘Women who want to give birth naturally in a private hospital have reported finding all the beds are reserved for scheduled deliveries. There have been numerous reports of women going into labour without a caesarean scheduled and being forced to travel from hospital to hospital in search of a bed.’ And as Pedro Octavio de Britto Pereira, an obstetrician and professor at the Federal University of Rio de Janeiro, said in an interview with BBC Brazil last year, “The best way to guarantee yourself a bed in a good hospital is to book a caesarean.”

Of course the blame does not wholly fall on the medical profession there –nor even, perhaps, on their preferred management strategies in pregnancy. ‘Researchers say many women also see caesareans as more civilized and modern, and natural birth as primitive, ugly and inconvenient. In Brazil’s body-conscious culture, where there is little information given about childbirth, there is also huge concern that natural birth can make women sexually unattractive.’

It is always dangerous to judge another country and another culture by our own standards. Our own sensibilities. And yet the risks are transnational and universal. They do not disappear simply because of a differing national mythos. Surgery is surgery; complications are inevitable co-travellers with it in spite of all precautions, and good intentions -the hidden, unwanted occupants of every operating theatre. And while we may never be able to stem the tide of primary elective Caesarians –even education on the subject has challenges overcoming fear or fashion- we may be able to convince women that their choice does not come without baggage. Unintended risks. To journey through a new geography, it helps to have thought about it first; planned the route to avoid unnecessary problems; consulted a knowledgeable guide –someone who will travel along with you. And remember what Seneca wrote: ‘Be wary of the man who urges an action in which he himself incurs no risk’.

The Body’s Clock

Scientists –well, all of us- have been suspicious about the health risks of shift work for a long time now. Perhaps there is a reason buried somewhere in our genes that suggests night is for sleeping and daytime for working. Originally, no doubt, it was because it was difficult to see things in the dark and lighting, even when it became available, wasn’t very good.

But there is another reason: the Circadian Rhythm (from the Latin circa –around, and dies –day) which is often defined as physical, mental and behavioral changes that follow a roughly 24-hour cycle, responding primarily to light and darkness in an organism’s environment. The body clock, in other words. And there’s the clue: light and darkness. These are not just elements in our environment that we have come to expect, they actually have a biological meaning for us although this is, to a certain extent, entrainable. Malleable. As Wikipedia (sorry!) puts it: The rhythm can be reset by exposure to external stimuli (such as light and heat), a process called entrainment. The external stimulus used to entrain a rhythm is called the Zeitgeber, or “time giver”. But it can take a while to adjust –think of jetlag, or sleep disturbance after starting a new shift at a different time.

The body can adapt to many things, no doubt; the problems seem to arise when the pattern keeps changing. As folk wisdom attests, we are inherently creatures of habit –acquired behaviour patterns that are repeated so frequently they can become almost involuntary. As no less an observer of folkways than Samuel Johnson once said: “The chains of habit are too weak to be felt until they are too strong to be broken.” So one might ask why we –and many other animals- seem prone to develop these routines, these almost unconscious ceremonies. Is it simply a need for predictability? Or is it something deeper, something tied to our evolutionary past..?

In our evolutionary development we obviously experienced disruption of light/dark cycles –they occur as we travel through the seasons- but these are gradual and steadily progressive; shift work –especially rotational shift work- is not. And only recently has it become more obvious that there may be a price to pay. There have been several studies that have looked at this in various ways, but ‘Although epidemiological studies in shift workers and flight attendants have associated chronic circadian rhythm disturbance (CRD) with increased breast cancer risk, causal evidence for this association is lacking’ as the abstract of a paper published in Current Biology noted. I saw this in a July 2015 article in BBC News reporting on a study co-authored by Dr. Kirsten Van Dycke which suggested that the chronic need to re-entrain the circadian rhythm because of changing light/dark cycles can increase the risk for both obesity and breast cancer! http://www.bbc.com/news/health-33569161 Now, admittedly, the study was done on mice who were prone to develop breast cancers anyway, but when the light/dark cycles were switched over a long period of time (‘Mice prone to developing breast cancer had their body clock delayed by 12 hours every week for a year’) they developed them sooner.

Humans are obviously not mice, but it is difficult to control for possible contributing factors in the average human study: ‘Several scenarios have been proposed to contribute to the shift work-cancer connection: (1) internal desynchronization, (2) light at night (resulting in melatonin suppression), (3) sleep disruption, (4) lifestyle disturbances, and (5) decreased vitamin D levels due to lack of sunlight. The confounders inherent in human field studies are less problematic in animal studies, which are therefore a good approach to assess the causal relation between circadian disturbance and cancer.’ http://www.cell.com/current-biology/abstract/S0960-9822(15)00677-6

And the conclusion from this study? ‘Animals exposed to the weekly LD [light/dark] inversions showed a decrease in tumor suppression. In addition, these animals showed an increase in body weight. Importantly, this study provides the first experimental proof that CRD [Circadian Rhythm Disturbance] increases breast cancer development. Finally, our data suggest internal desynchronization and sleep disturbance as mechanisms linking shift work with cancer development and obesity’.

This is worrisome, to say the least. One could certainly argue that a woman with an increased risk for breast cancer –say a heditarily aquired BRCA1/2 mutation- would be best to avoid jobs involving chronic irregular body clock disturbance such as flight attendants, commercial pilots, and so on. But I’m not sure the risk is confined to that population. What about others –especially if they have additional life-style risks such as smoking, diabetes, alcohol issues?

And what about men? If –as the study suggests- a chronic body clock disruption may cause a decrease in tumour suppression, would that not suggest a similarly increased risk? The disruption also seems to have an additional risk for increased weight gain –obesity. Is the risk for type 2 diabetes therefore also increased? Clearly this is an area requiring much more research -further elucidation of the mechanisms involved and mitigation strategies at the very least. Sleep is so important –regular sleeping patterns…

I can’t help but remember the words of Shakespeare’s Macbeth talking to his wife after he has killed Duncan, the king:

Methought I heard a voice cry, “Sleep no more!

Macbeth does murder sleep”—the innocent sleep,

Sleep that knits up the raveled sleave of care,

The death of each day’s life, sore labor’s bath,

Balm of hurt minds, great nature’s second course,

Chief nourisher in life’s feast.

Art, once again, anticipating Science…