The Moral of Pierre

I heard just a small bit of a story on NPR this morning about “crunch time” in family life, where working parents feel the pressure of getting their kids fed with a decent meal, finished with homework, and to sleep at a reasonable hour, and how exercise and play both tend to fall out of the picture many days.

The segment I heard featured a woman who talked about how she cried when she saw the NPR solicitation for the story on Facebook and another mother who talked about how she didn’t think this is what family life was all about. And then the experts came on and said, “Everybody knows what they’re supposed to do” (in terms of making sure kids get enough exercise and eat well to avoid obesity) and concluded that what we really need to do is figure out why so few people do what they know they’re supposed to do.

This is a fairly established line of expert reasoning in national discourse about issues that have been coded or marked as “public health” crises. Using a fairly narrow range of methodologies drawn from social science, particularly economics and social psychology, the experts verify first that existing forms of public education have been sufficient to establish baseline awareness of a public health problem that turns on behavior. Sometimes they read the evidence and conclude that the education needs to be in a different form or in a different location, or that more money needs to be spent on it. Usually that involves experts in the expert’s community of peers, if the recommendation is taken.

Sometimes (as in this case) the experts conclude that there is sufficient awareness, just not sufficient compliance. People aren’t doing what they’re supposed to be doing with the near-ubiquity that they ought to do it: not wearing helmets or seat belts, not quitting smoking, not taking a recommended pharmaceutical, not getting enough exercise, not minimizing their consumption of some kind of mass media, not following dietary recommendations, and so on.

Rarely if ever does the community of experts pause at this moment to inventory their own histories of error and exaggeration, or ask what the nature of their relationship is to the publics they advise and the resources they demand for the advising and studying of those publics. That alone might provide something of a testable hypothesis: that sometimes publics stall and defer on doing the things they ought to do because at least some of them are old enough to remember other things that they were told they ought to do that later on turned out to be not so important, or actively the wrong thing to do. Or that some of the advice turns out to be improvident or unrealistic in unnoticed or unacknowledged ways. Or that the experts are being impatient: on some issues, it turns out that people will change, if you just quietly keep working on the problem and don’t insist on changing your focus and approach every three seconds.

But the urgent rhetoric of many public health campaigns is a clue to a deeper problem. The rhetoric almost always calls back to a form of technocratic common sense. Ask an expert or government official: why should we wear motorcycle helmets? Lose weight? Smoke less? Use gun safes? Wear sun screen? The answer, often, is “so you won’t die earlier than you should, be injured far more severely than you would be otherwise, or injure others more than you might.”

All of which is often demonstrably true about the issues that have risen to the level of a general national concern or discourse. Though often the campaign to reduce death and injury stops short of an undiscussed political threshold where the competing good of individual freedom has a mostly unmeasured and unacknowledged weight in the conversation. You could reduce death and injury even more, for example, if you outlawed motorcycles and similar vehicles altogether.

The fact that freedom or autonomy sneaks into the discussion via the backdoor is a clue to the real weakness of a lot of well-meaning public advice. There is something still more important missing from the discussions started in this fashion. Namely, why should we care? Why do the experts care? What does it matter if some larger number of people die earlier than they would have on average, or are injured more often and in a worse manner?

The fallback answer embedded in most public policy is, “Because it costs us more money”, either directly in terms of treatment and other costs or indirectly in terms of lost or reduced productivity. That assertion, of course, sometimes kicks off the kind of further research that justifies the reputation of economics as the dismal science. In the terms of standard economics, it’s never self-evident that more injury or earlier death actually does cost more money. If I have to spend X amount of time washing my hands, exercising, cleaning all surfaces in my house and so on, and Y amount of money on vitamins and flu shots and Purell, maybe it turns out that the Z cost to my productivity of three days of flu is lower and I’m perfectly rational for taking no special measures to avoid flu. (Throw in for good measure that maybe being too aggressive at avoiding flu makes my immune system more vulnerable because it’s untrained.) (Also throw in for good measure the financial losses of a medical profession that has fewer flu patients to treat.)

Or maybe the math works out and yes, I should try to live a little longer and be injured somewhat less…in order to avoid costing society some slightly higher amount for my care or some fraction of lost productivity. And here we have arrived deep in the belly of the neoliberal whale, just in time to watch the experts and technocrats hand out machetes to we, the swallowed. If you want an explanation of the meanness of 21st Century American public discourse, for the fractures in the body politic, this will do as a starting place. “Get that guy to wear his helmet, because otherwise he’s going to cost you money.” “Get that woman to lose weight, because otherwise she’s going to cost you money.” “Hassle that couple because their kid plays too many video games and might slightly underperform in school and not make the contribution to net productivity that we are expecting of him.”

We are offered a thousand reasons to complain of other people’s behavior (and to excoriate and loath our own) on the grounds that it will cost us too much. That we should talk about what is good and bad, right and wrong, mostly in terms of the selfish consequences, or at best, in terms of the kind of closeted idea of a collective interest that neoliberalism dare not directly speak of–sort of the nation, sort of the economy, sort of the community, but really none of those directly or clearly.

What the experts generally rarely say is, “Because we care for one another, want the best possible lives for one another, and would not be deprived of each other’s company one moment sooner than we must”. Why does your mom tell you to wear a helmet and stop smoking and lose some weight? Ok, sometimes because of the ordinary psychodrama of family life and its little struggles for power, but sometimes, often times, simply because your mom or your dad or your kid or your friend loves you. Because they value you.

This humane sensibility drops from public policy and technocratic expertise because, for one, we’ve become profoundly unpracticed in its use.

For another reason, because it’s harder to just keep hammering at some change in an inflexible and unreflective way. When I was in seventh grade, I once screwed up my courage to tell my intelligent, sensitive, very queer, 50-something chainsmoking English teacher that he should stop smoking. He winced, teared up a bit, thanked me for caring, and said, “But darling boy, I think it would hurt me worse at my age to try and stop”. Which at seventh grade I was not prepared to understand, but now I can. When we care about others, we also know that there are reasons why they ride motorcycles without helmets or serve chicken nuggets three times a week, reasons that are profoundly built into their specific humanity or are at the least not really worth the harm and cost of the persistent harassment that might push a change in habit.

Which is another reason the technocrat avoids this mode of argument. Because to see people in this way is to be seen. If it’s about the empirical evidence and the abstract costs of acting or not acting, the expert can stay invisible and outside. But when we sit down to persuade through love or affection, we are naked and vulnerable ourselves. Our bodies and habits are as seen as those we are looking upon. The worst of all worlds is the person who borrows the grandiose certainty and intensity of public health and imports its rhetoric into more intimate kinds of observing and commenting upon others. There is no surer recipe for a flame war between “mommy blogs”, for example, than one blog attacking another’s vision of parenting in this kind of olympian voice, where the critic’s own family life is off the table and beyond the gaze.

But ultimately, if I had to put money on which kind of discursive approach most powerfully gets at the issues and changes that matter, I’d put my money on caring for one another. “Stop costing me money” in a society that also protects the autonomy of individual choice is a perverse and counterproductive angle of approach: it makes me want to do more of whatever that is up until I’m not allowed to any longer. It is, ultimately, the voice of the Boss, and at least for now, we can still say, most of the time, that the experts and the government and the human resource specialists and the doctors are not the Boss of Me. Small wonder that many policy wonks and technocratic experts flirt so relentlessly with prohibition and restriction as the big stick behind the soft talk.

Maybe the greatest reason that a neoliberal society doesn’t choose the route of caring and cherishing is the further obligations we might incur down that road. We might have to become far more subtle and careful about our entitled and dismissive readings of the ethical content of everyday life–and we might eventually have to do more than ask people not to do something.

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11 Responses to The Moral of Pierre

  1. Thinking about how I structure classes, in this same light, to highlight and even force “good study practices” by students instead of giving them choices about how to structure their time and attention. They make those choices anyway, as it turns out….

    [p.s. Vaccines don’t, as far as I know, leave your immune system ‘untrained’; quite the opposite. It’s overuse of antibacterials that’s associated with increased vulnerability]

  2. [Yeah, I didn’t mean vaccines: I meant general hygienic measures–e.g., the theory that some exposure to illnesses in general is important for training immune systems.]

  3. David Chudzicki says:

    The silliness of the “costs” justification really shines through if you ask “Does this ‘bad behavior’ actually cost us less because these people die earlier, drawing less retirement funds and less public health spending in old age?” as in this analysis of obesity:

    Makes it really clear that “costing us” isn’t really what we (should) care about.


    Evidence that lack of sunlight contributes to heart attacks, and it’s sunlight on the skin and not mediated through vitamin D.

    The lecture is by a dermatologist who’s not so sure any more about the advice he’s giving about avoiding much exposure to sunlight.

  5. nord says:

    This is why economists have moved to choice modeling and nudging:

    I certainly am better off if all of you save more, eat less, drive less, etc. if I can encourage you to make those tough decisions, it makes the costs of me not doing them less…

  6. LFC says:

    The problem with the smoking example in this context is that nicotine is an addictive drug, whereas e.g. riding motorcycles without a helmet is not.

  7. Jason Greenberg says:

    I agree with your thesis that the caring relationship is the most powerful medium to guide personal change. That’s why it’s supposed to be at the root of health care, in the doctor (or nurse, PA, NP, therapist)-patient relationship. Unfortunately, it’s often not, particularly when it would be most helpful, such as in the hospital, or when confronting life-altering illness. That’s a core shortcoming of how we provide medical care.
    From the policy perspective, though, the caring relationship must appear to be a blunt tool. It’s hard to move the behavior of a large population by using the influence of myriad individual relationships. Add to that the fact that a number of the risky behaviors targeted by public health types – smoking, alcohol, most of the unhealthy aspects of the American diet – have been carefully cultivated in us by years of corporate marketing. The choices we make in everyday life aren’t always completely ours, which puts these technocratic interventions in a slightly different light.

    On the other hand, Obamacare includes language allowing employers to discount insurance premiums up to 30% for employees who participate in wellness programs or reach certain targets (goals which have dubious relationships with outcomes that matter).
    Time will tell just what programs like this will accomplish. It’s interesting to note that one of the most successful modern public health interventions – blood pressure control – used more gentle means, with both public education and repeated one-on-one doctor (mostly)-patient interactions.

  8. cw says:

    We live in a society that has been totally infiltrated by business values. Talking about harmful behavior in terms of costs is speaking the language that we speak.

  9. peter says:

    The western medical profession has a very long history of blaming the victims of an illness or disease before the profession knows the true causes of the particular malady. From cholera (blamed on personal sinful behaviour before sewerage-tainted water was identified), through stomach ulcers (blamed on a personal inability to handle stress, before Helicobacter pylori was found), to obesity (blamed on personal or family failing). The plain fact is that we still don’t the know the cause – or, more likely, the causes – of the contemporary obesity epidemic in the west. And the remedies suggested by the profession we happen to know to be ill-advised: the experimental evidence exists on the relationship between exercise and weight, for instance, shows that this relationship is slightly positive: increasing frequency and duration of exercise will tend to increase weight, not to reduce it.

  10. herman van rijswijck says:

    ‘The problem with the smoking example in this context is that nicotine is an addictive drug, whereas e.g. riding motorcycles without a helmet is not.’

    Non sequitur!

    Thrill-seeking behaviours can be quite like addictions. Feeling the wind blowing through your hair at 120 mph is better than sex to some.
    But hell, even watching tv can be addictive.

  11. herman van rijswijck says:

    Only difference being, one is a potentially addictive substance and the other a potentially addictive activity. I’ll grant you that much LFC

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