Lourdes save me!: "Hankering after the lie"

Emile Zola's emotionally powerful book, Lourdes, published in 1894, is a poignantly detailed account of people suffering from severe disease, traveling to Lourdes, France, in the hopes of a miracle cure at the hands of a young maid, Bernadette Soubirous.  It was her visions, years earlier, that started the phenomenon by which the Virgin Mary was supposed to have endowed the local waters with miraculous healing properties.  Zola spent some time at Lourdes, to soak himself in the phenomenon and live up to his idea of 'naturalism', making the novel a kind of fictionalized documentary.

Bernadette Soubirous (source: Wikipedia)

Bernadette's story turned the Grotto at Lourdes into a major pilgrimage destination for those most in agony.  They crowded together in trainloads by the tens of thousands, rumbling across France to Lourdes in the hope of a cure centered around the intervention of God, prayer, priests, or angels. In his sympathetic empathy for people "hankering after the lie" of a miracle just down the track, Zola was understanding, but his explicit, highly angry skepticism was made, one might say, painfully clear.

Zola's tale is full of the wrenching tears, sadness and suffering of people with the most desperate of problems that medicine couldn't cure.  Indeed, this is as most of us will be when our time finally comes.  Most of humanity have died not knowing that their hoped-for miracles never happened. Today there are still desperate or credulous people who seek cures from God or from mountebanks, but at least those who are reasonably educated and have the access mainly trust to empirical medical science; that seems a huge conceptual jump beyond simple, desperate prayers.  Medical science is a huge conceptual jump beyond simple, desperate prayers, and has marvelously transformed our health experience, especially in the developed world. We have to be entirely thankful to the biomedical research and clinical systems for this.  Who would trade our medical (or dental) lives for those of the 19th century?  Still, I'll wonder below whether there's some potential irony in that.

Flooding to miracle waters by the trainload.  Source: Wikipedia

"The need of the Lie, that necessity for credulity, which is characteristic of human nature."
A young woman, Marie, a suffering heroine in Lourdes, had become paralyzed in an accident. She poignantly believes in St Bernadette,  and says glowingly after hours of intense prayers at Lourdes that "At four o'clock I shall be cured!"  And she was--but it was no miracle, as we'll see.

Zola noted in great and angry detail how the simple purity of Bernadette in her (apparent) apparitions and belief in the curative powers of the waters, were quickly shunted aside, and co-opted as a grotesque source of mammon by Church officials, turning Lourdes into a kind of health-tourist Disneyland: "An elaborate organisation had been gradually perfected, donations of considerable amounts were collected in all parts of the world, sufferers were enrolled in every parish...."  Do we not have our equivalent in much of the biomedical system today?  Research clearly is costly, but one must note the similar self-serving and open-ended nature of this enterprise side of things, engaged in by our particular version of the high priests, the academic 'church', and the magical waters it promises in our own time.  This is actually not new, even to medicine, and the various territory-guarding priesthoods of health go back to Hippocrates.

One could perhaps, write a similar novel today.  Patients wouldn't be in crowded trains but in crowded waiting rooms in hospitals, or in the skilled nursing sections of a modern retirement center. The struggle to get 'hospitalisation' care in Zola's time, or tickets on the trains to the curative waters of Lourdes, is today the struggle to get care covered by insurance, or to get a bed or scheduled treatment.  It might seem more orderly, and be administered by bureaucrats rather than nuns and priests, though as Zola clearly documents, the Church was a massive bureaucracy of its own, even when it comes to formal committees--including at Lourdes--to give the imprimatur to claims of miracle (not so unlike today's PR empires trumpeting each daily research miracle?).  The psychological and even material circumstances are quite similar, because the old pathos and wishful thinking are still here, along with the hopes, dreams and judgments, though perhaps they're often harder to see as people sit quietly waiting for the nurse to call their names.

Ironic cautionary notes?
Zola rants at length against a world driven by superstition and false hopes, exploited by religions.  He pleads for a new religion, one based on reason, as he calls it, that is about the realities of finite life and its imperfections, rather than imaginary wishful-thinking.  But there is an irony in his emotional plea, one we might listen to carefully: he notes that this superstition still existed after what, even then, had been a century of science with its touted powers and promises.  The failure of science to cure their diseases was leading people to return to superstition, rejecting science--rejecting reason.

Zola bemoaned that the "thirst for the Divine, which nothing had quenched....seemed to have returned with increased violence at the close of our century of science....it seemed that science alone cold not suffice, and one would be obliged to leave a door open on the Mysterious....what divine falsehood...could be made to germinate in the contemporary world, ravaged as it had been upon all sides, broken up by a century of science?  Ah! unhappy mankind, poor ailing humanity, hungering for illusion, and in the weariness of this waning century distracted and sore from having too greedily acquired science, it fancies itself abandoned by the physicians of both the mind and the body, and, in great danger of succumbing to incurable disease, retraces its steps and asks the miracle of its cure of the mystical Lourdes of a past forever dead!"

We've now had an additional century of science since Zola's book was published.  That we still have unconquered disease is understandable.  Diseases are diverse, and those we still cannot cure or prevent present massive challenges.  Of course, the target is an ever-moving one, with solved problems giving way to the unsolved ones that remain.  For the latter, even highly touted new treatments often only help some patients and it is not at all unusual to see that highly hyped new treatments in reality add but a few months of life, or a partial remission, for but a fraction of those who received them--and it is not necessarily true that those extra months are all that tolerable.  We are aided and abetted in the strong claims by the media, university or commercial spinners, and the interlocked careerist, funding-based mutually reinforcing systems.  So far, in our century, the public is buying it, as ever.

No fault lies in our not having divined (forgive the metaphor!) a cure, and the exaggerated promises of transformative advances are understandable in human terms--but not so different than what was coming from other pulpits in times past.  Is there any danger that the public will again see science, with its opulent cathedrals and assertive promises that often mammonize hope, as an enterprise of false illusions?  The suffering remain, after all, in the realm of fear, not reason.  To what alternative solution--or lie--might their hopes turn?

Of course, our inherent inevitable mortality means even our modern system will ultimately fail every one of us. As sentient organisms we don't want pain, and as knowing organisms we don't want death, and it is all too easy to 'Tsk, tsk' the system when it is others than ourselves suffering from awful diseases, and it's not yet our turn.  Ultimate failure is an open secret that neither the system nor its patients like to acknowledge.  The currently growing hospice movement is facing these realities, unless it too becomes co-opted as a 'system' with its own self-interested self-promotion.  Precedent suggests that may happen, but it's a very good thing at present, as we've noted here before.

.

Zola visiting Lourdes.  Wikipedia, from the magazine Gil Blas, 1894

Maybe some day we'll have the promised cures, sipping genetics or whatever other magic waters come along.  If so, then the medical priests will have earned their respect in every way.  But of course that, too, is a dream.  If all known diseases were cured by one miracle or another, we would still degenerate or even if that could be prevented, we'd be so numerous as to be stacked many-high on top of each other, struggling for food or water and so on--a geriatric nightmare of its own sort.

An ironical year
A century on from Zola's time we may still be at risk of people again turning away from the exaggerated promises of science, and given much of the world today it would be ironic but not so strange if there were a turn to some form of religion or mysticism, some emotional rejection of 'objective' science.  

But there is another sort of irony in the story of Lourdes.  In 1858, eerily reflecting the impending conceptual clash that Zola writes of, while the real Bernadette Soubirous was having the visions that would lead to the pilgrimages to the waters of Lourdes, Charles Darwin and Alfred Wallace publicly announced their discovery of evolution, that directly threatened religious explanations and led steadily to the altars of science instead as a competing explanation for human affairs. 

Zola's touching kind of docudrama makes one aware of the nature of hope, as well as false hope, and our willingness to believe what our particular day's preachers promise.  Zola himself bitterly debunks the claims at Lourdes.  Many of the pilgrims died, some reported improvement (almost always temporary), and only a few were 'cured'.  The trains left somewhat emptier than they were a few days earlier, populated by the returning survivors, still with their ailments, each inspired that the cure will surely happen to them at Lourdes next year!

As described in the link given below, a biography of Zola suggests that he saw a cured case of tuberculosis but changed that to a fatality in his book, to make his main point against superstition. But he was very clear that, as we often see reports today of, for example, placebo effects, it was nervous afflictions (that we refer to by terms like 'psychosomatic') that seemed most likely to be 'cured'.  Real physical problems were not.  The hero in Zola's book, a doubting priest who even had carnal feelings for Marie, understood that that was the nature of her 'cure', but in deference to her faith in Bernadette he made the altruistic decision to let Marie live with her illusions, thus permanently distancing her from his non-belief.

Such a book, though sometimes a bit ponderous in realistic details, is a good reminder of the human rather than just the sociopolitical, economic or even coldly scientific sides of the story.  But this should not take our eye off the importance of keeping science's eye on the proper ball: not that of self-serving empire building and inertia, but of truly addressing human agonies in the best way possible, fallible though we be.

Overall, perhaps we never learn--or, maybe, in being mortal it is not possible that we can learn, and completely accept the grim-reaper's realities that we know, in our hearts, are there.  At least, each of us will have to learn this in his or her own way, at the end.  No miracle can prevent that.

An afternote for fiction lovers
Here is a very nice blog post discussing Lourdes.  The blog is a fine one, about great literature that has survived fads and fashions and stands on its own legs.

"Purchasing lace by the mile." (Zola, 1883): scientific consumerism?

Emile Zola and the origins of Wal-Mart and science commercialism
We have been reading Emile Zola's 1883 novel The Ladies' Paradise, a story about the first department store in Paris, and how it grew and out-competed small traditional shops.  Modeled after the real Bon Marché department store, The Ladies' Paradise offered merchandise at cut-throat low prices.  They could do this by buying their wares in very big lots from suppliers, and turning their stock over very rapidly--in today, out tomorrow.

Bon Marché department store, Paris, est'd mid 1800's; Wikipedia

The mark-up was small, so prices were lower than the other shops could afford, but Ladies' Paradise could thrive by large volume.  Sales pressure, advertising, and the now-familiar tactics of consumerism, by making potential customers feel out-dated or that they really had to have the latest in style.  Get rid of the old stuff, and get with it with the new!  Even if to the ruination of the customers, the Paradise thrived.  Eventually, the pressure was too great to resist: the consumer society was born. 

The high-throughput, scaled-up society is what we live.  It didn't start with them, but we have been Wal-Mart-ed!  Or Home Depot'ed.  Try to find a local hardware store where the clerk actually knows about hardware, or where you can buy just a couple of nails rather than a sealed pack of them!  McD for food, Amazon for anything else.

A tide that started in Europe in the 19th century, mastered by Americans, is irresistible.  Even if something can, or perhaps should be done more slowly, deliberately, on a smaller scale, the high-throughput society is a steamroller that squashes anything that dawdles in its path.

High throughput: science mirrors society
Did we say 'high-throughput'-- and does that ring a bell?  Nobody likes to think of science as just another part of our culture.  We want it to be a stand-aside, objective, look at the world, motivated by curiosity or societal need, perhaps, but not affected by factors other than the search for truth.  It should not be swept up in current culture's fads, emotions, or other motivations (including selfishness).

Of course, that's not the way the real world is.  Today, we are in a rapidly spreading, frenzied world that is trying to 'purchase nucleotides by the mile', almost literally.  Life science has to a very great extent become driven by the Wal-Mart mentality:  a rapid, unexhausted, through-put of new 'data', justified on whatever grounds but essentially to keep the wheels turning, the funds flowing in and the papers flowing out.  These are just as much quick-hitters (with some exceptions, of course) as the fabrics flowing through The Ladies' Paradise.

We continually hear that we 'need' whole genome sequence, that the cost will rapidly reach only $1000 per person--maybe even less!  Meanwhile, since it's not yet that cheap, we do whole-exome sequencing instead, whole copy-number, gene-expression, protein interaction, whatever identification. Quietly and sometimes openly, it is acknowledged that these are very poor substitutes for focused knowledge and experiment, but that we need to do it to keep our labs running until whole genome sequencing becomes cheap enough to do it on everything that moves.  And much that doesn't.

Nothing could reflect the cultural pattern The Ladies' Paradise inaugurated more than this does!  Taking time to think is outre.  There are of course some good reasons for this massive, frantic data-gathering effort, given how much we don't yet understand about genomes and their uses.  But rather than measured, tempered, slower and more deliberate experimentation and observation, we take the fast-food, in and out the door, just-in-time industrial approach.  It's our way of, yes, doing business.

Of course, the System knows very well how to keep us frantically worried about falling behind, about who's getting ahead or published in Nature and Science.  Advertising is certainly a part of this, and the ad industry is expert at bleeding us for whatever we have.  A relevant note is the veritable blizzard of "See our magnificent miracle-gear at our exhibition at the ASHG [American Society of Human Genetics] meetings!" postcards in our mailboxes every day (the meetings are in San Fran this week and we'll be there--not at the commercial hall, though).

Yes, whether it's lace or nucleotides, our culture knows how to turn a buck.

Saving Society through Science?

We've posted recently on the comparative successes of science in the 'hard' areas like physics and molecular biology and many others, and the rather bleak failure in the social sciences to live up to the hopes of the period known as the Enlightenment, that knowledge, reason, and science would lead to the perfection of society.  Utopian thinking dreamt of real perfection, but we don't have to be completely idealistic to ask how well the dream has been approached if not achieved.

Emile Zola

In our earlier posting we asserted that social science has been a rather dismal failure in that regard, despite extraordinary investment in research resources, the growing of university departments (psych., sociology, political science, economics, family studies, ethnic studies, and many others).  Tons of books and many board-feet of library shelves housing journals have resulted, but it's hard to say that society is better in major ways as a result of this kind of knowledge.  Cynically, what has been better is the lifestyle of social scientists.

It may be argued that the idea of such perfectability through knowledge is overstated and that it was not really something that 'stuck' after the 1700s and 1800s period itself.  But here is a quote, one of many on the subject of science triumphing over faith from the famous French novelist and political agitator (dreamer?), Emile Zola:

Was it indeed true that the cultured young were still and ever in their silent forge, renouncing no hope, relinquishing no conquest, but in full freedom of mind forging the truth and justice of to-morrow with the invincible hammers of observation and experiment? (The Three Cities Trilogy: Paris, Vol 2)

And later, Zola says, referring to the priest who has lost his faith,

And now the young men of intellect of whom he had despaired, that generation of the morrow which he had thought spoilt, relapsing into ancient error and rottenness, had appeared to him full of virile promise, resolved to prosecute the work of those who had gone before, and effect, by the aid of Science only, the conquest of absolute truth and absolute justice.

We have many criticisms of the life sciences, not so much because we haven't solved all the problems in biology but for the amount of largesse and the braggadocio and self-aggrandizement that is involved.  The same kind of boastful self-promotion is going on in the social sciences, especially as social scientists rush to do genomics--explaining all about your behavior and society in terms of genes.  This awful abandonment of social science in favor of genetics is a clear confession of failure but not an acceptance that loss of funding should go with it--until and unless social sciences begin to live up to what we should expect of them: to understand behavior and society so as to improve it and the world we live in.

Societies are perhaps the ultimate 'emergent' phenomenon, not predictable from measurement on individuals any more than the pressure of a gas can be predicted by enumerating each of its molecules.  It's a major challenge.  We can easily imagine an improved society, but we don't yet know how to engineer or even to predict it.

Zola's comments show that for quite a while there was a belief that science would do this.  The implicit promise of those still feeding at  the NIH and NSF funding trough shows that the belief, or at least the rationale, persists.  Isn't it time for some results?