Friday, October 30, 2015

Tolstoy and Kafka

It’s hard to find much in common in the lives of Leo Tolstoy and Franz Kafka, other than their being great writers. Tolstoy, the author of the mega-novels War and Peace and Anna Karenina, was a child of the Russian aristocracy. He wrote in a piercingly direct manner, and was brilliant at getting to the unadorned meaning of a person or an event. And he also had the good fortune of good genes. He lived to eighty-two, and when he died, in 1910, he was a revered figure. He had recognized as well as anyone that Russia was slouching toward revolution. The Communists lionized him for his sympathy to the leveling of class distinctions. He had great literary success throughout his life, even after he embraced a radically stripped-down version of Christianity. His funeral was a major cultural event.
Kafka, who was born into a middle-class Jewish family in Prague and grew up speaking and writing German, died at forty of tuberculosis in 1924, a lifetime that lasted less than half of Tolstoy’s. The Nazis regarded Kafka, as they did all Jews, as a degenerate, and burned his books. Tolstoy was handsome as a young man, with fashionable sideburns. Kafka was not bad looking, but had the misfortune of oversized ears. Not being wealthy, he had to work, and, after obtaining a law degree, the profession he chose was insurance. It was a profession he disliked. He was editing his final story, “A Hunger Artist,” on his deathbed, leaving three novels, including his masterpiece, The Castle, unfinished.

Where do these two very different writers intersect? They both wrote memorable novellas that, literally or symbolically, dealt with illness (Tolstoy, The Death of Iván Ilých; Kafka, The Metamorphosis). Each book also includes a famous sentence at or near its start. Tolstoy: “Iván Ilých’s life had been most simple and most ordinary and therefore most terrible.” Kafka: “As Gregor Samsa awoke one morning from uneasy dreams he found himself transformed in his bed into a giant insect.”
In The Death of Iván Ilých, Tolstoy showcased his talent for cutting through social pretension. When Ilých’s death is announced, after a long illness, presumably cancer, his colleagues immediately start wondering which of them will be promoted to the late man’s position. Tolstoy wrote of his characters, “Each one thought or felt, ‘Well, he’s dead but I’m alive!’” Each of these colleagues also could not help thinking that they would now have to fulfill the “tiresome demands of propriety” by attending the funeral service and consoling Iván Ilých’s widow.
And even his widow herself feels sorrier for herself than she does for her late husband. When she is asked if her husband suffered, she replies, “Oh! Terribly! He screamed unceasingly, not for minutes but hours. For the last three days he screamed incessantly. It was unendurable. I cannot understand how I bore it; you could hear it three rooms off. Oh! What I have suffered!”
Genuine pity for Iván Ilých appears to be lacking. His legal colleagues are eager to vie for his prestigious position as a judge.
To make full sense of this story, it’s helpful to know that this was Tolstoy’s first work of fiction since he published Anna Karenina in 1877. He had once commented that he had no interest in using his fiction as a vehicle to promote his social views, yet in his later years, this is exactly what he did. He had no patience with the Russian Orthodox church. He envisioned a society based on Jesus of Nazareth’s Sermon on the Mount, a radical inversion of the ethos of revenge.
Not long after the publication of Anna Karenina, Tolstoy experienced a massive spiritual crisis. The Death of Iván Ilých was his first work fully informed by his religious conversion.
On one level, the novella is a graphic example of the horrors of nineteenth-century medical science. I was surprised to learn that in the 1880s, morphine (along with opium) was already available as a palliative. But the suffering described in the book, especially once Iván Ilých is close to death, is horrifying. Doctors, largely clueless, cast out an assortment of possible culprits, including a burst appendix and a “floating kidney.” But Iván recognizes, in his pain, that doctors are utterly helpless to save him.
In the latter sections of the story, Gerásim, a strong, cheerful servant, appears to reflect Tolstoy’s radically pared-down interpretation of the New Testament. This very young, uneducated man has a centeredness that almost every other character in the book lacks.
Inevitably, death draws near, and Tolstoy, deep in his profoundly religious period, summons up allusions to the Book of Job: Iván Ilých “wept on account of his helplessness, his terrible loneliness, the cruelty of man, the cruelty of God, and the absence of God.”
Tolstoy, who earlier in his writing career made clear he had no interest in trying to prove his social theories through his writing, does in fact try to demonstrate a central tenet of Christian faith: In place of death there was life.
Does Gregor Samsa resemble Iván Ilých in any meaningful way? Both go through horrible transformations, Iván Ilých over many months, Gregor Samsa overnight. The Death of Iván Ilých is a didactic novel, but in the word’s older meaning, “to be instructive.” Tolstoy’s message couldn’t be clearer: Iván Ilých, in death, achieves salvation.
Kafka died in 1924, just thirteen years after Tolstoy, but in those years the world changed irrevocably. World War I, once known as “the war to end wars,” ushered in an era unlike any before it. In nineteenth-century literature, unusual creatures – most notably, Frankenstein’s monster – had tended to convey some kind of cautionary tale. Kafka’s “monster” immediately accepts the reality of his transformation, yet maintains his humanity. A traveling salesman and a dutiful son and brother, Gregor is most concerned by his need to catch his train to work. It does not occur to him that people would find his appearance repulsive. His cheerful, determined demeanor is, in the best sense of the term, absurd – a brilliant commentary on, among other things, the sometimes dehumanizing consequences of our jobs.

Friday, October 23, 2015

A century of centenarians?

When I was in elementary school, my parents bought three sets of encyclopedias: Encyclopedia Britannica; the junior version of Encyclopedia Britannica for my brother and me; and Compton’s, which had recently been acquired by Encyclopedia Britannica. My recollection is that, on account of our being such avid consumers of knowledge, we also received a free collection of forward-looking essays. The first of these articles posed the question: Will You Live to 100? I already knew that such a thing was possible. I had a great-grandfather who was in his mid-nineties and, along with his somewhat younger wife, still grew vegetables on their land. Not until his late nineties did his mind begin to slacken.
I was thinking of my great-grandparents while attending this year’s Simons Research Symposium on Alzheimer’s Disease in Waltham last week. The event’s primary speaker, Dr. Claudia Kawas, a researcher at the University of California-Irvine, discussed some eye-opening trend lines. In 1961, the year I was born, life expectancy in the United States was just over seventy, according to World Bank data.
Kawas noted that children being born in the United States this year are projected to live to an average age of 103. This is, for lack of a better word, staggering. Of course, today’s infants are not expected to reach this projected median age until the second decade of the twenty-second century, when almost all of us will be gone. It’s easy to imagine a hot, crowded planet with terrible unemployment and extraordinary suffering—something like the vision laid out in the 1973 movie Soylent Green.
Kawas’s interest, of course, is in the here and now. She has long been involved with the “90-plus study” in Orange County, Calif., which got underway in 2003. The study’s roots, however, reach back to 1981. That was when researchers launched the initial Leisure World Cohort Study, named after a vast Orange County retirement community. The rate of participation in the survey among Leisure World residents was extremely high—more than three-fourths of the retirement community’s 18,000 residents took part. And there have been follow-up surveys in the decades since.
“We didn’t just want to know how long people lived,” Kawas said. “All of us, we want to live well.”
Some of the recent findings among people in their nineties were surprising. In terms of health and nutrition, neither Vitamin A, Vitamin C, nor Vitamin E appear to have much, if any, impact on longevity. And people who drink moderate amounts of alcohol, be it red wine or beer or Scotch, appear to live longer on average than those who don’t drink. Moderate consumption of caffeinated beverages also appears to boost longevity, but the benefit, according to Kawas, is the same whether it is coffee, black tea or green tea.
Another of the study’s observations is that, in old age, it is better to be moderately overweight than skinny. Throughout much of human history, and as recently as the Victorian era, only the well-to-do were likely to achieve the status of being overweight, though there were exceptions. When nineteenth-century anthropologists encountered the coastal peoples in the Pacific Northwest, they were surprised to find tribal members with pot bellies, thanks to the enormous amounts of salmon and other protein-rich seafood available.
But, of course, the longer one lives, the likelier one is to develop dementia, which Kawas defined as “the loss of mental abilities severe enough to interfere with your vocational or social functioning.”
Among people in their early nineties, there is a doubling of the risk of dementia, from 5 percent to 10 percent; for people in their late nineties, the risk is 20 percent; and at age 100, the odds are 40 percent.
Kawas’s conclusion: By the middle of this century, there will be more people in the United States with dementia over the age of 100 than among all younger people combined.

Friday, October 16, 2015

In praise of cemeteries

 Unter jedem Denkmal liegt eine Weltgeschicte.

A quarter-century ago, a German friend of mine introduced me to this epigraph from the Romantic-era poet Heinrich Heine, which can be translated as “Under every gravestone lies a history of a world.” I was twenty-nine, and, for the first time, dwelling on my mortality. I had arrived in the port city of Hamburg at the end of the summer. At a latitude equivalent to northern British Columbia, darkness and dankness settled over northern Germany by the beginning of November, also known as Der Todesmonat—the month of death.
My then-girlfriend Paula, now my wife, joined me in Hamburg in January, but that was still two months away. Having grown up in the Northwest, I was no stranger to gloomy, rainy autumns. Compounding my misery was that I was burning the candle at both ends. In the mornings I taught English to factory workers before they started their shift; in the evenings, in a different part of the city, I instructed well-dressed businesspeople. I also taught at a school that enabled me to tap into Germany’s generous and inexpensive health insurance, despite not being a full-time employee. Much of the time when I wasn’t teaching, I was listless and lonely.
I think of that dreary autumn as the time when I became fully adult. It was when I first fully appreciated that life is fleeting, even for those who live into their seventies or beyond. It also was when I began to appreciate the presence of cemeteries.
That this realization struck me in Germany is no coincidence.  My failure to find a publisher for the novel in which I had poured an enormous amount of energy had left me listless and uncertain about what to do next. Those long months in Hamburg, usually alone, sharply altered my perspective. I recalled a short essay by Freud in which the founder of psychoanalysis counseled a young poet.
“He was disturbed,” Freud wrote, “by the thought that all this beauty was fated to extinction, that it would vanish when winter came, like all human beauty and all the beauty and splendour that men have created or may create.”
Not surprisingly, my mood improved as soon as Paula arrived. We have always enjoyed going for walks, and Hamburg, with its many parks and cemeteries, was excellent for strolling.
In the decades since, I have come to cherish cemeteries.
My chief reason for this is the most obvious: Cemeteries are peaceful places, largely free not just of noise but advertising, the irritating background in the early twenty-first century. In German-speaking lands, people are buried in a Friedhof, a term that translates literally to “peaceful yard.” In my hometown in the Pacific Northwest, my dad lies buried under a tombstone with the chiseled image of his purse-seiner fishing vessel. The life span of that boat (built during World War I, scrapped in the early years of this century) was almost exactly the life span of my father himself. The marker also makes clear that this grave is not yet at full capacity. My mom remains vibrantly alive.

In our country, peacefulness seems an underappreciated virtue. Occasionally, Paula and I will go for walks in Mount Auburn Cemetery, which straddles Cambridge and neighboring Watertown. The site was established in 1831 as the nation’s first “garden” cemetery, with extensive walking paths and many old-growth trees. The surrounding area bustles with cars and buses, and all their noises and odors. To enter the cemetery gates is to visit the nineteenth century.
As Heine suggested, cemeteries invite us to imagine a bygone world, one that is made manifest by arching monuments as well as homely, low-lying grave markers. Who, for example, was Robert C. Winthrop, interred along with his loved ones in the family crypt—a descendent of John Winthrop, the most prominent founder of the Massachusetts Bay Colony? Etched into the stone is the news that this Winthrop was “Eminent as an orator a statesman a philanthropist above all a Christian.”
Elsewhere, in a single view, a visitor can take in an array of shapes: an obelisk, an abstract crucifix partly hidden by a beige rectangular monument with a pyramid on top, and two almost identical rounded tombstones. And what does a group of pale, missile-shaped memorials imply? Souls poised for take off, pointing toward heaven?
My only regret about this cemetery is that the burial plots, like so many other things in Cambridge, are way beyond our price range.

Friday, October 9, 2015

A better way of dying

The novelist Richard Ford, writing in the New York Times soon after 9/11, contrasted the enormity of the terrorist attacks with the intimacy of his father’s death when Ford was sixteen years old. Ford had woken to his mother’s pleading voice, trying to shake Ford’s father into consciousness.
 “‘Daddy, Daddy, wake up,’” Ford recalled saying. “I could smell his large, sweaty body, feel his flaccid self, loose-limbed and malleable, his cheeks and mouth relaxed. He had quit gasping. I tried to open his mouth with my fingers and breathe in air. I tried to push down hard on his chest. I tried to move him. I put my arms around his shoulders and shook him. I heard my mother say, ‘Oh, God, no, no, no.’ And I felt dread and terror, love and ferocity, confusion, physical exertion, a need for greater ingenuity, for greater efficiency, and I felt failure. In short, I experienced all the small and large coefficients of a son's unswerving love.”
The passage is similar to something I came across by Elisabeth Kübler-Ross, who in 1969 published her influential book On Death and Dying. At one point, Kübler-Ross describes the fatal injury to a farmer in Switzerland who had fallen out of a tree. Kübler-Ross was a child at the time, and she later commented on the stoic calm of the dying man.
“He asked simply to die at home, a wish that was granted without questioning. He called his daughters into the bedroom and spoke with each one of them alone for a few minutes. He arranged his affairs quietly, though he was in great pain, and distributed his belongings and his land, none of which was to be split until his wife should follow him into death. He also asked each of his children to share the work, duties and tasks that he had carried on until the time of the accident. He asked his friends to visit him once more, to bid good-bye to them. Although I was a small child at the time, he did not exclude me or my siblings. We were allowed to share in the preparations of the family just as we were permitted to grieve with them until he died. When he did die, he was left at home, in his own beloved home which he had built, and among his friends and neighbors who went to take a last look at him where he lay in the midst of flowers in the place he had lived in and loved so much. In that country today there is still no make-believe slumber room, no embalming, no false makeup to pretend sleep.”
Since On Death and Dying was published forty-six years ago, much has changed in American health care. Advances in medical technology continue to extend many lives. But these advances come at a significant cost. End-of-life expenses, in particular, can be obscenely high, and dignity is sometimes sacrificed. In “Seven Keys to a Good Death,” an article published on the Berkeley, Calif.-based website, Greater Good: The Science of a Meaningful Life, Charles Garfield recounts an experience he had with a friend who was terminally ill.
“Near the end of his life,” Garfield writes, “he had reached a place of equanimity about dying. But instead of honoring his wishes for a peaceful death, his doctors ordered aggressive chemotherapy, which did nothing to halt the cancer. The treatments caused him immense suffering, rendering him unable to sleep, eat or converse with family and friends as he was dying.”
My dad, who died of congestive heart failure in his late eighties, had the good fortune of dying in the home he had lived in for forty-five years. He died in late March, amid pleasant early-spring weather, and, in his last days he had the consolation of not just his loved ones and his Catholic faith but his familiar surroundings, which included a view of Bellingham Bay, the body of water he  traversed in his fishing boat thousands of times.
My dad died in 2004, when I was forty-two, and I pretty much took it for granted that, barring some terrible accident, I too would live into old age. But it is always foolish to assume that one is exempt from bad luck.
Greg O’Brien, a prominent figure in the Massachusetts Alzheimer’s community and author of On Pluto: Inside the Mind of Alzheimer's, also has been diagnosed with stage-3 prostate cancer, a disease that he does not intend to have treated. His logic strikes me as airtight. No one wants to enter into the fog of advanced dementia, a place that might as well be festooned with signs proclaiming, “Abandon hope, ye who enter here.”


Wednesday, October 7, 2015

A song of love and death

My first real exposure to opera came when I was eight years old. For years before that, I would observe my dad sitting cross-legged on the living room carpet, sorting through his huge collection of records while he listened to famous tenors—Mario Lanza, Jussi Björling and, most of all, Enrico Caruso, who I understood to be the operatic equivalent of Babe Ruth. The opera house in Seattle was ninety miles from our home, but in those days it was a fast ninety miles.
The opera that night was Tosca, and my dad probably summarized the plot for me, but by the climactic third act my eyelids were seriously heavy. Earlier in the evening I had been hushed by a well-dressed matron; she objected to my crunching the candy that my brother and I had procured from the concession booth. The first act had featured parishioners filing into church, while the villain, Baron Scarpia, sought to ruin Tosca, a big-time diva in love with the painter Mario Cavaradossi.
In the second act, Scarpia was having dinner with Tosca at a long table illuminated by candles, and it appeared that Scarpia wanted something from Tosca, and that Tosca was willing to give it. The wining and dining had little to do with sex. Scarpia’s motive was to seduce Tosca into divulging the hiding place of Mario’s friend, an escaped political prisoner. I was not clear on what was happening, back in the era before supertitles, but I did enjoy watching Scarpia, still singing, flopping liked a gaffed fish after Tosca stabbed him. Ever the diva, she paused for a moment to look down at the now-deceased villain and artfully arrange glowing candles around his body.
The third act opened with a shepherd boy only a few years older than I singing his girlish song that welcomed the dawn. Then came the soldiers, the orchestra heavy with percussion. Mario was to be shot by a firing squad. But actually, before murdering Scarpia, Tosca had been assured that the firing squad was just for show, and that Tosca and Mario would be free to leave Rome.
Nope, not quite right. When Tosca kneels down to congratulate Cavaradossi for his acting ability, she realizes that Scarpia was deceitful to the end. Those weren’t blanks! Those were real bullets! Mario! Mario!” L’opera e finita!
A quick questionaire: Based on this summary of one of my favorite operas, what word first enters your mind: Absurd or sublime?
My wife’s response might be overlong.
Well, we can’t agree on everything. But as I have gotten older, and particularly since I learned that my life may wind down well before I assumed, opera’s ability to move me has become more potent. The genre’s cathartic power is captured in the title of Peter Conrad’s book, A Song of Love and Death. As in other forms of dramatic tragedy, operas tend to end with the bodies piling up. Drawing on Freudian terminology, Conrad suggests that “Id in opera never learns to fear the superego; libido never acknowledges the repressive rule of society…. Music bypasses the rational quibbles of language to plead on their behalf, and persuades us to envy such lack of inhibition and maniacal consistency.”
This definition of the genre is contrary to the popular perception of opera as a rather arid art form, patronized mainly by the well-to-do, and relying on a repertoire, the bulk of which was assembled in the eighteenth and nineteen centuries.
But Conrad is correct: Terrible things happen to opera characters. In Verdi’s Rigoletto, the ill-fated jester is doubled-crossed by a charming but psychopathic prince, who seduces Rigoletto’s daughter, Gilda. For puzzling reasons, Rigoletto himself is complicit in his daughter’s exploitation. But this doting father cannot avoid the blowback. When Rigoletto contracts with Sparafucile, a hit man, to kill the Duke, Rigoletto promptly receives the body bag. But then he hears the Duke singing off stage: a sure sign that the corpse in his bag is his daughter’s.
The grotesque is a common feature in opera.
A couple of weeks ago, ahead of my trip to Berlin and Prague, I came across a boxed set of Wagner’s Tannhäuser, performed in Berlin at the direction of the acclaimed Jewish conductor Daniel Barenboim at the city’s Staatsoper. Wagner’s music is deeply controversial in Israel – it’s not much of an exaggeration to say that this enormously gifted nineteenth-century composer provided the score for Naziism. In 2000, Barenboim’s intent to perform Wagner’s Siegfried in Israel had to be OK’d by Israel’s Supreme Court. Woody Allen nicely captured the ambivalence that many people have about Wagner’s music in his movie Manhattan Murder Mystery: I can't listen to that much Wagner, you know? I start to get the urge to conquer Poland.”
 Having largely ignored the efforts of my middle-schooI music teacher, I lack the vocabularly to explain why Wagner’s music, or Verdi’s music, or Mozart’s music, can be so powerful. I am a lover of  music who is musically illiterate.
But I know what I like. And when I hear the recording of Barenboim conducting Tannhäuser, the voice of the heldentenor booming out of my modest speakers, I welcome the music’s blunt force, its shuddering catharthis.

During my recent trip, I attended two operas, including a spectacular performance of Bizet’s Carmen, one of the most popular operas of all time. My thanks to my longtime friend Jeff Kramer for making this trip possible.

Friday, October 2, 2015

Green tea and red wine

A decade or more ago, when I was in my early forties, I phased out drinking coffee in favor of tea. My rationale was that, being somewhat sensitive to caffeine, I didn’t need a full cup of coffee to start my day. I didn’t even need a half a cup. Black tea would suffice in the morning, and at work, after lunch, I would open one of the seemingly endless packets of Bigelow green tea in my workplace’s kitchen. Among my forty-plus colleagues, only a handful of us drank tea.
I was forty-three when I started working for this employer and just shy of fifty-four when I left after being diagnosed with Alzheimer’s. While this disease was taking its toll on my ability to do my job, I was otherwise a model of health. Like everyone, I caught colds from time to time, but mine tended to be short-lived. I rarely called in sick.
A study released last year suggests that green tea’s touted benefits on short-term memory are real. The study, which the national office of the Alzheimer’s Association has circulated, involved twelve healthy adults, each of whom received a milk whey–based drink. For half of the participants, the beverage included 27.5 grams of green tea extract. Based on magnetic resonance imaging, researchers reported that those who received the green tea extract in their beverages performed better in “working memory at the neural system level by suggesting changes in short-term plasticity of parieto-frontal brain connections.” (Parieto-frontal integration refers to how different brain functions, such as attention and memory, work together.)
Red wine, in moderation, also has been cited for a number of health benefits, including memory function. However, the Alzheimer’s Drug Discovery Foundation (www.alzdiscovery.org/cognitive-vitality/report/low-to-moderate-alcohol-consumption) reports that while consuming low-to-moderate amounts of red wine can be therapeutic, its efficacy may be overstated. Under the heading, “Can It Benefit Someone with Dementia or Mild Cognitive Impairment?,” the foundation offers some caveats.
For people with mild cognitive impairment, low-to-moderate levels of alcohol consumption was associated with a 50 to 85 percent slower rate of cognitive decline, according to the foundation. But the website notes that other factors may also be in play; for example, wine drinkers, on average, may be healthier in the first place.
As for the potential for moderate drinking  in general to help forestall death, the results are mixed. On the one hand, low-to-moderate drinkers were 16 percent less likely to die than compared to both heavy drinkers and non-drinkers. The website notes, however, that factors other than drinking could explain this discrepancy.
 “Given that alcohol can acutely impair cognitive function and interact dangerously with many medications, it is unlikely a good choice for Alzheimer’s patients.”
I agree. And I did once make the mistake of taking Aricept, the drug widely prescribed for Alzheimer’s, less than an hour after my daily glass of red wine. Not a good idea.
But I still make a point to have a glass of red wine with my lunch, especially when the wine is good and the sun is providing a near-perfect early autumn afternoon. I regard my daily glass as a dose of contemplation.