I've been thinking about illness, and how to live well in the face of it. If you are a seriously ill person, who might never recover from that illness, how do you deal with this? Authors such as Havi Carel and Elizabeth Barnes have examined this question from different perspectives—respectively, analytic philosophical and phenomenological—helping us to get beyond simple answers.
You might think, drawing on Barnes's earlier work (The minority body, 2014) that illness could either be a bad difference, a harm that makes you worse off, or a mere-difference, something that makes you different but isn't necessarily a harm. However, illness often is a substantial harm as it causes pain, loss of possible options that you can realize that require physical health or fitness. But to consider and get at the heart of the matter is difficult. As Elizabeth Barnes writes in the “Forward” to her book Health Problems, health and illness are philosophically tricky because,
We want to replace unclarity with precision, we want to provide resolution where ideas conflict. And there’s value to all of that. But what I was struck with, the more I thought about health, was my own sense of wonder.
Here I want to focus on one specific phenomenon that evokes wonder: individuals who adapt in creative ways to their illness and, in doing so, are able to thrive and develop virtue. Ian Kidd raises this possibility, arguing (building on and expanding Carel's work) that you can cultivate virtue in response to illness. Not all virtue ethical and natural goodness frameworks are responsive to this possibility. Some, such as Aristotle's are ableist, implying that natural is normal.
Carel argues that illness presents itself phenomenologically as a rupture between the biological body and the lived body. A biological healthy body allows you do to the things you like, cooking, going to a concert, taking a bus. But when you become seriously ill, your biological body does not cooperate. Taking the stairs, a shower, or concentrating to even write a short Substack article suddenly becomes a huge ordeal. This causes the rupture. The two bodies are not in sync anymore.
One way a person can try to repair this rupture (not to previous baseline, but to a new state) is by creative adaptability and engagement with the illness. For Carel we can “open a space for the creative adaptability that can enable a good life even within a context of illness.” In this respect, we can learn from illness. Not just the person who is ill, but society at large. This includes, I think, both witnessing ill people deal with their illness in creative ways to realize goods, and to help them to realize those goods which thus helps and edifies society at large.
Now, we have to be careful (and Kidd and Carel are careful) not to instrumentalize ourselves and our suffering, or to see illness in general as some useful tool for self-improvement (here lurks the worst kind of theodicy, in my view). We need public health infrastructure, health professionals, etc. that keeps a high standard of health. But understanding how people can thrive in spite of illness due to their creative response can still be insightful. I'll now give two brief examples of what we can learn from these people.
Matisse's cutouts
By the 1940s, the great French painter and sculptor Henri Matisse's (1869–1954) health had significantly declined to the point that he was not able to paint anymore. He had a rare form of cancer that left him weak, bed-ridden, and that almost killed him. When he became ill, although he had made some cutouts prior to this period, he decided to focus on cutouts as a way to express his creative intentions. He would have an assistant cover several large sheets of paper with even coatings of gouache. Then, he would select them and cut them with scissors, creating most beautiful and wondrous cutout artworks. The method was long in the making. It was a natural outgrowth of his continued obsession with color and line, which dominates his earlier paintings. You can see him seated in a wheelchair in his studio, while large sheets of paper are lying in front of him.
Note how Matisse used the help and labor by assistants to realize his art. He selected the hue of gouache; they would cover the paper with that hue. Under his direction, they pinned the pieces onto the wall or the surface he wanted to cover, made tracings to make a note where a shape would come. Matisse would give guidance, moving the cutouts around until they were just at the right place for him. Below is a picture of his assistant Annelies Nelck and her cat as they are working at a fresco in Nice.
I went to the Saint Louis Art Museum earlier this week and I could see these beautiful cutouts in real life. They feel so spacious and wonderful, as Matisse himself said they were frescos, and also that they were inspired by Islamic art because this art, “suggests a greater space, a truly plastic space.” Here's Oceania, the Sky, which was featured at the exhibition.
One easy philosophical takeaway we can gain from Matisse's creative response to his illness to create these incredible works is a story of individual resilience and ingenuity. However, I think a mere focus on this message can become problematic because, as Joseph Stramondo has argued, it risks turning ill or disabled people into “supercrips” who are only valuable insofar as they are exceptional. We can't all be exceptional! It is a heavy burden for an ill person to demand that they not only cope with a devastating illness that ruptures their link between biological and lived body, but also do so in admirable, exemplary ways. It seems to demand too much and set the bar too high for ill and disabled people.
However, there is a different way to think about this, namely, that we can learn from Matisse's creative dealing with his illness, learn from it, and be edified. In this view, Matisse becomes more than an inspiring model but his way of doing things tells us something about the scope of possibilities that exist in the world, if we seek to scaffold our abilities and seek collaborative help from others. It can also tell us that a diagnosis like his, while devastating, still does not leave you without hope. And also, it shows the importance of community, of how studio assistants and a master can together create artworks that are impossible to create on one's own.
Finally, it gives us a glimpse of a better society. A society where we help people to creatively adapt rather than force them into this mold of normality. A different world, filled with strange and wondrous forms, created by strange and wondrous bodies, is possible.
Spinoza's Ethics
Now follow some more tentative thoughts, the very early stages of a chapter in a new book project I am working on (I would normally develop ideas a bit more carefully before letting them loose in the world, but time is precious now!) One thing I'll do in the book is try to offer an interpretation of Spinoza's Ethics, and illness will play a central role in it.
A striking aspect of Spinoza's life is always mentioned in any biography worth its salt (e.g., Nadler's, Israel's, Gullan-Whur's) namely, that he was ill, probably tuberculosis.
We have two sources. First, his biographer Colerus (1703), who mentions this about Spinoza's death:
Spinoza wasn't very healthy and was suffering for twenty years of consumption. Because of this, he was very skinny and forced to eat and drink very moderately.*
Then there is the preface to the Nagelate Schriften, the Dutch translation of his collected works including the Ethics which was edited and published simultaneously in Dutch and Latin posthumously by a collective of friends and admirers (probably in 1678, but publication date 1677). In the Dutch version (which is likely the original) for the introduction, we read:
[He] left his birth city Amsterdam, and far away from acquaintances, first went to live at Rijnsburg, then Voorburg, and finally in 's Gravenhage, where he died in this year 1677 on the 21st of February, over forty-four years old, from a certain disease called consumption [Tering].**
While 17th-century people called lots of things “consumption” or “tering” in Dutch, it's plausible given the long-term nature this is the correct diagnosis. For pulmonary TB (an airborne disease) the immune system raises a defense within the lungs, isolating the disease after initial infection. But if these cells begin to malfunction, you can get active TB and it can eventually kill you. Given Spinoza fought the disease for so many years, likely influencing his decisions to move or prioritize some projects over others (as Kevin von Duuglas-Ittu speculates in this blogpost) it is interesting how the disease rarely gets more than a cursory mention in most scholarly biographies.
I think it's plausible to see its role more centrally. The creative response to illness is, I argue, one of the many strands that come together in the rich work that is the Ethics, specifically its notion of blessedness. In undergrad classes, we often focus on Spinoza's metaphysics: his view that there's only one substance, God or nature. But the overall aim of the book is ethical (it is after all named the Ethics). The overall project is to help you to live well in a difficult, uncertain world. In Emendation of the Intellect, an early work by Spinoza, we read the following passage
I thus perceived that I was in a state of great peril, and I compelled myself to seek with all my strength for a remedy, however uncertain it might be; as a sick man struggling with a deadly disease, when he sees that death will surely be upon him unless a remedy be found, is compelled to seek a remedy with all his strength, inasmuch as his whole hope lies therein. (DEI, 7, Ewles translation)
That remedy doesn't lie in richness and honors, or even in hedonistic pleasures (which Spinoza had to probably carefully choose which to take part in and to what extent, e.g., going to the theater as he mentions in Ethics). So it lies in something else.
This something else is beatitudo, or blessedness. Although this topic is relatively neglected in Spinoza scholarship, the ultimate aim Spinoza has for the reader is to achieve blessedness. Blessedness is not just happiness, but a supreme state of happiness and wellbeing; it's the best state you can possibly get. You don't have to wait until some afterlife—you can achieve blessedness in this life. You can read the Ethics as a kind of therapy that helps you as the reader, through careful slow moving through propositions, proofs, corollaries and so on, to gain this state, though it is (as he puts it all at the end), difficult, excellent and rare.
Here's where insights from illness might be relevant. It's a bit hard for us to imagine how precarious life was in the 17th century. Wars swept through Europe. The plague was still a major killer and had successive waves in the mid-17th century when Spinoza lived. Many infants died, even among the wealthiest people in society. You could go out for a night at the opera, catch a cold, and just die. A cold was never an innocuous affair but something to treat with great concern.
My lute teacher, Anton Birula, always tells me I should simplify my playing of baroque music. When I play pieces from the baroque era, my finger positions are often contorted and I am straining, but as my teacher says “Life was very difficult for people in those days. They were dying left and right. They didn't play the lute to make life difficult, but because it was pleasant and sweet, and a source of joy.” —this was something he told me encouraging me to find a simple way to play something, for there is always a simple way, you just have to find it. I think of this in the context of sprezzatura (see my essay here). Sprezzatura is a kind of sublime excellence you gain by finding the simplest, cleanest path and where your mind can be at rest.
Okay, back to the Ethics. Spinoza lived in a period of great uncertainty, and he himself with latent TB probably also felt uncertainty. Moreover, his deteriorating health clearly prevented him from realizing certain goods, such as eating and drinking well. So, how can blessedness be found, this difficult, excellent and rare thing, if not in earthly pleasures, honors, or money? How can you find it if you are physically unwell? Religious and secular prosperity gospels all tell us it's impossible. To be well is to be wealthy, healthy, fit. But what if you aren't?
It's not a problem if you are not wealthy or healthy for Spinoza, for you can find blessedness if you see yourself the right way—as a mode of God. Knowledge of God (Remember, for Spinoza God is all of reality, he also calls it “God or nature” 4Epreface) will lead you to blessedness.
Alexander Douglas has a beautiful new book on this aspect of the Ethics. In Douglas's interpretation of the Ethics blessedness lies into properly understanding (having adequate ideas) of you as a mode of God, that is, a way God expresses himself. You are not a part of God, but a full expression of God, which is the one substance. If you can fully understand this, not just by reason but also intuitively, then you achieve blessedness.
For Spinoza, our mind is the idea of the body (E2P13). What does this mean? At first it seems like your identity would be threatened by thinking of our minds/bodies this way (Spinoza is not a dualist). Particularly if your body wastes away from illness. However, as Douglas remarks,
If we define ourselves more expansively, however, this need not be so: the old man is as much myself as the young man was – transformed rather than deteriorated. But is there any limit to how expansive our bodily self-identification might be? Could I identify myself just as strongly with a decaying corpse? Surely if God, with his infinitely expansive, superdeterminate essence can be identified with each and every item in the universe then we too might be identified with a much vaster range of material things than those with which we normally identify ourselves
So here, the threat to loss of identity with the loss of bodily function or being alive is being mitigated by a perspective-shift: If I am really the universe (as a mode or expression of it) then I cannot die. This is why Spinoza goes on to remark, "the human mind cannot be absolutely destroyed with the body, but something remains of it which is eternal." (E5p23). Now, most recent Spinoza-scholars such as Steven Nadler seem to think that the immortality you get in Spinoza is symbolic at best, a consolation prize. Once you're dead, that's it. But some other authors, notably Stephen Harrop (in work in progress) and Alex Douglas see something more substantive there: an appropriate shift in identity of yourself to encompass God and all there is makes that there still remains something of you “under the aspect of eternity.”
Now in these very preliminary thoughts as I'm working through the Ethics I by no means want to suggest something psychologizing. I'm not saying the phenomenology of illness is the main driver of this rich and very multifaceted work. But I do believe that it is an aspect, and an important one, namely that the notion of blessedness developed in the work is in part a creative way on Spinoza's part to deal with illness and threats to bodily identity and wellbeing.
The perspective-shift Spinoza proposes has this benefit: by seeing yourself as a mode of the one substance we recognize our interconnected nature (something he develops also in his main political works, the Theologico-Political Treatise and the Political Treatise) and our own unique expression of this one nature, exemplified in his idea of conatus, "Each thing, as far as it can by its own power, strives to persevere in its being" (E3P6). Things will try to persevere in their own being, but they will sooner or later come to an end (die, fall apart, disintegrate).
The intrinsic vulnerability of each thing, especially our vulnerability to passions (which Spinoza says you can never master completely, though you can learn to control them somewhat), gives us the value of vulnerability and uniqueness as creatures. But the conception of all of this under one substance, God, makes us also invulnerable to specific conditions such as illness or poverty, because ultimately for Spinoza adequate knowledge of God, and therefore, reality as a whole, is sufficient for blessedness.
This perspective-shift, Spinoza admits is rare (recall 5p42, “If the way I have shown to lead to these things now seems very hard, still, it can be found. And of course, what is found so rarely must be hard. For if salvation were at hand, and could be found without great effort, how could nearly everyone neglect it? But all things excellent are as difficult as they are rare.") The book Ethics presents a perfectionist ethic which is not for the faint of heart.
But I think that ultimately, achieving blessedness is a kind of sprezzatura achievement. This is because for Spinoza, the second kind of cognition is hard work (reason) but the third (intuition) is restfulness. Like my lute teacher says that playing a horrendously difficult passage just requires finding the right restful state of mind, the right approach, an understanding of the dynamics, adequate knowledge of God gives you acquiescence of the soul, i.e., mental quietude.
*original (I updated the 17th-c Dutch spelling, my translation) : “Spinoza was niet zo gezond en leed al twintig jaar aan tering. Daardoor was hij erg mager en genoodzaakt om zeer matig te eten en te drinken.”
**original: “…zijn geboortestad Amsterdam verlaten, en verre van zijn bekenden, eerst te Rijnsburg, daar na te Voorburg, en eindelijk in ’s Gravenhage, zijn woonstee genomen, in welke leste plaats hijin dit jaar 1677 op d’eenentwinstige van Februari, ruim vierenveertig jaren oud zijnde aan zekere ziekte, de Tering genoemd, overleden is.”
Your remarks apply especially to chronic illnesses, such as platform of pneumonia, tuberculosis or Crohn's disease or my own problem, Parkinson's disease. I tried to write something philosophical about the experience relying on Greek sources, but I think Spinoza would be an appropriate addition to what I wrote. What struck me at the time was that Epicureans and Stoics, despite metaphysical and epistemological differences, had roughly the same views about how to handle illness. I think there are problems with their views, but they make a good starting point. In the last chapter of my essay, I tried to take up, not very successfully, a problem that confronts all proposals such as mine and what I take to be Spinozas: dementia, which undermines the kind of self-awareness that I was relying on to talk about ways of living more spaciously with Parkinson's disease. My essay can be found by searching for "A Shaky Walk Downhill". David Kolb
I like the idea of a rupture between the biological body and the lived body. That also seems like a pretty good description of being trans.