I.
Simone Weil’s most famous essay is entitled “The Iliad or The Poem of Force,” written in the late 1930s and first published in December 1940 when France had been conquered by Nazi Germany. Weil admired Homer’s Iliad as “the purest and loveliest of mirrors” for its truthful depiction of “force” as a constant factor in human affairs, which she defined as “the x that turns anybody who is subjected to it into a thing”(Weil, 2005, p. 183).
Everyone, in Weil’s view, is subjected to force, even those who exert power over others since they are blind to how they are themselves altered by force and to the possibility of their own destruction. It is a very different, and darker, view of power than fashionable algorithms of victimhood and oppression that are tacitly based on an assumption that if only oppressor group A has its power taken away then victim group B will be set free. Weil was not persuaded by an easy calculus of liberation. Coming from left wing circles in the 1930s, more anarchist than Marxist-Leninist, she was already well-aware that the Russian revolution, had not set anybody free, least of all the workers. She worked in car factories in Paris for a while and found the experience dehumanizing, because of the relentless, exhausting physical demands, and for the way roles of workers, foremen, and managers locked everyone into an oppressive system. She was keenly sensitive to injustice, to the denial of human beings of opportunities to flourish to their best capacity, but did not indulge in fantasies of deliverance from suffering as such, which is bound up with natural limits to human existence.
In her analysis of the Iliad, and in the world around her in 1939-40, it was not hard to find examples of force as the violence of war and conquest. It would be a mistake, however, to lose sight of her point about the pervasive presence of force as that tendency for people to become indifferent to the suffering of others. With this in mind, she makes a point, almost in passing about the relation between force and prestige:
A moderate use of force, which alone would enable man to escape being enmeshed in its machinery, would require superhuman virtue, which is as rare as dignity in weakness. Moreover, moderation itself is not without its perils, since prestige, from which force derives at least three-quarters of its strength, rests principally upon that marvellous indifference that the strong feel towards the weak, an indifference so contagious that it infects the very people who are the objects of it. (Weil, 2005, p. 199)
She argues first that we get into trouble with force, which is inevitable, when we lose a sense of proportion. The best we could do would be to strive for a sense of balance in relations with others, yet force by its nature seeks expansion and domination. But then she adds that even given moderation, force has another trick to play through the love of prestige. Since prestige is a question of how people look in others’ eyes, she is suggesting that the appearance of strength is seductive and can entice attention away from the suffering of others even among those who themselves are subject to the strong. Donald Trump’s appeal to millions of voters in the US, the fervour of his supporters, even in the face of his demonstrable lying and attempt to overthrow an election, look like a case example of Weil’s point. There does seem to be some element of reflected prestige that people feel in their vocal support of Trump, regardless of whether his stint as president brought them any tangible benefits at all.
II.
There are some who are in darkness
And the others are in light
And you see the ones in brightness
Those in darkness drop from sight. (Brecht, 1931)
When I re-read Weil’s essay recently, her comment about prestige struck me in a new way. I thought about how prestige operates in health care professions and how it can cover up degrees of indifference towards the weak, in Weil’s phrase, or in more contemporary terms, towards patients, those in need of help, and the marginalized. And how layered, enfolded depths of shadows thrown by the light of prestige exist too between and within health professions.
Modern medicine as a global entity carries a lot of prestige. It is not hard to see why. The childhood mortality rate has plummeted over the past 150 years, notwithstanding inequalities that still exist (see a chart that shows just how dramatic the drop has been here: https://ourworldindata.org/child-mortality-in-the-past). The benefits of modern medicine are so great they are hard to keep in sight. Even people who are critical of “biomedicine,” when it comes down to it are often more concerned about problems of distribution and access than the entity itself. Nursing is carried along in its wake, catching some rays of reflected glory. In the world of healthcare, nurses have less prestige than doctors, but within nursing, more technology-rich, higher acuity specialties like ICU or emergency nursing have higher prestige than those like mental health or geriatric nursing, that are mostly unwired and slower paced with less obviously lifesaving outcomes. Registered Nurses have more prestige than Licensed Practical Nurses, who have more prestige than nursing aides. Unmistakeably, as one moves up the steps of that pyramid, there is less contact with bodies and body fluids, and more contact with technology.
ICU nursing is highly complex, working with patients with the most extreme conditions still compatible with being alive. Of course. But Weil’s point was not that prestige cannot be associated with people using their strengths to beneficial ends in an instrumental sense. We all want the best biomedicine can provide when we need it.
Her point about prestige, however, does reveal something about how we chronically run into communication problems in healthcare. Talk to anyone who has had a lot of interactions with healthcare professionals, and they will invariably be able to give you vividly different accounts of what it feels like to be heard and cared for or treated indifferently (even when “the treatment worked,” and they are profoundly grateful for it). Most of the time, communication problems result in nothing more than unneeded frustration or anxiety, and sometimes, errors of losing sight of people in the shadows of prestige have disastrous consequences.
And as Weil noticed, those basking in prestige use it without even noticing they are doing so. It feels natural. Definitions of “prestige” in contemporary usage have in the Shorter Oxford Dictionary: “respect, reputation, or influence derived from achievements, power, wealth, etc.” and in Merriam-Webster: “1. standing or estimation in the eyes of people: weight or credit in general opinion. 2: commanding position in people’s minds.” These attributes may come about from individual achievement, or at least a powerfully projected self-belief, or they may be prestige by association with a group or, let’s say, a profession. Too often, we make assumptions about what patients need or want or ought to want without taking the time to ask them. We rely on the prestige of a title and location to set the standards for communication and unwritten rules that patients are expected to follow – and for the most part, they quickly pick them up and follow them.
III.
Prestige is about seeing and being seen. It is not entirely in the eye of beholder, but neither is it entirely under the control of the person with the prestige. It arises in chiasms of appearances and perceptions, projections and interpretations. Etymologies bring out the importance of prestige as a way of seeing and being seen. There is an association with magic and illusion, from the French, “prestige (16c.) “deceit, imposture, illusion” (in Modern French, “illusion, magic, glamour”), from Latin praestigium “delusion, illusion.” Related is “prestidigitator,” a nimble-fingered magician or juggler, related to the Italian “presto” meaning “quick.” One thinks of the dexterity of the surgeon and at the same time of fluttering thumbs shoring up self-projections on social media.
IV.
Those are a few thoughts sparked by Simone Weil’s comment about prestige in relation to healthcare. Her comment about the relationship of prestige to force does have application to how we look at layers of difference in healthcare and more importantly at the communicative space between professionals and patients. Her view that the Iliad is a mirror is important. She is saying it can show us things about ourselves that are there, whatever we might think. That is different from naming a problem to be fixed or from claiming to have special insight into both problem and solution, which leads to moral arrogance. I have no suggestions except to try to notice when and how prestige shows up, like magic! We are all on the hook of force and of prestige. We can try to catch it in our environments (not hard to find in academia) and most of all in ourselves. That is Weil’s point. It is not a bad attitude that we need to eliminate, but an aspect of force that is always there in human affairs. To live with it as well as we can seems like a modest aim, but it is a lifelong practice.
V.
Imagine a corporate institution, let’s say a university, deciding that prestige was a questionable thing, and then appointing a Director of Humility to organize humility workshops for all. Given the premise, what a prestigious post that would be!
References
Brecht, B. (1931). Mack the Knife. https://en.wikipedia.org/wiki/Mack_the_Knife
Roser, M. (2019). Mortality in the past – around half died as children. https://ourworldindata.org/child-mortality-in-the-past
Weil, S. (2005). Simone Weil: An anthology (S. Miles, Ed.). Penguin.
Nursing and Humanities 