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“READ it and act!” commands Alice Walker, in her back-cover comment to Elvia Alvarado’s Honduran testimony Don’t be Afraid, Gringo (1987). A souvenir button from an MLA book exhibit features the words of Toni Cade Bambara: “Read a lot and hit the streets!” The felt need for such exhortations, however, attests that the link between reading and social responsibility is far from automatic, even when the book in question presents an admirable role model. Alvarado herself points out there are other ways of reading such texts. Readers might conclude simply, “Those poor campesinos. What a miserable life they have. Or others might say What a nice book. That woman Elvia sounds like a nice woman.” “But,” Alvarado insists, “the important thing is not what you think of me, the important thing is for you to do something” (146). By means of a reading of Mountains beyond Mountains, Tracy Kidder’s 2003 profile of the physician and activist Paul Farmer, this essay examines how certain presentations of role models can make our students less likely to act—the paradoxical effect of the “problem of goodness.” Kidder’s biography and Farmer’s own books serve as points of departure to examine how some representations of goodness make it easier for students to gaze in passive admiration, while other forms of representation encourage them to begin scaling those “mountains beyond mountains” that stand between present circumstance and a more just future.
Farmer directs the Program in Infectious Disease and Social Change at Harvard Medical School, and his clinical practice is split between Brigham and Women’s Hospital in Boston and the Clinique Bon Saveur in rural Haiti, where he spends most of each year. Trained first as an anthropologist, he reports that his fieldwork in Haiti was a key influence in the decision to enter medical school. In his books, which include AIDS and Accusation: Haiti and the Geography of Blame (1992), Infections and Inequalities: The Modern Plagues (1999), and Pathologies of Power: Health, Human Rights, and the New War on the Poor (2003), as well as in numerous articles and speaking engagements, Farmer has underscored the relation between economic inequality and infectious disease, particularly HIV/AIDS and multiple-drug-resistant tuberculosis.
Kidder met Farmer in 1994, while researching an article on the role of the United States military in reinstating the Aristide government. In 1999 Kidder interviewed Farmer for a 2000 New Yorker profile, “The Good Doctor” which served as impetus for Mountains beyond Mountains. As explained in the preface, the book’s title comes from a Haitian proverb: “Dèyè mòn gen mòn” ‘Beyond mountains there are mountains’—as you solve one problem, another problem presents itself. In an interview on C-SPAN2’s Public Lives series, Kidder discussed the process of writing Mountains beyond Mountains. Interviewing Farmer and watching him work, the writer observed, had presented unusual physical challenges; but writing about him had proved even more difficult—because of what Kidder’s editor had dubbed “the problem of goodness.” It was always very difficult, the editor cautioned, to write convincingly about someone’s doing good. Biographers, of course, are not alone in facing the problem of goodness. The presentation of admirable role models is a commonplace of the socially engaged classroom.
Before considering the problem of goodness, it is important to distinguish among various kinds of goodness. Writing about each of them is subject to distinct sets of conventions, and encounters with each kind of goodness present different challenges to readers as well as to writers. Least challenging is the representation of someone who is trying to do good but obviously failing, overwhelmed by local and global circumstance. Learning about these subjects offers readers a perverse comfort: if even this well-meaning and obviously hardworking individual is unsuccessful, then any effort on my part would be futile, hence I have no real obligation here. In The Differend, Jean-François Lyotard takes note of this requirement when he asserts that in order to hear “You ought to” with regard to a need, the addressee must first grant the truth of another phrase, “You are able to” (121).
Evidence of effective goodness presents another problem entirely. The individual who is doing something both good and effective confronts us with prima facie evidence that good can be done, which is potentially far more unsettling than the evidence of futility. If effective good acts are possible, people of goodwill may feel obligated to do some. The discomfort of feeling obligated and remiss often leads writers and readers to reframe both subject and actions. They may redefine an action as actually ineffective (whatever it was, it was too little, too late), pushing the subject back into the category of well-meaning but ineffectual, or else they may redefine the subject as a model impossible to follow.
Two sets of conventions come ready to hand for this second kind of redefining. While both are nominally presented as exempla, in fact each does much to remove responsibility from the shoulders of ordinary people. One convention for the representation of efficacious good is hagiography, the lives of saints. In this genre, the apparently ordinary human is revealed over time to be in fact superhuman. With divine intervention saints can do things that no mere mortal could. Despite the usual exhortations to follow their example, the rest of us can instead find alibi and solace in the knowledge that at times of great need someone else like them might emerge to take care of things—since, of course, “we’re no saints.” The second convention is the superhero. While not all representations of this type are as far over the top as the heroes of a Marvel or DC series, those avatars still serve to illustrate a way in which people who are able to do good are different from you and me. Like saints, superheroes have capacities that the rest of us lack. Sans such superpowers, what could we ever do? Once again, the one who can do good is set safely apart from ordinary human beings.
Avoiding these seductive but socially unproductive conventions is only the start of the challenge to the writer. If the writer succeeds in presenting a subject who remains a mere mortal and who is apparently doing effective work, readers are likely to respond with at least a degree of anger and frustration, directed not only against the social problems that the effective subject is confronting but also against the subject and even against the sufferers on whose behalf the subject works: all of them make the reader uncomfortable. Here is the Scylla that accompanies the Charybdis of comforting representations: even if the writer, filmmaker, or teacher manages to avoid the aforementioned pitfalls, representations that cause readers pain will evoke defenses. Readers may reframe the subject away from potential role model and back into one of those three less challenging categories: well-meaning fool, saint, or superhero. These, then, are some of the dangers that must be avoided in writing (or teaching) about effective goodness.
In Mountains beyond Mountains, Kidder’s account of his responses to Farmer in the course of interviews and observation illustrates all these defense mechanisms, and Kidder reports them with varying degrees of self-awareness. It is clear from the start that his contact with Farmer provoked some sense of personal obligation: Kidder reports that after interviewing Farmer for a New Yorker essay, he began to send small amounts of money to Farmer’s clinic. Reflecting on his defensive attitude regarding Haiti, Kidder reports that during his first trip there in 1994 he came “to share the pessimism of the soldiers” who had been sent by the United States to reinstate the government of Jean-Bertrand Aristide after a military coup. “I think we should have left Haiti to itself,” one of the soldiers concludes.
Does it really matter who’s in power? They’re still gonna have the rich and the poor and no one in between. I don’t know what we hope to accomplish. We’re still going to have a shitload of Haitians in boats wanting to go to America. But I guess it’s best not even to try to figure it out.
At first Kidder concurs.
The soldiers had come to Haiti and lifted a terror and restored a government, and then they’d left and the country was just about as poor and broken-down as when they had arrived. They had done their best, I thought. They were worldly and tough. They wouldn’t cry about things beyond their control. (8)
As Kidder’s contact with Farmer continues, the writer finds such “realistic” responses to poverty and suffering less and less persuasive. “In Farmer,” he states, “ I’d been offered another way of thinking about a place like Haiti” (8). That “other way of thinking” creates a nagging sense of sin of omission, and Kidder reports growing annoyed with Farmer “the way one gets annoyed at others when one has done them a disservice” (29).
In the course of the book, Kidder’s appraisal of Farmer oscillates between annoyance and awe. Soon the writer’s comments show a growing admiration for Farmer’s asceticism. After weeks of watching Farmer operate on little sleep and even less food and water, he sees the doctor enjoy a restaurant meal and a good bottle of wine. Like many of Farmer’s associates, Kidder is surprised at Farmer’s susceptibility to worldly pleasures. The saint or superhero convention apparently allows a person to manifest either humanity or goodness, not both. Belief in the mutual exclusion of humanity and capacity for social change is a powerful support for the status quo: if social projects can be accomplished only by saints and superheroes, then the rest of us are either hopeless or off the hook, depending on our side of the economic divide.
While mythologizing Farmer is common occurrence both at Harvard and in Haiti, some of his closer co-workers discuss the drawbacks of holding out for a larger-than-life hero as a foundation for social projects. Farmer’s fame attracts additional resources for his projects, but the double valence of the mythological Farmer is illustrated in a quote from Jim Yong Kim posted in the office of Partners in Health. At first glance the sign presents its public face: “If Paul is the model, we’re golden.” Closer examination reveals that the final adjective is a more recent overlay, written on a flap of paper that opens to reveal the original: “If Paul is the model, we’re fucked.” Kidder reports the covert efforts of Ophelia Dahl, another of Farmer’s co-workers, to “normalize” the workday at the clinic in order to attract and retain more staff members, to make it, in Kim’s words, “okay to have children, to go home some days at five o’clock, to take a vacation” (242). Both Kim and Dahl attest to the fact that superhuman models can inhibit recruitment of ordinary mortals.
Farmer appears to regard ascriptions of sainthood or superheroism as a personal challenge to do more: “It’s not that I mind [being called a saint]. It’s that it’s inaccurate. . . . People call me a saint and I think, I have to work harder. Because a saint would be a great thing to be” (16). But to people who romanticize what he is doing or lament their inability to follow in his footsteps, he takes pains to provide practical alternatives. When Tom White, a major donor, declares admiringly that he would like to abandon his business and follow Farmer to Haiti, Farmer responds flatly, “In your particular case, that would be a sin” (95).
Nonetheless, Farmer makes it clear that he considers everyone obligated to do something. “I feel ambivalent about selling my services in a world where some can’t buy them,” he reports. “You can feel ambivalent about that, because you should feel ambivalent. Comma.” Kidder helpfully glosses Farmer’s special use of the iterated punctuation mark, which always
stood for the word that would follow the comma, which was asshole. I understood that he wasn’t calling me one—he would never do that; he was almost invariably courteous. Comma was always directed at third parties, at those who felt comfortable with the current distribution of money and medicine in the world. And the implication, of course, was that you weren’t one of those. Were you? (24)
The studied nature of Farmer’s rhetorical and political strategies becomes ever more apparent as Kidder spends more time with him. In a less guarded moment Kidder asks Farmer how he would respond to someone who criticized his efforts to improve health care for the poor as neither replicable nor cost-effective. Farmer’s first response is, “Fuck you.” “Then,” Kidder reports,
in a stentorian voice, he corrected himself: “No, I would say ‘The objective is to inculcate in the doctors and nurses the spirit to dedicate themselves to the patients, and especially to having an outcome-oriented view of TB . . .’ In other words, ‘Fuck you.’” (42)
Farmer notes the special difficulties of convincing people to undertake local and small-scale projects. Donors and volunteers, he observes, want to see immediate and dramatic results. Their patience soon wears thin.
People from our background . . . we’re used to being on a victory team, and actually what we’re trying to do in [Partners in Health] is to make common cause with the losers. Those are two very different things. We want to be on the winning team, but at the risk of turning our backs on the losers, no, it’s not worth it. (289)
Farmer is painfully aware of readers’ and listeners’ defenses against the call for social action. Even his fellow health-care workers resist the idea of funding HIV and tuberculosis clinics in the Haitian countryside. Their grounds sound highly pragmatic: the combination of political instability, lack of infrastructure and education, and abject poverty makes Haiti a poor site for long-term programs. Moreover, treatment with standard protocols would run counter to local traditions of spiritual healing, and a community with few clocks would not be an appropriate venue for drug regimens that demand patient compliance with precise medication schedules. Farmer’s motives are admirable, they conclude, but he is not being realistic.
Farmer responds with a series of rhetorical strategies that he calls collectively “narrating Haiti”: researching, representing, and reframing the evidence in order to confront his readers and listeners with the facts and with their own prejudices. He explains how depictions of Haiti have been shaped to present poverty and suffering as part of the natural landscape. Baring the mechanisms of the rhetoric that have persuaded his listeners is a key element of Farmer’s persuasive strategy, as important as the public health statistics that he sets forth to make his case. He offers a subtle and practical analysis of how progressive arguments of well-meaning people can work against social action.
At first glance, their reasoning seems unimpeachable. What could be wrong with solidarity; cultural awareness; respect for diversity; limiting oneself to appropriate and sustainable interventions; and, above all, realism? Several episodes in Mountains beyond Mountains illustrate how unexamined good intentions can couple with an implicit double standard of care to pave the road back to the status quo for Haiti. In one case, although Farmer has gone to great lengths to arrange a medevac flight from Haiti and treatment in a United States hospital, a desperately ill young man dies. After waiting what he judges to be a respectful interval, Kidder asks Farmer whether he still thinks that the enormous expense was justified. Even before Farmer answers, it is apparent that his perspective has had an impact, as Kidder reflects that such a question “would never have occurred to me if John had been my son. You do all you can for a patient. If I were seriously ill myself, I wouldn’t find that policy unreasonable” (279). When he does ask Farmer, the doctor points out that by accepted professional standards the young man’s tumor was treatable; the cure rate ran sixty to seventy percent. Farmer asks, in essence, why the Haitian patient should not receive good medical care.
Farmer goes on to point out a patient who needs specialized crutches and asks, “You know how much shit I’d get for that, Canadian crutches in rural Haiti?” “Because they’re not appropriate technology?” Kidder asks. “Yeah,” responds Farmer, “Now you can see the critiques revealed for what they are. But I have to limit the amount of time I put into explaining all that or it just sucks your soul dry” (290). Appropriateness of treatment, it is clear, has many possible senses, including euphemistic substitution for “in keeping with socioeconomic surroundings and the patient’s ability to pay.” When researchers defend with disquisitions on folk medicine, local custom, and spirituality the failure to provide clean water or adequate public health care for outbreaks of HIV/AIDS, multiple-drug-resistant tuberculosis, or diseases preventable by immunization, Farmer’s patience wears thin.
In his own writing, Farmer advocates a “pragmatic solidarity,” as one “that acknowledges and responds to the material needs of the destitute” (Infections 92). The qualifying adjective “pragmatic” highlights a distinction from another notion of solidarity—one that he terms “fictional”—which pretends to share other people’s burdens instead of taking practical steps to lighten them. Such an outcomes-based approach, he explains, is what led him to abandon his preference for casual clothing and instead wear suits, which have proved more effective at fund-raising events. “The poor,” Farmer and Kim conclude, “don’t want you to dress like them. They want you to put on a suit and go get them food and water” (101). In Pathologies of Power Farmer is sharply critical of the conflation of all types of discrimination and pain and of the refusal to take into productive account one’s own relative privilege and hence responsibility. “Not all forms of suffering are equivalent,” he insists; “the risk of stretching the concept of rights to cover every possible case is that obscene inequalities of risk will be drowned in a rising tide of petty complaint” (231). One emotional response that Farmer does endorse, Kidder reports, is “the guilt some rich people felt toward the poor, because it could cause them to part with some of their money. And they ought to feel guilty besides” (93).
To conclude, the problem of goodness is far more than a literary challenge to biographers. It is clear that descriptions of any person who is willing to work exceptionally hard to help people whom much of the world has essentially written off entail a distinct risk of ascriptions of quixotic foolishness, sainthood, or superpower. The concomitant attraction of fictional solidarity enables the illusion that we are not responsible because, in the ironic words of the critic Paula M. L. Moya, “we are all marginal now” (68). Writers and teachers are hardly immune to the defenses that permit ordinary people to lament idly the suffering of others. Nonetheless, presentations that confront readers and students with effective outcomes and at the same time do everything possible to discourage hagiography and hero worship can offer some counterweight to those defenses.
In his books, speaking engagements, and everyday negotiations to improve health care in Haiti and around the world, Farmer explicitly addresses a broad spectrum of prejudices: racist, sexist, ethnic, nationalist, and classist. The urgent and concrete nature of his work has given him a ready source of empirical feedback with which to refine his rhetoric. Under his definition of pragmatic solidarity, success in persuasion is measured by actual social action on the part of readers and listeners, and his strategies offer useful lessons for teachers who hope that having students read or see films about admirable people might inspire them to work for social justice. We need to be aware of the defensive propensity to view social activists as quixotic dreamers, saints, or superheroes. Keeping in mind the problem of goodness, we need to be careful to present evidence of the humanity of those figures as well as their effectiveness.1 We need to encourage students and colleagues to examine the practical consequences of invoking such appealing concepts as solidarity, appropriate intervention, sustainability, respect, and difference—and help them discern when the rhetoric of social responsibility serves the status quo. Finally, we need to help students move forward from admiration of those whom we would present as role models to an identification of their own capacities—and responsibilities.
Portions of this essay were presented in November 2004 at the Midwest Modern Language Association, in a session organized by Keith Alan Sprouse for the Division on Peace Literature and Pedagogy; and portions were presented in December 2004 at the Modern Language Association Annual Convention, in a session organized by Laraine Fergenson and Finley Campbell for the Ad Hoc Committee on Diversity and Tolerance.
1. Of course, goodness is not the only problem. Acknowledging the humanity of those whom we would present as role models carries its own set of risks, since focus on a hero’s feet of clay offers another potential defense against calls to action.
Alvarado, Elvia. Don’t Be Afraid, Gringo: A Honduran Woman Speaks from the Heart. Ed. and trans. Medea Benjamin. San Francisco: Inst. for Food Development Policy, 1987.
Farmer, Paul E. AIDS and Accusation: Haiti and the Geography of Blame. Berkeley: U of California P, 1992.
———. Infections and Inequalities: The Modern Plagues. Berkeley: U of California P, 1999.
———. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: U of California P, 2003.
Kidder, Tracy. “The Good Doctor.” New Yorker 10 July 2000: 40–57.
———. Mountains beyond Mountains. New York: Random, 2003.
———. Mountains beyond Mountains. Public Lives. Book TV. C-SPAN2. 5 Oct. 2003.
Lyotard, Jean-François. The Differend: Phrases in Dispute. Trans. Georges Van den Abbeele. Minneapolis: U of Minnesota P, 1984.
Moya, Paula M. L. “Postmodernism, ‘Realism,’ and the Politics of Identity.” Reclaiming Identity: Realist Theory and the Predicament of Postmodernism. Ed. Moya and Michael R. Hames-García. Berkeley: U of California P, 2000. 67–101.
© 2005 by the Association of Departments of Foreign Languages. All Rights Reserved.
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