Many thanks for your admirably detailed letter. The attitude you speak of, that of cursing the world and oneself, is, in a sense, the beginning of wisdom. Revolt is the first reaction of an intelligent man when he begins to understand the desperate nature of his situation in the world; and it is probably true to say that nothing great has ever been achieved except by a man in revolt against his situation. But revolt alone is not enough—it eventually contradicts itself. A man in blind revolt is like someone in a railway compartment trying to stop the train by pushing against the opposite seat with his feet: he may be strong enough to damage the compartment, but the damaged compartment will nevertheless continue to move with the train. Except for the arahat, we are all in this train of samsāra, and the problem is to stop the train whilst still travelling in it. Direct action, direct revolt, won't do; but something, certainly, must be done. That it is, in fact, possible to stop the train from within we know from the Buddha, who has himself done it:

I, monks, being myself subject to birth, decay, and death, having seen the misery of subjection to birth, decay, and death, went in search of the unborn, undecaying, undying, uttermost quietus of extinction (nibbāna), and I reached the unborn, undecaying, undying, uttermost quietus of extinction.
Revolt by all means, but let the weapons be intelligence and patience, not disorder and violence; and the first thing to do is to find out exactly what it is that you are revolting against. Perhaps you will come to see that what you are revolting against is avijjā.

The True Health

I notice that at the top of the hospital notepaper there is the motto 'Ārogya paramā lābhā'. Everybody naturally takes this to mean that bodily health is the highest gain, and it might seem to be a most appropriate motto for a hospital. But perhaps you would be interested to know what the Buddha has to say about it. The following passage is from Majjhima Nikāya Sutta 75 (M.i,508-10, in which the simile of the leper who scratches and roasts himself also appears). The Buddha is talking to Māgandiya, a Wanderer (paribbājaka—follower of a certain traditional school of teaching):
Then the Auspicious One (Bhagavā) uttered these lines:
—Good health is the highest gain,
nibbāna is the highest pleasure,
and the eight-factored path is the one
that is peaceful and leads to the deathless.
 (Ārogya paramā lābhā nibbānam paramam sukham,
Atthangiko ca maggānam khemam amatagāminan ti.)
     When this was said, the Wanderer Māgandiya said to the Auspicious One:—It is wonderful, Master Gotama, it is marvellous, Master Gotama, how well said it is by Master Gotama 'Good health is the highest gain, nibbāna is the highest pleasure'. I, too, Master Gotama, have heard this saying handed down from teacher to pupil by Wanderers of old 'Good health is the highest gain, nibbāna is the highest pleasure'. And Master Gotama agrees with this.
     —But in this saying that you have heard, Māgandiya, handed down from teacher to pupil by Wanderers of old 'Good health is the highest gain, nibbāna is the highest pleasure', what is that good health, what is that nibbāna?
     When this was said, the Wanderer Māgandiya stroked his own limbs with his hand.—This, Master Gotama, is that good health, this is that nibbāna. At present, Master Gotama, I am in good health and have pleasure; there is nothing that afflicts me.
     —Suppose, Māgandiya, there was a man blind from birth, who could see no forms either dark or light, no blue forms, no yellow forms, no red forms, no crimson forms, who could see neither even nor uneven, who could see no stars, who could see neither sun nor moon. And suppose he were to hear a man who could see, saying 'What a fine thing is a white cloth that is beautiful to look at, clean and spotless!', and were then to go in search of such cloth. And suppose some man were to deceive him with a coarse cloth stained with grease and soot, saying 'Here good man is a white cloth for you that is beautiful to look at, clean and spotless'. And suppose he were to accept it and put it on, and being pleased were to utter words of pleasure 'What a fine thing is a white cloth that is beautiful to look at, clean and spotless!'—What do you think, Māgandiya, would that man blind from birth have accepted that coarse cloth stained with grease and soot and have put it on, and being pleased would he have uttered words of pleasure 'What a fine thing is a white cloth that is beautiful to look at, clean and spotless!' because he himself knew and saw this, or out of trust in the words of the man who could see?
    —Certainly, Master Gotama, that man blind from birth would have accepted that coarse cloth stained with grease and soot and put it on, and being pleased would have uttered words of pleasure 'What a fine thing is a white cloth that is beautiful to look at, clean and spotless!' without himself knowing and seeing this, but out of trust in the words of the man who could see.
    —Just so, Māgandiya, sectarian Wanderers are blind and sightless, and without knowing good health, without seeing nibbāna, they still speak the line 'Good health is the highest gain, nibbāna is the highest pleasure.' These lines, Māgandiya, 'Good health is the highest gain, nibbāna is the highest pleasure, and the eight-factored path is the one that is peaceful and leads to the deathless' were spoken by Arahat Fully Awakened Ones (sammāsambuddhā) of old; but now in the course of time they have been adopted by commoners (puthujjanā). This body, Māgandiya, is a disease, an ulcer, a wound, a sore, an affliction. It is of this body, which is a disease, an ulcer, a wound, a sore, an affliction, that you say "This, Master Gotama, is that good health, this is that nibbāna"' You, Māgandiya, do not have that noble eye (ariyacakkhu) with which to know good health and to see nibbāna.
(The Buddha then goes on to indicate to Māgandiya what is really meant by 'good health' and 'nibbāna'.)

***

Thank you for sending me the copy of Panminerva Medica.The idea that diseases are useful as a means of adaptation to adverse circumstances, namely pathogenetic causes, would perhaps be valid if the only alternative, in such circumstances, to being sick (and surviving) were death—though even so, as you suggest, the incurable cancer patient might need some persuading before accepting this principle. But why does Prof. Vacira assume that without pathogenetic processes we should die? Or to put the matter another way, since Prof. V. is clearly a firm believer in cause-and-effect he will consider that pathogenetic causes and pathogenetic processes are indissolubly linked—where there is one there is the other. This being so, if he regards pathogenetic processes as 'indispensable' he must inevitably regard pathogenetic causes as equally necessary. Admitting that man will always encounter adverse circumstances, is it necessary to assume that they must be pathogenetic? There are pathogenetic causes only if they result in pathogenetic processes, and from this point of view pathogenetic processes serve no useful purpose whatsoever—we should be far better off without them. The Buddha tells us <D.26: iii,75> that in periods when the life-span of man is immensely long he suffers from but three diseases: wants, hunger, and old age—none of which involves pathogenetic processes. Man falls from this state of grace when his behaviour deteriorates; until, gradually, he arrives at a state where his life-span is extremely short and he is afflicted by innumerable calamities. General improvement in behaviour reverses the process. It seems, then, that adverse circumstances become pathogenetic causes as a result of the immorality of mankind as a whole. But this connexion between the General Theory of Pathology and what we may call the General Theory of Morality remains hidden from the eyes of modern scientific philosophy.

***

Many thanks for sending me The Medical Mirror. I don't know how it is in England—philistinism is the usual order of the day—, but it seems that the German doctors are not insensitive to current trends of philosophical thought.
I was struck by the remarks of one doctor whose task it is to look after patients suffering from anxiety. Formerly, no doubt, anxiety in patients would have been attributed to nervous (and therefore physiological) disorders, and the remedy would have been treatment by drugs or perhaps surgery. (Even now in America, I believe, the opinion is that all mental disorder will eventually be amenable to treatment by new psychotropic drugs and neurosurgical techniques—but then the Americans are the least philosophical of mortals. One of Sartre's characters remarks somewhere that 'For an American, to think about something that worries him, that consists in doing all he can not to think about it'.[2]) In other words, the whole matter of mental sickness would have been regarded as intelligible—in theory at least—in purely deterministic terms. But now this German doctor says
As some people commit suicide in order to escape fear, the knowledge of death also cannot be the ultimate reason of fear. Fear rather seems to be directly related to freedom, to man, whose task as an intellectual being it is to fashion his life in freedom. His personality is the authority which permits this freedom. But his freedom, on the other hand, allows man to become aware of himself. This encounter with himself makes him fearful.
With this, compare the following summary of Heidegger's philosophical views.
The only reality is 'care' at every level of existence. For the man who is lost in the world and its distractions this care is a fear that is short and fleeting. But let this fear once take cognizance of itself and it becomes anxiety, the perpetual climate of the lucid man 'in whom existence comes into its own'. (Myth, p. 18)
Man, in short, becomes anxious when he learns the nature of his existence; he becomes afraid when he finds he is free.
 
But if this is true, it is true always. Why, then, is anxiety so much more prevalent today, apparently, than it was formerly? The world is more comfortable than it was (and nobody has invented more unpleasant forms of death than have always existed), and yet mental homes are multiplying and full to overflowing. Why should it be so? This is where Nietzsche comes in—he is the diagnostician of our times. Nietzsche declared that 'God is dead', and called himself the first accomplished nihilist of Europe. Not, indeed, that Nietzsche himself assassinated God; he found him already dead in the hearts of his contemporaries; and it was by fate, not choice, that he was a nihilist. He diagnosed in himself and in others the inability to believe and the disappearance of the primitive foundation of all faith, that is, belief in life. (I am quoting Camus.[3])

Here, in a Buddhist tradition, it is not always realized how much in Europe the survival of death, and therefore of valid ethical values, is bound up with the idea of God. Once God is 'dead' (and he started dying, convulsively, with the French Revolution), life for the European loses its sense. 'Has existence then a significance at all?—the question' (says Nietzsche) 'that will require a couple of centuries even to be completely heard in all its profundity.'[4] And so the task that Nietzsche set himself was to find out if it was possible to live without believing in anything at all: to be absolutely free, in other words.

Being a man of integrity (there are not so many after all) he used himself as a guinea-pig—and paid the price with madness. But he discovered in the process that complete liberty is an intolerable burden, and that it is only possible to live if one accepts duties of one sort or another. But what duties? The question, for the European, is still unanswered. ('No one would start to play a game without knowing the rules. Yet most of us play the interminable game of life without them, because we are unable to find out what they are.'—Cyril Connolly in 1944.[5]) In the old days, when God was still alive—when Christianity was still a living force in Europe—, people were faced, just as they are now, with the anxious question 'What should I do?';[6] but the answer then was ready to hand—'Obey God's commandments—and the burden of anxiety was lifted from their shoulders. They feared God, no doubt, but they did not fear themselves. But now that God is dead, each man has to carry the burden for himself, and the burden—for those who do not shirk the issue and bury their ostrich heads in the sands of worldly distractions—is impossibly heavy. No, it is not death that these anxiety-ridden inmates of our asylums fear—it is life.

'And what is the answer?' perhaps you will ask. As I have tried to indicate (in KAMMA), the answer, for the ordinary person, is not self-evident. On the other hand, he may well feel that there ought to be some answer—as indeed Nietzsche himself did when he wrote
It is easy to talk about all sorts of immoral acts; but would one have the strength to carry them through? For example, I could not bear to break my word or to kill; I should languish, and eventually I should die as a result—that would be my fate.[7]
And this feeling is not mistaken—except that one can never have certainty about it until one has actually seen the Buddha's Teaching for oneself. In the meantime, all one can do is take it on trust—even if for no other reason than to keep out of the mental home. But these days are so arsyvarsy that anyone who does succeed in seeing the Buddha's Teaching may well find himself lodged, willy-nilly, in an asylum.
 
I was fascinated by the account of 'a surgical super-operation reported recently from abroad [America?], where in nine hours of hard work a patient was operated for a malign tumour, an intervention which removed the entire pelvis including the legs and re-established new openings for urinary and intestinal tract'. Just imagine—no more itching piles, no more ingrowing toenails. But surely they could have removed a lot more? After all, one can still live without such useless impedimenta as arms, eyes, teeth, and tongue, and with only one lung and one kidney, and perhaps no more than half a liver. No wonder the writer comments that the surgeon should make inquiries about the patient's reserves of asceticism—just the right word!—before he starts on his labour of love!

 
Editorial notes:
[33.1] Medical Mirror: The quotation is found in issue 6 of 1963, as part of a translated extract from a talk (in German) by Prof. Dr. Thure von Uexküll given at a symposium on 'Fear and Hope in Our Times'. 
[33.2] Sartre: 'Americans do not enjoy the process of thinking. When they do concentrate, it is in order to escape all thought.' Troubled Sleep, p. 29. 
[33.3] quoting Camus: This passage paraphrases sections of The Rebel, pp. 57-67. 
[33.4] Nietzsche: From 6ET, p. 30. 
[33.5] Connolly: The Unquiet Grave, p. 79. 
[33.6] What should I do?: Check also the draft of an article The Foundation of Ethics found among the Ven. Ñānavīra's effects. 
[33.7] Nietzsche: The quote is found at The Rebel, pp. 68-9.

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