Why Bother Trying to Change the World?

Ethan Casey gave this talk on the University of Colorado’s Anschutz Medical Campus in Aurora, Colorado on October 17, 2014.

Is there anything good happening in our world today? And what can we do, either as individuals or as a community, about all the bad things that we know are happening? More specifically and concretely, what can people sitting in this room today do, as members of a medical community? What can the rest of us do who are not medical people?

These are among the questions I was asked to address in my speech today. They’re big, even daunting questions. But I will have failed in my task if anyone were to leave here today feeling daunted. I hope that instead you’ll leave feeling encouraged and needed. I’m here to tell you that there is good news, and it’s this: We may not be able to save or change the world, but that was never a feasible goal anyway. And, regardless of the state of the world, we always have plenty of opportunities to make ourselves useful.


I’d like to begin by telling you a story from my own very recent personal experience, then recommending in the strongest possible terms a book that everyone who asks the same big, daunting questions should make a point of reading. First of all, the story: This past summer I built a patio – something I had never done before. I couldn’t have done it at all without my friend Pete, who has both experience and tools that I lack. I had first to imagine the patio – beginning at least a year ahead of time – then haul out a lot of dirt, then build a retaining wall to correct for the slope of the ground toward the back wall of my house, then haul in crushed rock and sand. The surface is about two thousand reclaimed bricks: assorted antique pieces of Seattle history, some of them from the original harbor steps dating to the 1880s. It took me all summer.

I could get run over by a bus tomorrow, or a major earthquake could destroy my house, or rampaging condo developers could devour my quaint neighborhood. And anyway, ISIS is overrunning Iraq and Syria, and police in armored vehicles have been terrorizing residents of Ferguson, Missouri, and radiation from the 2011 nuclear disaster in Japan has reached the West Coast of North America, which is where I live. So why bother building a patio? My answer is that, regardless of all the bad things happening around the world, my wife and I and our friends and relatives plan to enjoy it for years to come and, I hope, eventually to pass it on intact for others to enjoy. Like planting a garden or writing a book, building a patio in an uncertain world is an exercise in enlisting the passage of time to advantage: an act of faith.

“Faith” is a widely and glibly abused word, but the sense in which I use it here should ring true to anyone, religious or not, who lives in our world as it is and wants to do what he or she can to make it better. “Faith is not belief in spite of evidence,” said Clarence Jordan, who among much else was instrumental in the founding of Habitat for Humanity, “but a life in scorn of the consequences.” If you’re going to bother getting out of bed in the morning and doing anything at all, you have to believe that life is worth living and that human beings are meaningfully connected through time as well as across space. Needless to say, that can be easier said than done. As Paul Farmer has said, depression is a rational response to the state of the world.

But over thirty years, Farmer and his Haitian and international co-workers have achieved remarkable things in a certain very poor region of rural Haiti, as I’ve seen with my own eyes, as well as a great deal more elsewhere, from Peru to Russia to Rwanda. And they couldn’t be doing any of what they’re doing now if they hadn’t started doing it thirty years ago. In case you’re not familiar with Dr. Paul Farmer and Partners in Health, the remarkable organization with which his well-earned reputation is closely associated, you can brief yourself by reading the bestselling book Mountains Beyond Mountains by the journalist Tracy Kidder. You will also read about my own visits to Cange and Mirebalais in central Haiti, and my in-person encounters with Farmer himself and other Partners in Health staff, in my book Bearing the Bruise: A Life Graced by Haiti. Each of you is being given a copy of Bearing the Bruise today, with my compliments.


Paul Farmer, Partners in Health, and Haiti are not featured in my friend Paul Loeb’s wonderful anthology of encouraging stories of real-life work and activism titled The Impossible Will Take a Little While: Perseverence and Hope in Troubled Times, but they could well have been. And that’s part of the book’s beauty: Paul Loeb could have conveyed essentially the same message of chastened encouragement with an entirely different selection of specific material, because there are many, many encouraging stories out there to choose from – if what we want is to be encouraged.

The Impossible Will Take a Little While is a judicious selection of writings, grouped thematically and with section introductions by Loeb, from contributors involved in public activism past and present, from South Africa (a compelling excerpt from Nelson Mandela’s autobiography and Desmond Tutu’s “No Future without Forgiveness”) to Chile (“The Black Hole” by Ariel Dorfman) to Nebraska (Mary Pipher’s “Reluctant Activists” on the remarkable story of how broad-based local citizen opposition arose to the Keystone XL pipeline). Also included are poems and reflections on the personal costs as well as enrichments of involvement and action. As I know from both reading his books and knowing him personally, Loeb is a very literate and humane person, and the book’s greatest value is that it addresses, implicitly and at times explicitly, the question of why we should bother in the first place. In his introduction to the section titled “Beyond Hope,” Loeb writes:

Sometimes we achieve the impossible sooner than we expect. Knowing that can stiffen our resolve. But relying on quick victories can also tempt us to place too much emphasis on outcomes; it can cause us to become unduly impatient, brittle, with our will easily broken by setbacks. A deeper, more farseeing hope, by contrast, combines realism with resilience, acknowledging suffering and despair without giving in to them. … By letting go of impatient hope we can persist no matter how hard it gets.

Loeb also quotes his friend Abe Osheroff, who fought in the Spanish Civil War and was still politically active when he died at age 92, and who told him: “When I was younger, I acted because I hoped to achieve a certain something. Now I’m path-oriented. I act to get in contact with the best part of who I am. I do the work whether we win or lose.” For his own part, Loeb rightly emphasizes that it’s both permissible and necessary for us to live with paradox. “If we let go of consequences altogether, we can delude ourselves into thinking that critical life-and-death outcomes don’t matter,” he writes. “Yet if we base our commitment solely on whether we’ll prevail, we run the risk of giving up before the full promise of history is fulfilled.”


Activism is important and can be necessary, even historic. But often, and even necessarily, activism is extracurricular to whatever we do for a living. Most of us need to spend most of our waking hours doing one thing or another to support ourselves and our families. So I want to challenge you with a question: How do you choose to spend most of your time, and why? Why do you do what you do? Why did you go to medical school? Or, if you didn’t go to med school, why did you get whatever education or training you did get, to do whatever work you do? What knowledge, skills, and other resources have you acquired, and to what end? A more pointed way to ask the same things is: How can you make yourself useful? I think that, however each of us answers that question, answering it at all is the antidote to the depression and despair that Paul Farmer rightly calls a rational response to the state of the world.

In a previous life I reared a boy, and one thing I strove hard to impress on him was that the work you choose in life – or that chooses you – should serve three purposes. Of course it should provide you and the people for whom you are directly responsible, whomever you define as your family, with a livelihood. It should also be something you enjoy. And, not least, it should be useful to other people. That’s what I told the boy that I reared. But I can’t take credit for making this stuff up. Human beings have known these things at least since the Book of Ecclesiastes was written, several thousand years ago. I’m not a conventionally religious person, and for exactly that reason I find a lot of truth and wisdom in Ecclesiastes. Far from “laying religion” on its reader, what Ecclesiastes wallops you with are highly concentrated doses of earned wisdom that ring true exactly because they arise directly from lived experience. “I know that there is nothing better for people,” its unnamed author tells us, “than to be happy and to do good while they live. That each of them may eat and drink, and find satisfaction in all their toil – this is the gift of God.”

Unlike the author of Ecclesiastes, I’ve never written anything that’s been selected for inclusion in the holy scripture of any world religion. But, like him, I believe that the highest purpose any human being can serve is to get out of bed every morning, whatever the circumstances, and pursue happiness by making himself or herself useful to other human beings and living creatures. There’s too much important work to do, and we’re up against too much, to justify any of us approaching life with any other attitude.

So, again, if you did go to med school, why did you? What attitude toward work, and toward his or her own role and position in society as a highly credentialed professional, should a physician hold? Paul Farmer addressed these big questions in a remarkable commencement address at his alma mater, Harvard Medical School, in 2003. Farmer titled his talk “If You Take the Red Pill.” (The text of the speech is published in To Repair the World, a collection of Farmer’s speeches, edited by Jonathan Weigel.) The reference is to the film The Matrix, starring Keanu Reeves as Neo, a young corporate cog who is invited by a mysterious character called Morpheus, played by Laurence Fishburne, to take one of two pills: a blue one or a red one. If he takes the blue pill, Neo will wake up in bed and life will go on as before. If he takes the red pill, he’ll find out what’s really going on. Morpheus promises to show Neo “how deep the rabbit hole goes.”

“It’s my contention, of course,” Farmer told the new Harvard Medical School grads – young people about to become not just physicians but elite physicians, anointed with the most prestigious of credentials – “that a certain amount of red-pill popping is just what we need in medicine and public health. But how many of us want to see how deep the rabbit hole goes? … Do we dare take the red pill? A serious question from a guy who is gagging on the red pill and still falling down the rabbit hole.” Ignorance, says Farmer, “is not bliss. Ignorance is just that – ignorance – and ignorance and medicine are simply not compatible.” Neo, Farmer points out, “goes for truth, which is all that Morpheus promises. And the truth is ugly.”

I could belabor the implications of what Farmer means by urging us to take the red pill, but I don’t think I need to. We all know that the social, political, and economic aspects of our world are severely, violently, and dangerously unjust, and getting more so. We know the truth of the world as we’ve made it, but we avert our eyes from it, because the truth is ugly. But I’m not here to give you bad news in the form of that statement of the obvious. The good news is that those aspects of our world – social, political, economic – are not natural, but manmade. As Farmer told the Harvard Medical School grads, “Here’s a glass half full for you: as doctors, you are granted special license to fight for a better world.” The fact that the world in its social, political, and economic aspects is manmade means that we are free to change it. So the question is not whether we can change the world, but whether we want to. The real question is whether we can be bothered to change the world. I’m not going to tell you how to answer it for yourself but, please, in the name of intellectual and moral honesty, please listen askance to anyone telling you that “the reality is such-and-such” or “such-and-such is just the way things are.”

Doctors are granted special license to fight for a better world. But so are the rest of us. Not only are we licensed to fight for a better world, we’re obligated to. We’re free not to but, if we don’t, we’ll be compelled to continue living in the world as we’ve made it. And not only is the world as we’ve made it morally intolerable, it’s fast becoming pragmatically untenable. But, in a way, that alarming fact is actually salutary, because it frees us from having to continue making excuses for the status quo.


On that point, regarding the status quo and our habit of making excuses for it, I want to recommend another book to you. In A Paradise Built in Hell: The Extraordinary Communities That Arise in Disaster, the wonderful San Francisco-based writer Rebecca Solnit shows us how ordinary people on one hand, and established authorities on the other, have responded to natural and other disasters, from the 1906 earthquake and fire in San Francisco to Hurricane Katrina. There are exceptions in both categories, but generally speaking Solnit shows that those in power respond to disasters by circling the wagons to protect their own interests both institutional and personal and by sending in the troops, not to rescue victims but to control and even criminalize them, whereas ordinary people often quite spontaneously rescue and comfort each other and assemble themselves into communities of mutual aid and support.

After the 1906 earthquake, for example, ordinary people in San Francisco organized and ran ad hoc soup kitchens, while the mayor and his cronies were busy scheming to relocate Chinatown from the prime real estate it occupied to the far southern edge of the city. The overall impression Solnit leaves us with is an optimistic one: that “just the way things are” is not really the way things are – that human beings are actually a much better species than we tend to give ourselves and each other credit for, if ever we’re left to behave freely without coercion. The obstacle is a phenomenon that Solnit identifies as “elite panic”:

Elites and authorities [she writes] often fear the changes of disaster or anticipate that the change means chaos and destruction, or at least the undermining of the foundations of their power. So a power struggle often takes place in disaster – and real political and social change can result, from that struggle or from the new sense of self and society that emerges. Too, the elite often believe that if they themselves are not in control, the situation is out of control, and in their fear take repressive measures that become secondary disasters.

Solnit’s chapters on the aftermath of the attack on the World Trade Center are extremely moving, as well as revealing. She interviews, for example, a young woman named Astra Taylor, who tells her:

There was a sense on the street on September 11 of calm, of trusting in the people around you – kind of being impressed with how intelligently the people around you were handling the circumstances. There was camaraderie, no hysterics, no panic, you felt that people would come together. That’s obviously what happened in the towers, there was a lot of heroism that day. But then suddenly you’re back in your apartment and you’re isolated and you’re watching the news and it’s hysterical. … They were so overwrought and they’re just showing the image again and again of the plane hitting the tower and the tower collapsing. The experience on television was so different than the experience on the street.


I felt connected to the people on the street and I felt impressed by them. I also felt that reality is not what I thought it was, I still have a lot to learn. The reality that people would do this, commit this act of terrorism but also the reality that people in the street are trustworthy, that people would help you and that you would help.

That last point is especially revealing, I think: “Reality is not what I thought it was,” says Astra Taylor. Or, as I’ve been saying, “just the way things are” is not really the way things are. This brings to mind as well a highly suggestive comment that the great British writer J.G. Ballard once made to an interviewer: that growing up during the Second World War in the chaos of Japanese-occupied Shanghai – which he called “almost a twenty-first century city” – had taught him “many lessons, above all that the unrestricted imagination was the most accurate guide to reality.” Today, in the chaos of the actual twenty-first century, we need to find the courage to let go of cherished illusions and to imagine that future social, political, and economic configurations in the world we’ve made might be very unlike the ones that we’ve been used to for so long.

The conclusions that Rebecca Solnit draws from the experience and behavior of victims of disasters are relevant to us today for several reasons. Disasters are happening around us all the time these days, almost routinely. For all we know, as I speak to you today, we might well be on the verge of a new, serious, widespread disaster in the form of an Ebola epidemic. If you want to educate yourself about Ebola, by the way, I urge you to read the article by none other than Dr. Paul Farmer in the issue of the London Review of Books dated 23 October 2014.

The particular, ostensibly discrete disasters happening around us are the starting point. More broadly and deeply, the 21st-century world into which we’re slouching shows signs of becoming, essentially, one long, nonstop disaster of global scope. This is why we have a lot to learn from the experience of people in places like New Orleans and Haiti. Spike Lee’s masterpiece of documentary filmmaking When the Levees Broke – one of the greatest works of American journalism of recent years – documents unanswerably both the failures and the mendacity of the established authorities of New Orleans, of Louisiana, and of the United States before, during, and after Hurricane Katrina. By contrast, illiterate landscaper and New Orleans resident Tyrone Williams told me:

They figured everybody is killers and murderers and thieves, and everybody’s not like that. … They had a lot of people that I know that went to jail, drug addicts, crackheads, but that day everybody helped everybody out. … They was stealin’ boats to get people to high ground, and they was goin’ back to get other people, you know, to do the same thing. Some people made it and some people I haven’t saw yet [seven years later] and I don’t know if they moved and are staying where they stayed at. I don’t know if they couldn’t make it or what. A lot of people died in Katrina ’cause they couldn’t get out of the attic.

Similarly, Michele Mitchell’s excellent documentary film Haiti: Where Did the Money Go? documents the mendacity, in the wake of Haiti’s horrific January 2010 earthquake, of high-toned and well-funded international aid organizations such as the American Red Cross and Catholic Relief Services. And by contrast, my Haitian friend Gerald Oriol Jr. told me:

We organized a mass burial with some community leaders. We collected cadavers in the streets, children and adults; we dug a hole in the local cemetery and buried the corpses. We must have organized a burial for hundreds of people. I don’t remember the count, but it was a lot. We provided transportation to hospitals for people that were still alive but injured. … I also realized that the Haitian people really were fighters, that they were truly the heroes. They were trying to remove people that were under the rubble, trying to help out friends, trying to help out neighbors, or trying to help out total strangers. Some of them spent hours digging with their bare hands, helping out, and I realized that the Haitian people really were tremendously courageous and were able to build great solidarity in the face of unprecedented catastrophe.

In both New Orleans and Haiti, a lot of what you heard from reporters and commentators on TV was about ordinary people committing acts of looting and violence. Don’t believe everything you hear on TV. We have a lot to learn from the people of New Orleans and Haiti, because where they’ve already been is where we’re heading. We need to get over our misplaced confidence in Big, Important Institutions. That includes the United States government, for sure and for starters, but it also includes the United Nations, which has been part of the problem in Haiti both before and since the earthquake, as well as many nonprofit outfits, up to and including the hallowed Gates Foundation. Institutions are collapsing and hemorrhaging credibility around us left and right, and we can’t count on the world remaining stable enough for us to build durable new ones. There is no longer a status quo for which to make excuses. That’s scary, I know. But I invite you to lay aside unproductive and paralyzing fear and instead to think of this extraordinary global moment as one of opportunity.

Why bother trying to change the world? Because the world is changing whether we like it or not. And, as the profoundly encouraging books by Paul Loeb and Rebecca Solnit both demonstrate, and as my own experience corroborates, each of us ordinary human beings has the capacity to change it for the better, if only we want to.