Support or Illumination?

Numbers have never really been my thing. However, a few years ago I knew I needed to learn more. Having joined an NHS research ethics committee, I wanted to understand more about health statistics. Fortunately I had the opportunity to complete a postgraduate course in health research – which included a module on statistics. Despite my misgivings about data this turned out to be one of the most enjoyable parts of the course, shedding light on the use and abuse of figures to further an argument.

“Most people use statistics as a drunk … uses lamp-posts for support rather than illumination”

Attributes to Andre Lang

Now, in the light of the pandemic, the world is trading statistics like never before. Government scientists present graphs and tables each week, sometimes daily, to explain the R number (transmissibility); exponential growth; and much, much, more. Even where it might seem that there should be greatest clarity, for example the number of people who have died, there are typically three figures offered. The nuances of criteria and methods reveal just how much the nature of the question influences the form of the answer.

Dorothy Bishop’s bishopblog is one of many sites on the internet that have interrogated the presentation of data and called for greater clarity. Using the example of the difference between relative risk and absolute risk the case is made for the importance of accuracy when communicating data to the public. What might seem to be a huge increase in risk (e.g. 30%) may make limited difference in actual cases depending on the total numbers involved.

“we might hope that, in a pandemic, where public understanding of risk is so crucial, particular care would be taken to be realistic without being alarmist”.

Dorothy Bishop, bishopblog, accessed on 27 January 2021

When I was a curate on placement in a rural church near Lancaster I took part in a service in which the Bishop confirmed 25% of the population of the parish. This meant about 15 people, and it was a fairly rare event for the bishop to come to confirm – so several years’ worth of candidates were gathered up together. It seems astounding that in England in the 1990s a quarter of a parish’s entire population was making a declaration of faith all at once – context is everything.

There appear to be more opportunities for people unaccustomed to interpreting statistical data to find accessible information. Radio 4’s More or Less is a good example of how academic expertise can engage with the questions people are keen to interrogate. In response to the emergence of ‘alternative facts’ there has also been growth in the independent reality checking for which there is an increasing demand. Nowhere could this be more important than in the need for accurate information about the vaccines being offered to combat COVID-19.

It seems to me that one of the problems faced by the desire for both clarity and accuracy is that the truth isn’t always simple. What is the difference between something being ‘safe’ and ‘completely safe’? When vaccines have been developed so quickly there are understandable questions about both immediate side-effects and longer-term consequences. Even a very good sample of people used in the testing phase of the vaccine development cannot be representative of every human characteristic. The question for me is not about the absolute safety of vaccines to be used on billions of people, but about their likely safety and the common good.

Born in a vicarage in the mid-1700s, Edward Jenner is usually seen as the founding figure in the development of modern immunology. At a young age he was given the maxim of William Harvey: “Don’t think; try”. We must be thoughtful, enquiring and considered in our choices – but there comes a time to act. It may be possible to wait for the complete clarity we desire, all the data weighed and balanced, but sometimes we need to make a judgement-call before we know as much as we would like. If the pandemic has taught us one thing, it is that if you wait until something is blindingly obvious you have left it too late. There is a stage in every pandemic when the damage being done is stealthy and silent – yet the foundations of tragedy are being laid comprehensively and irretrievably.

Perhaps one of the legacies of COVID-19 will be to create better systems of public education about risk and probability. Not that any of us will know everything, but – importantly – that each of us might be better able to ask the right questions. Numbers cannot tell us how to live. They provide illumination enabling us to see more clearly the context in which our choices are made. Used well, they support the priorities we have chosen based on our values and moral commitments.

Lonely Sits the City

The Book of Lamentations can hardly be described as a fun read. The concept of lament may seem old and irrelevant – a crying over spilled milk, rather than the ‘can do’ attitude needed to manage a crisis. Yet scholars have argued that this caricature misunderstands Lamentations. Rather than a self-absorbed despondency it is a book that reflects an accurate perception of tragedy. It names experience and seeks to convey the visceral reality of exceptional trauma in all its horror.

My eyes are spent with weeping;;

my stomach churns;

Book of Lamentations, 2: 11

Several writers have explored the meaning of Lamentations and its relevance for other situations of overwhelming loss. Certainly the writer of the book is engaged with an experience of catastrophic destruction, where a community has been ripped apart. It is common in many such experiences to search for meaning and interpretation, as well as to apportion blame. Garber has written about the relationship of this kind of literature with reference to trauma studies. He quotes O’Connor’s understanding of this type of text as an ‘ancient poetry of “truth telling”‘.

For vast as the sea is your ruin;

who can heal you?

Book of Lamentations, 2: 13

There will be many who will not link this kind of traumatic lament with the experiences of COVID-19. While much has changed there remains a level of functioning in Western societies which suggests huge stress rather than catastrophic collapse. Nevertheless the level of human loss, especially considering the many mitigations which have been put in place, is remarkable. In some families and sections of society the cost of COVID has been dear, with deaths, severe illness, reduced income, disruption to social structures and lost education. To name these experiences accurately will give rise to lament.

“there may yet be hope” Book of Lamentations 3:29

Lamentation has a number of consequences. It begins to articulate experience, putting words and sound to voice the inner turmoil when the immediate crisis is passing. In the Book of Lamentations it wrestles with both God’s presence in disaster, and simultaneous silence in the face of the people’s prayers, pleading and petitions. It may have the effect of affirming a sense of community and shared experience that lays the foundations for recovery. At the time of lament this may not be apparent but it may be a consequence of putting words to a crisis which might otherwise disband the survivors of a common trauma.

Lamentation is a form of stringent speaking. It sees through the gloss, the veneer of interpretation, and names the truth of desperate times. It is not a counsel for despair but a cri de coeur for accuracy and understanding. In this there is a prophetic edge. It challenges the superficial discussion of events that shatter communities and wreck the lives of individuals. The loss of life and suffering with over 2 million worldwide COVID-19 deaths, is surely worthy of lament.

“We’re grieving the world we have lost: normal life, our routines, seeing our friends, going to work. Everything has changed. And change is actually grief – grief is a change we don’t want”.

David Kessler quoted in an interview with Joanna Moorhead, The Observer 17 January 2021

David Kessler, who has spent his career in palliative care, describes us as a ‘grief-adverse society’. The consequence of this is the failure to recognise and experience post-traumatic growth. Only by exploring the parameters of loss can we begin to see any meaning which may emerge from tragedy. As many of us have known through the pastoral support of the bereaved, as well as in our own experience, it is unhelpful to speak of hope in the midst of crisis. Yet even unspoken, hope is often present, and although straggling and diminished it has a remarkable capacity to grow.

I hope that there will be a willingness for society to lament. To trace the sharp edges of grief and in doing so, encounter unexpected gifts. Gifts that will arrive in their own time. I have already seen, as people write and paint and create in response to their suffering, the kind of lament that may yet lead to new meaning. The risk is that we will try to rush past this crisis and its consequences and silence the voices of those who recall us to the suffering that has been all too real. Hopefully, wisdom will remind us that a future of greater promise, fairness and compassion, cannot be built successfully on a buried past.

I pray that we shall both lament and learn.

Loss and Love

Around this time of year I like to read Sir Gawain and the Green Knight. Either read, or listen to Simon Armitage recounting his own translation of the tale. It is a magical story of an imagined past, where the Christmas and New Year festivities are celebrated in the bitter cold of a Medieval winter. Full of detail and drama, the story is heard at its best while sitting beside a roaring fire on late afternoon during the first days of January.

“And wonder, dread and war
have lingered in that land
where loss and love in turn
have held the upper hand.”

Armitage, S. (2008). Sir Gawain and the Green Knight (A New Verse Translation). WW Norton & Company.

Fortunes change. Tragically, loss appears to have held the upper hand for much of 2020. Not only in the UK, but around the world, a tsunami of illness has broken on our shores and borne many away. It has been a year of mortality significantly above and beyond the pattern of recent decades. As we remember the people who have died it is also important to recognise the frightening illness many have experienced, with breathlessness and anxiety that this is ‘the end’. Doctors are only now starting to understand the many consequences of illness and the reality of long covid. We know that a legacy of mental illness will follow the events of 2020, whether linked to physical suffering or arising from that myriad of losses both great and small. Employment, education, key life events, holidays, income, and the company of family and friends. It seems endless.

At various points in the year we have been reminded this this will pass. That humanity will recover from this seismic stumble and continue to progress towards greater longevity, health and wealth. However, as we also know, this was at best a partial narrative. Plenty of places in the world were already suffering through lack of resources, access to clean water, education and food. In the UK we learned recently that UNICEF will be feeding children here for the first time in 70 years. Wealth inequalities continue to widen and there is some indication that sections of society in countries with the greatest inequality have been the most vulnerable to COVID-19.

Cover illustration for Armitage’s Sir Gawain by Bevis Martin

We must do better. While the frost and freeze of a Medieval landscape may be enjoyable by a fireside, it cannot be the reality for people unable to keep warm for want of basic necessities. As the UK departs fully from the European Union, with many of the leaders of change seeking greater flexibility and entrepreneurialism, its cost cannot be carried by the poorest in our society. Success in this new venture must be measured by a change in fortune for the vulnerable in our communities, not only the privileged.

It is to be hoped that 2021 will not bring as much unexpected damage as its predecessor. The path ahead is still uncertain, which makes it all the more important to do whatever we can to help love have the upper hand in our personal and collective actions. This may seem a fanciful and unrealistic vision, but it can have real edge and ambition when we strive to implement its qualities. William Temple knew that loving your neighbour could not be a government policy but he believed that when love was expressed in any kind of social organisation it was experienced as justice. The emerging analysis of COVID-19 shows that wealthy societies denying many citizens a share in resources are both unjust and damaging – for everyone.

The author of Sir Gawain was no doubt an entertainer of an antique time. Yet even poets who please a crowd sew truth with the yarn they are telling. In this case it was the risks and rewards of chivalry and courtly love. Just before Christmas I was given a more contemporary poetic offering in Diane Pacitti’s 2020 title Dark Angelic Mills. It is beautifully written and delightfully northern. As we begin to digest an extraordinarily difficult year, and to build some of our experiences into 2021, we need poets to help us see more clearly the realities and opportunities of our time. In her poem A Prayer of St Hilda, Pacitti concludes as follows:

Transform each barrier wall into the tall
Support of a broad tent, a spacious hall;
Saint of wise love, it is to you we call;
Help us to build a sheltering home for all.

Diane Pacitti Dark Angelic Mills (2020) Canterbury Press