Authenticity   /   Fall 2021   /    Book Reviews

Sisyphus Gets a Prescription

Doomed to wellness.

Carl Elliott

The Idleness of Sisyphus (detail), 1981, by Sandro Chia (b.1946); The Museum of Modern Art, New York, NY, USA, digital Image © The Museum of Modern Art/Licensed by SCALA/Art Resource, NY; © 2021 Sandro Chia/Licensed by VAGA at Artists Rights Society (ARS), NY.

Sisyphus is burned out. It’s not simply that the work is grueling. He just can’t see the point of it anymore. None of the old strategies are working—not rebellion, not resignation, not even a passive-aggressive slow-walk down the mountain. Shaking his fist at the gods feels like an empty gesture now. Naturally, his workplace wellness program has been no help. All they had to suggest was an online yoga class. Desperation has finally driven Sisyphus to a Zoom appointment with his “primary care provider,” who has called in a prescription for Zoloft and Ativan.

Sisyphus hasn’t filled the prescription. He knows his reluctance makes no sense. He is drinking way too much. The mere thought of a boulder gives him a sick feeling in his stomach. Wouldn’t happiness be preferable to depression? Wouldn’t serenity be better than dread? There is no rational, evidence-based reason for Sisyphus to refuse the medication. Double-blind, randomized trials have shown antidepressants supplemented by anxiolytics to be at least 20 percent more effective than placebo in subjective quality-of-life assessments among mortals condemned to perform futile work for eternity.

When the coronavirus emerged early last spring, many of us reached for Albert Camus’s novel The Plague. But as the pandemic stretched into the winter, The Myth of Sisyphus began to look like a better choice. We appeared to be facing some kind of existential reckoning, even if it wasn’t clear exactly what the reckoning was. Forced confinement had left many of us feeling trapped and lonely. More than a few of us were stunned by the colossal failure of the American social and political systems. Poorer countries with more solidarity and cultural trust were handling the pandemic far better than we were. For some, the reckoning felt deeply personal. If there is nothing like the death of someone you love to make you reconsider the hours you have left on earth, there is nothing like mourning that death by Zoom to make you rethink the way you want those hours to end. Many of us were tempted to moralize the virus, imagining it as a punishment directed at those who had defied the commandments of our designated moral authority. Too bad about poor Sisyphus, we thought, but he brought it on himself.

The question of how to treat Sisyphus lies at the heart of Robin Downie’s new book, Quality of Life: A Post-Pandemic Philosophy of Medicine. According to Downie, Emeritus Professor of Moral Philosophy at the University of Glasgow, the COVID-19 pandemic ought to make physicians rethink the fundamental ethos of medicine, which has produced an individualistic, consumerist, science-worshiping form of medical practice. Physicians consider themselves enlightened when they emphasize the importance of improving their patients’ “quality of life” rather than simply curing their diseases, yet most of them have a narrow, unexamined view of what that entails. Downie would not deny that Sisyphus has a poor quality of life, of course. Nor would he dispute that he faces a serious problem. Yet not all suffering is a medical problem, and not all remedies for suffering include medical intervention. What else does a physician have to offer?

For Downie, the path forward is obvious. First, you start with workplace safety and occupational health. Tartarus must be cleaned up immediately. It is true that boulder pushing will never be a picnic, but it would be far more tolerable if the mountain were not so fiercely hot and dusty. Another dramatic improvement would be regular breaks, or even vacation time. Better still would be a transfer to another workplace, such as, say, Ben Lomond in the Scottish Highlands. The loneliness of the trek up and down the mountain could easily be fixed by adding a few congenial companions for conversation and maybe a drink after work. Even the meaninglessness of the job could be mitigated. Downie imagines Sisyphus building a structure from the stones he is forced to haul up the mountain, perhaps a Scottish cairn or a shelter.

If this all sounds more like social work than medicine, so be it. Not only should physicians think more like social workers, Downie suggests, they need to collaborate far more readily with other professionals. Downie also recognizes that improving conditions for Sisyphus will be impossible without savvy political organization, the solidarity of fellow citizens, and a robust system of public health. Indeed, this is precisely his point: Many of the basic goods necessary for a decent individual quality of life cannot be provided without attention to the community in which the individual is located. If the pandemic has taught us anything, it is that the health of the community is essential to the health of the individual. As Downie says, “We are members one of another.”

Downie is emeritus professor of moral philosophy at the University of Glasgow and the author of many books on the philosophy of medicine, a number of them coauthored with physicians. (Full disclosure: He supervised my doctoral dissertation more than thirty years ago.) He is also a native Scot, born and raised in Glasgow, and his communitarian roots are evident in his philosophical stance. Downie argues that communities, rather than individuals or the state, should be at the source of our value system. This argument translates into three specific claims for medicine: first, that health can’t be conceptually separated from ideas such as well-being and quality of life; second, that we can improve the health of individuals by making our communities flourish; and third, that far too many financial resources are devoted to treating individual health problems rather than to removing the causes of poor health in dysfunctional communities.

Understanding what would improve the plight of Sisyphus would require a philosophical account of quality of life that goes beyond basic biological needs. For example, it would need to include an account of happiness—which, for Downie, means an Aristotelian conception of human flourishing rather than, say, a mere elevation of mood. It would also need to account for individual autonomy and choice. This is why basic improvements in workplace conditions are only the beginning of a solution. Part of what makes Sisyphus so miserable is the fact that he is trapped in a situation not of his own choosing. A cage is still a cage, even if it is carpeted and air-conditioned.

Of course, the punishment devised for Sisyphus is truly diabolical, not because his work is unchosen, or even because it is difficult, but because it is meaningless. That bleak fact will remain regardless of any improvements in his basic workplace conditions. Rolling smaller, rounder boulders up the gentle slopes of Ben Lomond may be more pleasant than pushing heavy boulders to the top of hot, dusty Tartarus, but it is no more meaningful. Even the addition of a minor creative purpose, such as building a shelter, would strike many people as small comfort, like allowing a prisoner in solitary confinement to make sculptures out of chewing gum wrappers. It may pass the time, but it’s no way to spend eternity.

No explanation of quality of life would be complete without an account of what gives life meaning, and this is a question that medicine is ill equipped to address. Medicine will always be centered on biological needs, even if those needs are expanded to include some account of the social nature of human beings and their need for communities in which to flourish. The question of meaning is rooted in the subjective experience of individuals in a particular time and place. Addressing that question doesn’t require more and better medicine but, rather, a sense of humility about medicine’s limits. In the view of Camus, for example, Sisyphus can succeed only by understanding the absurdity of his task and the certainty of his fate, and facing up to both with clear-eyed acceptance.

The physician-novelist Walker Percy understood this. For the epigraph of his novel The Moviegoer, Percy chose a remark by Kierkegaard: “The specific character of despair is precisely this: it is unaware of being despair.” Percy would not disagree with Downie’s prescription for Sisyphus, at least as far as it goes. Indeed, he would probably go even further. You could give Sisyphus psychotherapy, an active social life, weekly cello lessons, and a “church home” where he could teach Sunday school and sing in the choir. These additions would probably improve his scores on a validated quality-of-life scale. But even if those scores improved, Sisyphus would still be living a charade unless he came to terms with the nature of his predicament. As Percy might have put it, being in a predicament is no great thing. It may be very bad indeed. But it’s still better than being in a predicament and believing that you’re not.