AIDS AND THE MORAL EDUCATION OF SOCIAL WORKERS: SOME REFLECTIONS ON ALBERT CAMUS' THE PLAGUE

JOSEPH W. LELLA (Academic Dean and Professor of Sociology at King's College, University of Western Ontario)

BACKGROUND: EXPRESSIVE ARTS AND THE EDUCATION OF HELPING PROFESSIONALS

Recently, educators and practitioners of the helping professions have become interested in what the expressive arts have to offer their work. Meetings of the Society for Health and Human Values, representing a range of academics and practising nurses, medical social workers, pastoral care workers and physicians, regularly feature poets, dramatists and writers of fiction. Interdisciplinary symposia on death, dying and bereavement have included such artists; and, recently, prominent meetings concerned with AIDS have presented similar work. (1)

When added to the knowledge and skills offered by traditional social science and clinical disciplines, such approaches, I believe, can be extremely useful in preparing social workers to meet the daunting challenges presented by the AIDS epidemic. It is becoming increasingly clear that helping professionals need not only appropriate knowledge and specific skills, they also need qualities of moral excellence, or what we used to call virtues - the strength of character to face up to highly charged work situations. Evoking the concrete and experiential, the arts often focus in a concentrated way on the moral dimensions and qualities of real situations and people.

By stimulating the emotions and promoting serious reflection, they can help us to acquire the strength of character that is needed.

Albert Camus' novel THE PLAGUE, is a particularly apt vehicle for illustrating this. It vividly portrays human dilemmas which characterize not only the AIDS epidemic but also more general professional situations. As it triggers reflection on these, the novel also presents models of that strength of character which is needed to face them in a continuing way.

CAMUS' NOVEL: AN OVERVIEW A plague strikes the North African town of Oran. First the rats come above ground to die and then the people fall ill and cannot be cured. The authorities are helpless and the population despairs. A group of men band together to combat the plague: Rieux, the doctor who can limit the plague's ravages but can no longer heal, the mysterious Tarrou, who has crusaded against the death penalty, ... Panelous, the Jesuit for whom the plague is a trial of his faith,... The group sets up special hospitals and vaccinates people until the plague disappears as suddenly as it has come. Paneloux and Tarrou have died while Rieux is left to tell the story. (2) (McCarthy, 1982, p224).

THE PLAGUE can be read for at least three related themes. First, it is an engrossing narrative. Rieux, who tells the tale, is presented as a scrupulous observer of "the facts" who takes pains to establish the credibility of his account in a way which is almost "scientific". (3) (Camus, 1960, p8).

The book can also be read as an analogy to life in France under the German occupation in World War II. Camus was a member of the French resistance. He was painfully aware of the excruciating choices forced upon people when they face severe limits to their usual freedoms. He saw the possibilities for moral degeneracy inherent in such situations but also their potential to stimulate growth in personal and human dignity.

THE PLAGUE is also a discourse on the problem of evil. Much as the social sciences have tried to transform the concepts of right and wrong, good and bad into morally neutral notions in a world and in humanity viewed with dispassionate abstraction; and much as we have learned from the attempt, it has not been impossible to rid many of the sense there is a purpose to be found in human life, and that events which are in harmony with that purpose are "good", those in disharmony bad; that actions freely chosen and intended to be in conjunction with this are right and that the opposite are wrong; and that human beings have the responsibility to choose the former rather than the latter.

THE PLAGUE adds to this awareness Camus' sense of the inevitability of evil. In human action and in society, evil emerges as much from intended good as from intended evil, often inescapable despite the best of intentions (4) (Camus, 1960 p110). He asks in consequence: How can we orient ourselves to the inevitability of evil? Must we yield to it or can we act to maintain our integrity, to choose the good, in spite of it? (5)

VIRTUES, ROLE MODELS AND CAMUS' MAIN CHARACTER, RIEUX In the Judeo-Christian tradition, the "virtues" have been traditionally taught through the lives of the prophets and the saints. In modern times, the professions have recognized the necessity of role models and have also had their heroes celebrated in popular biographies and autobiographical works. For example, in medicine, Sir William Osler (6) (Cushing, 1925) is often cited as an exemplar of the humanistic physician (7). Florence Nightingale (8) (Bishop, 1952) is nursing's patron "Saint", as are Jane Addams (9) (Addams, 1910) and Mary Richmond, social work's patrons. Understanding the realities rather than the myths of such lives in social, cultural and professional context, studying their character strengths and weaknesses and the reasons for these can help the practitioner tease out what is worthy of emulation, what can and cannot be applied to him or herself, in his or her own situation. It is my view that more of such study should be promoted in professional education.

But along with this, the study of fictional characters in appropriate situations can also be of use. An author's creative imagination and artistic skill, dealing with approriate situations can often touch the reader more profoundly than a biographer or autobiographer's concern with establishing facts.

The main character of THE PLAGUE is the public health physician and narrator of the story, Dr. Bernard Rieux. His identity as narrator is not revealed until the book's conclusion, it would seem, in order that the author might allow the character to distance himself from his feelings in telling the tale, and in describing Rieux's role within it. The ability to achieve such detachment and distance while remaining fully engaged in action is perhaps the first strength which Camus shows us in Rieux, both as narrator of the story and as participant in its events.

In this, we see a health-social service professional fully capable of placing the evils of the plague in the perspective of history and sociological analysis while remaining engaged in the attempt to eradicate that evil, or at least mitigate the suffering it causes. Thus, Rieux begins with a rather detached description of his own home town, site of THE PLAGUE (10) (Camus, 1960, p5).

As the story goes on, we find Rieux both as narrator and participant attempting to place the town's evolving understanding of and mobilization against the plague in historical and sociological context. His analyses yield insight which he then uses in planning his own work and in his post-plague reflections.

Rieux first sees a phase of "denial". Initial problems are either ignored or explained away both by public officials and the "man in the street". When symptoms and rising mortality become incontrovertible, public and official concern is finally expressed. Bureaucrats attempt to calm the populace and take cautious first steps. Finally, when the symptoms and statistics can no longer be minimized, a state of plague is pronounced and more drastic measures taken. The people persist in their denial and protest curbs on their freedom. However, the town finally acknowledges its situation and settles into a long siege, coping with the death or exile (quarantine) of loved ones and the poisoning of life's daily pleasures. "Plague had killed all colour, vetoed all pleasure". (11) (Camus, 1960, p95). People try to compensate. They resort to bacchanals or superstition or "false" prophecy. Opportunists respond by profiteering; others with generous service.

After many months, the plague subsides, then disappears. Again we see denial, hope against hope for the end while fearing disappointment. The plague is officially declared "over". Emergency measures are revoked. There are reunions and great rejoicing. Life returns with renewed meaning.

While describing these phases, Rieux reflects upon them and upon his own reactions. He looks to history and to social analysis for understanding while continually stressing the FACTS of his observatons, the symptoms, the deaths. Analytically recognizing the need for denial in himself and others, he stubbornly and professionally stresses what his knowledge tells him in the case, and what needs to be done.

"Wisdom", one of the virtues, has been defined as the possession of knowledge, of experience, and the power of APPLYING these critically and practically, with prudence or common sense. (12) (Fowler and Fowler, eds., 1951, p1475) Camus shows us Rieux, first and foremost, as an exemploar of wisdom. A man who can read the signs of the times, identify the facts, the biological, psychological and social realities of plague. He understands his reactions to these as well as those of society, of government, and of the population at large. He takes these into account and builds his professional strategies accordingly. Rieux's analytic capacity is always working, in dialogue with his observations and emotions.

" 'Your view, I take it,' the Prefect put in, 'is this. Even if it isn't plague, the prophylactic measures enjoyned by law for coping with a state of plague should be put into force immediately?'...

'It doesn't matter to me,' Rieux said, 'how you phrase it. My point is that we should not act as if there were no likelihood that half the population wouldn't be wiped out, for then it would be.'

Followed by scowls and protestations, Rieux left the committee-room. Some minutes later, as he was driving down a back street redolent of fried fish and urine, a woman screaming in agony, her groin dripping blood, stretched out her arms toward him." (13 (Camus, 1960, pp45-46).

Fortitude is another of the traditionally defined virtues; courage or the ability to face up to pain or adversity. Before the plague's epidemic character became clear we find Rieux voicing the following thoughts:

"Throughout the day the doctor was conscious that the slightly dazed feeling which came over him whenever he thought about the plague was growing more pronounced. Finally, he realized what it meant; simply that he was afraid". (24 (Camus, 1960, p51).

Despite his fear and as the plague settles into its gruesome routine, Rieux faces up to his responsibilities, organizing the day to day work of "sanitary teams", diagnosing suspected cases at home, making sure that they are separated from their healthy relatives, quarantining the latter, caring for the stricken, in hospital, in their convalenscence or more likely during the agonies of their death. The constants are long hours and exhaustion, the ongoing frustration of an inability to prevent, cure, or even alleviate suffering.

Even ordinary human emotions become traps in the deadly routine of his work:

" 'Oh, I do hope it's not the fever everyone's talking about'.

After one glance, the mother broke into shrill, uncontrollable cries of grief. And every evening mothers wailed thus, ...every evening the nearing tocsin of the ambulance provoked scenes as vain as every form of grief. Rieux had nothing to look forward to but a long sequence of such scenes, renewed again and again. ...

Rieux had learnt that he need no longer steel himself against pity. One grows out of pity when it's useless. And in this feeling that his heart had slowly closed in on itself, the doctor found a solace, his only solace, for the almost unendurable burden of his days. This, he knew, would make his task easier, and therefore he was glad of it". (15) (Camus, 1960, p76).

And so, Rieux bears up, shows fortitude, courage and persistence in the face of adversity through the support of wisdom gained in confronting openly what he sees as the evils of the world; the data, or "facts" of evil. Further, he responds to these facts with generosity, charity or a sense of service which he then cultivates and reinforces through his persistence or fortitude. These virtues or strengths reinforce one another. Perhaps, they are all aspects of an underlying strength that manifests itself in different ways.

Rieux's charity or sense of service, as part of the above, his willingness to work on behalf of others, to help the helpless (16) (Fowler and Fowler, eds., 1951, p198) is illustrated in his response to his friend's, Tarrou's, idea to organize voluntary "sanitary squads" to help in disposing of the dead, and the other difficult tasks necessitated by the plague. Rieux asks Tarrou why he is exposing himself to a more than normal risk of infection: why he is risking his life to perform this service. Tarrou turns the question on Rieux himself. Rieux responds:

" 'What's true of all the evils in the world is true of plague as well. It helps men to rise above themselves. All the same, when you see the misery it brings, you'd need to be a madman, or a coward, or stone blind to give in tamely to the plague...' " (17) (Camus, 1960, p106).

Tarrou prods him further. How can you act, if there is no absolute (or divine) guarantee that you're right. "Who taught you all this, doctor?" Rieux replies promptly, "Suffering". (18) (Camus, 1960, p108).

As the story's narrator, Rieux continues to reflect on his reasons, and on those of the volunteers like Tarrou, for risking themselves for others. His reflections extend the above. He takes no great credit, finds nothing particularly admirable about it. It is merely a logical act in the face of the facts.

"...we do not congratulate a schoolmaster on teaching that two and two make four, though we may, perhaps, congratulate him on having chosen his laudable vocation ... The essential thing was to save the greatest possible number of persons from dying and being doomed to unending separation. And to do this there was only one resource: to fight the plague. There was nothing admirable about this attitude; it was merely logical". (19) (Camus, 1960, pp110-111).

And yet, Rieux seems to recognize that there is merit in having 'chosen to be a schoolmaster', and further merit in concluding not to give in to the plague or "evil". Later, he notes in a conversation with another friend:

" '..there's no question of heroism in all this. It's a matter of common decency. That's an idea that may make some people smile, but the only means of fighting a plague is - common decency'.

'What do you mean by "common decency"?' Rambert's tone was grave.

'I don't know what it means for other people. But in my case I know that it consists in doing by job'". (20) (Camus, 1960, p136).

Rieux, at least implicitly, comes to agree with the notion that there is merit, or strength in what he has called common decency, although in this recognition he illustrates another virtue, that of humility. He also indicates that it must be cultivated.

Rieux summarizes much of what we have said thus far in relating Tarrou's philosophy:

"... each of us has the plague within him; no one, no one on earth, is free from it. And I know, too, that we must keep endless watch on ourselves lest in a careless moment we breathe in somebody's face and fasten the infection on him. What's natural is the microbe. All the rest - health, integrity, purity (if you like) - is a product of the human will, of a vigilance that must never falter. The good man, the man who infects hardly anyone, is the man who has the fewest lapses of attention. And it needs tremendous will power, a never-ending tension of the mind to avoid such lapses. ...

All I maintain is that on this earth there are pestilences and there are victims, and it's up to us, so far as possible, not to join forces with the pestilences.

... 'It comes to this', Tarrou said almost casually, 'what interests me is learning how to become a saint'.

... the doctor answered. 'But you know, I feel more fellowship with the defeated than with the saints. Heroism and sanctity don't really appeal to me, I imagine. What interests me is -- being a man'.

'Yes, we're both after the same thing, but I'm less ambitious'. (says Tarrou). (21) (Camus, 1960, pp207-209).

Rieux the narrator, Camus the author, express the tremendous complexity of the question of living a moral life, of acquiring virtues, of strength of character. And yet, it is clear that there is will power involved, one must choose to be for "the victim", one must pay attention and avoid being a bearer of evil, a "plague bearer". For Rieux, the choice, the work is simple, a result of common decency, or rationality. And yet, he too, has chosen his vocation, chosen to speak the truth, that "two and two make four".

RIEUX, AND HIS FRIENDS: SOLIDARITY Rieux, and Tarrou, after their reflections, go for a moonlight swim. "Of course a man should fight for the victims, but, if he ceases caring for anything outside that, what's the use of his fighting"? they swim and silently enjoy the fellowship of two fighters against "the plague", friends no matter how differently they conceive of their fight; as a quest for sanctity or a quest for humanity, "and this was good, but now they must set their shoulders to the wheel again". (22) (Camus, 1960, p210).

Rieux, the sceptic, also becomes friends with Paneloux, the Jesuit, who through Rieux learns to fight the plague but motivated by faith. While performing his duties as a volunteer, Paneloux witnesses the painful death of a young child. It shakes him to the core. "My God, spare this child...!" (23) (Camus, 1960, p176).

Having first seen plague as God's punishment on evil doers, Paneloux no longer has an easy explanation. However, he now must assume that God wills it for our good even though the evils which it brings are in themselves without merit. But, he says, one must believe. The more difficult it is to believe, the more one must believe that there is an explanation -- a good behind the evil:

"we must go straight to the heart of the unacceptable precisely because it is thus that we are constrained to make our choice. The sufferings of children were our bread of affliction, but without this bread our souls would die of spiritual hunger". (24) (Camus, 1960, pp184-185).

Paneloux's faith that there is good behind the evil leads him to no easy fatalism, however, for it is clear that its suffering must be opposed. He cites the chronicle of a monastery's experience with the black death at Marseilles, and notes that of 81 monks only 4 survived; and of those, three fled. In his final sermon to the town, he cries out, "My brothers, each one of us must be the one who stays". (25) (Camus, 1960, p185).

And so, Paneloux stays -- in comradeship with Rieux and the others. After being infected, he dies clasping a crucifix, his faith, his solidarity with the suffering Christ, sustaining him in his death as in his work; but, Rieux the unbeliever implies, no matter, it is the work, the fight against suffering that counts and that makes us friends.

SOME FINAL RELFECTIONS Camus makes Rieux an exemplar of wisdom, of courage, of charity or service and of realistic humility. He also shows us a network of like-minded friends, peoople who support one another in their difficult work. The author's eloquence and insight shining through Rieux's example, I feel can be an inspiration to all of us, social workers above all, who aspire to similar wisdom, courage and service as we try to confront the analogous ravages of AIDS. But beyond this, Camus' novel indicates the broader educational potential of other artistic work.

The data, the knowledge of biological, psychological and social science; the techniques and skills of therapy are largely, perhaps of their very nature, distancing. They tend to describe and prescribe for what is "out there", and have less to offer what is "within", or what is most intimately the practitioner her/himself. And yet, they presuppose something "in there" -- the will to acquire knowledge and learn technique, the wisdom to reflect upon and use these well, the courage to continue to use them in the face of adversity, the humility to recognize that we are never self-sufficient, complete in our knowledge, skills and virtues. As educators, we spend more time on the knowledge and techniques, on what is "out there", and less on what is "in there".

The arts specialize in what is "in there". As Camus has done, they can lead the reader, the listener, the viewer to experience the emotion, to identify with the artist and her/his creations, to cultivate depth of experience and reflective capacity as well as to identify particular strengths of character which are often illustrated.

Social work education would gain in human depth and relevance were it to include the study not only of Camus' novel, which is of particular relevance to AIDS, but of other works which are pertinent to more generic situations faced by practising social workers. (26) Serious study of the intensity of experience reflected in these works cannot but help in the development, deepening and strengthening of those aspects of character needed to confront this complex world of ours.



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