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August 25 - 31, 2005 Edition
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At Large No answers August 25, 2005 By Doug Cabral In his matchless study of Vineyarders - People and Predicaments: Of Life and Distress on Martha’s Vineyard (Harvard University Press, 1976) - Dr. Milton Mazer of West Tisbury wrote, “The studies of island life and the counts of the predicaments experienced by islanders were done in order to design a rational community mental health program for the people of Martha’s Vineyard. The epidemiological studies showed that only a small fraction of those with psychiatric disorder reached a source of effective help …” And, Dr. Mazer acknowledged, “The epidemiological studies also showed that the amount of disorder among islanders was beyond the capacity of any feasible system of mental health services alone.” There has been no formal follow-up of Dr. Mazer’s work, done in the late 1960s and early 1970s when we were about 10,000 year-round and who knows how many in the summer. But it is safe to assume that as nutty as we were then, we’re nuttier in greater numbers today. Which is not to say that nothing has been done. Martha’s Vineyard Community Services, of which Dr. Mazer was a founder and inspirational force, is today the overmatched and under-funded centerpiece for mental health and other social services that so many Islanders need. Dr. Mazer, faced with the infeasibility of the task, forged ahead, and Community Services’ leaders have over the years accepted ever-greater responsibility for the social welfare of Vineyarders, as conscientious leaders do. And, of course, it’s not to say that nothing more should be done. More is always needed, and what we provide is never enough. Maybe the lesson is that, like traffic in August, we must take every reasonable step we can think of to improve the flow, acknowledging that there is no one thing to be done that will untie the traffic knot. Similarly, regarding development, planning, and conservation, we must do everything reasonable to plan carefully, conserve wisely, and create conditions to improve the economic lives of our neighbors, all the while accepting that change is the constant and outcomes uncertain, no matter the assurances and forecasts of the experts. And similarly, as regards disease and death. Someone I know died recently, and near the end of her life she was furious. She had done everything the physicians and alternative health care practitioners had told her to do, everything her extensive and intelligent investigations had led her to do. She’d done it all with a persevering determination to overcome whatever the odds were. And, despite it all, here she was. Or, another friend, whose frustration over her husband’s relentless illness cried out, “We did everything they told us to do. Absolutely everything right, and now what?” Or, the other day, in a New York Times series about being a patient, Jan Hoffman wrote, “Nothing Meg Gaines endured had prepared her for this moment. Not the six rounds of chemotherapy for ovarian cancer that had metastasized to her liver. Not the doctor who told her, after Ms. Gaines was prepped for surgery, that he could not operate: a last-minute scan revealed too many tumors. ‘Go home and think about the quality, not the quantity, of your days,’ he said.” Then, faced with another therapy option, a dangerous one, Ms. Gaines wanted to know who would decide whether to try it. Ms. Hoffman wrote, “The doctor then recited what has become the maddening litany of medical correctness: ‘We’re in the outer regions of medical knowledge,’ he said, ‘and none of us knows what you should do. So you have to make the decision, based on your values.’ “Ms. Gaines, bald, tumor-ridden and exhausted from chemotherapy, was reeling. ‘I’m not a doctor!’ she shouted. ‘I’m a criminal defense lawyer! How am I supposed to know?’” Knowing is important. Knowing the answer. Knowing what would do the trick. Knowing what the therapy is that would cure the disease, what planning rule would protect the environment, what economic incentive would elevate low and moderate income. But Dr. Mazer suggests that Vineyarders, unlike contemporary mainlanders, may not put so much stock in knowing what the solution is. They may instead believe in not knowing. “In the man-nature contest,” Dr. Mazer wrote, “one of the values dominant in contemporary America is that man can acquire power over nature. We dam our streams to harness their waters, we transplant organs from one man to another, and we confidently expect to be able to modify if not control the weather. The islander, on the contrary, is more inclined to accept, and enjoy, his subjugation to nature or at least to hope to live in harmony with her … Even illness is often approached as a part of life, and the effort to maintain life for a few more days or weeks in the presence of a terminal illness is not pursued as relentlessly as it is in some of the great hospitals of the cities … When high winds and tides cause the ferry to remain in the harbor at Woods Hole, cutting the islander off from the mainland, he does not rail either against the sea or at the men who man the ships, as his summer visitors often do, for he has long been persuaded that in such a struggle, nature always wins.” The human complexion of the Vineyard has changed a lot in the 30 odd years since Dr. Mazer published his studies. We’ve learned to rail against undesirable outcomes, and to give a pretty good account of ourselves in the railing. Nowadays, for many of us, everything’s a contest, and the contest doesn’t end, because there’s always the chance of winning. It’s not the old Island way, but it may be our way.

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