A management discussion at work this week on the need to improve perinatal and child mortality rates in our clinical training platform hospitals, and cleaning up my bookshelf and picking up a book I haven’t thought about for a long time, got me thinking about Existentialism as a concept, something which occupied a lot of my thoughts and philosophical reading in my twenties, but which I have not thought of for a long time. I became aware of the philosophy of Existentialism while travelling round Europe on a holiday as an early ‘twenty-something’ with my good friend from my medical student University days, Simon Anderson. After a particularly hedonistic few weeks touring around, and wanting a bit of quiet down-time, at a bookshop in England I bought Albert Camus’s epochal book depicting existential philosophy but written as fiction – ‘The Fall’. I read it seven or eight times sequentially during the rest of the trip, and it changed my life and career choices thereafter.
Existentialism is broadly defined as a philosophical theory emphasizing the existence of the individual as a free and responsible agent determining his or her own development. Existentialism is conceptually underpinned by the Absurdist paradigm, which Camus described as defining the basic paradox or ‘confrontation’ between an individual’s search or desire for significance and meaning in their life on one hand, and the ‘silent, cold universe’ on the other. In other words, while it seems like the things we do in our daily lives have meaning, in the context of the universe they are purposeless, and indeed, it is difficult to ultimately define any purpose or meaning to the universe itself – the universe is essentially indifferent towards humankind. The reason for calling this an Absurdist paradigm is thus that it is therefore absurd to ascribe meaning to anything in life, given that our lives are so irrelevant in the context of the universe, and there is no meaning in the world beyond the meaning we ourselves personally give it.
Understanding, or becoming aware of, this Absurdist paradigm can create what is called an ‘existential crisis’ in the individual when they become aware of it. This existential crisis comes from wanting to have meaning in one’s life, yet having become aware of its meaningless. A person faced with this existential crisis has several ways of resolving the dilemma, including, firstly, one can commit suicide, and end it all, though as Camus suggested this would not counter the absurd, but would merely be playing out a part of the absurdist paradigm itself. Second, one can embrace a religious, spiritual or transcendental belief and us this as a life viewpoint that would counter the concept of the Absurd and one’s existential crisis, and give oneself a sense of ‘meaning’ again, though doing so would require a ‘leap of faith’ and a belief in something that is impossible to prove. Thirdly, one can accept the Absurd and continue to live one’s life in spite of being aware of it’s absurd nature, which would mean that one would live continuously aware of the inherent meaninglessness of all of one’s actions, while still performing them.
Camus believed that by taking this third option, one paradoxically achieved absolute freedom from all societal, moral, or religious restraints, and therefore this option of living with ‘doubt’ and awareness of life’s essential meaningless would allow one to ‘create’ a life in which one could determine how and be responsible for living life however one chose, and this is essentially what and how an Existentialist life and world view is defined. Therefore, by recognizing and embracing the position of the absurd gives one ‘freedom’ from all of life’s ‘constraints’, and the ability to choose whatever meaning one wants in life, while understanding it is essentially meaningless whatever one does, and indeed any ‘meaning’ is created by an awareness of its absurdist condition. Camus insisted that one must maintain an ‘ironic distance’ between the created meaning and the condition of the absurd, lest the created meaning ‘beguile’ one in to losing one’s perspective of the absurd.
In an Existential life therefore, one is not necessarily ‘immoral’ but rather ‘amoral’, and one can build a life however one chooses – we are ‘condemned to be free’ in all the choices we make because of the inherent Absurd nature of life. This paradoxically creates more responsibility on the individual for each of their choices and actions, given that one cannot assign blame for their outcomes to any external agent or belief, whether religious or secular, and this ‘allows’ one to create any life one chooses for oneself, and to set any goal one chooses, free of any external pressure or requirements. If one did not maintain an understanding of the Absurd in all of one choices, this could create a paradoxical feeling of pressure and fear of the responsibilities associated with each choice needed to be made during one’s life, without recourse to an external agent which could (and is often used) to absolve us blame for each of these choices and their consequences. So, in effect, an understanding of the Absurd can be liberating rather than depressing, though the opportunity for the latter emotion is obviously high in those contemplating the Absurdist paradigm, as evident in the use of the words existential ‘crisis’ or ‘angst’ in those contemplating Existentialism and the Absurdist paradigm.
So coming back to why the discussion with my colleagues on how we can improve neonatal and child mortality rates generated Existential thoughts in me – the thought of a child dying, and even more so a neonate a few minutes or hours after they are born has always raised the question large in my mind (apart from the feelings of grief and sadness for both the child and their parents) of what was the ultimate point of their short lives, and how on earth they could have been ‘struck down’ so soon after starting their lives. In many ways accepting the Absurdist paradigm is the only relief and ‘balm’ that one can have to attenuate and come to terms with these challenging concepts, and feelings of helplessness that come from not being able to help more these children in their distress. As with the three choices described above, one could commit suicide, but that would be ultimately a selfish act, one could turn to religion for salvation, but then one in confronted by the notion of an angry or uncaring deity for allowing suffering in a small child, or one can acknowledge the Absurd in all of it, and that there is no meaning or reason for these children’s death, and yet still in the best Existential tradition, work as hard as one can, and dedicate one’s life to trying to improve and enhance the practice associated with the care of such children and the prevention of their death’s to the best of one’s ability, even if one has to live with the knowledge that one ‘hopes for nothing, fears nothing’ and that in the broad context of the universe, a child’s death, and our actions in this life, are essentially meaningless, and the Universe surely unaware of the tragedy that occurs each day all around us. A thousand years from now, surely all we do in our lives will be absolutely forgotten and unknown, and potentially the earth could itself not exist, and we live ‘condemned’ to be aware of this knowledge. But, paradoxically, with this awareness comes our own individual freedom to choose to live our lives as we wish to live them, and the capacity to choose to be as best we can and to act with the best personal integrity we can without the restraint of any external influence when confronting all life and situations we are involved in. The challenge perhaps to each person is to fill their life to the best of their ability while realizing personal ambition, goals and desires are all ‘straw’ in the winds of time, and that the concept of ‘meaning’ in life is potentially ‘absurd’ – and if one is able to, then one can indeed call oneself an Existentialist, for what that is worth!