Claim the Real World

Before every role, there stands a human being

My father was a family doctor. When I was a boy, he sometimes brought me on house calls, and I carried his black doctor’s bag. I thought there was magic inside it because he left people feeling better.

I was too young to understand the presence required in those situations. Now I know better. My father entered not only a house but a family. He knew its relationships, tensions, history, and social dynamics. The medicine inside the bag mattered, but so did the person carrying it. What I had mistaken for magic was partly the cultivated presence of the physician himself.

Gerald Epstein, M.D. called this “being in the presence of the present.” It is what makes involvement with art, prayer, music, or playing with a child or dog special. Each requires us to step outside our self-enclosure and give our attention to something beyond ourselves. Without cultivating this capacity outside of work, exercising it inside work is nearly impossible.

Epstein also described our ordinary way of seeing the world in four words: “Me real, you shadow.”

We experience ourselves as real and complex. We know the density of our memories, the ambiguity of our motives, the fears we conceal, and the hopes we have difficulty naming. But when interacting with others, we minimize their complexity. They become patients, employees, customers, opponents, or strangers—figures occupying roles within our world. We remain inexhaustibly real; they become shadows.

This reduction comes easily. Our evolutionarily older threat-and-reward systems rapidly sort people according to danger, safety, pleasure, frustration, and usefulness. Categorization is efficient; full encounter is demanding. Our call to become fully aware and fully human requires another operating system—one that begins with recovering the awareness that the person before us is also a complex being or, in religious language, possesses a Divine soul as we do.

One concept that helps us do this comes from Dr. Robert Rhondell Gibson, who distinguished between the man-made world and the real world. The man-made world is composed of roles, categories, institutions, rules, expectations, and interpretations. The real world is what is actually happening before those constructions tell us what is supposed to be happening. It is the world of direct experience, living people, and conscious response.

Civilization could not function without shared agreements, standards, and roles. Medicine likewise needs schedules, records, diagnostic categories, standards of care, and professional responsibilities. These structures are necessary. They allow the institution to function and can ensure a certain degree of safety, comfort, and quality.

But the rules that govern the game cannot define the person playing it.

Gibson pointed to the bureau of standards and measurements. Standards can properly be established for manufactured things. Applying the same logic to living beings is a perversion because no two people are the same and no ideal can contain a human life. Human beings can be measured in certain respects, but they cannot be reduced to measurements. The danger begins when the map replaces the territory, the diagnosis replaces the patient, and the role answers the moral question before the living moment declares itself.

The modern medical institution necessarily exists within the man-made world. But then the examination-room door closes.

At that moment, one person has the possibility of encountering another in the real world. Institutional rules remain useful as peripheral guidelines, but they cannot create the encounter. A visit can be medically competent, technically correct, and fully compliant while never reaching the person. When we pass through such encounters without connecting in some way, much is lost. It is as though we are drifting unconsciously without humanity, and the whole thing becomes dehumanizing.

I feel this most strongly when I am asked for a second opinion, or when I am the fourth or fifth doctor a patient has seen. There have been diagnoses that did not explain enough, treatments that failed, normal tests, and encounters in which the inability to find an answer slowly became an inability to believe the question. The patient arrives carrying symptoms, but also the burden of having had to prove that the suffering is real.

Such an encounter demands a different kind of presence—usually one of radical acceptance and an equalization of roles. The physician may need to admit uncertainty without losing authority. Listening may have to come before solving. The diagnosis may have to become secondary to the encounter, and the conversation may need to open into other parts of the patient’s life and lived experience.

This does not mean abandoning medical judgment or accepting every explanation a patient proposes. It means accepting the reality of the person before requiring that reality to become medically intelligible. The doctor may know more about a disease. The patient knows what it is to inhabit this particular life. “I do not yet know” can become the beginning of accompaniment rather than the end of care.

The German film The Lives of Others, winner of an Academy Award for Best Foreign Language Film, offers a remarkable artistic rendering of what happens when a role almost completely replaces the person and of what may be required to recover the person beneath it. 

Gerd Wiesler is an officer of the East German secret police. At the beginning of the film, he inhabits the man-made world almost without remainder. He is officer before man. The playwright Georg Dreyman is not a human being to be encountered but a subject to be surveilled. His home becomes information. His friendships become associations. His intimate life becomes evidence. Wiesler does not need to ask whether violating this private world is right; the institution and his role within it have answered the question in advance.

Then, through his headphones in the attic above Dreyman’s apartment, Wiesler hears Dreyman play a piano sonata.

The camera rests on Wiesler’s face. Something buried becomes visible. The sonata breaks through the institution and the job. The system has created layer upon layer of institutional behavior and identity that Wiesler has falsely identified as his own. But in the raw emotion of the music, and in Dreyman’s words about what such music can mean, those outer garments split open.

The music has not argued with Wiesler’s politics or presented a counter-ideology. It restores an awareness of beauty beyond politics and returns him to a private inner life—a place within himself that the state did not create and cannot completely govern. Dreyman begins to cease being a category in Wiesler’s official world. His grief, love, and inwardness become real. The man beneath the role of officer encounters the man beneath the designation of subject.

The awakening is remarkable, but it must develop into action to be realized. Otherwise, Wiesler would enter an unbearable division: he would see through the institutional identity while continuing to obey it. His recovered humanity becomes morally real only when he begins to disobey the outer garments, accept personal risk, and extricate himself from the role that had claimed him.

The film takes place within a totalitarian state, but its warning is not confined to totalitarianism. Every institution creates roles, and every role carries the temptation to substitute its prepared responses for conscious engagement. Medicine can turn suffering into data. Business can turn people into functions. Religion can make obedience a substitute for moral responsibility. Even the roles of parent, spouse, or dutiful child can become ways of performing responsibility while withdrawing from the person directly before us.

Political movements create a particular danger because they erase nuance and insist upon the party line. When politics takes possession of our moral lives, we stop encountering each question directly. We look first to the proclamations and leaders of the movement with which we identify, then bring our judgment into alignment. We outsource our opinions and begin to see an enemy in anyone who holds the opposite view. This is “me real, you shadow” in one of its clearest forms.

Institutions matter, but we are not called to sacrifice ourselves to them. Yet many people place themselves on the altar of an institution by assigning goodness and identity to the organization itself. Duty is necessary, but duty can also become a hiding place. The question is whether the role remains an instrument of encounter or becomes an insulation against it.

We therefore need ways of recovering the private inner life from the man-made world. Beauty and serious art interrupt our utilitarian categories. Silence and solitude reveal what conditioned reactions conceal. Prayer, music, play, and direct human relationship train us to give attention to something beyond ourselves. Encounters across political and social boundaries restore understanding between people.

These practices do not remove us from reality. They return us to it.

So the next time you walk into a meeting, an examination room, a family disagreement, or another place in which a role is expected of you, recognize the rules of the game established by the institution. But realize that before you stands a unique human being as complex as you are.

You may not always be able to make a connection. The other person may remain enclosed within his own role, as Wiesler was before his awakening. That is all right. The essential thing is not to lose your own humanity.

Recognize the man-made world. Choose the real world.