The right amount of performance

On ensuring the roles we play are consistent with our values.

We live in a culture that values authenticity. It is never hard to find books, articles, films, songs and other media extolling the virtues of being our authentic self, of transcending the barriers that keep us from showing the world who we truly are. In this context, it can be uncomfortable to consider the ways we might embrace a level of performance in how we present ourselves. Yet I will start today’s essay with a perhaps countercultural assertion: We perform all the time. We perform in what we say, what we do, how we dress. For example, as I write these words, I am wearing what I usually wear to work: A formal suit with a jacket. I am writing the way I tend to speak in professional settings, with formal language. This is, to an extent, a performance. I am choosing to present in these ways in the hope that doing so will help me to better navigate the spaces I inhabit and better serve the interests of public health. In this sense, performance is a tool, a means to the end of helping to advance our mission.

This time of reevaluating foundational assumptions about public health is also a time for thinking about aspects of what we do that we had perhaps not considered before. Our relationship to performance fits well within this category. Each day, many of us play what is to some extent a role—on social media, in our engagement with colleagues, in classrooms and at professional conferences. We play these roles, in part, because doing so allows others around us to also play roles, and because we believe that these roles collectively become shared efforts to create healthy communities and a better world. Our performances can become so second nature to us that we may not even notice that we are spending much of our lives on a kind of stage. Yet we are. And such as we are, it seems worth examining how, and why, we perform.

Helpfully focusing, there are two main definitions of performance. First, performance is the act of working in front of an audience or playing a role. Second, performance is our aptitude in carrying out a task—the effectiveness with which we do our job. To my mind these two definitions should inform each other. Our performance, defined as our success in the pursuit of health, is shaped by our ability to inhabit and project the roles we play.  And conversely, our inhabiting of the roles we play should be in service of success in our goal—improving health and narrowing health gaps.  There are many fields where this is also the case, but perhaps the most obvious example is that of politics. In politics, the serious work of shaping and implementing policy is deeply, even decisively, tied to a political actor’s ability to “perform.” This was well-captured by the relationship between President Franklin Roosevelt and the actor Orson Welles. The latter served as a campaigner and occasional speech and joke writer for FDR, the two men linked by their shared understanding of the power of performance. When they met, FDR is said to have told Welles, “Orson, you and I are the two best actors in America.” And that acting was in the service of the programs that FDR was trying to implement, programs that in many ways remade the country.

This approach suggests that performance has utility when it is linked to the task we are trying to achieve. I might argue that that is the case even in performance in art; in that case the goal is to create beauty and in and of itself performance without that is simply a collection of actory mannerisms that may not serve the whole. So, key to our interrogation of the role of performance should be, when is it useful, necessary, in the pursuit of a healthier world? And conversely, when is performance  counterproductive, when does it become less a means to an end and more an end in itself? Performative behavior can tip into the moral grandstanding I have critiqued in this newsletter, in which we pursue the appearance of virtue rather than the substance of it. I was struck by a recent piece in The New York Times by Nicholas Kristof on changing linguistic norms. Kristof wrote “[M]uch of this effort seems to me performative rather than substantive. Instead of a spur to action, it seems a substitute for it.” Now, it is indeed important for us to revisit the language we use in order to avoid terms that have taken on a stigmatizing connotation. The performance of specific language scaffolds some of what we are trying to build in public health. It is important, for example, to use person-centered language around disease, so that we can see the humanity of all who we are trying to help.  My old colleague and friend Professor Rich Saitz taught me well that it is important to talk about persons with substance use problems rather than “addicts”.  And that is using language performance to indeed achieve our ends. However, Kristof’s case that this can sometimes become a performance that takes the place of substantive change is one that should resonate with us. There are times when the words we say and the actions we take—the performances in which we engage—can seem more like they are for our own benefit than for that of the populations we serve. It is a hard truth that the appearance of virtue has become currency in our field. Our ability to play the role of the correct-thinking, correct-speaking activist is tied to professional advancement as much as it is tied to creating a healthier world. It seems to me that we need our performance to match what is necessary to achieve our goal of healthy populations without exceeding necessity to become something we pursue for its own sake. As a tool, performance is useful, provided we do not lose sight of the fact that it is a tool. Our performance is meant to serve our mission, not the other way around. Bearing this in mind, we can leverage performance towards a more effective pursuit of health.

So, in this pursuit, it is worth asking: What do we want our performance to do, what do we want it to help us accomplish? For the purposes of public health, we might say we want to use performance to advance our work, to help elevate good ideas, and contribute to the creation of spaces that inspire the best of what our field can do. History provides many examples of the intersection of performance and the movements and ideas that change the world. Consider religion. People regularly attend churches, synagogues, and mosques where ritualized performance plays a key role in affirming and upholding belief structures. These beliefs have persisted throughout the ages, in some cases for thousands of years, in part because of the durability of these rituals, reflecting the power of performance to act as a vessel for ideas in history. Performance can in a similar way shape and sustain the ideas of public health. I have long believed that building a healthier world starts with changing the conversation about health. This conversation is only partly about words. Performance, the roles we play, how we project ourselves in the world, is a form of communication, of participating in the health conversation by engaging with the broader narrative of public health. Performance can help embed in our collective consciousness ideas that become the framework for new approaches that support a radical vision of health.

In many ways, we are already using ritual and performance to do just this—to support processes that help generate new knowledge and practice in pursuit of a better world. In my own field, academic public health, we embrace rituals in which performance helps reflect and uphold our values, values we aim to spread in the wider world to advance public health. The most notable of these rituals is perhaps Graduation Day, when we celebrate with pomp, circumstance, and the wearing of regalia the achievement of our students as we look ahead, with excitement, to their future. The ceremony hearkens back to the past, reflecting universities’ medieval origins, while helping carry into the future our values of free inquiry and the pursuit of truth. In the graduation ceremony, these abstract values intersect with the tangible reality of students about to take their knowledge and skills into the arena of history, to engage with the forces that shape health and build a better world. We help them do so through performance, which provides a familiar, time-honored framework for their first steps into an uncertain future full of challenge and potential.

It is worth noting that in each of these areas—religion and academic ceremony—performance is used to point attention not at the “performers” themselves, but towards a higher value, towards ideals seen as worth preserving and advancing. In religion, this includes ideas about how humanity can better understand, and achieve alignment with, the will of God. In the case of academia, our rituals point to the pursuit of truth and the business of educating the rising generation. This highlights, again, that the constructive use of performance is taking care that our performance is in service of some greater good. And challenging performance that falls short of that goal, calling it out when it fails in that aspiration. As he was dying, Augustus, the first Roman emperor, is said to have asked if he had played his part in life well. It is striking that even someone as consequential as Augustus had the humility to regard his achievements as, in the end, the playing of a part—his contribution to a story he recognized as bigger than any one person. We, too, are participants in a larger story, playing roles in the ongoing narrative of the forces that shape health. In this context, performance can be, fundamentally, an act of humility, of service. In public health, we pursue what is surely among the greatest possible goods: healthy populations. This goal can help ground our performance in our core values, to ensure that we continue to play our roles as a community dedicated to creating better health for all.   

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Also this week.

A Dean’s Note on the Turkey-Syria earthquake, the ongoing challenge of disasters, and the importance of addressing the physical and mental health consequences of mass traumatic events.