Review

Addiction

Art

Culture

Masculinity

Trauma

26 September 2023

5 min read

To the abyss and back. The art of Peter Howson

Painter Peter Howson captures personal conflict, toxic masculinity and horrific wars. Alastair Gordon reviews his work. Part of the Problem with Men series.

Alastair Gordon

Alastair Gordon is co-founder of Morphē Arts, a painter and art tutor at Leith School of Art. He works from his studio in London and exhibits across the UK, Europe and the US.

A painting shows a group of refugees waiting behind a barrier across a road, the background is intense yellow.

Barrier Sunset; 1995; oil on canvas; 122 x 183cm.

Flowers Gallery, London; © the artist; photograph Antonio Parente.

“Everybody’s capable of doing wild things,” says artist Peter Howson, scratching his head as he looks pensively over his paintings. He is talking about the events of his youth and how experiences of trauma, addiction and childhood bullying have influenced the way he paints the misfits, non-conformists and the overlooked.

Howson is one of those rare breeds of artist who garners both public adoration and critical acclaim, an achievement celebrated in his recent retrospective at Edinburgh City Art Centre, an ambitious show spanning four floors and four decades of the painter’s career.

I asked curator, David Patterson why Howson’s work continues to draw public interest. “People can see in every brush stroke how he pours his heart and soul into it,” he replies. “A lot of people are commenting on his honesty. He’s brutally honest and speaks what he feels in his heart.”

Howson rose to public attention shortly after his graduation from Glasgow School of Art in the 1980s with a public commission for a series of wall murals for the Feltham Community Association in London. He became known for his visceral depictions of men caught in contradictory states often painted in monumental scale with his particular style of raw, fleshy realism, an approach influenced by his interest in German Expressionism. It was his tutor, Alexander Moffatt who first introduced Howson to the work of Otto Dix and Max Beckmann, their brutal exposition of the German bourgeoises clearly making an early impact. From the hulking boxers and football hooligans of his early career to the bullish vulnerability of soldiers currently fighting in the Ukraine war, his characters are rendered with a raw realism, matched only by the brutal honesty of the artist himself.

People misunderstand the meaning: they think that I’m making (those men) into heroes, when it’s not that at all.

Howson was part of a group of male figurative painters known as the New Glasgow Boys, alongside Adrian Wiszniewski, Ken Currie and Steven Campbell, who studied at the Glasgow School of Art at a similar time in the 1980s. Later artists such as Jenny Saville and Alison Watt would continue the Scottish figurative tradition.

It might be easy to misread his early work in particular as a kind of ode to masculine swagger but when Howson speaks of his work it becomes clear his intentions are more to dispel such toxic masculinity. “I was bullied a lot at school,” he reflects. “I felt so emasculated when I was young, I tried to build myself up: I became a bouncer and wanted to exact revenge on my bullies and I joined the army. All these things that are really not me. People misunderstand the meaning: they think that I’m making (those men) into heroes, when it’s not that at all. It’s a contradiction: I’m trying to get power into my work at the same time as taking the mickey. But some of the Bosnian work is my freest.”

In 1993 Howson was appointed as official war artist to the Bosnian conflict where he witnessed first-hand the atrocities of conflict. This work culminated in a solo exhibition at London’s Imperial War Museum with some of the most harrowing and empathetic works of his career so far. Barrier Sunset, painted in 1995, shows a line of Bosnian refugees, emaciated and restrained by a blockade that bars entry to safe land. Behind them, a burning sky speaks to the ravages of war.

Howson is an artist who wears his past on his sleeve, speaking openly about his autism, childhood traumas, recovery from addiction and unnerving experiences serving in the army which he describes as “hell on earth”. Rather than dismissing these traumatic experiences, Howson finds way to manifest them in paint, a process that demonstrates profound empathy with his subjects, both villain and victim.

“You’re always walking a tightrope and I always say I’m walking on the edge of the cliff,” says Howson as he reflects on the influence of traumatic memories. “The trick is not to fall off. But you can go to the edge and look over into the abyss and the abyss is frightening.” Howson takes us to the abyss and brings us back again. Like Dante, a key influence on the artist, Howson doesn’t shy away from the more macabre, morbid and sinister subjects of the human experience yet refuses wallow. His recent ink paintings depict the effects of corona virus and atrocities of the war in Ukraine. Rendered with biblical intensity, bodies writhe in a mass of human flesh pulling and straining as in battle or torment.

His faith is as sincere as his painting, neither dogmatic or didactic, worn on his sleeve along with his experiences of trauma and addiction

Unusually in British art, Howson also speaks openly about his faith, having converted to Christianity later in life. Indeed, a whole floor of the exhibition is dedicated to his religious paintings. “There’s a part of me that wants that peace” he says. “It’s why I’m not frightened of the death thing. The real life is yet to come.” Howson acknowledges the unusual nature of his belief, not least in an art world where sincere religious faith is something of a novelty.

“There’s hardly anyone believes these days but I don’t care if I’m wrong anyway because I’ll never know it anyway.” Even his faith is expressed with honest cynicism. “Religion in art is unfashionable,” he says yet Howson seems unfazed by fashions. His faith is as sincere as his painting, neither dogmatic or didactic, worn on his sleeve along with his experiences of trauma and addiction.

Prophecy

2016; oil on canvas; 183.5 x 245cm; private collection; © the artist; photograph Antonio Parente.

A painting of a melee of many people across Christ on the cross.

This exhibition laments the broken nature of our world yet offers glimpses of hope in human empathy, compassion and ultimately in a redemptive God. In this way Howson describes his painting as “a warning of what’s to come”. Howson refuses to be defined by his traumatic past and it seems evident he now sees the world through the lens of his Christianity, a perspective that clearly defines his understanding of human nature, masculinity and redemption. Whilst we might consider Howson a chronicler of our times his painting are more than reportage. He looks into the very soul of humanity, finding hope in the horror, making visible the invisible and giving voice to the unheard.

Article

Assisted dying

Care

Culture

Death & life

13 November 2024

8 min read

The deceptive appeal of assisted dying changes medical practice

In Canada the moral ethos of medicine has shifted dramatically.

Ewan Goligher

Ewan is a physician practising in Toronto, Canada.

a doctor consults a tablet against the backdrop of a Canadian flag.

Once again, the UK parliament is set to debate the question of legalizing euthanasia (a traditional term for physician-assisted death). Political conditions appear to be conducive to the legalization of this technological approach to managing death. The case for assisted death appears deceptively simple—it’s about compassion, respect, empowerment, freedom from suffering. Who can oppose such positive goals? Yet, writing from Canada, I can only warn of the ways in which the embrace of physician-assisted death will fundamentally change the practice of medicine. Reflecting on the last 10 years of our experience, two themes stick out to me—pressure, and self-deception.

I still remember quite distinctly the day that it dawned on me that the moral ethos of medicine in Canada was shifting dramatically. Traditionally, respect for the sacredness of the patient’s life and a corresponding absolute prohibition on deliberately causing the death of a patient were widely seen as essential hallmarks of a virtuous physician. Suddenly, in a 180 degree ethical turn, a willingness to intentionally cause the death of a patient was now seen as the hallmark of patient-centered doctor. A willingness to cause the patient’s death was a sign of compassion and even purported self-sacrifice in that one would put the patient’s desires and values ahead of their own. Those of us who continued to insist on the wrongness of deliberately causing death would now be seen as moral outliers, barriers to the well-being and dignity of our patients. We were tolerated to some extent, and mainly out of a sense of collegiality. But we were also a source of slight embarrassment. Nobody really wanted to debate the question with us; the question was settled without debate.

Yet there was no denying the way that pressure was brought to bear, in ways subtle and overt, to participate in the new assisted death regime. We humans are unavoidably moral creatures, and when we come to believe that something is good, we see ourselves and others as having an obligation to support it. We have a hard time accepting those who refuse to join us. Such was the case with assisted death. With the loudest and most strident voices in the Canadian medical profession embracing assisted death as a high and unquestioned moral good, refusal to participate in assisted death could not be fully tolerated.

We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

Regulators in Ontario and Nova Scotia (two Canadian provinces) stipulated that physicians who were unwilling to perform the death procedure must make an effective referral to a willing “provider”. Although the Supreme Court decision made it clear in their decision to strike down the criminal prohibition against physician-assisted death that no particular physician was under any obligation to provide the procedure, the regulators chose to enforce participation by way of this effective referral requirement. After all, this was the only way to normalize this new practice. Doctors don't ordinarily refuse to refer their patients for medically necessary procedures; if assisted death was understood to be a medically necessary good, then an unwillingness to make such referral could not be tolerated.

And this form of pressure brings us to the pattern of deception. First, it is deceptive to suggest that an effective referral to a willing provider confers no moral culpability on the referring physician for the death of the patient. Those of us who objected to referring the patient were told that like Pilate, we could wash our hands of the patient’s death by passing them along to someone else who had the courage to do the deed. Yet the same regulators clearly prohibited referral for female genital mutilation. They therefore seemed to understand the moral responsibility attached to an effective referral. Such glaring inconsistencies about the moral significance of a referral suggests that when they claimed that a referral avoided culpability for death by euthanasia, they were deceiving themselves and us.

The very need for a referral system signifies another self-deception. Doctors normally make referrals only when an assessment or procedure lies outside their technical expertise. In the case of assisted death, every physician has the requisite technical expertise to cause death. There is nothing at all complicated or difficult or specialized about assessing euthanasia eligibility criteria or the sequential administration of toxic doses of midazolam, propofol, rocuronium, and lidocaine. The fact that the vast majority of physicians are unwilling to perform this procedure entails that moral objection to participation in assisted death remains widespread in the medical profession. The referral mechanism is for physicians who are “uncomfortable” in performing the procedure; they can send the patient to someone else more comfortable. But to be comfortable in this case is to be “morally comfortable”, not “technically comfortable”. We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

There is also self-deception with respect to the cause of death. In Canada, when a patient dies by doctor-assisted death, the person completing the death certificate is required to record the cause of death as the reason that the patient requested euthanasia, not the act of euthanasia per se. This must lead to all sorts of moments of absurdity for physicians completing death certificates—do patients really die from advanced osteoarthritis? (one of the many reasons patients have sought and obtained euthanasia). I suspect that this practice is intended to shield those who perform euthanasia from any long-term legal liability should the law be reversed. But if medicine, medical progress, and medical safety are predicated on an honest acknowledgment about causes of death, then this form of self-deception should not be countenanced. We need to be honest with ourselves about why our patients die.

There has also been self-deception about whether physician-assisted death is a form of suicide. Some proponents of assisted death contend that assisted death is not an act of deliberate self-killing, but rather merely a choice over the manner and timing of one's death. It's not clear why one would try to distort language this way and deny that “physician-assisted suicide” is suicide, except perhaps to assuage conscience and minimize stigma. Perhaps we all know that suicide is never really a form of self-respect. To sustain our moral and social affirmation of physician-assisted death, we have to deny what this practice actually represents.

There has been self-deception about the possibility of putting limits around the practice of assisted death. Early on, advocates insisted that euthanasia would be available only to those for whom death was reasonably foreseeable (to use the Canadian legal parlance). But once death comes to be viewed as a therapeutic option, the therapeutic possibilities become nearly limitless. Death was soon viewed as a therapy for severe disability or for health-related consequences of poverty and loneliness (though often poverty and loneliness are the consequence of the health issues). Soon we were talking about death as a therapy for mental illness. If beauty is in the eye of the beholder, then so is grievous and irremediable suffering. Death inevitably becomes therapeutic option for any form of suffering. Efforts to limit the practice to certain populations (e.g. those with disabilities) are inevitably seen as paternalistic and discriminatory.

There has been self-deception about the reasons justifying legalization of assisted death. Before legalization, advocates decry the uncontrolled physical suffering associated with the dying process and claim that prohibiting assisted death dehumanizes patients and leaves them in agony. Once legalized, it rapidly becomes clear that this therapy is not for physical suffering but rather for existential suffering: the loss of autonomy, the sense of being a burden, the despair of seeing any point in going on with life. The desire for death reflects a crisis of meaning. We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

We have also deceived ourselves by claiming to know whether some patients are better off dead, when in fact we have no idea what it's like to be dead. The utilitarian calculus underpinning the logic of assisted death relies on the presumption that we know what it is like before we die in comparison to what it is like after we die. In general, the unstated assumption is that there is nothing after death. This is perhaps why the practice is generally promoted by atheists and opposed by theists. But in my experience, it is very rare for people to address this question explicitly. They prefer to let the question of existence beyond death lie dormant, untouched. To think that physicians qua physicians have any expertise on or authority on the question of what it’s like to be dead, or that such medicine can at all comport with a scientific evidence-based approach to medical decision-making, is a profound self-deception.

Finally, we deceive ourselves when we pretend that ending people’s lives at their voluntary request is all about respecting personal autonomy. People seek death when they can see no other way forward with life—they are subject to the constraints of their circumstances, finances, support networks, and even internal spiritual resources. We are not nearly so autonomous as we wish to think. And in the end, the patient does not choose whether to die; the doctor chooses whether the patient should die. The patient requests, the doctor decides. Recent new stories have made clear the challenges for practitioners of euthanasia to pick and choose who should die among their patients. In Canada, you can have death, but only if your doctor agrees that your life is not worth living. However much these doctors might purport to act from compassion, one cannot help see a connection to Nazi physicians labelling the unwanted as “Lebensunwortes leben”—life unworthy of life. In adopting assisted death, we cannot avoid dehumanizing ourselves. Death with dignity is a deception.

These many acts of self-deception in relation to physician-assisted death should not surprise us, for the practice is intrinsically self-deceptive. It claims to be motivated by the value of the patient; it claims to promote the dignity of the patient; it claims to respect the autonomy of the patient. In fact, it directly contravenes all three of those goods.

It degrades the value of the patient by accepting that it doesn't matter whether or not the patient exists.

It denies the dignity of the patient by treating the patient as a mere means to an end—the sufferer is ended in order to end the suffering.

It destroys the autonomy of the patient because it takes away autonomy. The patient might autonomously express a desire for death, but the act of rendering someone dead does not enhance their autonomy; it obliterates it.

Yet the need for self-deception represents the fatal weakness of this practice. In time, truth will win over falsehood, light over darkness, wisdom over folly. So let us ever cling to the truth, and faithfully continue to speak the truth in love to the dying and the living. Truth overcomes pressure. The truth will set us free.