What Those in Power Are Missing About the Opioid Epidemic

Patricia Perry
Trish Perry organizes weekly outreach for homeless populations in Newark, Ohio. (William Widmer / Redux)

Updated at 10 a.m. ET on July 25, 2021.

On a street corner in Newark, Ohio, every Saturday, rain or shine, Trish Perry distributes harm-reduction supplies—syringes, Neosporin, saline, and the overdose-reversal drug naloxone—to people who use drugs. She also provides food, clothing, tents, and blankets to the more than 75 people who stop by each week. Set up in a grassy lot shaded by a scrawny hackberry and a silver maple, her outreach efforts are funded purely by donations. Sometimes health-care workers will check wounds; sometimes a stylist will offer free haircuts. The people who come here for aid know that Perry isn’t going to ask them for personal information or expect anything in return.

Perry’s efforts aren’t supported by the local board of health. In fact, two years ago, it voted unanimously against establishing a syringe-service program. Perry, the mother of a son with substance-use disorder, decided to continue getting lifesaving supplies directly into the hands of the people who need them most.

People who use drugs and those who love them have helped reverse thousands of overdoses in the United States, saving friends, family members, and strangers. They’ve done this work without recognition, without fanfare, and sometimes at great risk to themselves. They know firsthand the benefits of access to sterile syringes, naloxone, and drug-testing strips, which detect the presence of fentanyl in a particular drug. * But few in power listen to their advice. Some state and local governments actively ignore them. If local governments want to tackle the opioid crisis, they need to listen more to harm-reduction advocates, especially those in hard-hit communities.

The CDC estimates that more than 93,000 Americans died from drug overdoses in 2020, up 29 percent from the year before. And since 1999, more than 840,000 Americans have died from overdoses. In recent years, the overwhelming majority died from using the synthetic opioid fentanyl, which is used on its own or found in other drugs, resulting in people taking it unintentionally.

[Read: The true cause of the opioid epidemic]

Overdose-death rates are especially high in West Virginia and Ohio, where I live. In the years that I’ve reported on this crisis, I’ve seen local-government officials act ineffectively, sometimes in direct contradiction to the recommendations of experts. Even today, with a supportive federal government, I’ve seen pushback against the kinds of harm-reduction efforts that research shows can save lives and prevent disease.

Critics argue that syringe-service programs create needle litter and crime, and enable drug use. The evidence, though, does not support these concerns. According to the CDC, “New users of SSPs are five times more likely to enter drug treatment and three times more likely to stop using drugs than those who don’t use the programs.” Syringe-service programs, which provide sterile syringes in exchange for used ones, also help reduce transmission of blood-borne infections and other risks of intravenous drug use.

Still, in rural Scott County, Indiana, where the biggest U.S. HIV outbreak in recent history occurred in 2015, county commissioners voted to shut down a local syringe-service program. In the past year, lawmakers have also sought to restrict syringe services throughout North Carolina, and last week the city council in Atlantic City, New Jersey, shut down a program. West Virginia Governor Jim Justice and local city-council leaders have rolled back syringe programs and signed into law measures that further restrict access to syringes and free health care. West Virginians are already seeing the repercussions. Amid a rise in intravenous drug use, Kanawha County, the home of West Virginia’s capital, Charleston, is experiencing an uptick in HIV cases that the CDC has called the “most concerning in the United States.”

These laws complicate the efforts of grassroots harm-reduction advocates and, in some cases, could make their work illegal. Yet with few resources and, typically, no pay, volunteers push on. These advocates believe in meeting people who use where they’re at—both physically and emotionally—and in respecting them as humans. People who use drugs, for example, can face judgment, mistreatment, or even arrest when they seek resources at traditional health-care facilities, which makes them reluctant to go. The harm-reduction community knows that people feel this stigma, so the advocates have learned how to reduce the physical harms, including hepatitis C, HIV, abscesses, and overdoses, that can come with drug use. They see the benefits of incremental improvements—a sterile syringe is better than a used one; a naloxone-reversed overdose is better than death. The advocates I know go out day after day, night after night, meeting people in drug houses, on corners, in their homes, and under bridges. In Columbus, Ohio, for example, the Columbus Kappa Foundation—an alumni organization for members of Kappa Alpha Psi, a Black fraternity—distributes naloxone in churches and barber shops. Sometimes they knock on doors.

Fentanyl testing strips
Perry distributes fentanyl testing strips at no cost. (William Widmer / Redux)

“We didn’t invent grassroots harm reduction,” Brooke Parker told me. She helps run a street-outreach harm-reduction organization called SOAR in Charleston. “This is what happens when public health fails. Communities step up, especially in Appalachia.” For Parker, the work is about much more than giving people harm-reduction supplies; it’s about building trust and connection. But, she said, people view her willingness to help people who use drugs—to give them what they need to stay healthy without judgment or questions—as naive or even radical.

The pushback against SOAR has been aggressive, and the organization has stopped handing out syringes. Parker said that ostracizing people who use drugs has become so normalized that some people no longer see them as humans. Her empathy comes from personal experience—she’s in recovery herself—as well as from her upbringing. “I remember my dad telling me when I was younger, ‘Love people through hard things.’ That’s the whole idea behind agape, love. It’s unending … There’s no other way; people just end up alone. And if you’re alone, you don’t get anything. You don’t get anything done. We’re meant to be in community. We’re meant to take care of each other.”

Grassroots harm-reduction advocates’ organizing principle is love. This kind of love is not admonishing people to pull themselves up by their bootstraps. And it’s not the showy, egocentric do-goodism primed for viral videos. Radical love is unconditional, and so is evidence-based harm reduction, which asks nothing from the people being helped, not even a tinge of reciprocity. As the preacher, writer, and harm-reduction advocate Blyth Barnow told me: “Radical love is incredibly ordinary. It’s just … of course this is how you act.” But it’s also visionary—a way of seeing what is possible for the person in front of you.

Joe Biden’s platform for ending the opioid crisis supports important interventions, including expanded access to treatment, harm reduction, and health care. But he has spoken in favor of measures such as mandatory treatment for substance use, which takes away a person’s agency and is not proven to be effective, and drug courts, in which a judge essentially supervises treatment. The people most harmed by the structural violence of these policies, and by a lack of adequate health care, are poor, and many of them are people of color. Combatting the overdose crisis by punishing people who use drugs through the criminal-justice system will not work.

[Read: The opioid epidemic might be much worse than we thought]

Federal, state, and local governments should heed the advice of harm-reduction advocates. Because the drug supply is full of fentanyl, people need more fentanyl-testing strips, safe consumption spaces, and access to regulated medication. Allowing harm-reduction programs to use federal dollars to purchase syringes, which is currently prohibited, would be an important policy change. Funding to fight the opioid epidemic, as well as the opioid settlement money from lawsuits against pharmaceutical companies, needs to reach grassroots programs in order to help them become more sustainable.  

Finally, more official harm-reduction work should move out of health departments and into the streets. Syringe-service programs can be gateways to better health and, if folks are ready, to treatment. They are a place for people to experience radical love and potentially build connections—to nonjudgmental health care and to a supportive community.

Harm reduction doesn’t have to be fancy; it just has to meet people where they’re at. I’ve seen successful harm reduction carried out in storefronts, in vans, and, in Perry’s case, at some card tables in a grassy lot. On summer days in Newark, after getting a hot dog and some harm-reduction supplies, folks head for the shade of the hackberry and maple. They talk and rest in this cool refuge. This is their safe space, and they are loved.

* Due to an editing error, an earlier version of this essay misstated what testing strips are measuring. It’s the presence of fentanyl, not the amount.

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The Books Briefing: The Dark Side of Athletic Perfection

Baseball, like many sports, sometimes seems as though it’s leaving the realm of human athleticism and instead marching toward an almost technical optimization. Steroids (illicitly taken) have made some players stronger than ever. Sabermetrics, which involves the detailed statistical analysis of baseball data, has turned the artistry of staffing a team into mere mathematics, a phenomenon that the author Michael Lewis writes about in Moneyball. Even players’ skills are best honed through technical means, the writers Ben Lindbergh and Travis Sawchik contend in The MVP Machine.

Such innovation is a far cry from the extreme technical limitations facing early sports stars, especially women. Charlotte Dod, a multisport athlete in the Victorian era, was forced to wear cumbersome outfits while competing—a dynamic that the journalist Sasha Abramsky explores in Little Wonder. Women’s sports remain underfunded to this day, but more devoted training (along with more reasonable attire) has allowed athletes of all genders to reach heights that early competitors, such as Dod, were never able to approach. Dvora Meyers’s history of modern gymnastics, The End of the Perfect 10, traces the development of the sport from a time when a 10 was an impossible score to achieve to an era in which trained gymnasts so unfailingly conduct flawless routines that a new, uncapped scoring system had to be introduced.

The pursuit of such perfection, of course, comes with its own challenges. The novelist Gabe Habash explores the mental and physical toll on athletes in Stephen Florida, which follows a college wrestler’s slow demise. And beyond its risks for individual players, some people believe that the quest for optimization threatens the joy of the games themselves. For example, the writer Eduardo Galeano’s love for soccer is palpable in Soccer in Sun and Shadow—as is his fear that technocratic standardization is encroaching on passionate play. Still, as Galeano himself saw, glimpses of athletic elation peek through even the most technically incredible performances, revealing a spirited and unmistakably human greatness.

Every Friday in the Books Briefing, we thread together Atlantic stories on books that share similar ideas. Know other book lovers who might like this guide? Forward them this email.

When you buy a book using a link in this newsletter, we receive a commission. Thank you for supporting The Atlantic.

What We’re Reading

illustration of a pitcher

Golden Cosmos

The new science of building baseball superstars

“Would democratizing baseball greatness actually be good for baseball? Part of what makes baseball’s greatest players so memorable is how much better they are at playing the game than anyone else on the field. In important ways, the sport’s drama relies on inequality.”

📚 The MVP Machine, by Ben Lindbergh and Travis Sawchik
📚 Moneyball, by Michael Lewis

Charlotte Dod

Illustration by Paul Spella; image from PA Images / Alamy

In search of the first female sports superstar

“If [Sasha] Abramsky’s biography [of Charlotte Dod] feels rather slight, it is because he refuses to co-opt her into an uplifting parable of women’s liberation. Instead, he celebrates her as a brave and talented and determined original.”

📚 Little Wonder, by Sasha Abramsky

illustration of gymnasts over the number ten

Cristiana Couceiro; Express / Getty; Kazuhiro Nogi / AFP / Getty

The athleticism of competitive gymnastics

“An obsessive and illusory perfectionism may lie at the heart of many girls’ dreams of being a gymnast, but so does a more primal urge, the desire to just see if you can—or, as one former gymnast puts it in [Dvora] Meyers’s book, to get as close to flying as possible.”

📚 The End of the Perfect 10, by Dvora Meyers

two wrestlers compete

Turkmenistan’s Tahir Hanmamedov (left) competes against Syria’s Mazen Kdmane at the 16th Asian Games in Guangzhou, Guangdong province, China, in 2010. (Carlos Barria / Reuters)

Stephen Florida reveals the dark toll of athletic greatness

“[Gabe] Habash questions not only the true cost of achieving athletic greatness, but also how masculinity—defined in part by vengefulness, violence, and stoicism—can drive men to behave in self-glorifying and self-defeating ways.”

📚 Stephen Florida, by Gabe Habash

soccer fans

Uruguay fans in Montevideo in June 2018 (Andres Stapff / Reuters )

What Eduardo Galeano, soccer’s poet laureate, understood about the sport

“Soccer, in Galeano’s vision of it, isn’t just a war between teams or countries: It’s also a war between humanity and technocracy.”

📚 Soccer in Sun and Shadow, by Eduardo Galeano

About us: This week’s newsletter is written by Kate Cray. The book she’s reading next is A Burning, by Megha Majumdar.

Comments, questions, typos? Reply to this email to reach the Books Briefing team.

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The Awful Coincidence of 2 Friends Who Got the Same Cancer

Each installment of “The Friendship Files” features a conversation between The Atlantic’s Julie Beck and two or more friends, exploring the history and significance of their relationship.

This week she talks with two friends who were both diagnosed with the same cancer—acute myeloid leukemia—one right after the other. They discuss how this unhappy coincidence shaped their friendship and their faith, and what they’ve learned about the right and wrong ways to support a sick friend.

The Friends:

Doug Kelley, 64, a professor at Arizona State University who lives in Phoenix, Arizona
Ted Wueste, 51, a pastor who lives in Phoenix

This interview has been edited for length and clarity.

Julie Beck: Paint me a portrait of what your friendship was like before your diagnoses.

Doug Kelley: Our friendship was in a growth stage. One day in a sermon, Ted had quoted a couple of people who I was familiar with and who were a little bit out of the box. So I made an appointment to see him, because I wanted to find out if he was the real deal.

Ted Wueste: I probably quoted Henri Nouwen or maybe Richard Rohr. Doug and I both grew up in the more conservative evangelical stream of the Christian faith. Those two authors speak to the search for God in some really deep personal places, in ways that the more traditional [writings] didn’t.

[Read: Being a pastor is more joyful with a friend by your side]

Doug: Both those authors are Catholic. You don’t traditionally hear Catholics quoted in evangelical churches. Those authors lean more to a contemplative side of the faith. They quote freely. They might use a Buddhist or a Native American story.

Two men stand outside, wearing kilts and exercise shirts, with race numbers pinned to their kilts. They're posing with their arms around each other
Ted Wueste (left) and Doug Kelley (right) at a “Kilt Run” pre-diagnosis. (Courtesy of Doug Kelley)

We sat down and had a long, great conversation. I came home and I told [my wife], this is the real deal. We both had similar takes on our faith, which influences our worldview. And both of us love humor—really dumb humor. Ted loves practical jokes. I was like, “Oh my gosh, I can talk deeply with this guy about what it means to be human or the nature of our spirituality, and we can hang out and just be goofy.” It was so great to find that.

Beck: Ted, what was your first impression of Doug?

Ted: Here’s a kindred spirit. Somebody that is speaking a language that connects deeply with me and my experience. From the beginning there was a resonance. We went really deep really fast. I remember him sharing about his best friend who had died of cancer a few years before. I thought, This is somebody that has depth.

Beck: Ted, you were the first one to get diagnosed with cancer—when was that?

Ted: I was diagnosed in October of 2017. I’d been feeling sick and kept going to the doctor, and they just kept giving me antibiotics. Finally I got an X-ray. Doug and I happened to be together having a beer one afternoon when I got a call that something showed up on the X-ray that didn’t look good.

I was then diagnosed with Hodgkin’s lymphoma. I very quickly had surgery. I went through six months of chemo, and they told me at the end that I was cancer-free. Then it came back. I had a stem-cell transplant, but it didn’t work. It was pretty devastating.

They did another bone-marrow biopsy, and I’d developed acute myeloid leukemia.

Beck: Oh my goodness. Two cancers. That’s too many cancers.

Ted: It’s something else to find out that you have cancer when you have cancer.

I was in the hospital for seven weeks. It almost killed me. I went into heart failure. But the cancer was dealt with, I went home, and successfully went through the stem-cell transplant.

Beck: Did your friendship change as you were going through all that?

Ted: Doug was with me every step of the way. Especially during those seven weeks in the hospital. He would just come in and sit with me. There were times when I couldn’t even talk and he would just hold my hand and be with me, sometimes for hours at a time. That certainly bonded us deeply.

A man in a hospital bed smiles for the camera in a party hat. An older man, a young woman, and a middle-aged woman also wearing party hats smile from his bedside.
Doug joins Ted’s wife and daughter to celebrate Ted’s birthday in the hospital. (Courtesy of Ted Wueste)

Beck: Doug, what was your memory of that time? Especially since you had already lost a friend to cancer; that must have been hard to watch.

Doug: Yes. I have a distinct memory of talking to my friend—his name was Dick—on the phone one night. I was standing in the swimming pool, and he was telling me that he was going to die from his cancer. It just brings tears to me.

The whole time Ted was talking, I had tears. I thought, You’re just abandoning me. You’re the one guy I have. But I knew immediately: I was going to invest fully in this and not pull away.

Cancer just slows your whole life down, when you’re hospitalized. So in some ways it creates this great space to be together. Ted was reading when he could; we would talk about what we were reading. Now that we’re both healthier, it’s harder to find time to be together. We still do, but it’s harder.

Beck: At some point, you got the same kind of cancer Ted had, isn’t that right Doug?

Doug: That’s correct. Ted went to a stem-cell transplant in April of 2019. They just drip it from a bag, and it looks kind of like a strawberry Icee. There’s no big dramatic surgery. So a number of us were there for that, just hanging out.

Three months later, in July, I was feeling pretty bad. We were on a road trip up the West Coast, and I finally had to go to urgent care. They wanted to hospitalize me immediately. But I talked them into letting me come home.

The cancer had created a little leaking spot in my colon, so E. coli had gotten into my system. They kept poking around, and then they found the cancer—[acute myeloid leukemia].

Ted, I’m not sure what your experience was, but I remember when the doctor told me what it was. I just wanted to say, “No.” My job was to be the healthy one helping Ted. I was thinking I’m not the kind of person that gets cancer. I don’t know what kind of person is, but it’s not me.

Ted: I was in the midst of my recovery, just starting to feel a little better. I’ll never forget the night he called and told me he had the same kind of cancer I do. I must have cried for hours. I thought, I’ll take it back again if that’s what it would take. I don’t want him to have this.

Beck: What did you make of that horrible coincidence? Did you have thoughts that there was some greater meaning to it?

Ted: There’s mysteries to the way that God works and how the universe is put together. Doug got his transplant six months after I got mine. I had that sense of I walked through this, and now it’s my turn to be there for him. He’s going through something, and I can understand it fully. It looks like a coincidence and yet somehow, I think, we were meant to walk through this together.

Doug: I’ve always thought that I got the better end of the deal. I was healthy when I was showing up at the hospital and hanging out with Ted. Then I get diagnosed with this and I have this close brother who has been there that I can now lean on, and ask practical questions of.

Some talk about our spiritual perspective did come into play. Neither of us believes that God does this to you to teach you a lesson. It’s a mystery. It’s brutally difficult, and there’s a lot of uncertainty. But there are so many gifts and beautiful things in the midst of it. Our friendship is one of those.

Two men smile in front of a building with a sign that reads "O.H.S.O. Brewery"
Doug and Ted outside the brewery where they got their first beer together after their stem-cell treatments. (Courtesy of Doug Kelley)

Ted: I ended up writing a book about the journey called Welcome Everything. It starts off with those words: “Welcome everything. Everything? Well, yes.” The first chapter walks through the idea of welcoming cancer rather than fighting it. Trying to welcome whatever God was doing with us. It’s not something we would ever wish on anyone. But I can say for me, I wouldn’t trade what I walked through these last years for anything.

At this point, both of us are cancer-free. We don’t know how long that will last, if it’ll last. We pray that it does. But we have that perspective of: We can embrace it and know that there are gifts in the middle of it.

Beck: What have you learned about how to support a friend through illness, having each been on both sides of that in your friendship?

Doug: I think we’re both good at initiating with each other. It’s easy to feel like, No, it’s been a rough day. I don’t feel like talking. Then somebody just shows up at your door, and all of a sudden you realize what a gift it is that this person is here. I would’ve told you no, but I’m so glad you’re here.

[Dear Therapist: My friend is dying and has asked me not to contact her]

Ted: One of the most significant—and one of the most difficult—things is to just be present. The hospital is a really scary place for a lot of people. Often people don’t want to enter into that space because it’s just too uncomfortable. When I was in the hospital, there were some people who I had to ask to come visit me. But Doug was never scared. He was always just there.

That’s what people need. They don’t need answers, because most of the time there aren’t any good answers to some of the questions that illness brings up. But the presence of another person is huge, and it can’t be replaced by anything else.

Beck: Did your diagnoses change any of your other friendships? Making them stronger, or some of them falling away? Or were there friends who meant well who didn’t understand what you really needed?

Ted: I experienced almost all the different things that you said. There are people I didn’t hear from. After the fact, they said, “We wanted to give you your space.” And I was like, “Well, I didn’t ask for any space.” But for some people, I think that was their way of dealing with it—withdrawing.

A couple of other people tried to give me spiritual advice that I just knew wasn’t true or right. Or [they might] say, “What are you learning from all of this?” That can feel really demeaning. That all this is so that I learn a lesson. When you’re looking back, it’s incredibly valid to ask What did you learn? But in the middle of it, well, I just got punched in the stomach and I’m in pain. I’m not really in a place to think about that. We were holding on deeply to the idea that there was good that would come from it, and even good in the midst of it. But that’s a deep, visceral trust in faith, rather than some glib cliché.

I also have a whole box filled with cards and notes from people. Tons of people showed up. There were some bad examples of people not knowing how to be there. But far more wonderful, beautiful things.

Doug: Everybody has their own way of dealing with your pain. I was surprised that I didn’t hear from some of my friends more—I needed to let go of that early on. I realized they’re on their own journey trying to figure out how to deal with this too. If I need more from them, I need to tell them. I don’t harbor anything against anyone from that time.

I learned to appreciate the smaller things. I got a card once a week from my sister-in-law’s little church in the middle of Missouri saying that their prayer group was praying for me. I’d never met any of them. And you’re like, “Somebody in Missouri is just sitting there praying for you. How beautiful is that?” There were all these little beautiful moments along the way if you chose to see them.

When I was in the hospital for three months, Ted was still coming in for regular treatments, so he could pop in any time.

Ted: I really got to know the nurses on that particular unit. One of them was a bit of a prankster. So one day I said, “Let’s go play a trick on my friend.”

We went in [to Doug’s room], and she said, “I’m here to get your proctology sample.”

Doug: I’m thinking, Okay, they’ve been in pretty much every orifice of my body already anyway.

Ted: Then the nurse looked over at me and said, “Hey, Ted, could you help out with this?”

Doug: That’s when I knew for sure. We’re close, but we don’t do all that.

Beck: Doug, you sent me an article you wrote about having to wear a mask after getting the stem-cell transplant. Ted, you had a similar experience. How did wearing a mask shape your interactions and relationships? Has that changed during the pandemic?

Ted: I had to wear a mask for probably two and a half years before the pandemic. I had so many experiences where everybody’s staring at me. Little kids asking their parents, “What’s wrong with him?” During the pandemic, I wasn’t a weirdo anymore.

Doug: I’d only been wearing a mask since the end of November 2019.

In the hospital I had to intentionally work against adopting a patient mentality. All of a sudden everything is stripped from you. I was Dr. Kelley at Arizona State University, and now I’m in this funky gown, and everybody is doing everything for me. It’s kind of like being a child. You don’t know enough to make decisions.

Once you’re out, it’s easy to fall back into this everybody-does-everything-for-you mode. I found it easy to pull back, and the mask provided a place to continue to hide.

Beck: Did you feel like your instinct in interactions was to make yourself small?

Doug: That’s a great way to put it. There’s centripetal force, and there’s centrifugal force. Centrifugal throws things out and away, and centripetal pulls inward like a whirlpool. My sense of self, if I wasn’t careful, felt like it was spinning and becoming smaller and smaller.

If I was with my wife, they might talk to her about me like I’m not there. I had cancer, but I can still talk. People in wheelchairs experience this, and others with disabilities. If you’re not careful, and you just sort of accept that, you can feel like you’ve become smaller as a person.

That’s part of the importance of our friendship: We were able to engage each other so fully in those times—like we normally did. We were talking about things we were reading, and deep stuff, and we were being funny and inappropriate. That was a critical part of me maintaining a sense of self and not just letting it become diminished.

Beck: You could take up more space when you were with each other.

Doug: Yeah, that’s a nice way to put it.

Ted: The issue of identity is really significant when you’re dealing with life-threatening illness. For me it was really important to say, “I’m not a cancer victim.” Cancer just happens to be a part of my circumstance right now. It wasn’t my identity.

Doug: But neither of us wants to go back to how we were before. This has changed us in significant ways. We want to embrace that and not lose what we gained during those times.

If you or someone you know should be featured in “The Friendship Files,” get in touch at friendshipfiles@theatlantic.com, and tell us a bit about what makes the friendship unique

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Tokyo 2020: Images from the First Weekend of the Olympics

Despite a year of postponement and continuing health and safety concerns due to the COVID-19 pandemic, the Tokyo 2020 Summer Olympics are now underway. More than 11,500 athletes from some 205 national Olympic committee teams have gathered in Japan to compete in 339 events among 33 different sports. New sports added this year include skateboarding, sport climbing, and surfing. Collected here, images from the first few days of competition in Japan, with more to come, as the games continue through August 8.

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How to Write a Kaleidoscopic Character

Editor’s Note: Read Robert McGill’s new short story, “Something Something Alice Munro.”

Something Something Alice Munro” is a new short story by Robert McGill. To mark the story’s publication in The Atlantic, McGill and Oliver Munday, the design director of the magazine, discussed the story over email. Their conversation has been lightly edited for clarity.

Oliver Munday: Your story “Something Something Alice Munro” brings a Harold Bloom quote to mind: “Influence is influenza.” It’s clear from the opening sentences that the famed author Alice Munro will be a prominent influence on the text, but by the end you manage to take this conceit to unexpected places. The story is a witty look at the anxiety of literary influence, to cite Bloom once more. Did the story always follow from a conceptual premise, or did the characters emerge first?

Robert McGill: I started out wanting to write about Alice Munro: in particular, about the one time I met her, 15 years ago at a literary festival. I’d grown up in a town close to hers, and I’d read all her stories. At the festival, we shared a few minutes of small talk, and I was completely tongue-tied.

Once I started writing the story, I realized that it was going to be less about meeting Munro than about having been a young person in her part of the world and wanting to tell stories of a sort that she hasn’t. From that point, I developed the story’s peculiar sentence-by-sentence constraints (each sentence begins or ends with either Alice Munro or you), which channel a certain contradictory, Bloomian impulse in me: to make the story all about Munro and, at the same time, totally not something she would write.

Munday: In Canada, where you’re from, Alice Munro, the Nobel laureate, presides as one of the country’s foremost literary celebrities. It’s interesting for an American reader to consider this type of fame, because we lack such a singular prose star in our national imagination. How much has Munro shaped Canada’s literature as a result of her status?

McGill: I think of Munro and Margaret Atwood as the big, bright binary system in the Canadian literary firmament. (Together, their initials are “AMMA.” What would Freud say?) Atwood has established one way to gain global fame and influence as a Canadian author: travel the world regularly to speak, tweet prolifically, and appear in hit TV shows based on your novels. Then there’s Munro, just writing story after story while living quietly in the backwoods. It has been good for Canadian writers to have them both as models and know both paths are viable.

There’s also the fact that neither Munro nor Atwood has shied from writing undisguisedly about Canada. That’s still a big deal in a country where generations of writers felt they had to set their stories elsewhere if they wanted to make it.

Munday: Nessa and Hadi, the two characters at the center of “Something Something Alice Munro,” are both writers. Nessa is pursuing a Ph.D. and writing a dissertation on the work of Munro, and Hadi is a poet. You describe them as best friends who sleep together. Would romantic love somehow threaten their respective intellectual pursuits, or are they simply hedging and afraid of commitment?

McGill: I don’t know if they’re afraid of commitment per se. They might just be wary of each other. They’re both still working out some fundamental things—for instance, in their relations to their parents. Maybe it’s an act of care for each other and themselves not to complicate things with one another.

I’m hedging here, aren’t I? They’re my characters, so I should know them inside out. But I sometimes feel that I’ve gotten characters down to the best of my abilities when I’ve brought them to the point where they’re intriguing puzzles to me as well as to others.

Munday: The title of the story, along with the regular invocations of Munro, act as a kind of comic diversion from the drama. The characters use Munro as a distraction from life, but also as a lens through which to interpret it. Fiction writ large functions similarly, inflecting on events, suffusing our perceptions of the world, and often providing a form of escape. In what other ways are the characters, and you as their author, using Alice Munro?

McGill: There’s a quotation from Edward Said that might apply to Nessa: “It seems a common human failing to prefer the schematic authority of a text to the disorientations of direct encounters with the human.” For all that fiction helps you to see the world in new ways, it risks constraining how you see things too. If Nessa’s outlook begins and ends with Munro’s writing, she’s hamstrung herself. One wonders: What’s she really committing herself to when she commits herself to Munro?

For Hadi, the picture of small-town Canada associated with Munro’s fiction—stultifyingly homogenous, astringently Protestant—carries its own limitations. You can see why he might chafe against requests to discuss his writing alongside hers. But then, her picture isn’t quite so reductive as I’ve just suggested. So writers like Hadi—or me—who use Munro as a foil might be not using so much as misusing her. Failing to see her work clearly.

Munday: You begin “Something Something Alice Munro” in third person, remaining close to Nessa, only to switch to the second person to inhabit Hadi’s voice and limn the emotional core of the story—Hadi’s relationship with his father. How did this form of shifting perspectives develop?

McGill: In some vital ways, I identify with Hadi and Nessa. In other ways, the two of them are much more like people of my acquaintance than like me. So writing the story, I experienced this kaleidoscopic effect: the aspects of the characters emerging from what I know of myself kept blurring into what I know and imagine of others. Shifting the perspective between Nessa and Hadi, between third person and second, was a way of acknowledging this unique experience that fiction produces, in which the writer and readers all end up asking of each other and the characters, “Where, in this story, do you end and I begin?” If you come away from a work of fiction not having been unsettled from the point of view you had going in, then somebody hasn’t done their job.

Munday: There’s a sly, meta aspect to the story, an ambiguity around the narration that causes us to wonder who’s actually writing it. The question of authorial authority arises—whether writers should draw from only their lived experience as opposed to imagining the experiences of others. How do you feel about these demarcations, which seem to be hardening in fiction?

McGill: I back the idea that the label “fiction” should never be taken as a license to write without an obligation to the real-life cultures and identities affected by your writing. I think of fiction as a unique space where authors and readers, however partially and provisionally, shed their skins to imaginatively inhabit the lives of others; to learn about the enormous diversity of life. So as a reader, if I discover that an author’s trading in caricatures and stereotypes, I feel they’ve let down the side.

One of the things I like about Alice Munro’s writing in this regard is that she isn’t precious about the status of fiction. Writers in her work are always being told that they’ve gotten things wrong or that they’re trading in cheap tricks. But she still implicitly recognizes that fiction has a unique role in our lives. Nonfiction alone isn’t enough. Maybe it would be if being a good person required only listening to what other people say publicly about their lives. But all the time, we’re called on to imagine how others are feeling and thinking, to infer what they can’t or won’t say out loud. That’s where fiction gains one of its key roles: as a comparatively safe—because veiled—space of self-articulation and as a model for carefully, sensitively imagining how it is to be someone else.

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