From Tragic Form to Apocalyptic Reality in Four American Works: Toward an Epistemological Theory and Practice of Reading

The dissertation aims to articulate a theory of “the truth of literature” and a practice of reading aimed at grasping that truth, and to demonstrate and clarify this theory and practice through readings of works of modern tragedy and an modern “apocalyptic” genre emerging from the wars and horrors of the twentieth century and the imagination of nuclear and ecological disaster. Beginning from the common idea that we come to know something, both tacitly and explicitly, through reading great works of literature, I argue that—specifically—what we come to know are the realities and conditions of human life, conditions which are not just material but ideal—normative, narrative, and historical. Using Michael Polanyi’s theory of tacit knowledge and of “reality” conceived as both the object and condition of inquiry, I argue that in reading and reflecting on literature we are referred to our own largely tacit sense of a ground of sensemaking and judgment more adequate to our experience than the typified and conventional ground of our everyday experience. I then demonstrate a practice of reading aimed at the acquisition of this kind of knowledge, beginning from Norman Maclean’s nonfictional Young Men and Fire which seeks “to transform catastrophe into tragedy,” to find a tragic form adequate to the deaths of thirteen Smokejumpers in a 1949 forest fire. If tragedy represents events so as to show their underlying order, the conclusion of Maclean’s work suggests that modern tragic form must acknowledge the apocalyptic—the dawning possibility or likelihood of human self-destruction—which radically threatens any order. I further develop this idea of the apocalyptic through readings of McCarthy’s Blood Meridian, Robert Lowell’s “The Quaker Graveyard in Nantucket,” which imply the need to reconceive the telos of human life in light of its seemingly catastrophic historical trajectory and the impotence of conventional goodness, and Wallace Stevens’ “The Auroras of Autumn,” as well as his poetic theory, which imply the need to recognize the provisional, constructed, and threatened character of all our sensemaking. Collectively these works refer us to what I call the apocalyptic sublime, the inconceivable enormity of the inhuman forces at work in human history, as an essential aspect of the horizon—or myth—against or in light of which we must comprehend our present situation—to the degree such comprehension is possible. My readings suggest that that situation necessitates an ongoing effort of disciplined attention, dispossession and reorientation—a shift from the telos of individual fulfillment and flourishing (“happiness”) to that of an imperative to consciousness of the tenuous conditions of our humanity—and that a practice of reading and reflecting on literature is integral to such consciousness

Four-Year Visual Outcomes in the Protocol W Randomized Trial of Intravitreous Aflibercept for Prevention of Vision-Threatening Complications of Diabetic Retinopathy

ImportanceAnti–vascular endothelial growth factor (VEGF) injections in eyes with nonproliferative diabetic retinopathy (NPDR) without center-involved diabetic macular edema (CI-DME) reduce development of vision-threatening complications from diabetes over at least 2 years, but whether this treatment has a longer-term benefit on visual acuity is unknown.ObjectiveTo compare the primary 4-year outcomes of visual acuity and rates of vision-threatening complications in eyes with moderate to severe NPDR treated with intravitreal aflibercept compared with sham. The primary 2-year analysis of this study has been reported.Design, Setting, and ParticipantsRandomized clinical trial conducted at 64 clinical sites in the US and Canada from January 2016 to March 2018, enrolling 328 adults (399 eyes) with moderate to severe NPDR (Early Treatment Diabetic Retinopathy Study [ETDRS] severity level 43-53) without CI-DME.InterventionsEyes were randomly assigned to 2.0 mg aflibercept (n = 200) or sham (n = 199). Eight injections were administered at defined intervals through 2 years, continuing quarterly through 4 years unless the eye improved to mild NPDR or better. Aflibercept was given in both groups to treat development of high-risk proliferative diabetic retinopathy (PDR) or CI-DME with vision loss.Main Outcomes and MeasuresDevelopment of PDR or CI-DME with vision loss (≥10 letters at 1 visit or ≥5 letters at 2 consecutive visits) and change in visual acuity (best corrected ETDRS letter score) from baseline to 4 years.ResultsAmong participants (mean age 56 years; 42.4% female; 5% Asian, 15% Black, 32% Hispanic, 45% White), the 4-year cumulative probability of developing PDR or CI-DME with vision loss was 33.9% with aflibercept vs 56.9% with sham (adjusted hazard ratio, 0.40 [97.5% CI, 0.28 to 0.57]; P &amp;amp;lt; .001). The mean (SD) change in visual acuity from baseline to 4 years was −2.7 (6.5) letters with aflibercept and −2.4 (5.8) letters with sham (adjusted mean difference, −0.5 letters [97.5% CI, −2.3 to 1.3]; P = .52). Antiplatelet Trialists’ Collaboration cardiovascular/cerebrovascular event rates were 9.9% (7 of 71) in bilateral participants, 10.9% (14 of 129) in unilateral aflibercept participants, and 7.8% (10 of 128) in unilateral sham participants.Conclusions and RelevanceAmong patients with NPDR but without CI-DME, at 4 years treatment with aflibercept vs sham, initiating aflibercept treatment only if vision-threatening complications developed, resulted in statistically significant anatomic improvement but no improvement in visual acuity. Aflibercept as a preventive strategy, as used in this trial, may not be generally warranted for patients with NPDR without CI-DME.Trial RegistrationClinicalTrials.gov Identifier: NCT02634333</jats:sec