BJ Miller’s Foreword
Words by Dr. BJ Miller




I want to feel alive more than I want to be alive. My patients and their families do too.   

As a palliative physician, my job is to see patients in all manner of anguish. Suffering is the beginning. We start with feet that have gone numb or tingly.  Or maybe nausea. Fatigue is probably most common of all. Or maybe the patient is fine, but the family is burning out.

Eventually we get underneath the angst to its source, where the bigger issues lie. Connection, appreciation, realisation, and everything else meaningful that can go lacking when you’re distracted.

But down here, we have our opening: where in your day do you feel the slightest bit OK? When do you feel right with the world, even for a moment? What’s happening then? Illness is discombobulating to the point where it can be hard to find the ground. Answering these questions helps light a way.  

For many patients, it’s time with family or friends. A certain activity: the movies, music, their art studio, driving, swimming, being in their garden. Maybe it’s at work where they finally drop in for a moment.

Almost invariably, people’s answers to these questions have two things in common. One, they comprise a sensation. More than just the garden or the movies, what registers is how they feel being in the garden or at the movies. The emotional and the physical. Second, these sensations always hold their own significance for the patient, regardless of any other purpose the activities might serve. Purpose is good, but it’s not necessary.Here is where means and ends meet. In other words, these questions and answers bring us into the realm of aesthetics.

Does that register with you? It might not. That word ‘aesthetics’ has gone wonky. White teeth, smooth skin, Italian art, sunsets when the clouds are just so: the word ‘aesthetic’ is more typically reserved for these sorts of things. Something subjective and of a particular taste: exotic, special, arty.  Furthermore, to use a word like ‘aesthetic’, you might presume you need special glasses, like graduate degrees or secret passcodes. But here’s the real secret: you don’t.

As a force for breaking through, illness is helpful, shredding layers of shellac that build up over time, obscuring a person. The gum and goo of expectations, roles we think we must take on to be recognisable, all the while suffocating our real core: the thing of us that receives more than it sticks out.

Illness is also a foil. It dials up the contrast, so that beauty and the other bits of ease can pop. But don’t give illness too much glory. You don’t need to be amidst loss to appreciate something. You don’t need to exaggerate the contrast. Nor do you have to be ill to fall apart. Modern life gives us a luxurious number of opportunities to do so. In other words, you don’t need an excuse to be affected.  

For all our lurchings, our charge is the same as it ever was: to feel with this body while we can. To do so, all you need is one of the following: sight, sound, smell, taste, touch, or intuition.

It’s too bad that the word, ‘aesthetics’, has become so narrow, and for no good reason.  The world has much more to offer than such a small selection of things, and we humans have so much more capacity to handle it. In the realm of aesthetics, we’re freer than we know.

The aesthetic is generous and inclusive: anything that intensifies the immediate sense of living. That’s how John Dewey, philosopher, psychologist, and educator defined it. There’s no time required, and no memory either. Just a direct sensation piquing life in you. Or, to be even more inclusive, take Frank Zappa’s definition: anything, anytime, anywhere.

Gaps so easily widen between the world we have and the one we wish for. This is the price we pay for having imagination. That pain is nothing new, but nowadays we have an accelerating embarrassment of a gap that’s only widening. The times are at once so challenging and so promising. Ever more seems possible ‑ virtual realities, intimacies from afar, instantaneousness, simultaneousness ‑ but it turns out ever more isn’t really possible after all.

Surely, all these new developments have their aesthetic potential too. But for most of us, they arrive faster than we’re able to make the receptors required
to experience them. The tonnage is overwhelming to the point of anesthesia. It gets harder to know what we have, and harder to feel in time.  

If we’re not careful, we’ll look past all that’s in us and in front of us, busily seeking what we already have, earnest with furrowed brow and wild hair. And all the while time is counting down. The eyeglasses we’re looking for are sitting right on top of our sun-spotted heads.  

Stained teeth, graveled skin and dark skies will do. These things have every bit as much aesthetic potential as anything else. It’s your prerogative to say what turns you on and improves life for you.  And being turned on — enlivened — is one of the kindest things you can do for yourself and everyone around you. It seems more like a responsibility now than mere recreation or an academic pursuit. You glow. You make light. Maybe it’s the activism of our time.  

You don’t really have to have an adjective, but if it’s beautiful that you need — I know I still do — remember that it’s you who makes anything so. In the eye of the beholder, yes indeed, and in the fingertips, nose, ear, tongue, and mind too.  

With that, welcome to this edition of Satori. We hope you’ll feel anything.


This essay was the foreword to Issue Three of SATORI. Dr. BJ Miller (ucsfhealth.org/bj.miller) is a hospice and palliative care specialist whose interests lie in working across disciplines to affect broad-based culture change and in cultivating a civic model for aging and dying.


Discover Issue Three here >


Created by Duncan Woods & Seb Camilleri