Week 6: Novel reflections

I was in Amsterdam last year and found myself being interviewed by an unknown TV station at the statue of Albert Spinosa.  Don’t stress, the interview was about how come people don’t recognise him anymore.  Once a major thinker, important enough to have been banned, he is all but forgotten. There is a sad irony that in free thinking Holland, thinking is dead.

In this post I plan to outline my personal learning moments from this exercise in thinking about things ethical, and try to say something generally useful about the posts I have read.

Personal: I have found the exercise to be a far more stimulating form of obtaining ethical points than classroom based modalities.

I have enjoyed the possibility of pointing colleagues to resources they may not previously have considered. I have enjoyed the broadly collegial nature of the suggested links of others. I would have been curious to see how many of the links posted by the various participants were actually followed. Perhaps Michael knows a way to do this.

General. Time constraints mean that I could only follow a few other blogs. These have been the non-student ones in the main. I have been able to read some of the student blogs too, but not systematically.
I have been struck more by the uniformity in these than the plurality of views. I found the views to be broadly humanist, but without critically interacting with this paradigm. I had expected greater diversity of views given the apparent demographic differences. There have been far more question marks used than quotation marks, and I wonder if this reflects the nature of Blogging (to which I am a novice) rather than the depth of the thinking processes. Clearly, there are some exceptions to this, and I am encouraged that Michael intimates this programme may be run again next year, giving all of us the chance to re-engage.  We need to remember how to think again.
Suggestions for 2014: 1) This is a great idea. Advertise it better next time. I only heard about it through a comment on the SASP fb page.
2) how about splitting the broader list of participants into smaller groups of “must read each other’s blogs” in addition to those you elect to read. I am sure I have missed valuable contributions from people who were just not in my radar.

Week 1: Empathy – if only she had read the Book

This post is topsy turvey.  It is written as the penultimate one in the course for me, so I plead your indulgence with my tardiness.

I enjoyed Ms Brown’s TED talk.  I have an aversion to qualitative research, and narrative styles in general, but was quite taken with her…vulnerability, and willingness to share fallibility.  I found myself wanting to like her despite her repeated blasphemies, and tried to grasp the nub of her story.  I understood that she had experienced an epiphany of the non-religious sort, and had come to realise that being nice to others was a nice idea, that people are all basically broken, and that understanding that broken-ness is a healing and positive thing.  I take it that she has little Biblical exposure because that really encapsulates the Christian gospel.  Matt 7:12 – “do to others as you would have them do to you”, is the summary of God’s law.  However, we keep breaking it, because we are all fallen law breakers.  Realising this, and seeking appropriate “healing” is salvation.  Ms Brown could have suffered less if she had read the Book.

Shame was a prominent feature of her talk.  She has another excellent TED talk on just that.  It should be watched and read together with Dick Keyes’ paper on Shame, and even Hendrik Gustavsson’s talk on Shame, contempt and guilt.   I agree with her that Shame is a hugely powerful driver of human behaviour and dysfunction.  We are acutely aware of our fallibility and equally aware of the pressure to be perfect.  Sometimes this borders on the schizophrenic, with a riot of thoughts flying through the mind while the body calmly proceeds, all too mindful of those watching.  I find myself as a therapist all too often feeling shame at being angry with stupid patients, but having to wrestle the emotion down with the blunt instrument of “professionalism”.  The professional face is a face of perfidy.

Empathy-Endless-Origami-634x921

I have only read the Carol Davis article now toward the end of the course.  In it she interacts with the work of Jewish philosopher Martin Buber, whom I unwittingly cited in a later post.  I was initially elated to find other participants seeming to know his work and not being able to fully understand how our understandings of his main ideas differed, until I realised that this article informed their view, and that the author had a far lower view of the concept than Buber had intended.  This had the effect of opening the door for the idea of intimacy in therapy that I find profoundly unsettling.  Empathetic understanding of the patient’s situation is fine, but an intimate encounter with their reality is bound to run foul of the  necessary therapeutic barrier between therapist and client.  Appealing to the failed theological student Carl Rogers is no help here.  He redefined the terms of engagement in therapy to replace patients with clients, effectively commodifying them.  Despite his stated ambition of self actualisation of the client, the redefinition has cheapened the interaction. I cite the crass money oriented model of modern medicine in support of my contention.

I am a male therapist.  I need to keep a strict barrier between myself and my patients to avoid any hint of impropriety.  I think it is irresponsible to seek the level of intimacy that the article suggests.  To enter into this realm is to compromise – if even by baseless innuendo – my marriage, and to abuse the power dynamic inherent in Therapy.

By all means be thoughtfully kind and insightful into the bio-psycho-social milieu, but keep a distance.

Week 2: Morality

The TED talk by Sam Harris refers.

Sam Harris is an interesting bloke.  He is a little like Richard Dawkins in that they are the poster boys for secular humanism, but is not nearly as militant as the Dawkins in his atheism, nor quite so blatantly rude.  To be sure he has many detractors; he is forced to use close protection due to the numerous threats against his life, but he remains at least interesting.

Morality is not a-contextual.  Context defines meaning.  The development of an individual’s moral make-up is largely dependent on the cultural context in which they develop.  For this purposes of my contribution, I will begin with Mr Harris.  Sam Harris has very strong words to say against Islam and muslims, but his point of departure against them is predicated upon the same position – they are culturally different.  Their morality-defining paradigm is equally culture bound and it is difficult to see how either of the parties can claim moral superiority on that basis.  Harris is the progeny of a Jewish mother, a non-practicing christian cult father, has studied Bhuddism and Shinto, and has made his mark in neuroscience and secular humanism.  It cannot be a mistake that his moral compass reflects this life path.  He has certainly traversed the major world religions.  I take him to be a very religious man! That is his miscegenated cultural identity. 

In his talk he explicitly calls for the a priori exclusion of certain viewpoints that do not agree with his.  That is dogmatic.  He intends it to mean we need to exclude from the discussion of morality those ideas that challenge the majority view.  He argues this by example, saying that in science, there are obviously “wrong” perspectives, which should just be discarded.  The clear implication is that he would have us a priori exclude those moral contexts that do not accord with secular humanism.  To my mind, that is not terribly tolerant and is scientifically disingenuous.  Is he then any more or less moral than Muslims in his polemic?  Moot point. They proceed from the same basis. 

Not to be left out, and lest there be a hint of inequality, Dawkins reserves his vitriol for Christians.  

My personal moral perspective has a theological orientation; I am a reformed protestant evangelical.  I affirm the Bible to be the inerrant word of God.  Harris would have a problem with this position, but I make no apology.  As a thinking person I have evaluated the evidence for this claim and found it true.  I stand with Luther.

I cannot and will not recant anything, for to go against conscience is neither right nor safe. Here I stand, I can do no other, so help me God. Amen.

Martin Luther

I have spent some time in the liberal arts/social sciences, left wing politics and generally had an interesting life.  I am not a moral person.  That does not mean what you think.  A Biblical perspective on morality will better explain this.  Biblically, I believe humans are fundamentally spiritually broken through the sin of the first Adam, and that restoration is possible (through the second Adam). I think Calvin has the best understanding of this when he talks about people as being “utterly depraved” meaning that their imperfection affects body mind and soul. Professionally I think it is now common cause that there is a core link between the mind and the body (bio-psycho-social model). If there is redemption for the soul, there can be hope for the body.  Consequently I believe there is merit in physical therapy on an intellectual and spiritual level. 

I am a big fan of the work of the Labri fellowship and spend many profitable hours listening through their library of talks.  Fans of TED (I am one too) will appreciate chasing the link.  In the spirit of biblical skepticism, I have wondered if it is possible to be involved  in physical therapy and not acknowledge God. In reflecting on the themes covered, and challenged by the thinkers who share at Labri, I came up with 3 fundamental beliefs that I believe that physiotherapists have to confront if they are to practice in a thought through, consequent manner, and I do not mean just clinical reasoning.  There might be more than these, but these are my 3.  The ideas are developed further, but space does not permit the full expression here.  Please comment as you see fit.  I welcome your input.

  1. Physiotherapy assumes design in the human (Special Creation).  
  2. Physiotherapy pursues the concept of optimal function (Absolute Truth)
  3. Physiotherapy affirms the image of God in the human (Schaeffer’s Upper Story).

 

 

 

Week 3: Equality wrought or given?

There is an assumption that equality is a positive attribute inherent in the modern social discourse.  It extends from gender to race, across economic class and permeates even to the weight given to ethical choices.  This much is self evident; the topic under discussion reflects it. Our Constitution demands it.  My children seem to think equality and fairness are de rigueur.

Despite the fact that South Africa is deemed to be one of the most socially progressive countries in the world (on Constitutional paper at least), it seems to my mind that the opposite contention is equally valid.  Inequality appears to be the norm.  The Gini co-efficient measure the inequality in income in a nation.  South Africa rates a table-topping 63, which is almost two-thirds of the way to perfect in-equality.  Men and women are not equally suited for various tasks.  Cultural groupings find definition more in how they differ than how they are similar. The choice of conflict over unity seems to dominate the media space, leaving little space for positive energy (but see this cool idea).  The Orwellian mantra of “some are more equal than others” seems more certain today than at its publication in 1945.Image

The Freedom Charter is something of a Magna Carta for SA, reflecting a time when oppression wrought unity and progressive thinking among the masses.  It is idealistic in the highest sense, informs the current Constitution, but is not prescriptive in the way that this latter document is.  The individual freedom demands were collated from across the country from grassroots Congress members and the final document reflects that structure, not a hierarchical one.  The impetus was to give expression to the will of the people rather than dictate morality, which was the opposing paradigm.  The emphasis on equality of the demands must be seen against the background of the attempt to forge a united anti-apartheid front, and to include as many groupings as possible despite glaring inconsistencies.  The Greater Good seemed more vital at the time to most, who hated bigotry more than the differences between them.  Note the critical role of the Christian church, liberation theology and individual ministers like Chikane, Tutu, Beyers Naude, Johan Heyns, the Kairos document etc.  Clearly there were other groupings too, but I am concerned with just the broader Church

Now the Constitution, forged from the crucible of the Freedom Charter, has come back to bite the Church.  The Judeo-Christian stream is unique in world religions in that it has a foundational document, much like secular humanists now claim the Constitution.  It is the Bible, which is a unity of the Hebrew Bible and the New Testament texts. It is supposed to be the arbiter of life and faith for broken people living in a broken world.  It is claimed to be divinely inspired, and thus the tenants are claimed to be divinely inerrant. When people disagree with some part of the Bible, in Biblical terms, they are at odds with the author.

There are clear Scriptural warrants against racism, murder, rape and hatred.  These are coherently based on the character of the God of the Bible or the Law given.  There are  equally clear Constitutional laws prohibiting the same, but the source and rationale of the laws is not the same.  There are Constitutional precepts that encourage what the Bible calls lawless and wicked. Homosexuality is an obvious example, and so is divorce.  Without being pugilistic about this, we need to appreciate that the difficulties that each side has with the other is less about the wording of the source documents and more about the authors.  One claims a single divine authority, and the other claims a distributed, aggregated majoritarian authority.  Simply put, God gives equality to those things He regards as equal, and humanists forge equality among those they see as equal.  It is a paradigm battle, not a battle of behaviours.

Biblically, equality is given.  Humanistically it is wrought.  There is no basis to value equality over inequality in the latter condition.  Perhaps why there is such an oppressive gap in the country with the most liberal constitution.

Week 5: Euthanasia

Words have power.  Sometimes it is the context that confers power, and sometimes the words have power independent of the context.  Often the power of a word comes in unpacking it.  Loan words from different languages enable linguists to plot the movement of people groups across the landscape as with the movements of the Western Bantu language grouping down through Africa.  The combination of grammatical structures from differing cultures can reflect cultural miscegenation (as with English).  The power in the word euthanasia comes from unpacking its Greek roots and contextualising it in the global village.

Eu Thanatos” – a good death.  Historically, Thanatos was a Greek deity who was the son of Night and Darkness, and the twin of sleep.  Freud for all his faults called his human death wish the thanatos drive.  Dr Kervorkian brings us up to date with his killing machine which he called the Thanatos.  Kervorkian was a controversial figure who used his medical knowledge to assist patients to die.  It is this modern context the debate at hand plays out.

When can you choose a more self-determined terminal event is the question posed, not the rightness or otherwise.  It seems that – as with other controversial issues such as prostitution and drug use, the issue is management rather than ethics.  The debate moves to the mechanics of how to conduct the passing, the legal issues, the human emotion, and away from the absolutes of the matter.  In a sense this is purely practical, for the answer to the question as to when to end your own life is surely (for the 1.4/100 000pa in RSA) whenever you want to.  What stops you?  There are many examples of self-destructive behaviour that people already engage in during their lives.

I suspect that far, far fewer people suffer conditions like Locked-in syndrome, and NMD, my late mother among them, which effectively mean that the individual concerned no longer has the opportunity to end their own life.  There may or may not be a progressive decline in the ability.  If there is an ability to express a living will in which the individual expressly does not consent to any treatment that will prolong life, they maintain a modicum of self-determination. This small subset are those who are truly powerless to engineer a “good death”.

Euthanasia strictly speaking concerns only death, the management of planned death.  I appreciate that this relatively tiny group of people in distress need to explore this issue. They find themselves in an unfortunate position of legal minority, subject to the decisions of others.  Doctors have taken an oath to protect life, not destroy it, and are rightly ethically conflicted in this matter.  This lead to greater efforts to promote medicine, prolong life, relieve suffering, not fewer.  I guess knowing when to stop is the trick, but then you call a halt on the future.  I take a high view of the place of a human as being created in the image of God, but am disappointed in humans. I am concerned that the very real plight of terminally ill people may be hijacked in the interests of other groups.  I am concerned that the argument for the exception (euthanasia) may be extended to the rule.  The references to eugenics (note the Greek again) in the links are not out-of-place here.  I am professionally appalled at the thought of mere disability being used as an excuse to terminate life at either end of the temporal spectrum. Paul Brand, Joni Earikson Tada and others have written eloquently on the blessings of embracing disability and living good life despite less than optimal conditions.  If the person concerned is a legal minor in the process, do we not open the door to the possibility of forced euthanasia. There is after all a very small step between allowing a therapeutic option and making it protocol in managed health care.   My mother faced this question daily.  She asked as Wendy has – “Is the right to life the same as an obligation to live?”.  It cost a lot of money to keep my mother in relative health and gainful employment in the 30 years between her diagnosis and her death.  Left to herself I think she would have gladly taken the easy route, and her medical aid would have been better pleased with the return on investment.  But then the hundreds of people who turned up at her funeral and memorials would never have known how good it was to have known her.  What I learned from her was how to choose to take the hard path and rejoice.

 Suffering produces endurance, endurance produces character, character produces hope, and hope does not disappoint us

The topic is a good death.  Readers may wish to ponder if they are currently living a good life

Torture and Epistemology

The world is obsessed with suffering.  In the developed world, this obsession is hedonistic, a chasing after pleasure and the avoidance of perceived suffering. In the underdeveloped world, suffering – real, grinding suffering is the brutal daily reality for most. To the mass of humanity who find themselves counted among the wretched of the earth, much of daily life could settle comfortably with the varied definitions of torture contained in the Wiki referenced in the weekly post, and many other human rights violations besides. Buddhist readers may be nodding at this point at the familiarity of this postulation: “all of life is suffering and death the cessation thereof”. I admit this may seem overly pessimistic, but consider the paucity of actual joy in the lives of your colleagues and realize that the abiding experience of being human is of banal daily slog punctuated by all-too-fleeting quickenings of happiness. In terms that Martin Buber would use, we live the “me-you”, but yearn for the “I-Thou”.
In reading around the film Zero Dark 30 I was struck by the odd disparity between critics who saw a glorification of suffering in the film, and those who saw justification of the infliction of torture. It seemed to be a simple mirror of the macrocosm of the world described above. Those who lived in. Brutalized realty anyway, saw no problem with brutal activity. It was Justified by their paradigm. Those shocked by the jingoistic glorification of systematic barbarity revealed themselves to be from among those fortunate few who think that life should be free from suffering, not just for themselves but for all. Again, this is not surprising; it is the old chestnut of situational ethics versus absolute ethics, played out in the theatre of gore. Indeed, the reference to Biko is appropriate. Many other South African names could be added to the conversation. Wouter Basson, Joe Modise, places like Quatro, Vlakplaas, John Vorster Square.

Situational ethics is not new but could be regarded as a poster child for the post modern era. I suspect many of the moral dilemmas we might face in our daily grind come more from our personal inability to find and hold an absolute moral compass. A typical daily example for me is the use of dry needling therapy. Dry needling works. Most of the patient I see will benefit from the therapy, but it hurts, sometimes markedly so. If I ignore the potential suffering caused to the patient, and Just stick needles under my own self belief, I act upon the patient in much the same way an agent of torture. I am old fashioned enough to believe that causing suffering in that way is just plain wrong. Always wrong. I also does not make sense in term of nociceptive upregulation, but that is beside the point. My (very WASP) dilemma comes not from the sharp end of the suffering, but from the boring and blunt end of obtaining informed consent from non-English speakers. The only thing that separates what physios do from common assault is the informed consent form. No consent, then no delivery of effective treatment. That is a non-clinical issue, driven by an ethical concern to respect the right of a individual patient to self determination regarding health care choices. Potentially this could be a problem – I am often tempted to ignore the language barrier and trade off the power dynamic inherent in therapy and treat without true consent. Fortunately for my malpractice insurer, I have a prior immutable commitment to propositional logic and absolute truth, which dictates my response (written informed consent for each patient with each episode of treatment) without having to wring my hands in anguish.
If one is to follow a Darwinian approach to the inherent status of a human, one quickly spirals from all people being equally products of time plus chance, to the preference of some people over others based purely on their social dominance.  Contrary to conventional wisdom, I do not think that Adolph Hitler was insane because he tried to exterminate Jews and Gypsies in Europe in the 1930’s and 40’s.  He was not insane, but consequent.  He was merely taking social darwinism to its logical conclusion. If humans are just evolutionary accidents, taking either better or worse evolutionary paths, then there really is no sensible reason to believe that we are all equal. In fact, we can decide (as did Hitler, Vorster, and those involved in the forced sterilization of people with learning disabilities) that we are de facto a superior race  We can ten logically proceed to proclaim dominion as we deem fit. Surely it is no accident that the rise of the modern human rights culture dates to a revulsion against the horrors of WW2.

This post-war groundswell of human rights awareness is less a lesson in history than it is in epistemology.  In order to consider the topic of human torture, we surely need to consider the nature of humanity, or what Francis Schaeffer called “the mannishness of man”.  Biblically speaking, a human has no inherent rights. We have all abandoned The Lord and fallen short of His requirements in this life. Whatever standing we may have had when we were created was shattered in the Fall. The prescribed punishment for fallen behavior (another old fashioned word – sin) is death. Through sin we forfeit any rights we had.  We humans have no rights, only a sure expectation of the death sentence. This may seem to be at odds with the sense which the US Declaration speaks of “inalienable rights” for all in a unitary nation “under God”, but his paradox actually unlocks the curious link intimated in the title of this blog.  Humans are not darwinian accidents. The revulsion most people feel when faced with the opening half of Zero Dark 30 testifies to a core belief that there is something special about a human.  The Lord in His wisdom created us in His image, and sinners or not we still bare this image in our humanity.  This is a critical concept.  There is a direct causal relationship between Social darwinism and racism, Nazism, and the use of medical knowledge as a form of torture.  At its core is the epistemological question “What is a man”.  If he is just a product of chance+time, then it is of no consequence if he suffers at my hands for my benefit.  I win, you loose.  People who have abandoned the God of the Bible and a Biblical understanding of man in favour of the brutality of darwinism should really not be surprised by Eugene de Kok, Gitmo or any other expression of racial supremacism.

Our facilitator has posed questions around the Biblical references in Matt 26, Matt 5 and Exodus 21.  A contextual reading of these should make the answer plain.  The Exodus passage concerns limiting legitimate punishment, binding those who exact retribution to not go beyond the original offense.  It is not a prescriptive verse (Thou shalt punish to the nth degree and all is fair in war).  The New Testament exposition of the verses given by Jesus in Matt 5 seal this contention.  Even if you are unjustly provoked, that is not a mandate for brutality.  The high place of humanity in the Bible narrative is informed by their inherent value as being created in God’s image, not their “rights”.

Secular humanism is a religion based on the concept of each person having inalienable rights because other people think that is a nice idea.  It is inherently darwinist, and so stands on a house of sand.  It is always wrong to engage in torture because it violates the image of God in man.  An epistemological understanding of man built on the Rock is required.

As this is posted on Women’s Day, lets not forget the feminist metanarative of Zero Dark 30.  Take a listen to the this helpful affirmation of the value of men and women. John Piper: Male & Female He created them

On your marks…

I am a novice at blogging.  I need to set a plan of action and hope I don’t annoy any of the other participants.  First point of order is to declare a start point:  I intend to begin with the current week’s topic and catch up the previous ones as chaos allows.  All suggestions gratefully received, not the least of which is where the weekly thought provoking post will come from. I think I need to subscribe to the feed, but am not sure which.