Saturday, March 26, 2016
After an infant is born, passed through its mother's body, into my medicalized hands, gowned and gloved, after the cord is clamped and cut, cord bloods delivered in tubes, after the infant is into the living air and loving mother's arms and at the breast, one side of the chiasm of mother and child remains to emerge. The careful delivery of the placenta punctuates the birth of a new person into finitude.
Medicalized, gowned and gloves, I pass my hand into the womb and meet the fetal machine of life; I find a plane where womb and placenta meet, and slide, ever so gently, my body into the space where mother and child were separate only by molecules. My hand and my mind's eye traverse this space until the connection dissolves, as I lift the placenta off the maternal side, delivering into the air.
There is a violence in this separating of mother from the remnant of mutual gestation. For all its gentleness, my hand puts asunder what nature would have gotten round to, the dividing of the fabric of mother and child. In fact, the manual delivery of the placenta is quite passe. I no longer invade the womb; instead, I wait. I place my hand on the abdomen, and massage the womb, encouraging gentle contraction, and the womb releases the placenta. With gentle traction on the cord, the placenta delivers itself. Both mother and child are now completely in the world. I discover I am little more than a witness to a double individuation.
We must not miss the placental turn of the Cross. The Logos, united to the human flesh, witnesses at the level of personhood the suffering in that flesh, and in its chiasmic proximity, feels all that the flesh bears. In its placental relationship, the Logos give life but also separation: it is accomplished, completed--- the finitude of the human, embraced by the divine, finds itself within the womb of divinity. The Son calls to the Father, who, embracing his Son, suffers in Spirit what the Son suffers in the flesh, as the Son finds himself, and his human finitude, in the womb of the Father.
The double-womb-ing in the singular moment on Calvary points to the unexpected unities of Christ and the Trinity. The Incarnation comes crashing into history, into language and culture completely unprepared to receive it. We come to know it not by accounts of virgin birth or a ministry of wondrous deeds, but through the experience of the Passion-Resurrection, which alone issues the Gospel. From the side of the crucified Christ flows what the Tradition has named the hypostatic union, where the chiasm of the divine and human enter knowledge through a placental engagement of the womb of God and the flesh of the human. From the experience of the risen Christ flows the stirrings of the inner life of God, which the Tradition calls Trinity. The womb of the Father generates the Son, and delivers him to union with human flesh through the Spirit within the womb of the Theotokos: a 'trinity' of womb-ings.
The phenomenality of the Resurrection provides the point of departure between faith and nonsense. New Testament Greek cannot contain this phenomenon, neither can any language alone. The best it can do places the person of Jesus in a room with locked doors, describes an empty tomb, and dismisses visions of women as nonsense. The Resurrection is Christianity's greatest embarrassment, heightened by the further embarrassments of a God-Man and a triune God.
Yet what shall our response be to all this embarrassment? Why do we continue to inherit this Tradition, all this 'jewgreek', as Joyce and John Caputo might say? Even for the first witnesses to the Resurrection, the initial response was incredulity, so much nonsense. The very uncontainability of the experience gave way to the givenness of something new, something unexpected, something unforeseeable. All its saturating phenomenality haunts us, calls us, insists unconditionally but with no force but a weak force, an overwhelming unconditionality of the faintest whispers perhaps emanating from the womb of God, swerving in a placental turn.
Christianity embraces the birth of finitude, the realism of the body, the suffering and redemption of the flesh. Every Easter marks the active inheritance of a Tradition of life and a faith in the impossible. The paradox of Christianity reflects the paradox of the Cross and the saturated phenomenon of revelation. What do we do when we love God? With prayer and praise, tradition and Tradition, we respond to the call: hineni, Viens, Oui, Oui.
Saturday, March 12, 2016
Perchance to Dream What Dreams May Come: Day-Dreaming About Physician Assisted Suicide at the 2016 AAHPM Annual Assembly
What dreams may come after death frightened Hamlet to paralysis. Contemplating suicide, he explores realities far worse than death: a perpetual nightmare of greater terror than any in waking life
To die, to sleep;
|To sleep: perchance to dream: ay, there’s the rub;|
|For in that sleep of death what dreams may come|
|When we have shuffled off this mortal coil,|
|Must give us pause.|
In the context of Physician Assisted Suicide (PAS) and euthanasia, a perpetual nightmare of decisions and revisions (which a minute will reverse) should give us pause to reflect on what physicians do for patients, what patients ask of physicians, and why both do either. Despite the shift in values from what doctors do 'to' patients to what they do 'for' them, doctors nonetheless must consider that whatever they seek to do for patients, they often achieve this end by doing something 'to' them. The issue generates passions on either side, and the language we use points to the ground on which we stand: shall we continue to say PAS, or shall we say, perhaps more neutrally, Physician assisted Dying, or Physician aid in Dying?
As I sit through the many presentations here at the 2016 Annual Assembly of the American Academy of Hospice and Palliative Medicine and the Hospice & Palliative Nurses Association, I encounter choices considered and made, protocols considered and implemented (or not), discussions of collaborations and near-misses, issues of living and dying, and the intersection of medicine and death. As a physician-member of the Hospice and Palliative Medicine community, I share in a commitment to life, to life at the end of life, and in the perceived threat to that commitment by the process of legitimation of PAS. Certainly the formal venue the AAHPM provided for critical reflection on the matter was charged with tension and uncertainty, as genuine division played out, even if in a field of collegiality and palpable mutual respect.
What shall we do when our patients choose death and ask us for our help in achieving that goal? The choice for death in the face of illness is at once an expression of sovereignty and an expression of valediction. Yet, how are we of the good death, the death with dignity, death and dying with compassion and comfort, to participate in the circumvention of the platform of our commitments?
Perhaps no case compels us more to consider the complexity of such matters than patients who suffer from neurodegenerative diseases, diseases where the 'body' disintegrates in the presence of a sound mind; the paradigm for such illness is amyotrophic lateral sclerosis (ALS), more familiarly known as "Lou Gehrig's Disease." In ALS, all the kinesthesias of the lived body cease; the body itself becomes the field of medical mayhem, from infection, tissue break-down and even multi-system failure. All the abandonments of the body confront a vibrancy of the mind.
Surely PAS, if it is to achieve full legitimation and broad reception throughout all cultures and sub-cultures, will achieve it in the context of the management of the end of life of those suffering in the provocative and poignant example of ALS. What compassionate spirit would not empathize with the unspeakable horror of awareness beyond the reach any instrumentality, beyond the kinesthesia of the lived body? Who but we providers of compassionate care can conjure an ear to hear the screeching silent scream of a vibrant mind howling 'hold enough'?
Moreover, that mind might present its concern to us in a full-blown personhood, well in advance of end-stage disease, in the form of a thoughtful consideration of its request for death couched in a sense of dignity and authentic values. Such values might privilege instrumentality in the hierarchy of the elements of personhood, and the human person before us might present a structure of autonomy and dignity that crumbles in light of foreseeable, total custodial care. The sheer desire of control over one's own lived life, or a desire to avoid becoming a burden to loved ones, or even to 'society' could buttress the sanest of arguments for such an exercise of personal liberty. All sympathy and empathy aligns with this projected view upon suffering, and instinctively understands the horror of being unable to influence one's world. To be clear, that deafening screech grates most profoundly in the context of a change of heart, a change from one decision, to hold the course of palliation, to another decision, where, once unable to communicate, another change of heart occurs, to abandon the palliative course and choose the pursuit of death.
Yet, something is incomplete here; things are less than resoundingly clear. The judgment that comes into view denies the possibility of an inner life within a body dying from ALS. When an attitude of the understandability of a locked-in vibrant mind detached from the body collapses, or becomes bracketed, and the inner life of the mind, spirit and the flesh appears, another encounter sets the stage for experience. The vibrancy of mind surviving the devastation of the body might very well embrace a life of sight and sound, a life filled with music, visual arts, film, and sights and sounds, such as those of the voices and visages of loved ones, family and professional care-givers. Such values and possibilities haunt the natural attitude of the righteousness of asserting autonomy and even extreme expressions of freedom. The natural history of diseases like ALS does not occlude death, but neither does it occlude another version of quality of life that privileges the life of the mind and spirit.
Admittedly, the example of ALS has its limitations in grounding the suffering at the end of life, and is does not reflect the more immediate injury to the body that end-stage cancer does, or as heart failure or lung disease might do with their relentless dyspnea, anxiety, intense fatigue and asthenia. Yet, diseases like ALS can give a leading clue to what its sufferers think of it as they think of it in the flesh, in the self, in the spirit and in personhood that all may be operative in the experience of other terminal illnesses. Though there might be many other points of departure here, two come to mind, and they come to bear on how one's own life is experienced in one's lived life. On the one hand, life can be thrust upon someone: I find myself thrown, without any say, power or will, into 'life' as a random event in absolute contingency. What I have not chosen I do not receive. On the other hand, my flesh gives my very self to myself, where life is given as a gift, which I do receive as a receiving self, a self 'gifted' with life. When I see myself as a random event, I have no given that brings my flesh to give a self to myself, and I can reciprocate the randomness of my facticity by rejecting life. When I am the recipient of life as a gift, I receive as the 'gifted' a gift outside any economy of exchange; I cannot return the gift. There are no givebacks when the given moves my flesh to give my self to myself.
As providers of compassionate care for patients with life-limiting and life threatening illness, we should remain open to a version of life that values life despite the loss of the body. Furthermore, as professionals treating patients whose lives are such that the stakes are so very high, we should explore, if not challenge the value systems of our patients whose suffering, or anticipated suffering, brings them to ask for death. The hospice movement and community embraces life, especially life at the end of life, and we should adopt an acutely analytical attitude when exploring the demand for death as an exercise of freedom in choosing how and when one dies. Such a critical approach cannot be limited to ruling out clinical depression, or adjustment disorder, or characterizing the various coping mechanisms that mitigate the onslaught of loss, devastation and suffering.
If our patients do indeed convince us of their judicious approach to their own autonomy, of their own critical process of evaluating their own personhood and freedom, and that their request for death is rational in their own system of judgment, then our response must, of course, be compassionate understanding and unwavering support. Still, as professionals in a discipline dedicated to the alleviation of the symptoms of suffering, we cannot choose to provide the means of death. We cannot remain true to our commitments to life at the end of life, and directly cause the end of life.
Respectful dialogue among physicians and patients in which all judgment is suspended and communication is radically free can lead to greater understanding of the issue of requesting death near the end of life. There must be a place between 'abandonment' and acquiescence in the relationship between a physician and her patient. All the legalizations and decriminalizations of physicians' acts upon their patients do not exonerate either party from their responsibility in their acts and interactions. The instant the phenomenality of the request for death enters upon the stage of medicine, we must already have seen it on the horizon. What shall we at the intersection of two selves do?
Monday, March 7, 2016
As usual, I am late to the party, but grateful nonetheless for Amazon's analytics of my purchases and browsing there. I recently came across Habermas's and Ratzinger's The Dialectic of Secularization (Ignatius, 2007) and was stunned to find Habermas moving toward an authentic communication between secular reason and religious thought. In part responding to the stagnation of European liberal democracies and the disillusionment of citizens as expressed as a growing apathy toward the democratic process, Habermas seems to be continuing his exploration of religion and theology as a voice otherwise absent in the discourse of the post-secular, post-metaphysical 'lifeworld,' and taking it to the unexpected terrain of legitimation. So long as that voice, it would seem, offers something distinctly absent and wanting in secular rationality, its presence at the table of reasonable conversation is welcome. Indeed, in what was to me a startling movement of ideas in his Between Naturalism and Religion (Polity Pr., 2008), I find that Habermas's program is not merely pragmatic and post-secular, but also generative, alive and on the move.
Well that sounds so much like a turn toward verticality, as that idea has floated in this blog but certainly as enunciated in the recent works of Anthony Steinbock, especially in his Phenomenology and Mysticism. In his critique of the 'vertical' element of the 1st generation of the Frankfurt school of critical theory, Habermas had found a pessimistic messianism, for example, in the thought of Adorno and Horkheimer. Eduardo Mendieta has assembled a cross-section of Habermas' essays from the 1980s through the late 90s that traces the initial sojourn into this arena, in Religion and Rationality (Polity Pr., 2002), and the intimations of a theological 'turn.' How far down that turn goes remains to be seen, yet Habermas seems open to a real depth; but with a proviso: he has recently suggested, in light of his critique of Rawls (and Rorty), that religious language and its 'truth contents' that enter into the public sphere should be translated into a 'generally acceptable language' prior to their presentation to the bar of the democratic secular apparatus (The Power of Religion in the Public Sphere, NY: Columbia Univ.Pr., 2011, 25).
I make these observations not to rehabilitate Habermas for a religious audience, but to underscore the vibrancy of one of the 2oth century's most interesting thinkers, one whose thought has not come to rest in the past, but actively engages the 21st century; and to underscore the relative deafness of many of the thinkers so central lately to this blog toward Habermas's transformations. Habermas, after all, is no stranger to Husserl and other phenomenological thinkers, and while his work is not of a phenomenological flavor, it does indeed speak of a lifeworld, and implicitly, how the homeworld and alienworld might interact to co-create the lifeworld and invigorate the level of discourse and value the experiences of all potential political participants. Habermas might not himself have moved off the horizontal plane, but he seems to have positioned himself toward the vertical realm by de-limiting what is proper to the public sphere.
I offer this post as something of a prolegomena to placing God, the Flesh and the Other (2014), In Excess (2002), and Phenomenology and Mysticism (2009)in a broad dialogue that would not be tone deaf to the social imaginaries as they appear in Marion and Steinbock, but also in Habermas and Falque. I will not chide our phenomenologists for their shyness toward Habermas, which I interpret as an uncertainty toward his place in the discourse of theology and phenomenology. I will simply keep Habermas 'out there,' poised to jump in, similar to our engagement with Agamben not too long ago.
I am placing these books and their authors in dialogue because I seem them in such a dialogue already. Steinbock's discussion of "Individuation" in P&M and its far-reaching implications for the self, givenness, redemption, the flesh, has its resonances with Marion's discussion of the flesh, and with Falque's discussion of the flesh, haecceity, singularity and his presentation of Tertullian, Irenaeus and Duns Scotus.
I will be fleshing all this out in a subsequent post, but for now, I simply want to draw attention to the problem of individuation, especially as Steinbock dispassionately and painstakingly explicates it. Because Steinbock has remained within an orthodoxy of Husserlian phenomenology, despite bringing the founder's thought into a more robust 'generativity,' he still must confront the problem of essences, which leads him to distinguish individuation from 'individualization'. While this maneuver, remarkably, does no violence to his presentation of individuation per se, it does proffer a certain distrust of givenness, and in particular, a phenomenology of givenness. Steinbock distrusts, too, as does Merleau-Ponty, just how complete the 'reduction' can become. Both thinkers are therefore 'stuck' in Husserl's 'givenness' which translates in Steinbock's work as a necessary distance between 'verticality' and the 'saturated phenomenon,' and as a description of the inadequacy of the latter. So long as the description of verticality and individuation remains tied to even a muted Cartesian metaphysics, this version of generative phenomenology will maintain a jaundiced eye upon a full-blown phenomenology of givenness as Marion's oeuvre strongly evidences.
Falque's GFO struck me as another version of P&M, even if just superficially as doing for Irenaeus and others what Steinbock has done for his mystics. Both works accomplish remarkable feats of philosophy, but they are also marked by a suspicion towards Marion, his saturated phenomenon, his overplaying the anti-metaphysics card, and his description of givenness. But make no mistake about it, the language through which the 'truth content' of religion and religious language enters the public sphere is the language of phenomenology.
In my next post, I will be keeping Habermas's work in the natural attitude, while I look at the general swerve moving through some of the thought of Steinbock, Falque and Marion as suggested above.
Tuesday, March 1, 2016
By now it should be clear that no account of the most famous miracles, the miracles of Jesus, can ensue without first giving an account of the ground of the miraculous, those acts of creation given in the Creation proper, and in the Incarnation, and in an account of hope and love whose reality and nexus is the miracle-itself. Apart from the horizons of love and hope, and their orientations to the future and the other, miracles remain invisible. Hence, the appearance of the miracle depends on a special case of the gaze, the gaze of the vertical. Jean-Luc Marion has written extensively on the nature of the gaze and its relation to the visible and the invisible, but in The Crossing of the Visible (trans., James K.A. Smith, Stanford, 2004), a phenomenology ostensibly about art and the painting as image, idol and icon, as object and saturated phenomenon, he begins with the paradox and the miraculous, and provides for us a point of departure:
The paradox attests to the visible, while at the same time opposing itself, or rather, while inverting itself; literally, it constitutes a counter-visible, a counter-seen, a counter-appearance that offers in a spectacle to be seen the opposite of what, at first sight, one would expect to see. More than a surprising opinion, the paradox often points to a miracle---it makes visible that which one should not be able to see and which one is not able to see without astonishment...The paradox testifies...that what enters into visibility is that which one should not have encountered there: fire in water, divinity in humanity; the paradox is born from the intervention of the invisible in the visible...(1-2).
Visibility is not some chameleon that shape-shifts itself willy-nilly into the gaze of some, and not others. As Steinbock has noted, 'idolatry' emerges from within vertical experience, and takes the form of 'delimitation,' of foreclosing on verticality within the horizontal plane. The natural attitude, though, which is the posture within the horizontal plane, is already graced. Grace imbues all reality that presents on the horizontal plane with the possibility of verticality. The suppression of verticality then delimits grace, closes off the natural attitude to the grace that opens upon the vertical---idolatry---denies grace, denies that nature is imbued with grace, denies a 'graced nature.' When the posture of the horizontal 'will not see,' it denies the graced nature of the natural attitude and closes itself off from the paradox, which 'points to a miracle' that brings the invisible into visibility; such 'not-seeing' occludes the birth of the miracle, denying the appearance of the miracle-as-such.
This understanding of visibility, idolatry, and the horizontal would seem not to apply to the miracles of Jesus. Nearly everyone in the gospels acknowledged that something paradoxical and unusual was occurring in Jesus' presence. The event of the miracle was not questioned, but its source was questioned by some. That wondrous deeds were of God or the devil informed the natural attitude and the horizontal plane of the lifeworld in the Gospels. That God or the devil could work wondrous deeds required no 'departure' from the horizontal. That such deeds marked the inauguration of the Kingdom of God, the reality of the redemption through the God-man Jesus Christ, the reality of the Messiah already in the world certainly required the 'de-limitation' of grace, the discovery of graced nature that pointed to the vertical experience entailed in the miracle of the Incarnation.
As Marion points out, we should not, in the natural attitude normative for the horizontal plane, 'have encountered' the paradox of the Incarnation, the God-man, as evidenced by the miracles. Only in verticality, only where the invisible's 'intervention' makes visible the invisible, does one 'see' a miracle for what it is: a sign of the Kingdom, a sign of the Messiah, a sign of salvation and redemption. The pocketful of miracles (the finite number of miracles) that Jesus performs does not mark a fundamental change in nature, a fundamental change that the appearance of Meillassoux's virtual god would effect (that will have to wait for what comes after finitude). Rather, the semeia of the Gospels, the wondrous deeds of Jesus, are to be understood, not as the emergence of a new reality of a new universe with new laws and patterns, but as evidence within the vertical plane of experience of the Incarnation, that it is indeed the union, the solidarity of divinity with humanity, and the presence of salvation and redemption---the in-breaking of the divine into history.