Tuesday, November 29, 2016
"...habit kills desire"---A Very Easy Death, Simone de Beauvoir
Simone de Beauvoir's account of the last month of her mother's life, A Very Easy Death (trans. P. O'Brian, NY: Pantheon, 1965) presents experiences of death and dying, patients, doctors, nurses, daughters and families, as vibrant today as when they were lived in 1963. It should not shock that the author of The Second Sex was a daughter whose ambivalences and trials might echo those of any daughter, or child, or family whose grief and profound loss would indelibly mark a moment in life. Putting aside what might have been dubious in her politics, a reader can open upon emotional, visceral, even existential impulses within this famous daughter. What might remain somewhat abstract in the description of care at the end of life, for example, in Emmanuel Falque's piece, "Toward and Ethics of the Spread Body," comes to life in de Beauvoir's homage to her mother. The 'this is my body,' which clearly needs a fleshing out, finds a place from which to speak in the narrative of A Very Easy Death (VED).
Certainly the phrase 'this is my body' falls on biblically sensitive ears as inextricably linked to Jesus's words of institution as they appear in the Synoptics. I place the definite article, 'the', in front of it, to loosen it a bit from its biblical context, even though I concede that even this maneuver still points to the words of institution. I want the 'this is my body' to be jarring enough to permit the phrase to point elsewhere. I find biblical warrant for this 'elsewhere' in the biblical context itself. Sight, touch, smell, taste and hearing point, not to Jesus himself, his own body from which the words emanate, but to the species demonstrated by the 'this': this is my body...this is my blood. 'This' directs the senses to the actual bread and wine, smelled, touched, tasted, etc., and in fact away from the performative voice and its speaker. Only after the disciples cope with the 'this' pointing to the bread and wine must they contend with 'my body'.
VED possibly assists in an unpacking of my awkward phrasal noun. "The sight of my mother's nakedness jarred me. No body existed less for me: none existed more...it seemed reasonable to me that her body should retain its dual nature, that it should be both repugnant and holy---a taboo." (VED, 19-20). 'Repugnant and holy'---the eating of flesh and the drinking of blood, a scandal of the Church since John 6, and the crux of the body dying before me---my patient's body dying---in my care in the nursing home or the hospice. Falque has eloquently captured the repugnant and the sacred in his descriptions of experiences on the hospice unit in his essay. The oozing purulence exuding in and from his litanies of the 'spread body' calling forth an ethos, also conjures the pathos of the Last Supper and the Cross. So, too, does the 'this is my body' call from my patient's body, calls me away from the 'my body' and toward something else, from elsewhere. Not my patient's 'my body' which I share in a common humanity, but something uniquely my patient's and my patient's alone. It is a body that could not exist less for me, and one that could not exist more. A taboo we can no longer avoid, as Falque pleads, the middle term between the extended body and the lived body yearns to be heard, felt, seen. We seek the secret, often silent, voice of the spread body whose lingua franca is the 'this is my body'. This tenuous call emanating from my patient's dying body locates the spread body, the topos which is the continuum of the res extensa and the 'lived body' between which Falque has powerfully described the spread body. Me voici, hineni, exhorts this body.
The experience of being-with the dying body opens upon a 'nearness' so close that it might even imprint itself upon those present to that body; de Beauvoir even tries on her mother's mouth for size. "I had put Maman's mouth on my own face and in spite of myself, copied its movements" (VED, 31). This experience does not reduce to mimicry or even a conversion reaction. The movements of the dying body etch their signature on the lips of a bereaved daughter. Even in the absence of Maman, Simone, at home with Sartre no less, begins to partake of her mother's spread body, whose call not only speaks, but writes. Simone's lips reverberate, in sympathetic vibration, an emblem of the suffering other in the mouthing of soft words, in the whispering of woes (Falque's maux and mots, a pun in "Toward and Ethics of the Spread Body" somewhat lost in English for those who lack an ear for alliteration).
The speech of the dying other, the words of the 'this is my body' sometimes present in hieroglyphics that command a hermeneutics of the spread body. "One had to listen very intently to catch the words she labored to breathe out; words whose mystery made them as disturbing as those of an oracle" (VED, 46). Why would such words be 'disturbing'? Is it simply because they fall on struggling ears, faintly and undecipherably? Perhaps it is less a matter of physics, than metaphysics. Perhaps the words speak all too loudly and clearly, but hidden by a veil supplied by the hearer, to blunt their devastatingly plain meaning of a suffering begging for meaning. Only the anamorphosis of the senses toward the origin of the call provides the proper orientation to unlock the moment whose hermeneutics tax the limits of experience.
If the spread body, through its voice as the this is my body, manifests its own hermeneutic of living and dying, of living until not living, participating in life until death, today is the first day of classes."What touched our hearts that day was the way she noticed the slightest agreeable sensation: it was as though, at the age of seventy-eight, she were waking afresh to the miracle of living" (VED, 50). To experience the dying patient requires a loss of the mind and a coming to the senses. Ordinary rationality can only deny the spread body because it has yet to think the categories of knowledge that might find a portal to the call. Just as we do not know the transubstantiation of bread and wine through pure reason, we do not know the call of the spread body though objectification. What can we know of a 'waking afresh to the miracle of living' in someone dying of cancer? Only a theopoetics, a phenomenology at the border of theology, can open a 'miracle' inside a death by cancer.
A good amount of touching goes on in Maman's room: mostly clinical touching, the routine care of the human body--- cleaning, dressing wounds, positioning. With a daughter's touch, Simone touches her mother's face because her mother senses she is falling into 2 halves. Her right side feels as if in a dream, her left, 'real'. Perhaps because de Beavoir mentions Sartre a few times, or because Falque speaks of him in a discussion of the caress, I wonder about Falque's distinction between the medical touch and the caress. Falque quotes Sartre: "I incarnate myself in order to realize the incarnation of the Other (The Wedding Feast of the Lamb, 164; n. 280). Here, Falque also permits the 'lived body' a triumph: "the erotic takes precedence over the medical, and lived bodily experience recovers its right over the extended or spread-out body" (WF, 164). Tortured by the torments wreaked upon her mother's body, Simone muses, "I was not worried about her nakedness anymore: it was no longer my mother, but a poor tormented body" (VED, 53). What has become of repugnance and the holy here? A daughter has attempted to suppress what cannot be suppressed through an evanescent rationalization. Touch, even the caress, speaks in tender tones, but in clear and undeniable tenor.
Repugnance recurs thematically at the end of life, so much so that it never really stays 'repugnance' but becomes transformed through the daily rigor of continuous revaluation."And with a frown and a look of determination on her face she said, as though she were uttering a challenge, 'The dead certainly do it in their beds.' ...And Maman felt no shame...it was a form of courage to take on our animality with so much decision" (VED, 54). What shall we say of the 'courage to take on our animality' [emphasis mine]? Certainly this text does not encourage an incarnational hermeneutic in the same vein as Falque does in those exceptional pages in WF (chapters 4 and 5, "The Animal that Therefore I Am" and "Return to the Organic"), but neither does it discourage such a reading. Many characteristics unite members of the animal kingdom, but perhaps the most compelling is the gut. The little miracles that occur between the mouth and the anus unite man and the other beasts. My argument does not call for a medical knowledge of gastrointestinal physiology. Simply put, what goes in must come out: that fact unites all the beasts, including any and all bipeds, and for animals the inputs and the outputs are similar. The learned 'shame' in de Beauvoir's telling undergoes transformation into nothingness, except perhaps a certain kind of courage to be the animal that each human is. What fascinates here, though, goes beyond mere transformation: Maman does not just 'take on' her own animality, but ours as well. It must be a divine courage to take on animality, as that precisely is what the Incarnation takes on. Simone could never 'take on' this motif explicitly; instead she let's her mother's body speak it. Yet, we would be stingy readers indeed were we not to allow Falque's analysis and de Beavoir's narrative meet somewhere in a kind of existentialism, if not a phenomenology.
Though our experience of the dying is simply that, our experience, sometimes we catch a glimmer of how the dying experience their own experience of dying."Maman had not been in the habit of taking notice of herself. Now her body forced itself upon her attention" (VED, 59). The spread body spends its time on a continuum, somewhere between the extended body and the lived body. Where does Maman's attention direct her; does she, like either the palliativist or the surgeon, shift toward one end of the continuum? Is there a violence in this 'force', and does this force oppose in some way the life-force, the will to live, conatus, as it were? A close reading suggests that the wisdom of Maman's body enjoys a midpoint that grants a clear view to either end. Perhaps I am being a bit sentimental. Whether there is safety in the midpoint, where a middle term like the spread body can resist or postpone interpretation, or not, it remains a locus of refusal, of deferral. "The earthly meaning of eternal life was death, and she refused to die" (VED, 60). Maman often thought 'eternal life' very far away. Man stirbt, just not Maman, until she dies. Man stirbt. Auferstehen. Memory makes present the past."And the early tenderness that I had thought dead for ever came back to life again...in[to] simple words and actions" (VED, 76). These words are as close as Simone de Beauvoir could get to a theopoetics of resurrection. 'Words and actions' are for her the liturgies and sacraments of sacred memory. With rosaries and crucifixes safely stored in a drawer, the ritual of mother and daughter come onto the stage of death. These actants of life play on until the grim stage director puts out the lights and pulls down the curtain. Still, the actions play out the awesome changes within all the players, as the transitions at the dramatic peripety point toward an all-to-fast falling action and denouement.
The transition from bios to zoe, from a person dying to an organic body (the spread body) that lingers as bios moves into a distance---the release of the flesh, the yielding to mere organicity, while not a universal event for everyone at the end of life, manifests strikingly (if not stereotypically) when it does occur and enter the experience of those at the bedside. "Her mouth opened, her eyes stared wide, huge in that wasted, ravaged face: with a spasm she entered into coma...already she was no longer there---her heart was beating and she breathed...with glassy eyes that saw nothing" (VED, 88). This phenomenological moment draws the limits of the spread body. A person is 'no longer there' as the organic body stays awhile longer. The perception of a vacancy and also of something remaining diacritically pushes conatus before me. Something stubborn, something bodily, something cellular, and even molecular now, at this moment, can only echo the voice that directed it toward me. I am directed still toward something, but now it is a virtual presence, already emptied of the flesh but goes on, barely, as a tenacious reserve of chemistries and mechanics. Here I find something familiar: the objective, anesthetized, animal, extended body of the gaze of a surgeon (cf. WF, 42), who cuts boldly (not necessarily bodily) into medicalized bare life (zoe); yet here, the anesthesia cannot lift---bios makes no return. It breathes and pulsates (as it did before) but in a strange automaticity: the beating of a simple animal's heart outside its body. A flesh is all around me, but its locus is elsewhere; it is loosened from the spread body tout court, hovering perhaps, about to flee. A soul? No, the echo of a voice, a voice no longer able to emerge from the throat of a body now dis-inhabited, exhibiting the unsupressible residue of embodiedness and animality (WF, 40). Repugnant? No, but ever so holy: not a separation looking forward to metempsychosis, but the irreducible residua---my patient's own residual me when the other part of her me removes to a distance. These are both my patient's own me, which now enters my experience of her at this moment. The voice lives in my ear, but where does it come from? It still calls and directs me toward the body engulfed in the white linens under the blanket brought from home, my patient's own blanket palliating the whiteness of clinical white. She is there and elsewhere, and I am present in and to this moment, the moment of care.
Bereavement begins early for the dying and their loved ones. After the death, the living relive the past. To be a human being fully alive is to have a past. "When someone you love dies you pay for the sin of outliving her with a thousand piercing regrets...With regard to Maman we were above all guilty, these last years, of carelessness, omission and abstention. We felt we atoned for this by the days that we gave up to her, by the peace that our being there gave her...She had a very easy death" (94-95). 'A very easy death' does not make its first appearance here; interestingly, a nurse first utters them shortly after Maman's death, the moment the automatic engine that kept her alive ceased its moribund functions (88). The memory of medicine, or the interface with the clinic, the hospice, the nursing home, leave stigmata on those who move on. Medicine must take responsibility for the nature of the marks it leaves on the living and the dead, as it must note the varied anticipations of grief and loss. Medicine must begin to think the ebb and flow, the to and fro that govern the intercourse of bed and bedside, of room and hallway, of resident and visitor, the the living and the dying, of life and death.
In her final remarks, de Beauvoir offers a departing salvo: "You do not die from being born, nor from having lived, nor from old age. You die from something" (105). There something wonderfully poetic in this assertion, something even worth savoring; but it is, by and large, untrue. While it is certainly true that some die from disease or trauma---a direct cause of death, some others simply die by falling in their tracks or in the midst of a dream. Unless that something is finitude and facticity, some do indeed die from nothing, nothing at all, nothing---in particular--at all. When someone who dies in her sleep at 117 years of age, what shall I declare---what shall I certify---as her cause of death?
Still, I give the final word to Simone de Beauvoir, which came to her as she lived with Francoise de Beauvoir's living and dying, living until she died. A defiant word, it is a word that challenges the goals of care and the very heart of the hospice and its practitioners:
"There is no such thing as a natural death: nothing that happens to a man is ever natural, since his presence calls the world into question. All men must die: but for every man his death is an accident and, even if he knows it and consents to it, an unjustifiable violation" (106).
Tuesday, November 22, 2016
National Hospice Month enjoys celebrations across the U.S. in the month of November, and such celebrations have taken many forms. One such celebration took place in my own living room, and was reminiscent of the home seminars Heidegger conducted at Medard Boss's home in Zollikon.
On November 5th, a gorgeous fall day on Long Island, NY, Emmanuel Falque presented his paper, "Toward an Ethics of the Spread Body," to an attentive audience comprised of philosophers, physicians, psychologists, nurses and social workers in an afternoon that one can only describe as extraordinary. Falque, professor of philosophy in the Institut Catholique de Paris, addressed professors of philosophy and graduate students from local universities (Fordham and SUNY) and several of my colleagues from my own medical center, and entertained searching questions and comments generated by his thinking on the body. Notable seminar participant and Distinguished Professor of Philosophy at Stony Brook University, Ed Casey (fondly known by many as the father of continental philosophy here in the U.S.), received Falque's presentation with a warm enthusiasm and provocative commentary. Indeed, the paper, the presentation and the ensuing discussion among engaged attendees illuminated an already well-lit room.
Falque's paper takes the next logical step in his explorations of the body, flesh and phenomenology that he had already articulated in his fascinating study, The Wedding Feast of the Lamb: Eros, the Body and the Eucharist (New York: Fordham Univ. Pr., 2016; henceforth WF). His paper begins in Spinoza's Ethics, and moves through his poignant experience on a Palliative Care Unit, where he situates the notion of the 'spread body' as the middle term between the Cartesian 'extended body' (res extensa), and phenomenology's own 'lived body.' Describing the experiences of doctors, nurses, caregivers and patients who interact in the comings and goings in a hospice setting, the concept of the 'spread' body, the body expanded (epandu), splayed, poured out shapelessly, comes into sharp relief. Indeed, Falque speaks of
...the thing-like strangeness of my own body rather than solely reducing it to the lived body, the struggle for life or the power of the organic rather than simply welcoming suffering, all open up onto the concept of the “spread body,” caught between the “extended body” and the “lived body.” [T]he body ‘is spread out,’ more than it is extended or lived. To repenetrate one’s own being does not simply come down to being incorporated in a physical or objective body (Körper) or to be incarnated in a phenomenological or subjective flesh (Leib), instead it means to be embodied in an organic flesh made up of nerves, muscles, digestion, secretion, respiration... things that can, like so much of ‘this is my body,’ remain foreign to me if I am not fully able to make them my own.
In these lines Falque addresses the inadequacy of the phenomenological 'flesh/body' binary that all too often accomplishes little more than rewriting the 'soul/body' distinction into post-modern terms (cf. his brief but crucial introduction to WF). Such a dualism disintegrates in the face of the 'spread' body.
In my reading of both WF and Falque's paper and his presentation of it, 2 important, if not completely novel notions arise: the notions of the 'my body' and the 'this is my body' as distinct phenomenological entities, that is, as distinct experiences. Though I am already appropriating these concepts for my own phenomenological dispositions of the phenomena of the body in medicine, the concepts trace their way indelibly into Falque's oeuvre. When he writes of the 'this is my body' in WF, the phrase is always italicized and linked to the Eucharist. "Eucharisticized eros," the 'this is my body' stands on the foundation of the incarnation: "Certainly, this is not, or not directly, a question of the eucharist, (this is my body), but rather of the Incarnation (the person of Jesus Christ)" [WF, 46]. In short, the 'this is my body' points already to the 'spread' body, yet a body nonetheless, however traced to ratification of the 'spread body' by the Incarnation.
When I think the 'my body' I think the human body I share with the body that appears before me; but as I experience it, the 'my body' has its limits in what it shares, or could possibly share, within a common humanity. The 'this is my body' is the body of my patient, spread out against the whiteness of clinical bed linens. My patient's body, characterized by its uniqueness impressed upon it by its very 'thisness', its 'haecceity', is completely other to me, and I cannot 'know' its excess, its surplus of being. Yet, this haecceity, the 'this is my body' initiates a call from its vulnerability, a call that calls unconditionally but without sovereignty from this middle place, middle-voiced (as it were, pace John Caputo), calling to get itself done: the very insistence of the spread body whose Levinasian imperative positions me, perhaps anamorphically (pace Jean-Luc Marion), and obligates me to a posture of presence before it. Where the 'my body' appears as a surface that I already know because of its metonymy with my own [my] body and its saturated reflection of me, the 'this is my body' has a gaze of its own which points to me, as only an other that is 'completely other' can. The 'this is my body' therefore is flesh of my flesh and bone of my bones, yet it is irreducible to the 'my body'. I recognize it because its signification is given to me from a voice embodied in an organic flesh in a 'body language' that I speak, but it is a self that is not me, whose power (conatus, the centripetal vector that tends to undo the centrifugal spreading of the body) commands my agency.
The insistence of the spread body calls for the release of the event that constitutes an ethos and an ethics of a place between the Cartesian 'extended body' and the Husserlian 'lived body'. As Falque so poignantly has experienced and described in his paper, every 'body' on the hospice unit also 'knows' this. Perhaps the distinctive experiences of the 'my body' and the 'this is my body' might further qualify Falque's description of the surgeon who prods the spread body toward the extended body, and the palliativist who prods it toward the lived body. Because the 'my body' and the 'this is my body' cannot simply lay atop the extended and spread bodies, respectively, the spread body always has the last word, and insists on keeping just who is doing the prodding anonymous.
Just what is this unconditional call, without sovereignty or agency, swallowed up by the whiteness of clinical linens? Perhaps its voice calls not for a singular event, but a plurality of events, one of which is the brokenness of the world disclosed by the brokenness of the body---a brokenness of a body that can no longer do---now spread, poured out, emptied (kenotically?). It is a brokenness constitutive of the human body and the human predicament and calls for a proper formation of persons, relationships, and societies, a knitting of parts known to the Psalmist (139) of the knitter par-excellence.
Perhaps what appears as the spread body against the linens of the hospice recalls the reconfigured linens in the Johannine tomb, linens no longer configured for death, but reconfigured for and by a transformation. Poised between the res extensa and the 'lived body', the spread body whose finitude is laid bare before something new, enters into the incarnation itself, swallowed into a resurrection of God knows what. Nonetheless, "[t]here is a paradox here: the body finds itself all the more when it is lost...Or at least, we can say that the body is most present when it surrenders itself" (WF, 218).
The spread body is what I am and what I shall become.
I should not be surprised at all to find Emmanuel Falque's work engaged on this blog. His work is refreshing and courageous and has moved me through the limits of theology and phenomenology, a movement that has occupied him in his Crossing the Rubicon. The transgression of circumscribed disciplines is quite at home in the daily practice of medicine. A question remains: just where does medicine pitch its tent on the frontiers and intersections of theology and philosophy?