Friday, December 30, 2016

Altered States

If the Lacanian register of the Imaginary bears wakefulness and the panorama of images that appear before consciousness, and the register of the Symbolic bears the sleep where images and themes dance their dreams across the stage of the unconscious, then surely the register of the Real comprises the topos where dreams dream their dreams. Lacan does not by accident locate the divine within the precincts of the Real: God does not first appear in a bush burning in un-consuming flame, or the nightmare of a bloody Cross, but in the trace of these that points to the very heart of the Real, the place with sound but no sense, with melody but no logos, the place without an urge to grasp or otherwise conceptualize, the place before thought, the place where intentionality is not even a dream, a consciousness that is not conscious of something, but where, instead, waits to be born, where awareness waits for a theme.

The register of the Real contains the moment Levinas has described as insomnia. The cite of 'saying', the Real refuses thematization, the prison and ownership of language and image; it harbors the trace of the 'said', but prior to the being of the word.  An eerie place that awaits the things that go bump in the night, insomnia declares a wordless discourse of the infinite, the Cartesian 'infinite in me', an infinite not of me, but nonetheless found there: what Levinas names the il y a---there is.  To maintain the discourse of God beyond essence, to defer the meaning of God and therefore his entry into being, Levinas locates God's transcendence in the non-thematizable space of a wakefulness without a watching, a vigilance that does not already know what it keeps vigil for (or vigilant of), an insomnia that is interruptible, but without the trappings of, or tools for, naming God. For Levinas, once consciousness is a consciousness of something, that something is already dressed in the garb of being and outside the register of the Real. Levinas wants it the other way around: he wants transcendence to 'dress' consciousness in the garb of the 'otherwise than being'.

Levinas opens a space for the discourse of the divine, or transcendence, and that space subverts what he calls the moment of the Other within the Same, that which disturbs the empty---unthematic---wakefulness of insomnia. He names this place without terminus (ad quo/ad quem) 'Infinity' ("The God of Philosophy", in Basic Philosophical Writings, 133), which shakes up insomnia, making the "I" aware that the other is before it. Indeed, the very 'character of insomnia: the Other within the same who does not alienate the Same, but who awakens him" ("In Praise of Insomnia," in God, Death, and Time, Stanford Univ. Pr., Stanford, 2000; 209), puts this wakeful emptiness in the position for an irruption---always on the verge of an encounter.

Levinas's insomnia is not the 'insomnia' encountered commonly in medical offices throughout the world. This insomnia, this awareness of the difficulty in falling asleep, has many therapies, and many avenues for further diagnostics. Rather, Levinassian insomnia has its physiological reflection in the devastating medical entity known as the persistent vegetative state (PVS). Medically defined as 'wakeful unawareness', PVS evokes the infamous cases of Karen Ann Quinlan, and more recently, Terry Schiavo, and the 'right to death' movement. The particulars of these cases notwithstanding, certain things come to mind. Does the Other who is not merely unconscious, but beyond either the unconscious or consciousness, make the same claim on me, participate in the same ethos, as the Other whose awareness precedes itself or me? What ethics comes to the fore when the Other's mind and body are divided? How shall I respond to the 'Infinity' Levinas has posited in the structure of consciousness when the Other remains trapped in the insomnia of wakeful expectation, even if nothing is to be expected---has not the mode of expecting?

Joseph J. Fins, in his Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness (NY: Cambridge Univ. Pr., 2015), presents the compelling cases of patients and their families confronting PVS and the newly recognized diagnosis of the Minimally Conscious State (MCS), a state of profound impairment of consciousness, but a consciousness with demonstrable awareness, that which is absent from those with PVS. Fins, a physician and medical ethicist at Weill Cornell Medical College in New York City, bears his own historical consciousness here, and draws upon civil rights history to point to the civil rights of mind, of consciousness. His call for absolute diagnostic precision in assessing these cases is poignant and powerful. His ethical sense derives not only from medical integrity in diagnosis and treatment, but also from the identification of the presence of consciousness itself, obscured by horrible injury and brain malfunction. The medicine and technology behind what drives Fins to defend the rights of mind, while fascinating, do not command me here; what commands me is the patient before me who cannot be reduced to mind.

The Other who appears before me appears to me as the human other, and when the Other appears to me suffering or perhaps dying from devastating disease, appears as the spread body whose call is this is my body, or with a Levinassian tenor, thou shalt not kill. Both phrases intone the unconditional now pressed upon me. In medicine, we imagine we see PVS frequently, but in reality, PVS might be rarer than that. Perhaps, as Fins has suggested, we are better than 40 percent wrong about PVS, and what we are really seeing is MCS; much uncertainty informs the actual state of affairs. Because of the prognostic implications of either diagnosis, medicine simply has to 'get it right'. For Fins, the ethical imperatives drive 'getting it right' so that consciousness can be nurtured and healed, and a person can come home to a family in waiting. This is impossible for Fins: to be aware of the world when the world judges unawareness, and acts this judgement out. It is simply impossible to miss the presence of consciousness; missing it is not an option.

The ethics of the spread body, in the instance of PVS, the separation of mind and body, a wakefulness unaware of its embodiedness, calls from this body decisively: this is my body and thou shalt not kill. There is no greater vulnerability than this; it is equal to the vulnerability and precarity of the consciousness thought to be absent. The space Levinas has opened for Infinity is the mode of existence of the spread body in PVS. It is the physiological equivalent of the pre-phenomenality of insomnia, unaware that is expecting the arrival of consciousness---the disruption of insomnia by consciousness---the moment of transition from PVS to MCS. This place of Infinity, the distance between mind and body, the seeming impossibility of traversal within the vegetative state, the moment of the unthematic Real, bears the trace of the divine, the infinite, the otherness of the other, and opens and announces a sacred place.

Patients in PVS bear the posture of Infinity, which has locked them within itself. Perhaps what has divided here is not simply the mind from the body, but even the mind from mind, the non-intentional consciousness pointing aimlessly toward itself. In this sense, the patient with PVS remains within an infinite circuit whose centripetal vector points to what Levinas sometimes calls "God". This trace of the divine glows perhaps a bit brighter, inscribes its line perhaps a bit bolder, in the face of this other whose eyes move, yet trace no line, whose body moves, yet traces no direction. This is absolute vulnerability whose unconditional call calls me relentlessly: this is my body. This is a vulnerability that claims its right not to be killed, and compels me to be responsible for it unconditionally.


  1. Is there any state or condition in the world in which the person's right to live or die is not defined or informed by your own particular experience and encounter of that person? I think if a person has a right to die—if such a right exists—it has nothing to do with the form or content of what you do or do not encounter or experience of that person, their body, or any phenomenological dynamic dependent on your own awareness.

    If. If I have a right to die, that is not superseded or replaced by your encounter with the trace of God in my living misery. If I have a right to die, you have no right to force me to live to underwrite your own experience of the meaning you find in my torture.

    At this moment, I do not know why we do not have a right to die. In fact, I can't see why this is not the highest right we have, the one we must cherish more than any other, if for no other reason than our first moment of existence in this world was decided by the right of someone or something else.

    The decision or act which brings us into being was done so without us. Perhaps the decision or act which ends our being should be done by no one else. You can't, in an intellectually honest way, reject such a possibility before exploring it.

  2. On the one hand, everyone has a right to die and many exercise that right every day; on the other hand, what Fins advocates for is the right of a consciousness to be recognized. He sees this right of consciousness as a civil right. As far as I can tell, and I am no expert in his thought, he does not address how the rights of consciousness play out in an arena of rights.

    My encounter with the other is not about imposing any kind of being upon the other, and has no ramifications for legalities; I neither bestow nor reduce the rights of the other. In fact, it is the other who positions me to recognize the humanity of the other; the other does all the imposing. Regardless of the appearance of the consciousness of the other, the other obligates me just the same.

    The God of religion is absent from the claim of the other upon me. Levinas's God is not the God of religion, despite my hypothetical of a trace coming into the phenomenological field. Levinas would have none of that.

    The right to suicide is also a right exercised by many. That right is not on the same page as imposing life on someone who has chosen a natural death over against a Frankensteinian medicalization of ventilators, countershocks, artificial hydration and nutrition. I agree we have a right to determine what life is for us, and to have our preferences at the end of life honored. Happily at least this much is part of daily medical practice.