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Please go there for my Summer Learning Summary, as well as more to come, I hope…

The error of, and dehumanization that results from, building upon a prior body of work.

2500 years of philosophical and academic rigor creates human rigor mortis and vacant education by suffocating individual initiation and public connection, relationship and acceptance. It subjectifies, separates, isolates, mystifies, vacuumizes and eviscerates ultimate meaning.

Why does Western Civilization start from and draw all its truth by starting at the Greek Civilization? 1.) The Greeks had a public realm that valued immortalizing people stories–their deeds, actions and words so that they created a body of work unprecedented in prior history. 2.) Political forces invalidated and erased ethically and politically undesirable African, Egyptian and Mesopotamian (Arabian) civilizations that were actually the sources of Greek and Roman philosophy and knowledge.

The indoctrination, prioritization, channelization, and limitation of gaining wisdom, learning knowledge, obtaining education, being considered qualified to increase society’s productivity, and making historical progress through the harsh inflexibility and unyielding methodology of precisely and exclusively building upon existing bodies of work as the singular method for educational and social achievement has killed mental curiosity, emotional passion, new learning initiation, group achievement, self-guided mastership, speaking and acting in the midst of others, self-disclosure, mutual acceptance, story telling, immortalization of the human experience, ownership of discovery, insight, intuition, breakthrough, invention, solution, and a personally distinct and unique learning process that is different for every person who has never before and never again will be like anyone else in the history or future of the world.

It creates a fear based, action suppressing, blaming, vengeful, retaliatory, judgmental, promiseless, ruler-subject dichotomy. It creates a meaningless, repetitive, offensively connected, inappropriately disconnected, superficially dominating, practically absent, cyclically stagnant pedagogy that is praxis deficient. It saddens, frustrates, becomes absurd, a waste of effort; reduces richness of interest and genuine intention to every manifestation of a hollow frame and shell, creates hiding through superfluous goodness or enraged criminality, contributes to the lie and useless purpose of the meaningfulness of means and ends and therein propagates the dehumanization of people in their careers and lives. This is opposed to living in cooperation with a balanced acknowledgment of human plurality with sustainable continuity through action, speaking, forgiveness and promise of increasing knowing and kindness. On the subject of conversation, connection, relationship: Democracy is about debate not hate.

from a discussion between Raul Nakasone and Robin Hood and Hannah Arendt

Since I first published these words, I have come across a paper by Laura Mandell entitled “The Original Author: A History of the Concept”; this is a concept that relates to the rigor mortis or academic rigor., This article traces the history of the idea of ‘the original author’ as it has its roots in the desire to turn books and ideas into PROPERTY so people could get rich, same old dehumanization that comes from ownership and the legal concept of property!, and the same old trend away from shared public domain, ‘the commons’ thinking, to an unnatural organization, arbitrary origin of, and hierarchical valuation of thought that stifles people’s courage to believe in the value and power or their own thought and their own equal potential to any past thinker or author.

http://www.units.muohio.edu/technologyandhumanities/eng495/paper2.htm#iter

The problem with the long tradition of law is that it is exclusively based on the exchange value of things (and makes all that exists into a legal thing, even air) and not their ‘use value’ as both Aristotle pointed out and Marx addressed in his earlier writings.  As the old example goes, when a man who is starving takes some food from a man who has surplus food, the law equates these men as proprietors and makes the first man a thief because he doesn’t exchange anything with the second man for the food. What the law completely misses is the need of the man that is starving and the ‘use value’ of the food, that is ‘to feed someone’. If this was taken into consideration, than it would behove the second man to give the food to the man who is starving until he would be well. And there would be no criminalization of and prosecution of the first man, to add insult to injury. The law invalidates our responsibility for each other and the real value of things in this world, it obliterates care and the concept of suffering, the legal system, in short, is a societal enforcer and conforming force that is not perceived as a source of indifference and constriction.

Always thinking and caring,

Robin

“Echoing Heidegger, who appropriates Holderlin, we can say that “the animals are signs deprived of sense,” meaning that they are without direction, without destination, without “sens” or “Sinn” in the literal sense.”

Upon contemplating this sentence, I realized that “Sinn” or Sin could be interpreted as having been originally linked to sense, in other words, not only does religion teach that we are in original sin, and our nature is to sin, but our senses themselves are sinful. Or, I could say that, as soon as I discovered the etymological connection between sense and sin it, to me, became immediately obvious that the idea of sin is a man made construct based on the fundamental basic constitution of man. So to even be in the world physically, and to perceive the world is sinful. Of course, it is then concomitantly true that to be perceived is sinful for someone else who is seeing a shameful being. How could we not want to avoid ourselves and all others.

There is another dominating closely following logic here: because our sense of need and fulfillment is primarily experienced and actualized through each of our senses, our very motivation and acting becomes inextricably tied to sin. We have no hope than to become legalistic since the entire idea invalidates and idealizes the practical reality of the human condition; it inverts (reverses) and subjugates the very will and impetus of the human; and it divides us from any chance of unity. So instead of initiating new thoughts and actions (let alone coming together with others (the sinful other) and actualizing these ideas through the power of plurality (remember the other undermining un-truth–> ‘power corrupts’), we are lead by a ‘dead’ system of rules of behavior; we follow this written and socially propagated system that is repeated ad infinitum with banality; we emptily and painfully fluctuate between a sense of meaningless powerlessness and dutiful conservative politically-correct patriotism (or what ever is the current political line, e.g., nationalism…); we never create our own unique, distinct community public space where we often get together, find local solutions to local real problems, and experience ongoing, fulfilling, satisfying and fun connections that last, give us a sense of permanence, being accepted, liked and loved–a sense of home–saying, telling and doing things that are creative, vibrant, alive and powerful and meaningful.

How can the origins and linkage of this insidious conceptualization and oppressive, civilization wide and historically long tradition be countered and can we be freed from this self-perpetuating trap? Our whole understanding, conceptualization, analysis, judgment of the world is colored by our belief in a defective perspective that originates within this sin based constellation of the world and us and we conclude can only, always lead us to a sinful achievement or product and this, inevitably can only cause reluctance, passivity, self-alienation, deficit assessment, avoidance, suspicion, hate and often times leads to harm and injury (it automatically predisposes one to look for an enemy outside of oneself as the self cannot be comfortably seen or tolerated, and concurrently, avoiding oneself causes us to want to reject others which we do by projecting upon others this sinful archetype which can never be disproved because no human eye can see the motivations of a human heart, ’suspicious minds’ as a phenomenon, relies upon a typical ideological circular logic that presupposes a truth and then evaluates the truth of the premise based on interpreting behavior to fit the premise, all in a realm that cannot be disproved, such as in the future, or in a part of the human realm that cannot be objectively known–e.g., the heart); possibly worse, it invalidates and makes unnecessary, in our understanding, any development and inclusion of ethics and morality, since the whole realm and consideration of good and bad is super-circumscribed by bad; our framework, our hermeneutic, has been too deeply and inexorably concretized by this original association in Western Civilization.  In this paradigm our very existence and any action we initiate would be violating ourselves and all others. We are unknowingly and unconsciously paralyzed.

Well seeing the connection is wonderful.

“Instead of Prisons Table of Contents > Chapter 7

7. RESTRAINT OF THE FEW

The question of public safety deserves the focused efforts of everyone, including abolitionists. Fear of “dangerousness” is at the heart of public acceptance for holding hundreds of thousands of people captives: the accused in jails, the convicted in the grip of indeterminate sentences and under the thumb of parole boards, and the released under surveillance on the streets. In the interest of justice, it is imperative, therefore, that the question of “dangerousness” and its predictability be thoroly explored and clarified.

As abolitionists, our hope is to reduce significantly all violent behavior, including the act of caging. Our assumptions regarding definitions, causes and predictability of “dangerousness” are central to determining the solutions we advocate.

Long conditioned to the belief that problems of criminality lie mainly within the individual, society has fastened its attention on “dangerous individuals” largely ignoring the learned nature of behavior. Once educated to the notion that human behavior is significantly shaped by social interaction and subtle learning processes as well as the broader structure of society itself, we can begin to transform the institutions and values that are conducive to violent behavior.

In our view individuals cannot be accurately or reliably classified as “dangerous” or “not dangerous,” tho the violent acts they commit can. While individuals and their acts obviously are related, the assumption that a status of dangerousness can reliably be attached to a given person has been greatly overemphasized. Because psychiatric prediction is unreliable, owing to the tendency to over-predict, and because the definition of “the dangerous offender” is unclear, we had best discard the classification and focus on the acts rather than the actors. Our next task is to define as specifically as possible the violent crimes that require physical restraint for a period of time.

Acts which cause bodily harm, whether committed individually or collectively, by private citizens, corporate entities or the state, can be clearly classified as crimes on the basis of harm done to the victim. However, only a very small percentage of all lawbreakers cause bodily harm.

Those who do exhibit persistent patterns of behavior defined as dangerous, require restraint or limited movement for specific periods of their lives. This restraint should be subject to carefully drawn procedures. The goal of such “last resort” procedures should be to work out the least restrictive and most humane option for the shortest stated period of time.

Individual rights, safeguards and due process must be guaranteed to those who threaten public safety. The judiciary should bear the burden of proving in evidentiary hearings that no acceptable alternative to physical restraint exists for the present.

Focus should be on improving the life of the lawbreaker with the help of peer groups and the community. No person should be excluded from participation in as many decisions about his/her life as possible. The opportunity for changing violent, physically harmful behavior should always be present.

Small community restraining and re-education centers are needed. These centers should be controlled by peers of those who will be served. Such centers do not now exist, tho projects such as Delancey Street, Synanon and House of Umoja provide some criteria of what they might be like.

Confinement in peer centers should be considered as imprisonment because-at least for some-confinement will not be voluntary. However, intentional family-type structures in the community should be vastly superior to the iron bars, isolation cells, controlling drugs and arbitrary decision-making that are the standard of imprisonment today.

The politics of dangerousness

The selective and arbitrary process of labeling dangerousness is inherently political. Such labels are the basis of “preventative detention” and other forms of “treatment” which result in the violent (non)solution of caging. It is crucial that abolitionists examine the political implications and reliability of “dangerous” labels and predictions:

We might expect the origins of the word “danger” to be related to… its current use in denoting physical objects and events that might damage property or injure people. Surprisingly … the term seems to have shaped out of linguistic roots that signified relative position in a social structure, a relationship between roles on a power dimension. The root is found in Latin in a derivative of dominium, meaning lordship or sovereignty …. The implication … leads us … into the conception of danger as a symbol denoting relative power in social organization …. Those persons or groups that threaten the existing power structure are dangerous. In any historical period, to identify an individual whose status is that of member of the “dangerous classes,” (i.e., the classes that threaten the dominium or power structure) the label “criminal “has been handy.

-Theodore R. Sarbin, The Myth of the Criminal Type, pp. 16-17

People do not come into the world labeled “chattel” and “not chattel,” “schizophrenic” and “not schizophrenic,” “dangerous” and “not dangerous.” We-slave traders and plantation owners, psychiatrists and judges-so label them.

-Thomas Szasz, “On Involuntary Psychiatry,” New York Times, August 4, 1975

Prisons have been used to limit the movement of persons labeled as “dangerous,” “psychotic” or “disturbed,” a labeling process which began in the community, in the bad schools and continued thru each stage of the criminal justice system. The result has been the destruction of thousands of lives. We have been so concerned with containment, with limiting movement, that we haven’t looked for the real troubles in people, in communities, in our social and economic system.

-John Boone, Former Director of Corrections, State of Massachusetts, Fortune News, May 1975

It is no wonder that today preventive detention proposals are so intensely opposed by Black organizations. They recognize correctly that their movement for freedom and self-determination is seen as “dangerous” by established white America. We approach the concept of “dangerousness” with considerable skepticism, for it has little meaning apart from its social and political concept.

-Struggle for Justice, p. 78

Men in prison are dangerous because they are threatened with sophisticated forms of extinction in the hands of simple minded wage earners who claim they are “only doing their duty” or “just following orders” as five or six of them are wrestling you to the floor to stick a needle in your arm or ass.

-Howard A. Lund, prisoner, NEPA News, March 1974

The defenders of these treatment models refuse to acknowledge that society, thru its injustices which are magnified inside prison walls, remains the principle impetus to violent behavior. Almost inevitably, those prisoners who refuse to accept the authoritarian, dehumanizing conditions of prison and who organize disruptive political behavior, exhibit repeated, angry “acting out” behavior, and flood the courts with litigation are the prisoners deemed candidates for DSU (Departmental Segregation Unit) or other “special offender” programs.

-Donna Parker, NEPA News, June 1974

“Dangerousness” and predictability

“Dangerousness” is difficult to define. Definitions always hinge on the unstated assumption that it is possible to predict which persons will commit violent acts in the future. The ability to make such predictions has not been demonstrated. Judges, parole board members, psychiatrists and others who attempt to predict “dangerousness” err grossly on the side of overprediction.[1] This results in the needless imprisonment of the many out of fear of the few.

I charge that this so-called diagnostic study is a fraud, consisting of nothing more than the random and whimsical guesses and speculations of a team of men, most of whom know nothing at all about what they are doing. It would be just as valid to make judgements and assignments of prisoners on the basis of their astrological sign, their hat size or the last two digits of their social security number.

-Professor William Ryan, at hearings for the proposed Massachusetts Departmental Segregation Unit and Classification Rules and Regulations, NEPA News, September 1974

The thing we have to get thru our skulls is that we cannot predict with any degree of accuracy who is going to be dangerous in the future. That is the one hang-up that the system has to get over. Every time they attempt to do this, it over-predicts to such a degree that the injustice practice far outweighs the protection gains.

-John Irwin, “Rehabilitation vs. Justice,” Stanley L. Brodsky, ed., Changing Correctional Systems. Center for Correctional Psychology, University of Alabama, p. 57

Psychiatrists are rather inaccurate predictors–inaccurate in an absolute sense-and even less accurate when compared with other professionals such as psychologists, social workers, and correctional officials, and when compared to actuarial devices such as prediction or experience tables. Even more significant for legal purposes, it seems that psychiatrists are particularly prone to one type of error-overprediction. They tend to predict antisocial conduct in many instances where it would not, in fact, occur. Indeed, our research suggests that for every correct psychiatric prediction of violence, there are numerous erroneous predictions. That is, among every group of inmates presently confined on the basis of psychiatric predictions of violence, there are only a few who would, and many more who would not actually engage in such conduct if released.

-Alan Dershowitz, “The Psychiatrist’s Power in Civil Commitments: A Knife that Cuts Both Ways,” Psychology Today, February 1969, p. 47

Political considerations may also enter into the decision to overpredict dangerousness …. If psychiatrists consistently erred in their judgement by predicting that patients would not become violent, when in fact some did, the psychiatrists would lose the power and right to exercise their expertise in court. By overpredicting they avert that tragedy, and no one pays any attention to the 20 or more harmless people locked up to prevent the 21st from committing violence.

-Henry J. Steadman and Joseph J. Cocozza, “We Can’t Predict Who Is Dangerous,” Psychology Today, January 1975, p. 35

The conclusion to emerge most strikingly from these studies [predicting violence] is the great degree to which violence is overpredicted.. . Of those predicted to be dangerous, between 65 percent and 95 percent are false positives-that is, people who will not, in fact, commit a dangerous act. Indeed, the literature has been consistent on this point ever since Pinel took the chains off the supposedly dangerous mental patients at La Bicetre in 1792, and the resulting lack of violence gave lie to the psychiatric predictions that had justified their restraint.

-John Monahan, “The Prediction of Violence,” Duncan Chappell and John Monahan, eds., Violence and Criminal Justice, p. 20

… Our data while not conclusive, indicated that the “deviant offender” existed more in the minds of those responsible for labeling him as such than he does in the real world … if anything [the data] indicated those labeled deviant by the prison staff were not significantly different than “normal” inmates in any respect except slightly more depressed. And one need not wonder why that should be the case …. In a statistical sense as far as the data showed the “deviant” shared no other characteristics with other “deviants” except the name and treatment afforded him by the prison staff … it was my conclusion in looking at the data that far from being a group in any respect the “deviants” are as different from others in that group as they are the same. Obviously, a proposal to “treat” this group-since it is not a group in any meaningful respect-is nonsense, at least with regard to the inmates we saw.

-Joan Smith, Dartmouth professor, letter to NEPA News, April/May 1974

Counteracting belief in predictability

It is clear after examining the data, that “experts” cannot predict dangerousness, either among prisoners or among the accused. In both cases, over-prediction means that untold numbers of innocent persons remain imprisoned, needlessly punished.

Despite our awareness of problems with predictability, the public’s real emotional problem still remains. How can they be told that the “experts” they look to for protection cannot define who needs to be kept off the streets? The burden falls on judges, mental health workers and prison changers to take the lead in dispelling the myths of predictability of dangerousness.[2]

In the short range, we suggest three ways to begin to dispel the myths and deal with the concrete realities of defining, categorizing and responding to violent behavior:

(1) Encourage research to reveal statistics on overprediction of dangerousness. Utilize the findings for public education.

(2) Limit discretion by shifting the emphasis from “dangerous people” to violent behavior. Raise consciousness about cultural and institutionalized violence and support statutes that categorize violent crimes on the basis of harm done, rather than the individual lawbreaker’s personal characteristics.

(3) Actively challenge the concept of “special prisons” and classification procedures in general, which label certain prisoners as “special offenders.” Such labels focus on the individual as a predictable, unchanging, “sick” and dangerous object requiring treatment rather than as a human being exhibiting behavior generated in part by the violent society of prison.

Research challenging overprediction

Research can be cited which points to the myth of dangerousness. Many studies have established the lack of proof of predictive skills on the part of psychiatrists and others. In advocating decarceration and excarceration strategies, the following studies are useful:

• The American Psychiatric Association Task Force on Clinical Aspects of the Violent Individual. [3] This report, released in November 1974, concluded that predictions of dangerousness are fundamentally of very low reliability. With few exceptions they are predictions of rare or infrequent events.

The likelihood of the expected behavior, such as violation of parole by a released prisoner whose previous crime was violent or the possibility of serious assault being committed by a released mental patient, would be very slight. Even if an index of violence proneness could be developed to correctly identify prior to release 50 percent of those individuals who will violate parole by committing violent offenses, the actual employment of such an index would identify eight times as many false positives as true positives. This means that eight of the nine persons retained in prison as a result of application of the index would not have committed such offenses if released.

• The Research Center of the National Probation and Parole Institute [4] of the National Council on Crime and Delinquency. A study released in October 1972 follows the success and failure of more than 50,000 men thruout the country who were paroled in 1969. The rate of return for major crimes is not nearly as high as commonly believed -somewhere between five and eight percent in the first year, and presumably less after that, since the recidivism rate declines the longer parolees are on the street. Offenses involving violence–homicide, manslaughter, forcible rape and aggravated assault -accounted for less than one percent (.79 percent) of the men returned because of new commitment or allegation of violent offense. Another 1.1 percent were returned for potentially violent offenses (armed or unarmed robbery). The bulk of returns are for various forms of theft and violation of alcohol and narcotics laws.

• The Baxstrom Studies [5]. In 1966, the U.S. Supreme Court ruled in Baxstrom v. Herold that Johnnie K. Baxstrom, who was sent to an institution for second-degree assault, could not be held in a maximum-security hospital for the criminally insane without proper judicial review for a longer period than he would have served in prison for the same offense. The decision resulted in the transfer of 967 patients from New York’s two hospitals for the criminally insane to regular civil hospitals. These patients had committed or allegedly committed crimes, were considered dangerous, and were widely feared by the hospital staffs who had to house them in regular security facilities. Mental health officials were convinced that most of them would be so dangerous they would have to be returned to maximum-security hospitals, and if released, would be a threat to the community.

These patients were followed for more than four years after their transfer. Only 26 of them became troublesome enough to be returned to hospitals for the criminally insane. In a sample of 98 patients who were released, 20 were arrested, 11 convicted, but only two of the offenses could be considered dangerous: a robbery and an assault. If it hadn’t been for the Baxstrom decision, almost 1,000 persons would have spent another five, ten or more years in hospitals for the criminally insane while only a tiny minority of them would have exhibited dangerous behavior after release.

Other studies on similar populations have also found low rates of dangerous behavior. In 1968 P.G. McGrath reported the results of his study of 293 murderers who were released from Broadmoor Hospital in England. Not one killed again. Four years later only one had killed again. Moreover, said McGrath, in the past 50 years about 140 patients were released each year from Broadmoor, and only two had been convicted of murder since release. [6]

• Uniform Parole Report Studies of Murderers.[7] Nationwide statistics on parole performance, compiled by National Council on Crime and Delinquency, consistently show that paroled murderers are the best parole risks. Because, from the viewpoint of the general public, the murderer is perceived as the most dangerous type of offender, it might be supposed that murderers as a group present grave risks on parole. In fact, this is simply not the case. Parole Risks of Convicted Murderers, a special UPR study of 6,908 paroled murderers released during 1965-1969 across the nation, showed that 21 (0.3 percent) committed murder again during the first year of parole. A total of 122 (1.77 percent) were found guilty of new major offenses. Compare this failure rate with that of 9.03 percent for all other type of lawbreakers.

• The Center for the Care and Treatment of Dangerous Persons.[8] A team of five mental health professionals, including two psychiatrists, made clinical examinations of individuals who had been convicted of serious assaultive crimes, often sexual in nature. These lawbreakers were assigned to special treatment programs after conviction and, at the time of the study, were eligible for release. Based upon the examinations, extensive case histories and the results of psychological tests, the team attempted to predict which individuals would commit assaultive crimes if released. These predictions of dangerousness were made prior to the court hearings at which the ultimate release decisions were made. Of 49 patients considered by the evaluating team to be dangerous and therefore not recommended for release, but who nevertheless were released after a court hearing, 65 percent had not committed a violent crime within five years of returning to the community. In other words, two-thirds of those predicted to be dangerous by a team of professionals did not, in fact, turn out to be dangerous.

Shifting the emphasis

The media constantly reinforces the belief that crime is a symptom of underlying psychic disturbance. This view has bolstered the assumption that criminality lies mainly within the individual. One of the difficulties with this conception of crime is that it is almost impossible to prove or disprove, at least in a systematic way.[9]

A primary theme in the sociology of crime emphasizes the learned nature of criminal behavior. Learning includes not only direct instruction, but also the long term influences of the socialization process. These are often quite subtle. All human behavior significantly reflects such influences, and criminal behavior is no exception.[10]

As an example, learned behavior is particularly evident with the violent crime of rape (considered at length in the next chapter). A sexist culture which devalues and objectifies women is certainly instructing consumers of that culture in violent sexual behavior. The problem of violent behavior will not be decreased or controlled merely by locking up rapists individually labeled “dangerous” while such practices in one form or another continue to be glorified by the culture. We can challenge many other obvious examples of societal instruction in criminal violence, not least among them the daily instruction in murder and assault on t.v. Our energies must focus on changing the violent message emanating from the culture. Cultural values and behavioral patterns can be changed through broad, systematic public re-education and resocialization.

Prison: More dangerous than prisoners

There is little disagreement that for those very few people who exhibit continual violent and aggressive behavior in society, temporary restraint is not only indicated but demanded. Review and monitoring procedures can be designed with adequate due process safeguards.

We believe the public can be educated to recognize that dangerousness cannot he clearly predicted, but that violent acts, both individual and collective, can he enumerated. We believe also that most citizens will support the constitutional guarantees that people are innocent until proved guilty, and that no one can be deprived of freedom for what they might do in the future only because of what they have done in the past.

The danger of needlessly denying an individual his/her liberty is far greater than the risk of freeing certain individuals who may again commit violent acts. The dangerousness of prison exceeds that of the combined dangerousness of each and all of its prisoners.

We are clear that no one should ever be excluded from humane conditions or the opportunity for changing violent, physically harmful behavior. Prisoners speak clearly to this point:

The guiding principles of the phaseout of the old] and introduction of the new but ever-adapting system are: No single individual must be excluded as an incorrigible problem. States must not ship out their “problem “prisoners to other places. That is not a solution; it is a cover-up for a fundamentally unworkable program.

It is a social atomisni; it is a rat psychology; it is the first stages of ‘84 and Clockwork Orange; it is fascism, the expendability or final solution of human beings. The so-called incorrigible prisoner, or “completely” insane person is precisely the measure of the depths of the challenge and must be faced and touched and transformed, no matter what the cost, for she or he is who we are in the furthest reaches of our humanity.

-The Action Committee, Walpole Prison, Massachusetts, NEPA NEWS, March! April 1975

NOTES

1. Struggle for Justice, pp. 77-82.

2. Paul Warhaftig, “Prediction of Dangerousness-Does the Doctor Know Best? Or at All?” Pretrial Justice Quarterly, November 1975, p. 7.

3. John R. Lion and Donald P. Kenefick, et al., “Clinical Aspects of the Violent Individual,” American Psychiatric Association News, November 20, 1974.

4. David F. Greenberg, “How Dangerous is the Ex-offender?” The Freeworld Times, January 1973, p. 11.

5. Henry J. Steadman and Joseph J. Cocozza, “We Can’t Predict Who’s Dangerous,” Psychology Today, January 1975, p. 33. Also Henry J. Steadman and Gary Keveles, “Community Adjustment and Criminal Activity of the Baxstrom Patients: 1966-1970,” American Journal of Psychiatry, Vol. 129, September 1972, pp. 304-310.

6. Ibid.

7. “Questions and Answers,” Crime and Delinquency Literature, National Council on Crime and Delinquency, June 1974, p. 232.

8. Bruce Ennis and Thomas Litwack, “Psychiatry and the Presumption of Expertise: Flipping Coins in the Court Room,” California Law Review, 62 (1974) p. 693. Also Harry L. Kozol, Richard J. Boucher and Ralph F. Garofalo, “The Diagnosis and Treatment of Dangerousness,” Crime and Delinquency, October 1972, pp. 37192.

9. Edwin M. Schur, Our Criminal Society, pp. 6667.

10. Ibid. , pp. 96-97.”

I am going to read chapter 8 & 9 as well as they seem, also, to be giving some concrete information on how we can improve the problem, not just stating and complaining about the injustice. Here is the table of contents for those two chapters:

“8. New responses to crimes with victims

Crimes against women and children • Rape: Myth and realities • The victimization of women • Patriarchy • Sex-role socialization . • Wife assault • Rape & the criminal (in)justice systems • Placing the victim on trial • Rape law reform • Compensation • Restitution • Racist use of the rape charge • Repeating the cycle of violence • Empowering the victims of rape • Rape crisis centers • An empowerment model: BAWAR • Washington, D. C. Rape Crisis Center .• Women Organized Against Rape • Rape Relief • Innovative action projects • Men Against Rape • New responses to the sexually violent • Breaking the cycle of violence • Alternative House • Prisoner self help: PAR • Sex Offenders Anonymous • Sexuality re-education: BEAD • Treatment program for Sex Offenders • New responses to sexual abuse of children • Myths of sexual abuse of children • Child victimization study • Can a child consent? • Training in fear and silence • Child Sexual Abuse Treatment Program • Recommendations for action • Street crime • Media manipulators • Street crime & its victims • New responses to street crimes • Crime & the Minority Community Conference • CLASP

9. Empowerment

Empowering the community • Services needed • Community solutions • The House of Umoja • Delancey Street Foundation • Empowering prisoners • Qualities of a prisoner ally • Folsom prison strike manifesto • A bill of rights for prisoners • Prisoners’ Union • Prisoners’ voting rights • A prisoner voting rights project • Empowering the movement • Researching the prison power structure • Prisons as industry: Jobs • Research methodology • Your right to public information • Educating the public • Research/action as organizing”

Always thinking and caring,

Robin

Unconforming, Unindifferent Thinking & Acting for yourself & other beings.

Yes I made up two new words, but I don’t like the word nonconforming (I guess it doesn’t quite have the connotation I want and has a connotation I don’t want; that is, I am not advocating a primary emphasis of being against something, such as rebellion or fighting might constitute, but instead a passionate, acute, intelligent, questioning, not complying, powerfully unmasking and acting response) and there doesn’t seem to exist a direct word (that isn’t so over used that it has lost all its meaning and feeling and impact–i.e. caring) for the opposite of indifferent.

To exemplify my intent, two examples are 1.) I look before and beyond religion’s exclusion of animals as sharing an equal and whole part in life, religion being essentially humanistic and theistic (”This is not Sufficient, An Essay on Animality and Human Nature in Derrida”, by Leonard Lawlor, page 99), and 2.) I, having suspected Psychology along with its medication industry and criminal justice system, look before and through these foot soldiers of society,  who preach and enforce compliance and I see clearly, the concerted assault of the modern debunking “sciences”, Psychology and Sociology… (I love that she puts sciences in quotes) …[in which] nothing indeed has seemed to be more safely buried than the concept of freedom.” (”On Revolution”, by Hannah Arendt, page 1).

My new tag line:

Self originated, Self trusted, Self actualized thinking, speaking, caring and acting for yourself & other beings; we can change our world.

Always thinking and caring,

Robin

HERE IT IS: Consciousness is life’s sensation of a bending of the space/time continuum around the brain, heart and body.

(I better say something about soul, let’s see… soul is the experience when all that is meant to be actualized in life, the world, people and the individual are cogent–the human environment is conducive to these elements having the power to equally compel-conflation.)

Science is realizing the connectedness of the universe in wild new ways, and physically we innately feel our connectedness to the universe, but we don’t realize that our mind has a physics type of connectivity that feels the universe, is affected by it and affects it through its own sensors and force (like its own gravitational field). It is the interplay of our mind with the external world–universe–that reveals that life qua life is actually equally the sentient being and the world in which it lives.

and maybe intention (stretching out to an object) either somehow bends the space/time continuum around that object via consciousness radiation, which would be one state of a two or three state phenomenon (like light is energy and particles) called consciousness, or maybe doesn’t actually affect the external object at all (which I highly doubt).

Each object in the world may have its own effect on the continuum in addition to my affect upon it.

So consciousness is thought moving through the space/time continuum and becomes experienced as the tension or pull that is trying to achieve homeostasis between the out-of-placeness of it (thought) in reference to the bent continuum. The movement, as I have said, the inertia, is consciousness and maybe the final destination that equalizes the tension is the feeling of being alive that we are usually unaware that we are continually re-experiencing every moment. That is why one school of thought was aware of Being being known temporally (requiring the reference of time), that is 1) a repitition evokes the experience of time and 2.) this whole phenomenon is with reference to the continuum that includes time.

The space/time continuum is trying to put thought back into place and acts upon it; shows it how to move (like matter is shown how to move). This is not determinism as a universe that judges in a sense of correct place, but love as the experience of in-placeness–synergy. This is the resistance that infers a stretching out or againstness which happens in each moment of intentionality as a sine qua non of consciousness.

BTW, this is why the Capitalistic imposition of a daily work schedule is so oppressive, time is innately and fundamentally defining for our Being and being (as in the reality of ourselves in the world and as our experience and awareness of the oddness of being here at all). This unbalanced imprisonment in a biological rhythym of job holding on a incessent daily schedule rapes our innate need to have just as much personal solitude with free following of curiosity and passion; it unnaturaly and artificially creates a societal accumulation of singular labor-type bending of the space/time continuum that inversely pulls back on all of us and suppresses our need for that curious, passonate acting and speaking in the real world.

Important BTW, the condito sine per quam of meaning is distinctness, which can only be known in a place where things can be compared, so everyone’s equal and free access to a public realm, in the real world, is critical to fullfillment, a sense of well-being, feelings of happiness, navagation that leads to productivity and progress toward genuine wholeness and health on all levels (doesn’t go in circles, but triangulates the personal perspective, the world, man-kind, even including the animal), and existence as it is already given in the human condition.

Life, consciousness,  & gravity, still can’t be explained, but they are all consistent and related.

We live in a time in which we are dividing – in-divid-ual, we need to bring back the combining, com-mon, a balanced approach would divide without sacrificing the combining (unlike Capitalism) & combine without sacrificing the dividing (unlike socialism).

Am I superfluous or does a banality of spectacle constitute the better part of society; a dissonant frequency at which we all vibrate in sympathy.

Preconception: traveling at the speed of light would make time stop.

: dE=dMc3, dark energy equals dark matter multiplied times the speed of light cubed (everything in the universe ultimately comes in threes). All laws and entities (from multidimensional strings to particles to cosmic epiphenomenon) seem to have three complex dynamic parameters. Reality is a real place with real substance that occupies. So it can’t really be two dimensional on any level. All phenomenon could display three properties of one discovery. Even the trinity in religious systems could be three aspects of one.

Danger of going at the speed of light: Be converted to energy & die. Or maybe just appear to be converted to E by an observer.

: Everything is dark and you bump into everything.

: You get there too fast and you miss the journey.

Going faster than the speed of light may be possible if we just can’t see things that do, such as antimatter or dark matter? It could be coherent universal principle if there is dark matter there could be dark energy, and that it is dark because it is moving faster than the speed of light, so that it cannot be seen. This may account for the past which is past the point of time stopping at the speed of light. IOWs (in other words), if going faster that the speed of light would put us in the past, then it appears as we look out into the universe and our temporal existence that the past cannot be seen because it is composed of matter or energy that is going faster than the speed of light and so cannot be seen.

Remedies: being converted into energy at that speed would protect us from molecular anarchism since we would not be moving in form, through matter, as matter. Additionally, we would have to be shielded from all sources of gravity itself (possibly shielded by light that would convert a space around us into energy).

Steps: Find a propulsion system to create this speed. Then find a way to accumulate the force.

LIGHT PARTICLE (MATTER) PROPULSION SYSTEM:

Solution is to hitch to light inself, then we would be going at the speed of light or close to it given friction and external gravitational forces (such as affect light going through the universe). Use light as the propulsion. Problem is that light is not exactly matter and is very illusive of being affected by matter and affects matter very weakly. However, one force that affects the matter side of light (as opposed to the wave side) is gravity.So gravity is the middle man that will be the constant in our rocket ship, the structure that is moved by light for us to not only be freed from gravity at any spot in the solar system, but to be driven with light even in a external frame that is absent of gravity.

Find a way to use the gravity’s effect on light inversely to cause light to effect gravity and gravity’s effect upon us (tending to keep us down or accelerating downward), then in reference to a large body of mass we can use light to propel away from that mass, i.e., levitation or launch. IOWs, use gravity as the blockage that light pushes against. We would create a spinning mechanism whose inertial force would be the wall (gravitation component) constituting this blockage against which the force of light would push. So now we just have to hitch to this spinning mechanism and light will drive us both. Just don’t forget to navigate with adjustments for spacetime warping and twisting.

So we create a gravitational source within a rocket that changes the direction of light in its most radical angle possible, then we repeat this step in a chamber that goes on continuously so that light remains bent and the output of angular force moves us at the constant speed that is being bent, the speed of light. IOWs, we are trying to pit the deviate force (evil force) of gravitations effect on light against the inertial force of a spining body that is the original sorce of the gravitational force.

Then it remains for us to accumulate this force in measured amounts to set a desired speed beyond the speed of light in order to go backwards in time. This could be done with multiple chambers if the force can be accumulated, but in the instance that it cannot be, we could use the effect of large objects to slingshot us fastern than the speed of light that we are going.

Alternative, LIGHT WAVE PROPULSION SYSTEM: Or maybe we can discover a way to ride the wave of light. Vibration of a medium causes force (sound waves as force moving air) Some sort of harmonic frequency sympathetic to light’s frequency (a light machine) that causes a secondary frequency that releases radiation of gravitational particles that acts inertially against the timespace continuum, since the spacetime continuum tells matter how to move. If we adjust this frequency to a point where its interaction with light’s frequency has the effect of increasing the frequency (like bridges that violently collapse because the frequencies compound extenting them past the structural engineering limits), then we can go faster than the speed of light.

However, maybe in all these scenarios, we could not accumulate this force so we would be limited to the speed of light, at which point we would only be immortal (time would stop) but not be able to have a time machine (go back in time). Maybe we would need to use the dark force (matter/energy) instead of light. That sounds evil. Since the dark force is faster than the speed of light. Again we would oppose the inverse force of gravitational force bending light, the unbending reaction force against the spinning inertial force of a spinning mass right at the identical spot where gravitation is bending the light.

Alternate II: Find a way to bend the spacetime continuum back the other way to make matter behave in the opposite direction. If gravity is inertia through a bent spacetime continuum near a large mass that is doing the bending, then if we can artificially straighten this bend we would not fall, or if we keep bending further, we would rise from the surface of the large mass. This could then be used on light within our Time machine engine. In high school I remember discussing antimatter and how if it existed it would react with matter and destroy our universe, but the other day I saw a movie where they isolated antimatter in a vaccuum, which probably has matter quirks in it-so still a problem–but in this 2nd alternative, concentrating antimatter just in the immediate area surrounding the spacecraft would bend the spacetime continuum the other way, against any gravitational pull, or even the absense of one, which would cause the space craft to slide down the slope of the spacetime continuum in what ever direction was desired.

What is the point of this quest for the time machine?

Well, in respect to world alienation, which undermines our experience of meaningfulness in life and removes a balance given to the human condition that humanizes and personifies people and their treatment of the world and life in it, we don’t know if science and progress will hurt us or help us more, if it will secure our future or destroy it. But, in so far as it has taken us outside of our earthly frame of reference, into a frame of reference in space (the Archimedian point), and has allowed us to utilize forces that are only naturally unleashed beyond earth, it has tended to undermine our feeling that this world is pertinant and necessary. It seems to hold out the promise that it will fullfill us, but with every drastic change of theory, such as Newton to Einstein, it makes us feel that we are floundering and meaning is more arbitrary.

When all is said and done, no matter how well we see and understand the universe, we will still be a plurality of people in one space, whether this is in one community, one nation, one world (globalization), or one universe (Universalization-the next thing). So we need to acknowledge the existence of this space and let it do what it is meant to do, connect us, moderate us, give us reality feedback, and give us meaning, a place to share our stories. If we get the time machine, maybe we will use it to try to improve the past, which may mess up the future, or maybe we will use it to know our story better, to see history as it was happening, to get to pre-recorded history, to the origin of man and the world…

This example from Stanford’s article on the Gravity Probe B project to verify or disprove Einstein’s theories on their website, http://einstein.stanford.edu, under the article on Spacetime & Spin can be synthesized with world alienation:

“Here is a simple experiment that almost anyone can perform on a clear night: pirouette freely around while looking up at the stars. You will notice two things: one, that the stars seem to spin around in the sky, and two, that your arms are pulled upwards by centrifugal force. Are these phenomena connected in some physical way?…( a long and very nice explanation is given) …it will shine experimental light on what has heretofore been a theoretical mystery, namely the origin of inertia. For some, this is perhaps the most beautiful and profound manifestation of spin in Einstein’s spacetime: it binds us here to the universe out there, in such a way that you, standing at night under the stars on a planet known as earth, cannot turn so much as around without feeling a tug from the rest of the universe.”

Just as inertia binds us to the entire universe physically, that is, it shows us that there is some coherent relationship between us and the huge universe that even we in our limited senses and thinking abilities can actually know, so to the greatest power of mankind, to start something new, to act, and to speak, and to stop a bad progression through the new act of forgiveness, and then to bring a new act to fruition through the public world and cooperation of others, these fundamental abilities reveal to us right here in our limited condition, the very nature of the entire universe. If we look and see what these principles can tell us, we can discovery the General Theory of Relativity of Human Existence. And whatever the details of this theory it will include that however great the mysteries of the universe we discover, however much it helps us in survival, helps us to make a fine world, helps us to be more productive and progress even further (not valid ultimate ends in themselves), however much it brings us awe and a sense of safety when we can finally see how everything fits together and why it works, and we have perfect health, none of this will bring us meaning, only our acting, speaking and relating to one another in this understood universe and honoring and knowing and supporting each other’s experiences will give us this meaning and ultimate sense of well-being.

Even light is a combination of matter (particles that constitute distinct individual existence-private) and energy (action that is external in effect-public). So we have to always remain standing on the ground of our humanity no matter how we master the universe; and my heart and my intuition tell me that the mysteries of the universe will ultimately reveal this very balanced truth to us.

These are my thoughts, a little disjointed due to them coming from my recent contemplation notes:

Subjectivism-everything related to the perspective of a self. No objective, real, world. Although there are others roles of the real world in variations of subjectivism, this is the one that is hindering and does the most practical damage to the realization and experience of a public political realm, in my opinion.

Marx visualized one, universal personification (on most cognitive levels, a seeming oxymoron or mutually exclusive concepts). I think he visualized an ultimately safe world where no one would be violated in their personal identity. He must have interpreted every personal wounding coming from an arbitrary, tyrannical (had not been given authority) external non-necessity.

In his ideology the subjective self becomes completely revealed; creates a coherent reality; totally overtakes and defines any public and private realms (and eventually melds the two into one public realm that is private in structure and composition); becomes formalized and then enforced (this is obviously where the ideology becomes an inconsistent and impossible utopia) because of the ever dynamic and unpredictable human experience (acting and speaking, creating one’s own story) where every human will invariably stray or err outside of the universal personification that he visualized and would concretize.

But even more seriously, and germane to our current failings in how our predecessors and we have shaped American society, in his theory, the external world is completely invalidated and dissolved.

I had always wondered how Marx got to his ideas (Not in the sense of what body of knowledge had he learned from, although I believe that they especially included Aristotle and Hegel, but what had driven him to create such a unique and forceful political experience in the world. I was even more puzzled since he was so demonized in America, I mean, of course for the atrocities that he set the stage for and aided and abetted, but it seemed that his theories were demonized as well, again, of course for having led to the atrocities, but I detected a distinction and a muddying dynamic going on that did not jibe with my feeling that my intellectual curiosity was transparent and honest and my feeling that something was being glossed (or blackened) over. It was also like he was being intentionally avoided and obscured, while I had learned that if we don’t understand something we are vulnerable to falling into it ourselves (the danger in this particular case is that even a person who is highly gifted and has great compassion can become completely wrong, unbalanced and tyrannical, and sometimes it goes worse because of the greater start).  My sense, my gut, my intuition, tells me that pure vengeance can not create such sustained and powerful radical evil. And I don’t buy that it is as simple as power corrupts. The only response to that is don’t give power to anyone. This would make life absurd (as existentialism holds). Just as in the French Revolution with Robespierre, the man who was co-father of the revolution only a year later guillotining those who were opposed to the ‘rights of man’ illustrates that it is usually the most noble of causes that creates the greatest violations of effect, so too, Marx parallels this phenomenon. Additionally, compounding the difficulty of getting to the essential is that his theories, and he, are complex and hard to understand. So what went wrong?

But I think I got it. Marx’s great compassion (obviously, like every one who suffers, it starts on a personal level and then gets projected onto the world–becomes empathy), coupled with his high intelligence, lost the world’s natural spacing between individuals. He wanted so bad for the world to be a good place, eventually working to the point in his life where he wanted to make the world a good place, correspondingly wanting to remove what he felt made it a bad place, which was everything outside of the personal part of each human–the world out there… (because it was the personal part that got hurt-so obviously the personal part was good. He did not see the possibility that the external part, the world-the seemingly impersonal part–could be hurt). Even Hitler, obscured like Marx in American analysis, started out from a compassionate motivation; as a boy, he caught his original vision because of the exclusion of the German people from a nearby section of the country that had been given to another country, they were not accepted, but those that were already resident were oppressed for their German identity and in their German culture. It was this–I think French–occupied area that popular opinion held had been unfairly handed over in an arbitrary treaty, and in the dehumanization that he felt and saw while growing up (kind of similar to the Palestinian-Jewish occupation conflict), Hitler vowed that he would someday find a way to right the situation, eventually leading to such atrocities that, I believe, the scripture “it would be better if a millstone were hung around his neck and he were thrown into the sea, than for that man to have ever been born”, applies.

Utopian ideologies, including Christianity (It has its good and bad sides, the bad here being that it minimizes the real, present world with its associated needs, responsibilities and enjoyability and tends to maximize the after world just as all world alienating ideologies say sacrifice now for the good of some future reality), all do this; that is, they lose the real world and the natural spacing that it puts between men, giving us a place to have in common and a place to be distinct (”The Human Condition”, by Hannah Arendt). But how does this work.  Upon contemplation I came up with this: The real world mediates our individual perspectives, is the real, existent place we live in, amongst others, that dynamically (as opposed to any static ideology that we fixate on for a greater good) and continuously readjusts us; and even, readjusts ideologies, movements, governments, countries, economic theories (the current failure of supercapitalism’s Laissez-faire principle & including Ann Rand’s Objectivism); progress at times becomes regress, and productivity becomes useless (these are the two greater goods of our American society–the carrot on a string of the modern age, hanging just beyond demonstrative reality and realized payoff, but moving at an ever increasing speed to prove its value, even audaciously, increasing value and to support its intrinsic need to increase or die and to entrap us more to its pursuit through increasingly surfacy, less fullfilling meaning–which, like junk food, just makes you want to keep eating, and individual and societal fatigue that precludes questioning and analysis).

Just as Marx needed to, today, we need a balance between looking out for number one and seeing and looking out for the world; we need to give the world the equal place it needs to have in this age where the self has become the end all of all things. This means that we would be concerned with more than our own comfort and safety; we would be concerned for those around us, and for the world we live in. It is only by having this concern that we will have in place a philosophical, intellectual (which lead to a practical) balance that will keep us from, otherwise, inevitably dehumanizing people, disrespecting animals, and environmentally ruining our planet, all, in any one of countless ways. If we fixate only on ourselves, we become super-selved, super-sized, very satisfying to anticipate and when going down, but leads to horrible health problems. If we take care of our common world, and one-another, we will have the elements ‘in play’ that will keep us from straying too far in one direction, and will give us the resilience and encouragement to weather what comes our way; we will experience well-being.

Any nation, historical or contemporary, (I think of Germany, Russia, or America), that has a society based on a philosophical tradition (actually, all nations in Western Civilization) that alienates the world (a place we have in common to relate in) and makes this the human condition is existing in and maintaining a half-truth culture; it is a-lie-nation (alienation). Are we living in a half-lie culture in America?

Stated another way, there is some kind of serious lie going on in a society where people (plurality in one world) are so alienated from one another (merely connected to accumulation and comfort in duplicated singularity–rugged individualism–which is the ultimate depersonalization of Capitalism). The world is a home for the soul, not just a place for bodies to survive (in perfect biological rhythm–the ultimate depersonalization of Marx’s Socialism). It is our place to know meaning by experiencing our unique and distinct singularity contrasted with the moderating effect and enjoyable revelation of plurality (keeping us from the depersonalization and dehumanization of both Capitalism and Socialism–sisters in the original game of national expropriation which, in parallel with Utopian ideologies’ ill effects, both had their own progression to becoming societies constituted by world alienation).  Are we evaporating and dissolving this place? Can we support and develop this public space and create new forms of this space? The steps we can take are contemplating and understanding the need for such a space, valuing it, discussing it with others, creatively initiating various forms of the space, being involved with others in these spaces, being courageous to disclose ourselves and our stories to others, while helping and guiding one another to learn a neutral, non-harming, mutually accepting and mutually hearing approach (a positive example of praxis). In a-lie-nation, what truths do we need to keep, and what lies do we need to question?

“World alienation, and not self-alienation, as Marx thought, has been the hallmark of the modern age.” from “The Human Condition”, by Hannah Arendt, page 254)

P.S. The law, as in the legal system, needs to be adapted to include the concepts of natural and use value. At present it only includes exchange value being, as it is, based on property, supporting expropriation of all exchangable goods (which includes everything, including people and societal values), and the accumulation and protection of wealth. But that’s another blog…

2500 years of philosophical and academic rigor creates human rigor mortis and vacant education by suffocating individual initiation and public connection, relationship and acceptance. It subjectifies, separates, isolates, mystifies, vacuumizes and eviscerates ultimate meaning.

Why does Western Civilization start from and draw all its truth by starting at the Greek Civilization? 1.) The Greeks had a public realm that valued immortalizing people stories–their deeds, actions and words so that they created a body of work unprecidented in prior history. 2.) Political forces invalidated and erased ethically and politically undesirable African, Egyptian and Mesopotamian (Arabian) civilizations that were actually the sources of Greek and Roman philosophy and knowledge.

The indoctrination, prioritization, channelization, and limitation of gaining wisdom, learning knowledge, obtaining education, being considered qualified to increase society’s productivity, and making historical progress through the harsh inflexibility and unyielding methodology of precisely and exclusively building upon existing bodies of work as the singular method for educational and social achievement has killed mental curiosity, emotional passion, new learning initiation, group achievement, self-guided mastership, speaking and acting in the midst of others, self-disclosure, mutual acceptance, story telling, immortalization of the human experience, ownership of discovery, insight, intuition, breakthrough, invention, solution, and a personally distinct and unique learning process that is different for every person who has never before and never again will be like anyone else in the history or future of the world.

It creates a fear based, action suppressing, blaming, vengeful, retaliatory, judgmental, promiseless, ruler-subject dichotomy. It creates a meaningless, repetitive, offensively connected, inappropriately disconnected, superficially dominating, practically absent, cyclically stagnant pedagogy that is praxis deficient. It saddens, frustrates, becomes obsurd, a waste of effort; reduces richness of interest and genuine intention to every manifestation of a hollow frame and shell, creates hiding through superfluous goodness or enraged criminality, contributes to the lie and useless purpose of the meaningfullness of means and ends and therein propagates the dehumanization of people in their careers and lives. This is opposed to living in cooperation with a balanced acknowledgment of human plurality with sustainable continuity through action, speaking, forgiveness and promise of increasing knowing and kindness. On the subject of conversation, connection, relationship: Democracy is about debate not hate.

from a discussion between Raul Nakasone and Robin Hood and Hannah Arendt

Please read it, cause I love you,

Here is the article copied in full from the website where I found it:  IT IS A VERY GOOD ARTICLE so I wanted to share it with everyone, however, my second motivation is that it gives me a chance to share some of my synthesis on the topic of suffering, meaning and how this is linked to the motivation to becoming caring. I would say it this way: We need to make ‘becoming involved’ a selfish act so we automatically choose it. And this is by associating it with being useful and meaningful to us. It also necessitates that we become conscious of our innate sense of wellbeing, which is better than happiness, being continquent on a sense of meaning. This would cause us to help other people and animals in American society.

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The Nature of Suffering and the Nature of Opportunity at the End of Life
Clinics in Geriatric Medicine, Vol. 12, No. 2, pp. 237-252, May 1996.
Ira R. Byock, M.D.
Hospice Medical Director, Partners In Home Care, Missoula MT
Chair, Academy of Hospice Physicians Ethics Committee

(robin-m…, there is a little that is mundane in this article, a lot that is good, and some very good)

Introduction

Encountering a patient who is suffering in the midst of terminal illness is an all-too-common occurrence for clinicians who care for the elderly. Yet despite familiarity with the general situation, the task of caring for a person who is suffering in their dying can seem overwhelming. The challenges presented and stresses for the physician will be different, but may seem equally daunting, whether the physician has had a long term relationship with the patient or has only recently become involved in the person’s care.
Most physicians in current practice have had no formal education directed at the philosophy or phenomenology of human suffering, and very little training directed toward the management of the terminal phase of illness. Typically, empirical experience with human suffering accumulates during practice when the opportunities for being mentored, for formal study and for thoughtful reflection are scarce. Medical and nursing education remains focused on cure, life-prolongation and restoration of function. While these are among the primary goals of medicine, so too, is the relief of suffering. ^13,8,17,18
Despite voiced acceptance of “whole person care”, the Cartesian separation of mind and body continues to pervade clinical training. Suffering is understood mostly in terms of physical pain. Even within the domain of the physical, the theory and practice of controlling pain and various other sources of physical distress among the dying remains conspicuously absent from texts and from general medical and nursing curricula. ^9,16 As with any critical encounter in medicine, for the patient to optimally benefit and for clinicians to feel confident in the care they provide, it is essential that the approach to a patient who is suffering in their dying be preceded by thoughtful preparation.

Philosophy of Suffering

“For anyone who has developed…an interest in the most important, the most vital, the most practical of all life problems–those of philosophy and of religion, it is surely a great reward to be given the opportunity to apply what he believes in a way to help human beings in trouble….in medicine these problems are thrust upon us, urgent as a bleeding wound….Not a week passes in the practice of the ordinary physician but he is consulted about one or more of the deepest problems in metaphysics and religion–not as a speculative enigma, but as part of human agony.” ²
While a comprehensive review of the philosophy of suffering is well beyond the scope of this clinical inquiry, it is important to acknowledge that an articulated orientation to the place of suffering within the human condition is central to every religion and every ethnic culture. Characteristically, from within an individual’s religious tradition and prevailing culture the philosophical stance toward suffering seems self-evident and is often unrecognized.
In modern, secular, western culture suffering is assumed to be wholly adverse and devoid of value. The predominant personal orientation toward suffering is one of avoidance or alleviation. When we suffer, we present ourselves as patients. Indeed the etymology of the word patient means sufferer. ¹⁵
Traditional spiritual orientations toward suffering are instructive. The Buddhist world view holds that suffering is part and parcel of human experience. It is part of nature itself, the “stuff” of existence. For the Buddhist, suffering arises from a person’s attachments to the world. These include material possessions, physical pleasures, personal accomplishments and failures, relationships of love and of hate and, ultimately, attachment to one’s very identity. Only through severing those attachments and achieving a desireless state can suffering be transcended. This for the Buddhist defines liberation and enlightenment. Even death may not end suffering, for existence continues through cycles of birth and death until enlightenment is achieved. Buddhism teaches that death is the central organizing feature of a person’s life; it is to be prepared for diligently, through meditation and the progressive weakening of worldly desires.
In the traditional Christian world view, suffering also is seen as an inevitable component of human life. Hope for release from suffering exists not in this world, but in a heavenly everafter. (Robin—this would be another explanation of Christian values compounding our cultural indifference to suffering in a practical, local way, why do anything about others suffering when it’s not going away in this world anyway?) From a Christian perspective the purpose of human suffering has less to do with one’s own enlightenment or purification, as with alleviation of the suffering of others (Robin-but its practical extent is usually heavily on the side of pointing the suffering one to the hope of no suffering in the after life, rather than doing much practical sacrifice, are at the least, concentrated, persistent work, to alleviate that person’s suffering in this world, here and now). One’s suffering can be “offered up” for the sake of others in distress whether they abide in this world or in purgatory; thus, personal suffering is transformed into a sacrificial act. The daily lay offering carries this intent, “Lord Jesus, I offer to you my prayers, works, joys and sufferings of this day for all the intentions of your sacred heart, in reparations for my sins and the sins of all the world.”
Suffering and divine grace have a connection in the Christian tradition. Many of the saints and Christian mystics (among them Theresa of Avilla and Hildegaard of Bingen) recorded their experiences of ecstasy as being inextricably connected with experience of pain. Theresa of Avilla referred to being “wounded by the swords of angels.”
C. S. Lewis, writing from a Christian perspective, comes to a conclusion with similarities to the Buddhist world view. For Lewis, the ultimate good for man is in consciously surrendering oneself to God, which entails a complete commitment to approach God in love, with total openness, vulnerability and trust. Without suffering in one’s life, man would not, perhaps could not, turn toward God with utter faith, remaining instead, focused on one’s own goals, desires and worries of the world. Suffering, thus, is given to man by God out of love, so that man might be made perfect through surrender. ¹⁰
Suffering forms a strong, recurrent theme within the history, both ancient and modern, of Judaism. Judaism teaches that God chose the Jews for certain roles and responsibilities within a cosmic plan. While God loves and is responsive to pleas from his “chosen people”, his actions conform to this timeless scheme for the world. Inevitably, some human suffering will occur and must be accepted for the sake of others or the community as a whole or in congruence with God’s eternal plan. The parable of Moses on Mount Nebo illustrates another salient feature of the Judaic view of suffering.
After leading the Jewish people through forty years in the desert wilderness, Moses, the receiver of the Ten Commandments and the “servant of God”, ascends the mountain and looks across the Jordan river to Canaan. The covenant God had made with Moses was for him to live to see the promised land, but he was neither to enter nor witness his people entering Israel. Now, having attained that goal, Moses bargains with the Angel of Death, imploring God to allow him to observe his people entering the promised land, if only as a bird flying high above or as a blade of grass on atop Mount Nebo. God declines, gently at first, later with fury. The covenant must be maintained. God demands that Moses’ corpse be brought to him! The parable ends as the Angel of Death approaches the heavenly throne carrying the dead body of Moses and observes that God is weeping.
While adhering to the integrity of the eternal plan, God shares in the suffering of his people.

The Secular “Philosophy” of Hospice

While the practice of hospice or palliative care (robin- Palliative care (from Latin palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than striving to halt, delay, or reverse progression of the disease itself or provide a cure. What the doctors are doing for you, Marci, in regards to your alleged diagnosis of dystonia/corea, http://en.wikipedia.org/wiki/Palliative_care ) occurs within the secular health care system, an underlying philosophical orientation can be discerned. Dying is understood to be a part of living — an important part. The nature of dying and of human suffering is understood to be fundamentally personal. This basic precept is consciously intended to support the cultural and spiritual orientation of the patient and family and, in so doing, it is designed to maximize individual autonomy.
The profoundly personal nature of dying and of suffering often seems unrecognized by the larger health care system. Contemporary medicine is focused on cure and organized around problems. The problem-based approach to medical care emerged in the early 1970’s ¹² and has proven effective in improving organization and communication within health care. This approach is, in fact, well-suited to the evaluation and treatment of physical distress among the terminally ill. It is axiomatic that the process of dying entails pathology and progressively severe pathophysiology. The dying person has physical needs and symptoms that require expert attention, but the process of dying cannot be reduced to a set of medical diagnoses. Viewed from the perspective of the life of the individual, even the myriad of medical problems are dwarfed by the enormity and depth of this final transition.

Personhood

If dying is, most fundamentally, a personal experience, it follows that to comprehend the nature of suffering among the dying it is essential to understand the person. While persons will always be known one by another, as unique individuals, there are important features of the human condition that are universal, or very nearly so, and which can be studied. Eric Cassell contributed a valuable model for understanding suffering in defining a “topology” of personhood. ³ Personhood in this model exists as a dynamic matrix of dimensions or realms of the self.
Each person has a prominent physical dimension, a body, which is unique and yet, which has important features in common with the human bodies of other people. Additionally, each person possesses an inherent temperament and distinctive characteristics, preferences, aversions, habits and quirks that contribute to their uniqueness.
Persons exist in time, they have a past and perceive a future. And persons are inherently social beings. The period of infantile dependency of human beings is longest among mammals. It is not surprising that one’s family is an integral part of who a person is, often at the core of one’s sense of self. An individual’s cultural background, imparted during infancy and early childhood, often strongly influences personhood, who the person experiences him or herself to be. Relationships with friends, coworkers and acquaintances similarly contribute to personhood proportionate to the closeness of the connection with the other.
Persons possess beliefs (ranging from political to metaphysical), moral values, and a sense of meaning. Persons also do things and identify with what they have done or wish to do. The active aspect of self extends from the outermost layers to the deepest concentric core of the person: from “activities of daily living” and mundane chores, to routine work-related projects, civic affairs and the normal relationships of community life to work toward the most meaningful of one’s aspirations and relations of the most intimate nature. Considered collectively, activities form the medium through which nearly all the dimensions of self are given shape and texture (Robin-this is why Hannah Arendt’s public realm which is a place for speaking and acting on a higher, public level instead of being limited to the private realm in both working and free time, is so important—our activities amongst others play the greatest part of giving us a sense of being a person). They are the medium through which the rich, unique composition of personhood can emerge.
Some dimensions of personhood are more or less open for observation and may even be asserted to others. Most notably, a person’s professional activities, community projects or political beliefs contribute to one’s public self. Other realms of personhood are inherently or intentionally interior. Quite probably every person has dreams, aspirations, memories, beliefs, and fears that are kept to oneself out of concern that they would seem silly, trivial or even frankly objectionable to others. It is not rare that intimate, long term relationships which occupy a central place in a person’s present or past are kept secret. They may exist outside of the bounds of marriage or because they challenge acceptable norms of sexual preference or boundaries of race, culture or class. Persons may also carry within them thoughts that seem too particular to one’s self to have interest or relevance to others. Here may reside memories from one’s past that involve friends who no one in one’s current life knows, memories which continue to have value and meaning for the person.
Each person has a realm of the unconscious, most evident in our dream states. Intuition resides within the unconscious or pre-conscious dimensions of the person as do memories of taste, touch or smell which are experienced as emotions and impressions rather than as cognitive recollections. Considered together these aspects of the self comprise a person’s private, inner life.
Whether an individual has strong religious convictions, is agnostic or an atheist, each person has a transcendent dimension. This is experienced as a felt connection to something which will endure beyond the life of the individual (robin-which includes, but today is minimized as inconsequential, the world itself—its minimized in religion because it will pass away and in political theory, because labor is most important which creates a disposable, non-enduring, consumed world, not work which creates an enduring, stable human world. We are supposed to have a sense of contributing to a man-made world that will endure beyond our own life.) Many people have a sense of connection to their family which will live on for generations to come. Others may express a sense of meaning in being part of nature’s ongoing process of life, the cycling of elements through the biosphere. Soldiers in battle commonly express a connection to the country that will endure, partly through their own sacrifices. And, of course, many people do experience a vital sense of a supreme being. (robin-notice how he doesn’t say anything about being part of the ongoing man-made world, art, history, culture, politics).

The Nature of Suffering

This model of personhood can illuminate the suffering that clinicians observe among the dying. Cassell conceptualizes suffering as occurring when a threat to the integrity of the person is perceived and asserts that the experience of suffering persists until the threat has passed or until integrity of the person can be reestablished in some manner. ³
If this is true, it might seem that suffering among the dying would be universal and irremediable. For the dying patient, personhood often appears to be coming apart. Debilitated by illness, ultimately perhaps, confined to bed, a person’s sense of self is clearly assaulted.
As death approaches certain dimensions of personhood are particularly vulnerable. Vocation becomes assigned to the past as illness progresses. No longer is one the valued coworker or supervisor, handyman, clerk, teacher or physician. Activities in community affairs, such as team sports, one’s congregation, service groups or local government or a myriad of other interests which had previously given purpose to the person’s daily life are, similarly, now relegated to the realm of the past. More poignantly, the dying person no longer experiences himself or herself as the breadwinner of the family or the keeper of the household; no longer feels able to fulfill the responsibilities of husband or wife, parent or child.
The dimension of the future is under direct attack for the dying person. Whereas previously the future was filled with hopes and plans, it now seems empty and bleak. Expressions of suffering commonly are set in the near future: “If my breathing (pain or weakness) gets any worse, I’ll not be able to take it.” (robin-very similar).
In Man’s Search for Meaning, a book which recounts the author’s internment in Nazi concentration camps, psychiatrist Victor Frankl emphasizes that the dimension of meaning is central to the human experience of suffering.⁵ Pain and privation are insufficient to explain suffering, Frankl asserts. Human suffering requires the felt loss of meaning and purpose in life. Pain and privation can be endured if it is for a purpose.
The experience of childbirth provides a common, yet powerful, example of the dichotomy between physical pain and suffering. Indeed, only very rarely is the pain of labor and parturition expressed in terms of suffering; despite physical distress for most women childbirth is experienced as enhancing the meaning and purpose of their lives. For the dying person, however, suffering may seem inescapable. All that has given meaning and purpose to an individual’s life would appear to be dissolving. (robin-THIS IS VERY ACUTE INSIGHT).

Clinical Response to Suffering among the Dying

A purely philosophical approach to suffering, unbalanced by an experienced, therapeutic perspective, could engender a nihilistic (robin-nothing is going to make any difference anyway, and it’s all meaningless) attitude on the part of care providers. If some degree of suffering is inevitable, perhaps attempts to effectively respond are destined to be futile. This conclusion is insufficient for the clinician who must respond to people in distress. Compassion, from its roots in the old French, “to suffer with” compels the clinician to action (robin-and so too, suffering in the world compels us to action, not just pity with its loquaciousness {eloquent, passionate discussion}, and its emotionalism, got this from Hannah Arendt). ¹⁸
Subtle manifestations of therapeutic nihilism exist in current clinical practice, being revealed by the language we choose. The tendency to label difficult symptoms, such as neuropathic pain or nausea, “intractable” (robin-insuperable) or to refer to a person’s suffering as “uncontrollable” can prove self-fulfilling. Difficult symptoms elude control until the right intervention is found. Deeply personal suffering persists until the person finds his or her own way through.
Loved ones and caring professionals can help, at a minimum by easing the sense of “aloneness” the dying person may feel. The occasional phone call or physician’s home visit acknowledges the person of the patient and communicates caring. Even when suffering derives from the deepest realms of the personal — psychosocial, existential or spiritual — experience teaches that clinicians can be helpful, but only if they remain involved (robin-one of the central lacks in our society which becomes more obvious in this context, is lack of involvement which is another way of saying indifference. One of the things that sucks is the inevitable ‘conclusion to each cycle of getting worse’ to hauling the person off to a lonely, alienated, inconvenient, more difficult environment of the hospital where loved ones have much more to deal with just to be with the loved one and the feeling of being in the midst of an insurmountably impersonal institution that the sufferer experiences themselves).
A fundamental commitment of a hospice or palliative care team is to never abandon a patient. This commitment derives from the knowledge that, at times, simply being present can make a critical therapeutic difference. Frequently patients with agitated delirium or advanced dementia are observed to calm in the company of another person who by intention projects a calming influence by means of humming a lullaby, gently caressing the person or through a variety of complementary techniques. The physical presence of the physician can contribute enormous comfort by occasionally being at the bedside, checking a pulse, touching the brow or holding the person’s hand.
Intellectual models for understanding of suffering represent valuable resources for the clinician who encounters a patient dying in distress, yet the unique suffering of patient can only be known by knowing the person. The optimum way to know the experience of another person is to ask. In asking patients to help us understand the nature of their experience, the responses will, at times, prove unpredictable. (robin-asking opens the other part of the meaning injecting public realm besides action, speaking).
It is common for the dying patient’s subjective experience to change over time. Indeed, the effective treatment of physical distress may allow other sources of suffering to arise.

As with any other critical clinical parameter, routine reassessment of suffering is essential. Both the level of intensity and the quality of the professional care provided can powerfully influence the person’s experience and quality of life during the dying process.
Symptom management remains the first priority for the prescribing physician and the palliative care team. Without effective control of severe pain and other sources of physical distress, quality of life for the dying person will be unacceptable. The patients that hospice and palliative care programs serve are among the very sickest in the health care system. When the level of care is adequate to meet the needs of the patients and families served, hospice and palliative medicine becomes a form of intensive care.
A patient who is experiencing severe pain or dyspnea or agitated confusion must be considered a medical emergency. No less emergent is the suffering of a person whose physical symptoms are controlled and whose agony derives from the sense of impending disintegration or the loss of meaning and purpose in life. The appropriate response to situations of high clinical acuity will commonly require multiple members of the clinical team and consultations with appropriate specialists (robin-sounds like a lot of money, something professionals always seem to miss in these suggestions, economic bias I’ll call it.). In the effort to control symptoms and suffering there is no medical evaluation or intervention that is inherently disallowed on the bases of cost or complexity (robin-wow, in the very next sentence it comes explicitly out, surely this would ethically necessitate and good sense would dictate a comment here about the hypocrisy of our current medical system between ‘caring for the sick and dying’ and the profit structure of medical care in America!! People can’t live or die with the reality of this conflict between their needs and their means). Interventions likely to yield short term comfort, but which carry potentially serious long term side effects, may be indicated. Each must be judged in the context of achievable goals (robin-is this the attempt at palliating the moral injury above?) and the preferences and priorities of the patient and family.
Fortunately, suffering among the dying is not universal; in palliative care settings, unremittent suffering is becoming quite rare. Most people do achieve relative comfort and an acceptable resolution of interpersonal and internal conflicts during the months, weeks, days, or even hours before death (robin-I’ll go with the physical side, but NOT the interpersonal and internal in our society where this level of conflict is chronically undealt with through any phase of life).

Opportunity at the End of Life

Any examination of the human experience of dying would be incomplete without exploring the nature of opportunity at the end of life. Ironically, and in contrast to sudden or traumatic deaths, the process of dying from a relentlessly progressive illness embodies a number of discernible opportunities which range from the fairly mundane to the frankly extraordinary. A survey of the personal experience of dying must confront the clinical observation that some people emerge from the depths of suffering — and the virtual disintegration of the person they once were — to report a sense of wellness as they are dying. While seasoned geriatricians and hospice providers confirm the existence of such seemingly paradoxical transformations, the frequency of these experiences is not known. Here again, systematic clinical studies are lacking and we must learn what we can from empirical observation and anecdote.

Actor Anthony Perkins arranged for the following statement to be released posthumously:

A few years ago, on the completion of a workshop presentation I had given on end of life care, a woman stopped to speak with me and offered me a copy of the last letter her son had written to her. She asked that I use it if it seemed meaningful to others.

And the letter closes,

“If anyone ever asks you if I went to heaven, tell them this: I just came from there.” ⁶

Illustrative Case

Mrs. G., a 60 year old woman with metastatic lung carcinoma had been a wife and mother throughout her adult life. She grew increasingly despondent as her illness progressed and her functional status declined. Her physical pain could be controlled with narcotics and anti-inflammatory medications, but she had lost the ability to do any of the things that had brought her life meaning. Instead she was becoming dependent upon others, the very people she still felt a need to nurture and protect. She was painfully aware of the burden that her care represented to her family. She felt worthless and hopeless. Her suffering manifested as agitation, at times with confusion and paranoid delusions. Medications would calm her outbursts, but her suffering persisted. Additionally, her family suffered to see her in such distress and wished that her life would end quickly and with comfort.
Intervention involved listening attentively to the patient’s story of her life and focused on exploring the patient’s feelings of unworthiness and her fears of what she had left undone. She was able to speak openly about her impending demise and voiced concern about her children who continued to struggle in their adult lives. Her feelings of inadequacy were gently challenged by reflecting on the content of her life story and on how much she had accomplished and done for others in her life. It was suggested that the work she had remaining to do was about completing her full and meaningful life. In counseling, each of her close relationships were reviewed with attention to “what would be left undone” if she were to die before important things were said. The patient was able to meet with each of her children. These poignant visits included mutual expressions of forgiveness, of appreciation and of love. In a real sense the patient was completing her relationships and saying goodbye.
Furthermore, in counseling, Mrs. G. was asked to consider that an important task for this stage of life for any person might include the acceptance of care from others. Specifically, it was suggested that her willingness to receive care was the single most important thing she now could do for her family. During a subsequent meeting with Mrs. G. and her children in which this notion was shared, her children’s response was tearful, but enthusiastic agreement. One of them said, “We need to care for you Mom. Please let us do this for you as you have raised us and done so much for us in our lives.” Collectively, they expressed a need to provide care as a means of completing their relationship and grieving the loss of their beloved mother.
In addition to patient and family counseling, ongoing adjustments were made in Mrs. G.’s medications and meticulous attention to medical aspects of care continued by the hospice interdisciplinary team. Over a period of two weeks, Mrs. G.’s suffering improved. Her paranoia dramatically diminished, occasional night time confusion responded to calm reassurance and she was able to accept care from her family with grace and even a sense of humor. She died in her home, surrounded by family in comfort and peace.
As is evident from the examples chosen, even at the end of life the range of human experience remains vast, extending from intense suffering at one extreme, to a sense of comfort and genuine peace to, at the other extreme, a sense of profound wellness (robin-again, the concept of wellbeing, not happiness, being well is living well, which is living more deeply aware and doing more that is congruent with connection, meaning and feeling).
Often the term “good death” is used to describe the goal of terminal care. It has the disadvantage of connoting something that is static and formulaic. Furthermore, it perpetuates the confusion between death — about which we arguably know nothing — and dying, the personal process of living with progressive decline and impending demise. The phrase “dying well” seems better suited to describe the positive end-of-life experience that people desire. In conceptualizing “dying well” and the related notion of “wellness in dying” it is not necessary — and would be misleading — to glorify the experience. Dying, even for those who attain a sense of wellness, is rarely easy and may, instead, be arduous and unpleasant.
Hospice practice experience provides strong empirical validation for the historical and literary observations that suffering among the sick and the dying — suffering which to the healthy reader or observer may seem inevitable and unendurable — can, at times, give way to a heightened sense of well-being and quality of life. This aspect of the human experience of dying has, as yet, not been incorporated within the medical model. (robin-my emphasis, it is important to really stay mindful of the reality of this lack in our system) It is both wonderfully provocative as well as intellectually unsettling to confront the implications of this observation. How can this apparent paradox be explained?

A Developmental Model

In approaching this paradox it is necessary to restate the most fundamental tenet of the hospice or palliative approach to care: Dying is a part of living. The period of time referred to as dying can, therefore, be considered as a stage in the life of the individual person and the family. Modern psychological theorists, among them Erik Erickson, Jean Piaget and Abraham Maslow, whose work collectively forms the basis of modern behavioral medicine, all asserted that human development is a life-long process.
There is a tendency within contemporary culture and reflected in medical practice to assume that on receipt of a terminal diagnosis meaningful life has ended. Within this perspective the person is constrained to wait for death, being reduced to hope only for some measure of comfort and to avoid being a burden to others. This attitude is incongruous with the basic philosophy of modern palliative care for it inappropriately devalues and separates this last stage of living from the continuum of a person’s life.
It is useful to conceptualize dying as a stage of the human life-cycle, comparable to infancy, childhood, adolescent, adulthood and advanced age. While individuality, of course, extends through the very end of life, characteristic challenges, or developmental landmarks, can be discerned and representative task work toward achievement of these goals can be identified. [Table 1] The specific landmarks and task work delineated will vary from one author or clinician to another. The specifics are far less important than the conceptual framework of life-long human development.
It is important that a developmental approach to dying not be misconstrued as introducing a set of requirements against which to judge the personhood of an individual. These broad landmarks are intended to serve as diagnostic tools enabling clinicians to anticipate issues with which patients may struggle and from which suffering may arise. This framework provides a means of recognizing opportunity which may otherwise remain overshadowed by the person’s distress. The word opportunity is carefully chosen to describe in general terms the status of dying patients who have an acceptable level of physical comfort. The dictionary defines opportunity as “a combination of circumstances favorable for the purpose” (robin-culturally a lot more ‘opportunity’ is absent than is recognized in the mix of causes and solutions touted by the various social sciences, such as psychology or sociology, they don’t want the onus of the systemic problem, they just want to further their discipline hoping that somehow the system wide problem will eventually get better if their part gets better. But the problem with this myopic approach is that the systemic problems might be different in nature from the micro problems, and that the micro approach could exacerbate the macro situation, which I think is actually the reality of the empirical blindness and lack of empirical common sense, and finally that the system being sick can make the disciplines themselves infected with wrong and destroying beliefs, practices and methodologies). ¹⁹
The task work offered in Table 1 represent various means through which persons in their dying may develop a sense of completion, satisfaction and even a sense of mastery within areas of life that are of subjective importance to the person. The examples listed are intended illustrate the conceptual framework and are not meant to be exhaustive (robin-they always say this, as if society is going to find their work definitive and fixate on their new paradigm, like I better make a humble disclaimer because my pride can’t get over my discomfort when I move toward praxis—we are so in fear of action). The task work involved in the process of dying is the person’s own to do — or not do — as they so choose. As clinicians, we can explain opportunities, offer suggestions and, if there is interest expressed, we can facilitate the person in his or her own work. In this manner people can be gently assisted in achieving a sense of readiness as they approach death.
Cassell’s multidimensional construct of personhood and the model of life-long human development provide a means for understanding the human experience of dying. Together they suggest a language for its expression. The key to solving the apparent riddle of how suffering can give way to a heightened sense of well-being lies in the realization that during each phase of life the personhood of the individual changes. In fact, throughout a person’s life the sense of who one is changes most dramatically in the process of responding to the challenges and crises that virtually define the developmental stages of infancy, childhood, adolescence, mid-life and late-life.
During each major life transition there may be suffering. At times people may be broken and never fully recover an integrated sense of self, but most find a way to grow through these turning points, achieving a measure mastery (robin-is this a typo or is it a term?) as they look ahead. One need not undergo a “peak experience” or achieve ultimate “self-actualization” to experience growth in the last stage of their life. People who can be said to have grown in their dying are those who express satisfaction in the direction of personal change that occurred in response to progressive stresses of disabling illness and for whom an enhanced subjective sense of self emerges during the process. (robin-some inner growth is good)
Dying is surely the most profound of life’s challenges. We speak of growing up and growing old; perhaps, we can refer to those who emerge from suffering into a subjective sense of wellness in their dying as “growing on.”
Abrupt disability can result in the patient feeling as if critical dimensions of self had been amputated. When the clinical course provides sufficient time and when aid is available through support of caregivers, social roles and responsibilities can be completed and dimensions of self to be consciously released from the person. Business can be completed, legal and fiscal responsibility transferred (to the medical industry… did I add that?), the value of others can be acknowledged and appreciation mutually expressed. Even intimate relationships gradually can be brought to a sense of completion. Families can be helped to effectively resolve problems of communication such as the “conspiracy of silence” in which neither patient nor family will openly acknowledge the terminal nature of the illness in order to protect one another from the pain of separation. In actuality, the shared pretense only adds isolation to the grief each person is feeling. One example of a “clinical tool” for assisting in the completion of relationships is the “saying of the five things”. Years ago a nurse colleague taught me that in order for people to feel complete in any close, personal relationship they need to have conveyed and acknowledged five things: “Forgive me.” “I forgive you.” “Thank you.” “I love you.” and “Good-bye.”
In contrast to a sudden, “easy” death, progressive illness, offers a precious opportunity to reconcile previously strained relationships — perhaps between previous spouses, or between a parent and estranged child. The history of a relationship (and family) is transformed when the story of two persons ends well. Completion does not require an ending of interaction or a severing of relationship. Rather, it conveys a sense that there is nothing left unsaid or undone. When a dying person and loved one come to feel complete between themselves, subsequent time together is as often marked by joy and the exchange of loving affection as it is by sadness. (robin-he is repeating himself in this paragraph now, this is mundane)
Inwardly, as well, the process of dying in a progressive, rather than sudden fashion, provides an opportunity to acknowledge achievements and savor a sense of accomplishment and satisfaction. It is a rare individual who achieves all that he or she had hoped for in life, and this waning phase of life also offers the opportunity to come to terms with life’s frustrations and disappointments and to accept one’s own imperfections. A clinician who enjoys a good rapport with a patient can point out that the person is “only human” and that humans, by their very nature, tend to be imperfect. In this and similar fashion a patient who is suffering from low self-esteem can develop — perhaps for the first time in life — a feeling of self-worth. (robin-it’s never too late—as long as they haven’t missed their final appointment yet—no matter how well you think you know someone)

Life Review

While a person’s past is protected from the ravages of illness, through life review a broader perspective can be achieved. Previous mistakes and misdeeds can be understood as part of a larger whole, self forgiveness can be extended. Here, as with the history of strained relationships, a life story that ends well casts a positive light on all that has preceded. In this manner a person may come to feel “enlarged”, even as he or she is so physically diminished. (robin-meaningful, transcendent, good, time to make a summary, write or speak a conclusion, I have had the idea of asking J… what are her insights about life having had the chance to live a whole life.)
Geriatricians Lewis and Butler have emphasized this point: “The therapeutic possibilities of the life review are complex. There is the opportunity to reexamine the whole of one’s life and to make sense of it, both on its own terms and in comparison with the lives of others. Identity may be reexamined and restructured. There is the chance to resolve old problems, to make amends and restore harmony with friends and relatives.” ¹¹
The process of storytelling as a particular form of life review often has valuable salutary effects and should be encouraged. Stories from the person’s past can be elicited by an interviewer with even modest experience (such as a trained volunteer) and can be aided by leafing through a family photo album. Patients who have interest in having their stories recorded in their own voice can be assured that others, especially their children, grandchildren and, quite possibly, those yet unborn will regard the recordings as heirlooms to be treasured. In this manner persons who can no longer contribute in accustomed ways to their families, and who may feel a burden to others, can regain a sense of tangible meaning in the effort to preserve and transmit their stories.

Meaning and the Transcendent

The transcendent dimension commonly assumes greater subjective importance as one nears the end of life, perhaps because the person’s perspective becomes unobstructed by the priorities and demands of an active life. The related dimension of meaning which is so pervasive and central to the nature of suffering is also pivotal to the resolution of suffering and the subjective experience of personal growth. (robin—suffering brings us meaning, and meaning reduces our suffering and increases a sense of well-being.) Each religious and philosophical tradition provides a method for infusing the suffering of a person with meaning. The person may come to experience suffering as a sacrifice for sake of others or as a means by which they are connected to the transcendent realm. Hospice experience confirms that suffering often becomes endurable — or miraculously dissolves — when it becomes meaningful for the person. The personal meaning of suffering may seem to others to be abstract but for the person dying meaning is a tangible entity, deriving substance and shape from the individual’s life history. The profound, therapeutic power of meaning for human beings is at the crux of Victor Frankl’s logotherapy. (robin-I looked this up and it is very interesting. http://en.wikipedia.org/wiki/Logotherapy It goes in line with my findings regarding our society and indifference.)This school of psychotherapy which he founded focuses on helping the person find a sense of meaning in his or her life experience, including the most adverse of experiences (robin-one can’t escape the seeming opportunism of touting meaning right at the most suffering filled point of one’s life—we don’t have anything physically good so the next best thing is mental meaningfulness—but if there is truth to man’s genuine desire for meaning, and his sense of happiness when genuinely found is experienced to be real, albeit, subjective, if the world is real, and people are real, then maybe their conceptualization of the world and themselves is real and decisive enough, and therefore meaning is real enough to be real, meaning qua meaning is the end of experience and thought and enough for the end of life. But this meaning cannot be formulized or artificial, each person will know if it springs from genuine and actual connection and involvement and mutual recognition of contribution.)
The personhood of the dying individual can be conceptualized as gradually becoming less dense as some spheres of self fall away and others are consciously released. Those dimensions of self which only require the person to “be” — such as one’s past, one’s sense of meaning and the transcendent realm — gradually assume prominence. The person’s experience of self identity often becomes fluid at the end of life. The person’s sense of self tends to become less complex, however, personhood may remain subjectively intact. (robin-our whole society needs to move toward being rather than competing as satisfactory for acceptance. This should happen much earlier in life.)

Conclusion

Dying well, therefore, can be understood in terms of the subjective experience of personal growth, embodying a sense of renewed (at times enhanced) meaning and a sense of completion (robin-he did not really deal with the idea of how a job, especially the job of life could be conceptualized as being complete, just initially I would separate life as having a cyclic biological repetitiveness that would never be complete until death and would only have a pride of having had the experience at all as one non-temporal accomplishment, and the other component being the contribution to the man-made human artifice of the world, as such. This is a starting point, but would necessitate his dealing with a realm that he neglects earlier on per my note on the areas left to inventory or sum up), at times even fulfillment in life. Personal growth is rarely easy at any stage of life, and a growthful dying may actually be difficult. It probably must entail a measure of suffering. The touchstone of dying well — the sense of growing in the midst of dying — is for the experience to be important, valuable and meaningful for the person and their family. (robin-this is good)
Care for persons who are dying is at once complex and simple. The details of managing atypical pain, intermittent bowel obstruction, fistulas or pruritis all may be intricate, yet the general orientation toward care for the dying patient remains straightforward. Comprehensive care for people who are dying rarely requires more than careful management of symptoms and attention to the basic psychosocial needs of the individual — as a person — and their family. Beyond symptom management, hospice and palliative care intervention can be directed at helping the person to attain a sense of completion within the social and interpersonal dimensions, to develop or deepen a sense of worthiness and to find their own unique sense of meaning of life.
Most fundamentally, clinicians can serve the dying person by being present. We may not have answers for the existential questions of life and death any more than the person dying. We may not be able to assuage all feelings of regret or fears of the unknown. But it is not our solutions that matter. (This touches on the dichotomy that pisses off so many people who are suffering—If we can’t fix it, we switch to an ideology in which solutions don’t matter, isn’t that convenient? And isn’t it then just double talk that serves more for those around the suffering person to let themselves off the hook and misses the real tragedy of the situation? And then leads away from a real sense of meaning, if there in fact is one.) The role of the clinical team is to stand by the patient, steadfastly providing meticulous physical care and psychosocial support, while people strive to discover their own answers.
The poet Rilke wrote:

TABLE 1
Developmental Landmarks and Tasks for the End of Life

• Sense of completion with worldly affairs
  • Transfer of fiscal, legal and formal social responsibilities
• Sense of completion in relationships with community
  • Closure of multiple social relationships (employment, commerce, organizational, congregational). Components include: expressions of regret, expressions of forgiveness, acceptance of gratitude and appreciation
  • Leave taking; the saying of goodbye
• Sense of meaning about ones’ individual life
  • Life review
  • The telling of “one’s stories”
  • Transmission of knowledge and wisdom
• Experienced love of self
  • Self-acknowledgement
  • Self forgiveness
• Experienced love of others
  • Acceptance of worthiness (robin-good turn around here)
• Sense of completion in relationships with family and friends
  • Reconciliation, fullness of communication and closure in each of one’s important relationships. Component tasks include: expressions of regret, expressions of forgiveness and acceptance, expressions of gratitude and appreciation, acceptance of gratitude and appreciation, expressions of affection
  • Leave taking; the saying of goodbye
• Acceptance of the finality of life – of one’s existence as an individual
  • Acknowledgement of the totality of personal loss represented by one’s dying and experience of personal pain of existential loss
  • Expression of the depth of personal tragedy that dying represents
  • Decathexis (emotional withdrawal) from worldly affairs and cathexis (emotional connection) with an enduring construct (robin-as close as he gets to the man-made world and immortality associated with it, but he probably is referring to eschatology and religious enduring concepts of heaven).
  • Acceptance of dependency
• Sense of a new self (personhood) beyond personal loss
• Sense of meaning about life in general
  • Achieving a sense of awe
  • Recognition of a transcendent realm
  • Developing/achieving a sense of comfort with chaos
• Surrender to the transcendent, to the unknown – “letting go”

References

1. Bergen, R., Anthony Perkins: A Haunted Life, Little Brown & Co., London 1995
2. Cabot, Richard C., Training and Rewards of the Physician, J.B. Lippincott Co., Philadelphia, 1918, pp 151
3. Cassell, EJ: The Nature of Suffering and the Goals of Medicine, N Eng J Med, 1982 306:11, pp 639-645
4. Doyle, D., Have we looked beyond the physical and psychosocial? J Pain and Symp Mgmt, Vol 7:5 July 1992, pp 302-311
5. Frankl, Victor E., Man’s Search For Meaning, Washington Square Press, NY, NY 1984
6. Goethe, C., Personal Communication, May 3, 1994
7. Guyatt, H., Cook, D., Health Status, Quality of Life, and the Individual, JAMA, August 24/31 1994, Vol 272, No 8
8. Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying; a report by the Hastings Center Indiana University Press 1987
9. Hill, T.P., Treating the Dying Patient: The Challenge for Medical Education, Arch. Intern. Med., June 26, 1995, Vol. 155, pp 1265-1269
10. Lewis, C.S., The Problem of Pain, Macmillan Publishing Co. 1962
11. Lewis, M.I., Butler, R.N., Life-review therapy, Putting memories to work in individual and group psychotherapy, Geriatrics, Nov. 1974 Vol. 29, pp 165-173
12. Nelson, G.E., Graves, S.M., Holland, R.R., Nelson, J.M., Ratner, J., and Weed, L.L., A performance-based method of student evaluation, Medical Education, 1976, 10: pp 33-42
13. President’s Commission for the Study of Ethical Problems in Medicine: Making Health Care Decisions, US Government Printing Office 1982
14. Rilke, R.M., Letters to a Young Poet, trans. Stephen Mitchell, Vintage Books, NY, NY, 1984, pp 34-35
15. Sontag, Susan, Illness As Metaphor, Vintage Books, NY, 1979 pg 125
16. Wallace, K.G., Reed, B., Pasero, C., Olsson, G.L., Staff Nurses’ Perceptions of Barriers to Effective Pain Management, Journal of Pain and Symptom Management, April 1995; Vol 10, No. 3, pp 204 – 213.
17. Wanzer, SH et al. The Physician’s Responsibility Toward Hopelessly Ill Patients, N Eng J Med 1984 310:15 pp 955-959
18. Wanzer SH, Federrman DD, Cranford RE, et al. The Physician’s Responsibility Toward Hopelessly Ill patients: A Second Look. N Eng J Med 1989:320, pp 844-849
19. Webster’s New Universal Unabridged Dictionary, Second Edition, Simon and Schuster, 1983

Brief Synopsis

Encountering a patient who is suffering in the midst of terminal illness is an all-too-common occurrence for clinicians who care for the elderly. This chapter explores the personal experience of suffering in the context of life-limiting illness. The concept of personhood is utilized to illuminate the nature of suffering. Clinical observation documents that some persons experience a subjectively heightened sense of well-being as they die. The concept of personhood and the model of life-long human development is applied to the explication of this apparent paradox, enabling an understanding of the nature of opportunity at the end of life.

The Nature of Suffering and the Nature of Opportunity at the End of Life
Clinics in Geriatric Medicine, Vol. 12, No. 2, pp. 237-252, May 1996
Ira R. Byock, M.D.
Hospice Medical Director, Partners In Home Care, Missoula MT
Chair, Academy of Hospice Physicians Ethics Committee

Also Visit  BYOCK’S LANDMARKS and DEVELOPMENTAL TASKWORK
A  working set of …
Developmental Landmarks and Taskwork for the End of Life
presented in a practical framework with introduction by Dr. Byock

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