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Take Me With You: the Museum of Friendship, Remembrance and Loss

8 Feb, 16 | by cquigley

 

Take Me With You: the Museum of Friendship, Remembrance and Loss

6.00-8.30 pm, Thursday 18 February 2016 at the Chowen Lecture Theatre, Brighton and Sussex Medical School, Falmer Campus BN1 9PX

Museum open from 6.00 pm

Clare Best and Tim Andrews in conversation (+q&a) 6.30-7.30 pm

Drinks reception from 7.30 pm

Museum open until 8.30 pm

 

From Clare Best’s blog:

‘Here is what I wrote in my journal after Tim and I first met in a café in Brighton in January 2013:

Met Tim Andrews in Brighton 16 Jan. Thought on train on way home about some kind of flexible/low-maintenance start to a collaboration. Thought more overnight.

‘Take me with you’ – this is the phrase that kept coming to me in the night. It has connotations of journey, of packing, of accompaniment, of company, of gathering in, of sharing.

I see it perhaps for now as making ‘swaps’ by email of what each of us would take with us to the next world, if we could, if there is one… Things/ideas we hold dear. Then each of us interprets or responds to each other’s chosen thing. And so on.

The items sent might be very fragmentary and abstract. They could be anything: a line from a song, a particular person’s smile, a food, a mood, a book, a film, a favourite walk, a memory, etc etc – it could be literally anything.

So we’d build up a collage, a narrative. And each time we corresponded we’d know each other better, so we would construct a kind of overlapping journal, or a conversation, through what we’d choose and send each other.

And here we are, three years later, with a robust friendship and about 50,000 words written, quite literally, between us – and all kinds of things we’d like to show you.

It’s been a stimulating journey, full of laughter and tears and adventure and tea and cake, and we look forward to sharing it at BSMS on 18 February.

The event is free, but if you’re coming along please register in advance here.

Tim has produced a trailer and has blogged about the project.’

 

The Reading Room: Clive James’s ‘Sentenced to Life’

4 Feb, 16 | by cquigley

 

Sentenced to Life

by Clive James. Published by Picador, 2015.

Reviewed by Dr Sam Guglani.

 

On a ward round, I notice a colleague speaking with one of the palliative care nurses – about a patient, or perhaps about processes, maybe even about a personal matter. His posture, and what I can hear of his tone, feels familiar. That particular weight and tempo given to conversations with palliative care, like those invoked for hospital chaplains – both the ostensible familiars of death and carriers perhaps of a particular wisdom. What wisdom? What lessons are there for the living – or do we romanticise it all? – from those so near the dying and those close to death?

The extraordinary Clive James – critic, essayist and poet – is unwell and almost certainly close, however modern medicine allows us to define that, to death. In 2011, he developed emphysema, renal impairment and leukaemia. A couple of years ago, medics and media alike anticipated his death as imminent, but new drugs have him in remission, very much alive and impressively prolific. He finds this ‘all a bit embarrassing’ and, regardless of the sensibility of that emotion, there is a sense of the world’s said media shuffling its combined feet and checking its watches. Waiting for him to die, so they can get on with the business of illuminating his life.

James, however, is ‘restored by [his] decline/ And the harsh awakenings it brings.’ And amongst a remarkable number of recent publications – translations of Dante, collections of essays – last year he returned to one of his first mediums of artistic expression: poetry. Described by James himself as ‘funeral poems’, Sentenced to Life feels like a collection of elegies. It forces us to think again about elegy as poetic utterance: what it is for and what action it might hold for the still living. Is it an analgesic against the pain of loss? Or might it turn us to face that loss, face death squarely, and in doing so actually illuminate life? Understood as such, might every poem – as Seamus Heaney is said to have commented – in fact be an elegy?

Throughout the collection, James points to the stark fact of human life’s presence and all our experiences, here, transiently, on this earth. In Event Horizon, he proclaims:

you get to see the cosmos blaze

And feel its grandeur, even against your will,

As it reminds you, just by being there,

That it is here we live or else nowhere.

 

And all the poems feel like they follow from this assertion, worrying away at the question of what we then do with our lives, how best to live, questions of meaning. For Clive James, so much meaning clearly gathers in the very fact of the world’s beauty as refracted within the human gaze. In Too Much Light, his cataracts ‘invest the the bright spring day/ With extra glory, with a glow that stings.’ In the title poem, he looks with astonishment at goldfish swimming in a garden pool: ‘never touching, never going wrong:/ Trajectories as perfect as plain song.’ Both poems sing of the imperfections of human agency, our messy trajectories and sight, as being both a source of pain and of wonder. But the fact of dying, of breathing the air ‘as if there were not much more of it there’, heightens for him a sense of sustained astonishment in the brevity and glory of every conscious moment, and its released multitude of revelations. He goes on, in Sentenced to Life, to reflect:

Once I would not have noticed; nor have known

The name for Japanese anemones,

So pale, so frail. But now I catch the tone

Of leaves. No birds can touch down in the trees

Without my seeing them. I count the bees.

 

This view of life’s preciousness echoes Dennis Potter who, in the last months of his life, spoke of seeing the beauty of the blossom outside his window in Ross: ‘it is the whitest, frothiest, blossoms blossom that ever could be, and I can see it…The fact is, if you see the present tense, boy do you see it! And boy can you celebrate it.’ Within these poems though, the revelation of our earth- and time-bound lives and of these brightly lit moments, carry further still. They bring us to what T. S. Eliot described as: ‘the only wisdom we can hope to acquire…/ the wisdom of humility.’

This is most manifest in his acknowledgement of the inevitability of death. In Driftwood Houses he declares this unsentimentally:

To hear me talk

You’d think I found my fate sad. Hardly that:

All that has happened is that I’ve hit the wall.

Disintegration is appropriate’

 

Such honest and forthright acceptance that our flesh must weather and fray feels infrequent in the consumer clamour within medicine and society for longevity, perhaps even for immortality. In Plot Points, further to the expressed awe in Event Horizon, James parallels the universe’s diminishing with our own, and notices how capable we are of choosing to forget both:

While you were reading this

Millions of stars moved closer

Towards their own extinction

So many years ago –

But let’s believe our eyes:

They say it’s all here now.

 

None of this hard-won sense of truth feels bleak or despairing, but instead is suffused with enchantment and perspective. He suggests that the truth clears away ‘so many souvenirs’. And in a life such as his, there are many such souvenirs. If there is regret in these poems, and there’s much of it, it isn’t around the fact that he is dying, but rather around how he has lived, how he might have lived otherwise: ‘If I seem close to tears/ It’s for my sins, not sickness.’ And from this regret he comes away with the remarkable conclusion that his current state is in fact more authentic than the illusory existence that preceded it. In the brilliant poem, Landfall he asks – ‘those years in the clear, how real were they’, and goes on:

I called it health but never stopped to think

It might have been a kind of weightlessness,

That footloose feeling always on the brink

Of breakdown: the false freedom of excess.

 

So now, rather than a life of ‘sirens’ and adoration, he asks for, and is gratified by, the present and the real: ‘Remember when I asked for thousand kisses?/ Let’s make it ten. Why not kiss me just once?’ And he arrives at, and brings us to, a place of ‘Thanks for the heartbeat which still lets me live:/ A consolation even now, so late’. Thanks for our life-giving pulse is a different position altogether to one of reductive expectation and rights. Faced with our finitude we might readily arrive at either: at thanks or at greed. However, it is a position of gratitude that opens us to what we owe, over and above what it is we are entitled to.

T.S. Eliot asked not to hear of ‘the wisdom of old men but rather of their folly, / Their fear of fear and frenzy, their fear of possession, / Of belonging to another, or to others.’ In the presence of his death, Clive James pushes against Eliot’s assertion and details in formally accessible and powerful poems, a recognition of his essential belonging to others, his fragility and so demonstrates acres of wisdom. In Leçons de Ténèbres, he wonders at the value of this:

But are they lessons, all these things I learn

Through being so far gone in my decline?

The wages of experience I ran

Would service well a younger life than mine.

I should have been more kind. It is my fate

To find this out, but find it out too late.

 

I can’t agree that wisdom like this can ever be won too late for any of us and, if we choose to listen, it will serve younger lives. So we ought to listen – as patients, as doctors, as one-day patients, and as human beings.

 

Khalid Ali and Jane Peek: Cinema of splendour: Reporting from Dubai international Film Festival (DIFF) 2015

29 Jan, 16 | by Ayesha Ahmad

Cinema of splendour: Reporting from Dubai international Film Festival (DIFF) 2015

Dr Khalid Ali, Screening Room Editor

When I visited Dubai International Film Festival (DIFF https://www.dubaifilmfest.com/) for the first time in December 2015, I was not expecting to find so many films exploring health and well-being from all over the world. The variety of films on offer explored contemporary issues such as euthanasia and the right to die (Last cab to Darwin, directed by Jeremy Sims, Australia 2015), terminal illness (Dry, hot summers, directed by Sherif El Bendary, Egypt,2015, http://blogs.bmj.com/medical-humanities/2016/01/04/khalid-ali-taxi-ride-to-eternity-review-of-dry-hot-summers/), doctor-patient relationships (Waiting, directed by Anu Menon, India 2015), sports medicine and its ethically challenging medico-legal implications (Concussion, directed by Peter Landesman, USA 2015), and the aftermath of an epidemic of sleeping sickness (Cemetery of splendour, directed by Apichatpong Weerasethakul, Thailand 2015).

Old age and its colourful diversity of frailty alongside resilience, health and disease, creativity and cognitive decline were also present in ‘The lady in the van, directed by Nicholas Hytner, UK 2015’ and ‘Youth, directed by Paolo Sorrentino, Italy 2015’. I was once again reminded that arts and films in particular have a lot more to offer. By portraying artistically the lived experience of human suffering, healthcare professionals can begin to understand the determinants of physical and mental well-being and subsequently deliver dignified compassionate care. Films are no longer entertainment vehicles only; they do have a ‘healing power’. An elegant example of such ground-breaking ability of ‘healing through understanding’ came from the film ’23 Kilometres’ that will be reviewed here.

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Nadeem Akhtar: Film Review – “Wake in Fright”

29 Jan, 16 | by Ayesha Ahmad

‘Wake in fright’ directed by Canadian director Ted Kotcheff’s film is considered a masterpiece for its innovative, daring storyline, psychological focus and exceptional visual imagery [1]. The film premiered in Cannes in 1971 to great critical acclaim, but in its homeland of Australia (where the film was set), it was poorly received.

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The Reading Room: Ronald Britton’s ‘Between Mind and Brain’

27 Jan, 16 | by cquigley

 

Between Mind and Brain: Models of the Mind and Models in the Mind

by Ronald Britton. Published by Karnac, 2015.

 

Reviewed by Dr Neil Vickers.

 

Ronald Britton is one of the most significant psychoanalytic theorists writing today. Now retired from clinical practice, though still active in training, he is perhaps best known for his contributions to Kleinian theory. His first book, Belief and Imagination: Explorations in Psychoanalysis (1998), asked questions such as ‘What is and where is the Imagination in any modern model of the Mind?’ and ‘How can we conceive of it in psychoanalytic terms?’ His second, Sex, Death and the Superego: Experiences in Psychoanalysis (2003), set out his thinking on three concepts that were important to psychoanalysis historically. Britton has always used literature as a kind of interlocutor for analytic theory. Belief and Imagination contains lengthy discussions of, and arguments with, Wordsworth and Coleridge, Blake, Milton and Rilke, as well as Freud, Klein and Bion; and Sex, Death and the Superego contains a compelling reading of the Book of Job and a fascinating extended speculation about the role that Wagner’s operas played in Jung’s correspondence with Sabina Spielrein. Britton is a medical humanist avant la lettre.

 

The theme of his new book, Between Mind and Brain: Models of the Mind and Models in the Mind, is that we think in models. Britton’s concern is more with the mind than the brain though the early chapters do make reference to contemporary neuroscience. In the first chapter Britton asks a question that once tormented Freud: would psychoanalysis and brain science ever arrive at a substantially overlapping account of mental experience? Britton’s answer is ‘probably not,’ though he thinks the reasons for this have changed since Freud’s time. The success of quantum biological models in neurology has resulted in a situation in which a mechanistic account of how the brain works has been replaced by one that is probabilistic (so outcomes can never fully be determined in advance), and full of complex, counterintuitive interaction (Patrick Haggard of Queen Square has demonstrated that, in a range of situations, the brain executes our intentions before these are consciously formulated in the mind). Freud originally hoped to ground concepts like repression in the workings of different types of neurones. Today, Britton suggests, convergence would have to be sought in other places, using different concepts borrowed from each discipline. At one point, he playfully suggests that the evaporating black holes of quantum mechanics might somehow dovetail with the psychic ‘black holes’ that psychoanalysts have described in very disturbed children. But the comparison remains at the level of play, because the two models aim to capture very different things. And models, along with their potential and limitations, are where Britton’s real interest lies.

 

For better or worse, psychoanalysis, like other psychotherapies, has to derive its models from directly-reported mental experience. Fantasies, conscious and unconscious, are models in Britton’s sense. But so too are theoretical constructs such as the Oedipus complex, the ‘depressive position’, or ‘basic assumptions’. Many people imagine that psychoanalysts apply these models dogmatically to their patients. On this view, patients are talked into seeing their difficulties as having an Oedipal origin, say. Britton takes this case apart at some length. The psychoanalyst, in his view, should aim as far as possible to set aside all models, especially those to which he is most attached. They will only distort what he sees. To understand another person, you have to tolerate not understanding him or her for a long time. Britton is on record as saying that he assumes he does not understand his patients for the first two years of four- or five-times-a-week analysis. Of course, psychoanalytic models are brought in, sceptically, but only gradually.

 

Occasionally, patients’ difficulties will be very well captured by a model. In Chapter 6, Britton gives the example of a man called Peter who entered psychoanalytic psychotherapy with a stammer. Peter led a very ordered life. He did not work. He had a celibate marriage. He avoided talking to his mother on the telephone, writing typed letters to her instead. And he appeared to have few friends. The model that seemed to fit Peter’s case was of a narcissistic organisation, as described by Herbert Rosenfeld. Patients in the grip of narcissistic organisations may want to make contact with others in the outside world but are prevented from doing so by an internal figure or group of figures who threatens terrible punishment. So it seemed with Peter who felt he had to isolate himself from his wife and mother and from the world of work for reasons that were unclear. Eventually he revealed that from the age of fourteen, ‘there had been a voice in his head that had ordered him not to speak and not to get close to anyone’ (53). Stammering was a way of obeying that voice. Peter also revealed he never stammered and could talk fluently when he was at home alone or when he was with children. Britton and Peter’s analyst took care not to introduce Rosenfeld’s model directly in Peter’s treatment until such time as he gave them cause to, which to their amazed delight he did. The model might otherwise have been a source of distortion and misunderstanding.

 

Analytic models can be useful only if they illuminate the analyst’s subjective experience of the patient’s subjective experience. But before such a point can be reached, analyst and patient have to learn to hear one another in as unprejudiced a manner as each can manage. It is to Britton’s credit that he does not minimise how difficult this can be for both parties. This stage of ‘building out into the dark’ as Freud called it, has its own micro-models too. Chief among these are the beliefs that the patient holds about himself and his analyst. ‘Believing,’ writes Britton, ‘is a form of object-relating. I think belief as an act is, in the realm of knowledge, what attachment is in the realm of love. The language of belief is clearly cast in the language of a relationship’ (82). For this reason, beliefs offer a point of entry into the patient’s internal world and the figures who inhabit it. They supply models of that world, seen from a certain point of view. At a more basic level still are the unmentalised psychophysical experiences that manifest themselves in the transference as ‘imageless expectations’ (19). These await transformation into the models constituted by fantasies, symbols and dream elements. These lower-level models form the bedrock of most patients’ and analysts’ analytic experience. The larger theoretical models such as the Oedipus complex or the ‘depressive position’ shimmer in and out of view but they must take their shape from this more detailed and theoretically open work. They have no substantial existence independently of it.

 

The systole and diastole of this process are transference and countertransference. Britton subscribes to the now widely-held but once heretical view that the analyst’s countertransference, far from being an obstacle to analytic progress, is a spur to it. The analyst has to be willing to receive the patient’s unconscious fantasies and to allow them to act on his unconscious mind. The hope is that the analyst will have enough self-understanding to distinguish what belongs to the patient from what he brings himself. Acting as the crucible for other people’s unconscious experience in this way is intellectually and emotionally demanding. As Britton observes, ‘Analytic neutrality does not mean freedom from emotion, it means unbiased observation of its play within ourselves’ (23). In his last book, Sex, Death and the Superego (2003), Britton went so far as to propose a new psychoanalytic nosography based on the kinds of countertransference experience that different sorts of patients evoke and some of that work is rehearsed again in chapter 7 of Between Mind and Brain.

 

Unsurprisingly, given his previous books, Britton thinks that literature and theology are rich sources of models of mental life. This volume contains interesting new material on myth as a model of mental life and on writing by Blake, Milton and Mary Shelley. Britton sees Milton as a man divided against himself. The theologian author of De Doctrina Christiana needed to secure himself against a suspicion that God might be a sadist (a line of inquiry which Stanley Fish argues runs through Paradise Lost). But the poet of Paradise Lost makes Satan the hero of his poem and depicts him as ‘a whole person experiencing conflict, remorse and dread’ (115). Satan (distinct from Milton) is a destructive narcissist in Herbert Rosenfeld’s terms and by engaging with him imaginatively, Milton defends himself against the depressive melancholia Britton thinks lay at the core of his theology. Britton has a vivid sense of what an achievement it is to live out ones conflicts in this way. In similar vein, Britton reads Blake’s Marriage of Heaven and Hell as an exploration of what is entailed in substituting one’s own ideal self for the superego. Most impressive of all is the chapter on Mary Shelley’s Frankenstein (‘What made Frankenstein’s creature into a monster?’). which Britton reads as a parable about the absolute horror of perinatal rejection for both mother and child’ (106).

 

I have given the barest indication of the many riches contained in this very fine book. I was left with only one puzzle. Britton says a great deal about Darwin the man in this book but very little about Darwinism’s implications for psychoanalysis. He complains at one point that the radicalism of Darwin’s theory of evolution has scarcely penetrated educated opinion. I think he’s wrong about that but what about Darwinian models of psychoanalysis: Bowlby’s, pre-eminently, but also the more modern version of attachment theory promulgated in this country by Peter Fonagy, Anthony Bateman and Mary Target and in the United States by figures such as Allan Schore? Neuropsychoanalysis is completely Darwinian in outlook. It would be good to have Britton’s opinion of these models, not least because they engage so many of his interests. The same thought was with me when it came to neuroscience, a field Britton holds in high regard. Neuroscience uses a thoroughly Darwinian framework when considering the structures of the brain: the basal ganglia making up the reptilian complex were the first to evolve; later came the limbic system, the seat of most of our emotional reactions; finally, the neocortex evolved, from which we humans derive so many of our cognitive advantages. These structures, which can be found in non-human animals too in different proportions, now supply the basis for a great deal of neuroscientific theory. Has psychoanalysis nothing to say about them?

These quibbles are based on a wish that the book had been longer. Coming away from it, my overall feeling was of gratitude for such an incisively-argued and powerful book.

Ageing, Embodiment and the Self: A One-Day AHRC Symposium

13 Jan, 16 | by cquigley

Khalid Ali: Taxi Ride To Eternity: Review of ‘Dry, Hot Summers’,

4 Jan, 16 | by Ayesha Ahmad

Taxi ride to eternity: Review of ‘Dry, hot summers’,

Directed by Sherif El Bendary Egypt, Germany, 2015, 4*

Premiered at Dubai International Film Festival, December 2015, and due to screen at Clermont-Ferrand Film Festival in February 2016

Available to view on major TV channels, and to buy DVDs in late 2016

Traditional teaching in medical schools and hospital practice recommends that doctors should share with patients and their families the prognosis in terminally ill patients, emphasising ‘the worst possible outcome’ to avoid giving unrealistic hopes when discussing resuscitation. However the film ‘Dry, hot summers’ challenges the above notions through the story of an elderly man terminally ill with disseminated liver cancer.

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Ayesha Ahmad: Spirituality in Conflict

25 Dec, 15 | by Ayesha Ahmad

This is a story about spirituality in conflict. As with all stories, there are two sides to the tale. There is, on one side, the battle to find and keep the spirit during conflict, when lives and worlds and families and homes are falling apart and disappearing. On the other side, there is the spirituality that emerges and grows and finds roots in conflict; not to celebrate or rejoice in the suffering of the human condition, but to create an unshakeable foundation for life. This is the story about spirituality in conflict that will be told.

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The Reading Room: Erik Parens’ ‘Shaping Our Selves…’ reviewed

1 Dec, 15 | by cquigley

 

Shaping Our Selves: On Technology, Flourishing and a Habit of Thinking by Erik Parens. Oxford University Press. 2014. xi+200 pages. Hbk. ISBN: 9780190211745.

Reviewed by Nathan Emmerich, Visiting Research Fellow, Queen’s University Belfast.

 

On the face of it Shaping Our Selves is about the way biomedical technologies, such as neurochemical enhancements and reconstructive surgeries, can be sued to alter and mould the human body and mind. However, the author has previously addressed both of these topics. What is on offer here is, first, a consideration of the way the ethical analysis of these technologies are characterised by polarised positions and, second, an account of binocularity. This latter is a metaphor and names a habit of thinking that, if adopted more generally, purports to promote a greater degree of mutual understanding between different sides in these debates.

Parens’ strategy is to demonstrate that participants in these debates do not simply disagree but have differing intellectual orientations, or lenses, through which they consider the matters at hand. Such disagreements are, therefore, a result of a fundamental incompatibility, even incommensurability, that lies at the heart of opposed ethical perspectives. Parens proposes that if we wish to increase our understanding of the matters at hand we should attempt to consider them by thinking in a binocular, as opposed to monocular, manner. Whilst he thinks that in the final analysis, and when deciding to act, we must lapse into monocularity (p.158), he maintains that when trying to fully understand the issues we can and must oscillate between different ‘lenses’ if we want to fully comprehend the issues at hand.

The binocular metaphor works because Parens is able to divide bioethics – or, at least, the literature on the topics he discusses – into two opposing and mutually incompatible camps each of which adopts different stances on a variety of matters. The camps are those of the enthusiasts and the critics. Those who inhabit these camps have, he says, two different kinds of ethical stances, each of which is associated with two different sets of conceptual ‘lenses.’ When he suggests binocularity involves oscillating between different perspectives it is these conceptual lenses he has in mind. This endeavour can be compared to the way our vision flips between seeing a duck and a rabbit in Wittgenstein’s famous example (p.39).

Thus, the purpose of binocularity is not to help us to see further and with greater clarity or to see in greater depth, at least not insofar as seeing in greater depth means developing a more detailed appreciation for the dimensions of a ‘monocular,’ ‘singular’ or ‘unified’ ethical picture. Rather it names a habit of thinking about different, mutually incompatible approaches to ethical arguments. The aim is not to adjudicate the arguments, to effect some kind of reconciliation or to uncover some sort of ‘third way’ compromise – although, particularly when one begins to think about substantive policy, this latter may in fact result. The avowed aim is, instead, to sensitise us to our own ethical partiality and, in so doing, to encourage us to become less combative and more bipartisan in our thinking. It is Parens’ hope that we will become less rigid in maintaining our ethical stances and, in so doing, become less concerned with winning ethical arguments and more concerned with developing a greater understanding of the issues.

It is a laudable aim and Parens’ discussion contains a great deal of insight into and appreciation for the essentially political problem of engaging in contemporary ethical debate in a mutually respectful manner. Nevertheless, there are some questions to be answered. For example, Parens divides bioethicists into enthusiasts and critics, roughly those who embrace emerging biotechnologies and those who are more cautious and critical of its potential impact. The characteristic perspectives of these two groups is fleshed out by a series of conceptual binaries, one of which is the idea that enthusiasts see biotechnology as ‘value-free’ whilst critics see it as ‘value laden’ (Chap. 4). Whilst this might be true of bioethicists like Julian Savulescu and John Harris, it is not clear that this applies to others who are positioned in this camp, such as James Hughes (p.60 & 95), Andy Clark (p. 81) and Donna Haraway (p.81). Indeed it is also not clear that these latter techno-enthusiasts – and other comparable figures such as, for example, Steve Fuller – would have much sympathy for the relative simplicity of utilitarian accounts. Equally, one could suggest that utilitarian bioethicists would no doubt find Haraway’s or Fuller’s thinking needlessly complex.

One can make a similar point about those who adopt a more critical stance. In Parens view the inhabitants of this camp include outright bio-conservatives such as Leon Kass (p.51), as well as more moderate conservatives such as Dan Callahan (p.15), Michael Sandel (p.60), and Hans Jonas (p.67). However, it also includes many if not most, sociologically inclined bioethicists such as Illina Singh (p.58), Jackie Leach Scully (p.136), and Tom Shakespeare (p.136), none of whom could really be considered anything but liberal in their general outlook. Whilst one might take this as suggesting there is a distinct problem with Parens binary nomenclature, it is important to note that he rejects the idea that the enthusiasts and the critics map onto standard political divisions of progressive liberals and traditional bio-conservatives (p.52).

Given the evident and significant differences between the perspectives held by those Parens groups into enthusiast and critic, we might consider Steve Fuller’s recent suggestion that the notions of left wing and right wing are undergoing an ‘axial rotation.’ Fuller’s thinking indicates that we should reframe these basic political differences in terms of ‘up wing’ and ‘down wing.’ The latter is associated with the ‘precautionary principle,’ something often espoused by those Parens has termed critics. In contrast the ‘up wingers’ are associated with the ‘proactionary principle’ or ‘imperative,’ an idea that stems from the enthusiasts’ reaction to the precautionary principle. Whilst they come from very different perspectives, Parens (the critic) and Fuller (the enthusiast) have, it seems, independently divided the world in very similar manners, indicating that their ideas have some degree of validity.

Whilst Parens’ division of bioethicists, and those who labour in associated fields, into enthusiasts and critics stands up to scrutiny, some of the associated binaries seem less robust. For example, he holds that enthusiasts see technology as value-free whilst critics hold that it is inherently value-laden (chap. 4). However, even if these individuals are not bioethicists per se, this division can be supported when we consider enthusiasts like Haraway, Clark and Fuller. Furthermore, given the scope of this division, what might it mean to propose that we oscillate between the view that our techno-scientific achievements are value-free and the view that they are value-laden? Parens asserts that “no thoughtful person would want to choose between thinking that technology is value-free and thinking it is value-laden” (p.93). Whilst I am not a true Scotsman, I certainly aim to be a thoughtful person and, as such, I fail to see why one should not ‘choose’ or, rather, conclude that all human technology is value-laden. In my view the alternative position is fundamentally flawed.

This is not to say that I cannot appreciate the arguments, the motivations and, to a degree, the value of arguments that presume that technology is value-free. Nevertheless, I cannot take them as seriously as work conducted from what I consider to be the more defensible perspective. Given that Parens is not proposing binocularity as a ‘grand, meta-lens’ (p.9), ‘cure or solution’ (p.10), or ‘panacea’ (p.172) perhaps this is all that is required when oscillating between competing, contradictory and incommensurable points of view. If so, one could think that what Parens is proposing is a mode or style of interaction between those with differing ethical stances and perspectives. Whilst he is not suggesting we abandon the pursuit of singular or monocular ethical perspectives, arguments and accounts, he is questioning how we ought to conduct ourselves when speaking across such divisions. One might, then, take him to be offering an ethics of the public square or, to put it another way, attempting to find a common socio-political space from which we can give proper consideration to divergent but genuinely held ethical perspectives. As such ‘binocularity’ is a kind of political stance, built upon the recognition that the neutrality of liberalism is not the same as liberalism being value free (p.49).

Whilst it is not discussed, at least not in any detail, Parens’ approach can be seen as insisting on the value-laden nature of the public square, our political debates and, for that matter, our ethical discourse. One can, I think, see this as predicated on the assumption that applied or practical (bio)ethics is, in essence, a contemporary political technology, one that bolsters the apparent neutrality of liberalism. As such it would seem that binocularity is predicated on the assumption that human technologies are not value-free, but inherently value-laden. Binocularity is, then, something that conforms to the worldview of the critics. However, it is not clear how well it might sit with those enthusiasts who cleave to the notion that technology is, or can be, value-free and that ethics is, or can be, considered in an ‘objective’ matter to be pursued through adopting an ‘impartial’ stance (p.23). If my analysis is well-founded, it is not clear to me why Parens’ putative opponents, the enthusiasts, would think the binocular approach worth considering; it seems to be founded on a set of values that seem anathema to their favoured approach.

In the chapter ‘Closing Thoughts’ Parens details how, when he embarked on his first major project at the Hastings Centre, he adopted a ‘high reason’ approach to (bio)ethical analysis of enhancement and did so against his own academic training and intellectual inclinations (p.161). Given that Parens identifies with the critics’ camp, one can see this as an attempt to adopt the stance of his opponents, the enthusiasts. Whether this was done to prove them wrong on their own terms or, as is more likely, something that naturally resulted from the process of entering a new field, of being a newcomer who naturally tries to fit in and find his feet by conforming to the rules of the disciplinary game, is not relevant. What matters is that the approach adopted by Parens belonged to his opponents. Whilst one cannot fault him for it – it was through doing so that Parens was able to fully develop his own ethical stance – it is nevertheless illuminating. In this light one might consider if Parens’ metaphor of binocularity fails to fully challenge his opponents; if, despite his intentions, it cedes too much ground to the enthusiasts thereby allowing their style of monocular ethics to flourish and, ultimately, maintain its position of dominance.

Against this one can, I think, point to an underdeveloped aspect of Parens’ account. On the one hand he claims binocularity runs against the grain of “the first law of thinking dynamics” (p.40), as conducting intellectual enquiries using more than one lens requires more effort than monocular thinking. However, towards the end of the book, Parens discusses a couple of cases that reveal the way in which ordinary individuals often appear to be thinking in a binocular manner and, furthermore, seem to be doing so with relative ease (p.149-151). If this is the case it seems to belie the notion that “we can’t actually think with any two lenses at once” (p.39). As the notion of lens is, here, a metaphor for ‘conceptual framework’ we should, I think, acknowledge that monocularity is a product of thinking from within specific disciplinary perspectives and may not be something that troubles everyday human reflection, at least not to the same degree.

To be clear, monocular disciplinarily has served us well. Nevertheless, given that the notion of ethical expertise or, at least, moral authority is widely rejected, then we should consider the positive and negative consequences that disciplinary rigour in the field of ethics has had for the way we understand our ordinary or everyday ethical thinking. Read as a plea to further reconnect academic ethics, and the study of meaning questions more generally (p.4), with lived experience as – for example, those working in feminist and disability ethics have done – and a broader, humanities based, understanding of human being, Parens’ argument takes on greater significance; it indicates that further reflexive development of this field of enquiry is possible. Indeed, consistent with this thought, Parens suggests that we are at the beginning of a ‘second wave’ in enhancement debates, one that exhibits a greater degree of binocularity (p.9 & 175). If what Parens calls the second wave is, as I suspect, marked by a relatively sophisticated and interdisciplinary approach to bioethical analysis, then his binocular habit of thinking may offer a much needed guide as to how such scholarship might be collectively understood and, ultimately, pursued in such a way as to contribute to and participate in the common good or, in Parens terms, human flourishing in the broadest sense.

 

 

 

 

 

The Annual Sowerby Lecture in Philosophy and Medicine

26 Nov, 15 | by cquigley

 

“If I had to live like you, I think I’d kill myself”: Explaining the Disability Paradox

Havi Carel, Professor of Philosophy and Head of Subject, University of Bristol

Comment: Brian Hurwitz, Professor of Medicine and the Arts, King’s College London

 

Thursday, November 26, 2015.

18.30-20.00

Guy’s Campus, New Hunts House, Theatre 1

 

Free, no booking is required

 

Abstract:

“The ‘disability paradox’ identifies a significant difference in how ill and disabled people rate their wellbeing, compared with healthy people asked to imagine how happy they would be if they were unwell. Ill and disabled people’s wellbeing rating is only slightly lower than that of healthy people. However, healthy people rate their hypothetical wellbeing as much lower when asked to imagine themselves as ‘hypothetical patients’. There are three possible explanations: either patients misreport their wellbeing due to adaptation, or healthy people mis-imagine ill-health, or both.

In this paper I examine these explanations and suggest that it is healthy people who misimagine ill-health. I also claim that it is impossible to claim that ill people are misreporting their wellbeing due to adaptaion without this having general consequences for any subjective wellbeing measurements. I also claim that the phenomenon of adaptation to illness raises important questions for health economics, and that the psycho-social mechanisms involved in adaptation can be illuminated by a phenomenological analysis.”

 

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