Ethics Talk; Talking Ethics: An Example of Clinical Ethics Consultation

This written account of a clinical encounter - depicting fragments of a more extensive array of events - attempts to exemplify many facets and associated complexities of clinical ethics consultation. Within the general telling, I provide more detailed portrayals of several key events. In secion 1, I document briefly my initial interactions at the beginning of the consultation, focusing on the information gained - in the context of those interactions - as I read the medical chart of Mrs. Rose. Next in section 2, I briefly describes my initial conversation with Mrs. Rose's three sons. Section 3 illustrates several questions raised in sections 1 and 2. Then section 4 presents my encounter with Paul, the youngest son, as he was carrying out his vigil at his mother's bedside in the hospital. Section 5 chronicles my interactions with several care providers involved in Mrs. Rose's situation, including two different meetings that occurred with Mrs. Rose's attending physician. I conclude in section 6 by telling about a conversation I had with Mrs. Rose's middle son, Russell, approximately one month after Mrs. Rose died.     

Altruism and Boundary Violation

ABSTRACT

The desire to help others is a common motivation for becoming a therapist, and boundary crossings are an expectable part of psychotherapeutic work. However, progression to boundary violation is rare. The concept of an altruistic boundary violation is presented and illustrated with detailed clinical material drawn from the analysis of Mrs. A,¹ a generally ethical therapist, whose violation of the therapist/patient boundary with her patient, M, began as an altruistically motivated enactment and boundary crossing. In Mrs. A’s case, and arguably in all similar altruistic boundary violations, a specific fit existed between patient and therapist. The intense need to rescue this particular patient was fueled by Mrs. A’s history of early physical and abandonment trauma, which increased her vulnerability to overidentification with her traumatized patient. The stress of relocation to another city and closing her practice further magnified her susceptibility. The complex clinical, professional, ethical, and legal issues inherent in consulting on such a case are discussed. I describe my countertransference and my parallel enactment, an initial crossing of the boundary between the roles of supervisor and therapist.     

Talking About Talking About Patients

Several years ago, I talked about a case in a clinical seminar. I presented the work in a style that is different from usual because I was experimenting with how to best evoke the experience of being with this patient for my listeners. This paper is a continuation of that presentation, now through written rather than spoken word. In writing it, I struggled with the same dilemma of how to evoke the ambience, the feel of being with this patient. I begin with a discussion of some of the dilemmas involved in writing up clinical work when the aim is to stay close to the experience rather than to illustrate theoretical or technical points. I present a few sample vignettes of my work with this patient and then an analysis of how my writing style, including use of sounds, grammar, and word placement, contributes to evoking experience. I continue with a brief discussion of my experiences in presenting the case in the seminar and use these experiences to highlight aspects of the case. I ask the reader to become personally involved in the experiment by paying attention to what is evoked when reading the material.     

Killing, Letting Die, and the Morality of Abortion

abstract   David Boonin, in his A Defense of Abortion, argues that abortions that involve killing the foetus are morally permissible, even if granting for the sake of argument that the foetus has a right to life. His primary argument is an argument by analogy to a 'trolley case'. I offer two lines of counterargument to his argument by analogy. First, I argue that Boonin's analogy between his trolley case and a normal unwanted pregnancy does not hold. I revise his trolley case in light of my objections. Second, I argue that Boonin's arguments for the permissibility of killing, when applied to this revised trolley case — and by extension, typical unwanted pregnancies — do not succeed in justifying killing.     

Abortion and Ownership

I explore two thought-experiments in Judith Jarvis Thomson’s important article, “A Defense of Abortion”: the violinist example and the people-seeds example. I argue (contra Thomson) that you have a moral duty not to unplug yourself from the violinist and also a moral duty not to destroy a people-seed that has landed in your sofa. Nevertheless, I also argue that there are crucial differences between the thought-experiments and the contexts of pregnancy due to rape or to contraceptive failure. In virtue of these differences, it would not follow from my conclusions about the violinist and people-seeds cases that abortion would not be permissible in a case of rape or in a case of voluntary intercourse with contraceptive failure.     

Commercial Contract Pregnancy in India,Judgment, and Resistance to Oppression

Feminist scholars have done much to identify oppressive forces within transnational commercial contract pregnancy and its social context that may coerce women into becoming gestational laborers. Feminists have also been careful not to depict gestational laborers as merely passive victims of oppression, though there is disagreement about the degree to which contract pregnancy offers opportunities for agency. In this article I consider how women who sell gestational labor may be agents against their oppression. I make explicit connections between resistance and judgment, which I will take to be a critically considered, intersubjective evaluative claim. Drawing on work by Jennifer Nedelsky and Hannah Arendt, my main argument will be that individual judgments can better enable oppressed persons to resist some aspects of their oppression, and that judgment helps to (further) develop agential capacities, in particular, the capacity for a person to be self‐constituting, to see herself as giving reasons for her own actions. I use Indian contract pregnancy as a case study to think through connections between resistance and judgment.     

Humor and the Rebellious Spirit of the Early Adolescent Boy

In my companion article on the making of the reliably religious boy (D. Capps, 2006c) I presented my argument that, whereas the younger boy of three to five is becoming religious as a result of his emotional separation from his mother, the early adolescent boy (age 11–14) has become reliably religious in that he has developed a religious habit of mind, a habit reflected in his embrace of the religions of honor and hope. I presented myself as a case study in this regard. I noted, however, that there is a third form of religion, that of humor, and that it relativizes—and thereby preserves—the religions of honor and hope. I also noted that religion and spirituality are capable of being differentiated. I suggested that my own spirituality took the form of rebellion and that this spirit of rebellion fueled and was fueled by the religion of humor. Employing Freud’s writings on humor, I explain in this article how this works.     

Climbing for My Life

As a woman in my 50th year, as a psychotherapist, a mother, a lesbian, I look back over my years as a technical rock climber. Returning to rock climbing after a 15 year break, I climb now in a new way and only with other women. Here I describe the experience of climbing, and the fulfillment and joy it can bring. I discuss the challenge of being an older woman beginning a sport that is associated with youth and can be risky. I discuss the importance of passionate play within women's lives and its therapeutic value.     

A Psychotherapist Retires

Abstract

This article reflects on a year of my personal experience as I prepared to retire from my psychotherapy practice of 40 years. While aware that this might be a poignant experience for bothmyself and my clients, my own surprising emotions and dreams demanded that I pay attention to myself. By acknowledging my feelings I was able to direct sensitive attention to the clients' feelings of loss and sadness. Finding the balance between the sadness that filled the therapy room and my own enthusiasm for what awaited me outside that room, was not a simple task     

Geometry, intuition and experience: From kant to husserl

I take this opportunity to thank my colleagues at ZiF for their very helpful comments and criticisms during the academic year. For the preparation of this paper, I am especially indepted to Michael Hallett, who not only improved my English but also saved me from a number of errors.     

Moving towards Soul – an alchemical journey. Rehabilitation of women suffering from ‘chronic pain’ in a clinical and Jungian context

The aim of this paper is to explore the connection between symptom and symbol in the body of women suffering from chronic pain, diagnosed as fibromyalgia. The working hypothesis has been that the symbol that emerges from the symptom in the body can bridge the gap to a deeper meaning of pain and suffering, thereby becoming the agent of change for healing of the bodymind and the experience of pain in the physical body. To explore this subject I will introduce some recent research from the field of fibromyalgia, and the concepts of agency and affect systems in the body, which are important cornerstones in my work. I will briefly present my clinical concept of ‘Form and Freedom’. From this theoretical base I give some clinical examples of what I see as an alchemical journey towards soul, presented through vignettes, images and the words of three women – Maria, Riba and Ishtar. I conclude with how I see analytical psychology taking its rightful place alongside, informing or in conjunction with, as in my case, other psychotherapeutic modalities, working in creative ways that enhance healing in patients who suffer from chronic pain.     

Blessed are the uncertain,for they will experience excess

In this paper I look at the possibility that uncertainty may not merely be a stage in the research process, but an outcome in itself. Exploring how university education and scholarship collided with my own personal experiences and identity I discuss how a combination of poststructural theory and my encounters with peace, conflict and religion enabled me to value uncertainty, and I make the case that uncertainty can open up the future to the gift of chance. By intertwining discussions of both lived experience and academic work, the organisation of the paper reflects how the two became inextricably linked, continuously folding into each other, so that my sense of self influenced my research, and conversely, my research influenced my sense of self. The outcome is a discussion of how I incorporated uncertainty into my research and personal life, which I explore using the example of religion, and how I lost and gained my faith, rejecting my previous Christianity while reconstructing a kind of faith found in uncertainty, a sense of place and ethical space to come.     

The Dialectics of Relational Psychoanalysis and Group Psychotherapy: Commentary on Paper by Robert Grossmark

In this commentary, I address the question of why so few psychoanalysts become group therapists as I respond to the thoughtful and impressive paper written by Robert Grossmark on his work with a psychotherapy group, now in its 10th year of meeting. Prior to discussing the clinical material, and to set the stage for a discussion of Grossmark's work, I comment on my sense of the prevailing attitudes on group affiliations and group therapy within our culture and field as they have progressed over time. I then discuss my reactions to Grossmark's handling of his group session. Many of his conceptualizations of group treatment are in accordance with my own beliefs. There are some differences, however, in how I view my role as a leader and some ideas I have about group treatment that Grossmark did not address.     

Spinoza's Thinking Substance and the Necessity of Modes

How should ‘the physical’ be defined for the purpose of formulating physicalism? In this paper I defend a version of the via negativa according to which a property is physical just in case it is neither fundamentally mental nor possibly realized by a fundamentally mental property. The guiding idea is that physicalism requires functionalism, and thus that being a type identity theorist requires being a realizer‐functionalist. In §1 I motivate my approach partly by arguing against Jessica Wilson's no fundamental mentality constraint. In §2 I set out my preferred definition of ‘the physical’ and make my case that physicalism requires functionalism. In §3 I defend my proposal by attacking the leading alternative account of ‘the physical,’ the theory‐based conception. Finally, in §4 I draw on my definition, together with Jaegwon Kim's account of intertheoretic reduction, to defend the controversial view that physicalism requires a priori physicalism.     

Memoirs of a Mentor: Using Creativity for Counselors in Coping With the Loss of a Mentor

This article was inspired by my (S.S.) own personal loss. My mentor passed away during spring break of my 2nd year postgraduate school after a short battle with systemic lupus. I remember the deep sadness that I felt when it became apparent that she was coming home from the hospital for the last time. No words can describe the emotions; she had helped me through the toughest times in my academic life. How would I ever get the type of mentorship she provided again? She was there when I almost quit as a young student, back when my anger still got the best of me. She talked me down from the edge so many times; I never expected to be on this journey without her.

I dedicate this article to her and mentors like her. Equally, I dedicate this article to mentees who have lost their mentors. I offer my story (in italicized font) in the hopes that it will help others who are dealing with a similar loss. In this article, we attempt to illuminate the true power of mentorship, honor the significance of the relationship between mentor and mentee, and provide a tool useful to anyone who has lost their guide. I share my story in gratitude for my own mentor; I am so thankful that she was a part of my journey and that I can pass on to others the patience she had with me.     

Speaking of Silence

In a previous article (Capps 2011) I discussed a short story and essay I wrote in high school and showed that themes that had figured prominently in my later writings were prefigured in these earlier writings. Invoking John Bunyan’s The Pilgrim’s Progress (1957) I concluded that the high school boy who lives inside of me has been my faithful companion throughout the years. In this article I focus on a sermon I preached in my senior year of high school and on several poems I wrote that year. The sermon and poems reflect my interest at the time in the harmful effects of silence on human relationships. An article that focused on the son of Saint Augustine (Capps 1990b) signaled my return to the issue of silence after a thirty-year hiatus. My subsequent reading of Alice Miller’s Breaking Down the Wall of Silence (1991) and The Truth Shall Set You Free (2001) helped me to understand why silence had been a personal issue for me. It also encouraged me to listen to the fledgling poet who lives within me and to appreciate his insights concerning silence and love.     

SYMBOLIC FOODS: PREGNANCY CRAVINGS AND THE ENVIOUS FEMALE

In my article I intend to show that the pregnancy cravings by Sri Lankan women constitute a system of personal symbols that must be understood in relation to the female role and the psychological problems engendered by it. I define personal symbols as those operating simultaneously at the level of both personality and culture. Through the notion of personal symbols, I intend to bridge the conventional distinction between private and public symbols and between culture and emotion. I show that pregnancy desires, which may be constituted as symptoms in the West, have been converted into personal symbols in South Asia since antiquity and given public meaning and validation.     

Pedagogical cliff‐jumping

This article chronicles how Introduction to the Study of Religion has become my favorite course to teach. In it, I narrate my process of pedagogical reinvention and syllabus redesign. Framed by professional and personal backstories, I share my pedagogical desires, list some pedagogical cues I took, and articulate pedagogical decisions and associated wagers. (Along the way, I draw on a range of disciplinary, interdisciplinary, and pedagogical materials as guides.) Then I tell how my Intro course realized these elements in its design and its execution. By doing so, I make a case for taking pedagogical risks and for reinventing Intro courses as performative responses to the practical and disciplinary question “how might we study religion?”     

PSYCHOTHERAPY AS PHASE-SPECIFIC INTERACTION

I am writing this paper to help myself, and hopefully some readers, to a better understanding of why some analysands in certain phases of the analysis develop the idea that they are homosexuals or that their analyst is homosexual. My basic thought is that even if these ideas have their individual roots and differ from case to case, they are also dependent on certain phenomena that are included in the analytic encounter and specified by different gender constellations constituting the analytic couple. I will present two examples from my own practice. From these two vignettes, I will draw some conclusions which are supported by my general psychoanalytic experience. The first example concerns male analysands. I have often seen male patients develop the fantasy that they “in reality” are homosexual. This fantasy is so common that it is a rule in my experience. I see it as a product of the fact that the psychoanalytic constellation consists, as in my case, of two men. The second example concerns female analysands. In a few cases with female analysands, I have seen the fantasy emerge that I, the analyst, am homosexual—a fantasy not seen in my male cases. Another difference is that I can't see this as a rule like the fantasy of the male analysands. In both the male and the female cases, I see the homosexual fantasies as a protection against discovery of the mother-transference to me. However, the fantasies have found different expressions depending on the specific gender constellation of the analytic couple: man and man and woman and man, respectively.     

Reconsidering a transplant: A response to Wagner

Nils-Frederic Wagner takes issue with my argument that influential critics of “transplant” thought experiments make two cardinal mistakes. He responds that the mistakes I identify are not mistakes at all. The mistakes are rather on my part, in that I have not taken into account the conceptual genesis of personhood, that my view of thought experiments is idiosyncratic and possibly self-defeating, and in that I have ignored important empirical evidence about the relationship between brains and minds. I argue that my case still stands and that transplant thought experiments can do damage to rivals of a psychological continuity theory of personal identity like Marya Schechtman’s Person Life View.