Death education in American medical schools: Tolstoy's challenge to Kübler-Ross

No one has done more to shape contemporary physicians' and nurses' understandings of dying and death than Elisabeth Kübler-Ross. A comparison of her views to those of another era, as delineated by Leo Tolstoy, raises questions concerning Kübler-Ross' five-stage theory and points out inadequacies in current medical education and in the values that shape American culture. According to Kübler-Ross, the dying person angrily asks “Why me?” Tolstoy's Ivan Ilych is more concerned about the implications for cosmic justice than for self-perpetuation, and angrily asks “Why death?” One's sadness is born of depression (sadness over the nearness of one's death), the other's is born of despair (sadness over the apparent meaninglessness of life or of life as one has lived it). Kübler-Ross and Tolstoy also differ in their views of what can be done to “sweeten the pill,” whether “acceptance” is the best way to face death, and whether death ought to be viewed as a barrier to self-fulfillment or a means of self-transcendence.     

Creativity,Spontaneity, Impasse,and Leaps of Faith: Reply to Commentaries

In my reply to the commentaries, I address several points of convergence with and divergence from Drs. Danielle Knafo and Philip A. Ringstrom. I clarify my view that while shame can drive the creative process, the thrust of my paper is about ways in which shame can close down access to one's creative potential, as well as creating obstacles to vitality and intimacy in relationships. I expand on how it was indeed a visceral, embodied sense of my own shame which served as an “informant,” as Ringstrom suggests, of Julia's chronic experience of shame, opening a door to our exploration of the repetitive enactments between us. Grounding my understanding of therapeutic action and enactments in a relational perspective, I describe how I view enactments as inevitable and co-created, and reflecting on them collaboratively as a potentially useful opportunity in analytic work. I resonate with Ringstrom and Knafo's belief in the creativity inherent in the psychoanalytic process, and the importance of spontaneity and risk taking, particularly in negotiating impasses in treatment. Finally, I describe Julia's poetic reflections upon reading the paper.     

Intimacy and the face of the other: A philosophical study of infant institutionalization and deprivation

The orphans of Romania were participants in what is sometimes called “the forbidden experiment”: depriving human infants of intimacy, affection, and human contact is an inhuman practice. It is an experiment which no ethical researcher would set out to do. This paper examines historical data, case histories, and research findings which deal with early deprivation and performs a phenomenological analysis of deprivation phenomena as they impact emotional and physical development. A key element of deprivation is the absence of intimate relationships with other human beings. However, the absence of intimacy impacts not only the social/emotional abilities of infants, but their very ability to perceive the world. Philosophically and from a radically Merleau-Pontean perspective, the intimate face of the other appears to be a world opening event for the child. Its absence has a profound impact on the child's experience of embodiment, coexistence, spatiality, temporality, and language. When seen through early deprivation, intimacy appears as a necessary foundation for establishing the transcendence of the world beyond perceptual presence, and it provides the possibility for language, culture, and history.     

Stages of Intimacy

In this essay, the authors have noted the common awareness in our culture of the "staging phenomenon" in intimacy relationships ("the end of romance," "the seven-year itch") and concluded that it must be possible to outline a framework which describes the developmental processes of intimacy against the background of the partners' individual developmental issues. In this context, many symptoms or troubles in a relationship can be seen as predictable crisis or impasses in normal relationship development. Even the emergence of bitter "warfare," resolute withdrawal, reduced sexual desire within the intimate relationship, or the sudden awareness of a new sense of one's own sexuality outside the marriage is both predictable and explainable as the growth of intimacy. The developmental framework outlined is reminiscent of Erikson's stages of identity-development and, in fact, acknowledges that it is the interaction of two or more evolving Identity-configurations that generates the predictable unfolding of intimacy itself. Attention is focused on the sequencing of critical tasks and common complaints normative to the first and second stages of intimacy-development, and casework illustrates the use of this construct as an approach to marital therapy.     

Surrender as a Developmental Achievement in Couple Systems

This article explores the concept of surrender in couple relationships. It proposes that the ability to allow oneself to “surrender” to one's partner is a developmental achievement that enhances intimacy between partners. Rather than conceptualizing the act of surrender as an indication of submissive behavior and/or the abuse of power dynamics in the relationship, it is argued that surrender can be growth promoting for individuals in the context of their relationship. The article expands the conceptualization of Emmanuel Ghent's (1990) classic paper that differentiated the concepts of masochism, submission, and surrender. The concepts of the paper are illustrated in a summary of clinical work with a heterosexual couple.     

Relationships between religiosity and attitudes towards death and dying in a middle-aged sample

Bivariate relationships between each of five components of (Christian) religiosity and each of six variables covering an individual's attitude towards death and dying were examined in a German sample of 93 men and 93 women aged 45–55 years. Most of the variables were assessed both by questionnaire and by means of interview and subsequent content analytical coding. In men, the fear of other persons' death and dying proved to be consistently negatively associated with various aspects of religiosity whereas in women, the fear of one's own dying was consistently inversely related to religiosity. Agreement with the moral standards of the Roman Catholic Church concerning sexuality and birth control was found to be positively correlated with two aspects of the fear of death and dying in women only. Belief in God showed a positive correlation with an attitude of acceptance towards death and dying in men only. Results are discussed within the context of Eysenck's theory of personality.     

ABSOLUTE ACTION: DIVINE HIDDENNESS IN KIERKEGAARD'S FEAR AND TREMBLING

This article reads Fear and Trembling constructively as a theological work. Abraham's faith is a lived movement irreducible to either ontology or epistemology. Faith is an action that waits upon what it alone could never accomplish. This is absolute action. In Abraham's case, he offers up Isaac to death with the absurd expectancy that Isaac will be returned. This double movement is a doxological abandonment of oneself and one's world to God that waits expectantly to receive them back as gifts. It is these dynamics of faith that show God to be hidden, precisely within the intimate drawing near of God. The article concludes with a constructive gesture toward an “apophaticism of action.”     

Phenomenology of Bodily Integrity in Disfiguring Breast Cancer

In this paper, I explore the meaning of bodily integrity in disfiguring breast cancer. Bodily integrity is a normative principle precisely because it does not simply refer to actual physical or functional intactness. It rather indicates what should be regarded and respected as inviolable in vulnerable and damageable bodies. I will argue that this normative inviolability or wholeness can be based upon a person's embodied experience of wholeness. This phenomenological stance differs from the liberal view that identifies respect for integrity with respect for autonomy (resulting in an invalidation of bodily integrity's proper normative meaning), as well as from the view that bodily integrity is based upon ideologies of wholeness (which runs the risk of being disadvantageous to women). I propose that bodily integrity involves a process of identification between the experience of one's body as “Leib” and the experience of one's body as “Körper.” If identification fails or is not possible, one's integrity is threatened. This idea of bodily integrity can support breast cancer patients and survivors in making decisions about possible corrective interventions. To implement this idea in oncology care, empirical‐phenomenological research needs to establish how breast cancer patients express their embodied self‐experiences.     

Experiencing Gendered Seeing

This paper explores the concept of “gendered seeing”: the capacity to visually perceive another person's gender and the role that one's own gender plays in that perception. Assuming that gendered properties are actually perceptible, my goal is to provide some support from the philosophy of perception on how gendered visual experiences are possible. I begin by exploring the ways in which sociologists and psychologists study how we perceive one's sex and the implications of these studies for the sex/gender distinction. I then discuss feminist philosopher Linda Alcoff's concept of “interpretative horizons,” which highlights the role that one's social and political identities play in how we understand the world around us. I also discuss Elizabeth Grosz's notion (borrowed from Merleau‐Ponty) of double sensation. I then apply some work in the philosophy of perception on perceptual learning and the cognitive penetration of perception to gendered seeing. My hypothesis is that we can explain how one's interpretative horizons are acquired through some notion of perceptual learning. I conclude by suggesting some of the epistemic and ethical implications of gendered seeing.     

Personal Inadequacy and Intimacy Predictors of Men's Hostility Toward Women

In this study we examined social/personality and intimacy predictors of men's hostility toward women (HTW). The study was framed in terms of a projection model that suggests that men's feelings of inadequacy contribute to hostility toward women. The sample consisted of 172 college men. The strongest attitudinal predictors were measures of locus of control. These data support the feminist analysis of sexual violence as an issue of power and lend support to the proposed projection model in terms of perceived powerlessness. In addition, based on the projection model, intimacy predictors for best male friend and female romantic partner were examined. The strongest correlate of men's HTW was intellectual intimacy, which conceptually is more related to the idea of an egalitarian relationship than other aspects of intimacy and may be most inhibited in men who are hostile toward women's intimate relationships.     

The nature of stress experienced by lesbians and gay men

Abstract

This study examined both the meanings and sources/causes of stress from the perspectives of lesbians and gay men (n=30), using a series of focus groups. The findings suggest that stress is considered a part of life itself, and is perceived to contain both negative (e.g. detrimental effects on health and overall functioning, unfairness, out-of-control), and positive (e.g. a motivator, growth-facilitator) elements. The sources/causes of stress (i.e. stressors) identified include stress experienced from the “coming out” process, stress in family relations and intimate relationships, conflict over one's sexuality given society's homophobic and heterosexist attitudes toward lesbians and gay men, as well as stress from financial and work-related issues. More importantly, this study suggests that culture/ethnicity, gender, and aging, which are interconnected with one's sexual identity, play an important role in shaping the experiences of stress among lesbians and gay men.     

Progressive Dying: Meaningful Acts of Euthanasia and Assisted Suicide

In this paper I use William James's understanding of “significance” in life to show that for certain patients euthanasia and assisted suicide can be importantly meaningful acts that family, friends, and health care professionals must acknowledge and even, at times, aid in bringing to fruition. Dying with meaning is transformative. It reshapes the lives of others that are left behind, giving to their lives new groundings by engaging them in the meaning of dying for us. For the patient, dying with meaning takes the seemingly formless void in the abyss of death and gives it a significant purpose in the last stages of life itself; it turns potential nothingness into actual significance. To the extent that we outsiders do not help the dying, we condemn terminally ill patients to a meaningless existence until they die.     

Talk about a past relationship partner: Metacommunicative implications

Abstract

Within many intimate dyadic relationships, individuals talk to their partners about a past relationship with a former spouse or lover. The impact that “talk about a past partner” (Tapp) has on one's current relationship is reviewed. Four metacommunicative functions of Tapp are suggested: disclosing past relationship history, conveying relationship rules or expectations, creating closeness or distance, and confirming self-perceptions. It is argued that the role of Tapp, within any given relationship, not only affects partners' feelings of security, control, closeness, etc., but also may reveal their characteristic patterns of communicating, metacomrnunicat-ing, interpreting and misinterpreting.     

Love from Afar: Distance,Intimacy and the Theology of Love

Proceeding from Jean‐Luc Marion's The Erotic Phenomenon, this article discusses how the Christian concept of love can manifest intimacy. While most theological concepts of love spell out the requirement of distance, they do not pay sufficient attention to the intimate variants of love. The article argues that a full‐fledged theological account should make room for love's different economic and donative variants, as well as for love's advance from ‘distance’ to ‘visibility’ and, finally, ‘intimacy’. Concrete examples of intimate love include mystical union, transforming hospitality, fidelity and love that is as strong as death.     

Practical Reason,Sympathy and Reactive Attitudes

This paper has three aims. First, I defend, in its most radical form, Hume's scepticism about practical reason, as it applies to purely self‐regarding matters. It's not always irrational to discount the future, to be inconstant in one's preferences, to have incompatible desires, to not pursue the means to one's ends, or to fail to maximize one's own good. Second, I explain how our response to the “irrational” agent should be understood as an expression of frustrated sympathy, in Adam Smith's sense of sympathy, rather than a genuine judgement about Reason. We judge these people because we cannot imaginatively identify with their desires and attitudes, and this is frustrating. Third, compared to the standard cognitive view, my account better explains the nature of our criticism of the “irrational,” and, by portraying “irrationality” as a cause of upset to other people, provides a better normative basis for being “rational.”     

Daily experiences of intimacy: A study of couples

The present study examined people's working definitions of intimacy, which emerge through daily interactions that are perceived as intimate by the participant. We proposed that working definitions should be reflected in a set of interaction characteristics that prompt relationship partners to label their interaction as intimate. Participants were 113 cohabiting couples who completed questionnaires and kept diaries of their interactions for 1 week. Interaction characteristics explaining perceived intimacy were interaction pleasantness, disclosure of private information, the expression of positive feelings, the perception of being understood by one's partner, and the disclosure of emotion. Further, more satisfied couples perceived their interactions as more intimate and showed stronger associations between interaction intimacy and partner disclosure than did less satisfied couples. Findings indicated that couple characteristics are more salient than person characteristics as predictors of intimacy in interactions. The deepest need of man, then, is the need to overcome his separate‐ness, to leave the prison of his aloneness. The absolute failure to achieve this aim means insanity, because the panic of complete isolation can be overcome only by such a radical withdrawal from the world outside that the feeling of separation disappears–because the world outside, from which one is separated, has disappeared.     

Radical Moral Imagination: Courage,Hope, and Articulation

This paper develops the basis for a new account of radical moral imagination, understood as the transformation of moral understandings through creative response to the sensed inadequacy of one's moral concepts or morally significant appraisals of lived experience. Against Miranda Fricker, I argue that this kind of transition from moral perplexity to increased moral insight is not primarily a matter of the “top‐down” use of concepts. Against Susan Babbitt, I argue that it is not primarily a matter of “bottom‐up” intuitive responsiveness to experience. Beyond courage and hope, radical moral imagination involves the articulation of inchoate experience, which allows individuals to make new kinds of moral moves and to lay claim to others' acknowledgment of the meaning of these moves.     

I Love to Tell the Story: Reshaping the Narrative of Adoption

Abstract : This article argues that a Christian theological understanding of adoption can be a helpful corrective to some of the negative interpretations and assumptions around adoption that continue to circulate in secular culture. The article proceeds as follows: First, I argue that the way in which Christians understand and describe the experience of being adopted into God's family counters the idea that one's birth family is one's “real” family. Second, I argue that a Christian understanding of adoption mitigates the tendency to view adoption as a sort of “Plan B.” Finally, I argue that because of the value Christians place on caring for those in need, and the replacement of kin relationships with relationships of love and faith, the metaphor of adoption can and should be used more widely, to create broader networks of family that encompass far more than mere blood ties.     

Maslow's Puzzle: A Reconfiguration

Abstract

A.H. Maslow (1963, 1993) characterized the “creative attitude” in ways such as giving up the past and future, loss of ego or self-forgetfulness, Taoistic receptivity, and innocence. He suggested that underlying these and related characteristics may be “certain prerequisites,” which he offered to us as a “puzzle.”

“Maslow's puzzle” may be considered in relation to what he regarded as a sine qua non of creativeness: “fusion of person and world.” The greater intimacy of such a relationship means that the individual has more fully extended self into that which lies beyond self, that is, into transpersonal realms or fields. A study of such fields, based on representations of fields in general, may provide a different insight into “Maslow's puzzle” and the enhanced creativity with which it is associated.