Identity Two


I sure do miss reading Potentilla’s sharp and friendly comments, so was glad to read what’s on her mind at Auspicious Dragon yesterday, where her husband Colin posted this. He tells me he’ll read comments to her. Potentilla’s “Christian” in real life…funny, she once told me, because she’s not. — Jean Kazez

Christian may not be always able to remember why she started the sentence that she is currently in the middle of, but that doesn’t stop her being able to remember the title of philosophy essays in obscure journals when they help her make her point. In a way it makes sense – easier to get somebody to read something than to try and explain it.

Anyhow, Peter Strawson, ‘Freedom and resentment’ from the Procedings of the British Academy, 1962.

The essay isn’t primarily about the point she was trying to make, but it does contain a succinct description of her current state. That is, the state of not being considered to be a full human being.

In the hospice a patient would have to be much worse than just badly behaved to get any opprobrium. Probably to provoke the staff a patient would have to be doing something harmful to another patient. And maybe in extreme cases not even then. Your status as a responsible adult is held in suspense. It isn’t fully revoked but it isn’t in place either. The relationship between the carers, helpers and domestics and the patients is odd. Not odd as in being unexplicable, but odd as in being outside of the norm of everyday life.

Strawson talks about our reactive attitude to people that we see as being excused from normal civil behaviour because of some factor no fault of their own. He was thinking of the very young, or the mentally ill, but it can also apply to those in pain, or under the influence of necessary drugs.

The second and more important subgroup of cases allows that the circumstances were normal, but present the agent as psychologically abnormal – or as morally undeveloped. The agent was himself; but he is warped or deranged, neurotic or just a child. When we see someone in such a light as this, all our reactive attitudes tend to be profoundly modified.

(Note: if you read the essay, I realise that I may be conflating Strawson’s two subgroups. But the aim here isn’t to produce a critical essay of Strawson’s ideas).

So when Christian talks about not knowing who she is anymore, this is partly a result of what is going on in her head, and partly a result of the fact that everybody around her is treating her in a way she can understand is not normal. It is this loss of her complete identity that, possibly, distresses her most.

This is worth thinking about because this is a state that waits for many of us. And if you think not, then you haven’t looked inside an old people’s nursing home. Identity isn’t about the practicalities of numbers on a card, but about being treated like an adult by being expected to behave like one.

Strawson talks about our ability to suspend our normal reactive attitudes in exceptional cases and for short periods of time. We will allow people we know a certain scope or allowance for behaviour not normal nor mature. To receive permanent, or at least long term, dispensation, a person needs to be marked out in some way – be it illness, or learning disability, or youth – such that they are clearly outside of normal expectations. Being tied to an oxygen tank and a morphine pump is one such marking.

The question of ‘what is a person?’ and how we, collectively or individually, respond to the walking bundles of chemistry that make up the outward appearance of person-ness turns out to be a fascinating question.

A copy of the Strawson essay appears on the UCL website – but note the warning to refer to the original before relying on the web copy.

Leave a comment ?


  1. I haven’t read the Strawson essay, but I promise to.
    However, you seem to be talking about the way, for example, one generally reacts to a severely depressed person. One at times recognizes that said person is ill and thus, need not make a normal effort to share the workload, and then one begins to think that hard work never hurt anyone and that said person is just lazy and why, after all, am I making an extraordinary effort for an able-bodied adult? Thus, one wavers between considering the depressed person as sick (and therefore exempt from a normal effort at sharing the work) and seeing her as a spoiled child with a strategy for doing less than her share. For a while, one is a model of consideration and empathy and a little later, one thinks that a cold shower would do her good.

  2. There is a little known and poorly rated movie, the only one made by philosopher turned movie maker Greenebaum. It is precisely what Guest (?) Jean (?) is talking about in Identity Two. Based on a true story, a dope- smoking, unshaven, late-to-work, goofy floor scrubber is unable to adopt the mind set of the caretakers of the old people in the assisted living home. His problem: he sees them as people, plain and simple; this leads him to behavior that is humane and incorrect. The bits of symbolism are only a little bit too obvious: goldfish slightly too large for their bowl; dog wants out, he lets it out, grief comes to dog; someone wants to talk to her father in heaven, he calls and pretends, unhappiness sometimes results. Certainly, the movie, which is mostly real inhabitants of a real terminal house of care, makes clear that it is very difficult to know how far to let yourself into the minds and senses of those handicapped by their circumstances. I don’t know if the movie is generally available. I got it on the Sundance channel and I know that Netflix has it. I wonder if the director went back to philosophy. Maybe he’s right here, using a synonym.

  3. I’m going to read that Strawson essay too…I think I did, a long, long time ago. I always loved the title.

    rtk–“Identity Two” was written by Colin, expressing what’s on Potentilla/Christian’s mind. What’s the movie called?

  4. Sorry, I left out the name of the movie.
    Assisted Living.
    Not to be a spoiler, but it is made clear in the beginning that he loses his job.
    The bingo scenes are worth the price of admission.

  5. I wonder if we put too much social expectations on the healthy, mentally competent adult. Maybe it is children and mentally-hindered people who most treat as actual people where we treat others as we would employees–people who have a duty to do something and are valued to us only by how much they perform that duty.

    Maybe society would benefit if we were as forgiving and understanding with everyone as we are with children and the mentally ill.

  6. This definitely happens. Clinical psychologists are often asked to come in and understand why someone’s behaviour is ‘difficult’ in, say, a dementia, learning disabilities or mental health ward.

    What you find is that carers and staff who know the person well are actually being quite blaming in their attitude towards them. Psychology will do a behavioural formulation and show everyone how the ‘difficult’ behaviour reflects some sort of operant conditioning by staff or family. We then ask staff or family to change their behaviour and see what happens.

    After we explain all this, something strange happens in the staff or families approach to the person. A shift happens, and they stop seeing the person as a rational agent, and more like a bag of contingencies. They may feel more compassionate, but they also begin to care less and detach. It’s at this point that families often decide to put people into nursing homes.

    Personally I sometimes celebrate when the person defies explanation and the ‘difficult’ behaviour continues. It often seems like a fairly justified protest.

  7. Paul: That’s another problem with depressed person, A. At times the depression, the difficult behavior, seems like a “fairly justified protest”, to use your words. At times it seems like self-pity or a failure to recognize that the universe owes us nothing .

  8. True – but misery is misery and can come about for many reasons – it’s probably the cause of the misery, not the misery itself, which will determine our reaction.

    E.g., there’s misery because of a failure to be better than everyone else or then there’s misery because of loss, or misery because of the pain of others.

    By the way, see the following link for quite a profound article on love, death and grief. It asks us whether we have cause to regret our ‘resilience’.

  9. Paul: Good psychology. Yes, it’s the cause of the misery which determines our reaction. The problem is that person’s A perceived causes, that is, the causes of her misery that she perceives, often are not the causes that I perceive. So, if person A blames her misery on lack of decent (according to her upmarket standards) summer vacations, I tend not to sympathize. When I reflect upon the chain of causes which lead her to blame her misery on a lack of decent summer vacations, which I don’t always have leisure and space to do, I feel sympathy. I’ll read your link later. Thanks.

  10. Sounds like a trip to the travel agent would be more appropriate than anti-depressants then?

    (don’t tell the drug companies)

  11. Paul: I’d say neither a travel agent nor anti-depressants, but a different attitude, more realistic, more stoic (in the philosophical and the normal sense of the word), more thoughtful, more critical of the confused and contradictory values that she was raised with, more willing to recognize that she shares the common lot of humanity, that no one is special.

  12. I’m feeling highly edified now, as I spent the afternoon reading Freedom and Resentment. I can sure see why the article popped into Potentilla’s head…the vivid parts, anyway. (I hope the very abstract Oxford-ish parts did not…ouch.)

    In Strawson’s terms, it sounds like the staff at a hospice don’t adopt the usual “reactive attitudes” to patients–like resentment, gratitude…all the things involved in seeing them as responsible human beings. They take an objective attitude, where the patient is just to be understood and managed. Strawson says the result can be isolation for the person who is treated this way. Makes sense.

    I wonder how I would feel in this situation. Is it really being seen as responsible that I would want, or just some power and individuality? My only remotely similar experience was being stuck in a hospital on bedrest for two months before my kids were born. I remember being irrationally fixated on the horrible food and throwing fits about things like how it would take two hours to get a fork sent up with which to eat a salad.

    Then again, I probably didn’t have that terrible feeling of losing identity because I wasn’t, even though some of the nurses would get into that “how are we feeling?” talking-to-a-child mode. If I ever find myself losing identity (we all stand a pretty good chance) I wonder if it would do any good remembering some Buddhist wisdom about no-self. I find that stuff appealing and actually quite reasonable … but so far just on paper.

    I’ll stop rambling now. I’m looking forward to reading Paul’s link.

  13. Hello! This is written with trepidation as I haven’t posted on a site like this before… In fact, it was Christian who directed me here in the first place.
    This ‘dialogue’ you have been having made me think of two things: firstly, Oliver Sack’s book, Awakenings, where he talks about two sets of people suffering from the disabling aftermath of sleeping sickness. He describes how one set remain animated and vivid: they live in a ‘caring’ environment; while the others – who are in an efficient, impersonal institution – are slow and apathetic. He does point out, of course, that there might be other mitigating factors.
    But, secondly, I was thinking of how we treat people who are temporarily ‘not themselves’: grief stricken or stressed. ‘Go easy on so and so’, etc’; and even that phrase, ‘not themselves’. We can maintain an attitude of understanding for a certain amount of time. Then, it’s as if either we lose patience; or perhaps we perceive that, if the person hasn’t ‘snapped out’ of it, we need to change tactics.
    Perhaps we’re not evolutionarily equipped to deal with such a situation long-term, because it’s only relatively recently that people with high dependency have been able to receive the physical support they need.
    The other point I wanted to make is slightly different and involves simple cause-and-effect; if we fail to treat people using natural, human interactions/reactions, then they risk losing part of their humanity, don’t they?
    Anyway, I must read Strawson, too!

  14. Paul: According to your link, I’m sub-resilient. The only significant loss in my life taught me to cry again, left a space in my life which will never be filled and changed me in many ways. I did not bounce back, and I’m not sure if there is any place to bounce back to.

    Jean: Hospitals (horrid places) tend to treat us objectively, not reactively, but so do hotels. Actually, Strawson exaggerates the quantity of reactive relationships which occur in normal, everyday life. Most of my interactions with other human beings are governed by what Marx calls “the cash nexus”: I sell my services as a translator; I buy products or services, including health care. Those are objective, not reactive relations. The reactive relations are few and far between. Perhaps things are different at Oxford.

  15. Perhaps Martin Buber’s distinction between ‘I-It’ and ‘I-Thou’ relationships matters here too?

    Although I don’t really understand it all too well I think it’s been pretty influential in theology (and psychotherapy).

    Can’t wait to read Strawson and I’m going to email it a behaviourist lecturer I argued with last year – he tried to make the point that treating people like determined objects was empowering. Talking about having one’s cake and eating it.

    Amos: I agree entirely with the stoicism and solidarity you advocate. The latter is what I liked about Richard Rorty’s book ‘Contingency, irony and solidarity’ – although every chance I may have misunderstood large parts of that book. And I also note resilience and sub-resilience are evaluative statements, born out of the idea the former is a good thing and the latter bad – all of which is up for debate as per the link. Again, I’m going to wave it around next time the psychiatrists start lecturing about ‘pathological grief’.

  16. “…that no-one is special”

    Amos: that’s a difficult one to realise though. Even once you’ve realised it, it’s even harder to remember. We all desperately want to be special don’t we?

    It’s a pretty hard one to put down – wanting to be the prettiest or the bravest or the wisest or the richest or the most powerful or the kindest or the most generous etc etc…

    We’re getting to basic reasons for living for a lot of people (erm, not myself of course…). Again, Frankfurt (2004) is good on this:

    “One of the best recent moral philosophers, the late Bernard Williams, suggests that it is a person’s ambitions and plans—what he calls the person’s ‘projects’— that provide ‘the motive force that propels the person into the future, and gives him a reason for living.’ These projects are ‘a condition of his having any interest in being around’ in the world at all. Unless we have projects that we care about, Williams insists, ‘it is unclear why we should go on’…”

    “…Surely Williams has it backward. Our interest in living does not commonly depend upon our having projects that we desire to pursue. It’s the other way around: we are interested in having worthwhile projects because we do intend to go on living, and we would prefer not to be bored. When we learn that a person has acted to defend his own life, we do not need to inquire whether he had any projects in order to recognize that he had a reason for doing whatever it was that he did.”

    Frankfurt, H. G., (2004). Taking ourselves seriously and getting it right: The Tanner Lectures on Human Values. Stanford University.

  17. Katie, It sounds like Christian is in a very caring environment, but maybe they’re “killing her with kindness”…that’s what Colin’s post made me think. It must be strange to be on the receiving end of nothing else, on and on and on. We are used to interacting with people in many other modes.

    Paul–Hmm… When philosophers try to be “real” about life they often get into talk that sounds unreal…all that project talk! These people never spent a weekend loafing around. Or maybe Frankfurt did and Williams didn’t.

    Amos–I suspect I have no resilience at all where my kids are concerned…I am all vulnerability. It’s a terrifying thing.

  18. The affirmation that no one is special has nothing to do with whether one is the best at something or not.
    It’s more about what I might call the only child syndrome. In popular theory at least, although not always in my experience, the only child grows up believing that all her mother’s love is focused on her and therefore, that she is special, that the universe revolves around her. Actually, we are all the best at something, perhaps something very trivial to the rest of humanity, like understanding the woman in our life, but we realize that everyone else is also best at something. As to the project debate between Frankfurt and Williams, I can see the point of view of both. Once we have a project it gives meaning and focus to our lives, and a depressed person generally lacks that focus. On the other hand, there are people, Frankfurt people, who just enjoy living. I’m more like Williams myself.

  19. “The affirmation that no one is special has nothing to do with whether one is the best at something or not.”

    I hadn’t thought about it like that – I see what you mean. I don’t agree that the desire to be special and the desire to be the best at something are completely unrelated, but I see they are partially distinct. I guess we need a distinction between being the best at something (e.g., natural ability) and wanting to be the best at something.

    As for the only child syndrome, I don’t know the data or theory well but I suspect there is a link between having an ‘ideal caregiver’ in childhood and needing the same in adulthood. Attachment theory probably explains a fair bit here – or object relations.

    Re the project debate – I’ve gone from Williams to Frankfurt in my thinking and, bizarrely, my enjoyment of my ‘projects’ has increased in turn. I suppose you might say I’m a Frankfurt person now.

  20. The need to be best at something, first of all, is tested by reality. Either I win the chess game or I don’t. Second, even if I win the chess game and all following chess games, the day that I need a plumber fast and a guy shows up who fixes in five minutes what I could not fix in five years, I see that my excellence only extends to a small area of human
    expertise. The feeling of being special, on the other hand, which is by no means just an illusion of children without siblings, is never tested against reality. Rather, it’s a defense against reality. It’s the feeling that one is the center of the universe, that one by divine right, so to speak, deserves more than the rest of humanity, that the desires/preferences of others are of lesser importance than those that one has. The arts seem to attract those who feel that they are special, I imagine because in the visual arts today there is little or no reality testing of quality.

  21. Said Amos: The arts seem to attract those who feel that they are special, I imagine because in the visual arts today there is little or no reality testing of quality.

    Delicious! Now we’re on my turf. Was there ever a time when there was a *reality* testing of quality? Whatever does that statement mean, anyhow? The work is either not new and may conform to old standards or the work is indeed original and has no reality against which it can be tested.

    I realize I am diverting here. Sorry. Ahem.

  22. You’re not denying though, that some people, some of the time, seek ‘specialness’ through trying to be the best at something?

    Or that some people some of the time believe that their excellence at say, making money, is evidence in support of their theory that they are in fact ‘special’?

    Your point that excellence can be empirically supported, while specialness can seem more like an unfounded assertion seems true enough!

  23. “It’s the feeling that one is the center of the universe, that one by divine right, so to speak, deserves more than the rest of humanity, that the desires/preferences of others are of lesser importance than those that one has.”

    Back to metaphysical respect for others?

  24. rtk: Sorry to tread on your turf, and I may well be on shaky ground, but there was a time when there existed peer review among visual artists, as there does today among musicians. Musicians will tell you that A cannot follow a score or that B plays too fast or that C has no sense of rhythm. At one time, way back when, painting and sculpture dealt with the reproduction of what I’m going to call reality (let’s not argue about what reality is, please), and so peers might well say that artist X cannot sketch a human face or that artist Y has trouble with perspective in his or her painting. Now, if I am clever enough, I can exhibit this post or my shopping list as a work of art (I once did it), and no one really knows what standards of quality are. Perhaps you find me to be impossibly old-fashioned or square. For the sake of diplomacy, I will not continue with my opinion of the art world today. By the way, just to situate myself historically, in my opinion, abstract expressionism can be judged with fairly clear standards. The fact that something is original surely does not make it aesthetically valuable, in any case. I have the feeling that if you come from the contemporary art world, our conceptions of aesthetic value are so different that we are going to find it difficult to maintain a dialogue.

  25. Paul: Sure, some people might imagine that there ability at making money makes them special. In fact, it tends to happen. Yes, my viewpoint on specialness has something to do with metaphysical respect for others or rather it’s part of the same mindset, so to speak. Imagining oneself to be special seems to entail a lack of recognition of the worth of others, thus, a lack of metaphysical respect. Imagining oneself to be special also entails a need to feel superior to others, a metaphysical superiority, without a basis in concrete achievements. I suspect that it often is related to class prejudices, especially those prejudices found in a traditionally prestigious social class which finds itself to be threatened by a new, rising or emerging social class.

  26. And bringing it all the way back round to the Strawson essay, perhaps it’s a lack of metaphysical respect which a patient in hospital often detects, albeit for different reasons.

  27. This is getting complicated, but from my experience in a hospital, the problem isn’t a lack of metaphysical respect. Hospital workers, from doctors to the people who clean the rooms, probably are more well-intentioned than the general population and they try to treat each patient with respect and concern, even if that respect and concern is forced and somewhat artificial at times. The first problem is the patient’s lack of autonomy: she is passive, without control over her life. Space is another problem, at least for most of us who cannot afford a private hospital room. Another problem may be that the hospital staff in their desire to show concern and metaphysical respect for all patients no longer react naturally or spontaneously to patients: they smile at patients who they dislike as well as at patients who they like. Jean remarks above that the hospice where Christian is sounds like a very caring environment, but where the patient, being passive, is just on the receiving end, is just an object, never a subject. I agree with her: one is never an active subject in a hospital or in most medical situations and that may be a lack of metaphysical respect, after all. You may be right, Paul: however, if that is the case, metaphysical respect is more complicated than we first imagined.

  28. Amos: Much contemporary art is generally not about aesthetics at all anymore. Aesthetics can be a component, but concept is key. “Ugliness” is actually lauded by some as being “less superficial” and more difficult to achieve deliberately than an appealing aesthetic. However, having said all that, I suppose anti-aesthetic art is really just another kind of aesthetic. Aesthetics are still important in commercial art and in many lowbrow sub-cultural art forms, but in the cutting edge of the contemporary art world the ultimate aim of the game is certainly not to make something look appealing: it’s to make a comment of some kind, often about art itself. That’s not to say aesthetics aren’t often incorporated into the mix, it’s just that it’s not the highest value anymore.

    That’s my understanding of it anyway: I’m not formally educated in contemporary art, I just have an interest in it.

    And Paul: I don’t think depression is necessarily about not being special. I think it could often be a sort of confusion about who one might really be, and therefore a feeling of a lack of fulfillment in life, due to choices made in error of an understanding of oneself. I think it has a lot to do with social pressure to be something special, or at least not a “loser”. I guess everyone needs to learn at some stage to be happy with less.

  29. Ugliness is lauded? Not really.
    Is art about aesthetics? Is any art about itself? I hope not.
    Is music about music? Is philosophy about philosophy? If it has a number attached, like 101 or 302, yes. Otherwise all of the above are about whatever is on the mind of the person trained to express himself in that particular medium. There is considerable cross-over: visual ideas expressed in poetry, philosophical ideas via music. Strictly speaking, aesthetics is in the eye of the beholder. Less strictly, whatever the artist says is art is, in fact, art. Whatever resonates with the mind or heart behind the eye or ear of the beholder is aesthetic although not defined as pretty. The argument has been going on for centuries. Especially isms have all been accused of being not only ugly, but belligerently anti-beautiful.

    I think the basis for hostility towards modern art of all persuasions is the confusion caused by new approaches that sometimes gives the viewer the sense of being fooled by the artist’s apparent trickery. Tricking the public is not such a satisfying pursuit that it is likely the practice of work that seems hard to understand. Our tastes are formed in our own time and often can’t readily connect with expressions reflecting current sensibilities. The key word is readily. I think it’s worth trying.

  30. Interesting, rtk. “Ugliness” has at least been explored, if not lauded, by some, or been merely created as a by-product. I didn’t mean to imply that ugliness was the goal of all contemporary art, but that
    ‘beauty” was not always, if ever, the goal.

    Like philosophy, conceptual art takes time to figure out. It’s great when it “clicks”. Education helps one understand the ongoing dialogue through the eras. I think appreciation comes with understanding.

    Re “it’s art if an artist says so”: surely recognition by others also plays a part here though, both of the artist and of the art?

  31. I don’t think ugly or beauty even enters the mind of the artist. Just truth, which contrary to rumor, isn’t necessarily beauty, and isn’t all we need to know. Speaking the artist’s truth and letting the chips fall where they may has been the custom since artists first drew portraits of their intended prey on their cave walls. Picasso’s take on Guernica certainly left beauty out the equation. As for judgement by others being of help, it does get in the way of direct response, for me at least. Even if I’m the one judging my own response. Case in point: I was listening to music that I know I would not like, certainly I would judge it harshly, I couldn’t possibly like Enya, of all people. But it did resonate and all my reasons were worthless to me.

  32. Hi Rose – I completely agree that depression isn’t necessarily related to not being special (hope you didn’t think I was saying that!). Probably most of the time it’s not – just some of the time for some people.

    Depression or extreme misery is an endpoint (or even side-effect) of lots of different processes in my view including all the ones you mentioned.

    Anyway, what’s wrong with wanting to be special? At least to someone…

  33. Getting back to hospices for a moment!

    I just wanted to say people who work in them must be worth their weight in gold. When I was in the hospital for 2 months, I had interactions with zillions of nurses and technicians, etc., and have to say I was amazed by all these people. The doctors would rush in and out, but at the lower end of the pecking order you’ve got just very nice, caring people. (Except the people in the cafeteria–they are evil folks who surely have no other goal but to torment patients.)

    The problem that Colin brings up is that nice is not enough and there’s a very deep problem with maintaining your whole identity amidst a tidal wave of niceness. It is difficult. Maybe harder for some than for others to just be accept being on the receiving end and to be unaccountable. I have the impression that Christian expects a lot of herself! (Which is one of the reasons I think she’s amazing.)

  34. I once knew a man, a retired officer from the Royal Marines, who had leukemia, and had been maintained fairly well on medications for several years. Finally, he ended up in the hospital. The nurses called him by his first name. When I stopped by to visit, he said, ‘I didn’t say they could call me by my first name. And they treat me like a child. I won’t stand for this.’

    Shortly after being discharged, and knowing full well that he would be back soon, perhaps for good, he shot himself. The signs were there, and I didn’t notice. But he would not have been happy in a hospice or nursing home, and I often think he did what was for him the right thing.

    You know, I don’t know about Christian, but I think in the case of a lot of people who are in Christian’s situation it really has nothing to do with Strawson, except insofar as Strawson was concerned with the conceptual structure (if you like) of freedom. For people like my retired officer, it had to do with the unmaking of his world, and I wonder why no one (I’m afraid I read over the notes quickly) has raised the issue of the right to die. May not apply to Christian — probably doesn’t — but it applies to a lot of people who are in distress, and whose worlds are simply coming apart at the seams.

    And, lest you think this is something that is unusual, read Sherwin Nuland’s “How We Die”. It’s a sobering read, and helps one appreciate the kinds of distress and dehumanisation that the terrible process of dying brings to so many, something I have witnessed more often than I should like to have done. Hospices are all very well, but they can’t deal with the deepest suffering and the most searing distress.

  35. I agree that people being so nice to you can be a very unsettling experience. When I was in the hospital, I tried to penetrate the masks of niceness of the hospital staff, and it was almost impossible. I suspected that the head male nurse, in my opinion, the most intelligent and lucid member of the staff (I exclude the doctors who are untouchable) disliked me for trying to pry into who he was and what motivated him, but he never dropped his mask. I asked everyone questions about why they entered such a demanding profession, with long night shifts, but never got answers which satisfied me. The masks may also be part of Christian’s dilemma.

  36. Whoops, sorry for going completely off topic before!

    I suppose medical staff would need to develop a kind of detached and measured compassion. I’m not sure whether it’s taught or a natural reaction to constantly dealing with sick people who may die. I think allowing an emotional reaction to all charges would lead to doctors and nurses being burned out in a matter of weeks.

    There are far less favourable postures to be met with than detached compassion. When I was six months pregnant with my second child, I was hospitalised with an asthma attack at two o’clock in the morning, as my normal drugs had stopped working. The nurse who was assigned to my bed was skeptical of me, as though I was only there to get sympathy or attention. It was a horrible and very frustrating experience, and is not the only time I have been met with skepticism by hospital staff. I speculated it might have something to do with my appearance: I guess you could say I don’t look very conservative. I noticed that people who were older or elderly seemed to generate the most gentle, caring treatment, however that too had a kind of patronising undercurrent to it.

    I would say a kindly mask is better than contempt, and is preferable to emotional involvement that risks burn-out for staff. One positive way I have found to get a reaction out of hospital staff is to make a joke about my situation, or to ask them about how long their shift has been. I suppose they would need to be receptive in the first place though.

  37. Rose: Sorry that you had a bad experience in the hospital. I was thinking why I tried to see what was behind the kindly masks. The hospital staff literally and figuratively sees one naked, sees one struggling with the bedpan, missing the bedpan (bad marksmenship or markswomenship), sees one in pain and helpless. But there’s no reciprocity. Not that I wanted to see the hospital staff literally naked, but since they saw through me, my normally self-controlled public persona, reciprocity called for them to reveal something of what lies behind their public persona. But they reveal nothing. No give and take. It’s not just a way of avoiding burn-out; it’s also a way of maintaining a position of superiority.

  38. Keith McGuinness

    amos: “Not that I wanted to see the hospital staff literally naked, but since they saw through me, my normally self-controlled public persona, reciprocity called for them to reveal something of what lies behind their public persona.”

    I disagree with your idea of what is required.

    I would say that the staff are required to do their job — it is a job — in a professional manner: this includes being courteous and competent. Being professional, however, does NOT, in my view, require that they reveal anything of “what lies behind their public persona”, although they may choose to.

  39. Keith: I’ve never liked the whole idea of professionalism. When I was in psychotherapy, I always felt that the therapist should reveal more of herself (although she did without meaning to), while I was revealing all of myself. I agree with you that hospital jobs, as professional jobs, only require being courteous and competent, but forgive me, I still have the crazy idea that an “I-Thou” world would be preferable to our world of masks. Don’t worry: I’m not going to sue the hospital. However, I have the idea that there is something radically wrong about the way the people relate to each other in contemporary society. I confess that I wear a mask too, one that is courteous and competent. Nevertheless, I see my own way of life as radically wrong too.

  40. Amos, I think I know what you mean. I love those moments in life when we manage to break through the masks a little, like when someone farts loudly on the bus and everyone laughs. When there’s some kind of palpable humanity instead of robotic officiousness and “niceness”, a constructed veneer of “perfection” that puts a wall between all of us.

    Displays of emotion, particularly negative emotion, is seen as a weakness. People displaying negative emotions are smugly looked down on. Those going through hardship are blamed and judged. No-one has time for anyone that takes work.

    I remember when I worked for a year doing phone surveys, whenever a business number was dialled accidentally instead of a residential one, the tone of voice of the recipient was so drastically different. So friendly, so calm, so smooth . . . so fake, so self-effacing and ultimately BORING. It seems like we’re all faking it one way or another. I wonder whether the world would be better or worse if we were all ourselves, all of the time?

  41. Interesting indeed, an old question as well.

    Brings to mind the old soul, mind, will, spirit, etc., and their intertwining, the psuche-nous “problem,” and many great readings. I am not sure who it was, maybe Haugeland, who more recently restated some old Greek sentiment to the tune that we assume consciousness is inside us, when really it might not be all.

    So if we want to divide identity, then consciousness, apart from mind, will, and soul, should also be figured into the equation.

    So let’s try a hypothetical multipartite “fusion” theory of identity, which would say that all these things make up the self. A consciousness to perceive data (perceptions, experiences); a mind to store and later supply data; a will to manipulate that data, and which also manipulates body movement.

    Now through all this what is missing is that homunculean-type thing which is what is BEHIND consciousness, which if we don’t feel to anti-religious about it we can call soul. When you can direct your hearing to either hear or not hear the ticking clock, is an example of the type of directional locus that is required, a centre.

    I can only maybe give an example of this, what i think right now, from Aristotle. You remember he declares nous as the rational faculty (mind), and that this mind is present in all creatures by degree, depending upon the type of soul they have. The highest type of soul there is (lowest is vegetative) is the rational soul. Most higher animals, namely all mammals, according to Aristotle, insofar as they can be trained, have to some degree a rational soul.

    This rational soul (psuche) is posessed of a rational mind (nous). That this is not the other way around is important. He divides this rational mind into two types, nous poetikos and nous pathetikos. Pathetic mind (let’s call it), is rational in that it can execute complex tasks instinct. It can be trained. It can perform tricks, even feign love and affection.

    But it is pathetic indeed because (again this is Aristotle) it cannot have ideas, mental blueprints, and create by itself. It cannot write and use language in that way. it cannot calculate. No beaver says “hey, let’s improve this structure,” or even “to hell with building this thing period.” it is the poetic mind, the creatibve mind, that for Aristotle constitutes the sole distinction of the human race.

    So where is identity in all this? well to put it the easiest way possible, only you can say “I am that I am.” Whether that is by descent I cannot tell you.

  42. Yes that was me, just a joke (an email I received).

  43. Rose: All I know that if I were myself all the time, the world would be worse off. Maybe we need to be ourselves, but after a period of learning and disciplining of the self. After all, our selves, far from being spontaneous preserves of authenticity in a society of sell-outs, are the product of years of inculcation by the media, advertising, the school systems, the confusions of our parents.

  44. “I suppose medical staff would need to develop a kind of detached and measured compassion”

    I worked as a kind of auxilliary nurse on an acute medical ward for about six months (a long time ago now – I was working to fund a Phd).

    I certainly very quickly became pretty detached from what I suppose one might say are the everyday emotions that people have about death and suffering. I was soon able to watch a person die (somebody I would know, in a way), clean up their body, and then five minutes later, eat my lunch in the canteen.

    Partly it was just that there was so much death and suffering. It just became normal. Also, I don’t think I was very different from the other people working in the job (those who couldn’t become detached, tended just to leave).

    Mind you, it does make me wonder whether people like Eichmann are actually very different from the rest of us (I can certainly imagine not caring about relatively anonymous, large scale death and destruction).

  45. Maybe you could sit down and eat lunch because you’d done everything you could do to prevent death and suffering, and now there was nothing left to do.

    Granted, it’s still a bit unsettling that you could do that, but it’s for the best. We’d be constantly flooded with debilitating emotions, if it were otherwise…what with 7 billion people in the world and fast communication about who’s suffering and dying somewhere.

    It seems very different to sit and eat your lunch when someone’s in the same room suffering and dying, and there IS something you can do. Or to eat lunch knowing that you’ve ordered a lot of suffering and dying (Eichmann) and it’s within your power to do otherwise. Or to eat lunch with one hand while torturing people with the other…

    OK, you see what I mean.

  46. Eating lunch under any of the circumstances above seems like a stretch to me. Breakfast maybe. And a snack, definitely okay. Don’t even mention dinner! That is unfeeling beyond imagination. What is it that you would be having for lunch, anyway? There could be mitigating circumstances. Like patient’s leftovers? Go ahead, eat, it’s morally okay, it seems to me. A big Mac? That is like sooo ….. I won’t even say.

  47. Jean – It would be comforting to think that it wasn’t simply that my capacity to care, empathise, etc., had been diminished because of a process of normalisation, etc (in that particular context – it didn’t particularly spill over into my non-work life; and also there was one particular exception – a young lad who died terribly of AIDS).

    But I think it was that. It was just too routine. Most people were suffering most of the time (not necessarily acutely, but still suffering). A lot of people were dying (and would die). (I remember one particular shift where 2 (or 3?) within the space of an hour. There were two of us on duty. We had to leave the bodies in the bed because we had to look after the patients who were still alive.)

    How it is possible to care (except in an abstract sense) in such an environment? It’s possible to be compassionate. But it’s much harder to care in any kind of meaningful or deep way. Hence being able to eat lunch.

    “Or to eat lunch knowing that you’ve ordered a lot of suffering and dying ”

    Sure, but there are different ways of knowing that.

  48. Jeremy: First of all, I see no analogy between a stressed-out health worker rapidly eating his lunch among the dying and Eichmann, who sent millions to their death. In my experience, in adrenaline type situations, such as working in a hospital, one cares less, thinks less, and works harder. Perhaps there are even genetic mechanisms which allow us to keep functioning in situations that if we thought of them from our armchair, would cause us to break down in tears. It may well be that total empathy and total concern for others are, like philosophy, ways of being best developed in leisure (that’s what Aristotle says about philosophy, as you well know) and harder to develop in a hospital emergency room. In my life, my extreme sensibility towards and concern about the suffering of others has always been ex post facto, upon reflection after having witnessed suffering with relative numbness.

  49. ” I see no analogy between a stressed-out health worker rapidly eating his lunch among the dying and Eichmann”

    That’s because it wasn’t an analogy.

  50. The way hospital workers “move on” is interesting (also surprising to me), but it’s to say what it shows. Perhaps it shows that Eichmann wasn’t unusual in his ability to calmly imagine horrible suffering and death, but in his desire for it to occur. Most of us can get used to these things happening or having happened, but very much don’t desire it. We don’t desire it because we can imagine what it is to be the person suffering and dying. We know that’s extremely bad, though from the outside we certainly only feel a tiny fraction of the badness. Eichmann was quite unusual and I’d say aberrant in desiring it.

  51. amos: “However, I have the idea that there is something radically wrong about the way the people relate to each other in contemporary society. I confess that I wear a mask too, one that is courteous and competent. Nevertheless, I see my own way of life as radically wrong too.”

    Amos, I must live in a different kind of world to the one you inhabit. I don’t feel that I go around wearing a mask, or that most people I meet do either.

    Of course, that does NOT mean that I reveal my innermost thoughts, feelings and secrets to anyone and everyone, nor do I expect others to reveals theirs to me. It DOES mean that I try to deal with other people honestly and, to the extent that it is appropriate and comfortable, openly.

    I do end up making a fool of myself on occasion but I’ve got rather used to that over the years and I’ve never found that it has done me all that much harm.

    I think I would have a real problem if I thought my life was “radically wrong”.

  52. Jean, I think you’re wrong about Eichmann. That’s the point that Arendt makes in her book about his trial in Jerusalem. Eichmann didn’t calmly imagine suffering and death. He saw it happen, and it made him sick. So he went back to his desk and continued with his work. Eichmann’s problem was a failure of imagination, not a sin of it. Gilbert, the Jewish psychologist who wrote about his relationships with the Nazi bigwigs on trial at Nuremburg, put it down, I think, to a lack of empathy. I’m not sure about that either. I think even Eichmann could empathise, but he also could feel pride in his power and his work, so he put those things out of his mind and continued on with the task in hand. That’s Arendt’s whole point about the banality of evil. I think it’s very unfair of some to compare this kind of thing to the attitude of people, very often, very deeply caring people, who attend those who are dying, but who, if they allowed their emotions to get too directly involved, would be unable to do what is required of them in caring for the dying. Different people do this in different ways. Some people become quite hardened by it, and the edge of their compassion is dulled. Others do it in other ways, and allow their humanity to show, but do not take it home with them. Some, on the other hand, find it too hard to endure, and choose to do other things for a living. We should be thankful that some people are able to do this without cracking up. But Eichmann was a completely different kettle of fish.

  53. amos: “When I was in psychotherapy, I always felt that the therapist should reveal more of herself (although she did without meaning to), while I was revealing all of myself. … I confess that I wear a mask too, one that is courteous and competent.”

    There is an interesting juxtaposition here. Most of the time you “wear a mask” but on those occasions when, due to circumstances, you take yours off, you feel that the other person should do the same for “reciprocity”.

    I have been in hospital and experienced the various “indignities” that this entails but I don’t (and didn’t) see that this required any kind of “reciprocity”; just professional, competent and courteous treatment (which is what I got).

  54. Eric MacDonald” I think it’s very unfair of some to compare this kind of thing to the attitude of people, very often, very deeply caring people, who attend those who are dying, but who, if they allowed their emotions to get too directly involved, would be unable to do what is required of them in caring for the dying.”

    I was going to respond to this part of this discussion but Eric has said just what I was thinking but done so more clearly than I think I would have done.

  55. But you guys aren’t arguing, you’re just asserting it’s a different kind of thing. (Not that I’m arguing for my position, as such – but then I’m just reporting my own experience here, and suggesting that this kind of thing might be psychologically related to the Eichmann type situation).

    The point about doing this kind of work isn’t that you consciously decide to leave your feelings behind when you start work. You just – quite naturally – don’t have these feelings. It’s no effort. It doesn’t require any kind of cognitive shift.

    So, for example, when I first started working in the hospital, a porter took me to see the mortuary. He took great joy in showing me the corpse of a 15-year old lad who had been beheaded in a car accident. The thing is – he wasn’t unusual; he wasn’t pathological; and in other contexts, I’m sure he would have found such behaviour outrageous.

    It’s comforting to think that Eichmann was somehow aberrant. Comforting, but not very persuasive.

  56. Keith McGuinness

    Jeremy S: “You just – quite naturally – don’t have these feelings. It’s no effort. It doesn’t require any kind of cognitive shift.”

    But people who can tolerate working in such an environment are a self-selected special group. (I couldn’t do it.) And not everyone may deal with it the way you did.

    So I don’t find your experience surprising but I also don’t find it persuasive.

  57. Well, now, Jeremy, I’m not so sure. I was speaking with a police officer the other day who spent some time in counselling, because of distress caused by dealing with gruesome accident scenes. Sure, some people don’t have the feelings, but many, in my own experience, do. I speak from experience too, and though I have seen quite a few people die, and watched them in their last moments, it was not something that I could simply turn on and off. The feelings were there alright, but my responsibilities precluded the “luxury” of expressing them. Sometimes I cried inwardly, but seldom on the surface. I don’t know. I haven’t done a survey. But I think your porter may have been a bit unusual. I hope he was. But of course Eichmann wasn’t aberrant in this respect at all. He had the feelings, and was revolted by what he saw. This is one point that Arendt makes, that he, along with Himmler and others, turned the moral reasoning around, and said, “See what our duties have required us to do. And yet, to have done it, and remained decent” — well, you know about that. After awhile, perhaps, it does not require a cognitive shift. But at first? Well, I don’t know. Did you feel nothing when you saw the body of a fifteen year old decaptitated in an accident? Just wondering.

  58. “I couldn’t do it.”

    You sure?

    Is your proposition then that if nurses, etc., did a battery of personality tests, we’d different significantly from the rest of the population?

    What about hospital porters, policeman, fireman, soldiers, etc?

  59. Keith: I assume (from your post of 11:38) that we live in the same world, although I live in Chile and you live I don’t where. We must therefore perceive our common world in different ways. I tend to be a very critical and radical person (I’m not talking about politics). I do see that the lives of very few people around me conform to the ethical codes that our canonical texts on ethics propose: Aristotle, Buddha, the Stoics, the New Testament, Spinoza, Kant, Nietzsche. I suppose that one could say that things are as they have to be, that given human nature, the world couldn’t be any other way and that wisdom is recognition of that. Still, wasn’t there a moment in your life, perhaps as a teenager, when you said to yourself: this is all wrong. Perhaps not. I say that to myself most days. I see most of the people, not everyone of course, chasing things that don’t seem important: social status, more money than they need, packaged entertainment, a lifestyle that is unhealthy in both mental and biological terms and what’s more, damages the planet. I ask myself: is that what matters in life? You ask if life is a problem to me, and yes, it is. Not life as biology, but life as I see people (once again, most people) living it around me. If I seem confused to you, perhaps I am. Perhaps a bit of confusion is healthy at times, and too much sureness may indicate that one has stopped questioning oneself. I don’t know you, and I am not calling into question your lifestyle, which is a mystery to me. As to reciprocity, for me reciprocity is basic to any form of ethical living. Regards, Amos

  60. I think we just have different experiences here Eric. I worked with a small team of nurses; there were about 10 of us. I think only one found the job difficult in the sense that you’re talking about. She left, and ended up working in a building society.

    I was shocked by the 15 year old lad. But it was my first week at the hospital, so I hadn’t got used to it.

    Anyway, I certainly wouldn’t claim that everybody found it as easy as I did. I guess my proposition is that human beings have the ability to compartmentalise their feelings in such a way that what is horrific in one context is not so horrific in another; and also simply not to attend to the more human dimensions of one’s actions, what one is seeing, etc (if that makes sense). And that this kind of stuff becomes automatic, routine, etc., in certain situations.

  61. Keith McGuinness

    Jeremy S: “You sure?”

    Time to hedge! About as sure as I can be of such things…but as I get older I get less certain of such things. I now know from experience that my feelings in certain situations are not always what I would earlier have expected them to be.

    “Is your proposition then that if nurses, etc., did a battery of personality tests, we’d different significantly from the rest of the population?”

    I suppose I would, assuming that the personality tests administered tapped into the sorts of things we are discussing here. Interesting idea!

  62. Keith McGuinness

    Jeremy S wrote earlier: “You just – quite naturally – don’t have these feelings. It’s no effort. It doesn’t require any kind of cognitive shift.”

    But later: “I was shocked by the 15 year old lad. But it was my first week at the hospital, so I hadn’t got used to it.”

    The later statement seems to imply some sort of shift or adaptation. It does not suggest that you “just don’t have those feelings”.

  63. “The later statement seems to imply some sort of shift or adaptation.”

    Sorry I wasn’t clear. What I meant was that once you’ve “adjusted” (or whatever it is), you don’t have to make any special effort to get into what was at first a new state each time you enter the work context. You’re just used to it.

  64. Jeremy, it still doesn’t ring true to me. Of course, people get used to situations of great stress. No question. Soldiers do their job with skill and determination, and then many return home with post traumatic stress syndrome, vastly increased because of the effectiveness of modern armies in getting them to kill the enemy, something that was rarer at one time. And I recall, with sadness, the oncologist who broke down in tears when recounting the stories of patients to whom he had to give the dreadful news of their diagnosis and prognosis. I think we need a bit more data to go on here.

    You made a cognitive shift to a stressful task. You found it easier than some, much easier than another one you do remember. Some can control their feelings by the sense of the good that they are doing. Some get hardened by it, and respond impersonally towards those for whome they care. Some watch extraordinary pain without batting and eyelash, and without helping much either, apparently indifferent to the suffering. Some doctors I know give very poor pain relief to people in distress, sometimes afraid of causing addiction (in people who are dying, no less!), some who simply do not understand pain. There are all sorts of reasons for the emotional responses of people who care for the sick and suffering. Hopefully, at some level, for those who care for them, there is a basis in feeling, that makes their care human and caring. Otherwise they’re not doing their job. That’s why I worry about your statement that some people in caring situations simply don’t have those feelings. That is truly frightening, and here we border, I think, on cruelty. I have seen it, and it is not pretty, but I have always felt that those who respond this way should not be in helping professions. Some simply lack the ability to empathise, and that is dangerous. People will suffer much more than they need to under the care of such people. This too I have seen happen. It is not a happy situation.

    I can still remember the time I had to order a nurse to abandon her routine in order to give much needed pain relief to a dying patient. She kept muttering, “I have other things I have to do, you know.” But at least the dying woman got some relief. I hate to think how often this kind of callousness is played out in hospitals around the world day after day. I hope you just don’t, as you say, simply ‘get used to it.’ Pain is a very human experience. It is a call to the compassionate for help. Hopefully, they will find some kind soul to respond with compassion, and not just with routine, and grudging help.

  65. Keith McGuinness

    amos: “Still, wasn’t there a moment in your life, perhaps as a teenager, when you said to yourself: this is all wrong. … Perhaps a bit of confusion is healthy at times, and too much sureness may indicate that one has stopped questioning oneself.”

    You seem to suggest that as people — presumably including me, since you refer to me when a teenager — get older they stop questioning things and start simply accepting what happens.

    This does not, I think, apply in my case (as part of one of my responses to Jeremy indicates); I can’t speak for others.

    But there are differences between being questioning, being critical and being pessimistic.

    “I see most of the people, not everyone of course, chasing things that don’t seem important: social status, more money than they need, packaged entertainment, a lifestyle that is unhealthy in both mental and biological terms and what’s more, damages the planet. I ask myself: is that what matters in life?”

    I think other people have the right to decide, and pursue, what is important to them (provided that they do not harm others in the process). I wouldn’t want other people setting priorities for me, so that seems only fair.

    You seem very concerned about what other people do. I am more concerned about what I do.

  66. Let’s see… Jeremy said there was a similarity between hospital workers being unmoved by death and suffering and Eichmann being unmoved.

    I decided to give him the benefit of the doubt on the facts of who felt what, but said this didn’t mean Eichmann wasn’t aberrant. He desired and deliberately brought about mass pain and suffering. If anyone thinks most of us desire mass pain and suffering, they’ve got the burden of proof…surely.

    But does he have the facts right? I don’t know enough about Eichmann to say…and have never worked around death and suffering. I guess I went along with Jeremy because I know it’s true that you can get very upset by distant problems and be merry an hour later. But close up problems?

    I have a doctor who cries about patients…or so his nurse has told me. On the other hand, people are amazingly good at coping. I visit an oncologist regularly (for unexciting reasons) and I’m always amazed what a cheerful place the office is. Maybe Eric’s right though that someone who is routinely numb to everything doesn’t belonging in a helping profession.

  67. These conversations always get complicated and time-consuming! (That’s just a general observation, not a complaint!)

    Okay, Eric:

    Soldiers – Sure, but two things: 1. Many return home without PTSS; 2. PTSS is also going to be related to the fact that soldiers are in constant danger.

    I wonder how many pilots suffer in the same way…? (And I’m not saying that you won’t find pilots affected – but I bet it’s a smaller percentage.)

    The oncologist and Jean’s doctor (below) – well obviously I can find examples where the opposite is the case (which, of course, is the difficulty with this kind of argument from personal anecdote/intuition). But, more generally, I wonder whether the kind of nursing that I did inhibits the development of empathy because the people you’re dealing are already very ill, and often very old, when they arrive. So there’s never really any veneer of “normality” with them.

    Your second paragraph seems to be arguing something like my position!

    So does your third!

    But I should say that I’m not really talking here about the ability to respond in a compassionate way, or even feel compassion. It’s more that I found that there wasn’t much else. I remember – this was working in a nursing home – that some guy lost control of his bladder, and I got soaked, and he felt humiliated, etc. In that situation, of course, one feels nothing but compassion, and it is terribly sad, and when you’re in the situation you desperately want to make things okay, etc.

    But then you go home, or go to lunch, or talk to another person, and you forget about it. Or at least I did. And really – I think that everybody else I knew did as well.

    (Though, of course, I realise the fact that I remember the incident is not terribly helpful for my argument!).

    Actually, there’s an interesting point about that example which is that it didn’t so much involve suffering (which one is very used to), but humiliation (which is less common). I wonder whether I would have had the same reaction if people were constantly feeling humiliated in that fashion…

  68. Keith: I certainly allow others to set their own preferences, and as a matter of fact, I don’t have the power or the influence to change anyone’s preferences, not even those of my own family. Now, I may consider those preferences to be mistaken or wrong, and I often do. No, not all people stop questioning things as they get older; some, in fact, question things more as they get older or learn to focus their questions more wisely. There is a difference, as you say, between questioning, being critical and being pessimistic. One can even combine all three traits, as I do. But the way, it is complicated point to what extent the preferences of others affect (or harm) my life. No man is an island, as the saying goes. If in every social space there is a giant TV set blaring reality shows or pop videos at full volume, then I find it hard to read a serious book, don’t you?

  69. Jeremy. You’re right, of course, that doing this sort of thing takes a lot of time, time better spent, perhaps, doing one’s job!

    However, I’m still intrigued by your response. I don’t think I argue your case. I want to consider that case more closely. You write this:

    “We will allow people we know a certain scope or allowance for behaviour not normal nor mature. To receive permanent, or at least long term, dispensation, a person needs to be marked out in some way – be it illness, or learning disability, or youth – such that they are clearly outside of normal expectations. Being tied to an oxygen tank and a morphine pump is one such marking.”

    This is precisely the reverse of what should obtain, and that’s the point I’ve been trying to make, perhaps not as clearly as I might.

    I think the fact that people are marked out by illness and suffering, by oxygen tanks and morphine pumps, puts the onus on others, not to give the patients a dispensation, but to act in a more caring, compassionate, and feeling way than they might in ordinary circumstances, with people distinguished in these ways.

    The man who lost bladder control, and was humiliated, makes this point very clearly. Here was a human being, a person, for all that, capable of the kinds of feelings of self-regard that, as Strawson points out, are related to his sense of dignity, who felt his world collapsing, as it were, because of his inability to control something which, for most of us, is an important aspect of our sense of being persons. Though marked out appropriately by illness and location, he still retrained that sense of dignity, and was devastated by his inability to maintain it.

    Of course, because of this ‘marking out’ or ‘marking off’ into a group labelled ‘not responsible for certain aspects of self-control’, you would have been wrong to have held any resentment towards or contempt for the man in question. But his humiliation was a sign that, marked off or not, he was still a person within the meaning that we ordinarily give to that word, all be it one who needed help to hold onto what dignity was left to him. Obviously, since you still remember the event vividly, you provided him with the kind of support that he needed. Many nurses do not do this, and express frustration and even anger in such situations: reactive responses which are uncalled for, not because the sick person is less than a person, but because his personhood is more fragile and more easily damaged.

    Regarding your last point, contrasting suffering with humiliation. I’m sorry, but here you simply misunderstand. Humiliation is a part of what people in that kind of situation experience as suffering. In many senses, it is the growing loss of personhood, or expectation of that loss, which causes the greatest suffering. Pain, of course, is a different thing, and you may get used to it, but in most cases, if there is still pain, then someone has simply not provided the pain control that is necessary. No one, nurses or doctors, should simply get used to pain.

    Suffering, though, is a different thing. It may involve pain, of course, and it usually does, but it has much more to do with the breakdown of personality structure, and the ability to hold on to one’s sense of dignity. This causes acute distress, and is too seldom recognised by those in the caring professions. Hospice care more and more recognises this, and strives to help people hold on to their dignity as persons. The only way, though, to assure that people do retain their dignity until the end, is to provide opportunities for people to control the timing of their dying — which is why I have already suggested that this issue is closely related to the question of assistance in dying, a thread that no one so far as bothered to pick up.

  70. Hi Eric

    Now I’m confused. Since I didn’t write ““We will allow people we know a certain scope or allowance for behaviour not normal nor mature”!

    That was Christian’s husband, I think.

    I’m not making a moral argument here at all. I pretty much agree with everything you said in that regard.

    I’m just arguing that we’re hampered in the kind of stuff both you and I think would be desirable by what might be called a psychology of indifference (though actually that’s the wrong word) bred by familiarity, etc.

  71. “These conversations always get complicated and time-consuming! (That’s just a general observation, not a complaint!)”

    I’m shocked! But anyway–I’m not sure how important the emotions really are. It’s one thing to feel less, have lunch after someone dies, etc., another thing to stop giving good care to patients, or actually start harming them. I’ve been running a project responding to the Darfur genocide for 6 months. At the beginning I was very emotional about it, now I’m much less so. I’m still completely committed and do what I need to do.

  72. I’m not sure how important the emotions really are

    I agree completely. But I’m not sure that you can easily square that with:

    Maybe Eric’s right though that someone who is routinely numb to everything doesn’t belonging in a helping profession.

    Unless, of course, one wants to argue that numbness precludes one acting properly in the caring professions. But I’m not actually sure that’s the case.

    I must admit I certainly wouldn’t want a doctor examining me for some fatal illness, and then bursting into tears! 🙂

  73. I agree that the emotions aren’t the most important thing, and I agree that numbness doesn’t affect competent medical care. However, I may be treading on some cherished UK ways of seeing the world, but what would be the problem with a doctor bursting into tears after examining one for a fatal illness? I would be moved and would see her tears as a sign of empathy, not of weakness. I would not want her to cry as she performed a delicate operation though.

  74. “I’m not sure that you can easily square that with…”

    Yes, well, but I said that last night, and now I’ve had 8 hours of sleep.

    I don’t want my doctor bursting into tears in front of me. If he’d like to burst into tears later on, that’s fine with me.

    To tell you the truth, I’m just not clear what difference emotionality makes. I have the feeling some people are more cerebrally driven…the sheer thought of what’s right or wrong or needed or important is propulsive enough. For others, feeling is everything. It makes them work harder, do more, stay up all night trying to come up with another treatment.

    Some people are like this, some like that…what a dull way to start the day. But it seems true!

  75. “bursting into tears after examining one for a fatal illness? ”

    It was a joke, Amos! (The point being that one would rather not have a fatal illness at all.)

  76. Jeremy, I apologise. I did confuse you with the guest contributor, and of course that confused the issue awfully.

    No, you’re quite right, you don’t want doctors to break into tears, and, indeed, if they do, they are not able to do their job.

    I do think, however, that the kind of numbness you’ve been describing does really make it impossible for people to show appropriate care. I’ve met some numb people — you obviously are not one of them, otherwise the recollection of the man’s humiliation would not be still so vivid — and they tend to be quite inhuman in their attitude towards those they care for.

    But one’s human emotions can be involved, even when one has, as you say, ‘got used to it’, and it is that appropriate emotional involvement that is necessary, I think, for the best care. In fact, it seems to me that compassion is precisely the ability to care without being overcome by emotion. I have seen too many patients in tears because of the inhuman way they have been treated by caregivers who cannot recognise and respond to the humanity of their charges. It is far more common than you might think.

    Having said that, I think I’ll give you a rest! 🙂

  77. Stangroom said:
    I don’t want my doctor bursting into tears in front of me. If he’d like to burst into tears later on, that’s fine with me.

    Oh, that is very good! I’m going to repeat that to my doctor. She’ll love it. And your point is very well taken. Control is called for, equanimity is the name of the game, stoicism in the face of whatever is very desirable, hanging tough is demanded from patient and the doc sets the example. Please, doc, don’t burst into tears or I will really melt down. However, as long as I’ve got that thingie up my nose and down to my stomach, you don’t have to chew in front of me either.

  78. Jeremy said part one, I added part two. But I think I put it much too mildly. Actually, I’d like a national day of sorrow to be called ever time I have to go to the dentist. All of my problems should obviously matter profoundly to everyone.

    Feeble attempt at humor. It is interesting how much we do or don’t or should matter to other people. Paul’s link, way, way up, was very interesting and has made me think about that issue for days.

  79. Five deadly words. “I/we got used to it.”

    On a tv documentary about Japanese medical experimentation in China during WWII, one doctor was asked how he could have performed painful experiments on conscious subjects; that was his answer. It was difficult at first, then he got used to it.

    So along with the phrase ‘be careful what you wish for’ we could have ‘be careful of what you get used to.’

  80. This thread is really excellent – been enjoying reading it.

    Jean, that paper’s stuck in my head too. Reminded me of ideas in ‘Love in the Time of Cholera’ by Garcia Marquez. At some point in that novel someone expresses regret that no-one kills themselves over heartbreak anymore.

    Regarding compassion and helping – here are some questions that rankle and unsettle me a bit (there are others too!);

    What about the ‘darker’ motives for helping that some or indeed even all professionals have, to some extent? Some psychoanalytic thinkers hold that people who are very kind and caring to others may do so (in part at least) because they are unconsciously projecting their own needy or damaged parts into the other person – and by caring for the other they actually care for themselves.

    Sounds a bit far fetched and unfair until you think of Nietzsche and his critique of compassion (a weapon used by the weak to cripple the strong?), and also think of those cases of Munchausen Syndrome by Proxy (MSbP), which may be extreme examples where the need of the helper to help someone outweighs the need of the person they are ‘helping’.

    In the land of child and family psychiatry MbPs (and more dilute versions) happen more than you’d like to think. And taking a continuum approach, ‘psychiatric conditions’ can reveal a great deal about human nature generally, and the underlying propensities we might all have to one degree or another.

    Is there some truth in the idea that sometimes compassion and caring can be used to ‘cripple’ people? To keep them near us and needing us?

    In terms of ethics and morality, I’ve started to think this supports the idea we should pay less attention to the motives of the helper (as they may be complex, dark and mysterious!) and take a more Kantian approach – duty and the like.

  81. Sorry – postscript.

    Is solidarity not often a better way to respond to suffering than compassion? Compassion implies ‘they’ suffer – ‘we’ do not. Us and them. The relationship pattern can become fixed and unequal.

    Solidarity recognises we are all in the same boat… Having another person express solidarity allows us to retain some equality and dignity in the face of our suffering – rather than feel like a child again.

  82. Paul. Since there is only one word in German to mean alternatively either pity or compassion — Mitleid — it is not altogether clear that we can conclude anything very much from Nietzsche’s use of it. As pity, certainly, it is an expression of us and them, I suppose, and I think you will find that Nietzsche usually uses the word in this sense. But, as compassion, as a feeling with, or suffering with (Mitleid, in fact), it has a very different resonance.

    There may in fact be darker motives for most of the things that we do. Even duty can be darkened by menace.

    I should have thought that the word ‘compassion’ (though perhaps not Nietzsche’s pity) comes very close to the meaning of solidarity, but, of course, even solidarity can be used for darker purposes.

    Pity, and the care that derives from pity, can cripple people. It often does. Nursing homes are full of such cripples. But compassion, I think, is something quite different. It is the caring of the suffering by those who know that they too can suffer, and will. And if the wounds of those who show compassion are healed in the process, then perhaps we have not us and them, but a sharing of the human condition.

  83. Is the idea of strength not missing in the concept of compassion though? Does solidarity not capture this more appropriately?

    Our ability to experience compassion is thought by some to emerge from our evolved ability to care for our children. Caring for someone seems different to standing shoulder to shoulder with them. Or at least it is in the psychotherapeutic literature.

  84. “And if the wounds of those who show compassion are healed in the process, then perhaps we have not us and them, but a sharing of the human condition.”

    This is very useful and true.

    It’s not a bad thing to help others and at the same time help yourself. But it is a bad thing to hurt others and in doing so, help yourself.

  85. Here is our old friend Hannah Arendt on the differences between pity, compassion and solidarity, from her book On Revolution: “It is out of solidarity that they (people) establish deliberately….a community of interests with the oppressed and the exploited….For solidarity partakes of reason, and hence, of generality…..But this solidarity, though it may be aroused by suffering, is not guided by it….compared with the sentiment of pity, it may appear cold and abstract…..But pity, in contrast to solidarity, does not look upon both fortune and misfortune….with an equal eye; without the presence of misfortune, pity could not exist, and it therefore has just as much a vested interest in the existence of the unhappy, as thirst for power has a vested interest in the existence of the weak. Moreover, by virtue of being a sentiment, pity can be enjoyed for its own sake, and this will almost automatically lead to a glorification of its its cause, which is the suffering of others. Terminologically speaking, solidarity is a principle that can inspire and guide action, compassion is one of the passions, and pity is a sentiment”.

  86. Strength — such a Nietzschean word! And standing shoulder to shoulder is what soldiers do. But sometimes, just sometimes, it’s nice to have a shoulder to lean upon. And if the shoulder belongs to someone who can feel your pain, but not be undone by it, then you may find a strength that you did not know you had.

  87. Great passage. She’s fairly hit the nail on the head there.

  88. “And standing shoulder to shoulder is what soldiers do.”

    It’s also what you do when there is nothing else you can do I suppose.

  89. Much as I admire Hannah Arendt, I do not think her analysis does justice to the concept of compassion. It is not merely one of the passions. Martha Nussbaum has a fairly detailed analysis of compassion in her book “Hiding from Humanity”. The context is ‘compassion in criminal sentencing.’ However, she points out, correctly, I believe, that there is a cognitive and evaluative component in compassion. Compassion includes an evaluation of the other person’s predicament (it has ‘size’, in Aristotle’s language — 49), a judgement that the person is not fully to blame for their predicament (50), and, as I have already suggested, a recognition that we are also vulnerable to similar harm. As she says, “This creation of a community of vulnerability is among the great strengths of compassion …” (50) There is also, she says, a ‘eudaimonistic judgment’ (51), the thought that the suffering person (or, indeed, animal) comes within one’s circle of care.

    So, I think, compassion, in this sense cannot simply be dismissed as ‘one of the passions’, and though compassion may not be action guiding — we may, as Adam Smith observed, feel compassion for the victims of a far away earthquake, and yet be distracted by a sore finger — that is, the object of our compassion may be outside our circle of immediate care — it is clear that it could not, like solidarity (and this is why this term doesn’t work for me), be, or at least appear to be, cold and abstract. Solidarity may be a great motivator of revolution. I’m not so sure that it would ensure the best of care. And, unlike pity, compassion cannot be ‘enjoyed for its own sake.’ Compassion does not glory in the suffering of others, because it includes a reflection on one’s own vulnerability to harm.

  90. Eric: I think that we’ve gotten to the point where we’re just arguing about words. Martha Nussbaum, as you probably know, studied the Stoics and so sees the emotions and passions as cognitive judgments.
    Hannah Arendt makes the traditional distinction between reason and passion, as, it appears, does Hume. So, Martha Nussbaum’s compassion has elements of Hannah Arendt’s solidarity. The word “solidarity” is not in fashion these days, given its political connotations. However, it seems that what Arendt means by “solidarity”, a principle guided by reason based on a sense of community with others, could be used in non-political situations, such as medical care and is not so different from what Nussbaum means by “compassion”. As you mentioned above, there is no difference between “pity” and “compassion” in German and that fact may have led Arendt to emphasis “solidarity”, since as far as I know, Arendt learned English rather late in life.

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