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Facing Cancer and the Fear of Death |
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Wednesday, 10 April 2013 16:26 |
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Facing Cancer and the Fear of Death: A Psychoanalytic Perspective on Treatment Edited by Norman Straker (Jason Aronson Publishers, 2013.)
Of Recent Interest… is the new collection of essays Facing Cancer and the Fear of Death: A Psychoanalytic Perspective On Treatment, edited by Norman Straker (Jason Aronson Publishers, 2013). This book emerges out of concerns psychiatrist Norman Straker has noticed in current medical education, treatment and policy. In medical education, students are pushed in a direction that most rewards those who are able to set feelings aside, suppress a sense of vulnerability and helplessness, and make treatment decisions in an impersonal manner. This continues in medical education despite the fact that the AMA has explicitly advised that students should be selected giving more weight to interpersonal skills and signals of empathy. Why is it so difficult for medical education to shift in that direction?
In the area of treatment, despite new areas of medicine such as palliative and hospice care that explicitly recognize the limitations of life, the overriding momentum in treatment is to ignore such limitations. The very concept of “futile treatment” hardly makes sense in much of medical practice, except perhaps in hindsight, after the “battle has been lost.” Likewise, in medical policy, the momentum is strongly in the direction of treatment as if each and every patient were on the road to full recovery, and only need to be kept on that road. All of the rewards are in the direction of more treatment, especially for those who have money or good insurance, and even while the costs of medical care are sky-rocketing, it is all but impossible to move National healthcare policy in a more rational direction.
Each of these problems of inertia in the system, Dr. Straker concluded, have a related core, namely, the fear of death and the inability to understand human life within a framework in which death is not the extreme enemy. Straker has gathered essays organized around the theme of death anxiety and its impact on medical students, practitioners, policy makers and the general public in order to demonstrate this common thread. Because he is a psychiatrist, publishing on a psychotherapy-oriented press, his writers also tend to be psychiatrists and psychiatric themes run throughout the chapters of the book. However, the points being made are not confined at all to the psychiatric specialty; one can think of examples and studies drawn from psychiatry as cases in point of the wider world of medical care and policy.
Of special interest to readers of this newsletter will be the chapter contributed by Molly Maxfield, Tom Pyszczynski and Sheldon Solomon, which proposes the Terror Management framework as a way to understand the psychological defenses and coping behaviors people develop in facing a terminal diagnosis. Much of the research points toward the conclusion that younger and older adults react very differently to the experience of a terminal diagnosis. This is in line with the concept being picked up by observers in gerontology of a general developmental shift that often (though by no means universally) occurs in late middle age and older adulthood, in which the prospect of death becomes less anxiety provoking. This concept is bolstered by TMT research that suggests the younger people tend to become more punitive toward others when acting under the influence of reminders of death, whereas in older adults the tendency is to become more tolerant and forgiving. Other studies indicate that older adults tend to focus more on creating a pro-social legacy when reminded of their mortality, in contrast to younger subjects in whom there are no noticeable changes in this area. The chapter concludes by placing TMT research with groups suffering post-traumatic stress experiences, and with older adults, into the stream of research coming from different perspectives with terminally ill patients. Like most of this research (much of it reported on in other chapters of this book) TMT also points toward to fruitfulness of therapy aimed at reorganizing and strengthening people’s sense of meaning, value and building personal relationships.
In my view, Straker succeeds adequately with this book in his goal of showing the common threat of death fear running through medical education, treatment and healthcare policy, although I was convinced of that before and thus may not be the best judge of his efforts here. In terms of solutions, I was not satisfied with how little attention was given throughout the book to hospice care and all that we have been learning from the last 20 years related to it. Perhaps because physicians in general and psychiatrists in particular play such a small role in hospice care, it was easily overlooked by the writers contributing to this collection. Nonetheless, the literature and research relating to hospice care represents a rich pool of accumulating knowledge relating directly to the topics at hand, all but ignored here.
Daniel Liechty is Professor of Social Work and a member of the Graduate Faculty at Illinois State University,and also serves as Vice-President of the EBF. |
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The Letters of Sigmund Freud and Otto Rank |
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Written by James Chapman
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Monday, 02 July 2012 11:49 |
[The EBF helped support this invaluable contribution to the Rank /Becker synthesis.]
Of recent interest...is The Letters of Sigmund Freud & Otto Rank: Inside Psychoanalysis edited by E. James Lieberman and Robert Kramer.
This book is readable by a lay audience as well as one more versed in the thought of either man, or psychology in general. It includes 250 letters written between 1906 and 1926, adds missing elements to the history of psychoanalysis, and vividly illustrates the complexity, strengths and weaknesses of the primary figures.
An overall perspective on the book cannot be better stated than this quote from the Preface:
“The letters tell how Rank, with Freud’s support, evolves from a reticent disciple into an intellectual and administrative force in psychoanalysis. Close and warm colleagues for twenty years, Freud and Rank come alive through these letters, their collegial—indeed, loving—relationship ultimately strained to the breaking point: unforeseen, unwanted, inevitable.”
The two men had a close, complex relationship, initially father-son, then collegial for many years, but ending when Rank’s thoughts eclipsed those of Freud, who could never move ontogenetically prior to the idea that the father was the predominant influence on the child. Freud’s clarity of vision in this area was shaded perhaps by the shadow of the male child’s sexual attraction toward the mother, while Rank saw more clearly that the relationship of both male and female child with the mother was the archetype of all subsequent relationships.
Due to the breakup, Rank’s work was excluded from the body of psychoanalysis for decades. His genius and his expansion of the understanding of human nature and relationships have even today not been adequately recognized. Expanding this recognition of Rank’s genius is perhaps the greatest contribution of this book to the body of human knowledge.
Illustrating the deep emotional issues that boil beneath the veneer of human rationality, the letters show, for even the greatest of humans, the degree to which the emotions trump reason.
Havelock Ellis, in 1923, called Otto Rank “perhaps the most brilliant and clairvoyant of the young investigators who still stand by the master’s side”. And stand by his side he did, from 1906 to 1926. Rank wrote his first book in 1905, before he met Freud. The Artist was triggered by Rank’s early reading of Freud, merged with his own developing view of human nature. They met, and Freud sent Rank for his PhD in Vienna. Rank became the secretary of Freud’s Vienna Psychoanalytic Society, and became the closest to and most valued by Freud until their break.
Early in these years, Rank professed close adherence to Freud’s ideas, as his own more extensive ideas developed. Yet intimations of Rank’s more general view were even initially expressed in his 1905 work. Rank’s conception developed past Freud’s limitations and the inevitable departure came to pass. As the letters make clear, the emotional relationship between the two was such that Freud was perhaps the last to see this inevitability. On the other side, the break, and Rank’s recognition that it was coming, were perhaps among the causes of Rank’s own struggles with depression.
While Rank worked for the master, Freud accepted the relationship. As Rank developed the confidence to bring forward his ultimately more complex understanding of human nature, the other members of the group, and finally Freud himself, recognized the threat of the more complex schema to Freud’s relatively more static body of work, and the final schism began its troubling completion.
In some ways their relationship was based on complementary skills and styles of thinking. Freud had many characteristics of a left hemisphere thinker, and Rank, it seems evident to me, was primarily a right brain thinker. Rank loved music, while Freud did not. Freud’s writing was clear, if less complex, while Rank’s writing was dense, difficult to read, and not always well organized. But Rank had a far better perspective on the complex interrelationships of the human experience. He recognized that the mind begins before birth, and that prenatal and early postnatal influences are carried throughout life.
This book, the latest work of, no doubt, the world’s two finest Rank scholars, captures in fine detail the nature of the relationship between these two giants, Rank and Freud, as well as Rank’s own transition beyond the limitations that Freud could not surpass. Freud, for reasons possibly relating to his relationship with his own mother, could never consciously accept Rank’s insight that the relationship of the child and the mother was the original template for all future relationships. |
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McGinn's "The Meaning of Disgust" |
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Wednesday, 28 March 2012 12:57 |
 Of Recent Interest… is the new book by philosopher Colin McGinn, The Meaning of Disgust (Oxford UP, 2011). Warning! This book is not for the squeamish or faint of heart! If you are not prepared to think philosophically (that is, with focused and lengthy attention) about all those things that make you gag, vomit, and screw your face up in revulsion, this is not the book for you. Even if you are ready for such a jaunt, I wouldn’t suggest you advocate this as a selection for your book reading group, or that you propose to read it aloud with your lover. You may want to take it in small doses. I will try to keep this review in the general “rated PG” range, though it will mean that some of McGinn’s most pungent writing (pun intended) cannot be quoted.
“Disgust belongs in the area of human experience most protected by taboo and hedged with euphemism.” From that opening sentence, it is already clear that McGinn’s work is going to lean into Becker’s ideas about death denial. McGinn does not disappoint on that score. Becker’s work is one of those most prominently drawn upon by McGinn in his illumination of disgust.
The first part of the work presents McGinn’s “analysis” of disgust. Here he looks at disgust in the context of other negative emotions, at what causes disgust specifically, and what these things have in common. It turns out (surprise!) that there is a tight little pool of literature dealing with disgust, and McGinn knows this literature well. McGinn presents at least six distinct theories of disgust, starting with the very concrete (Taste-Toxicity Theory – we evolved to be repulsed by that which is poison to us) on through to more abstract theories, such as the one to which McGinn subscribes, the Death-in-Life Theory. This states that we are most disgusted by the “mixing” of life and death. McGinn draws this theory from philosopher Aurel Kolnai. Kolnai was a Hungarian born Austrian, a Roman Catholic convert, who because of his Jewish background had to flee the Nazis and spent most of his career in England and America. But his work on disgust was published in 1929, and I couldn’t help but notice the common themes it seems to share with a number of passages from Wilhelm Reich’s work on the nature of fascism. That connection might be worth exploring further, if you have the stomach for it (I don’t!)
In the second part of this book, McGinn relates disgust to “the human condition.” Here again, there are echoes of Becker throughout. McGinn writes with grace and humor, and many of his passages sparkle with the sort of existential wisdom that draw so many readers to Ernest Becker’s work. In my view, the strongest part of McGinn’s work here is his focus on disgust and humor. Clearly, much of our humor is based on throwing that which is disgusting into people’s face. Laughter is one of the social acceptable reactions we have to disgust. Much of our laughter easily combines with “OOEEWW GOD!” and a facial expression of revulsion. If you doubt that, try reading this section of the book while looking at yourself in the mirror!
Now, much as I “enjoyed” this book (if that’s the right word) I also found it very frustrating. Many philosophers seem to be allergic to the concept of the dynamic unconscious, mostly I suspect, because it ultimately asserts that we are motivated by irrationality rather than rationality. That sort of cuts philosophers, the self-fancied doctors of rationality, off at the knees. McGinn is all philosopher in this regard. Thus, although he certainly has read at least Becker’s Denial of Death and quotes from it liberally, he persistently (mis)reads what Becker is saying because it is shorn of the dynamic unconscious. Thus, for example, McGinn characterizes Becker’s view of disgust as the Death Theory, which woodenly interprets “fear of death” as a conscious condition, and therefore sees disgust as rooted in the idea that “we know we must die.” But that is not at all what Becker meant, though it is the common way philosophers tend to read him. I suggest the absolutely fundamental hermeneutic for properly understanding what Becker was driving at is Becker’s repeated claim the death is an extremely “complex symbol” to a self-conscious species. This, in turn, cannot be adequately understood apart from the workings of a dynamic unconscious. Reading McGinn reading Becker is like watching a film in black and white that you have already seen many times in full color.
There are many other statements McGinn makes throughout the book that one could quibble with; for example, his repeated claim that animals do not feel disgust - any dog or cat owner who has tried to sneak a medical pill into the pets’ food will tell you this is highly disputed! But it would frankly just be disgusting to end my review of such a fine book with such quibbling. |
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Kirby Farrell's "Berserk Style in American Culture" |
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Thursday, 08 December 2011 13:53 |
 Of Recent Interest… is the new book by Kirby Farrell, Berserk Style in American Culture (Palgrave Macmillan, 2011). Readers of the EBF Newsletter are well acquainted with Professor Farrell’s work, and a number of the ideas and examples in this book have been previewed in his conference presentations over the years. It creates a whole new impact, however, to have them presented together in one place, each building on the other.
As the title indicates, Farrell is pinpointing something peculiar about American popular culture, the adulation of what he labels as “berserk abandon.” Just consider some of the major themes of current American pop culture - “teens gone wild,” and “shock and awe,” and “just do it!” and “go for broke,” and “make a killing,” and “going postal,” and “deal or no deal.” In such an environment, it is easy to overlook the berserk style that connects these cultural themes. The author focuses attention on the concept of “berserk abandon,” and clearly demonstrates that this concept as “style” has become increasingly pervasive in the past few decades. Farrell draws generally from the death-anxiety thesis associated with Otto Rank and especially Ernest Becker, and more recently with Robert J. Lifton and Irvin Yalom, to situate his concept of berserk abandon within an established interpretive stream of thought.
The concept of berserk style draws together and points toward a thread of apocalyptic commonality in broadly diverse areas of modern culture such as economics (the unconscionably leveraged gambling of the bubble-prone financial sector), politics (the near-total bifurcation of partisanship from the national on down to the local levels), conduct of war policy (subsuming into an open-ended War On Terror), religion (narrative advocacy of “we” versus “them” redemptive violence in the name of God), media (highlighting crossfire pyro-argument and winner-take-all entertainment) and artistic fashion (with films focused increasingly on run-amok total-revenge and end-of-the-world themes). Furthermore, this berserk style hermeneutic helps us see how each of these areas of culture feed off of each other and thus move the general environment ever-deeper into run-amok thought and action in our society.
Reading Farrell’s book really gets your juices flowing! Much current pop-phenomena simply cry out for examination under the lens of the berserk-style hermeneutic. Just a few that come to mind are the current crop of gladiator, do-or-die, double-or-nothing, go-for-broke game and talent shows; World Wide Wrestling in general and the Smack-Down Death Match aspects in particular; the Twilight phenomenon, particularly the Vampire vs. Werewolf aspect that has become the mold within which much teen and young adult conversation now occurs. I have already been able to use some of this material in classes to good effect, allowing an old-timer such as myself to make a meaningful connection to the young people’s world of interests. Any book that does that gets my automatic thumbs up!
Farrell’s book will certainly be recognized as a valuable contribution within the field of cultural criticism, but also in American Studies, modern history, cultural philosophy, sociology, and other fields that seek to understand and interpret American culture and, more generally, the ethos of late capitalist society.
See Kirby Farrell's website at http://people.umass.edu/kfarrell/ and read his and Dan Liechty's blog posts at The Denial File. |
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