The Personalist Project

Compassion in medicine

Compassion has a moral quality; it is not just a fine bedside manner or a capacity to have a physiological empathy with the patient... Every human experience is unique, especially the experience of illness. No one can fully experience another person's experience of illness. Nevertheless, if we are to arrive at a medical decision that fits as closely as possible a patient's experience, we must penetrate that unique experience to some degree. That's what compassion means. To feel something of what it is to be ill: not in general, not in society, not in one's family, but in this person here and now. Compassion becomes a moral requirement because a truly healing action requires some comprehension of what this illness means to this person. Objectivity required by medical science is a stepping back, which is absolutely necessary for the technical decision. But with compassion we step back into the patients experience in order to make a good, morally defensible decision.

Edmund D. Pellegrino, Toward a Reconstruction of Medical Morality

The Pope is back on the other side of the ocean. The crowd-control fences are gone, the altar dismantled, the traffic patterns back to what passes for normal here in the District of Columbia. The legions of TSA agents are off on some less spectacular assignment.

Even the moon is back to normal.

It’s not that I feel cheated. My husband snagged me a ticket for the Papal Mass, and the clouds cleared away just in time for us to get a good, hard look at the supermoon. (We even found the binoculars before the spectacle was over, a once-in-a-lifetime portent in itself.) 

But now what?

In the aftermath of all the excitement, one question seems obvious: how to hang onto all your good intentions when the euphoria is over? You were touched, or moved, or shaken out of your customary inertia? Fine. And so what? For how long? After all, emotional highs aren't guaranteed to translate into a better character, improved habits. And if no transformation ensues, wasn't it all just an illusion? You're back where you started, but a little more disenchanted, a little more cynical.

The obvious moral of the story seems to be: Distrust the heart. Stick to the solid ground of intellect and will. 

But wait a minute.

Not so fast.

The simplistic assumption is everywhere: as if, on the one hand, you have random, irrational sentiment, floating in the void, and sub-rational animal instincts. On the other, intellect and will: that by which we connect with reality and get things done.

Dietrich von Hildebrand wrote an entire (though short and accessible) book called The Heart about this caricature of affectivity, and he says it better than I do. But affectivity is not given to the human person just to be warily ignored or incessantly overruled. Nor are all affective responses created equal.

Some are physiologically driven and can be traced back to a stray hormone (or some other equivalent of the "undigested bit of beef" which Scrooge blames for the apparition of Marley's Ghost). Others are fleeting sentimental reactions too feeble to affect your action, or even your sentiments, ten minutes after they're felt.  But others are responses of the heart--the center of the person--and shouldn't be dismissed so carelessly.

It seems obvious--but only at first glance--that the affections are uniquely untrustworthy, because, after all, they can be so misleading. How many people have pleaded "love" as an excuse for adultery; how often has manipulating, or even destroying, the helpless masqueraded as "compassion"?

But is the intellect any more reliable, when it's out of sync with the heart and the will? Intellectuals have committed more than their share of insidious crimes. And the will, in isolation, can be monstrous.

I don't mean to make the human person sound like one of my son's Lego figures, composed of three kinds of parts, with the trick being to get the proportions just right. Bur a realistic view doesn't reduce the heart (or the intellect or the will, for that matter) to a caricature of itself.

So I can understand if some are unmoved (as  the always-worth-reading Max Lindemann describes in "Immune to the Francis Effect"), or suspicious when they see the Vicar of Christ being treated like Taylor Swift. (As Michael Gearson notes, they're the only two for whom the NFL schedule has ever been adjusted). I can understand skepticism at the notion that emotional overload can save the world.

But the danger, post-Francis, is not so much that people will count on an emotional high to deliver more than it can. If this past week took you out of yourself, and made the impossible seem plausible, the question is not whether your affections were touched by his gestures, or your reason inspired by his words, or your will boosted by his example.

It's whether you'll continue to generate a chain of free, personal responses to the reality you've bumped up against.


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For weeks, we on the outskirts of Washington  D.C. have been watching the preparations for Pope Francis' visit to our neighborhood. Fences sprouting everywhere, Secret Service types at every turn, low-flying helicopters. And detours. Lots of detours.

Two days ago, my husband surprised me with a ticket to the Papal Mass and canonization of Bl. Junipero Serra.

And this afternoon, I found myself in an endless line, snaking around blocks and blocks, waiting to get in.

Around me I heard Japanese, French, Italian, lots of Spanish, and even some English. A thin girl, hair streaked pink, was talking earnestly about a late assignment. Salesmen were hawking buttons and t-shirts ("I Heart Papa Francisco," and "Love All People"). Flocks of Dominican sisters strolled cheerfully past, reminding me not at all of the tough Italian nuns who used to shove us out of their way--with surprising strength of  elbow--on their path to Pope John Paul II in St. Peter's Square. Regal African women in sparkling gowns and turbans rubbed shoulders with sloppy American students. 

No strollers were allowed, and I saw unsung heroes, like the father with a toddler sitting happily on his foot, arms wrapped around his ankle, as he trudged along the sidewalk, over the bridge you had to take into Brookland ("Little Rome") because traffic was prohibited between there and the Shrine.I saw them later. She had migrated to his shoulders. 

A college-age girl was jumping up and down excitedly. "Imma keep my ticket forever. Imma frame it. Can I?"

Another, one of the many who had already risen early to catch a glimpse of Pope Francis on the parade route that morning and then come here to wait hours to get into the Mass, was explaining, "Yeah, you couldn't really see him, he was up high, but he was just blessing everyone, and then he did thumbs up when he passed the disabled section."

There followed a long, long period of waiting for Pope Francis to be installed in his seat. Untill he was settled in, the police wouldn't let us into our sections to be seated. As the sun beat down, I listened to two ladies next to me kvetching about how THEY would have handled the logistics of seating thousands of people and keeping them all happy all afternoon, and how simple it would have been to do it correctly.

One tall man, who could see the Pope better than most of us, would report periodically, "Yeah, he's doin' laps...Yeah, he's still cruisin'..."

Then all at once Pope Francis made a turn and came closer to us, and a gaggle of little kids who had been playing quietly on the grass instantly rose as one, screaming at the top of their lungs, and made a joyful beeline for their Papa.

Eventually the Mass began. He seemed very, very tired--like any almost 80-year-old man with one lung who, on the heels of a trip from Rome to Cuba to Washington, was about to face New York and Philadelphia, one right after the other. But he seemed to gather strength as the Mass went on. My husband was happily surprised. "In Spanish," he noted, "he sounds like a father telling us things we need to know. The couple of times I looked at the screen translation, the words were more pointed, somewhere between remonstrative and accusatory, closer to the former. I like listening to him better than reading him in translation."

I'd heard the Mass was going to be in Spanish. A lot of it was, but I think nearly as much was in Latin. The remainder was mostly in English, along with Korean, Tagalog, Ameican Sign Language, Vietmamese, and Creole. There was also a reading in "the Chochenyo Native American language." A lector with Down Syndrome was also included--the first time I've seen that, but I hope not the last.

And the homily? It brought up by-now familiar themes of not allowing ourselves to be enclosed in our own comfortableness. He urged us not to settle for "placebos," not to let our hearts be "anesthetized." It reminded me of passages I loved when, right after his election to the papacy, I was helping to translate a collection of his homilies and talks. It's a beautiful introduction to themes he's been returning to ever since, patiently, themes which, if we could grasp them and be convinced to live by them, would make us all so much happier. Two years later, he still radiates affectionate hope and patience, not disappointment and frustration, as he gently tries to pound them into our heads.

Home again, I was met by my excited younger kids, who'd watched the Mass live-streamed on the computer.They'd gotten a far better view than I had, and had noticed all kinds of details that had gotten by me.

But I wouldn't have missed it for anything. 

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When Hitler invaded Austria, Dietrich von Hildebrand and his wife had to flee for their lives. For months they lived in Switzerland as refugees, relying for food and shelter on the generosity of the Swiss Catholics who took them in. When a friend later commented that that must have been a difficult time, considering that he had been born and raised in luxury, von Hildebrand responded that he wouldn't trade the beautiful experience of being on the receiving end of Christian charity for any amount of material security.

I had a similar experience today, albeit on a much more modest scale. After Benedict got off to school, Jules and I set out together for a 16-mile bike ride. It's a lovely time of year, and I was looking forward to the exercise. But, having slept very badly two nights running, on a big hill six miles in, I pushed too hard and fell apart. 

I got off my bike and lay in the grass, trying to catch my breath and recover the energy to go on. Jules didn't judge me. He didn't tell me I was being ridiculous. He didn't get annoyed and pressure me to show a little more gumption and willpower. He just waited patiently till I felt ready to get back in the saddle. I told him I might not be able to make it. He said, "Don't worry, I'll push you on the hills." 

The Dutch, who are practically born on bicycles, have this great trick of riding close beside a weaker rider with a hand on her back, propelling her forward by their strength. (I wish I had a picture to show what I mean.) For the rest of the ride, that's what Jules did. Whenever we came to a hill, he drew up beside me and put his hand on my back, boosting my feeble pedaling and making it easy for me to keep going.

During one longish stretch like that, side-by-side, linked by his strong arm, it occurred to me that this was a perfect image of married love, and of love in general.

It was frustrating to be so weak that I couldn't manage 16 miles by myself, but I will always cherish today's ride as one of my very favorites—much more beautiful and rewarding than the longest one I've ever done on my own strength.

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Unless we are fully integrated personalities, resting in God, clear and confident in our identity as individuals, full of virtue and free of all compulsions and destructive dynamics, we have interior work to do.

A big part of that work involves coming to true self-knowledge and genuine self-acceptance. Both are prerequisite for the sincere gift-of-self that is our fulfillment as persons. Neither is easy to attain, because, thanks to our fallen condition (plus the shortcomings of our upbringings), we are afflicted with confusion, error and illusion about ourselves. To a greater or lesser extent, most of us are double-minded, deluded, and in denial.

In my own interior work, I've found it helpful to distinguish both conceptually and existentially three "selves" at issue in the soul.

Ego is the selfish self, the demanding, voracious, competitive or obsequious self; the self that masters and slaves, uses and abuses, connives and manipulates to get what it wants—power or pleasure or prestige or protection. It has no concern for others, except in terms of what it can get from them. It doesn't serve or share, it takes and devours. It doesn't admire and cherish, it scoffs and exploits. It disregards objective goods and values, moral laws and norms. Everything is subordinated to ego-interest.

Egotism is the mode of being and acting in which we "live for self to the contempt of God" (and others). It's the way of hell—and a kind of force within each of our souls that has to be consciously repudiated and subdued by grace.

The false self is an image we create of ourselves. It's typically a mixture of what we've been taught and/or believed and what we want to be true and want others to believe about us. It is the "willed self" we present to the world. It's a facade, though sometimes only unconsciously so. Most of us are unaware that we are hefting a false self—striving to maintain an image, even in our religious lives.

The false self is recognizable by its inefficacy. It dwells in theory, abstraction, and appearances; it lacks traction in the concrete. When we're operating from the false self, we experience a tension and disconnect between the idea we have of ourselves and the way we actually feel and behave and react. The false self is the one who says, "I'm not mad," or "that's fine," expressing not our true feelings, but our notion of what we should feel or what we wish we felt. The false self is threatened by criticism; it worries about what others think; it is anxious, judgmental, brittle, and insecure. It's the self that gets enmeshed in dysfunctional relationships.

The true self is the unique and irrepeatable (plus limited and imperfect) person we're actually created to be; its roots are in God. Its reality is revealed in and through our feelings. Its authenticity is recognized in the efficacy of its free choices and responses. It's the ground of right relations and communion with others, the locus of love in our lives.

In my experience, believing Christians are generally pretty good at recognizing and repudiating the ego. We know it's not okay to live for self to the contempt of God or to treat others as mere objects. We reject that way of living.

We have a much harder time coming to terms with the false self, because it's so deeply and subtly entwined with our sense of identity. Ridding ourselves of it means letting go of long-cherished illusions we have of ourselves in favor of a reality that seems (at first) so much less impressive, less valuable, plus weaker, more vulnerable and more dependent. 

It's extremely painful. But it's the only way to God and communion. A passage in Spe Salvi lays it out powerfully.

47. Some recent theologians are of the opinion that the fire which both burns and saves is Christ himself, the Judge and Saviour. The encounter with him is the decisive act of judgement. Before his gaze all falsehood melts away. This encounter with him, as it burns us, transforms and frees us, allowing us to become truly ourselves. All that we build during our lives can prove to be mere straw, pure bluster, and it collapses. Yet in the pain of this encounter, when the impurity and sickness of our lives become evident to us, there lies salvation. His gaze, the touch of his heart heals us through an undeniably painful transformation “as through fire”. But it is a blessed pain, in which the holy power of his love sears through us like a flame, enabling us to become totally ourselves and thus totally of God. In this way the inter-relation between justice and grace also becomes clear: the way we live our lives is not immaterial, but our defilement does not stain us for ever if we have at least continued to reach out towards Christ, towards truth and towards love. Indeed, it has already been burned away through Christ's Passion. At the moment of judgement we experience and we absorb the overwhelming power of his love over all the evil in the world and in ourselves. The pain of love becomes our salvation and our joy. 

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Twice in recent months Jules and I have had the great good fortune to be present for a talk by Rabbi Meir Soloveichik. The first was in May, at the formal launching of the wartime memoirs of Dietrich von Hildebrand, My Battle Against Hitler. There he spoke movingly about the role of Jews throughout history in giving unique witness to the fullness of humanity as made in the image and likeness of God. (As soon as the Hildebrand Project makes the video available, we'll link it.)

The second was just the other day, at an Agora Institute event, where the topic was religious liberty in America from the point of view of Jewish experience. It was a rich and deep and thoroughly engaging presentation—providing ample material for many discussions. It has inspired Jules and me to make Jewish personalism the focus of this year's reading circles. But more on that later. Here I want to zero in on just one of his themes and insights.

Rabbi Soloveichik began by referring to a book by Catholic theologian Maria Poggi Johnson, called Strangers and Neighbors: What I have Learned about Christianity by Living Among Orthodox Jews. (I've just bought the Kindle version.) He proposed that this title captures well the American ideal of religious liberty. Our Constitutional order is not a secular order, like France's, where religion is relegated to the private sphere. Nor is any one religion privileged over others, as in pre-modern Europe or current day Islamic countries. Rather, the American ideal of religious liberty allows (in theory, if not always in practice) for believers to be fully engaged citizens precisely as religious men and women. That entails believers and unbelievers of different kinds and traditions learning to live and cooperate with each other without losing our distinctiveness as individuals and communities of faith. We want to  be both neighbors and strangers.

One member of the audience objected a little afterwards: Do we really need to be strangers? It sounds so cold and alienating. Shouldn't we strive for more than that?

Rabbi Soloveichik was adamant—stern almost—in his reply. Yes, we remain strangers, even when we become friends. That strangeness is a function of our holding different, even conflicting beliefs, experience, customs and values. 

In the unexpected almost-sternness of his reply, I sensed immediately how a rejection of the category of strangeness must feel to a religious minority coming from the majority. It must seem to carry an element of oppression, if not aggression, as if suggesting, "You are not allowed to maintain a zone to yourself, where we do not belong and are not welcome."

I associated it with what I have experienced in codependent personal relations, wherein there is an implicit demand that I abandon unamenable aspects of my subjectivity, for the sake of "unity"—as if any reserve of subjective plenitude is mere selfishness, the cause of unnecessary tension and divisiveness. I've learned to stay away from those people as "unsafe" (in the usual parlance of psychology). In wholesome inter-personal relations the irreducible "otherness" of the other is cherished and enhanced, not subdued or curtailed.

Likewise, in the religious pluralism of the American ideal, we don't merely tolerate, never mind try to reduce or abolish religious difference, rather we cherish it. We cultivate it as both challenging and enriching. And then, mysteriously and paradoxically, we find in it new avenues and sources of true friendship.

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