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

Language is meant to be communication—the prime way we share truth with one another. Often it isn't, though. Often it's manipulation. It's framed not bring the other to greater understanding or fuller contact with reality, but rather to get him to behave according to our will—buy this product or vote for that politician or accept this illusion. 

Josef Pieper has a wonderful small book on the theme, Abuse of Language, Abuse of Power.

It's tempting especially for people who are good with words to use that power to get what they want—attention, cooperation, money, prestige, an emotional response. I know a playwright who is explicit about it. His goal in writing is to manipulate his audience toward a particular emotional response. I protested when he told me this, but he had no ears to hear me. He thinks that's what playwriting is all about: emotional manipulation.

Not all authors think that way. I came across a different point of view yesterday, in another book I'm reading, called Good Prose.

Writers are told that they must “grab” or “hook” or “capture” the reader. But think about these metaphors. Their theme is violence and compulsion. They suggest the relationship you might want to have with a criminal, not a reader. Montaigne writes: “I do not want a man to use his strength to get my attention.”

These authors intuit the problem of the master/slave dynamic in writing.

I've said it often and often, and will keep bringing it up, because I think it IS "the mystery of iniquity": the master/slave dynamic has menaced all human relations and interactions since the fall in Eden. If we want to be free of it, we will have to become more aware of it, more sensitive to its operations, "in our thoughts and in our words; in what we have done and what we have failed to do."

"It's for freedom that Christ has set us free." 

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I'm really worried about all the women who have had abortions. (Some of them are people I know and love.) I'm worried that the moral horror now dawning on the public (thanks to those video exposés of Planned Parenthood) will overwhelm them—that they will be tempted to despair and self-hatred, or else to more entrenched denial and callousness.

We have to pray for them! We also have to deepen our awareness of our complicity, as individuals and as a society, in this evil. We have to help those women know and feel that they are not alone in their guilt. We have to help them carry it; it's ours too.

I've never had an abortion. I've also never had a boyfriend who used me for sex, but refused to take responsibility for a child we conceived together. I've never felt that fear of abandonment. I was never in a tight spot—pregnant out of wedlock with no money and nowhere to turn. I don't have a controlling, abusive husband. I didn't have the kind of parents or friends who would urge and pressure me to get an abortion—as if it were in the best interests of all concerned. I was never subjected to the lying propaganda that can convince a scared young woman that "terminating a pregnancy" is the right thing to do, because she's not ready to be a mother, not ready to care for a child. I wasn't indoctrinated to believe that recreational sex is "safe" or that "the product of conception" isn't a human being.

I knew the truth, and I've been free to live in accord with it, personally. "The boundaries have fallen in pleasant places for me." I was raised by Catholic parents with staunch moral values, who taught me that Planned Parenthood is an evil organization. If I had gotten pregnant as a teenager, they would have been disappointed, but they would helped me have that baby. Thanks to evangelicals, I've had a "personal relationship with Jesus," since I was 12. I've traveled my whole life in ardently religious, pro-life circles, surrounded by faithful Christians who deeply believe that each and every person is created in the image and likeness of God, and who make generous personal sacrifices from that conviction—sacrifices of money and time and energy and prestige. I know many, many people who pray regularly in front of clinics, who support single mothers, who volunteer at domestic violence shelters, who foster or adopt unwanted children, who give their retirement years to helping raise the unplanned babies of their unwed daughters... These are my people.

And yet, I've been enjoying life and sipping wine, and generally carrying on as if it didn't concern me too much that babies are being dismembered every week in my neighborhood. I am like the Germans under Hitler, who knew Naziism was wrong, but kept mostly quiet, from fear or complacency and self-interest.

Mea culpa, mea culpa, mea maxima culpa!

I understand very well what it means to conceal truth from my own mind, or to muffle its urgent voice, because it seems like I couldn't function otherwise. I also know the pain and profound, almost-aniliating humiliation of disillusionment. And I've learned that the only answer is to throw myself on God's infinite mercy.

I really hope Planned Parenthood is finally destroyed by the recent revelations, and I hope everyone who has ever had anything to do with abortion is saved by the same Love and forgiveness that I rely on to save me from my part in it.

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Buzzwords are dangerous things. But not just for the obvious reasons.

It's old news that whoever controls the language wields the real power. That's why Planned Parenthood is so tenaciously consistent about its linguistic contortions. One of its defenders, Jen Gunter, issues this bland correction to people who are going around saying that Planned Parenthood traffics in baby parts:  "The term baby is medically incorrect as it doesn't apply until birth." What the layman might unthinkingly call a baby is known to the scientist as "products of conception" and "fetal tissue."

Well, OK--it's not that these terms are inaccurate; it's just that they're scientifically useless. As many "alert readers" (as Dave Barry might say) have pointed out, we're all products of conception and we're all made out of tissue. The euphamisms are notable not so much for their scientific rigor as for their prize-winning vagueness. ("Tissue" has the added benefit of hinting at something completely disposable: a kleenex has no inherent value or dignity: its whole purpose, after all, is to be used and then discarded.)

But I'm thinking of another danger.

There's another kind of buzzword--think "dialogue," "compassion," "encounter," "equality," or even "love"--that raises red flags for anyone who's aware of how thoroughly they've been hijacked. The first evil is that words like these get eviscerated: their real meaning is excised and a false one inserted. "Dialogue" means not just speaking and listening, but viewing the back-and-forth itself as an accepatable substitute for defending goodness and defeating evil. "Compassion" has come to mean not suffering with the sick or the elderly but ending their troubles by getting rid of them. And so on.

But here's what else happens: people who do know better become unable to hear anything BUT the buzzword meaning of terms like, say, "mercy" or "sensitivity" or "encounter." We hear certain words and right away get our defenses up. Oh, come on, we think. You can't fool me that eaisily. You can't take me in.

And it becomes impossible to speak of the real thing.

This is natural enough: who wants to be the dupe of the language-destroyers, taking their euphamisms at face value? But if we let them rob us of the reality,we're doubly duped. They can't eviscerate the realities for us unless we allow them to. I guess that's what cynicism is: not just believing that nobody lives up to the good, the true, and the beautiful, but allowing your enemies to cut you off from the realities themselves. You go from refusing to be taken in by buzzwords to being unable to believe in real goodness.

I think this happens with Pope Francis' words a lot. He's full of genuine mercy and sensitivity and compassion, but who hasm't been trained to regard such qualities with suspicion? We end up unable to recognize the real thing even when it's staring us in the face.

Or think of a rainbow: it's one thing to be savvy enough to see how cleverly it's been hijacked by the celebrators of sexual confusion; it's another to give up without a fight so that spotting a real rainbow doesn't even call to mind God's promise of compassion, but only the strategy of your political enemies.

By all means, let's call Planned Parenthood out on its virtuoso juggling of euphemisms, so that they dupe as few people as possible. But let's also do what's in our own hands to make sure we're not cut off from the very thing we're fighting for.

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I'm reading a book of Alice Munro stories: Hatesphip, Friendship, Courtship, Loveship, Marriage. It's my first encounter with her writing, which I'd heard of only recently, in a podcast with Jay Nordlinger and Norman Podhoretz. Both named her as one of the greatest fiction writers of our time. "Every word is perfect." So I bought this book. And they were right. I am marveling over how much complex emotional reality she manages to convey in only a few lines. 

Take this passage from a story titled "Post and Beam." Lorna and Brendan got married, when she was 18. He was a 30 year old professor. (So, double master/slave potential—in the sexual difference and the age difference.)

Nevertheless, she cried, and cried again when she got letters from home in the early days of her marriage. Brendan had caught her at it, and said, "You love your family don't you?"

She thought he sounded sympathetic. She said, "Yes."

He sighed. "I think you love them more than you love me."

She said that was not true, it was only that she felt sorry for her family sometimes. They had a hard time, her grandmother teaching Grade Four year after year thought her eyes were so bad that she could hardly see to write on the board, and Aunt Beatrice with too many nervous complaints to ever have a job, and her father—Lorna's father—working in the hardware store that wasn't even his own.

"A hard time?" said Brendan. "They've been in a concentration camp, have they?"

Then he said that people needed gumption in this world. And Lorna lay down on the marriage bed and gave way to one of those angry weeping fits that she was now ashamed to remember. Brendan came and consoled her, after a while, but still believed that she cried as women always did when they could not win the argument any other way.

It's a perfect illustration, isn't it, of the master/slave dynamic discretely at work? It puts on display the kind of emotional neglect and abuse that are so commonplace in marriage as to be unrecognized for what they are.

Brendan isn't physically or verbally violent. But he's plainly not open to his wife. He's controlling, contemptuous, and egotistical. He thinks of a fraught conversation as an argument to be won. His consoling her is full of condescension.

She is having to learn to hide away her heart from him, lest it be ill-used.

I haven't finished reading the story, so I don't know how it turns out. I don't know if suffering  leads to an epiphany on Brendan's part, or if Lorna's disillusionment will lead her to divorce him.

Either way (or some other way), this passage stands on its own as a perfect illustration of unlove. I'm sure Brendan would be shocked and offended to hear it, but it's true.

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Privilege is usually discussed in terms of race, income, class, gender, etc. However, I found myself thinking about a different sort of privilege recently when a friend, a convert, tried to share a bit of her past with a friend of hers on Facebook. She replied to a post about Planned Parenthood with an account of her time interning in an abortion clinic, describing the kinds of interactions and dialogue that helped her make her journey from proabortion to prolife. While the public response was muted, she was attacked in private messages as an “accessory to murder.”

The acquaintances who attacked her found it impossible to believe that she had really acted out of goodwill and concern for women during the time she spent at the clinic—one lambasted her over her failure to immediately recognize abortion as murder: “It’s just so obvious. How could you?” Having never suffered a qualm of doubt over the righteousness of the prolife position, the writer could not wrap her mind around how prochoice reasoning had once attracted my friend. Her very virtue in this particular arena fueled her lack of mercy to the testimony of a repentant convert. She had, I think, a form of privilege that made it hard for her to understand the struggles others face—virtue privilege.

I’ve heard similar stories from women who have had (and repented) past abortions, from those who have left behind a sexually promiscuous lifestyle, from chaste individuals who identify as gay, from individuals recovering from broken marriages.  Depressed people are reluctant to discuss their struggles with suicidal despair for fear of the lecture about the evils of despair that is sure to follow. Those of us who are blessed by upbringing, temperament, environment or circumstances to have never had an inclination to one or another sin or set of sins can so easily take unearned credit for our ‘virtues’ or disparage those who lack what we never had to work overmuch to attain.

I’m not sure how useful the idea of privilege is in furthering discussion. It is not likely to be useful at all if it is used primarily to silence the “privileged,” which is how it has occasionally been used. But it seems to me that the usual purpose to pointing out privilege, of whatever type, is an intensely personalistic one—the intention is to make someone conscious of the subjectivity of those whose lives, experiences, and norms differ from their own. Awareness of the ways in which we are formed by our environment, upbringing, and social roles can remind us not to project on to those around us.

The Pharisee and the Tax Collecter, Julius Schnorr von Carolsfeld

Only when we learn to differentiate between the accidents of our birth and upbringing and the truly universal will we find grounds for communion with one another. While I may not be tempted to the things that tempt you, I know what it is to be tempted. While my suffering has different causes and effects than yours, I do know what it is to suffer. Whatever our advantages, we know, or should know, all too well how easily we fall prey to our own pet vices. We need not be able to imagine how a woman could believe herself to be doing good while working in an abortion clinic—we need only be able to remember how often we ourselves have been tempted to ignore or deny a “lesser evil” out of disordered but sincere love for something or someone.

The idea of virtue privilege may be especially relevant to those of us who are cradle Catholics. Being raised in the faith has not made me especially immune to temptation, but it does give me a particular advantage in recognizing sin—or at least, certain sins—when they are encountered, and gives me access to the graces to resist sin and recover when I succumb. This is, after all, the primary function of the Church—to teach us how to be like Christ, and to give us the graces we need to pursue that goal.

Privilege, we are told, is typically invisible to those who benefit from it. The child of wealth may underestimate his own advantages while struggling to establish himself as an entrepreneur. He knows the hours he has put in to his business and prides himself on his success when so many others fail. Having struggled, he fails to recognize the role his connections and capital have had in his victories. Likewise, those of us who have been steeped in the graces and wisdom of the Church for years may fail to recognize how those very graces have eased our path—that as hard as we have struggled (for everyone struggles), we have had unearned riches to draw upon along our way. 

But maybe I need not invent a new term to counter hard-heartedness towards those who fall because they lacked the graces, knowledge, or advantages of temperament which I enjoy. Perhaps I only need to call upon a somewhat older response to the sins and struggles of others, a prayer of thanksgiving for God’s mercy, of petition for the future, and of solidarity with the fallen. Perhaps what is needed is that I, and all of us, remember: There but for the grace of God go I.

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