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Living in the Epilogue: Social Policy as Palliative Care

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“A self is a machine for making you concerned about your organism.”
— Antonio Damasio


The Story as a Cognitive Bias

The essence of consciousness, says Antonio Damasio, is the internal narrative – the story one tells oneself about oneself. The ability to create this narrative – to conceive of oneself, to project oneself into the past and the future, to connect events meaningfully – has proven to be a very effective evolutionary strategy to ensure that an organism acts to promote its own ends.

Our evolutionary history ensures that we think in stories. They are so central to our thinking that it is hard to think about them. An old fish said to a couple of young fish, “Morning, boys! The water’s fine today!” and swam off. One young fish turned to the other young fish and asked, “what’s water?” Thus it is with humans and stories.

Stories are extremely useful; as information-hungry, social creatures, we are as pleased to hear stories as dogs are to sniff the pee stains of other dogs. We love stories. We are stories. We think and remember in the form of stories. As Roger Schank puts it (in Tell Me a Story: A New Look at Real and Artificial Memory), “In the end all we have, machine or human, are stories and methods of finding and using those stories.”

But stories are not real. They are constructs that we apply to the universe, but there is no story out in the universe. There is no “gist” or “point” to the universe, as stories have gists and points. We construct meaning to serve our evolutionarily-determined ends, and this is, I think, the most central of all the cognitive biases.
<!–conflict
causation (story v. narrative)
events follow each other in time
a protagonist pursues his goals
we empathize with the protagonist
conflict followed by resolution – structure/pattern of events
characters affect each other
not just what stories we are attracted to (what makes stories “interesting”) – but the very form of the story itself
positions in time of the story have different emotional connotations–>
Living in the Epilogue

My name is Sarah. I’m 32 and I live in Los Angeles. Since I was a small child, I have wanted to die. But here I am.

I keep two bottles labeled “Poison” on the shelf next to my bed. They are filled with an alcohol extract of several pounds of macerated immature Conium maculatum seed pods, the part of the plant that is highest in toxic alkaloids. I feel much better having it there. My hope is that someday I’ll get drunk and upset and drink it down without even thinking about it. I think it will work; my only worry is a couple of papers that point to extreme pain while dying and possible kidney problems if one survives. (Also, the stuff smells like the Grim Reaper’s boiled turd smeared on a rat with gangrene.) Still, here I am.

A few years ago, I wanted to die all the time, every minute. I suffered intensely, and the main project of my life was to get through time. I researched suicide methods, made repeated attempts, but always failed, and was left with the conviction that suicide is extremely difficult without barbiturates, which I could not (and remain unable to) get. At some point, I changed my focus from trying to end my life to trying to make what years I am forced to endure less miserable. In the language of illness, I put myself in hospice and gave myself palliative care.

I tried many therapies, including a six-month attempt at alcoholism. Many of my experimental palliative care therapies (including this) failed, but a few were extremely successful at making me not suffer all the time. I stopped trying to be in monogamous relationships. I take a couple of prescription SSRIs. I exercise in a rather extreme fashion. I see a therapist. I smoke marijuana and have riotous group sex with my boyfriends and girlfriends. I go to lectures and watch experimental animation at the independent movie theater. I write essays on my couch with my books all around me and Shehnai music playing.

I suspect that I have more fun that most people in the world. Life remains an irritation, but for me, it is not the constant grind of pain and humiliation that it must be for millions of people. In many ways, my very suicidality makes life more pleasant for me, since I utterly lack the fear of death and all the cringing urgency that fear engenders.

But there is something missing. Here is the problem, if it is a problem: I am not in a story.

Living outside of any story – living without hope for the future, without the belief that one is part of a narrative – is confusing. It’s hard to get anything done when nothing has a point. For any not-immediately-pleasurable action (or inaction) I contemplate – getting up in the morning, vacuuming, answering the phone, spending an entire day sober – there is no readily-available answer to the ever-present question in my mind, “why?” At least, there is no long-term “why.”

Do I wish I were in a story again? Ultimately, no. Even if it were possible to imagine myself as a character in some narrative about to unfold, I don’t really want to. This would be sacrificing truth for comfort – and questionable comfort at that.

I spoke about this with my closest friend, and he suggested that I have had a story, and now I’m living in the “ever after” part. I am, for all relevant purposes, living in my own epilogue. This is also, I think, the status of people with terminal illness who are about to die: their story is essentially over. This is even true if you believe in magical sky friends and heaven and all that.

There Are No Stories In Heaven

There are no stories in heaven; heaven is all epilogue. It functions as a bookend on our stories; we may even call it the “hereafter,” as in “happily ever after.” There can be no conflict in heaven, so there can be no stories, either.

Aristotle scholar Martha Nussbaum explores how crappy it is for humans to live outside of a story, even in heaven, in her essay “Transcending Humanity.” Here, she considers Odysseus’ choice to give up eternal youth and pleasure with Calypso in order to return to his wife and the certainty of inevitable death. She says,

What, in the face of the recognized human attachment to transcendence, could justify such a choice? Odysseus has little to say. But what he does say makes it perfectly clear that they key is not any surpassing beauty in Penelope herself. He freely grants that from this point of view Calypso will be found superior. And he points to no superiority in Penelope that could counterbalance Calypso’s divine excellence. So he is not, it seems, choosing a glorious prize in spite of the fact that he has to face death to get it; that is not at all how he sees the issue. He is choosing the whole human package: mortal life, dangerous voyage, imperfect mortal aging woman. He is choosing, quite simply, what is his: his own history, the form of a human life and the possibilities of excellence, love, and achievement that inhabit that form. What, then, can he say to make that choice intelligible, once the alternative of divinity and agelessness is on the scene?

And yet, to readers of the poem from ancient to modern times, Odysseus’ choice does seem intelligible, and also admirable — the only choice we would have our hero make.

Odysseus’ choice is perfectly understandable because the alternative is so . . . boring. Without the possibility of loss, nothing is interesting. Without limitation, there is no possibility for excellence, which is, in the Aristotelian view at least, the purpose of a human being:

We don’t quite know what it would be for this hero, known for his courage, craft, resourcefulness, and loyal love to enter into a life in which courage would atrophy, in which cunning and resourcefulness would have little point, since the risks with which they grapple would be removed, and in which love, insofar as it appears at all, would be very different in shape from the love that connects man to wife and child in the human world of the poem.

And:

The Greeks, no less than contemporary Americans, praise outstanding athletic performance as a wonderful instance of human excellence. . . . But clearly, such achievement has point and value only relatively to the context of the human body, which imposes certain species-specific limits and creates certain possibilities of movement rather than others. . . . But if this means that even races or contests between different animal species will usually seem pointless and odd, it means all the more that there will be no athletic excellence at all, and no meaningful concept of athletic excellence, in the life of a being that is, by nature, capable of anything and physically unlimited. . . . What would such achievement be, in a being for whom it is all easy? What would be the rules of the game? [Bolded emphasis mine.]

But the real appeal of Penelope, and of the mortal world, compared to heaven, is the possibility of stories. We root for Odysseus to choose Penelope over immortality, says Nussbaum, because of

this more general uneasiness about the shapelessness of the life Calypso offers: pleasure and kindliness and on and on, with no risks, no possibility of sacrifice, no grief, no children. All we need to do to see this is to compare accounts of lovemaking. Odysseus and Calypso “withdrew, and in a recess of the arching cavern they took their pleasure in love, and did not leave one another’s side.” That’s the end of that; the poet can say no more; for they have nothing to talk about, since they have done nothing and nothing has happened to them. As for the human husband and wife:

The two in their room enjoyed the delights of love, then pleased one another with recounting what had befallen each. The queen told how much she had suffered in these halls, seeing always there the pernicious multitude of suitors who in wooing her had slaughtered so many beasts, fat sheep and oxen, and drawn so much wine from the great jars. The king told of the harm he had done to others and the misery he had endured himself. Penelope listened to him enraptured, and sleep did not fall upon her eyelids till he had told his tale to the end. [Oddyssey, V.226-27, XXIII.300-09, W. Shewring transl.]

It’s perfectly plain that the human pair are, at least from the viewpoint of the human reader, more interesting and more erotic. A sexuality divorced from conversation, from storytelling, from risk and adventure and the sharing of risk and adventure, seems extremely boring; and we feel that it is a great tribute to the goddess’s beauty that Odysseus retains his interest in her, after so much time.

Life is quite unbearable, for a human, without the “risk and adventure” of a story-bound life. What we are looking for when we look for the “meaning of life” is the greater story. The unfortunate truth, suggested by science and vehemently denied by religion, is that there is no greater story. We may make up stories and allow them to shape our perceptions, but ultimately there is no story. We are all living in the epilogue of reality, or rather worse, because there never was a story. For many of us, our personal stories have run out – and it’s extremely difficult to push oneself into a new story once you see that all stories are vanity. It is like the difficulty of staying in a dream once one realizes one is dreaming.

The Cheery and the Damned

Why are drugs, prostitution, gambling and suicide illegal, when they clearly give so much relief to suffering people? I think it is because, at a societal level, we are deluded into thinking that happiness is possible, maybe even easy or likely, without these things. I have called this cheery social policy.

The fundamental problem with this sort of cheeriness is the assumption that a good life – a pleasant life – is relatively easy to achieve. Cheery people are able to hold such a belief because they are able to ignore – and perhaps can’t even conceive of – the suffering of a significant minority of the population. A good life is not easily achieved for many of us.

There is a majority belief that we need not use extraordinary means to achieve a happy and meaningful life. Behaviors that deviants engage in, perhaps in pursuit of a tolerable life – weird sex with lots of people, say, or using steroids or marijuana or LSD or benzodiazepines – strike cheery people as perplexing and frightening. For a cheery person, these behaviors are wholly unnecessary – life is perfectly tolerable without them. And they increase the risk of harm! Who wants harm?

What the cheery cannot imagine is the importance, the function of these behaviors, and others like them – the pursuit of the interesting, and the temporary suspension of the intolerability of existence, which intolerability (for many) the cheery do not even perceive, and therefore do not properly weight as a problem.

Jason Roy’s “Explanations for drug war” makes this point with respect to the drug prohibition. He quotes John Gray’s Straw Dogs:

Drug use is a tacit admission of a forbidden truth. For most people happiness is beyond reach. Fulfillment is found not in daily life but escaping from it. Since happiness is unavailable, the mass of mankind seeks pleasure.

Religious cultures could admit that earthly life was hard, for they promised another in which all tears would be wiped away. Their humanist successors affirm something still more incredible — that in future, even the near future, everyone can be happy. Socieities founded on a faith in progress cannot admit the normal unhappiness of human life. As a result, they are bound to wage war on those who seek an artificial happiness in drugs.

But it is not necessarily the case that prohibitionists think that life is great. It’s that they think it is meaningful – that we are in a story, and it’s worth participating in, win or lose.

The idea that life is inherently worthwhile, and happiness easy to achieve, underlies many social policies, including prohibitions (legal or moral) on suicide, abortion, nonmarital sex, drugs, gambling, and even eating fatty food.

On the other hand, if life were not inherently worthwhile, suicide would be understandable, and bringing a new life into the world would not be an unqualified good, but an uneasy question mark. Sex, drugs, and fun would be appropriate ways to treat oneself for the unwanted condition of life.

Palliative Care: A Double Standard for People in the Epilogue

The terminally ill are at the end of their story. If you’re going to die anyway, what does it matter what you do? Take ecstasy. Go skydiving. Fuck a prostitute. Kill yourself. Who cares?

There is a sense that, once you’re terminally ill and an official short-timer in life, what you do ceases to really matter. This is, I think, at the heart of the double standard our society imposes with regard to suicide and the other activities mentioned above. If you’re young and healthy, you have an obligation to stay alive and be sober and responsible. But if you’re toast anyway, anything goes. For the dying, we can conceive of allowing them pleasure as mercy. But we are not so eager to offer mercy to healthy people. That is because we mistakenly believe in the concept of health.

Toward Social Policy as Palliative Care

We are all terminally ill. Not one of us is going to survive. And our stories are delusions. Each one of us lives in The Matrix – a story-dream created by our minds. Happiness is not easy; meaning is elusive. Young, healthy people who find themselves miserable, or find that they no longer inhabit a story, have even more need of the kind of “palliative care” that we offer to terminally ill people, simply because young people have so much more time to get through. Eighty years! Ninety years! A hundred years of epilogue ahead of us. It’s crushingly boring to ponder. As Martha Nussbaum says,

When Calypso speaks of “calm possession of this domain,” our hearts sink; for there’s no story in that. . . . Stories have shaped and continue to shape the readers’ desires, giving them a preference for onward movement over stasis, for risk over self-sufficiency, for the human form of time over divine timelessness. They play upon and nourish the emotions — fear, anticipation, grief, hope — that presuppose the form of life of a being both needy and resourceful, both active and finite — and that seem to have their point and function only within the context of such a life.

Regarding antinatalism, someone recently asked me if it was my belief that the bad outweighed the good, or whether I thought they weren’t even comparable. I believe the latter. Ray Brassier, in his introduction to Thomas Ligotti’s excellent The Conspiracy Against the Human Race, puts it thus:

The optimist fixes the exchange rate between joy and woe, thereby determining the value of life. The pessimist, who refuses the principle of exchange and the injunction to keep investing in the future no matter how worthless life’s currency in the present, is stigmatized as an unreliable investor.

This is the view from hell. Hell is not the state of experiencing a great deal of suffering with no pleasure to “balance it out.” Hell is popping out of the notion of meaning altogether. And this Hell is the meta-condition that we are all in, whether we perceive it or not.

Memento mori

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Written by Sister Y

December 8, 2010 at 9:54 pm

On Being Your Patients’ Keeper

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Sexy psych nurse Mr. Ian of MentalNurse wonders why “risk assessment” (for harm to others) is the exclusive province of mental health professionals, to the exclusion of other specialties. Medical patients other than mental patients often pose a risk to other people – but doctors and other health care workers are not expected to police them. Whose risk is it, anyway? He says:

Who says it’s my responsiblity to assess, manage and mitigate risk of harm to others?

I could flip the question – why is risk assessment and management only an obligation of the mental health sector?

Why aren’t parole boards required to meet the same standard when releasing a known violent person? They don’t even have an obligation to the offender. Their obligation is to the safety of the public.

Why can’t opticians remove someone’s license to drive when they’ve failed an eye test or GPs remove licenses from those with ‘at risk’ medical conditions? Why aren’t these people risk assessed and arrested if they fail the eye test but found driving a car?

I think the same questions can be asked for risk assessment focusing on “danger to self.”

Written by Sister Y

March 22, 2009 at 5:26 am