6/21/2008

Vulnerable and fragile, but also strong, competent, powerful…

Of some reason I came to think, once again, of how fragile we human beings are, fragile, vulnerable and strong, powerful, competent… I will continue this posting later today I think. Starting it with Sting’s “Fragile.”


Fragile

If blood will flow when flesh and steel are one
Drying in the colour of the evening sun
Tomorrow's rain will wash the stains away
But something in our minds will always stay
Perhaps this final act was meant
To clinch a lifetime's argument
That nothing comes from violence and nothing ever could
For all those born beneath an angry star
Lest we forget how fragile we are

On and on the rain will fall
Like tears from a star like tears from a star
On and on the rain will say
How fragile we are how fragile we are

On and on the rain will fall
Like tears from a star like tears from a star
On and on the rain will say
How fragile we are how fragile we are
How fragile we are how fragile we are

Addition in the evening from earlier postings (slightly changed and edited):

From the earlier posting The vulnerable human being…:

In an article in a Norwegian newspaper it stood about Homo vulnerabilis – the vulnerable human being...

In this article it stood about what we today talk about as “the most vulnerable groups”, an expression that has been more and more common in the societal debate the last years (in Scandinavia at least) they mean. They write that the expression "the most vulnerable groups" can be a transcription for women and children, victims of abuse or nature-catastrophes, poor people that has been marginalized or the ones that are psychically or somatically sick.

And yes, of course these groups are vulnerable they write. But we are all vulnerable. Vulnerability belongs to our human beings basic conditions. In an ethical perspective the human vulnerability is a prerequisite, yes, even a resource…

However, much in our time can be read as assiduous attempts to deny and repress/suppress the innate human vulnerability… Yes, I think this is right. We don’t want to admit these sides in us!? We don’t want to get in contact with the power and helpless child we once were, the weak and incompetent child. The contempt for weakness. And this is quite natural, the feelings that are connected to these experiences of being a help- and powerless child, a child that was entirely handed out to her/his caregivers/parents and the clear, real insight that the child couldn’t change this situation, it was entirely impossible, how clever or sensitive or anything it even was – realizing the truth with all its implications, are so painful, so we want to avoid it at all costs.

But we have also got a growing insight about how much feelings and emotions mean for the development of ethical insight and responsibility they write… Feelings are also compassion and empathy in other people and other people’s needs and feelings (how many of us are good at that?). Without our feelings/emotions we wouldn’t be (aren’t) capable of grasping/apprehending the ethical challenges where they occur, neither in near nor more distant relations…

Or said in another manner: It is the fellow human beings vulnerability which makes the need for ethical behavior obvious or needed…

However, if I deny my own vulnerability this (being compassionate, emphatic) will be difficult…

We are back to a former blogpost, the addition in the end, about violence, not only the one between men and women (men being violent towards women), but about the violence between men too!?

And Bosch actually writes about this I think (denial of needs and thus our vulnerability, and the consequences of this denial, in our ability for nearness for example): about the different defences we use… One of these is to deny how vulnerable I as child actually was (a protection against realizing the real extent of what the caregivers actually showed with their behavior, i.e., how little they knew about a child’s needs, and that this also was a sign of lack of love!? A realization that had meant death for the child, but a truth an adult can survive, even if it feels as we can’t survive it), by adapting a defence she calls False Power anger or False power denial of needs. Or we resorted as children to the defence False hope: if we tried hard enough - then… Or blamed ourselves, what she calls the Primary defence.

It stands in the article about the mutual dependency human beings between… Probably very scary for many? Admitting ones needs and dependency on others (phew, I know psychoanalyst influenced therapists talks about this too!! In a similarly contradicting and confusing manner as our parents raised us: you shall dare to admit your dependency, but not be dependent at the same time, or in other circumstances be independent, or? And knowing the difference and being able to control even this. Phew again! And all this is a question of wanting or not wanting, and of intellect!?? How sensitive and compassionate and empathic is this from the therapist's side?)? Because realizing this would trigger early things, when the child’s natural and justified needs weren’t filled, and the feelings connected to this that had to be suppressed, probably before they even reached the consciousness? So this is very understandable, but no excuse for behaving badly…

Insight, fantasy and understanding form the “power of judging”… And it is here, in forming this “power of judging”, where our own vulnerability becomes a resource they write (in my interpretation). Oh, this can sound so very moralizing – and isn't this very intellectual!!

They also write about building rocket or missile-systems, both on an outer and on an inner level, i.e. literally and metaphorically. The dream about invulnerability continues to sow distrust and exclusion instead of trust and mutual obligations in all fellowships…

But the invulnerable human being, if he/she existed, would be inhuman they write, because vulnerability constitutes the human, constitutes that we are human beings.

But vulnerability is often presented as a lack, a weakness, as something we should help others get rid of, telling them (and ourselves too?? Blaming ourselves for being sch failures, so incapable, so weak, bad, lousy -the Primary defence?!):

“You shouldn't be so sensitive!”

And how many of us aren’t raised to think of others??? At the same time! First we are told not be so sensitive – or vulnerable, and then asked to think of others… We shall be both less sensitive and more!! Confusing!?? We shall make ourselves invisible in a way!? And then we are blamed for hiding our light under the bushel (sätta vårt ljus under skäppan)!!!

See Bosch on children learned to share at a too early age… (“Being sensitive to out children’s pain”, in the midst of the linked blogpost about “Biologism”).

I also came to think of Kirkengen who refers to the Hebrew Philosopher Avishai Margalit (Kirkengen also writes about bio-medicine!!!).

The last fall there was a TV-program with the Swedish professor in religion-psychology Owe Wikström in a talk with the Swedish author Torgny Lindgren on compassion. A couple of years ago Wikström’s heart stopped when he was at a gym with his wife (physician). Suddenly he was totally handed out to other people! At the hospital he started to reflect over what he calls “the era of self-centeredness”.

“The popular-psychology’s picture of the happy human being is extremely concentrated on the individual. This creates a very cynical society, where all shall boost [puffa för] their own selves and realize themselves. Those who don’t manage this are cast into the shadows”,

he says. Contempt for weakness again.

These reflections resulted in the book “Sonja’s goodness” (he refers to Dostoevsky’s Sonja throughout the book! I haven’t read any of Dostoevsky's books though), a book in which he seeks literature where compassion is described. Books mean a lot to Wikström!!

Wikström’s home site. About him at Wikipedia (only in Swedish).
About Avishai Margalit at Wikipedia. More about him with links to essays by him. And even more about him here.

It stands about Wikströms book (my amateur-translation, the text a bit shortened below):

"Nutiden överöser oss med slagord:

'Du kan bli framgångsrik', 'Du måste förverkliga dig själv!', Du har bara ett liv, unna dig storslagna upplevelser!', ' Tänk positivt!' [Halleluja!!].

Men alla vet vi, innerst inne, att tillvaron är oberäknelig. Hur mycket man än försöker så styr man inte sitt liv. Vi är, utan att vara särskilt medvetna om det, ständigt beroende av andras omsorger.

I Sonjas godhet frågar sig Owe Wikström vart medkänslan, omsorgen och samtalen om de goda handlingarna tagit vägen. Har osjälviskhet blivit omodernt? Vad sker i ett samhälle där individualism och upplevelsehets står i centrum? Är det omodernt att föra samtal om individens personliga ansvar för andra än sig själv? Förstärks självcentreringen av populärpsykologins tro-på-dig-själv-budskap och en upplevelseorienterad andlighet?

Utgående från en dramatisk personlig upplevelse diskuterar författaren hur det är att vara föremål för andras omsorg, utelämnad i den svages position. När tillvaron är som bräckligast minns han Sonja – den goda kvinnan i Dostojevskijs roman Brott och straff. Hon blir en sinnebild för det goda i människan. Samtidigt ger hon oss en föreställning om en typ av förebild som tidigare sågs som självklar. Att det är en litterär gestalt som på detta sätt väcker tankar om ömhetens betydelse leder över till en diskussion om böckers existentiella betydelse och deras roll som motkrafter. Frågor om ansvar och godhet diskuteras utifrån flera författarskap, främst Fjodor Dostojevskij men även Torgny Lindgren och J. M. Coetzee.

"- Det är en skimrande illusion att tro att 'ensam är stark'. När det kommer till kritan är man beroende av andra.

'I kondenserad form', skriver Owe Wikström i sin bok, 'visar varje sjukdom förödande tydligt hur svag människan innerst inne är. Den pekar på hur beroende hon är av and­ras omsorg, att få släppa kontrollen och förlita sig på att andra accepterar, förlåter och orkar ta över.'

Genom sjukdomen fick han alltså upp ögonen för 'det medmänskliga beroendet och en osjälvisk livsstil.' Han ville skriva om detta, och om det i förhållande till den egoism och självbespegling han tycker breder ut sig i samhället."

“The present time shower us with catchwords:

‘You can become successful,’ ‘You have to realize yourself!’, ‘You have only one life, allow yourself magnificent experiences!’ ‘Think positively!’ [I don't think he wants to moralize though, but he sees backs of this way of behaving, being Does it have to be either/or always? Either you care about yourself OR others? You can't care about both yourself AND others? At the same time?].

But innermost we all know that existence is incalculable. How much one even try one doesn’t steer ones life. We are, without being especially aware of it, constantly dependent on others care [but of course we each of us have responsibility for ourselves, but alone isn’t strong in the end]."

In his book ‘Sonjas’ goodness’ the Swedish religion psychologist Owe Wikström asks himself where empathy, care and the talk about the good actions have disappeared. Has unselfishness become outmoded, unmodern? What happens in society where the individualism and experience-excitement [or experience-bustle] stands in the centre? Is it outdated talking about the individual’s responsibility for other people more than her/himself (or for both her/himself AND others, my addition)? Is the self-centeredness strengthened by popular psychologies believe-in-yourself-message and an experience-oriented spirituality?

It is a shimmering illusion to believe that "alone is strong". In the end we are dependent on others. If not earlier so when we get sick, and old etc. Wikström means that in condensed form, as he says, each illness shows devastatingly sharp how weak man is at heart. It points at how dependent she is on others care, to let control go and trust that others accepts, forgives and have the strength to take over.

And that the one he/she is dependent upon doesn't misuse or exploit the dependency, sickness... How important trust is... Are all worth our trust?

Meeting a trustworthy… Genuinely trustworthy. And then dare to trust (not be so damaged so you can't then and when you need to rely on others!?).

Through the illness he suddenly got his eyes opened for "the fellow human dependency and an unselfish life-style." He wanted to write about this and about it in relation to the egoism and “self-mirroring” he thinks is spreading in society.

Yes, there are forms of this self-centeredness that are less "good"? Or how one shall express it?

See what Bosch wrote about sharing at a too early age…

See what Anna Luise Kirkengen writes about the vulnerable human being and the philosopher Avishai Margalit.

Made sick by silence/gjord sjuk av tystnad...:

Kirkengen writes in the chapter "Conclusions and implications" at pages 390 and forward in her book "Inscribed bodies...":

"...biomedicine is ignorant as to how life is inscribed into human lived bodies, and how lived bodies are inscribed in the social politics of silencing.

Violated humans are made sick by the silence and are sacrificed to the silence about overwhelmingly male sexual violence, which societies still resist becoming knowledgeable of and reflect upon. Both psychiatric and somatic medicine takes part in the silencing, 'the sickness', the sacrifice and thus, the violence. [this is hard words, but true I think! Even psychiatry contributes to silencing I think, all too often, even fairly often or even very often?]. In outlining the implications of these finding, I shall argue that not only sexual violation or any other violation of personal integrity, has potentially pathogenic impact, but also any structural humiliation of human integrity."

Kirkengen refers to the Hebrew University philosopher Avishai Margalit, and writes for instance, about what he says and means:

"He finds it more fruitful to construct a negative argument, based on the fact that human beings share the morally relevant characteristic of being 'something which can be humiliated'. This negative argumentation, he states, far surpasses in usefulness all of the positive ones /.../

According to Margalit, human beings no longer have Truth, God, Wisdom, Language, or the Law of Nature or History in common. Paradoxically, however, they do all share the ability to be humiliated.

A decent society is reflected, according to Margalit, in the way its institutions meet the most vulnerable of its members - or its non-members. Any measures which marginalize people stigmatize them. And a stigma is the public sign of deviation from the norm, be it the norm of honor, mores, gender, race, faith or function.

Regarding the concepts of honor, self-respect and self-esteem, Margalit writes: 'A humiliating society is one whose institutions cause people to compromise their integrity,' and, 'a decent society is one whose institutions do not violate the dignity of the people in its orbit.

My study provides evidence that structural humiliation of human dignity occurs within medicine [and in psychiatry and therapy too, because what clients have to come with too often becomes belittled and diminished, and analyzed and intellectualized and put a label or diagnose on, instead of being solved/dissolved. Kirkengen writes more about the power of narrative, and if these narratives are met with distrust, what this can lead to instead. I will write a separate blog post about that. And this occurs both in somatic medicine and psychiatry I think].

Whenever people deviate from the norm of biomedicine they become marginalized /.../ ...if their symptoms do not respond to presumably appropriate measures; if their health does not improve as fast as expected; and finally, whenever they return with the same presenting problem despite that, according to standard medical practice, it ought to have been solved.

These scenarios all lead to medical marginalization, regardless of their origin. It is known, however, that social stigma and shameful, silenced experiences cause health problems but, at the same time cannot be communicated frankly and explicitly /.../ In other words: socio-culturally originating suffering and bad health are not only misunderstood in medical contexts; they will also most probably be aggravated by being responded to with 'more of the same', so to speak /.../

Consequently there is a path from silenced humiliation in private to legitimized humiliation in public. There is a link between the private experience of being made to feel worthless [originating in childhood] - through domestic abuse [physical, sexual and emotional abuse and violation], subordination, exploitation, neglect or deprivation [in grown ups too, who reeanct what they endured during childhood; if their self-esteem was damaged they won't be able to protect themselves adequately and maybe also behaves self-destructively, if they don't act it out on others in destructive behaviors], and the public doom of being unworthy to receive help - through correct medical and legal objectification."

Also see what the ACE-study has found about adverse childhood experiences and their impact on health (so these experiences doesn't only or even always cause psychic problems, but can result in what we usually mean are somatic troubles, and in many cases they result in both, even among those we deem as "socially respected"; the ACE-study is performed on middle-class Americans, who can afford health insurances, thus aren't the ones in the absolute bottom of the society!!).

---

Den norska läkaren Anna-Luise Kirkengen skriver i kapitlet "Conclusions and implications" på sidorna 390 och framåt i sin bok "Inscribed bodies..." (min amatöröversättnng):

”… biomedicin ignorerar hur liv skrivs in i mänskliga levda kroppar och hur levda kroppar är inskrivna av den sociala policyns nedtystande.

Kränkta människor har blivit gjorda sjuka av tystnaden/tigandet och är offrade till tystnaden/tigandet om överväldigande manligt sexuellt våld, vilket samhället fortfarande motstår att bli medvetet om [dvs. kort och gott vill man inte veta om det] och reflekterande över. Både psykiatri och somatisk medicin deltar i detta (ned)tystande, ’sjukdomen’, offrandet och sålunda våldet. Genom att skissera innebörderna av dessa fynd, ska jag argumentera inte bara över vad sexuellt våld eller varför vilken annan kränkning av personlig integritet har potentiellt skadande effekter, utan också varför varje strukturellt förödmjukande av mänsklig integritet har det [Kirkengen skriver om reviktimisering av människor i somatisk medicin och psykiatri, dvs. klienter som blir kränkta igen och på samma sätt som de en gång blev, vilket lett till deras sjuklighet. Bara för att man inte vill veta om de grundläggande och underliggande orsakerna, inte frågar efter dem, inte ’vågar’ (??) fråga efter dem].”

Kirkengen refererar till den hebreiska filosofen Avisha Margalit:

Han finner det mer fruktbart att konstruera ett negativt argument, baserat på fakta att mänskliga varelser delar den moraliskt relevanta karaktäristiken att vara ’någonting som kan bli förödmjukat’. Denna negativa argumentation menar han vida överträffar alla de positiva i användbarhet /…/

Enligt Margalit så har mänskliga varelser inte längre sanning, Gud, visdom, språk eller naturens och historiens lagar gemensamt. Paradoxalt dock, delar de alla förmågan att bli förödmjukade.

Ett anständigt samhälle reflekteras, enligt Margalit, i sättet dess institutioner möter de mest sårbara av dess medlemmar - eller dess ickemedlemmar... Alla åtgärder som marginaliserar människor stigmatiserar dem. Och ett stigma är det offentliga tecknet på avvikande från normen gällande heder, ?, kön, ras, tro eller funktion.

Avseende konceptet heder, självrespekt och självförtroende, skriver Margalit: ’Ett förödmjukande samhälle är ett samhälle vars institutioner får människor att kompromissa med sin integritet, ett anständigt samhälle är ett vars institutioner inte kränker värdigheten hos människor som befinner sig i dess omlopp.’

Min studie förser oss med bevis att strukturell förödmjukelse av mänsklig integritet uppträder i medicin [och i psykiatri och terapi också]. När än människor avviker från normen i biomedicinen blir de marginaliserade /…/

…om deras symtom inte svarar på de åtgärder som antas vara ändamålsenliga; om deras hälsa inte förbättras så fort som förväntats; och slutligen när de än återvänder och presenterar samma problem trots att de borde ha lösts enligt det som är medicinsk standard praxis.

Dessa scenarier leder alla till medicinsk marginalisering, oberoende av dess ursprung. Det är dock känt att socialt stigma och skamfyllda, tystade erfarenheter/upplevelser orsakar hälsoproblem men, på samma gång, inte kan kommuniceras frankt och uttryckligen /…/ Med andra ord: lidande som har sociokulturellt ursprung och dålig hälsa är inte bara missförstått i medicinska sammanhang; de kommer också högst sannolikt att bli förvärrade genom att man möter dessa med ’mer av samma’ så att säga /…/

Följaktligen finns det en väg från tysta förödmjukande i det privata till legitimerad förödmjukelse i det offentliga. Det finns en länk mellan den privata upplevelsen att ha fåtts att känna sig värdelös [vars yttersta ursprung finns tidigt troligen] – genom familjevåld [fysiskt, sexuellt, emotionellt], underordnande, utnyttjande, negligering eller deprivation och den offentliga domen att inte vara värd att erhålla hjälp – genom korrekt medicinsk och legal [fullt laglig?] objektivisering.”

Se också vad ACE-studien säger om skadliga barndomserfarenheter och dess inverkan på framtida hälsa. Dvs. dylika erfarenheter leder inte bara till psykisk sjukdom eller problem utan kan leda till somatisk ohälsa. Och i värsta fallen av övergrepp och misshandel till kriminalitet av den värsta sorten (Pincus).

Se också tidigare blogginlägg om tystnadens mur.

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