Ethics of Grief: Profiting from the Pain of Others

Imagine you and a friend go to see a documentary (or even fictional film) about the plight of victims of famine, war, disease, or oppression, and you bawl uncontrollably throughout the film as your friend sits next to you unmoved and indifferent to everything happening on the screen. You think anyone who isn’t moved by the extreme suffering you’ve just seen must be some kind of monster (or a sociopath at the least). You feel, in short, that crying is more moral than just sitting there.

You will admit, of course, that your crying through the movie didn’t help the victims any and your friend’s indifference didn’t really hurt anyone. Still, it seems that a moral person should have feelings for those who are suffering, even if you can’t find any real benefit for these strong feelings for strangers who get no benefit from your tears, heartfelt as they are.

In fact, your friend might point out that you are getting all worked up for no reason, and it might be better to keep your emotions in check. Your wailing for these strangers won’t change anything for them, but it might impair your ability to attend to problems you can change. What good are you to your children, for example, if your mind is on the poor souls in some far corner of the world? You should get your head together, friend, and get on with the business of life.

But, you counter, if you learn to be indifferent and unmoved by the pain of strangers, you may become indifferent to the pain of others, including friends and, yes, your own children. You don’t want to become the kind of monster you now suspect your friend of being. You want to be the kind of person who is moved by the suffering of others. You may not be able to help in every situation, but you do not want to become callous and cold. You want to be a caring individual. It isn’t about what you can do but about what you are.

And now your friend points out that not only did you cry during the movie, but you seemed, in some sense, to enjoy it. In fact, you apparently went to the movie with the prior intention of being moved to tears. You chose the movie because it was described as “moving” and “emotionally riveting.” Will you be happy when your children fall ill because it will satisfy your need to “let it all out”? Perhaps you are the monster, after all?

You didn’t enjoy the pain, you object, but you enjoyed the high quality of the film and its ability to elicit the pain. It was beautiful in its ability to enlarge compassion and trigger a caring response. The film will help, if nothing else, audiences develop a greater sense of concern for others, even if it doesn’t affect everyone (with a sly and disapproving nod to your friend).

And your friend now points out that people had to suffer in order to expand compassion and develop a greater caring response, so the suffering of others is used as a means to your own ends. You are actually acting selfishly after all, and the film makers are also exploiting the suffering of these people in order to teach a moral lesson and even to make a profit and perhaps sit in the spotlight after receiving coveted awards. You can just imagine the director’s teary expressions of gratitude and exhortations for a more acts of compassion at the ceremony.

In 2012, comedian Anthony Griffith told the story of his daughter’s cancer in a moving performance for The Moth. The video quickly went viral. You can see the video here:

The video on YouTube now has more than 1.8 million views. It is almost impossible to watch the video without sobbing, and people shared it by promising that anyone watching should have some tissues on hand. For reasons that aren’t entirely clear, we enjoy experiencing his grief with him. It might be objected that we are emotional voyeurs watching a sort of grief porn. By watching, we are not helping his daughter, we are not preventing future cancer deaths, we are not improving medical care, and it isn’t clear how we might be improving ourselves.

Paradoxically, we simultaneously want to avoid our own pain but glom onto the pain of others. Watching the story enables us to experience the pain without having to actually experience the loss of child. Doing this while watching a fictional account of loss seems justifiable in many ways, but to seek out a chance to cry and experience this kind of pseudo-grief that is provided by the actual grief of another person certainly raises an ethical concern.

We might say that Anthony Griffith needed to talk about his loss, and we are providing him with an audience. We are doing him a great favor by listening. We are honoring his loss. And he may agree with us. In this case, he is using us to help him along his healing journey, but this doesn’t seem to be what is going on. We want to see and hear his story. We want to be part of his grief story without having to do any heavy lifting ourselves. We watch the video, feel emotional excitement, hug our loved ones because one never knows when they will be gone, and then we are done with it.

We might say that we want to hear the story because it is well written and well performed. Griffith is extremely talented as a story teller, and we appreciate his talent and courage to share such a personal story. When we watch the video, we are paying tribute to his writing and his acting. The only problem is that he really doesn’t seem to be acting. He has merely put his pain on view for the world. He is certainly talented, and the story is well-written, but most people will be moved by anyone’s story of a lost child. It is relatively easy to evoke strong emotions with a story of intense pain and grief.

It may be that we want to hear his story so we can prepare ourselves for the times our story might be the main event. Someday we will have to do the heavy lifting. If we can live through Griffith’s pain, maybe we can face our own. By experiencing Griffith’s grief, we see that we can also face it and live through it just as he has done. We finish the video feeling somehow more prepared.

Or we may be drawn to the stories of others because it provides an evolutionary advantage. By hearing stories of others, we develop compassion and care. Other than providing an audience, we may not be helping Griffith directly, but we may be better able to empathize with others in the future. We are preparing not only for how to face our own struggles but to help others through theirs. If this is true, then we are actually doing something noble and beneficial by watching such videos.

Or, maybe we are just seeking the thrill of an emotional roller coaster ride.

Comments are welcome below. I appreciate corrections to typos and so forth (randall@ethicsbeyondcompliance.com).

“When Clients are Grieving” CEU ethics workshop in Houston (Friday, December 4, 2015)

We are offering a workshop on the ethics of grief on Friday, Dec. 4, from 9 a.m. till noon. We will be exploring proper responses to grieving clients. Most therapists accept the dictum that “There is no wrong way to grieve,” but we will look at extreme cases such as homicide and self-destruction and search for the “bright line” between good and bad grief. We will then frightening2-800pxask whether “bad grief” is unethical or merely unhealthy. We will examine the ethical response to “bad grief” and explore whether men and women should respond to grief differently.

The workshop is open to anyone, but we offer 3 Continuing Education Units (CEUs) to Licensed Professional Counselors, Licensed Marriage and Family Therapists, and Licensed Clinical Social Workers.

The cost is $25.00.

For more information, write randall@ethicsbeyondcompliance.com

The Social Dimensions of Gaslighting

In the last few years, it seems the term “gas lighting” has become nearly ubiquitous. The term was first used in the 1950s to mean some kind of emotional manipulation, but more specifically to mean making someone doubt his or her own sanity by repeatedly presenting a false narrative about events within the relationship. At least one person, (you can see Alfred MacDonald’s blog here), claims that gaslighting actually requires someone to tell an outright lie in order to convince someone their memory or perception is faulty. Others believe the manipulation can be more subtle, and still others use the term so loosely that almost everyone is guilty of gaslighting (e.g., telling someone they are over-reacting to a minor event or episode).

I don’t think anyone has provided strict diagnostic criteria for gaslighting, and I won’t try, but I think we can agree that it does involve manipulating someone to question whether abuse-800pxtheir perceptions are accurate. It is a form of abuse and a means of exercising control. When one person complains of some behavior, the other partner may question it by saying, “I think you’ve been working too much—that never happened.” Or they may say, “Did you remember your meds this morning?” Or they may say, with an air of concern, “Honey, that didn’t happen. Do you think it is time to see a psychiatrist or something?”

This type of manipulation can be extremely subtle. We all over-react sometimes, and who can claim to have a perfect memory? With any given instance, we may doubt our memory or perception. When you start carrying around a voice recorder or considering keeping security cameras in your home just to verify your account of things, though, you are either a victim of gaslighting or you really are suffering from some severe psychosis. If you are psychotic, you are probably having more than relationship problems, so if you do all right around other people, you probably live with an abusive partner.

If you are lucky, your friends, family, and coworkers can help assure you that your memory and grip on reality are firm; unless, of course, your abuser has gotten to them first. In early stages, her or his campaign against you may appear to be genuine concern. He or she may tell close friends, “I’m worried about my husband. He never seems happy anymore.” Or, the abuser may become more assertive: “I can’t get him to go to a doctor. If you see him, maybe you can find out why he is so reluctant.” By making such comments, the abuser raises suspicion that you are not in your right mind, and you may also begin to doubt whether you are in your right mind.”

As things progress, the abuser may begin to portray herself or himself as the victim, saying things like, “She keeps track of everything I do,” or “She controls all the finances. I don’t even know how much money is in the bank.”

A blog on AngieMedia (attributed only to Rob) describes how far abusers sometimes go: “An abuser who is using gaslighting on you is also likely to behave similarly with others to make them dislike you. This is a common attack used during what can become tremendously damaging distortion campaigns that these abusers will use against people close to them to maintain control and a sense of superiority. Such abusers may report you to police to get you falsely arrested and perhaps prosecuted for absolutely no reason other than they want to be in control of you and how others perceive you. They are likely to make remarks to their friends, family, neighbors, and others to “prove” they are being abused, often behind your back for years until you learn what they have been doing. “

The abuser may then come back to you and say, perhaps accurately, “All my friends think you are a bully.” Or, “Your Mom thinks you need to see a psychiatrist.” Living in an intentionally distorted reality, it becomes impossible to verify or even corroborate claims about your mental state, others opinions of you, or what has been said about you. Your alleged mental breakdown may, indeed, be imminent. Under the stress of this type of relationship, you are likely to doubt yourself, question the loyalty of your friends and family, and withdraw from all social contact. Once you are isolated, you are under the control of your abuser. You will no longer have access to the solid moorings of reality, and will drift in a cloud of confusion as you become more depressed, anxious, and desperate.

If you are doubting yourself, it helps to hear of the experiences of others. If you have survived this type of abuse, please help others by sharing your story. For example, I suspect Princess Diana helped many people when she described her marriage in her famous BBC Panarama interview:

DIANA: Well, people were – when I say people I mean friends, on my husband’s side – were indicating that I was again unstable, sick, and should be put in a home of some sort in order to get better. I was almost an embarrassment.
BASHIR: Do you think he really thought that?
DIANA: Well, there’s no better way to dismantle a personality than to isolate it.
BASHIR: So you were isolated?
DIANA: Uh,uh, very much so.

This is how people become trapped in toxic and destructive relationships. The only way out, really, is to find others who can verify your sanity and help you see the campaign against you for what it is. This is why it is important for survivors to speak up about their experiences. When people speak about what happened to them, victims who feel trapped may recognize the techniques of the gaslighter, and may gain some strength.

Finally, when you encounter others who seem unhappy in a relationship who may feel trapped, try to remember they may be victims of a gaslighting campaign. Things may not be as they seem. Your patience and understanding may save a life.

Therapy: The Poison of the Phrase “Usually the Man”

When Charles Dickens wrote Oliver Twist, he never bothered to make mention of the race or religion of any of the characters, except one. Throughout most of the novel, Fagin is referred to as “The Jew” with occasional variations on the theme. You may think his choice of words was simply standard at the time, but he was challenged on this choice. When criticized, he seemed surprised, and said, “It unfortunately was true, of the time to which the story refers, that the class of criminal almost invariably was a Jew”. He said he wasn’t biased against the Jews but was merely reflecting a simple truth about the nature of certain criminals. He even exclaimed, “I have no feeling towards the Jews but a friendly one. I always speak well of them, whether in public or private, and bear my testimony (as I ought to do) to their perfect good faith in such transactions as I have ever had with them…”

He really couldn’t see that any of this was his fault, but he eventually did change his ways. 11163694886_802d9911b7_zHe did have actual Jewish friends, and as hard as it was for him to see the problem, he didn’t want to offend them. He explained, “There is nothing but good will left between me and a People for whom I have a real regard and to whom I would not willfully have given an offence.” In the last chapters of the book and in subsequent readings, he deleted the offending appellation in the way you might finally discard a favored but hopelessly stained garment.

Dickens wasn’t unique by any means. We all have biases that we feel certain are nothing but statements of fact, supported by our frequent observations. In my interactions with therapists, I often hear the phrase “usually the man” sprinkling their descriptions of couples with marriage difficulties. Something like this: “When one partner has difficult expressing emotion (usually the man) . . .).” Or, “When one partner struggles with monogamy (usually the man . . .). Or, “When one person is addicted to porn (usually the man . . .). I’ve asked a few therapists about this construction, and the response is always some variation of, “What am I supposed to say when I’ve observed this time after time in my office?”

The fact is, of course, when we believe something is true, we tend only to take note of that occurrence in our observations. Even when we are aware of our own confirmation bias, it is exceedingly difficult to diagnose our own blind spots.

Some examples:

  • Dr. Gerald Stein, listing several kinds of unhealthy sexual activities, describes “selfish sex” as “a cousin to Obligatory Sex. However, in this example, it is usually the man who satisfies himself quickly, not out of duty, but simply because his needs are all that matter to him.” Note that it is usually the woman who has sex out of a sense of obligation, or so Dr. Stein believes.
  • In a paper by Barry McCarthy on marital sex, he says, “A realistic expectation is forty to fifty percent of sexual experiences will be satisfying for both people, twenty to twenty-five percent are very good for one partner (usually the man) and good for the other.” He begins the paragraph by saying the data is empirical, but only cites a study on sexual dysfunction that occurs before the statistics about satisfaction, which is not cited. I’m sure his experience confirms his claims to his satisfaction.
  • An article on domestic violence in Psychology Today by Neil S. Jacobson and John M. Gottman says, “In many unhappy marriages, when one partner (usually the woman) requests change, the other one (usually the man) resists change, and eventually the woman’s requests become demands, and the man’s avoidance becomes withdrawal.”  Again, if asked, I am sure these therapists/researchers would insist that their statements are supported by many hours of clinical observation, and they probably are; however, it is likely that men who are victims of domestic violence are much less inclined to seek therapy because they know they will not be taken seriously as victims or because they also refuse to see themselves as victims.

I could go on and on with examples, but you can do it yourself. If you want to see how pervasive this phrase is, just Google “psychotherapy” and “usually the man” or “marriage counseling” and “usually the man.” I promise, you will have plenty of examples.

What I would like to point out is that these “empirical” claims about what men do in relationships always conform to negative stereotypes about men. Men are selfish lovers. Men are abusive partners. Men are kinky. Men are more easily satisfied sexually than women. This thinking eliminates the opportunity for men to be abused, neglected, unloved, and unfulfilled. It denies women the opportunity to be the partner who is more sexual, more liberated, or more powerful. I once sat through a panel discussion by three male therapists, and one of them admitted that his sympathy just naturally went to the women when he saw heterosexual couples.

A couple of things to consider:

First, it may be correct that in some cases men are more likely to exhibit certain behaviors or attributes than women, but assuming they do makes it extremely difficult for you to see the men who are atypical. Second, it may be that men and women are not as you perceive them to be at all. Rather than interpreting data as it appears, you may be constructing data from your own biases.

A final note:

If you wonder whether your statements may reflect a bias or stereotype, try the Dickens test: Substitute “usually the Jew” or other racial term for “usually the man,” and see how it sounds. If you aren’t comfortable with the racial term, consider revising both your words and your expectations of your clients.

Ethical Codes: Moving beyond autonomy

Ethical theories can be divided in a number of ways, but one easy way is to separate the rule-based theories from theories that are not rule based. If you happen to be writing a code of ethics for your organization, you are going to drift toward rule-based theories because, in fact, you are writing a set of rules. These rules are important to ensure and protect the professionalism of your organization or profession. Ethical codes, made up of rules, establish a system of accountability for your members. Ethical codes are useful and often essential for professional organizations and vocational fields.

The rules in professional codes tend, whether stated or not, to focus on autonomy as begging devildefined by Immanuel Kant. His advice is generally interpreted somewhat loosely to say that we should only do to others what they have chosen to have done to them and use them only in ways that help them achieve their own ends. We should not use others only as a way to achieve our personal goals.

Based on this thinking, we would only provide people with treatment after receiving their fully informed consent, we would use people in our research only if they wanted to participate, and we would always be honest with clients and work in their best interest. Some would be a little shocked by the full implications of Kant’s views. For example, to have sex without the intent to procreate is to use both yourself and your partner as a mere means to pleasure. Lying to a murderer in order to save a child’s life would lead to you being charged with a crime in the event of the child’s death.

When it comes to integrating ethics into your professional practice, however, you may find rule-based systems too limiting and seek a theory that feels more inclusive of your entire professional life. It may help to look at two other groups of ethical theories: 1. Theories that focus on what kind of person to be. 2. Theories that focus on how to relate to others. This isn’t a neat division as these two types of theories overlap in significant ways, but it can be a useful starting point.

Virtue Ethics

Friedrich Nietzsche rejected rule-based systems of morality, which he referred to as forms of “slave-morality,” for morality aimed at character, which he called “master-morality.” He said, “It is obvious that moral value distinctions everywhere are first attributed to people and only later to actions.” For Nietzsche, it is the powerful who will see moral behavior as a by-product of being a great person while the weak will seek moral rules to protect their interests from others. Nietzsche suggests we should all strive to become great people rather than subjecting ourselves to the rules and will of others.

In a similar vein, Aristotle saw morality as a process of becoming a good person rather than following a set of rules, though he did say that things like theft, adultery and murder are always wrong, allowing for the existence of some moral rules. In general, though, a person becomes good, not by following rules, but by developing a virtuous disposition. This approach does emphasize activities, as it is through our actions that we develop our character. By choosing the actions a good person would choose, we become a good person, and by being a good person we tend to choose actions that are also good.

Relational Ethics

If you work with people on a regular basis, you may find a theory based on relationships conducive to moving beyond rule-based systems and ethical codes.

In the past, I didn’t really think of existentialism as a good foundation for a relational ethics as many existentialists focus on subjective experience, but Simone de Beauvoir’s “Ethics of Ambiguity” changed my mind. Beauvoir specifically tackles the problem of making ethical choices in an ambiguous world. Contrary to Immanuel Kant, she says it is not possible to arrive at certain rules to guide our behavior, but this does not mean we can shirk our obligation to act with concern for others.

Beauvoir says we experience life through our own experience by exercising our own freedom, but we do not experience it in isolation. If we do experience it in isolation, she says, “The saving of time and the conquest of leisure have no meaning if we are not moved by the laugh of a child at play. If we do not love life on our own account and through others, it is futile to seek to justify it in any way.” Our authentic self is expressed through free acts, but “[The individual] exists only by transcending himself, and his freedom can be achieved only through the freedom of others. He justifies his existence by a movement which, like freedom, springs from his heart but which leads outside of him.” Though our actions can’t be pinned down by a set of rules, we find meaning in life by seeking, willing, and nurturing the freedom of others in the world. In a sense, our affirmation of freedom is an exclamation of love.

Love may not seem an appropriate emotion to mention in a discussion of ethical relations with clients, but we don’t have to think of it in romantic or sexual terms. Love may be a matter of valuing others. Philosopher Martha Nussbaum argues that love is an essential feature of a liberal democracy. Some might quibble over how she defines love, but certainly it is a concern for others that drives both the ethics and political struggles of some of us. For example, she notes that we all live in a state of dependency at one time or another (childhood, old age if we are lucky to live long enough, and periods of impairment). Some of us live in states of dependency for our entire lives. Protecting the dignity of all requires us to recognize the value in others, and love for others is sufficient motivation to remove the shame and stigma of dependency. Our concern for others motivates our most basic moral impulses.

In this sense, both Beauvoir’s and Nussbaum’s views can be seen as forms of an ethics of care. If you are familiar with care ethics, though, you probably heard of it through the work of feminists such as Carol Gilligan and Nel Noddings. Care ethics was introduced as an alternative to theories seen to value men’s experiences over women’s. Feminists pointed out that women’s experiences have largely centered on care. Some will say caring is natural to women and others will say women have been forced into caring roles.

Over time, care ethics has become somewhat less gendered, meaning both men and women may recognize the value of care in their ethical lives. Noddings says our moral obligations arise between the “one-caring” and the “cared-for.” The response of the “cared-for” drive our actions. The most debilitating kind of existence, she says, is to care for someone who is unable or unwilling to respond to care. Controversially, she says, “We are not obliged to act as one-caring if there is no possibility of completion in the other.” This means are have no obligations to “the needy in the far regions of the earth.” Philosopher James Rachels objects, saying, “A more sensible approach might be to say that the ethical life includes both caring personal relationships and a benevolent concern for people generally.”

Some philosophers see narrative ethics as a logical extension of an ethics of care. Narrative ethics emphasizes the role of stories in our moral lives. Most of us grew up hearing “didactic stories” about foxes and wolves and so forth that left us to learn “the moral of the story.” This is an important feature of narrative ethics but stories need not be didactic to aid our moral reasoning or impulses. We may also learn from both fiction and true personal narratives.

Fiction can help us broaden our imagination of what life is like for others. It helps us to understand feelings and motivations outside our own experience. It gives us a way of testing different points of view and outlooks. Similarly, listening to or reading the accounts people give of their own lives gives us greater insight into their emotional lives and helps us to develop an empathetic response. Our moral obligations and intuitions look quite different when we are better able to “read” the minds and motivations of others. Those who work intimately with clients on a regular basis are immersed in their stories. In this sense, ethics is integral to the practice. I personally think it is helpful to think of ethics as being embedded in our work rather than a separate function that requires attention outside of our “real job.”

Again, autonomy plays an essential role in developing ethical codes of behavior. If we fail to respect the autonomy of others, we violate them in ways that are always wrong and often illegal. Still, other ethical approaches can expand the role of ethics in our practice and help us pursue ethics that really is beyond mere compliance.

Sunshine disinfects nothing

I seem to remember Jon Stewart once playing a clip of a politician declaring that sunshine is the best disinfectant. After the clip, Stewart warned viewers that using sunshine as a disinfectant could lead to a nasty infection. In response to the Sunshine (Open Payments) Act, bioethicist Mark Wilson sounds a similar alarm in a recent paper.

For years, many people, including myself, have argued that industry payments to physicians should be disclosed to the public, so that we will all be aware of possible financial conflicts of interest (FCOI). My hope was that disclosing conflicts of interest might help actually reduce corruption or even simple bias in medical practice, but Wilson points to our experience of Wall Street before and after the 2008 financial collapse to show that knowledge of conflicts of interest does not prevent them. Rather, disclosure only shifts the burden for reducing FCOI to patients, who are least empowered to eliminate them. Rather than fixing the problem, Wilson claims the Sunshine Act only “mythologizes transparency.”

Wilson pointed me to a paper (“Tripartite Conflicts of Interest and High Stakes Patent Extensions in the DSM-5”) in Psychotherapy and Psychosomatics that illustrates the problem. If you want the details, you can read the paper yourself, but I will skip right to the conclusion, which I admit is how I read most papers anyway:

[I]t is critical that the APA recognize that transparency alone is an insufficient response for mitigating implicit bias in diagnostic and treatment decision-making. Specifically, and in keeping with the Institute of Medicine’s most recent standards, we recommend that DSM panel members be free of FCOI.

Telling people about FCOI does not reduce bias and corruption; it only offers an opportunity for people to be aware that bias and corruption exist. I think it is valuable that the Sunshine Act is making people aware of FCOI. In response, though, I hope we will take steps to reduce FCOI. Unfortunately, the burden is indeed shifted to voters and consumers. The most disturbing and obviously true statement Wilson makes in his paper is this: “Until politicians end their own commercial COIs, the Sunshine Act will likely remain the governance order of the day.”

We can’t hope the experts will solve this problem. We must demand that FCOI are eliminated.

You shouldn’t have to go to jail for mental health treatment

Last week I tweeted a link to a Texas Observer article by Emily DePrang about sexual assaults in Harris County jails. DePrang had written about two Bureau of Justice Statistics studies that showed the Harris County Jail on Baker Street had sexual assaults that are higher than national averages.

One survey reported rates of sexual victimization as reported by inmates, and found that inmates reported higher than average rates of victimization from other inmates. The other survey was based on official reports of sexual violence in jails and also reported higher than average rates for the Baker Street jail. DePrang did not discuss, in her short post, all the statistical and methodological limitations of the studies in question.

To my surprise, Alan Bernstein, the director for public affairs at the sheriff’s office tweeted me, saying he hoped someone would fact-check DePrang’s article as it had many mistakes, so I asked him what the mistakes were, and he sent me a list of items he felt were misleading. Later, the Texas Observer agreed to publish his response to the article (his published response was slightly different from what he sent me).

For the most part, his response pointed out the limitations of the study. Also, he noted that only one of four jails in Harris County had a higher incidence of sexual assault, and he also noted that jail had a high percentage of inmates who are under treatment for mental illness. In his note to me, Bernstein asked, “Is touching a clothed inmate’s thigh sexual violence? Maybe so. But this is one of the actions considered sexual victimization in the study.” I will just say that I consider any unwanted touching of my upper thigh over or under clothing to be sexual assault, even if the “violence” seems minor.

In trying to separate the signal from noise, though, what interested me most was not the definition of sexual violence or even the limitations of the study but the fact that the jail had so many inmates on medications. The Houston Chronicle quoted Sheriff Adrian Garcia saying, “The Harris County Jail has been referred to as the largest psychiatric facility in the state of Texas” and “More than 2,000 inmates … are on psychotropic medications on a daily basis.” And in Bernstein’s response, posted on the Texas Observer site, he said:

That building houses the jail system’s inmates with acute mental illness. In fact the statistician who worked on the 2011 study tells us that two-thirds of the surveyed inmates in the so-called “high” rate building had “psychological stress disorders.” We don’t know how that was determined, and we would never allege that people with mental illness fabricate allegations more often than anyone else.

I’m not sure what “acute” means in this context, but I suspect anyone on medication is assumed to have an acute mental illness. Given the number of prescriptions written for antidepressants and anti-anxiety medications these days, I suspect a fairly high percentage of the general population is acutely mentally ill, according to these assumptions. Even someone being treated for mild depression, though, will experience unpleasant side-effects if doses are missed, as they are likely to be missed inside a jail. We should be concerned both about lack of treatment for mental health and the over-prescription of  drugs for depression and anxiety. Withdrawal sometimes leads to aggressive behavior and could account for some problems. On the other hand, mental illness is also stigmatized, and those receiving treatment may become targets for abuse at the hands of other inmates.

Fortunately, I found more information on treatment of the mentally ill in Harris Country jails in excellent article by DePrang titled “Barred Care.” According to the article, the jail “treats more psychiatric patients than all 10 of Texas’ state-run public mental hospitals combined.” And why is that? Because no one else is treating those patients. Again from the article: “Harris County has one of the most underfunded public mental health systems in a state that consistently ranks last, or almost last, in per capita mental health spending.” Some people get so desperate for relief, that they break the law just so they can go to jail and get treatment.

The program in the jail is commendable. The funding priorities of our state government are not. In 2003, the Texas legislature slashed funding for mental health services in Texas. According to DePrang’s article, “In Harris County, the number of law enforcement calls about people in psychiatric crisis jumped from fewer than 11,000 in 2003 to more than 27,000 in 2012.” So, the Harris County jail has a high number of mentally ill as a result of deliberate action of our state’s lawmakers. This should make us all angry. Cutting funding for mental health services only to force the mentally ill into jails is cruel and expensive. No matter what sends people to jail, many will never really recover from the stigma and the trauma of the experience.

What should be done? We should lobby our lawmakers to restore funding for mental health services in Texas. We should stop blaming the mentally ill for their problems. We should resist the temptation to treat even minor difficulties with powerful and addicting drugs. We should insist that Texas expand Medicaid as part of the Affordable Care Act (this would cost the state nothing) so that people can receive basic medical care and avoid crisis.

In short, we should learn to heal each other. The person with a mental health crisis tomorrow could be you.

The Proper Way to Grieve for a Child: Cicero’s Example

Epictetus stated he would embrace death before...
Epictetus stated he would embrace death before shaving. (Photo credit: Wikipedia)

In advising us on how to respond when we encounter someone who has lost a child or suffered an equally calamitous loss, the stoic philosopher, Epictetus said, “Don’t reduce yourself to his level, and certainly do not moan with him. Do not moan inwardly either.”  These negative emotions are dangerous to us and to others, so we must be sure to keep them in check.

This sounds harsh, but Epictetus also advises us not to beat ourselves up when we do give over to grief. He says, “Some who is perfectly instructed will place blame neither on others nor on himself.” Epictetus assures us that death is not to be feared, and our terror of it comes from within, but blaming ourselves for our feelings is also pointless.

Scottish philosopher David Hume, reflecting on the nature of tragedy in art, makes a comment about the best way to comfort a parent who has lost a child. Hume says, “Who could ever think of it as a good expedient for comforting an afflicted parent, to exaggerate, with all the force of elocution, the irreparable loss which was met with by the death of a favorite child?” I’m sure Hume is right that we shouldn’t exaggerate the loss, but I would also advise against minimizing the loss in any way, which is what Cicero’s friend, Servius Sulpicius Rufus,  did after the death of Cicero’s daughter, Tullia.

David Hume
David Hume (Photo credit: Wikipedia)

Sulpicius said, “If you have become the poorer by the frail spirit of one poor girl, are you agitated thus violently? If she had not died now, she would yet have had to die a few years hence, for she was mortal born.” Sulpicius sounds harsh in this instance, but this is actually offered only after he introduced the topic, saying, “If I had been at home, I should not have failed to be at your side, and should have made my sorrow plain to you face to face. That kind of consolation involves much distress and pain, because the relations and friends, whose part it is to offer it, are themselves overcome by an equal sorrow.” If he had been available, he would have comforted Cicero and perhaps avoided the need for such harsh and critical words later, apparently.

Cicero, Kopiezeichnung einer Büste aus London ...
Cicero, Kopiezeichnung einer Büste aus London (Herzog Wellington) (Photo credit: Wikipedia)

Cicero expressed his gratitude for the comforting words laced with recrimination, but also acknowledged their ineffectiveness, saying, “For I think it a disgrace that I should not bear my loss as you – a man of such wisdom – think it should be borne. But at times I am taken by surprise and scarcely offer any resistance to my grief, because those consolations fail me.”

Cicero had also been writing consolations for himself, and he felt himself the inventor of this type of self-help. He said, “Why, I have done what no one has done before, tried to console myself by writing a book.” (This is quoted by Han Baltussen in the Nov. 2009 issue of Mortality in an essay titled, “A grief observed: Cicero on remembering Tullia.”) Unfortunately, Cicero’s Consolations have not survived the passage of time, so we can only infer what they may have said. In a letter to Titus Pomponius Atticus, Cicero remarked that he wrote in order to heal, but his writing also kept him out of public view, preserving the privacy of his grief and avoiding a vulgar display of emotion.

Cicero also took his turn in consoling others, Baltussen notes, “In the examples where Cicero aims at consoling others, we find a subtle approach, developing, as it were, a ‘philosophy of empathy,’ in which he consciously or unconsciously takes personal and political aspects into account. He shows great sensibility in narrowing or widening the emotional gap between him and the consolee.” Cicero noted that one task as consoler was to establish that he needed consolation himself, as he was grieving for his friend’s loss. I think this goes a little beyond mere empathy. Cicero actually feels his own sorrow upon hearing of the sorrow of a dear friend. He understands the friend’s pain because it is a magnified form of his own pain.

I personally feel that Cicero’s struggle with his grief highlights a social failure to deal with grief constructively. Can we not manage to express and process grief openly without fear of censure from friends and counselors? Since the time of Cicero, we have developed grief therapy, expressions of support for the bereaved, and paid lip service to the process of healing. Yet, we still criticize those who can’t “get it together” within a short time. Sadness is seen as weakness, especially for men, and we do not tolerate prolonged grieving. Cicero was lucky to have friends and the ability to spend time grieving and writing his consolations. Men with less power would have had no option but to keep working without respite.

Grief
Grief (Photo credit: tombellart)

As for me, I don’t know the best way to console others, but I’ve thought a little about what kinds of consolations have helped me in the past, and these are the things that I appreciate. First, recognize that my pain is of such a magnitude that it obscures the horizon, and I can’t see beyond it. Second, do acknowledge the enormous value of the life I have lost. Third, do remind me that the person I lost had life filled with wonder, love, accomplishments, and happiness. Fourth, remind me also that this person is in a state of peace with no more struggle, pain, or discontentment. Finally, and perhaps most importantly, assure me that I am not alone in the world, my grief is justified, and that a future is possible.

The Ethics of Caring and Seasonal Depression

I don’t know if it is the changes in the weather, the length of the days, or what, but we

The suicide
The suicide (Photo credit: Wikipedia)

sometimes find the world slipping away from us. As we reach, objects, people, and activities seem to continuously recede into the distance just beyond our grasp. We forget how to be engaged with even the most basic tasks. Seasonal changes can leave us feeling depressed and melancholy. As the poet Phillip Larken put it:

The trees are coming into leaf
Like something almost being said;
The recent buds relax and spread,
Their greenness is a kind of grief.

For reasons that aren’t completely understood, spring seems to bring a surge of depression and suicides, but winter gets all the attention for warnings about seasonal depression. Some researchers have noticed that suicide spikes coincide with increased pollen production.  Apparently, allergies release cytokines, which affect appetite, activity, sex drive, and social engagement. There may be a philosophical question in there as to the difference between having “depression” and having a response to allergies that looks a heck of a lot like depression. Sufferers of either will probably not worry the distinction too much.

Some theorists suggest that suicide peaks in spring because of a “broken promise effect.” When spring doesn’t bring the joy and energy it generally promises, the depressed are moved to suicide. Others have suggested that springtime brings more energy and agitation (and a corresponding drop in melatonin), especially to people with bipolar disorder, that moves them to act against their own lives.  Still others speculate that springtime increases in serotonin give people the energy to kill themselves.

I don’t want us to turn away from people who are depressed during the holidays. Rather, I just hope we can remember that some of us occasionally feel depressed and hopeless throughout the year. The extra effort we make through the holidays may be worth making year round.

Still, I know it is true that many of us mourn with greater intensity during the holidays as we count all those who are no longer with us and grieve for our losses, so maybe we should be a little extra careful during December. A little care can go a long way to avoiding a holiday crisis. But we should remember to keep caring and reaching out during the new year, into spring, and for the rest of the year. When we help each other, we are all stronger.

The Ethics of Grief

It seems each time I attend a funeral, I overhear someone being criticized for grieving too subtly, too gregariously, too privately, or while dressed inappropriately. I dismiss the critics as judgmental and ignorant cranks who should have better things to do. We all know that each person grieves differently. We should all be allowed to grieve in our own time and in our own way.

But I wonder whether there is am improper way to grieve. Many of us tell our loved ones not to cry for us when we are gone. We’d rather imagine they will have a party to celebrate our life. We would like for them to pay tribute to us through their own joy. And when people ask us to do this, we promise them we will, even though we know we won’t. We make an impossible promise out of respect for those we love.

But some people take such promises seriously. This past week, I came across a paper by Amy Olberding that discusses different approaches to grief by Seneca and Zhuangzi. In letter 63, Seneca counsels his friend, “We, however, may be forgiven for bursting into tears, if only our tears have not flowed to excess, and if we have lost a friend, nor let them overflow.  We may weep, but we must not wail.” But Seneca goes on to confess that he wailed excessively over the loss of his friend, Annaeus Serenus.

Seneca
Seneca (Photo credit: tonynetone)wailed excessively over the loss of his friend, Annaeus Serenus.

He admits the power of his grief, but admonishes himself, “I must be included among the examples of men who have been overcome by grief.  Today, however, I condemn this act of mine.” In describing Seneca’s position, Olberding says grief for Seneca is “a form of self-injury that neither effect relief from pain nor alter the event that stimulated it.” As a Stoic, Seneca claims that death should not be seen as an injury, so it is wrong to grieve something that is not actually harmful. Many Christians find themselves in a similar state. Should we not celebrate someone’s passage to a blissful eternity?

English: Zhuangzi dreaming of a butterfly (or ...
English: Zhuangzi dreaming of a butterfly (or a butterfly dreaming of Zhuangzi) (Photo credit: Wikipedia)

And Zhuangzi, the Daoist, finds himself in a similar state. Zhuangzi taught that death is a mere transition to another state and nothing to grieve at all. Olberding says the Daoist views death as part of a “global harmony that sustains the natural world.” But when Zhuangzi’s wife died, he also reacted with extreme emotion. He said, “I with my sobbing knew no better than to bewail her. The thought came to me that I was being uncomprehending towards destiny, so I stopped.” Unlike Seneca, Zhuangzi did not express any self-recrimination over his grief.

Whether we consider it appropriate or not, the feeling of grief when something of great value is lost is universal. We are shocked when someone seems unaffected by the loss of someone who should be valued. With later reflection, we can reassess our grief and our loss more rationally and understand death in a larger context, especially if we have, indeed, learned to live without our valued loved one.

In Buddhism, Kisa Gotami also learns to reevaluate her grief after some reflection and guidance from the Buddha and her neighbors. Kisa Gotami had a young son who died, and she carried his body from person to person seeking aid to revive him. Finally, she was directed to the Buddha who asked her to obtain a mustard seed from every house where no one had lost a child, spouse, parent, or friend. After she couldn’t gather even a single seed, she judges herself for being selfish in her grief while remaining ignorant of the suffering of others.

The Buddha tells her, “In whatever manner people think a thing will come to pass, it is often different when it happens, and great is the disappointment; see, such are the terms of the world.” Even when death is expected, it is painful, but surprise intensifies the pain. The loss of young and healthy friends, siblings, and children often shatters the narrative people tell themselves about how the world works.

The advice of Seneca, Zhuangzi, and the Buddha all seem to be good advice, so long as we acknowledge that no human can suppress an immediate expression of extreme grief when faced with loss of someone so valued. As time passes, we may benefit from reminders that death is a transition, that death is universal, and that we can, indeed, live on after our loss. I do realize there are cases where survivors do not seem able to live on after loss, and compassion should move us to try to help those who are crippled by grief or loss of support.

It is true that people grieve in their own way and their own time, but compassionate care, free from judgment, might help people reach acceptance of the reality of a world that often seems to lack moral order, fairness, and predictability.