Tuesday, 6 March 2007

Thriving and flourishing

Anyone interested in the mind’s involvement in health confronts the difficulty of making two vocabularies connect to each other. What is at stake is a relationship between thriving as a mammalian body and flourishing as a human being. While it is less controversial to think that a failure to thrive bodily may impact on one’s ability to flourish personally, our sense of this impact has changed as it has become less determined through the past century that a physical handicap will necessary force you to limit your life plans. Where 4000 athletes participated in the 2004 Paralympic Games in Athens, it would have been unthinkable in the Athens of 1896.

But we are interested in an impact which runs the other way, a failure to flourish bringing about a failure to thrive. Now, anyone writing about such phenomena must have a conception of what it is for a human to flourish, and this necessarily relates to their political and ethical beliefs. For instance, we might claim that we cannot flourish if made to work an 80 hour week as insufficient leisure time would remain to allow us to live fully as people. But the drive to make the psychological end of the matter ‘scientific’, which includes a movement to free vocabulary from value judgements about what the Greeks called ‘eudaimonia’, the good life, attempts to avoid this difficulty. It must fail. Generally it achieves its conjuring trick by implicit reliance on the everyday ethics and politics of the kind of late capitalist, Western liberal democracy in which it takes place.

We are used to our qualities being scored in various ways - our credit rating, our attractiveness to the immigration services of another country, our research achievements for Higher Education’s Research Assessment Exercise. Unsurprisingly, then, a large part of the psychosomatic literature has looked to form a total of the number and severity of 'life events' we have faced: so many points for loss of spouse, so many for caring for dependent spouse, for loss of job, for moving house, etc. Implicitly a view is taken here that adverse events have an objectively quality in terms of their impact on our lives. We find for example that "caring for a dependent partner ages our immune system". But is this effect really independent of the ethical-political environment in which such an event occurs?

The BBC have recently broadcast Jane Eyre in 4 one hour episodes. This is not nearly enough to do justice to the book, of course. What is so clear here, and in many other cases of adaptations, is how time and again directors fail to let the past judge the present. Remaking ‘Pride and Prejudice’, we lose the Shaftsburyesque moral philosophy of Jane Austen, and instead project our contemporary 'girl power' back into the early nineteenth century. In the case of Jane Eyre, we scarcely touch upon the variety of brands of religious belief and practice prevalent in nineteenth centruy England. Only glimpses are offered of the missionary zeal of St. John Rivers, the mysticism Helen Burns imparts to the young Jane, or indeed much of Jane's own beliefs. We are not told that Jane sets herself the task of drawing herself and how she imagines Blanche Ingram to look as an exercise in correcting a moral failing she has located within herself.

To return to the topic of the adverse life events, consider this passage, which beautifully expresses a conception of the good life:
Mr. Rochester continued blind the first two years of our union: perhaps it was that circumstance that drew us so very near-that knit us so very close! for I was then his vision, as I am still his right hand. Literally, I was (what he often called me) the apple of his eye. He saw nature-he saw books through me; and never did I weary of gazing for his behalf, and of putting into words the effect of field, tree, town, river, cloud, sunbeam-of the landscape before us; of the weather round us-and impressing by sound on his ear what light could no longer stamp on his eye. Never did I weary of reading to him; never did I weary of conducting him where he wished to go: of doing for him what he wished to be done. And there was a pleasure in my services, most full, most exquisite, even though sad - because he claimed these services without painful shame or damping humiliation. He loved me so truly, that he knew no reluctance in profiting by my attendance: he felt that I loved him so fondly, that to yield that attendance was to indulge my sweetest wishes.
What a gloriously intricate web of feelings expressed at the end. If we could aspire to these feelings in our relations to our dependents, how differently then might the ‘life event’ of caring impact on our health? For a contemporary philosophical discussion of an ethics which acknowledges our dependency on others and their dependency on us, I thoroughly recommend Alasdair MacIntyre's ‘Rational Dependent Animals’, where it is explained how, rather than seeing the provision of care for others as a burden, we should find that our good resides in it.


Maggie said...

I saw either you or your co-author on "Breakfast" on BBC 1 the other day. I do apologise for not knowing which of you it was - the item had started before I realised it was of interest to me. The doctor (sorry, name escapes me) made some comment about Chronic Fatigue Syndrome being "cured" by talking therapies (I don't recall exact words, as it rather took me by surprise). As an ME/CFS patient myself, I wondered what your take is on this?

Maybe my question will be answered when I read your book - have ordered it from Amazon, but being cash-short have gone for free delivery so not sure when it will arrive.

I look forward to reading the book - I'm sure I will find much of interest in it. After I first became ill, 15 years ago on March 9 this year, I was sacked from my job as a University (Cytogenetics) Technician. But learnt to touch-type, and then went on to begin a BSc in Applied Psychology, part time.

Unfortunately I was not able to finish the degree - got about half way through - as other family commitments took up my small amount of energy. I hope that maybe sometime in the future I may be able to finish it, but at present it's impossible as my parents are old and need a lot of help - mainly provided by my husband as I am unable to drive at present, and am not able enough to help them as I wish to.

Best wishes from sunny (at the mo anyway!) Liverpool

connie said...

Re Comment by Maggie.

I would also be very interested on your take on the lady docs comment at the end of the BBC1 Breakfast programme. It was something along the lines of: "people with Chronic Fatigue Syndrome can think themselves better"


david said...

That would have been Darian on "Breakfast".

You ask about my views concerning the participating doctor's comment about Chronic Fatigue Syndrome being "cured" by talking therapies. Let me start by saying that the implied dichotomy between real organic illnesses untouchable by talking therapies, and imaginary 'functional' illnesses which can be so treated, is one we reject. Our outlook is well captured by Brian Lask's statement here.

Even if it is found that a talking therapy helps many people with a certain condition, this does not make it any less real. To approach things from the side of illnesses taken to be 'real', we discuss in our book the case of a transvestite who for his family's sake decides to stop cross-dressing. On two occasions when he tries to do so, however, he suffers a heart attack. Now, if a talking therapy allows him to give up cross-dressing without further heart attacks, nobody will say that the illnesses of people suffering from heart attacks aren't real.

Conversely, the possibility of physiological interventions which prevent a bodily manifestation of a psychic state doesn't stop us from admitting the existence of that state. Someone who is sad may cry frequently. If their tear ducts are removed and the crying stops, we would not say that there is no such thing as sadness.

In sum, I don't think I'm being evasive when I say we don't have a 'take' on CFS. Even if the condition was found to arise in conjunction with a certain kind of infection, we should still be interested in potential psychological contributions, as with the research mentioned here concerning continuing gut problems.

No two patients are the same. One can only have a chance to understand an individual case by a careful exploration of the illness's psychological circumstances.

david said...


Your comment came in as I was composing my response to Maggie.

There's an aspect of what you ask which I'm going to talk about soon in a new post. That's the contemporary notion of 'self' which understands that if there are psychological factors involved in an illness, then one can think oneself out of that illness.

To reiterate the point about psychological factors involved in what are taken to be 'real' illnesses, it is well documented that those suffering from depression at the time of heart surgery have a much worse prognosis compared to those who are not.