Tag Archives: philosophy

Kintsugi

The tragic reality regarding eating disorders is that every objective, fact-based study and research paper indicates the number of persons afflicted with eating disorders, the severity of those eating disorders, and the mortality rate for persons afflicted with eating disorders are at the highest level we have ever known. In short, more people are suffering and more people are dying. And yet, no accountability is being taken. No consequences are being enforced. Honest answers to difficult and pointed questions are avoided or are non-existent.

There are undoubtedly many causes for that grim reality. Unfortunately, part of that reality must be laid at the feet of the eating disorder therapist mind set — group think currently infesting and harming the community.

In general, when many therapists are asked about the cause of the alarming reality, they point fingers at Covid, and “diet culture,” and fat phobia and white supremacy and weight discrimination and the patriarchy and ableism and healthism and every “ism” know to humankind.

However, where do most therapists refuse to point any fingers?  What will not be investigated? The answer quite simply is … themselves. There is no push back let alone accountability. Conflicts of interest ignored. Patients also being utilized as employees. Narcissism. In the name of social justice, reduced priority given to those who suffer and their families. And that is the “most unkindest cut of all.”

Make no mistake … there are some incredibly erudite, insightful, wise, compassionate and inspirational therapists. They are more than deserving of our gratitude, admiration and respect. But they are far too few and far too unknown. And that leads to tribal mentality and questionable mind sets and programs.

For example, a new proposed, certification program for eating disorders, not even in its infancy and not accredited by anyone, starts to roll out its program not by discussing eating disorders, nor their serious nature, nor the many complex factors and issues involved nor the incomprehensibly horrific mortality rate.  No. This program starts out by addressing “Indigenous Peoples’ Land Use Acknowledgement” and how you can reach out to groups supporting that “very important aspect of eating disorders.”

Because nothing says “this certification program is a very serious, hard-hitting, science based, evidence rich program designed to effectively address eating disorders in the 21st Century” than leading right out of the gate addressing Indigenous Peoples’ Land Use Acknowledgement! And the people who thought that would be an incredibly good idea are … therapists?

My initial response was going to expose the absurd nature of that messaging and its irrelevancy to eating disorders. In a very direct and blunt manner. But then sometimes, a different message comes to us in the most unexpected way.  And in being open to that messaging and the wonders of the multiverse, we perhaps start to see and realize alternate ways of thinking, feeling and believing.

For there can be beauty in the broken.

Kintsugi is a Japanese art form that repairs broken pottery with gold, rendering a new piece more exquisite than it was before the break. It literally means “to join with gold.”

Katherine and Jay Wolf, in their book, Suffer Strong, state:

“The story of kintsugi—this style of pottery—may be the most perfect embodiment of all our trauma-shattered lives… Instead of throwing away the broken beloved pottery, we’ll fix it in a way that doesn’t pretend it hasn’t been broken but honors the breaking—and more so, the surviving—by highlighting those repaired seams with gold lacquer. Now the object is functional once again and dignified, not discarded. It’s stronger and even more valuable because of its reinforced, golden scars.”

An article written by Vaneetha Risner beautifully states, “Rather than trying to hide the damage, kintsugi highlights the repair. The imperfections are what make it beautiful and valuable. A broken piece that is put back together has more of a story, seems more authentic and real, is stronger and more resilient than something that has stayed pristine.”

“God is the restorer, the kintsugi Master who skillfully and tenderly puts the broken pieces of our lives back together.”

Kintsugi. Kintsugi.

And so, regarding that attempted new, broken certification program, roll it back, revise it, edit it.  Consult with intelligent people who disagree with you. Collaborate with professionals from throughout the community not just those in your tribe. There is gold for you to use in addressing the flaws in the program. Find the gold and utilize it. Mold it and make something better. And most importantly, always remember…  IT IS NOT ABOUT YOU!

Therapists … You are merely the messengers. It is about the families who are suffering from eating disorders.  And when your child is suffering, you simply want them to heal, to embrace the richness of life.

Now, I don’t like to think of our suffering children as being “broken.” Perhaps, bent a bit. Fractured perhaps. But from those hardships, those obstacles, from deprivation, from fear and hurt and anger can come … healing. Enlightenment. Beauty. Resiliency and strength. Kintsugi.

Our therapists, those whom we entrust to help save the lives of our children, must embrace the concept of kintsugi. You must be wiser, more insightful, get past your preconceptions, your own fears, your own inner turmoil. Instead of believing you have all the answers, know that you absolutely do not. But you can get closer to a place of healing by opening your hearts, your minds, your souls to the wisdom of others.

Take the broken. And make it more beautiful than it ever was before.

Kintsugi.

Obstacles, Self-Awareness and our Humanity

When people, organizations, and yes, even nations have strong disagreements, it seems to be human nature to focus on the need to be right. We look at existing problems myopically. It has become ingrained that we must be correct. We listen to reply … not to learn. And somewhere along the way, we lose our humanity.

Our humanity.

The essence of who we are, who we complex, yet fragile people are, becomes secondary if not lost altogether.

Our humanity.

This reality was recently brought home in an unexpected way. While on vacation, I was bobbing around in the Atlantic Ocean on the eastern most island in the Caribbean. I got this feeling of being a speck really, at the mercy of a force far greater than me. The ocean, its deep mysteries, its majestic nature, its unique characteristics, was made manifest as wave after wave pressed its might against me. Unstoppable. Unrelenting. I was in the presence of an overwhelming force, filled with its own living organisms and truth be told, I was helpless and at its mercy.

One individual. One human. Overwhelmed by the reality that the forces around me could take a life, any life, my life, without hesitation or delay. There was no humanity that I could see.

And yet, it is humanity about which we must be keenly aware. Especially in times of conflict, strife and crisis.

By now, most people know or have heard about the lawsuit involving Bonnie Harken, iaedp and the three (3) directors overseeing all of the corporate chapters. People may know the lawsuit alleges and illegal tying agreement involving certification and iaedp membership and mandatory attendance at iaedp’s symposium. This by itself would be a large obstacle.

But that is not the only huge obstacle being faced.  Complaints have also been directed against iaedp regarding BIPOC membership and lack of BIPOC leadership. The petition involving those topics (and certification) and calling for Ms. Harken’s resignation, is now up to 208 signatures. This number is incredibly significant when considering the size of the eating disorder community.

Then there is the issue pertaining to the demands for dissolution from iaedp corporate chapters. Baltimore. New Haven. St. Louis. Denver. Central Coast. Baltimore. Phoenix. All wishing to disassociate from the national chapter.

Any person facing these significant obstacles alone would surely question their own motivations and conduct. Your membership and chapters demanding disassociation and your resignation. The heartache knowing that an organization for whom you toiled for 22 years no longer wants you is shattering to the ego of any person.

And now, the stakes have escalated and exposure is far greater. With this added reality, the pressure must be nearly inconceivable. These added stakes now include complaints and requests for investigation being made to:

The Internal Revenue Service

The U.S. Department of Labor

The California Franchise Tax Board

California Senator Dan Cortese

The same Senator Cortese, the Chair of California’s Senate Labor, Public Employment and Retirement Committee who stated, “An independent contractor is a specific designation for self-employed people or businesses engaged in contract work. It’s not a gimmick for organizations to avoid paying for employee healthcare and other benefits or reducing their tax liability. Any company found breaking the law will be brought to justice, and they would certainly have no business advising other companies on labor law.”

If my reading of the law and its interpretation is correct, the tax issues facing not just Bonnie Harken and iaedp, but iaedp’s national board of directors could be momentous.  And result in draconian measures against one and all.

Ms. Harken believed she could run all operations of iaedp and remain outside the purview of state and federal administrative agencies. Most tax-exempt organizations, such as iaedp, are required to withhold and pay federal income tax with respect to wages of their employees in the same manner as for-profit organizations. These organizations are also required to withhold and pay these taxes, also known as Federal Insurance Contributions Act taxes, in the same manner as for-profit organizations.

California requires employers to withhold state income tax from wages paid to employees. There are also three other state payroll taxes.

Presumably, Ms. Harken believed she could get avoid these taxes by classifying herself as an independent contractor and utilizing her dissolved corporation as a “go between” entity.  If she is wrong, the consequences for not just her but iaedp’s board of directors could be financially, mentally, and emotionally catastrophic.

With all of these issues, I cannot begin to fathom the pain, the fear, the uncertainty, the anguish experienced every day by a person facing those insurmountable objects. As the twilight of our existence on this plain overtakes us, most of us hope to be able to look back upon a life well lived and filled with happiness, purpose and love. To be thrust into numerous battles against state and federal agencies would test the resolve and strength of any person. In the twilight of our life and career though? Devastation.

We are all but specks of living tissue. Fragile bodies. Throughout our lives, we face forces so much greater than us. What we are left with as we fight our on-going and dying battles is our humanity.

Humanity.

And grace that must be extended to those in such pain. For in extending grace, we embrace our own humanity. Accountability? Yes, absolutely. But that should never color or diminish extending grace and embracing our humanity.

And the humanity of others.

DOUBLE EFFECT AND PHYSICIAN ASSISTED SUICIDE

With the approaching legalization of Physician Assisted Suicide (“PAS”) for mental disorders set to take effect in Canada on March 17, 2024, both proponents and opponents are making last ditch efforts to forestall or support implementation.

The statutory law is complex, extensive and awash in legalese.  So, I am embedding a link to this law:

https://www.parl.ca/documentviewer/en/44-1/AMAD/report-2/page-ToC

A Reader’s Digest version of this law, as it pertains to “mental disorders,” and presuming the “mental disorder” does not result in a natural death that is reasonably foreseeable is as follows:

Safeguards for persons whose natural death is not reasonably foreseeable.

The following procedural safeguards apply to persons’ whose natural death is not reasonably foreseeable (*indicates safeguards specific to those requests):

  • request for MAID must be made in writing: a written request must be signed by one independent witness, and it must be made after the person is informed that they have a “grievous and irremediable medical condition” (a paid professional personal or health care worker can be an independent witness);
  • two independent doctors or nurse practitioners must provide an assessment and confirm that all of the eligibility requirements are met;
    • *if neither of the two practitioners who assesses eligibility has expertise in the medical condition that is causing the person’s suffering, they must consult with a practitioner who has such expertise;
  • the person must be informed that they can withdraw their request at any time, in any manner;
  • *the person must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care, and must be offered consultations with professionals who provide those services;
  • *the person and the practitioners must have discussed reasonable and available means to relieve the person’s suffering, and agree that the person has seriously considered those means;
  • *the eligibility assessments must take at least 90 days, but this period can be shortened if the person is about to lose the capacity to make health care decisions, as long as both assessments have been completed;
  • immediately before MAID is provided, the practitioner must give the person an opportunity to withdraw their request and ensure that they give express consent.

To provide greater insight, I am embedding testimony taken in May 2022 before the Special Joint Commission on Medical Assistance in Dying:

https://www.parl.ca/DocumentViewer/en/44-1/AMAD/meeting-9/evidence

This site contains much of the evidence and testimony elicited when the Canadian law was being vetted. And of course, there are a number of matters and issues of concern contained within the Report and testimony.

For example, with regard to the crucially important, “Balancing Individual Autonomy and the Protection of the Vulnerable,” the Committee’s findings constituted only four (4), short paragraphs and ended with the following conclusion: “The committee recognizes that a delicate balance must be struck between promoting individual autonomy and protecting against socio-economic vulnerabilities.”

We have an adequate grasp of the painfully obvious. Perhaps the Committee should have focused on the merely obvious conclusion.

Under the Canadian law, the Committee stated, “To be eligible for MAID, a person must have a ‘grievous and irremediable medical condition.’ As Jennifer Chandler explained, “irremediable” is not a medical or scientific term. Rather, as noted above, “grievous and irremediable” is defined in the law as incurability, being in an advanced state of irreversible decline, and “enduring physical or psychological suffering that is intolerable to [the person] and that cannot be relieved under conditions that [the person] consider[s] acceptable.”

Because of this wording, eligibility must meet ALL of these criteria. Further, if we are to use that definition, doesn’t that necessarily exclude all instances of anorexia nervosa? Incurability? Anorexia?

With regard to Minors, the Committee stated, “In Canada, a person must be at least 18 years old to access MAID. However, minors with the requisite capacity are generally entitled to make their own healthcare decisions. The exact parameters of minor consent to healthcare vary by province.” The Committee then held, “The term ‘mature minor’ refers to a common law doctrine according to which “an adolescent’s treatment wishes should be granted a degree of deference that is reflective of his or her evolving maturity.”

Minors. Our teenagers. Our children.  The Committee also found, “In the Netherlands, MAID is allowed for minors aged 12 and over, and may soon be expanded to include younger children. In Belgium, there is no minimum age, so long as the minor has the requisite capacity.”

So, are we to allow young people, our children, whose brain is not biologically developed let alone mature to make life or death decisions? Where is the morality in that?

Principle of Double Effect

Which brings us to the issue of a just society and the morality not only of medical professionals making this life or death call, but whether the very act in question is morally right. To this, we turn to the Principle of Double Effect. (Principle)

The Principle has its historical roots in the medieval natural law tradition, especially in the thought of St. Thomas Aquinas (1225-1274). It has been refined both in its general formulation and in its application by generations of Catholic moral theologians[1].

Although there has been significant disagreement about the precise formulation of this principle, it generally states that, in cases where a contemplated action has both good effects and bad effects, the action is permissible only if it is not wrong in itself and if it does not require that one directly intend the evil result.

Classical formulations of the Principle of Double Effect require that four conditions be met if the action in question is to be morally permissible:

  1. First, that the action contemplated be, in itself either morally good or morally indifferent;
  2. Second, that the bad result not be directly intended;
  3. Third, that the good result not be a direct causal result of the bad result, and;
  4. Fourth, that the good result be “proportionate to” the bad result.

Supporters of the Principle argue that, in situations of “double effect” where all these conditions are met, the action under consideration is morally permissible despite the bad result[2].

The Principle is regularly invoked in ethical discussions about palliative sedation, terminal extubation and other clinical acts that may be viewed as hastening death for imminently dying patients. Unfortunately, the literature tends to employ this useful principle in a fashion suggesting that it offers the final word on the moral acceptability of such medical procedures. In fact, the rule cannot be applied appropriately without invoking moral theories that are not explicit in the rule itself. Four tenets of the rule each require their own ethical justification. For example, the third condition must necessarily invoke the Pauline Principle which states, “One should never do evil so that good may come.” 

Some ethicists believe that if a suffering, terminally ill patient dies because of intentionally receiving pain-relieving medications, it makes a difference whether the death itself was intended or merely anticipated.  If the death was intended it is wrong but if the death was anticipated it might be morally acceptable[3]. 

Philosophers and medical ethicists have speculated that, “According to this Principle, euthanasia and physician-assisted suicide are always illicit acts, while the same is not said for other actions that bring about patient’s death as a foreseen effect, namely, palliative treatments that hasten death or failure or interruption of life support. The reason for this difference is that, in the first two cases, the patient’s death is intended as a means of pain relief; whereas, in the latter two, death is only a side effect of a medical act, an act justifiable if it is necessary to achieve a proportionate good.”

We also need to question whether the moral objection to an action is the same as the physical performance of that action. Dr. Paulina Taboada addressed this question accordingly, “But the physical performance of an action (actus hominis) does not necessarily coincide with a moral act. Only an action in which human freedom is exercised (actus humanus) can be morally qualified. A moral act is essentially an act in which human freedom is exercised. This means that the moral act itself is marked by an ‘intrinsic intentionality’; it tends towards an object (called moral object).”

Dr. Taboada then stated, “Hence, the moral act cannot be properly characterized by describing a mere physical performance. In order to find out which is the kind of moral act we are performing (i.e., the ‘moral species’ of the act), the key question is: What are you doing? And an answer like “injecting morphine to this patient” would not do it. The proper answer to this question – relieving pain – reveals the ‘intrinsic intentionality’ of the moral act. An analysis of the lived ethical experience shows that the moral character of our free acts is basically determined by this ‘intrinsic intentionality’ of the act, i.e., by the kind (‘species’) of act we perform.”

Dr. Taboada then concluded, “A careful analysis of our most basic human moral experience shows that the ethical character of human acts does not primarily depend on the motivation or intention of the agent, but on the moral species of the action to be performed. Hence, the common saying ‘the end does not justify the means’.[4]”

The Canadian law, at best, paid lip service to this incredibly complex issue. An issue which not only touches our existence, but the very heart of our humanity. Faith. The Soul. Life. Death.

Our society seems to be in such a rush to show all others that we are capable of performing a certain act better than it has ever been done … and thus, show our individual wisdom and humanity. However, in doing so, we have lost sight of the question we need to be exploring, that is, “Should we do this act?”

A question that our medical and mental health providers certainly cannot answer. Perhaps there is no answer. And yet, if we do not keep exploring the boundaries of our being, our imagination, our very lives, we will continue to fail. We will fail on a generational level.

We cannot, and do not have the luxury of taking action without seeking wisdom from all interested parties. We must work toward being open to options we never previously considered. We must strive to chart the unknown and unlimited possibilities of existence.

And we can only do that if we take all reasonable and necessary steps to preserve the sanctity of life.

[1] http://sites.saintmarys.edu/~incandel/doubleeffect.html

[2]https://pubmed.ncbi.nlm.nih.gov/3080130/#:~:text=The%20doctrine%20holds%20that%2C%20in,%2C%20and%20(d)%20there%20is

[3] https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/euthanasia

[4] https://hospicecare.com/policy-and-ethics/ethical-issues/essays-and-articles-on-ethics-in-palliative-care/shaws-criticism-to-the-double-effect-doctrine/