Archives for posts with tag: Listening

Japan is a country famous for suicide (http://www.newyorker.com/reporting/2013/06/24/130624fa_fact_macfarquhar). Its many suicide spots have become tourist attractions, including the Aokigahara forest, the Sea of Trees at the foot of Mt. Fuji, where bodies can lie undiscovered for months, and where tourists come to photograph corpses and to scavenge.

There is no religious issue about suicide in Japan, unlike in the West. On the contrary, the act of suicide is usually seen to restore honour, and is viewed more as a constructive than a destructive act.

A Japanese Buddhist monk, Ittetsu Nemoto, has set himself the task of confronting his country’s suicide culture. He conducts death workshops for the suicidal, where those affected are encouraged to imagine how they might feel if they were unexpectedly given a cancer diagnosis, with only three months, one month, one week, or minutes, to live. Within this imagined scenario, participants are challenged to consider how they might spend the limited time remaining in their lives. This approach, which encourages a shift of focus away from the desire to end life to a consideration of the act of living, appears to be both cathartic and therapeutic.

Nemoto did his training in a Rinzai Zen monastery, which was particularly rigorous and harsh – ‘Apprentice monks are treated like slaves on a brutal plantation’ – and seems to have had all the components of both extreme physical and psychological suffering. Few trainees manage to complete the programme. The aim of the training process is to eventually achieve a throwing away of the self, thereby ultimately discovering who you really are:

‘A well trained monk, it is said, lives as though he were already dead: free from attachment, from indecision, from confusion, he moves with no barrier between his will and his act.’

Nemoto is now abbott of a temple that is much less austere. Priests drink, smoke and marry, a deliberate move to ensure that they are not distancing themselves from their community.

In his work with those who feel suicidal, Nemoto advocates confronting rather than avoiding the fact of death. He has succeeded in opening up talking about dying, in a country where so many choose to kill themselves, and where notions of ‘talking therapies’ are far from commonplace. Nemoto has learned much about his own suffering since he embarked on this project. Initially, through his practice of Zen listening, he found that he became overly involved, and was deeply affected and distressed by every story he heard. He felt responsible for all those whose suffering he witnessed. He became seriously ill, with heart disease, and had to temporarily withdraw from the project. He was deeply shocked when his followers appeared to have no interest in his ill health, and persisted in seeking his help for their own needs, rather than enquiring about his. Nemoto felt he was dying, and that nobody cared, despite all that he had given of himself.

However, through this period of personal suffering, Nemoto discovered another truth: too much should not be weighted on the act of helping others; rather than it being something special or significant, helping others should be something one naturally does in the course of one’s life.

Today, following his recovery from illness, Nemoto only reaches out to those whom he physically meets. He no longer communicates by mail or email. As a result, those affected often have to travel very long distances, and need to be very committed, to seek him out in his temple. He interacts with fewer people, but Nemoto feels he achieves more. He also takes notes when listening to those who come to see him, an approach that has allowed him, he believes, to distance himself sufficiently from their distress and suffering. He also believes that such distancing has facilitated greater resolution for those he attends.

Nemoto ‘believes in suffering, because it shows you who you really are.’ I believe that to live, to truly exist, is to suffer, not in a penitential sense such as Nemoto might have experienced in his training, but in the sense that personal suffering, however one likes to interpret it (and it is a subjective experience in the end), is inextricably linked to living and to humanness.

Taking on the suffering of others, as Nemoto learned, can be a destructive and not altogether helpful act. Empathy, and the capacity for being there for the other, does not necessitate such…

CQ

I had been meaning to read this book for some time, and only just got round to it this week. Timely, as a BBC documentary on the author’s life will be screened over the Christmas period.

Jansson was already famous for her Moonintroll cartoon strips and children’s books before The Summer Book appeared in 1972.

The narrative focuses on the relationship between 6 year old Sophia and her grandmother, who live on a remote island in the Gulf of Finland. The child’s father is also there, but is very much a silent presence in the background. To some extent the book was a response to the death of Janssen’s beloved mother in 1971, and is based on ‘real’ people from the author’s life, her own mother represented by the grandmother, and Sophia the author’s niece. The location also reflects Jansson’s personal history, with the setting based on a house that she and her brother built on a remote island off Finland in 1947.

Although the (short) book predominantly follows the companions as they spend time together, exploring, talking, swimming and foraging, there are also other threads running through the narrative, particularly the grandmother’s musings on ageing and death. Deceptively straightforward sounding chapters such as ‘The Morning Swim’, ‘Moonlight’ and ‘The Magic Forest’ contain much more than is apparent at first glance. In the latter chapter, for example, the forest itself becomes a metaphor for living and dying:

‘This forest was called “the magic forest”. It had shaped itself with slow and laborious care, and the balance between survival and extinction was so delicate that even the smallest change was unthinkable.” (p.27)

The notion of death is introduced early, when Sophia asks her grandmother directly, with an endearing frankness and openness that only the very young can engender:

‘When are you going to die?’ (p.22)

Shortly afterwards, we learn that Sophia’s mother has died:

‘Sophia woke and remembered that they had come back to the island and that she had a bed to herself because her mother was dead.’ (p.25)

The book is about imagination, in both the old and in the young, and it is also about wisdom that similarly transcends generations. What is particularly impressive, is Jansson’s ability to portray a dual perspective, the simultaneously believable voices of both a child and an elderly woman.

It is thus not only 6 year old Sophia who bubbles with imagination, but her grandmother also displays impressive imaginative ingenuity. When Sophia’s friend Berenice comes to stay, and is bored and tiresome, the grandmother suggests that she draws something:

‘”Draw a picture,” she said.

“I don’t know anything to draw,” the child said.

“Draw something awful,” Grandmother said, for she was really tired now. “Draw the awfullest thing you can think of, and take as much time as you possibly can.”‘ (p.45)

Death features again in Sophia’s questions about heaven, and in the grandmother’s internal reflections on the euphemisms for death:

‘It was too bad that you could never have an intelligent discussion on the subject. People were either too young or too old, or else they didn’t have time.’ (p.135)

The grandmother struggles with the process of ageing, as she becomes aware that her memory for recent events is slipping (p.56), and how much she hates the chamberpot under her bed, a ‘symbol of helplessness’ (p.170). At times, she seems weighed down by sadness, and by an almost palpable sense of loss:

‘A very long time ago, Grandmother had wanted to tell about all the things they did, but no one had bothered to ask. And now she had lost the urge.’ (p.90).

She also feels that she cannot describe things anymore, the words have somehow been lost to her, and so, it will all die with her death:

‘And unless I tell it because I want to, it’s as if it never happened; it gets closed off and then it’s lost.’ (p.90)

But, just as she is there for Sophia, listening and reassuring during her many tantrums, so too is the little girl there for her grandmother. She attends to the older woman’s outburst:

‘But now I have the feeling everything’s gliding away from me, and I don’t remember, and I don’t care, and yet now is right when I need it!’ (p.93)

And so, on a night when she was unable to sleep due to ‘thinking about sad things, the grandmother shared her anxieties with the attentive child, thereafter sleeping soundly…

The relationship between the older and the younger companion is very moving. Even when they quarrel, it is with love:

‘One evening, Sophia wrote a letter and stuck it under the door. It said, “I hate you. With warm personal wishes, Sophia.”‘

The prose is just delightful, for example the tree trunks ‘formed a tangled mass of stubborn resignation’ (p.27), and when the pair quarrelled, they ‘quarrelled the wrong way.’ (p.111).

The Summer Book has never been out of print in Scandinavia. I am not surprised. It is a truly magical work, which can tell us much about humanness, but perhaps especially about relationships, and how being there for the other can enhance, and even make sense of, the whole business of being.

CQ

This play by Margaret Edson (London: Nick Hern Books, 2000) is a must read for anyone working, or considering working, in healthcare. Particularly, most particularly, doctors.

Edson, a school teacher, worked in a cancer and AIDS unit, an experience that inspired the play. It won the Pulitzer Prize for drama in 1999.

The play does not feel like a work of fiction, and I guess it is probably more of a fact/fiction hybrid, as presumably the narrative was informed by many individual stories Edson encountered in real hospital life. I saw the TV adaptation of the play, with Emma Thompson in the main role, some years ago, which was extraordinary. Only recently have I read the play itself, twice as it deserves a re-read, there is so much to experience in just 55 pages. It is a deeply moving, and harrowing, literary work.

Vivian Bearing, a Donne specialist, is diagnosed with advanced ovarian cancer. The play is set in a Cancer Centre, where Bearing is currently having chemotherapy. Flashbacks piece together her story, from diagnosis, and before, to ‘now’, the opening scene, which takes place just a few hours before her death.

She opens with her musings on how the ill are greeted:

‘I have been asked ‘How are you today?’ while I was throwing up into a plastic washbasin. I have been asked as I was emerging from a four-hour operation with a tube in every orifice, ‘How are you today?’

This reminded me of John Berryman’s Dream Song 207:

‘ – How are you? – Fine, fine. (I have tears unshed,

There is here near the bottom of my chest

a loop of cold, on the right.

A thing hurts somewhere up left in my head.

I have a gang of old sins unconfessed.

I shovel out of sight

a many-ills else…)’

With some irony and a dark humour that to some extent define her personality and coping ability, Bearing concludes on the question ‘How are you?’ that doctors routinely, and often unthinkingly, ask:

‘I am waiting for the moment when someone asks me this question and I am dead.

I’m a little sorry I’ll miss that.’

The humour continues (and we are only on page 2):

‘It is my not my intention to give away the plot; but I think I die at the end.

They’ve given me less than two hours.’

Thus, from the very outset, we know where this story is heading… But the remaining minutes in Bearing’s life are so worth attending to, and witnessing. We are invited into a (at least partly unneccessarily) tragic story that powerfully highlights the gap between how doctors behave and deal with illness and what the experience of such illness might be for the sufferer.

We hear of words such as ‘insidious adenocarcinoma’, ‘primary adnexal mass’, which are dropped into the initial breaking bad news consultation. We share Bearing’s experience of the medical ‘Grand Round’, where ‘the patient’ is discussed in the third person (or merely as the condition from which they suffer), and is visible only in a medical sense.

Bearing is keenly aware how the doctors ‘anatomise’ her, armed with a ‘potent arsenal of terminology’, which is mostly incomprehensible.

Cancer and its treatment constitute a life mostly of awfulness:

‘I receive chemotherapy, throw up, am subjected to countless indignities, feel better, go home. Eight neat little strophes. Oh, there have been the usual variations, subplots, red herrings: hepatotoxicity (liver poison), neuropathy (nerve death).

But she survives the radical treatment, and indeed becomes a somewhat celebrity case:

‘I have survived eight treatments of Hexamethophosphacil and Vinplatin at the full dose, ladies and gentlemen. I have broken the record. I have become something of a celebrity.’

And then, with insight and poignancy she observes:

‘But I flatter myself. The article will not be about me, it will be about my ovaries.’

It is this insight and knowing (and seeing-through the medical profession) that makes Bearing’s story feel, not just real, but authentic.

When pain becomes a major problem, and Bearing needs aggressive pain management to ‘stand it’, she comments:

”It’: such a little word. In this case, I think ‘it’ signifies ‘being alive’.

Donne provides a backdrop throughout. Bearing was an expert on the poet’s Holy Sonnets and her life had always been suffused and intricately linked with his words, words that now become acutely apposite:

‘Death be not proud, though some called thee

Mighty and dreadfull, for, thou art not soe.’

To mention Bearing’s death at the end does not indeed betray the plot. It is an important, and tragic, ending, which says so much about what is wrong with the whole business of how the voice of the ill is listened and attended to.

CQ