Several thoughts have preoccupied me over the past months. They came to me, as if in a series of dreams, but in fact they were the residual content of You Tube videos I have been watching, for weeks, of Jacques Derrida being interviewed on the major subjects of post-modern philosophy. I wrote these ideas (flashes of insight) down after each of those dreams, because I thought they could possibly help my patients, and me, understand human existence in a hopeful way.
For those of you unfamiliar with Jacques Derrida, let me briefly tell you about the man and his work, and the ideas that resonated so poignantly for me in my clinical work. Jacques Derrida was a French Algerian Sephardic Jew, who emigrated to France as a child in the early 1940s and became one of the great modern philosophers of the 20th century. The father of a branch of existential philosophy called “deconstructionism.” He died in 2004 of pancreatic cancer. Most of the snippets of You Tube video are from Derrida, a 2002 American documentary film directed by Kirby Dick and Amy Ziering Kofman. Derrida fascinated me for several reasons: (1) he had an enviable shock of thick white hair even as a 70 year old man; (2) he had this exotic French accent and could move effortlessly from French to English to French; (3) His identity as a Jew was profoundly strong and integral to his life and his work; (4) He was mentored by Emanuel Levinas, and finally (5) I see almost every patient with pancreatic cancer at Memorial Sloan-Kettering Cancer Center, and have done so for the last 25 years. Discovering that he died of pancreatic cancer, after being so influenced by his ideas, forced me to acknowledge the debt of life lessons and wisdom I owed so many of my patients who faced death with courage and dignity.
THE FUTURE
So many of my patients struggle with the idea of the future; either the uncertainty of the future or the certainty of death in the future. What many find difficult is how to deal with being in that space (that time) between now and death, struggling somehow to not give into despair and meaninglessness. They are trying to find something that can still be created in the face of death; within the limitations and constraints of the finiteness of life. Some of my patients write me e-mails, particularly to ask me questions about something I may have said in our therapy session, or just to seek some words of solace when they are particularly despairing. This has happened a few times over the past months and I saved the e-mails because I found that what I had written was an expression of caring that was particularly eloquent, and I felt I might never be able to express these thoughts in exactly the same way–again. I also feared I would forget the ideas. I have forgotten almost as much as I have learned in this lifetime.
Recently, a patient wrote me an e-mail, asking how he could possibly feel he had any future at all, given that he had metastatic pancreatic cancer. I had just watched a video clip of Derrida speaking about the future, so I wrote him the following:
“I think of the future constantly, perhaps to the detriment of living fully in the present. But your question is a basic human question that deals directly with the nature of our existence. I've recently begun to understand that there are probably two kinds of future. The predictable, basic, universal future, and the unpredictable, uncertain, unique future. The predictable future is the future where time marches on, the sun will set and rise, and we are all born and live and die.
The unpredictable future is more about “what (or who) comes, unpredictably, into our lives and how we respond to it” the people the events. The “others” who come into our lives and change our lives and our future. Your wife, creative ideas, … So while one element of the future is predictable, there is so much of the future that is unpredictable and that we take a part in creating. So never stop trying to create your future because there is always hope that something or someone will unpredictably enter it.”
PRAYER
Another patient wrote me that he was an atheist, but had this impulse to pray and was confused by it. Was it a betrayal of all he believed? Was it a lack of courage on his part? I wrote him the following e-mail in reply:
“So the question is — why would someone who is an agnostic or an atheist pray?
I have prayed and sometimes pray even though I am at least an agnostic. Who am I praying to? And why am I praying? And what am I praying for? Do I expect my prayers to be answered?
Well, one of the last times I prayed was a plea to god to take my son's diabetes from him and give it to me. Did I expect god to hear me? Or respond to my prayer? No.
My prayer was a hopeless act but not a meaningless act. It was an act of love. It was an act of connection to my son, to nature and the universe, an act connecting me to myself, my past and my future. It was a prayer meant for me to hear, exhorting me to bring to bear my love and courage and caring to deal with this uncertainly in my family's life, and take part in creating our future. The act of creating an uncertain future IS hope. The act of creating an uncertain future IS love. The act of creating an uncertain future IS our debt to life.”
LIES
Occasionally, we have patients whose intellect and persona just amaze and mesmerize us. Our therapy sessions become “events” that sustain us for weeks. I received an e-mail from just such a patient with far advanced disease after one of our sessions. He wrote: “Thank you for another helpful session. I wonder if you can expand on why you said it was important to learn how to lie? What does lying entail, when is it okay, and how far can or should one go? Of course I understand the gross definition and the obvious areas where it is not okay to lie, but what I'm trying to understand is when it is okay or even beneficial to lie to one's self, and to others?”
Well now the entire world (or at least the readers of Palliative and Supportive Care) knows that I occasionally point out the value of the importance of knowing how to lie in order to live in the world! Honestly (no pun intended), I had not recalled saying this to the patient, but clearly the subject of lies had come up and had an effect on this patient. What are lies? What purposes do they serve? All human beings lie. Perhaps it is even unique to us as a species. Is there an existential purpose I wondered.
I wrote the following e-mail after watching a Derrida video clip:
“Glad the session was helpful.
This business about lying can be complex as you suggest, but let's make it simple:
The lie is about the future
The truth is about the past.
In order to live with hope one has to be creating an uncertain future. Lies give this uncertain future a direction.”
I wrote this editorial on July 15, 2013, what would have been Jacques Derrida's 83rd birthday.
I had to make a choice. Do I write these ideas about the future, prayer, lies, as if they were my own revelations? Or do I credit Derrida with the thoughts and the inspiration. Since this Editorial is now a part of my past, I decided to tell the truth. Merci Jackie.
