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Camille Drach Hojaij: Stein and Empathy Fulfilment

 

Carlos R Hojaij's Comment

 

        In Athens, in the year 472 BC, Asclepius (1978) won four prizes in a theatre competition. One of the plays was The Persians, the theme of which was the Salamis' battle against the Persians, which had taken place eight years prior and ended with a magnificent victory for the Greeks. The play was dedicated to the great Pericles. But the piece was not merely a way to celebrate the Greek triumph; Asclepius asked to the audience to look at Salamina’s victory through the eyes of the Persians. The chorus, unusually composed by men, represented the Persian King’s Council, with the old and wise disclosing their worries, anxieties and their deep sorrow for their immense loss and the defeat of their great empire. In contrast to Ciro and Dario, the previous, more moderate leaders of the Persian Empire, Xerxes (Dario’s son) was less restrained in his political dealings, ultimately leading to the Empire’s destruction. Asclepius promoted in the audience a movement of reflection through which the Greeks came to take on the feelings of the Persians. Asclepius was not asking to the Greeks to abdicate from the joy of glory, nor to suffer in guilt for their fallen enemies, but rather to consider the meaning, intensity, and extent of the defeat for the Persians. This aspect of honoring the enemy was among the fundamental values painted in the Iliad of Homer (2019), centuries before Asclepius.

        It was in Ancient Greece that gods, demi-gods and men expressed their passions, joys, frustrations, exultancies, disillusions, solidarity, submission, hate, wisdom, despairs, lies, courage, guilt, reverence, vengeance, loyalty, irreverence, oppression, treason, sense of honor, mistakes, fidelity, fears, respect, humiliation, dignity, power, seduction, trickeries and the many other faces of humanity, all while composing values and principles valid until present day.

        It was during this time, about 3,000 years ago, that a man named Homer composed what are known as the Iliad and the Odyssey, perhaps among the first of humanity’s core texts. The Iliad centers around the hero Achilles, the seemingly invincible Greek warrior, in the war against Troy. Achilles eventually defeats Hector, the Trojan commander, King Priam’s eldest son. It was custom for the body of a defeated great warrior, already absent of its internal spirit, to be stripped of its robe, shield, helmet, and weapons and be taken to the win- ner’s camp, where it was left to the dogs and vultures. This was to be the fate of Hector. The heartbroken Priam, in an act of humiliation, felt obliged to visit Achilles and offer gold in ex- change for his son’s body, which he would take back to Troy so it could be by his family and the city’s inhabitants, all celebrating their great hero in a splendid funeral. Kneeling before Achilles, Priam kisses the hands of the man who killed his son and begs for Hector's body. The pleas uttered by Priam immediately remind Achilles of his own father. Achilles gently pushes Priam away and both men cry while one remembers his fallen son and the other his old father. Prior to this highly emotional scene, Achilles has a diverse reaction just after defeating Heitor. “The Greeks - says Achilles - a funeral will concede, but your body will be given to the dogs and vultures.” Almost without force, recognizing his imminent death and the destiny of being left to the dogs and ventures in the Greek's camp, Heitor replies: “For your knees, your life, for your parents, I beg not to have my body near the Greek ships to be thrown to the dogs. Abundant gold, bronze, and the so many presents my father will offer you as ransom to restitute to them, so my venerated mother, the Trojans and their young wives could at home deliver my body to the funeral pyre.” The wrathful, callous Achilles gives his final sentence: “Even if they pay me ten times the ransom’s value, or twenty times, and promise me gifts; even if the old Dardano, Priam, pays your body's weight in gold, your venerated mother to whom you own your life will not cry for you as you wish her to, for your body will be thrown as a meal to the dogs and vultures.” Within a short space of time Achilles displays two very distinct emotions and behaviors. In the first instance, Achilles remains emotionally indifferent to Hector's destiny, not to say exultant of how he will see Hector's corpse ravaged by dogs and vultures. Achilles here does not experience the emotional movement that the Greeks showed in Asclepius's play. But moments later, while facing Priam, Achilles recognizes a similarity between Priam's experience and the experience to be lived by his own father, Peleu, when he receives the news of his son's death. There is a synchronization of the two experiences. Achilles is not only aware of Priam's torment, but let’s himself be moved to compassion; Achilles and Priam cry together.

        In his play The Persians, Asclepius offers a paradigmatic example of empathy: under-standing the other without entirely letting go of one's original perspective and feelings. On the other hand, Homer describes how empathy may evolve into sympathy. While the empathic movement is promoted by the experience of the other, if going further - I understand the whole appropriation of the other’s experiences gives origin to sympathy. I suppose the confrontation of this specific part of The Persians' play with the encounters between Achilles and Hector, and Achilles and Priam could be explored to better highlight the similarities and differences between empathy and sympathy, both sophisticated human feelings.

        It seems that it was through the catharsis triggered by Homer's stories, and tragedies like Asclepius’ The Persians, that the Greeks developed a sense of civility (city, civil, com- mon sense), fundamental to democracy as it existed in Ancient Athens. One could say that empathy is the foundation of civil life.

        My following comments will mention a point from Barry Blackwell’s (2020) comment and another from that of Hector Warnes (2020).

        Blackwell finishes with an afterthought that I take as an alarming commentary on the way medicine, at its core, has progressed (or rather, regressed). Medicine now excludes empathy from the doctor-patient relationship; empathy is impossible in such brief and superficial medical encounters. Blackwell’s observations may stem from the very unfortunate Six Minutes for the Patient published by Michael Balint (1973). In his text – the title of which almost seems like a sarcastic reference to the limited time offered to patients by many doctors – Balint outlines a method by which to achieve diagnosis in six minutes. This original proposal from the 1960s evolved into “Fifteen Minute Psychotherapy.” According to Balint, his work was to be very useful for those doctors seeing 30-40 patients a day, a common practice not restricted to England but observed in several other countries. In Australia, for instance, GPs are forced to “rotate” patients every 10 minutes. It is not difficult to understand that such a limited timeframe does not allow the time for proper interaction with (empathy) and apprehension of the person who is front of the doctor. As most medical practices nowadays belong to economic groups, the majority of which are under non-medical control, doctors have be- come a kind of modern slave (along with many other professionals), assessing patients for merely economic reasons. The doctor has become nothing more than an economic tool. This vision of the GP’s activity may also be extended to many parts of medicine, where the patient is an object to be exploited by the medical-economic system. Balint’s work seems to be a late result of the English industrial revolution, which created modern slaves of workers, sub employed and submissive.

        It is also worth considering the role of medical schools in this gradual erosion of medical practice. One important factor is the absence of medical psychology in the academic curriculum in most medical faculties. Through the study of medical psychology the student would learn about what and who the patient is, personality characteristics; what a disease is for a patient; the meaning of a specific disease for a specific patient; the implications of that disease for that patient’s life; different diseases in different phases of the patient’s life; how to allow space for the patient to introduce him/herself and present his/her history and clinical picture; and how to establish an empathic link with the suffering person and gain their confidence so as to provide further treatment and guidance. Without trust, without confidence, the medico-patient relationship is a relation between a provider and a customer. No time, no empathy. No empathy, no healthy doctor-patient relationship.

        Hector Warnes considers empathy to be “rooted in our neuro-biological evolutionary heritage”; it is for this reason, he argues, that it is important to psychiatry. Warnes finishes his comment with the sentence: “This is a profound phenomenological study that enlightens us on the basis of our capacity to relate to others, (...) the recognition of alien egos...”

        His statements take me back to my thesis on (1987 “Understand in the Schizophrenic Individual” (1987), a research piece on how understanding (as an empirical method that allows for intuitive knowledge and co-existence between people) would be in an individual affected by schizophrenia.

        I will just mention two conclusions relating to Warnes’ comments: a) the transformation of the person through schizophrenia occurs at the level of the spirit, which forms part of human nature; one can observe a modification in the capability of understanding in the very constitution of the schizophrenic psychic process; and b) there is a disappearance of a sense of the teleological, due to a breaking down of intuitive and holistic apprehension. There is no longer a distinction between the essential and the non-essential in relation to the usual criteria of validity. The sequence of inner experience abandons the spiral of the process of under- standing, instead moving in accordance with causal laws. The capacity of inter-personal transposition is lost, jeopardizing empathy and affective participation.

        Empathy is the beginning of human relationships, normal or abnormal. Empathy, a complex natural human expression, gives color to the multitude of aspects of human existence.

 

References:

Asclepius. The Persians. In: Teatro Griego, Esquilo, Sofocles y Euripides, editors. Tragedias Completas. Aguilar S.A. de Ediciones. Madrid, 1978.

Balint M. Six Minutes for the Patient. Enid B, Norell J, editors. Tavistok Publications. Lon- don, 1973.

Blackwell B. Camille Drach Hojaij: Stein and Empathy Fulfilment. inhn.org.controversies. February 13, 2020.

Hojaij CR. Compreensão no Esquizofrênico. Doctoral Thesis. University of Sao Paulo. Uni- versity of Sao Paulo Library. Sao Paulo; 1987.

Homer. Iliade. In: Tout Homère. Éditions Albin Michel. Paris; 2019.

Warnes H. Comment. Camille Drach Hojaij: Stein and Empathy Fulfilment. inhn.org.contro- versies. January 30, 2020.

 

December 17, 2020