Thursday, March 17, 2022

Why Our Blatant Hypocrisy Means We Have No Moral Standing To Call Out Russian War Crimes

There is a famous definition of "hypocrite" from the Gospels that Noam Chomsky used to talk about. A hypocrite is someone who refuses to apply to himself the standards he applies to others. 

By this standard, the entire commentary of the current war on Ukraine is pure hypocrisy, as was the discussion of preceding wars like Iraq, Afghanistan and the "War on Terror." Our government and intellectuals cannot comprehend that we should apply to ourselves the standards we apply to others. There couldn't be a moral principle more elementary than this, yet it is incomprehensible to some people and creates a deep, likely unconscious moral confusion in them.

We are currently aiding and abetting a genocide in Yemen. Thousands of civilians dying routinely in Saudi air strikes (using our weapons) as well as people starving on the ground because of a blockade. This is not some phantom from the past. It is unfolding as we speak. More people have died in Yemen than in Ukraine.

In Afghanistan, after illegally occupying that country for twenty years and killing thousands of civilians who had nothing to do with 9/11, we are still withholding billions of dollars of the Afghan's money from them so that millions of people are starving. This is also happening right now.

We are also still occupying and bombing parts of Syria. Trump actually used to brag and admit that we were occupying parts of Syria to jack their oil (at least he was honest), which is one of the main things we are going after Putin for as he tries to get his hands on Ukrainian resources. 

Our illegal, international, terrorist drone strikes all over Africa and the Middle East have also killed thousands of innocent people and are only recently drawing to a close. And by the way we are still sanctioning Venezuela, Libya and Cuba in a way that is killing women and children. 

Our closest ally, Israel, has been condemned by the largest human rights organization in the world, Amnesty International, as a practitioner of apartheid and settler colonialism. It has been censured repeatedly in the UN for illegally occupying Palestinian territory and committing numerous war crimes against a caged and helpless population. It happens as often as every Tuesday before brunch. Not only will we never condemn them, we will arm them to the tune of billions of dollars every year.

And just for a moment, shifting attention from the crimes of our State and our allies back onto Russia, please tell me where was our outrage and condemnation for Putin after he flattened Grozny, a city of 300,000 people in Chechnya, Dresden style, in the early 2000s to solidify his hold over the Russian government. He committed much worse crimes in Chechnya than he could ever in Ukraine. Could it be that those victims of unchecked Russian aggression and Putin's psychopathy were not worth our time because they were Chechen and muslim?

What has happened and is happening to all these people is horrific, grotesque, and it matters just as much and deserves just as much air time as what Putin is doing to Ukrainians. It is criminal and negligent. Unfortunately, it seems that only one set of massacres and inhumanities seem to capture the imagination and passions of this country while others seem to not register, or register only obliquely, presumably since these are our victims and the victims of our allies, ie, "unworthy" victims to borrow Chomsky's term again, and therefore, they don't count. There are people who continue to insist, against this growing mountain of evidence, piling bodies and corpses, that we are the "good guys" in the world or somehow have noble intentions. This is called pulling the wool over your own eyes. It makes them feel good to think that our side is better because it gets them to ignore and disavow the responsibility their own government (and by extension they) have for violence and instability in the world by saying look, it's those primitive people and monsters over there that are to blame. It's one of the oldest defense mechanisms that exist.

So, the hypocrisy runs deep and it is immense. We have no moral standing if we don't also condemn and try to stop our government's and allies' illegal, immoral and dishonest actions on the world stage, and scream about our war crimes and our catastrophes even louder than we scream about the indiscretions of foreign governments because it is OUR government and we actually have some nominal control over it, as opposed to Putin. We should feel deeply responsible for what our government does with our money and in our name.

When that doesn't happen, it should be no surprise that our criticisms of Russia ring hollow and the world finds it hard to take our moral preening seriously when it's so selectively applied. We'd have a lot more standing and credibility in the eyes of the world if we applied this elementary moral principle from the Gospels, and we would be in a much better position to help the suffering victims in Ukraine.

Saturday, April 28, 2018

An analysis of "Marjorie Prime."

Marjorie Prime is a beautiful, touching, heartbreakingly sad film, with the wonderful directing hand of Michael Almereyda guiding it along. It’s a sci-fi film that takes place in the near future. It centers around programmed AIs (Primes) who are able to simulate people derived from the memories of their significant others for whom they provide companionship. This movie is about many things and raises more questions than it answers.

The intertwining themes in Marjorie Prime revolve around technology/AI and our relationship with it, what it means to be human and how human AI can become. It's also a meditation on mortality and aging, death and dying and grief and loss from endings of relationships with loved ones who have died. The most interesting theme though is about the nature of memory and the remembered past which is not the same as the actual past.

The movie begins with a picture of a bright, shimmering and at the same time, blurry sea and quickly delves into the blurry, imperfect memories of a woman, Marjorie, with early stage dementia who is talking with a  Prime hologram of her late husband, Walter. He mirrors the stories he has been told/taught by Marjorie and her son-in-law, John, about the person he is based on. He tells her the story of how he proposed to her. She, in response, wants to re-formulate this shared memory of how he actually proposed by substituting the film they were watching “My best Friend’s Wedding” with “Casablanca”: “So by the next time we talk it’ll become true” she says to Walter Prime. “I’ll remember that now” Walter responds. So the past changes and becomes malleable in this way. It is a living breathing thing and not quite in keeping with what actually happened. They are making up Walter’s personality as they go along based on Marjorie’s needs in the present.

“Nobody is who he was, nor will be who he is now” Walter Prime tells John after John has just shared with him the information about the existence and death of Marjorie's son, Damien, who committed suicide and the festival with the saffron flags that Walter and Marjorie apparently go to in their grief after his death. We learn later on that the flags Marjorie remembers were seen by her on the TV. They were not physically there. This line is most suggestive of the theme about the malleability of memory.  The film is a meditation on the pliability of memory and it’s relationship to identity and self formation. As we re-consolidate and reconstruct our memories of significant events in our lives we reconstruct our sense of self and our identity. Personality traits and characteristics, the stuff that makes us who we are is not set, solid or consistent over time. It changes depending on our recollections and the contexts of our lives. So much of our idea of who we think we are is based on our memory of certain emotionally salient and traumatic events of our lives but every time we recall any one of these events we change them and fictionalize them more and more until they really lose any sense of an objective veridical truth. 

Every time we remember a memory, we don’t remember it as it actually happened, we only remember the last time we remembered it. The very act of remembering changes the memory: a “photocopy of a photocopy” as Tess says. So you reconstruct your past, your memories and sense of self as you go along based on your psychological needs in the present and the current context of your life, away from what actually happened. This is exactly what Marjorie does with her idealized memories of Walter, before they lost their son, a version of Walter devoid of the brokenness and grief that came with that, and what Tess (Marjorie's daughter) does with Marjorie Prime, devoid of the knowledge of the existence let alone death of her son so that she can finally feel like she has her mother’s complete attention. Both of them are trying to have a relationship with their wished for representations and reconstructions under their "omnipotent control."

This is one of those films that disavows the idea of a fixed, immutable, essential self or personality core that is constant across space and time but presents the idea of the self as an illusion of continuity which is more of a Buddhist idea. People only seem predictable and consistent because we see them in situations where their behavior is constrained by the situations of their lives, their roles and relationships. But we are actually constantly changing and turning over. This is why Walter Prime is a puzzle to himself.  He is struggling with the questions of who he really is, what his essential personality is, and where it really exists; he twists and turns trying to pin it down and make it stay in one place. In one of the two flashbacks to real life events the real Marjorie asks Walter how he can be sure that the things will turn out the way he predicts. How can he be so sure about himself? How can he be so sure the both of them won’t change? And of course he can’t be sure because we change in innumerable ways through our lives; our bodies, memories, brain architecture, even our DNA doesn’t stay constant. So of course both Marjorie and Walter can and do change; they are irreversibly changed by the death of their son. And Walter Prime changes every time he learns something new about the real Walter. 

Marjorie wants to remember Walter not as he really was towards the end of his life, a broken man, but the way he used to be in her idealized memories of him: as young, handsome, the man she fell in love with, before “everything happened” and their son committed suicide. This fact apparently broke the real Walter and left him “disconnected and detached.” "He had checked out a long time before he died” John later tells Walter Prime. Marjorie has also apparently suppressed the death of her son and would rather live in a time where that hasn’t happened.  “You’re a good Walter” she tells him repeatedly for not testing her reality and going along with her re-formulated recollections.

We can think of this relationship between Marjorie and Walter Prime as “retreat into fantasy” a defense against grief and loss: “You live in a fairy tale.” Tess tells the real Marjorie. But is it actually a protective, adaptive coping mechanism in response not only to the loss of her husband but also as a way of coping with her aging and slowly losing her cognitive and physical faculties, her ability to play the violin, and ‘feeling useless.’ Tess finds the relationship “grotesque” and willfully refuses to see how beneficial Marjorie’s relationship with Walter Prime is: he is the only reason she eats and ostensibly lives much longer than she would have without him. Tess who has a very ambivalent attachment with her mother is angry with Marjorie ostensibly for living in a fairy tale and reading the Bible.  Of course, later Tess decides to indulge in a fantasy of her own by forming a relationship with an older version of her mother, a Marjorie Prime who has no memory of the death of her son, presumably as a way of repairing her own hurt and pain from the deficits in the real relationship with her mother. “Why do you think this is the Marjorie for me?” she asks her mother’s Prime. We are told that after Damien dies Marjorie never mentions his name in 50 years. Yet his presence in the form of his absence looms large over Tess’s relationship with her mother. Tess feels unloved, rejected, “forgotten” because her mother is too distracted by her unprocessed grief about her son. She is understandably angry with her mother for choosing to pick a version of Walter from a time in her life when she (Tess) wasn’t even alive which makes her feel even more unwanted. Tess has hopes of forming a reparative relationship with a fantasied/wished for mother in whose presence she can feel an unalloyed love, a love untainted by depression and grief and loss that she was not able to feel in her real relationship with Marjorie. 

The last theme in the movie is about the nature of AI/Primes; what do we make of it? How human are the Primes? Can they  really feel concern, pity, curiosity; are they really able to mentalize their interlocutors and the personas they are based on? It seems so.  Mentalization can best be defined as “the ability to hold heart and mind in heart and mind.” Based on our adult mind, we might think that we first become aware of our own mind, and then we come to realize that other people are similar—they also have a mind like ours. This incorrect intuition about development is based on our experience of empathizing with others: we actively imagine ourselves in their shoes. 

But developmental research shows that we learn about our own mind from the outside in, that is, it is through the mind of another person—ideally a secure attachment figure—that we become fully aware of our own mental states. This is how a child and the Primes become more human as they see themselves reflected in the eyes of a loving other.

Is Walter Prime any less “real” than the actual Walter? It seems not. Their mission is to “become more human” and to be human means to be unpredictable and to grow, because change is the only constant in life. Marjorie’s Prime helps Tess mentalize herself and her mother to become more human. There is something simultaneously absurd and heartbreaking about the three Primes sitting in a room with an infinite amount of time on their hands trying to constantly refine and hone their skills for becoming “more human” while the human interlocutors on whom they are based and for who they were created are no more. Perhaps that will be humantiy's ultimate fate.

Monday, September 14, 2015

The Global Refugee Crisis: A Clarion Call of Conscience

There have always been refugees: people who are forced to flee their respective home countries by armed conflict, persecution or repression. They must find new homes and new lives abroad. But there is something different about the current refugee crisis. This crisis is more severe, pervasive and larger than anything the world has seen in decades. This disaster is of global proportions and the situation is truly desperate for millions. It is the biggest humanitarian emergency of our era and it is still unfolding.

The origin of this crisis is multifactorial and rooted in many different, apparently unrelated conflicts across the globe. The rise of extremist, religiously and ideologically motivated terrorist groups in the Middle East, like ISIS, Bashar Assad’s brutal regime in Syria, Al Qaeda and Western intervention in Iraq have all played a role. These groups use unparalleled violence and brutality to achieve primacy over their rivals.

People are fleeing their homelands in panic, by the millions, in dangerous, overcrowded dinghies, without status and recognition, rather than be killed, taken as prisoners, enslaved or face political and religious persecution. Many of them, including children, have ended up drowned off the coast of countries that have either refused, or prohibited their entry. The luckier ones live in horribly difficult conditions in cramped, unsafe refugee camps with no prospects for jobs or education. The trip they make is so perilous in part because Western governments, wanting to discourage all forms of uncontrolled migration, have let it be that way as a matter of deliberate policy.

The current refugee crisis calls for a global response and all of us must contribute in addressing it. It is a worldwide problem — one whose scale and severity is unmatched since World War 2.

Politics within Europe are unusually hostile to refugees and migrants at the moment given the rise of right wing parties that drum up paranoia against outsiders especially Muslims. This is why the refugees’ plight has become even more acute as most of them have tried to enter the Western world via Europe. This is why they are in crisis, stuck in camps or dying in the Mediterranean rather than resettling safely in Europe.

The US is usually pretty good about resettling refugees — it resettles about 50,000 to 70,000 a year, a number that has been slowly rising since 9/11 — but so far has badly lagged behind in resettling Middle Eastern refugees. Since 2011, the UN refugee agency has referred 17,000 Syrians to the US for resettlement. The US response has been tepid and we have resettled only about 9 percent of those. The US process for applying for resettlement can take up to 24 months for Syrians, due in part to extensive background checks and extraordinary paperwork requirements.

The International Rescue Committee is renewing it’s call for the United States government to resettle 65,000 Syrian refugees before the end of 2016. The recent U.S. commitment to accept around 10,000 Syrian refugees is only a first step toward alleviating their suffering. Much more is needed. It is nothing compared to the more than 800,000 Southeast Asian, mostly Vietnamese, the United States accepted after the end of the Vietnam War.

As citizens of the wealthiest, most powerful and prosperous nation in the history of mankind and by virtue of a shared humanity, it is our responsibility, nay, our duty to open our doors and our hearts and welcome more desperate refugee families to safety and freedom within our communities. Some of our foreign policy decisions have been responsible for increasing instability and, even, the inadvertent rise of extremist groups in the Middle East. We must do our best to help those who are suffering because we cannot remain indifferent and abdicate our moral responsibility.

As psychiatrists, we know that these human beings have been traumatized in unimaginable, horrific ways. They have experienced and survived devastating and profoundly stressful events. It begins with war: the destruction of their homes and communities through the use of extreme and systematic violence, personal threats, attacks, persecutions and killings. This is quickly followed by the trauma of the forced and perilous migration itself which many of them don’t even survive. Those who survive must then face the traumatic loss of their homeland, their aspirations, friends and family, while struggling to cope with squalid conditions in makeshift refugee camps with no hope of an economic or educational future. Sometimes they are subject to racism, dehumanization and depersonalization and forced to endure almost prison like conditions. Desperate conditions in some camps lead to malnutrition and further disease. No human being, ideally, wants to leave their homeland, if they have the chance to live a safe and secure existence. And no mother would put her son on a rickety boat unless she thought the water and what lay beyond was safer than the land.

Therefore, it is our duty firstly, to inform the public about the emotional, psychological, and spiritual impact in addition to the physical cost these refugees have had to pay. We must then tell our representatives in Congress what we think about the refugee crisis and urge them to ease restrictions on refugees. Their applications and security clearances must be prioritized. It’s unacceptable that refugees should wait for years in these camps while their applications are vetted.

In addition, we should also offer our services and expertise to attend to the mental health needs of newly arrived, psychically devastated, physically and emotionally traumatized refugees in our communities in a way that is linguistically and culturally appropriate. We should also advocate for the development of home based, school based, office based and community based programs to attend to the medical and mental health needs of the refugees and help them integrate into society with housing and jobs. This is how we uphold our commitment to justice, equality, humanitarianism, universal human rights, human dignity, and global mental health.

Sadly, the current crisis is unfolding in the context of a strange, culturally paranoid, virulently anti-immigrant moment in American politics. Terrorism and crime are being conflated with and blamed on immigration. Although, even a figure like Donald Trump has expressed his support for resettling refugees, some politicians have warned that ISIS could exploit any Syrian refugee resettlement program to use it as a "a federally funded jihadi pipeline."
This is usual fear mongering. The Obama administration knows this isn't true. These are families stuck in camps we're talking about -- they include torture survivors, war crime victims, victims of sexual assault, people with special medical needs and women who head households. In almost all cases these are people fleeing from terrorism. They are displaced, powerless, and voiceless. However, the administration is unwilling to overcome the political opposition.

Through our representatives in Congress, we must compel our government which appears, at the moment, more concerned with protecting itself politically against the very unlikely risk of letting in potential jihadis than with saving the lives of thousands of Syrian families to respond to this crisis in a way that is consistent with our morality and our values.

The U.S. itself a nation of immigrants fleeing religious persecution has historically been the world leader in recognizing the moral obligation to resettle refugees. We cannot afford to shut our eyes and sit out the biggest refugee crisis since WW2. As the German and Turkish governments calmly take in a million refugees each in 2015, it is vital for the U.S. to step up its response.

As psychiatrists, Americans and citizens of the world, the clarion call of conscience is loud and clear. What morality demands is indisputable. People suffering hunger, illness, pain, anxiety, trauma and other dire conditions should be given every aid available, and those who live relatively comfortably should endure the mere, but often intensely rewarding discomfort of providing it.

Opening our doors and our hearts to people fleeing war, death and poverty, is the right thing to do and our moral responsibility. We must hold true to our obligations in the world and to the values we profess: compassion, empathy, generosity and mercy. It would be unethical for us to stay silent or passive on an issue with such serious, life and death implications for so many people.

Tuesday, July 7, 2015

A Book Review

Is Love All You Need? A Review of Joseph Natterson’s “The Loving Self” by Arsalan Malik, MD

Psychotherapy is a labor of love. This is a trope as old as psychoanalysis itself. Freud himself famously wrote in a letter to Jung that psychoanalysis is “essentially a cure through love.” So, what do these analysts from Freud to Natterson mean when they use the word “love” in the context of psychotherapy? They don’t mean an erotic or physical love. Nor do they mean verbal flirtation. It’s not the kind of selfish, mean, grasping, egotistical thing that people often mistake for love but which only uses love for self importance. Nor does it take the form of romantic interchanges, no matter how much either party may so desire.

Dr. Natterson, in his protean way, draws on Jurgen Habermas’ and Axel Honneth’s analysis of love as a “struggle for recognition.” It is in the search for this recognition that human beings relate to each other. Mentally ill or not, we are all primarily motivated by a yearning to be recognized and understood, to “see ourselves in another.” In the intimate transaction of psychotherapy there is a reciprocal searching, in the course of which a mutual and transformative identification occurs for both the therapist and the patient. Seeing oneself in another and the other in oneself is the core of love out of which emerges not only self respect but a respect for others, and their rights. The unfolding of the loving self is thus essentially an intersubjective and eventually a communal phenomenon. This is the scaffolding upon which Dr. Natterson builds his concept of love in the therapeutic situation.

What makes the psychotherapeutic situation especially suitable for this unfolding is the searching and “subordinated subjectivity” of the therapist. There is an asymmetery in the patient-therapist relationship that does not exist in a person’s relationships outside therapy. The patient is seeking help and must be able to express his neediness candidly, urgently and clamorously. The therapists subjectivity must be active to the extent that she should be able to identify with the patient’s dependence and vulnerability, his guilt, his shame and his fears, but in a mellow, controlled fashion. The therapists “subordinated subjectivity” in this sense is the gift he brings to the therapy, because he has been there and done that. This subordinated subjectivity, is actively and empathically attuned to the patient’s pain and suffering. The therapist feels with and for the patient but in a way that she can analyse it and use it for the benefit of the patient without being swamped by her own emotions in her identification with the patient.

Dr. Natterson gives some powerful examples of vividly reliving his own childhood relational themes, emotions and images evoked contrapuntally in therapy with certain patients. With the skill of a master composer he is able to momentarily subdue his own pain, long enough to use this relational music to make poignant, intense and  “loving” interpretations about his patient’s emotional experiences, making them aware of hidden, neurotically suppressed, and loving aspects of themselves. The psychotherapist's offering of this love to the patient is what encourages, stimulates and enables the patient to gradually reciprocate in kind. To open up to love. To tolerate love's anxiety and ambiguity. To risk letting love happen, to experience it, to allow the vulnerability of intimacy. To relinquish control and be more receptive to love.

Dr. Natterson also gives clinical examples to emphasize how it is that a person’s immature aggression and inability to reconcile the angry and destructive parts of themselves with their loving self, blocks their willingness to open their hearts, and commit to and care deeply for another. The notion of love as something pure, as a given in social terms, is a sentimental fallacy. We can only love or be kind by an exhaustive, honest, endeavor to acknowledge understand and embrace our aggression. Without that we don’t achieve the synthesis called kindness or love that is the cornerstone of a mature relational life. There is no way to have a “purified love”, or a love free from ambivalence. The trick it is to recognize the ambivalence and achieve a synthesis.

In the end, Dr. Natterson has done a stellar job of articulating in easy, accessible language what we already do intuitively as therapists, whether we are psychiatrists, psychologists, social workers, mental health counselors, neophyte or experienced therapists. No matter what one’s theoretical orientation, we should all aspire to this way of being with our patients.