Tag Archives: relationships

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Here’s ado to lock up honesty

Sometimes I think we want to simplify things too much; we crave bichromality: on or off, yes or no. We want certainty, not a spectrum. An answer, not another question -a decision, in other words. And yet if we stop to look around, it seems obvious that things are seldom black or white -there are colours everywhere.

Relationships are no different -how could they be when two unique individuals are involved? When evaluated over any period of time, they are in constant flux. Contingent. Their often turbulent waters involve negotiation -one might even say navigation. There are no reliable maps -and unless there is local knowledge, ‘Here be dragons’ like those drawn on medieval charts in areas where there was insufficient information to avoid dangers.

Even initial reassurance may require sudden modification depending upon the conditions -we cannot always know in advance how things will work out. Indeed, the very fragility of the substrate is one of the important reasons why we are so enamoured with fine porcelain, with delicate lacework, with Trust.

But relationships, except in a legal and sometimes transactional sense, are seldom maintained by official written contracts -it’s more of an understanding, verbal or otherwise. This is fine, of course, but susceptible to misunderstanding or deliberate deception. Vulnerable to sudden, unexpected changes in either partner. Difficulties in effective communication…

‘Words, words, words,’ says Hamlet to Polonius. It almost doesn’t need an explanation, does it? Similar to his ‘That one may smile, and smile, and be a villain’ -although admittedly in a different context. But the meaning is clear: one can hide behind a curtain of sound, or a reassuring appearance, so that what is being conveyed may be confusing -purposely, or accidentally.

The problem, I suppose, is in knowing the intent of either one of the participants and its effects on the other. This is especially important in sexual matters where effective communication often lags behind the actions, and frequently is restricted to vague, initial permission followed by hormonal dictates.

It is a subject that people often feel reluctant to talk much about beforehand. Meanings of words and actions can change in the heat of battle, making prior negotiation -setting ground rules, and such- important. Sexual dialogue is not something taught particularly well in School Health Classes, so I was pleased to find an article in Aeon that was willing to tackle it head on. https://aeon.co/essays/consent-and-refusal-are-not-the-only-talking-points-in-sex

The author, Rebecca Kukla, is professor of philosophy at Georgetown University and senior research scholar at the Kennedy Institute of Ethics. She explores the language of sexual negotiation. ‘Philosophers who specialise in what is known as ‘speech act theory’ focus on what an act of speaking accomplishes, as opposed to what its words mean.’ She writes that, ‘all speech acts are governed by what philosophers call ‘felicity norms’ and ‘propriety norms’. Felicity norms are the norms that make a certain speech act a coherent possibility… I can’t name someone else’s baby just because I feel like it, by shouting a name at it. These would be infelicitous speech acts. ‘Propriety norms are norms that make a speech act situationally appropriate. So, although I have the authority to order my son to clean his room, it would be a massive norm violation for me to walk into his classroom at school and shout at him to clean his room in the middle of class.’

‘In public discussions about the ethics of sexual communication, we have tended to proceed as though requesting sex and consenting to it or refusing it are the only important things we can do with speech when it comes to ethical sex… Consenting typically involves letting someone else do something to you. Paradigmatically, consent (or refusal of consent) is a response to a request; it puts the requester in the active position and the one who consents in the passive position. And in practice, given cultural realities, our discussions of consent almost always position a man as the active requester and a woman as the one who agrees to or refuses him doing things to her.’

And yet, ‘Autonomous, willing participation is necessary for ethical sex, but it is not sufficient. We can autonomously consent to all sorts of bad sex, for terrible reasons. I might agree to do something that I find degrading or unpleasantly painful, for instance, perhaps because I would rather have bad sex than no sex at all, or because my partner isn’t interested in finding out what would give me pleasure.’

‘Usually, when all goes well, initiations of sex take the form of invitations, not requests… But when I’m trying to establish intimacy with someone as I am getting to know them, an invitation is more typical and likely more conducive to good, flourishing sex than a request… Invitations create a hospitable space for the invitee to enter.’ An invitation to dinner, for example. And ‘An interesting quirk of invitations is that, if they are accepted, gratitude is called for both from the inviter and the invitee. I thank you for coming to my dinner, and you thank me for having you.’

‘A sexual invitation opens up the possibility of sex, and makes clear that sex would be welcome. Invitations are welcoming without being demanding… Notice that if I invite you, appropriately, to have sex with me, then consent and refusal are not even the right categories of speech acts when it comes to your uptake. It is not felicitous to consent to an invitation; rather, one accepts it or turns it down. So the consent model distorts our understanding of how a great deal of sex is initiated, including in particular pleasurable, ethical sex.’

Kukla goes on to talk about when and if invitations are appropriate, and then about such issues as ‘gifts’ of sex in long-term relationships, as well as the sociology of gifting. But her discussion of ‘safe words’ I think is one of the most important topics she covers. So, ‘Even if we freely consent to a sexual encounter, or otherwise enter it autonomously (for instance, by accepting an invitation), we also need to be able to exit that activity easily and freely. Entering autonomously is not enough; sexual activity is autonomous only when everyone understands the exit conditions and can stop at will, and knows and trusts that they can do this. This requires shared linguistic norms for exiting any activity. Safe words, properly employed, provide a framework that allows everyone to understand when someone wants to exit a sexual activity.’

‘Part of what is interesting about safe words is that they let someone exit an activity at any time without having to explain themselves, or accuse anyone of transgression or any other kind of wrongdoing (although they can also be used when there has been a transgression)… One reason they are important is that inside a sexual encounter, speech is frequently nonliteral… We need very clear ways to be able to tell when someone wants to leave this nonliteral discursive context.’

And, as she suggests, ‘Safe words are powerful discursive tools for enabling sexual autonomy, pleasure and safety, in at least two senses. Most straightforwardly, they offer a tool for exiting an activity cleanly and clearly, with almost no room for miscommunication. But even more interesting to me is the fact that safe words allow people to engage in activities, explore desires and experience pleasures that would be too risky otherwise. When we want to experiment with something that might give us pleasure, but also might make us uncomfortable or put us at risk, we need to be especially sure that we can exit the activity easily.’ But, of course, ‘safe words should never become the only way that someone can exit a scene or activity – all participants need to remain flexibly responsive to other discursive cues as well.’

Unfortunately, the ‘strong social tendency to focus our discussions of sexual negotiation on consent and refusal has resulted in a narrowed and distorted view of the pragmatics of sexual communication. Correspondingly, we have tended to focus on rape and assault, understood as nonconsensual sexual activity, as the only sexual harm we need to worry about. In fact there are many ways in which sex can go ethically wrong, other than by violating consent.’ Kukla feels that ‘sexual autonomy also requires the ability to engage in clear, pragmatically complex, fine-grained sexual communication – including uses of language that go well beyond consenting to and refusing requests for sex.’

There is so much more to communication than words, isn’t there -and so much more to words than meets the ear?  Hamlet again: ‘There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy…’

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Love, which alters when it alteration finds

I’m not certain I understand why, but I am being led to believe that Love can be described mathematically using Bayesian Probability Theory… Okay, as a start, I have no idea what subscribing to Bayesian probability theory might entail, except maybe a club membership, and a considerably manipulated personal profile to attract some interest. But, ever alert to new (or any) social possibilities, I decided to read the essay by Suki Finn, a postdoctoral research fellow in philosophy at the University of Southampton in the UK writing in Aeon: https://aeon.co/ideas/beyond-reason-the-mathematical-equation-for-unconditional-love

It starts with the not unreasonable premise that there are two basic types of love: conditional, and unconditional. Then, she dips her toes into some background to convince me that Thomas Bayes’ probability theorem is flexible enough to improve my social life.

‘Degrees of belief are called credences. These credences can be given numerical values between 0 and 1 (where 1 is being completely certain), to demonstrate how strong that degree of belief is. Importantly, these values are not forever fixed, and can change when given reason to do so… But how do you rationally alter your credence, and figure out how strong it should be, given the information that you have? Cue Bayesian probability theory to calculate conditional credences. A credence is conditional upon information when it is evaluated with regard to that information, such that the strength of the belief is sensitive to that information and is updated on the basis of it… But what if my credence is completely irresponsive to such evidence? … This is what it is like to have credence 1, in other words, a belief of certainty, which could not be any stronger and cannot be updated. It cannot be updated in either direction – it cannot get stronger because it is already at maximum strength, and it cannot get weaker on the basis of evidence because it was not built on the basis of evidence in the first place.’ Uhmm… easy, right? And these are the rational changes to credence. ‘When your strength of feeling is sensitive to information about how things are, a philosopher would call it rational, as it develops in accordance with that information. Such is loving for a reason: with more reason comes more love, and when the reason goes, the love goes. This type of conditional love is an analogy to rational credences between 0 and 1 (not including the extremes), which change on the basis of evidence.’

Still with me…? I mean with Suki, because I’m not in any way with her…  Okay then, ‘Alternatively, unconditional love is love that will not change according to any information, as it was not built on the basis of information in the first place. This is love without reason… This type of love has an untouchable and irrational mind of its own. As with credence 1, it can change only irrationally – it does not abide by any Bayesian law and so cannot be updated… You fall in and out of unconditional love at the mercy of love itself… This is loving in spite of everything, rather than loving because of something, and so appears unaltered by reason… But this does not make the love stable. It is simply out of your control, and can literally go away for no reason!’

It seems to me that the author is saying that conditional love is probably more predictable, or maybe controllable than unconditional love, because it is not subject to random (uncaused) fluctuations. It’s not as liable to be indiscriminately, or inadvertently snatched away. Nice. But have I learned any non-obfuscatory take-home lessons? Is it readily transferrable to any situations other than amongst rhetoricians? Could I use it in the car on the way home, in other words?

Sometimes the grandest ideas fall short of the mark in actual combat… sorry, relationships. How, in practice, and when you’re just getting to know somebody, can you possibly profess conditional love? And why would you? It sounds like a sort of one-time stand thing. It is of course, but normal rules of courtship require hyperbole. Metaphors -as in: ‘My love is as constant as the northern star, of whose true-fixed and resting quality there is no fellow in the firmament. The skies are painted with unnumbered sparks. They are all fire and every one doth shine, but there’s but one in all doth hold her place.’ As long as she doesn’t know you’ve cribbed the lot from Shakespeare’s Caesar, and you don’t mess up the words, everybody wins.

People are attracted to metaphors -they conjure up sincerity without linking it to unconditionality. Without requiring the intrusion of credences into an otherwise emotionally friable situation. It seems to me there’s nothing but trouble in store for anyone who decides to numerically assign emotional attachment parameters on the way home from a lovely dinner in an expensive restaurant.

Anyway, Thomas Bayes was a Presbyterian minister, and heaven only knows what that entails in terms of the slideabilty of relationships. I mean, their Regulative principle of worship (according to Wikipedia, at least) ‘specifies that (in worship), what is not commanded is forbidden.’ I’m therefore not entirely convinced that he would approve of the commandeering of his theorems in the somewhat tottery realm of Love, whether or not it is entwined with the idea of worship.

Of course, on the other hand, I suspect he would no doubt denounce any effort to charm with untruths, or at least equivocatory declarations. I certainly admire Suki Finn’s attempt to clarify intrinsically opaque emotions, but I’m afraid it will not do. And to revert back to Philosophy -her specialty- for a moment, there are just too many perils for any practical attempt at a Kantian Categorical Imperative application here, either.

It seems to me that I blundered into a more satisfactory solution to the declaration of Love: metaphor. It does not require any numerical assignations that might confuse or even spoil the moment; it does not even require positioning the feeling along a Bell curve for comparison with other loves you might have had. Nope, at the party -after you muster up the courage to ask her to dance- you merely say: ‘When you do dance, I wish you a wave o’ th’ sea, that you might ever do nothing but that’, or in the car on the way home, you just have to come up with something like, ‘O, how this spring of love resembleth the uncertain glory of an April day which now shows all the beauty of the sun…’ and let it go at that.

 

 

 

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Life would not yield to Age

There are times I think I’ve missed out on a lot. It seems to me that in my day, if a man re-chose a woman, he would almost always go for someone younger than himself. The reasons were obvious even then: overweening hubris, and expectations beyond capability. Indeed, dating sites online still seem to confirm my impression, and often -if not usually- the man’s eyes prove bigger than his stomach and the meal seldom lasts.

But retrospection is a stew of disappointments often sprinkled with only the barest soupçon of hope. Age is, well, age after all, and things happen as we get older. So, especially if one partner is significantly younger when they meet, the inevitable will occur -and worsen- in the older, and so you can guess who will become the default caretaker. Despite the best and most honourable intentions, this strikes me as unfair, albeit easily predictable by anyone watching from the sidelines.

And yet, although I concede that I am a creature of my era, I am still willing to be a witness to the triumph of hope over experience, so I was drawn to an article written by Gary Karantzas, an associate professor in Social Psychology/Relationship Science, at Deakin University (Australia) in the Conversation online magazine: https://theconversation.com/mind-the-gap-does-age-difference-in-relationships-matter-94132?

‘Across Western countries, about 8% of all heterosexual married couples can be classified as having a large age gap (ten years or more). These generally involve older men partnered with younger women. About 1% of age-gap couples involve an older woman partnered with a younger man. About 25% of male-male unions and 15% of female-female unions demonstrate a large age gap.

‘But what these trends tell us is that the majority of the population is likely to partner with someone of similar age. This largely has to do with having social circles that generally include peers of similar ages and being attracted to others who are similar. Similarity entails many things, including personality, interests and values, life goals and stage of life, and physical traits (age being a marker of physical appearance).’

If the article had stopped there I imagine I would have learned nothing new, and I might have remained an insufferable avocat du diable at dinner parties. But, fortunately for both me and my friends, I read further. ‘Many people assume that age-gap couples fare poorly when it comes to relationship outcomes. But some studies find the relationship satisfaction reported by age-gap couples is higher. These couples also seem to report greater trust and commitment and lower jealousy than similar-age couples. Over three-quarters of couples where younger women are partnered with older men report satisfying romantic relationships.

‘A factor that does impact on the relationship outcomes of age-gap couples is their perceptions of social disapproval. That is, if people in age-gap couples believe their family, friends and wider community disapprove of their union, then relationship commitment decreases and the risk of break-up increases. These effects appear to apply to heterosexual and same-sex couples.’

‘Another factor at play may have to do with the stage of life each partner is experiencing. For instance, a ten-year gap between a 20-year-old and a 30-year-old may bring up different challenges and issues than for a ten-year gap where one partner is 53 and the other is 63. This is because our lives are made up of different stages, and each stage consists of particular life tasks we need to master. And we give priority to the mastery of different tasks during these distinct stages of our lives.’

And he concludes that ‘The success of a relationship depends on the extent to which partners share similar values, beliefs and goals about their relationship; support each other in achieving personal goals; foster relationship commitment, trust and intimacy; and resolve problems in constructive ways. These factors have little do with age.’

I think I witnessed something like that once. I don’t normally sit on benches, especially occupied ones, even though they’re usually long enough to support a small family. Of course, maybe that’s the idea, because they often have little plaques commemorating someone who has died but used to sit there. So I feel a little uncomfortable sitting beside people who might be related to the deceased. And anyway, the act of sitting on a bench at my age makes me think I should be finding an unplaqued one so my own family can have one printed up.

But, I was tired and the bench that overlooked Vancouver’s English Bay was seductive, even though two people had already discovered it for a rather snuggly chat. They were both gazing lovingly into each other’s eyes and speaking softly to each other. I sat at the far end of the seat so I wouldn’t disturb them. I don’t think it bothered either of them particularly, although one of them, an attractive woman, probably in her early sixties, leaned even closer to her friend to whisper something when I sat down. I have trouble judging ages, but I would think he was  ten or fifteen years her junior, and yet equally enthralled. Anyway, both of their eyes were so entangled I might as well have been a bird sitting on a branch nearby for all they seemed to care.

And then, perhaps thinking they were being rude, they both sat back and stared at the waves breaking on the nearby rocks for a moment. Finally, the woman turned to me and smiled. “Isn’t it a beautiful day?” she asked, as if she suddenly felt a need to welcome me to their bench.

I nodded pleasantly, and we all sat in silence for a while, listening to the cry of a group of seagulls that had landed on the rocks. “I hope I didn’t disturb you,” I suddenly blurted out, embarrassed at choosing an already occupied bench, I suppose, although perhaps more concerned about admitting to myself that I had needed to rest.

The man leaned forward and his eyes circled around my cheeks like butterflies about to settle. “Not at all. We were just reminiscing about how we met on this very bench fifteen years ago -fifteen years ago today, in fact.”

“I’d just finished running around the seawall, and I think it was a bit too far for me, so I needed to sit down… And I happened to see this bench,” the woman said, squeezing his hand as she spoke. She glanced at her friend. “Jeff was…”

“I was sitting at the far end of the bench reading a book when Alice arrived, and…”

“And that was the beginning of a wonderful life,” she finished for him.

It was sweet the way they both finished sentences for each other -like they were completely comfortable being inside the other’s head.

“It’s our fourteenth wedding anniversary today,” he added, and kissed her gently on the cheek.

“We come to this bench each year to remember,” she said snuggling closer to him and sighing contentedly.

“Welcome to our bench, eh?” he chuckled, and winked at her as they both stood up and stretched.

“I’m sorry, I hope I didn’t…” I started to say, but she reached out and clasped my hand, her eyes twinkling in the sunlight for a moment.

“It’s the meeting bench,” Jeff said, hugging her as he spoke, then grasping her free hand he stood quietly with her for a moment, the wind tussling their hair like another hand.

And as they started to walk away, Alice turned towards me and her eyes softened as they rested on my face. “I hope someone sits…”

But just then some friends further down the seawall waved and yelled at them, and her smile caressed me briefly before she shrugged and walked away with Jeff to grace some other lives.

 

 

 

 

 

 

 

 

 

 

 

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Trust

Like time, trust is a difficult concept –easy enough to conceptualize, perhaps, but hard to define. To categorize. To understand. It is slippery, and slides through the fingers like water. As St. Thomas Aquinas said of time, you know what it is until someone asks you to be more specific. It is something, however, that seems to be essential  in many of our interactions –arguably none more so than in Medicine.

As a doctor, I could be accused of a confirmation bias I suppose –after all there are other relationships that require a high degree of whatever we understand to be involved in the concept of trust that might seem too numerous to list. That is true enough; trust pervades all levels of our daily lives, but I suspect we are likely more fastidious in entrusting our very existence –or the quality thereof- to an unknown person, especially since the interaction involves an unequal power relationship.

But it is a necessary trap, isn’t it? Sickness can be incapacitating and so we usually seek to alleviate it if possible, or mitigate the effects if not. Patients –the etymology of the word derives from the present participle of the Latin word suggesting ‘undergo’, or ‘suffer’- understandably seek what power they can exercise beforehand. If they have to place themselves in the hands of someone else, often a stranger, they can avail themselves of  information about the doctor beforehand. There are rating systems online that canvas opinions of interactions and results from the doctor in question to help with the decision. They may pre-engender that elusive trust -or at least, facilitate it in what are often constrained and inadequate time limits of a consultation visit.

My reputation –or lack of it- is therefore already packaged for a patient to open or discard as she sees fit. I am a sort of book already read and critiqued by someone else, dependent on the rating, even though I am –as is everybody else- a work in progress. The last chapters are yet to be written. But I have no such prescient knowledge about my patients –no way of knowing them beforehand. I must take what I get and write the next page…

And yet, that is not always the case: some, you get to know and enjoy; Sonia was one of those. I had seen her on and off for years, albeit at intervals that verged on epochs –often so long, in fact, that I sometimes assumed she was dividing her loyalty amongst several doctors. Sonia, I had realized long ago, saw medical opinions as bouquets from which she felt quite comfortable in selecting the most appealing flower.

She is a short, large woman, with a smile that says relax. Her hair has greyed over the years, but is invariably bunched on the top of her head and artfully fastened with a brightly coloured ribbon no doubt contrived to contrast with her clothes. It is probably a fashion statement; I see it as an idiosyncrasy, but I’m sure that my Rate-Your-Doctor file does not comment favorably on my own tastes in that area. My receptionists certainly don’t.

I have always liked Sonia. She seems to have that rare talent of being able to summarize her concerns succinctly and intelligently –almost as if she had written them down beforehand, memorized the salient features, and then practiced them over and over again until she was satisfied they made sense. Satisfied I would understand how important they were to her. Almost as if she had reused them many times…

But today, her referral letter suggested nothing new: fibroids -benign growths of the muscles of the uterus- with a past history of occasionally heavy periods. I had seen her for this a few years before and she had decided not to do anything about it, confident, as she had said, that the problems would go away with her menopause. I saw her watching me as I scrolled through the letter and the accompanying ultrasound on the computer screen.

I looked up at her from the monitor. She was dressed in a beautiful green, velvety dress like she was about to head for a cocktail party after the consultation. And, true to form, had fastened her long, unruly hair on her head with a neon bright, thick orange ribbon –like a trail marker tied to a bush in a forest… I buried the thought as soon as I noticed her smiling at my glance. “So..?”

“So, I’ve decided I want you to check my fibroids again,” she said as if I’d just canvassed her opinion the week before and was still trying to make up her mind about what to do. “Just my fibroids, that’s all.”

It was so like Sonia to want to help me to focus on the reason for her visit. I pulled up a comparison ultrasound done at her last visit three and a half years ago. She was 52 then and I had encouraged her decision at that time. Fortunately the fibroid –there was only one then and now- had not grown in the interval. But the lining cells of the uterus –the ones that are shed during a period- were now quite remarkably thickened. That had changed! I scanned the blood tests her family doctor had done a few weeks ago and they seemed to indicate that she had probably already gone through her menopause. So any bleeding now would be both unusual as well as worrisome –uterine cancer can present like that. I looked at what she’d told me on her last visit: heavy, but only sporadic bleeding. She’d refused to allow me to sample the cells in the uterus –an often painful but necessary procedure we commonly perform in the office but which could be done in the operating room under an anaesthetic if necessary. She’d promised to decide and come back on another day… But hadn’t.

“What about the bleeding, you had?” I said, mindful of her concerns about the biopsy I had suggested last time.

“You want to do a biopsy, don’t you?” she said with an almost flirtatious smile.

“Well, I’d like to make sure there are no abnormal cells in the uterus. The fibroid hasn’t grown, since we last met, but we never did that biopsy I’d suggested.”

She turned on another sweet smile and shrugged. “I’m sorry about that, but business took me out of town right after I saw you. Anyway, I had one done down in the United States and it was normal.”

I looked through the data her doctor had included with the referral, but I couldn’t find any pathology report or mention of the biopsy. “I can’t find any record of it here,” I said, busily scanning the screen to see if I’d missed anything.

“You won’t find it in there, I don’t think,” she said with a little toss of her head. I looked up. “The doctor down there just phoned me and said everything was okay, but never asked me where to send the results.”

That seemed a little unusual –if only for medicolegal purposes, doctors like to make sure results of tests are sent to the patient’s personal physician. “When was that?” I said, ready to enter it into her notes.

Another shrug. “I don’t know. Three years ago maybe?”

“Are you still bleeding, Sonia?” A simple question, I thought. But her face suddenly hardened. “Because a lot can change in three years…”

Her eyes tightened slightly and she looked at me suspiciously. “No, wait. I’m sure it was more recent…” She closed her eyes for a moment, obviously trying to decide what might be a better answer. She was now angry and her whole body stiffened.

I thought perhaps I could diffuse the situation. “Well, do you think you could ask that American doctor to send me the report of his or her biopsy at least?”

“You don’t trust me, do you doctor?”  She stood up and started to put on her coat. “And after all these years!”

“Sonia, let me just have a look at that report and see what it says…”

“I told you what it said,” she said through tense lips.

“And anyway, if you’re worried about another biopsy, if we have to do one, why don’t we do it in the hospital under a general anaesthetic..?”

Suddenly, her coat was on and she hurried to the door stopping only briefly to face me. Her face was an angry mask as it stared at me with a mixture of indignation and disbelief. “I’ve trusted you all these years to do what was best for me,” it said with a slow, almost sad shake of the head underneath. “But without trust…” She sighed loudly and walked stiffly but determinedly through the door without a backward glance.

Maybe she was right about the trust we shared, but I am still waiting for that report.