Richard J. Severson

This is chapter six of my book, Medicine, A Phenomenological Inquiry (2021).

Consciousness, according to Antonio Damasio, is the feeling of a feeling.1  Feelings are like a report card, a self-assessment of how you are doing.  “How are you feeling?”  That’s the opening line of every doctor’s exam routine.  The answer is usually brief, and predictable.  “I feel sick.”  Or, “I feel fine.”  Or, “Not too well, doc.”  Or, the smart aleck answer, “You tell me; you’re the doctor.”      

Emotions communicate body states to the brain and trigger necessary responses through the autonomic nervous system.  Feelings are more complicated.  Like emotions, feelings motivate actions.  When angry, for instance, we tend to raise our voices and make threatening gestures.  Emotions are involuntary reactions, feelings less so.  We are held accountable for outbursts of anger, but not for flinching when surprised.  Feelings are the prelude to agency and deliberation, which means that we have some measure of control over them.  Aristotle said that virtues are acquired habits that enable us to act and feel appropriately in any given situation.2  Our feelings let us know whether our behavior is acceptable or not.  They motivate us and pass judgment at the same time. 

The feeling of a feeling is the beginning of consciousness.  That’s another way of saying that feelings are the raw material of the mind.  If theoretical thinking is its highest achievement, then the food for such high-mindedness lies in our feelings.  Feelings anchor us to our bodies as the unity of all emotions, and they anchor us to our minds as the basis for all thoughts.  The attainment of this unifying double-duty is the foundation of self-awareness.  To be both alive and fully aware of being alive at the same time is a rare biological feat.  So far as we know, only our own species has completely achieved it.  Life itself became aware of its own journey in the workings of the human mind.  That’s the existential significance of consciousness. 

Consciousness is the feeling of a feeling, yes, but it has the purpose of a symbol.  It is symbols that give rise to thoughts, as another noteworthy phenomenologist proclaimed.3 What he neglected to mention was that symbols are animated by feelings.  The feeling of a feeling is a symbolic act because it represents who I am as a person.  That’s what symbols do: they stand for something else.  A fighter jet is a symbol of war.  As such, it projects power and menace.  For those who understand it, the message is clear: “Don’t mess with us.”  But that message would be lost on anyone who couldn’t interpret the symbolism properly.  In their representational work, symbols communicate meaning.  Their meaning is not always apparent because symbols are cultural artifacts.  They are part of a representational system that requires a shared understanding of the world.  If I had never seen an airplane before, the symbolic meaning of a fighter jet would surely be lost on me.  I must possess the ability to understand its meaning in order for a symbol to represent something to me.  In chapter 3, I mentioned that Darwin was struck by the behavior of the natives of Tierra del Fuego when the HMS Beagle visited their island home.  The Fuegians were fascinated by the rowboats that brought the English sailors to shore, yet they completely ignored the giant ship from which the rowboats were launched.  It was as if the ship represented something beyond their understanding.  As a symbol, it meant nothing to them; so they ignored it. 

Empathy is the feeling that binds us to others.  It is the symbol of a shared world.  Cultures represent the expansion of shared worlds through the work of symbols and their mental offspring.  As cultures progress, their symbols become more abstract, or thought-like, and sophisticated.  Symbolisms—meaningful categories of interrelated symbols—greatly expand the reach of human understanding.  In the end, it is creation myths that represent the highest achievement of symbolic expression.  Not all symbols inspire life fulfilling storylines, however; some of them deprive us of further meaning rather than enhancing it.  That is the difference between the symbolisms of sickness and healing.  The latter enable the creation of new meaning whereas the former represent its undoing.  Take the symbol of suffering, for example.  Unlike pain, which is an emotion that conveys information about the body to the brain, suffering is a feeling that represents what pain means to us.  Suffering overwhelms the mind’s ability to extend itself outward and forward into the world.  It snuffs out the instinctive optimism that buoys us up in life; it represents a living hell—a black hole—that seems inescapable.  It’s why the release from suffering is experienced as a new lease on life, an unexpected joy.  When we are in the midst of suffering, even the empathy that binds us to others is undone.  It’s what makes sickness so lonely and hard to bear. 

Despair is another example of a feeling that is also a symbol of sickness.  Kierkegaard called it the sickness unto death because it represents a total rejection of existence.4 Normally, every organism fights to extend its own life for as long as possible.  Despair symbolizes a desire not just to die—but to have never been born.  To be unwilling to be yourself is what Kierkegaard meant by despair.  He thought it was the only unforgivable sin.  What level of suffering could drive a person to such anguish? 

Conscience is the pinnacle of consciousness because it represents the unconditional freedom to become the sole agent of one’s own destiny.  The option to reject the will to live is one of the preconditions of moral freedom.  Despair isn’t the same thing as depression or anxiety, though they are closely related phenomena.  Only a fully conscious life possesses the ability to reject itself.  Every symbol of sickness carries with it the burdens of suffering that, in extremis, inflame the temptation to despair.  In sickness, we are no longer of use to ourselves.    

Every organism transforms its environment into a world that is hospitable to its own needs.  The life of the mind is no different.  Yet life is not always hospitable, which means that consciousness must face up to an inherent fragility that symbols are meant to assuage.  To become fully aware of life’s mortal predicament is a precarious adventure.  How can life be happy when death awaits us all?  That is just one of the innumerable laments of humanity.  Symbols enable us to transcend the harsh realities of existence.  The struggle to survive in the face of long odds makes more sense when it is couched in the symbolism of the hero.  To survive a serious illness is often considered a heroic endeavor.  It is the work of symbols to make sense out of life’s endless difficulties by representing them as meaningful ordeals. 

Meaninglessness is a real threat to the symbolic life of the mind.  Symbols sometimes fail because life can’t always bear the burdens of meaning that we place upon it.  In fact, I think symbols of sickness denote a breakdown of the tacit contract with reality that all symbols convey.  Symbols are like promises of good fortune.  Normally, they buoy us up for the hardships to come.  Like life itself, the mind has a built-in bias toward hope and optimism.  Every organism is relentlessly optimistic about its own chances to keep on living.  It is the one necessary illusion to counteract the ever-present threat of mortality.  Sickness and death are realities that are especially challenging for the mind to represent.  That is why symbols of sickness signify their own impotence as symbols.  The mind thrives on the creation of meaning, not the dissolution of it.  Symbols are supposed to lift us up, not tear us down. 

Falling down is one of the most universal images for a decline in well being.  Humpty-Dumpty had a great fall, as the fairy tale proclaims, and all the king’s men couldn’t put him back together again.  Sickness often befalls us like an unexpected body blow.  We live our lives in an upright position that takes us outward and forward into the world.  Yet, as Richard Zaner pointed out, to walk or run is little more than an arrested fall.5  Even in the vigor of health there is a premonition that we could fall down.  To be bedridden and unable to rise is a humiliating experience, a betrayal of the tacit contract with reality that impels us to keep on living for as long as we possibly can. 

The desperation of illness is not a permanent state.  In his analysis of despair, I don’t think Kierkegaard went far enough.  Life is resilient, and so is the mind.  Depressions rarely last forever.  The body’s immune system fights off pathogens, seeking a way back to health.  The symbolism of sickness is part of a much larger dialectic that includes the symbolism of healing.  Symbols of descent or falling never stand alone; they are paired with symbols of rising.  When we stumble, we right ourselves so that we can continue on our way.  When we fall down, we get up again.  Like life itself, the mind is driven to succeed.  Not only do symbols give rise to thought, they also give rise to feelings of hope and equanimity.  Symbols grant us safe passage through dangerous terrain. 

Grave illnesses often end in death.  Life has had billions of years of practice in the art of dying.  It seems likely that the genetic heritage of every organism retains some of that experience about how and when to let go of life.  In the grip of a lion’s mortal bite, the wildebeest stops resisting.  It’s as if it knows instinctively when to give up.  Certainly, not all human symbols of death are of the heart wrenching variety.  Some evoke the restful bliss of sleep after a long life well lived.  We tend to celebrate the lives of the elderly when they have died of natural causes.  Symbols of tragic loss usually are reserved for those who have been taken unexpectedly, or far too soon in life.  Every culture generates a whole range of symbols that parse the acceptability of dying.  In modern societies, the loss of a child is the most unacceptable and tragic death because children are innocent and full of promise.  The future belongs to them.  In the Stone Age, on the other hand, the death of a healthy adult was more tragic because adults were skilled in the necessary arts of group survival.  The loss of even one adult in a small band of hunter-gatherers could have tragic consequences for the entire band. 

Grief is a unique symbol because it is capable of performing double duty.  It is most often associated with death and dying.  When a loved one passes, we go through a period of grieving that enables us to accept the shock of our loss and gradually return to normal.  This same coping process has been applied to every kind of loss, including jobs, marriages, dreams, health, etc.  Elisabeth Kubler-Ross famously identified five stages of grief that terminally ill patients experience concerning their pending mortality: denial, anger, bargaining, depression, and, finally, acceptance.6  Further psychological research hasn’t supported a step-by-step grieving process.  However, there is strong evidence for a natural psychological resiliency in the face of loss.  I think it is the symbolic structure of the mind that inclines us to favor optimism over despair.  Every organism is imbued with the grit to live for as long as it possibly can.  Consciousness is no different.  We live on the basis of symbolic contracts—medical prescriptions of consciousness—that smooth out the road ahead.  

In its constitutional buoyancy, grief marks the turning point from sickness to healing.  That is its unique role in the paired symbolisms of sickness and healing.  Whereas sickness entails the undoing of symbolic meaning, grief is the negation of that undoing.  When we fall down, we rise again.  Grief symbolizes the resolve of that new arising.  In our sorrow, we discover the will to live once again.  That is grief in a nutshell.  The end of despair is the beginning of grief.  Healing follows upon the heels of a grief endured.  We don’t fall down with the intention of never getting back up again.  Even when stricken with chronic illness, we search for new ways to be at least partially well again.  No symbol worth its salt stops at the point of undoing the mind’s ability to overcome the difficulties of life.  It is true that the symbolism of sickness takes us on a downward trajectory.  But that is only half of the story.  When we hit bottom, we instinctively turn toward the light of healing.  Birth is the only real antidote to death, and the rebirth of vitality the only sure remedy for sickness.       

Symbols of sickness tend to revolve around graphical displays of the body.  An image of sorrow etched on a ceremonial mask conveys the message well enough, as does a person writhing on the ground.  Bending over to vomit is a universal sign of sickness; so is the careful placement of one’s hands on a painful region of anatomy.  The onomatopoeic sounds of sickness are especially graphic and emotive—groaning, retching, coughing, wheezing, etc.  Symbols of sickness are readily apparent to most observers, perhaps reminiscent of the six universal facial emotions that a famous cross-cultural study identified.7  Even the preliterate Fore of New Guinea were able to recognize facial expressions of fear, anger, happiness, sadness, disgust, and surprise.  Long before our ancestors learned to speak, they communicated with the mimetic language of the body.  Symbols of sickness are frequently associated with that more ancient language.  Even modern doctors ask their patients to show them where it hurts.  It doesn’t take a lot of imagination to represent the undoing of symbolic meaning, which is probably why symbols of sickness are so readily understood. 

It’s a different story with shamanistic symbols of healing.  They tended to be more dreamlike, imaginative, culturally distinctive, and metaphoric.  Their purpose was to restore the world to its original harmonious state.  It was through their healing séances that shamans expanded the role of imagination in the human psyche.  They underwent dangerous journeys through time that required the guidance of both animal and human spirits.  Their repeated efforts to recover lost souls enhanced and stabilized the mind’s ability to remember the past and anticipate the future.  Shamans were conjurers and storytellers who used drums and animal cries to spark the imagination and reset the rhythms of the brain.  If sickness is something that befalls us, healing is something that we must seek out and cultivate.  The calling of a shaman often involved strange dreams of disembodiment and rebirth.  Symbolisms of healing are filled with obscure references, images, hallucinations, etc., that require arcane interpretive skills to understand.  Their meaning is rarely self-evident.  The healing arts have always called for the assistance of knowledgeable seers capable of discerning the hidden secrets of both body and soul.

Normally, symbolic healing is associated with the creation of new meaning.  How exactly do symbols create new meaning?  Paul Ricoeur’s definition of a metaphor is instructive.8  He said that a metaphor is a semantic impertinence.  Take love is a rose, for example.  Love is not literally a rose, but when I see how love is like a rose—both beautiful and thorny at the same time—suddenly I have a new perspective on love.  New meaning is created in the metaphoric process of using an impertinent juxtaposition (love = rose) to trigger a leap in understanding.  This ability to stitch together opposing concepts in a construction that conveys new meaning is a characteristic of many symbols, healing symbols in particular.  Grief is the perfect example.  It resolves many of the most unsettling paradoxes of existence, including the agonizing disparity between life and death, sickness and healing, despair and hope, etc.  To find a new pathway between suffering and wellness is what healing entails.  Symbols of healing actually participate in the reality to which they point.9  Out of the misery of sickness comes the marvel of recovery.  How is such a rebirth possible?  The body is often capable of healing itself, of course.  But the mind is also capable of kindling the process of healing through the imaginative work of symbols.  It’s what symbols do.  Shamans—the first doctors—learned to harness that power.  It is often referred to as the placebo effect, but I don’t think that does justice to the achievements of symbolic healing. 

Our ancestors were inventing metaphors and symbols long before the invention of language.  In fact, the ability to think symbolically is probably what triggered the use of words to begin with.  Words are not things, but somehow we knew that they could be used to represent them.  I think one of the earliest and most significant symbols ever conceived was the notion that death is an illusion.  It became one of the pillars of animism, the worldview that enabled early humans to inch toward the full measure of conscious thought that we take for granted today.  Another very ancient symbolism of healing pertained to birds and their feathers.  Shamans wore special garments that often had bird-like wings attached to them.  Angels probably represent a later iteration of bird symbolism that switched the original bird totem for a person.  An insatiable desire to fly like a bird—to see far and wide—was a hallmark of the Stone Age.  Experimental flights of imagination might never have been undertaken without birds to imitate.  Perhaps we owe the extensiveness of our own mental prowess to the lowly envy of birds.  To be able to rise up into the sky and escape the earth-bound fate of illness and death is a quintessential symbol of healing. 

The bird feather also served as a symbol of impurity in the healing arts of the Stone Age.  A common trick of shamanistic performance was to pretend to suck the sickness out of a patient’s body.  Afterwards, the shaman would pull a hidden feather from his mouth to show the audience what had been causing the ailment.  This sort of farce was highly offensive to the earliest generation of mostly Christian anthropologists who witnessed it.  Yet the impertinence of such a “bait-and-switch” tactic bears a passing resemblance to the metaphoric process of creating new meaning.  To produce something that represents the illness in a new light really could trigger a sense of relief. 

There were other aspects of birds that galvanized them to human fate as well.  In many Native American cultures, for instance, birds were linked with humans because they both walked on two legs.  Most animals don’t.  Two-legged creatures are like blood relatives in their biological classification systems.  Their dance costumes favored feather headdresses because dancing was a way for them to transcend themselves and become spiritually connected to their bird relatives.  It was a ritual that involved much more than play-acting.  A good symbol, like a good metaphor or ritual, can serve as the impetus for a superabundance of new possibilities.  Healing is like that too. 

Michel Foucault traced the birth of modern clinical medicine to a shift in how physicians viewed death and disease in the span of a few decades at the end of the 18th century.10 That same shift corresponds to what I have been referring to as the great reversal in time-consciousness.  Prior to the modern world, the past was the dominant temporal horizon of our dreams and imagination.  We looked to myths of our own origins for guidance on how to live well and be happy.  Memory is naturally biased toward remembering the past; what could be more obvious than that?  Even anticipation of the future is based upon an intuition for how events in the recent past will play themselves out.  Humans have always looked back in time to figure out how to go forward in it.  Only in recent centuries have we managed to sweep aside our preoccupation with the mythic past.  For tens of thousands of years, our ancestors had been steadily building up a repertoire of external memory devices that eventually enabled them to escape from the limitations of human memory alone.  The tipping point was reached when we became free to focus our minds upon complex plans and theories that could actually build a future that eschewed the limitations of the past.  That shift represents the distinctive mindset of modern science.  According to Foucault, it was medicine that banished the myth of an eternal origin from our experience.  Medicine, in his view, was the forerunner of Romantic individualism and scientific materialism. 

Prior to the birth of modern clinical medicine, death and disease were still partially linked to mythic tales of cosmic origins.  Death was ultimately insignificant in that context because of the prospect of everlasting life.  It was the practice of pathology that changed everything according to Foucault.  From a pathologist’s point of view, death is the most significant event in a person’s life.  It’s not a way station on the journey back to eternity.  A pathologist reads the corpse as a palimpsest of the diseases that led to its final condition.  To an animist, life was the lens through which death acquired its meaning.  The medical gaze of the modern clinician reversed that order of significance, making death the lens through which life acquired its meaning.  This new medical perspective had tremendous consequences.  For one thing, every patient’s life could be summarized in a pathologist’s report.  The role of disease as a sign of poor health became of ultimate concern to the physician whose job now was to stave off premature death.  Since no two people ever suffer the same medical circumstances that lead up to mortality, the modern physician was compelled to treat each person as a unique individual. 

By assuming that death was just a temporary interruption in the continuation of life, the prospect of dying eventually became of little personal consequence to animists and their religious heirs.  By making pathology the starting point to their medical perspective, modern clinicians paved the way for a new belief in the precious uniqueness of each person’s life.  I think that reversal in the valuation of our mortality is one of the great ironies of history.    

Many symbols of healing in modern medicine tend to revolve around technologies that enhance the sense of sight.  That is why Foucault wrote at length about the medical gaze.  It wasn’t just a matter of looking at the patient’s body, but of penetrating it to see what was happening beneath the surface.  When visiting the clinic for a checkup, we acquiesce to a battery of probes and tests that allow the physician to see how well our internal systems are functioning.  Blood is drawn, urine collected, vital signs read, orifices probed, organs osculated, brain waves graphed, bones x-rayed, and so on practically to infinity.  The medical gaze is as powerful and intimidating as it is penetrating.  The growing edifice of medical know how that is enshrined in hospitals that dwarf most colleges is both reassuring and frightening at the same time.  To be a patient in one of these sprawling temples of health is similar to what Rudolf Otto described as a terrifying encounter with the Holy.11  Wouldn’t that just about cover what it’s like to endure a colonoscopy?  I recall an elderly doctor who asked for my permission before conducting a digital prostate exam.  “Do you mind if I violate you?” he said in a pleasingly gentle voice.  I was so surprised by the humility of his bedside manner that I smiled through the whole sorry business.      

I think hope is the signature symbol of modern medicine because it is a mood that is purely concerned about the future.  To look forward in time with such passionate desire is a uniquely modern sensibility.  Fidelity to the past is not exactly a modern forte.  We grieve deeply for a life that is taken too soon, and we idolize those among us who survive arduous healing regimens in the fight against horrific diseases.  We declare war on cancers and other deadly scourges that limit our chances for a long and healthy life.  For us, death is acceptable only as a limit to our longevity.  We dream of pushing the average life span out a half century further.  Life is so precious to us in part because of the materialist worldview that regards any alternatives as suspect.  There is only this life, and scientific medicine is our only hope for making it a healthy and rewarding experience.  Some version of that conviction, I suspect, frequents the minds even of the most ardent believers in an afterlife.  To ensure that each one of us gets a fair chance to be healthy is the dream and tacit promise of modern medicine.  It is a utopian dream, to be sure, but also tenacious and everlastingly hopeful. 

Nothing makes us more gullible than our own enthusiasms.  That is the dark side of hope that every con artist knows how to exploit.  Many observers have noted that an entrepreneurial spirit has infiltrated the medical research industry at least since the passage of the Bayh-Dole Act of 1980.12 That law ended the practice of federal ownership for all intellectual property stemming from research funded by the NIH and other government agencies.  As a result, universities set up their own intellectual property offices and technology incubator centers, which commercialized the pursuit of scientific knowledge.  Like venture capitalists, entrepreneurs want to get rich, which means they want to see substantial returns on their investments.  This added economic pressure incentivizes researchers to exaggerate the potential for new therapies, cures, and other marketable applications of their research.  It also encourages them to report only results that can be given a positive spin.  Eventually, that could have an unintended cumulative effect on large databases such as Medline that are the source for the literature reviews prized by practitioners of evidence-based medicine.  Hyperbole is part of the landscape of medicine now, as is the rush to market with anything that might save lives, advance careers, secure funding, beat the competition, and so forth.  Too much hope, or hope that is not carefully vetted, is a sure path to trouble.

There are still pockets within the broad landscape of modern medicine where the ancestral arts of symbolic healing continue to flourish.  Psychotherapy is perhaps the most obvious one.  Claude Levi-Strauss famously compared shamanism to psychoanalysis.13 “Illness and disease are not merely physiological phenomena,” he said (p. 318).  The physiological reality of illness can be manipulated by cultural symbols.  To demonstrate it, Levi-Strauss analyzed a mythic song used by Cuna Indians to facilitate a difficult childbirth.  The song relates to the shaman’s efforts to find the lost soul of the woman, who no longer has the will or strength to give birth.  The song coaches her to relive the painful experience of childbirth one last time with the promise of a different outcome.  It is a purely psychological treatment that pushes her past the pains and inhibitions that had stymied her body up until then.  Symbols affect the mind, which in turn affects the body.  That’s the gist of symbolic healing according to Levi-Strauss.  Many have argued that one of the drawbacks of modern medicine is that it uncoupled the body from the mind, thereby reducing disease to physiological processes alone. 

Following up on Levi-Strauss’s insights, James Dow argued that symbolic healing has a universal structure that maps emotions to mythical symbols that can then be manipulated to effect a healing catharsis in the body.14  He thinks that this symbolic transaction of emotions is part of every healing experience, whether it is acknowledged or not.  The underlying emotional communication system of the body is still at work in the symbolic communication system of the self-conscious mind.  That’s why symbols—the mind’s very own medicine—can affect the body.  Like feelings, they express the emotional value of our experiences.  Feelings are mental constructs (symbolic processes) that give meaning to our emotions; or, as Antonio Damasio claimed, consciousness is the feeling of a feeling.                

The hegemony of scientific medicine has not stamped out other healing traditions that often align with shamanistic practices and symbolic healing.  In fact, studies suggest that a vast majority of Americans avail themselves of various complementary and alternative medicine (CAM) products and services, including herbal supplements, homeopathy, meditation, prayer, acupuncture, massage, hydrotherapy, fasting, spirit quests, etc.  Medical pluralism is especially poignant on Native American reservations, which are marginalized borderlands in a larger society that excludes them.  The Navajo reservation in the four corners region of the desert Southwest is by far the largest and most populous reservation in the country.  Amongst the Navajo, there are four different healing/spiritual traditions that are variously integrated into everyday life, including traditional Navajo spirituality, Christianity, western medicine, and the Native American Church.  

Navajo life is a hybridized experience where families are forced to pick and choose their own ways of dealing with sickness and distress.  No matter what path they take, however, it usually includes a sense of belonging to the sacred land that is at the heart of Navajo spirituality.  Navajo healing is all about establishing proper relationships with family, which includes much more that just human relatives.  The Navajo have kinship ties to the sacred mountains of their homeland, and everything that lives there, including the Holy People who created it.  To maintain harmony with their world of kinships—to walk in beauty—is the purpose of life for the Navajo.  The most distressing condition imaginable is to have no relatives.  That disconnection from what matters most is the root cause of sickness.  The Navajo shaman is a haatali, or singer, whose ceremonial songs bring the patient back into harmony with the greater community.  The smoothing out of mental discord is precisely what healing symbols and ceremonies are designed to do.             

In one poignant case, a young Navajo woman who was raised Catholic on the reservation took holy orders and became a nun. 15 Unfortunately, her calling took “Sister Grace” far away from the sacred mountains of her people.  Leaving the reservation was a traumatic experience, and she gradually became seriously ill.  Finally, Sister Grace was allowed to return to the reservation where she participated in numerous Navajo healing ceremonies.  The diverse symbols and traditions of her hybridized upbringing restored her sense of harmony, and her health along with it.         

When we are stricken by illness, it diminishes us, even blocking out the future.  The symbols of sickness are disheartening as a result.  They portray the undoing of our lives, not its celebration.  Suffering is a universal symbol of sickness.  It turns us away from the world, isolating us in our own misery and pain.  I think Heidegger was right when he said that caring is the meaning of our being in the world.  We pay attention to the things that we care about.  To be deprived of care—to be completely indifferent to life—would be like losing the will to live.  It is one of the hazards of sickness.  The only thing that matters is the black hole of our suffering.  Healing, on the other hand, is a form of love, like the caring touch of a mother when her child is unwell.  Suffering is to sickness what caring is to healing.  Medicine begins as a caring gesture for those who can no longer care for themselves.  Abounding with excess meaning and possibility, healing symbols are capable of putting the world back together again.  If we didn’t care deeply about those who suffer, we certainly wouldn’t build hospitals that rival the most spectacular monuments of any civilization.  Caring is the antidote to despair.  It is a social experience that takes us out of ourselves and into the world.  It is the feeling of a feeling that is transferable from person to person.    

I remember visiting my maternal grandfather in the hospital the day before he died from heart failure.  He pulled the sheet aside and pointed at his ankles, which were swollen with fluids that his heart could no longer circulate.  “Look what’s happening to me,” he said.  Then he made me promise to spend the night with my grandmother so that she wouldn’t be alone.  I’ve often wondered about that precious last visit with my grandfather.  He was dismayed about his own death, to be sure, but he was much more concerned about my grandmother’s well being.  In the end, I think we care about our loved ones more than we care about ourselves, and that is why we fight against death and grieve our losses so dearly.  We don’t want them to be left alone in the world, or vice versa.   

A recent movie reminded me of my grandfather’s passing.16 It was about a man whose plane crashed in the Arctic.  He went about the business of trying to survive until help would arrive.  The body of the plane served as a makeshift shelter, and he created a system of fishing holes in the ice so that he could feed himself.  He also set up a short wave radio transmitter on a nearby hill that he could power with a hand pump.  In short, his life boiled down to an efficient system of minimal survival.  Then one day a helicopter flew overhead.  Before it could land, it was upended by a strong gust of wind.  Only the copilot of the helicopter survived, though she was unconscious and seriously injured.  The man created a makeshift sled so that he could drag her back to his downed airplane.  He did everything he could to nurse her back to health.  Then he made a fateful decision to leave his camp so that he could get her to an outpost where she could receive medical care.  It was a dangerous undertaking, but he did it without hesitation.  Until this injured pilot who needed his assistance came into his life, he was merely surviving.  Suddenly, his life was full of meaning and purpose again.  He sacrificed himself for her, willingly and eagerly.     

When we care for someone else, it gives our own life a meaning that cannot be surpassed.  To care for those in need is self-authenticating; it’s the reason for our being.  That’s why medicine itself is such a powerful symbol of the human predicament.  It makes the world go round. 

The mind is symbolic by nature.  It represents who we are.  Feelings are the first symbols of our experience.  By representing something else, a symbol creates new meaning.  Like metaphors, symbols are impertinent gestures of the mind; they are feelings that have the special role of taking us beyond ourselves.  That’s what thinking does as well.  It enables us to transcend our own minds.  To reach beyond ourselves mentally is a symbolic act.  In order to keep on living, every organism must live outward and forward into the world where it finds sustenance.  The mind recapitulates that brave endeavor.  Consciousness is the symbolic metabolism of a life that has achieved self-awareness.



  1. Antonio Damasio, The Feeling of What Happens: Body and Emotion in the Making of Consciousness (Houghton Mifflin Harcourt, 1999). 
  2. Aristotle, Nichomachean Ethics (Liberal Arts Press, 1962). 
  3. Paul Ricoeur, The Symbolism of Evil (Beacon Press, 1969). 
  4. Soren Kierkegaard, The Sickness Unto Death (Princeton University, 1980). 
  5. Richard Zaner, The Context of Self: A Phenomenological Inquiry Using Medicine as a Clue (Ohio University, 1981).
  6. Elisabeth Kubler-Ross, On Death and Dying (Simon and Schuster, 1969). 
  7. Paul Ekman and Wallace Friesen, “Constants Across Cultures in the Face and Emotion,” Journal of Personality and Social Psychology 17, no. 2 (1971), 124-29.
  8. Paul Ricoeur, The Rule of Metaphor: Multi-Disciplinary Studies of the Creation of Meaining in Language (University of Toronto, 1977). 
  9. Paul Tillich, Dynamics of Faith (Harper and Row, 1957). 
  10. Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception (Vintage Books, 1994).
  11. Rudolf Otto, The Idea of the Holy: An Inquiry into the Non-rational Factor in the Idea of the Divine and it’s Relation to the Rational (Oxford University, 1950). 
  12. Nikolas Rose and Joelle Abi-Rached, Neuro: The New Brain Sciences and the Management of the Mind (Princeton, 2013). 
  13. Claude Levi-Strauss, “The Effectiveness of Symbols,” Reader in Comparative Religion (Harper and Row, 1979). 
  14. James Dow, “Universal Aspects of Symbolic Healing: A Theoretical Synthesis,” American Anthropologist, New Series, 88, no. 1 (March 1986), 56-69.
  15. David Begay and Nancy Maryboy, “The Whole Universe is My Cathedral: A Contemporary Navajo Spiritual Synthesis,” Medical Anthropology Quarterly 14 (December 2000), 498-520.
  16. Joe Penna, Arctic (Armory Films, 2018).

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