Triage and Tyranny

1855. You are sitting outside a large medical tent in the freezing winter on the shores of the Black Sea. Future generations will know this is the Crimean War. To you, a young woman from a sheltered background with scant medical training, it is Hell.
Here they come.
The tent behind you is partitioned in three. To the right, the wounded soldiers likely to survive without medical intervention; in the centre, those likely to die without medical intervention; to the left, those likely to die; outside, those already dead. There are three exits from the tent. The word ‘likely’ does not mean very much, but it’s the best that can be done in the circumstances.
As the first one approaches, stretcher supported by brothers in arms, you know that your split-second decision for right or left or centre (or outside) is likely to save some lives and to end others. If you do nothing, many more will die. If you try to save them all, many more will die.
You steel yourself, thrust down your feelings, and begin the first, rapid, assessment.
This scene is an imaginary illustration of very real events that have been taking place just behind the front line in many wars for many years. A complicating factor, and there are many, is that there are only so many doctors and there’s only so much time. So only those most likely to survive will receive treatment. Any time wasted on those to the right or left means more of those in the centre will die – as some will anyway. This necessary categorisation, in these circumstances, is not only life-saving; it is almost certainly a sentence of death. Someone has to do it.
As morality deals with good and evil; ethics deals with right and wrong. Their relationship is complex. The kind of ethical decision-making employed by the young woman in the illustration is today called ‘utilitarian’ – meaning that such decisions are based on their utility, i.e. the good that may come out of them. Several modern philosophers are associated with utilitariansim but the foremost champion of a single ethical imperative outweighing all others is the Enlightenment philosopher Immanuel Kant.
Kantian ethics, deriving ultimately from Plato’s Socrates (via a misreading of Aristotle) had great influence in Nazi Germany and, as I show in my thesis, continues to have great influence in the United States of America.
What a horrible thing to say! How can I compare a courageous young woman doing her best to save lives against all odds in hellish circumstances, with Hitler and then with the Land of the Free?
Firstly, as the classicist Prof. Martha Nussbaum shows, Kantian ethics are an attempt to avoid the tragic conflict of opposing ethical imperatives. In other words, the young women sitting outside the tent in the Crimean War avails herself of the clarity of these ethics so that no matter the particularities of each wounded soldier (the one whose blue eyes remind her of her brother, the one who pleads for life because of his pregnant wife, the one who has high rank in the Army) she is able to make a decision based solely on the greater good: saving as many lives as possible.
I cannot fault the exercise of Kantian ethics in those circumstances. Grave problems arise, however, when frontline decision-making becomes the basis of ethical conduct in times of peace.
Kantian ethics rely on the total removal of all other ethical considerations opposing the main imperative. A key part of this process (as modern philosopher Dr Mary Midgley shows) is the reduction of particular people and particular circumstances into universal categories. (Also reduction happens, as I show in this book, by use of language.) So, for example, sandy-haired Private Benjamin Jones, 33, a nonconformist lay preacher and amateur boxer, married and faithful to pretty brunette Nelly Jones neé MacDonald, although in love with his lieutenant, who has three kids (the youngest coincidentally resembling the postman), doting parents, a dog and likes fishing, becomes ‘suppurating wound in the thigh’ and is sent to the left (to die).
The reason why frontline ethics are a problem in peacetime is that the only thing that recommends them is their simplicity. I’m not for a moment saying that triage is simple but Kantian ethics are designed to respond only to the greatest ethical imperative and ignore all the others. As Prof. Nussbaum shows, this is the reverse of Aristotle’s teaching that it is the particulars of each person and circumstance that most surely guide us towards a wise ethical response. Not simple, wise.
This kind of sensitivity to particular ethical situations is recommended by moral philosophers such as Rev. Charles Curran, the American theologian who was in frequent conflict with Pope John Paul II. What concerns me is that it is a sensitivity increasingly under threat as more and more organisations worldwide are affected by American corporate values.
Charitable organisations are especially vulnerable as they often flounder in terms of effectiveness, communication and organisation so a hard-headed person unafraid to make tough decisions may seem like a godsend. The catch is that such decision-making may indeed be tough, for anyone with much humanity, but for those hardly burdened by conscience it is quite simple: set goals, clear obstacles, forward march!
Further complications arise because charitable organisations are full of people who feel it is uncharitable not to think the best of others. So if a candidate for a powerful position shows psychopathic tendencies, these may be interpreted as ‘focussed’ or ‘business-minded’. Freud’s rather innocent example of such tendencies (a girl who likes a boy she met at a funeral hoping for another funeral to maybe meet him again) shows that they are not just shared by the criminally insane. In fact, a recent survey of top companies found that a fifth of CEOs shared these tendencies.
It’s a commonplace in the more smug varieties of chicklit and womens’ magazines to poke fun at males (never men) making up the majority of those on the autistic spectrum; on the other end of the same spectrum psychologists are concerned that women (never females) who make up the majority of those on the psychotic spectrum are not receiving support as the condition is so badly publicised.
Adding all this together with the everyday sexism that still abounds and the trend in the third sector is for organisations to be run by someone high on the psychopathic scale, with immediate subordinates (or support from Head Office) of men who find it easier to stick rigidly to rules than interact with changing human situations (as emotional particularities are so overwhelmingly complex to interpret) and with women in the majority of grassroots workers and many of them self-sacrificing and painfully sensitive to the opinions of others.
On top of all this may be the hothouse effect that occurs when communities are cloistered canonically, isolated geographically or otherwise shrouded in secrecy due to the vulnerability/ naivety of their client group or the difficulty in getting staff. An insistence on ‘professionalism’ may mean that dissenting/ abused employees and volunteers are prevented from expressing anything other than the party line – as the psychopathic boss controls formal communication and informal communication is condemned as ‘gossip’ unworthy of good people, scandalous to the public/ clients and contrary to the exemplary values of the school/ church/ home/ charity/ community. The hallmark of the psychopath is the inability to recognise or feel any remorse for the harm they have done to people, so they move effortlessly from sadistic treatment of an individual to community schmaltz with a beaming face of innocence.
There is much wisdom in the co-dependency awareness movement but what it may fail to grasp is that everyone involved may sincerely believe that they are doing the right thing:
– Laying down the law
– Sticking to procedures
– Self-sacrificing and keeping silent
As we watch in awe the debacle of American democracy, it may help to realise that the unprecedented administration is a symptom, not a cause, of frontline ethics applied in peacetime.
The reduction of complex situations to simple categories of right and wrong, the dehumanising of people, the control of the people by force and censorship of the free speech, these are the hallmarks of military crisis and in such times the Ancient Romans accorded special dictatorial powers to a designated senator (usually a consul). The Ancient Greeks called this person a Tyrant.


Thanks to Linnaea Mallette who has released her photo ‘Funny Hospital Sign’ into the public domain.


How to keep your head when someone around you is losing theirs and blaming it on you

This post is inspired by a friend who asked me how to deal with another who is currently experiencing addiction to alcohol. Although my suggestions focus specifically on that situation, they may be valuable in others. Firstly, please note that my suggestions are neither for coping with (i.e. denying, ignoring or blotting out) the addictive behaviour nor for fixing the person who is addicted. They are for people who find themselves having to be around or having to deal with people experiencing addiction. By ‘deal with’ I mean involved in some kind of voluntary interaction that has nothing to do with the substance or process to which this person is addicted. If the interaction is not voluntary, on both parts, my best suggestion is to leave the vicinity (whether in physical or virtual space) immediately. All that ground-clearing done, let’s proceed.

My life-coaching is based on my doctoral thesis, a reading of the work of Dr M. Pirsig, and I see alchemy as harmonious amelioration (improvement) on all levels of well-being. Let’s take them one by one (I use my own nomenclature and also suggest there may be a level superior to the intellectual, which Pirsig does not).

PHYSICAL SURROUNDINGS – depending on the way alcohol affects the body, a person experiencing addiction to alcohol may cause disruption in your home/ car/ office/ school/ church/ in a shop or a café/ on public transport. Some of this disruption may be in the form of misplacement of objects, breakages or theft; some may lead to situations raising concerns regarding health and safety.

Reading the fictional exploits (now televised) of a vicar in the Church of England I was struck by the lack of ability or willingness to physically limit the marauding of various drunken people who continually staked their claims to the personal space of ‘the Rev.’ and to the sacred space of the church. And then set about destroying it. This kind of abuse of friendship/ professional courtesy is unacceptable and any kind of thinking that justifies it, supposedly based on compassion, is only contributing to the deprivation of agency of the person experiencing addiction. In other words, holding such people responsible for their actions and physically preventing them carrying out acts of destruction is an acknowledgement of their continuing human dignity – no matter how that dignity has been degraded by their addiction.

So sometimes you might find yourself refusing to allow someone entry into a property which is yours or for which you are responsible; or refusing to enter a public building with this person. You may find yourself suggesting a meeting in a park and blandly stating, “I’m asking you to meet me there because I have concerns about the damage to property you may cause elsewhere”.

HEALTH – Focus on your own body, not that of the person experiencing addiction. If you are well fed and watered, warm or cool enough, suitably clothed and rested, if you have easy access to toilet facilities and also are assured of freedom from bodily harm from this person, then you have a better chance of feeling grounded enough to deal with them. If you are close to this person emotionally, check out your physical safety with someone who is not. You may not be the best judge of that. Ensure that you also have the means to swiftly and effectively leave the vicinity of this person, should the need arise.

SOCIAL RELATIONSHIPS – As you may responsibly limit access to physical spaces, so you may limit access to family, friends, partners, dependents, colleagues and acquaintances. I know of cases where young children, while suffering no physical harm or being in danger of such, have been traumatised by being around drunken adults whom their parents have allowed into the family home (e.g. to sober up) in mistaken acts of kindness. You may have taken all necessary precautions to remain grounded when someone is attempting to bend you out of shape but that doesn’t mean that anyone else you happen to know or bump into is similarly prepared. You don’t have the right to inflict potentially abusive people onto others without warning and preparation.

Both for HEALTH and for SOCIAL RELATIONSHIPS, you may decide that a limitation of time is helpful. Being around people experiencing addictions can be physically and emotionally draining. If, for example, you need to get a joint project done with such a person, then realise that it may be more prudent to divide the task into lots of mini-projects to be done in a few hours rather than a major one with a due date a few weeks hence. Think how many extended refreshment breaks may interfere with a vague schedule! Paying in advance is probably not a good idea whereas prompt payment for each small job done (or an agreed credit system which factors in quality and promptness of completion) may be useful.

Yau Chui Wah (2009) ‘Enhancing Self-Efficacy in a Strengths Perspective’ [in Ethan J. Kerr & Owen E. Gibson (Eds) Substance Abuse: New Research, New York: Nova Science, pp. 155-169] underlines the efficacy on the road to sobriety of valuing any success that people experiencing addiction have. So breaking off all social contact may not be the most helpful thing to do. Herbert Fingarette (1988) Heavy Drinking: The Myth of Alcoholism as a Disease [Berkeley, California: University of California] finds that labelling people as ‘addicts’ or ‘alcoholics’ firstly ignores the spectrum of addictive behaviour, which we all move along, and secondly reduces the agency of people experiencing addiction by seeing them only as chemical or biological complexes.

The dignity of the human being includes INTELLECTUAL GOALS and it is not unknown for very intelligent people to experience addiction. Patronising such people can only be counter-effective. They may in fact be capable and willing to read about their condition, once they pass through the stage of denial. However, the best way to keep grounded when dealing with someone experiencing addiction is not to suggest ways for them to effect their cure but rather to treat them with the human dignity which their behaviour endangers. This includes respect for their intellectual ability, which may be otherwise unimpaired. Sadly, it may not. Alcohol does destroy brain cells and even when the intellect seems to be functioning normally, there may be wildly impractical schemes or pervasive paranoia. So is advisable to exercise prudence regarding the intellectual components of any joint project.

Finally, like all human beings, this person searches for meaning. This may involve SPIRITUAL OR PHILOSOPHICAL VALUES. The addictive behaviour may be an unhelpful part of the search. Just because ecological tribes have retained the wisdom to embark on shamanistic journeys aided by herbal hallucinogenics, it does not follow that post-industrial culture can cope with these drugs. And yet the search itself is valid. Part of the frenzy of drinking may be a rejection of the emptiness of materialistic consumer culture and of the roles it requires that we play. That emptiness may not be filled simply by frequent attendance of church services or yoga classes. There may be deep questions about the life of a person experiencing addiction that are being avoided.

None of this is your concern. Everyone searches for meaning somehow. Not all of us destroy ourselves and others in the process. These suggestions may help you to understand someone in this situation. But mostly they are to suggest how to keep your head when someone around you is losing theirs and blaming it on you.

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