EP. 119: A PHILOSOPHY OF GRIEF

Jul 2

WITH MIKOŁAJ SŁAWKOWSKY-RODE, PHD

A philosopher discusses the nature of grief and mourning and shares how grief helps us better understand our identities, values, relationships, and responsibilities to other people — both living and deceased.

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Episode Summary

Death and grief are much more “hidden” from society today than they once were. The medicalization of dying means that death now occurs more frequently in hospitals and care facilities than at homes. The secularization of society means that traditional religious or communal rituals surrounding death and mourning have diminished. The fast pace and optimistic lens of consumer culture means less contemplation of aging, mortality, and grief.

But Mikołaj Sławkowski-Rode, PhD, a professor of philosophy at the University of Warsaw and research fellow at Oxford University, argues that experiences of mourning and grief are crucial to the human condition. They allow us to foster empathy and connect with others’ suffering. They encourage us to reflect on how we value life, relationships, and the responsibilities we have towards others, both living and deceased. They revitalize communal rituals and practices, creating a sense of shared humanity.

Professor Sławkowski-Rode has written widely on the philosophical and ethical dimensions of mourning, grief, and memory, and his works have appeared in The New York Times as well as various academic publications. Over the course of our conversation, we discuss the nature of grief as a multifaceted emotional response, extending beyond a psychological state and reaching into existential realms; the role of memory in the grieving process; why love and grief are fundamentally inseparable; how the atomization of modern society affects our ability to mourn; and more.

Mikołaj Sławkowski-Rode, PhD is Assistant Professor in the Department for Philosophy of Culture in the Faculty of Philosophy, University of Warsaw as well as a Research Fellow and tutor in Philosophy at Blackfriars Hall, University of Oxford. Since 2018 he has been a visiting lecturer at the School of Humanities and Social Sciences at The University of Buckingham and teaches on their MA course in Philosophy. Professor Sławkowski-Rode is also a founding member and organizer of the Humane Philosophy Project; he is a Fellow of the Dalai Lama Centre for Compassion, Oxford; and, he has, since February 2018, been working on the John Templeton Foundation project Science, Theology and Humane Philosophy: Central and Eastern European Perspectives.
In this episode, you will hear about:
• 3:20 - The focus of Sławkowski-Rode’s current work and what his day looks like as a philosopher
• 8:10 - The value of philosophy in society
• 12:42 - How Sławkowski-Rode became inspired to study grief
• 14:57 - Why grief has become more “hidden” in society over the past century
• 23:49 - How the “cult of individuality” leads our society to ignore aging and death
• 33:45 - How Sławkowski-Rode defines “human flourishing”
• 36:31 - How the atomization of modern society affects our ability to mourn
• 50:00 - Practical advices for clinicians on how to navigate grief and mourning for themselves and their patients
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and healthcare executives those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine, we will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:02] Though it may not be obvious at first, death, dying, and grief are much more hidden from modern society than they once were. The medicalization of dying means that death today occurs far more frequently in hospitals and care facilities than at homes. The secularization of society means that traditional religious or communal rituals surrounding death and mourning have diminished. The fast pace and optimistic lens of modern consumer culture means less contemplation of aging, mortality, and grief. But Mikolaj Slavkovski Roda, a professor of philosophy at the University of Warsaw and research fellow at Oxford University, argues that the experience of mourning and meditations on grief and loss are crucial to the human condition. They allow us to foster empathy and connect with others suffering. They encourage us to reflect on how we value life, relationships, and the responsibilities we have towards others, both living and deceased. They revitalize communal rituals and practices, creating a sense of shared humanity. Ultimately, they lead to personal development as we better appreciate our own emotions, priorities and life purpose in the face of a finite existence. Professor Slavkovski Roda has written widely on the philosophical and ethical dimensions of mourning, grief, and memory, and his works have appeared in The New York Times as well as various academic publications. Over the course of our conversation, we discussed the nature of grief as a multifaceted emotional response, extending beyond a psychological state and reaching into existential realms the role of memory in the grieving process, why love and grief are fundamentally inseparable. Why it's okay to never get over grief. How the atomization of modern society affects our ability to mourn, and more. Professor Slavkovski wrote a applies his philosophical analysis to illuminate the experience of grief in ways both intellectually robust and deeply humane. Mikolai, thank you for taking the time to join us and welcome to the show.
Dr. Mikolaj Slawkowski Rode: [00:03:14] Thank you very much for inviting me to doctors. It's a great pleasure and an honor to be chatting with you.
Henry Bair: [00:03:20] So what caught our attention initially was this New York Times op ed you wrote towards the end of last year titled, It's Okay to Never Get Over Your Grief, in which you explored why we should reconceptualize what it means to mourn loss. We're going to spend time delving into your ideas there. But first, can you tell us what kind of philosophy you research and teach and how you got to where you are?
Dr. Mikolaj Slawkowski Rode: [00:03:47] Sure, I mainly focus on philosophy of culture most broadly, but in particular in phenomenology, especially phenomenology of emotions and phenomenology is a term that refers to experience. So what is experience and how we can cash out the various ways that we take in the world or understand it in a perceptual sense. And perceptual here means broader than just visually perceiving, sort of, you know, a frame in which we capture the things that exist in our visual field. It pertains to also, uh, tactile experience, but also auditory experience and everything else. And so we live in this self-centered bubble of input that we sort of process and constitute the world that we understand to be part of. And so that, taken philosophically, is what we call phenomenology, the philosophy of experience and how we can understand the world in which we live through interrogating the various ways this experience is undergone. So I'm interested in how that experience creates the world that we call culture. The world of various symbols and forms that come together in order to give meaning to the raw stuff of color and sound. All these things feature in how we orient ourselves in the world and in our relationship to others. So. So these are sort of my broadest focus questions that I'm interested in. And in particular, I've been recently researching questions concerning loss and grief, as well as love and attachment to others and joint perception, which is encroaching a little bit on the field of cognitive science as well. That's what I'm interested in.
Tyler Johnson: [00:05:38] So this might sound like a funny question, but I've always sort of wanted to ask. I feel like I don't know if you've heard the term armchair quarterback, but that's a term that we use in the US a lot for somebody who, like, sits in the chair and is like, why is it that guy throwing the ball better when of course, the person sitting in the chair has no idea how to throw a ball in the first place? Or, you know, certainly couldn't do it nearly as well as that person. So I feel like Henry and I are sort of armchair philosophers, right? We like to we like to talk about these sorts of ideas, But of course, really our day jobs is taking care of patients. But for a real deal professional philosopher who that's what you do. What do you do all day when you get up and go to work or whatever? Like what is work? What does it look like?
Dr. Mikolaj Slawkowski Rode: [00:06:21] In a way, all philosophers are armchair philosophers, so no one should feel disadvantaged by finding themselves sitting in an armchair and thinking So in philosophy, the great discovery is that you can do quite a lot of reasoning and quite a lot of finding out about the world without ever getting off of your armchair. There are certain principles or certain patterns in the world that, once discovered, give you a key to understanding what you could experience in principle. So you don't even need to go out there in order to find out what could be the case once you leave your armchair. And these are sort of the foundational questions for what you can expect. So there's a big question in philosophy whether philosophy ever makes any progress, but I think it does. And that consists in being able to predict better and better what will happen if we get off the armchair. Of course, you might ask about, uh, do philosophers ever actually get off the armchair? Some philosophers prefer to leave this task to other disciplines, like the natural science or medicine, for example. But in a way, everyone has to leave the armchair in this metaphorical sense, because we're all in the world. We're all experiencing the world. So philosophers get to test their ideas in respect of their everyday intuitions and in respect of their everyday encounters with others. So philosophy is an armchair science, as it were, only metaphorically, because we're all immersed in the world. And so this trial and error pattern that has occurred since the dawn of philosophy or since the dawn of reflection, is getting better and better at predicting or at understanding or at describing what it is that we may encounter in the world and how we can conceptualize it.
Tyler Johnson: [00:08:10] So let me ask a question that in my mind goes sort of together with that. You know, I remember when way back when when I was in college, I thought for a time about going into religious philosophy, at least as an undergraduate major, and then maybe even studying it beyond that. And I had what I consider to be a pretty significant conversation with a roommate who saw me reading a religious philosophy book and said, asked what I was doing. And I explained, and he asked why I was interested in that. And I told him. And then he said, well, yeah, but the thing is that let's say that you were to major in philosophy and then you were to go and get a in the US, a PhD in philosophy, and you were to become a philosophy professor and spend your whole life reading and writing philosophy. But at the end of the day, would you really have made any difference? Even if you succeeded as the field defines success, would you have made anyone's life better or made a, you know, sort of a good mark on the world? And if I'm honest, that conversation was one of many things that helped persuade me to go into something like medicine where I, you know, can see the effects of what I'm doing, you know, every day now, I will also say that in later reflection, I mean, the part of the reason that we have this podcast is because both Henry and I believe that philosophy or ideas do have an important place and do benefit the world in important ways. But as a philosophy professor, let's say that you had a student who came to you and said, well, I'm thinking about studying philosophy, but I don't want to do that unless I'm convinced that doing that would do good in the world, that it would make the world a better place. And they asked you to sort of make that argument for them. How would you marshal that argument? How do you think it is that, as you put it, being in your armchair reading and writing and arguing ideas? How can that make the world a better place?
Dr. Mikolaj Slawkowski Rode: [00:10:03] Mm. Believe it or not, that's a question that I encounter quite often, especially from first year students. Um, and and that makes me wonder why did they sit the exams in the first place if they have to ask that question when they get in. But, uh, it's an excellent question, of course. And philosophy, as you rightly pointed out, is a very impractical discipline. You know, you don't see great change in the world because someone has done a bit of philosophy. No philosopher has come up with the equivalent or an iPhone or a motorcar or anything like that, or, you know, a cure for a disease. And that's because many people believe. Many philosophers believe philosophy only describes the world rather than changes it. But I think there is great value in describing the world. And that is, you know, for whatever task, a practical task that you can master with the, you know, any discipline that you study, you can always ask the very childish question, why? Why do that? Why produce motor cars or iPhones or, you know, why cure diseases? And when you seriously ask those questions, then the answer doesn't seem to be as obvious as we might have at first thought. You know, is health some sort of value that we should pursue over other values? You know, when we devote resources to curing someone, we definitely have to make sacrifices at other fronts.
Dr. Mikolaj Slawkowski Rode: [00:11:31] And are these sacrifices worth making? And so on. The industry that has produced the motor car and the iPhone has, as we know, damaged the environment and has produced social relations that many feel are very problematic. Has this been worth it? These are all philosophical questions and philosophy. Ultimately, in describing the world gives us the ground to say something about what we ought to do, not only what's possible to do and what we can achieve, but should we achieve it. And this is something that everyone needs in their life. I think not only a way of developing the possibilities that might lie out there, but, uh, an awareness of whether these possibilities are something that we ought to be pursuing or we should be pursuing. And that's a fascinating topic. It might not be a topic that creates anything new, but it's something that helps us to understand both ourselves in relation to the world and the path that we should be taking through it. So that consoles the students somewhat, and they stick around for at least the end of their undergraduate degree.
Henry Bair: [00:12:42] Well, thank you so much for that really well stated argument for the universality of philosophical thinking. Of course, as you mentioned lately, you have devoted a lot of your efforts to thinking about issues of mourning, loss and grief. What led you to start thinking about these issues? Was there an encounter? Was there an experience in your life that has allowed you to gravitate more towards these rather heavy, and maybe less popular issues?
Dr. Mikolaj Slawkowski Rode: [00:13:10] Yes, certainly. Everything starts in a way with with one's own experience. It's hard to engage enthusiastically in any pursuit if there isn't a sort of personal connection to it. And that's true not only for abstract philosophical thinking, but for people who work in very practical areas as well. So in my case, the loss of my grandmother ten years ago was quite an important point for explicitly turning to the question of grief and loss as well as the general interest, of course, in philosophy of culture, and the juxtaposition between the idea that culture is a certain form of continuity, of keeping certain elements of past experience or past understanding of the world that we culturally developed alive, with the predominant and still predominant, in my view, idea that in situations of personal loss, the goal is to move on as quickly as possible, and so having the prior interest in the continuity that constitutes the identity of of a given culture, I thought there's a bit of a tension or a bit of a paradox, that a culture that is supposed to be a continuity is formed by individuals whose private experiences are said to be importantly, influenced by the need to let go of our attachments where when they are no longer available. I thought, you know, this is not a pattern that necessarily is conducive to that sort of larger continuity that we call a culture. And so I started investigating that and then through my personal experiences, have become interested in personal loss as well.
Tyler Johnson: [00:14:57] I'm struck by the fact that as doctors, the ideas of mourning and loss, and in particular the ideas of the personal and cultural reaction to death, play out on at least three fronts, right? So on the one hand, as anyone does, doctors will have their own personal collection of people who they have known and loved, who have died. And just as with any cross-section of the population, some doctors will have experienced the deaths of many loved ones and some of very few, or maybe have never experienced the death of someone close enough to have really, you know, caught their attention all that much. And then on the second level, the one that is unusual is that doctors have this very privileged place where sometimes, even if somewhat unwillingly, they are witnesses to the deaths of other people. Right. And this can be, particularly for doctors in training, a jarring and sometimes very difficult experience, precisely because there is virtually no preparation in most medical school curriculums for thinking about, let alone encountering death. Right? And yet then you're thrown into a wards team where you could experience the deaths of multiple people over the course of a month, which in many cases is probably more encounter than you have had with death in your entire life. And then depending on the field of medicine that you go into, that may constitute a greater or lesser or more direct or more indirect part of your career. But the point is just to say that doctors also have much more experience with other people dying than most members of the general population.
Tyler Johnson: [00:16:49] And then the third level is that, of course, doctors, whether they want to think about it or not, just like everybody else, we are at least vaguely and sometimes more directly aware of the fact that all of us will die one day. And thinking about what are the implications for that on the people that we love, right. When we're on the other side of the equation and it's not us mourning, but it's us leaving people in mourning, there's always at least the vague appreciation in the back of your heart and mind that that will sometimes at some point befall all of us as well. But with all of that said, what is striking to me is the fact that I mentioned earlier, which is that in spite of all of that, this is something that in I think I can speak for Henry and myself. In our experience, most doctors are very poorly equipped to think about, let alone encounter the deaths of other people. And so part of the reason that we wanted to invite you on the podcast is because we are hoping that you can help to better equip our listeners to think about something that I think can actually, in a strange way, I think that shepherding people towards death under certain circumstances can actually be a beautiful and meaningful part of doctoring, but only if you have equipped yourselves with the intellectual and emotional tools to allow that to be the case.
Tyler Johnson: [00:18:14] And so we're hoping that you can help us to get our listeners a little bit better equipped. So the first thing I wanted to start with in terms of that goal is one of the things that is so striking, even in the very brief op ed that you wrote for The New York Times, is that you begin to outline the way in which the encounter with death and the the notion of our almost obligations or responsibilities with respect to encountering another person's death, how that has evolved over the last, let's say, 150 years. And I think that this is one of those things that for most of us, because death is something that we encounter pretty infrequently, it may not even occur to us that there is such an evolution, because by the time we get there, we just sort of assume that what we do and what we're told that we should do is just kind of the way things have always been, right? So could you sketch for our listeners a little bit, if there is an idea of what it is supposed to be like for a mourner to encounter the death of a loved one? How has that sense changed over the last, let's say, 150 years in general, in Western so-called, you know, industrialized or whatever in Western culture, how has that evolved?
Dr. Mikolaj Slawkowski Rode: [00:19:29] Right. That's a huge question and a really tall order that you have for me here. But I'll do my best, uh, to field this. So, yes, the attitudes to death, at least in, in the West, have changed quite dramatically, and there are several extremely good sources to consult on this one. One book is, uh, Felipe Arias, uh, a French writer. He wrote this very sizable volume called The Hour of Thy Death, where he divides various stages of familiarity and our relationship with death in the, in the broader society. And he notices that, there's a striking difference between he was writing in the 20th century. There's a striking difference between the second half of the 20th century and everything that has gone before, in a sense. So, as you pointed out rightly, doctors who enter into practice or even study are forced to encounter death in much greater intensity than than we normally do in our modern societies. And that is because, as Arias argues, and I think, as we all know, to be true, death has been hidden away from the public view, sanitized in hospitals and in care homes, and taken out of the everyday dealings. This is something that was almost never the case in human society. Death was something that people were able to see as part of life.
Dr. Mikolaj Slawkowski Rode: [00:21:02] Graveyards were something that that were part of celebrations throughout the year, and something that reminded everyone not of the absence, but of the presence of the deceased in our everyday life. Of course, this is underpinned by a religious attitude and explicitly religious attitude which evolved with the enlightenment and the Industrial Revolution, which changed our perception of this. As Arias argues, the enlightenment and the Industrial Revolution made death the enemy, not something that we have to live with, not something that we understand as part of life, but something that we should actively oppose, something that we should strive to resist as much as possible and then closer to our day. Death has become something of a taboo, something unpleasant, something even shameful. If someone is seen as burdened by or, you know, overinvested in someone else's death or just, uh, you know, uh, even contemplating the idea that death is the end of all of us, they're seen as someone, you know, slightly, slightly pathetic, even morbid, and contemplating these issues that don't help them in any way and aren't helpful to anyone around them. And it's seen as a sort of detachment from the communal life that the modern society offers.
Dr. Mikolaj Slawkowski Rode: [00:22:23] So these attitudes have definitely changed, and we're in a point in time that, as everyone points out, is comparatively very, very short to everything that has gone before. And I think in a way we're not yet completely adapted. And in effect, I don't think we should be adapted to this idea that death should be hidden away and taken out of our experience of life in the modern community completely, which has happened because, of course, of the great advances of medical science and and as part of that surgery, but also anesthetics and also treatments of all kinds, but also our ability to segregate our societies into the healthy and the unhealthy for the benefit of both, arguably, but also with the downside of the fact that we no longer are able to see death, old age, and illness as part of life. We see it as something of a scandal that in polite society, shouldn't be talked about too often. And I think this is hopefully a passing phase, and it's, in a way, a high time to notice that we can move beyond this combative attitude towards essentially all the predicaments of our biological development that inevitably mean one day we're going to pass away.
Tyler Johnson: [00:23:49] I'm so struck. So I go to church, and I've been part of the same church community here in Palo Alto for 15 years now, and one of the things that I love the most about church is that we have everything from little new babies who are crying and interrupting the service all the way through people who are 95 years old and, you know, can barely get in to sit down in the pews. And as a child growing up in a similarly constituted congregation, I developed this sort of native sense that this is the arc of a life. This is what happens, right? And by the same token, in the church, you celebrate the birth of new babies, and then you mark the passing of those who die. And that was also just part of sort of, you know, the way that life is stitched together. But what has become striking to me, especially living here in Silicon Valley over time, is that the very fact that I have a place I go every week that has that full span of, as you called it, human development from birth to those who are approaching death has come to seem like this sort of strange anachronism. Except for my doctoring.
Tyler Johnson: [00:25:02] There's nowhere else in life where I would go hang out with people who are in their 80s, right? Or even have almost exposure to people who are in their 80s. And to your point, if you look at the worlds of advertising or popular culture or popular television shows, whatever, it is clear that the according to popular culture, the ideal is a person who's in their, you know, maybe late 20s with an airbrushed look and a very particular kind of, you know, figure and form and face and whatever, as if everybody of any age should be aspiring to look like that. And anything that's not like that is somehow wrong. Right. And I guess one question that I have that I think would be helpful to explore is, you know, you mentioned that you hope that some of those things that I was just talking about will be a passing phase. But why do you think we are in that phase? Why do you think we have gotten to this place where it's as if societally, we want to almost deny the existence of old age and death and changing over the span of the life. Like what? What do you think has brought us to this point?
Dr. Mikolaj Slawkowski Rode: [00:26:08] Well, first, you're absolutely right. I think the church has been a meeting place, an intersectional place for people from all various parts of society. And with the secularization of Western society, that place has slowly been in regress. People have been closing themselves off in there more and more private bubbles. And we have to remember, of course, that even in medieval Europe there were trade guilds and people would hang out, the carpenters would hang out with other carpenters, and the seamstresses would hang out with other seamstresses and so on. And the bubbles were always there, but they would always come together in this one place. Well, in fact, two places there would be the market and there would be the church. Now the market is online and the church is disappearing. So people are drawn more and more to sort of reinforce their prejudices and reinforce the needs that pertain only to their social or cultural group through the social media and through the communities that they create, create around themselves. I completely agree with that. And the reason why I think this is this has happened is connected to the anti-hero of my op ed that you kindly mentioned in the in The New York Times, uh, Freud. So Freud is embodies this idea of individuality, singular individuality, where the fulfillment of our life is encapsulated by understanding what we as an atomic individual need for flourishing. And in the first place, that there is such a thing. And that precipitates a move towards more and more focused groups of interest, because, of course, every carpenter will soon realize that there's nothing really or very little joining them to lawyers or bankers. And so they will want to hang out in their carpenter community. And as long as we hold on to this idea that our individual flourishing is the most important thing that we ought to pursue in any walk of life, the effect will be insulating ourselves from anyone else who does anything other than we do. So I think the root of this is this cult of the individual.
Henry Bair: [00:28:28] Which brings me to a point. In your op ed, it was a very matter of fact statement that you included in there. In fact, I kind of read it and then had to go back and and think to myself, wait a second, that's actually fairly countercultural in that sentence is in life. Genuine commitment to others comes before our own happiness. I kind of read that skimming through it, and had to go back to it, because it occurred to me that's actually pretty different to how most people would conceive of happiness and what matters in life. You tie this, of course, into grief and mourning, because you go on to write that traditional mourning practices, with their permanent quote burdens, offer a way for those commitments to others to continue. Can you tell us more about what you mean and sort of try to convince us? Right. Convince people who might not be convinced of the validity of this statement.
Dr. Mikolaj Slawkowski Rode: [00:29:24] Yeah. So you're definitely right that this is something that, for modern ears, sounds a bit odd. We're all thinking about our lives in terms of work free time balance or, you know, work family time balance. And we're all looking for, you know, wellness and balance in our own lives. And that seems like an end in itself. But philosophically, we might distinguish between the meaning of life and the meaning in life. And it seems to me that the latter has replaced the former to a large extent. People for a long time were preoccupied with the idea that us being here and thus attending to the everyday business, has to have some meaning. Ultimately, there has to be some justification of why we attend the things we attend to every day. You know, a pessimist might say, why get up in the morning if there's no reason to? That is larger than, you know, just eating the delicious breakfast and the delicious breakfast immediately becomes pointless and not an effort worth embarking on. So this was the idea that life had some sort of meaning, independent of the meanings that we can create and attend to in life. So, for example, the skill of a of a worker producing the sort of, you know, the, the best quality good that the particular person is able to produce or, you know, the comfort that we're able to provide, either for ourselves or for our family or the health that we can pursue in order to see the next generations grow and flourish.
Dr. Mikolaj Slawkowski Rode: [00:31:03] Up to a point, of course, and it seems that there's larger perspective has been just simply reduced to meaning in life. There are philosophers who explicitly say this. Simon Blackburn, for example, who who is an excellent philosopher, says that the question about the meaning of life is a redundant question, that that this is a mistake in terminology, that we can find certain things in life meaningful, but it makes no sense to ask what the purpose or meaning of life is beyond, of course, the agglomeration of all the meaningful things that we find to pursue in life. But, you know, we can always ask the question, why do all of this? And it seems to me that if we ask that question, then it quickly occurs to us that happiness is a sort of. Our personal happiness is a low priority pursuit when put next to things that we should really deeply care about, things that really matter in our lives, things that we really want to succeed. So the easiest context to think of here is, is our children. We might say that a bit cynically.
Dr. Mikolaj Slawkowski Rode: [00:32:17] There is a perspective that is sometimes associated with Ayn Rand in America, the sort of, you know, systematic selfishness. You know, we love our children because they fulfill our selfish desires. But these things sort of, you know, come to blows when we see situations that no one really wants to encounter in our lives, like the famous, you know, Sophie's Choice or, you know, our children are stuck in a burning building, do we risk our life in order to rescue them or not? You know, it doesn't have to be that radical. But we see that, you know, like Sophie and Sophie's Choice, we couldn't go on living happily if we hadn't sacrificed our own well-being or happiness. At this one point. There is a fundamental paradox there that there is a perhaps not explicitly happiness, but something that we recognize as intrinsically more valuable than something that we associate with our own personal flourishing. I realize this is an unpopular idea. People don't want to be put in a position where their own flourishing is not an option. But in a way, life is not possible to live without encounter and embracing some sort of setback here and there that prevents opportunities for individual flourishing as a trade off, for the well-being of someone that we care more about than ourselves.
Henry Bair: [00:33:45] So you use the word human flourishing quite a bit. I'm wondering if you could just tell us what you mean. What does flourishing actually look like for you?
Dr. Mikolaj Slawkowski Rode: [00:33:53] Oh, gosh. Well, that's a that's a huge topic.
Tyler Johnson: [00:33:56] Again, just tell us how to flourish in 30 seconds, if you would.
Dr. Mikolaj Slawkowski Rode: [00:34:03] Okay. Well, we can say that a flourishing human being is a is a healthy specimen of Homo sapiens who both physically and psychologically. Finds themselves fulfilled. But what does that fulfillment consistent? Can it be just something that is independent of anything that happens around us? Some people think that this is possible, that through meditation, for example, we can detach ourselves from any concerns that encroach on our self-realization. But I think that's a paradoxical idea. Fundamentally, I think self-realization is impossible without being able to empower and live with others and join our lives with other people, either in very intimate or less intimate communal bonds, where social animals, as the platitude goes. So this idea of detached atomic flourishing is in a way incoherent to me. It's a it's a it's a fiction of the modern world, perhaps, and how to flourish in a society. Well, that's a question not about the individual, but I think about the community. What makes a healthy community? That's a very unpopular view, that a community is something independent of the individual. At least since the enlightenment, the community has been seen as a collection of individuals and something there only to serve the needs of the individual. But I think that, uh, we only need to look at the family to realize that this is not true. The family is not there just so everyone can can flourish. Rather, everyone who belongs to a family, natural or otherwise, knows that their role in the family is to contribute to the continuation and well-being of that small community. And I think that losing that perspective for larger communities is responsible for the rise of that myth, that all structures in which we feature, in which we function, are only things that we ought to continue belonging to if they serve our individual well-being. And this fails to notice the fact that this individual well-being is a is a fiction. It's a utopia that's impossible to realize, because we can only find fulfillment if we give up that pursuit of being individuals who find fulfillment without any burden that could be imposed on us from outside.
Tyler Johnson: [00:36:31] You know, as I listen to you talk, I probably more than any past guest that I personally have quoted in subsequent episodes on the show is Anna Lemke, who we interviewed very early on in the podcast, who is a I mean, she is billed as a specialist on addiction, which is true, but she also, in her way, is something of a moral philosopher. And her sort of meta thesis to much of her work now is that everybody in the modern world, at least in the Western world, is addicted to everything because everything brings us dopamine, right? So whether you're addicted to calorie dense foods or to social media or to videos on Netflix or to pornography, or to actual substances like alcohol and tobacco and recreational drugs and what have you. But the point is that it's just that we have become beings that seek dopamine above all else. And the thing that is really striking to me is that I don't mean this in a pejorative or a morally judgmental sense, but in a descriptive sense. Addiction, almost by definition, is atomizing. It's individualistic, right? It puts you in a bubble of one, and your life becomes a quest for more dopamine. And in effect, part of what I hear you saying. So just like Henry had to stop and reread the line that he mentioned from your piece, the line that really brought me up short is the first lines of the the final paragraph of your piece.
Tyler Johnson: [00:38:03] You write the most significant thing in our lives, however, surely cannot be how good we feel. And yet for much of us in modern life, we act as if that is precisely the most important thing in life. Or the only important thing in life is how good we feel. And so much, it seems to me, of modern behavior is centered around that. But the fascinating thesis that Doctor Lemke draws out, which I hear parallels in what you're saying and your work. She points out that the problem with making your life all about dopamine is that if the only thing you're ever doing is seeking dopamine, it becomes a self-defeating quest, because the more of it you get, the more of it you need to feel satisfied, let alone something more than satisfied. And so it's like trying to run up a slope that is eroding as you're running. The faster you run, the faster it erodes and the less progress you make, right? So that precisely by seeking dopamine hits all the time, in whatever form, we make it harder to feel the way that we're trying to feel by seeking that. And part of what I hear you saying, and really the the argument that you make in the op ed is that, you know, that we have made it so that we act as if our responsibility when someone we love dies our Our most important responsibility is to, quote unquote, get over the death as quickly as possible so that we can move on.
Tyler Johnson: [00:39:30] You don't use these words, but in effect to whatever will bring us dopamine next, right? Yes. But what I hear you saying and in a way, what I hear Doctor Lemke saying, is that it is precisely by escaping the dopamine bubble and saying, in effect, to your point, this is a person I loved for many years who had a deep impact on my life. Why would I pretend not to need them anymore just because they have died? Allowing that bond of community, even to someone who has died, allowing that to continue to cohere after their death is actually a powerful way of drawing me out of myself. And it seems to me that, in effect, your call for community is a call for us to remember that much of the richness of life lies necessarily outside of ourselves. And it's only by by escaping those personal dopamine bubbles and remembering that, ironically, we find ourselves by losing ourselves, we we discover richness precisely by sacrificing in behalf of others. And then it is those self-sacrificial. I don't mean that in a dramatic sense it can be very small, but whatever it looks like, it's the formation of those self-sacrificial bonds between mutually invested individuals that allows the creation of community and the coherence of community that brings a richness to our lives. Does that sort of resonate with the point that you're making?
Dr. Mikolaj Slawkowski Rode: [00:41:00] Absolutely. I think I think that's completely spot on. I think, uh, what you're referring to with the with the dopamine, uh, hype that we're constantly pursuing and that you're absolutely right in pointing out that it has the atomizing effect of, uh, severing our bonds with anyone who might undermine or anything that might undermine the pursuit of that dopamine hit in the in the context of mourning and at least Freud's theory has a lot to do with the idea of repression. Freud thinks that the only way in which we come not to fulfill our desires is repression. There's very negative process in which we're unable to pursue the desire that we want fulfilled, and therefore we pathologically deny ourselves subconsciously the ability to fulfill that desire. And so the role of psychoanalysis of or the role of medicine there is to give us a substitute for the fulfillment of that desire that will give the equivalent, in this case, dopamine hit or release us from the repression that makes it impossible for us to get that hit in the first place. What Freud misses, of course, here, is that we can deny ourselves the fulfillment of a desire completely consciously. It can be a choice. It doesn't have to be something that we're unable to fulfill and something that, for extrinsic reasons, we don't have access to, even though we want very much, we can very much realize that something is not worth pursuing a pleasure or some sort of form of fulfillment, and that has been seen as something that is almost impossible in the drive conception of human human psychology.
Dr. Mikolaj Slawkowski Rode: [00:42:42] So you're absolutely right about that. But some credit should be given to Freud. Freud is not just, you know, completely one sided on this. There's a fantastic essay that I would like to just quickly mention here by Robert Gaines. It's a paper from 97 Detachment and Community. And he goes into great detail about these two different currents and Freud. And one is the detachment from the object of loss, and one is a reverse drive for the continuity. Freud's 1917 essay Mourning and Melancholia famously sets out the idea that the sort of dwelling or prolonged dwelling on the object that we have lost is pathological and suggests that we're unable to let go of it. But later, in 1933, in his introductory lectures, he suggests that there's also he doesn't say there's a need for, but he suggests that there's an equivalent drive going the other direction that requires continuity. He doesn't develop that thought, but it's there. In Freud, he saw that there is a need for continuity, and Robert Gaines brings this out, I think, better than anyone who I have read on this. Nonetheless, what I find in that essay is the idea that both the letting go and the continuing of bonds. There's a movement in, uh, uh, bereavement studies or grief studies that emphasizes the need for continuing bonds.
Dr. Mikolaj Slawkowski Rode: [00:44:10] Both of these focus on the final benefit to the morning individual. Either way, you know the continuing bonds movement or the detachment is supposed to lead us to a resolution of the trauma that we have suffered because of losing someone and being able to get on with it, either with some sort of internalization. Freud speaks about internalizing into the ego of the object that we have lost, or the value that we have lost, or letting it go and being able to move past it. Perhaps some people even speak about combining these two in healthy mourning, but healthy mourning is almost exclusively still seen as something that must result in a benefit to ourselves. And this is something that I find particularly strange because of of the reasons I mentioned that in a healthy relationship with someone else when they're alive, you know, our own well-being can't be the only goal of falling in love, of having children and so on. If our loved one told us that, uh, the reason that they're with us is, is because it makes them feel good. I mean, of course, this is a bit of an oversimplification, but that, you know, the benefits outweigh the costs, then we would feel that it's not a genuine attachment or it's not a very deep attachment that the other person has with us. And so I find it slightly strange that although we all, I think, have this intuition about relationships that are ongoing, as soon as the relationship is broken by death, we revert because of this individualistic strand in our culture to thinking about what? Uh, benefits in this.
Dr. Mikolaj Slawkowski Rode: [00:45:52] Can we preserve for ourselves? Of course we're going to be hurt. But how do we get over this? And I think that a particularly interesting strand in philosophy of grief is how continuity can contribute to our psychological well-being or psychological health. I don't think it's a morbid position to say that, you know, we sometimes have to take a hit in life. It's just a fact of it. So one of my favorite philosophers who speak about grief as Colin Murray Parkes, I think he coined the phrase that grief is the price that we pay for love. And even though that rings very true, I think it's, you know, not a question of barter, as it were. It's not that, you know, the cost is something extrinsic that we have to accept as offset for the benefit that we get. You know, we have to put the chips in in order to get the jam as, as it were. I think, you know, it's not so much a price that we pay for love as part and parcel part of it, and we're not living part of our relationship with the other person. If we don't include in it the grief that we have to suffer once they're gone. And I think that is something that connects individual life and the connections that we have with others, with the broader picture that we see in the development of culture.
Dr. Mikolaj Slawkowski Rode: [00:47:13] In culture, losing something is as much part of the development of culture as having something be present and appear in it, you know, great traditions and great literary works and geniuses who are able to capture in one sentence or in one work, the zeitgeist or the spirit of the time in which everyone sees their reflection and understands, oh, yes, this is this is where we are. That's how we understand our place in the world. If I may mention another philosopher, Simon May, he speaks about love as a sort of ontological homecoming. Ontological just means in philosophy being or existence. So he believes that when we find love, we find our place in the world. We find a sense of belonging in otherwise hostile environment, an environment in which we're just individuals, sort of, you know, atoms knocking about in darkness. And suddenly when we find love, we see that we belong to a place or more concretely, to another person. And I think that belonging in that way has to include both the benefits and the downsides as well. We learn about other people not only when we encounter their good sides and share happy moments with them, but also when we're let down by them. That's part of a relationship that we have with them. And of course, this is not up to them, but we're all open to being let down by the other in the moment that they're no longer able to be there for us when they pass away.
Dr. Mikolaj Slawkowski Rode: [00:48:42] And that's part of what we have to expect and accept when it happens, rather than either move past it or try to sublimate it, as the freudians might say, into into our own ego. So I think in both of the currents, there is a sense in which, even if we're not only liberating ourselves from the loss we have suffered, it is still our individual well-being that we're thinking about when we're thinking about attachment. And that has to then be a sort of a qualified attachment, a sort of a safe attachment, which is sectioned off from the rest of our lives in a careful way so it doesn't spill over. And I think that that produces the risk that eventually it will spill over and, uh, make us realize that we've been we've been living in a sort of pretend reality where you've thought that we haven't been hurt and that we've managed to compartmentalize that part of our life in a way that it doesn't influence any other. And I think we can get over that. I think, uh, we don't need to live in extreme times, like, uh, you know, medieval Europe where death was omnipresent in order to, in the same time, not sort of shuffle it away or file it away and, uh, ignore it.
Henry Bair: [00:50:00] Yeah, that that makes me think about we had a, uh, David Kessler on the show who was the, uh, protege of Elisabeth Kubler-Ross. And, uh, about five years ago, he added an official sixth stage of grief to the five that are more well known and the sixth age is finding meaning. So sort of all ties together. We've been talking about where grief and love are kind of come together as a package deal. So we've been thinking a lot about the more intangible and more philosophical ethical aspects of grief and loss. Now, as we talked about earlier, a lot of our listeners are clinicians, trainees, people thinking about going into medicine, which is, of course, by its nature a very practical calling. So I'm wondering, after all this is said and done, what is some advice you have about how clinicians can better help their patients navigate grief and mourning?
Dr. Mikolaj Slawkowski Rode: [00:51:04] Well, that's that's another huge question. I think, uh, first of all, something that's already happening, I think, but could be happening more. And this is something that, uh, I say, based on both my own experience and conversations with others, is, as the title of the op ed goes, it's okay not to get over your grief. You know, it's not something that, uh, is a task that you have to take off. It's not something that you're failing at. If you keep on finding ways back to the relationship with the other person, perhaps that's a completely natural part of that very relationship. It just might feel wrong. And, uh, obviously we know there are various different speeds for different people for being able to reengage with the world. And, uh, the paradox in mourning, of course, is that even though I'm talking about holding on to the relationship and, you know, continuing bonds and finding a place for the relationship in our life once the other person is absent, obviously there has to be some letting go, because of course, some things are irretrievable. The other person is obviously gone and there is that dynamic in mourning. We have to, at the same time, realize that we have to let go of some things, but also that we need an extra effort to hold on to other things. And the temptation, in my view, is to go radically in one direction or the other direction. And the thing that Freud saw pathological is holding on exclusively. He thought that is the danger, because that makes us vulnerable, to hamper our capacity to reengage with the world and form a new life. So he thought, that is the target holding on too tightly or pathologically. I do not want to say there isn't such a thing. I think definitely there can be morbid wallowing, and I would go even as far as saying that that is a form of not continuing the original relationship, of abandoning it, but in a different form.
Dr. Mikolaj Slawkowski Rode: [00:53:14] And so the exclusive focus, the temptation is to go exclusively in the other direction and just let go as much as possible, or just move on in order not to be stuck in that one place. So the hard thing is keeping balance between those two things, between letting go and holding on. And I'm not a psychologist or a clinical doctor or in fact, a medical doctor. So I'm not sure what practical advice I could give. But from this theoretical perspective, I think that there needs to be a sort of careful negotiation of the balance between finding the things that we have to let go, because there's no longer a route back to those things and holding on. And this can be painful, of course, and will be painful, because the things that we have to let go of and the things that we can't let go of, or we shouldn't let go of are very, very closely associated. They're both associated with the same person. So it's inevitable that this will be a painful and difficult process, and it's inevitable that there will be people who require help with it and can't help themselves navigate it. So the most general advice would be to suggest that things aren't as simple as Freud thought. It's not that you know if something is wrong, then surely we're stuck in the past and just need to be ushered along in order to get over the hump and continue with whatever we were doing, or engage with something new. But rather, the reality of loss is, you know, as unique and individual as individuals are and their relationships.
Tyler Johnson: [00:54:53] And I think I would just add, Henry, as an attending physician who has worked with a lot of trainees as they're so I when I attend in the hospital, I attend on the inpatient cancer service. And so we have the patients that we take care of are some of the sickest in the hospital, and it's the exception if we don't have people die when I'm on service for a couple of weeks because they are so ill. And one of the things that I think is sort of an important parallel to what we're talking about in terms of dealing with the loss of people, either that you know and love, or helping your patients and their family members to deal with the loss of people that they know and love is also to recognize that there is even people who we have known very briefly, like a patient that you have cared for in the hospital because of the intimate nature of the doctor patient relationship, there is still likely to be some degree of emotional investment there. And so on the one hand, of course, you can make a mistake. You were talking earlier about balance. You can make a mistake in trying to sort of fake that, that death means as much to you as it would mean if your grandmother or spouse or something died, which is almost certainly not going to be true, because how could it be? But in my experience, at least recently, the more common I think problem is actually with trying to pretend that the death of a person that you met five days ago and have taken care of on the cancer ward or whatever, is trying to pretend that that death should mean nothing to you, that it should have no moral or emotional valence, and that you should just be able to move on to the next thing.
Tyler Johnson: [00:56:26] And sometimes the bustle of hospital life sort of implicitly suggests that to us, just because we're so busy that it feels like we just have to move on to the next thing because we don't have time to mark, let alone mourn the loss of a patient. And I think it's important to recognize that even someone we have met very recently, because of the intensity and the intimacy of the doctor patient relationship, even the death of that kind of a person can still make a mark, and it is appropriate to clear a space for mourning and to allow yourself grace in the feelings that you may feel in processing that death. Because witnessing, especially up close, the death of any person is a an emotional and sometimes even overwhelming experience, even if it's someone that we met relatively recently.
Dr. Mikolaj Slawkowski Rode: [00:57:16] Oh, absolutely. Yes. So so we started with talking about how death has been hidden away in our societies, in, you know, hospitals and care homes. But, you know, a result of that is, of course, that there is a social group that is particularly heavily exposed to it, and that's doctors. And as much as everyone else is able to escape from the omnipresence of death, doctors are not. But there's not a place for them to express or to live through their experience of having to face the passing away of people, sometimes countless people, in their profession over the years of their career. I think that is extremely difficult task to embark on. I think no other career has that kind of requirement day in and day out. And I think that this individualism, this idea that, you know, especially since the ties weren't so deep, as in, for example, familial relations. The doctor should move on quickly, and there's something pathological happening. If the doctor is experiencing stronger emotions than just acknowledging that loss. I think that long term this can be extremely damaging. And of course, we all know about the effects that this has on doctors, a well-documented phenomenon of compassion fatigue, where because the ability to engage or the capacity to engage with someone's loss emotionally has been internally stifled for so many years and over so many cases, it becomes very difficult to engage in that way with loss that we suffer personally.
Dr. Mikolaj Slawkowski Rode: [00:58:59] Doctors sometimes form this block that they have in relation to someone passing away, and switch on their professional attitude to it. And I think obviously there needs to be a spectrum or of a differentiation of intensity. Obviously someone who we've met five days ago, as you rightly pointed out, it would be strange or false, in fact, to mourn or grieve, for as strongly as we grieve for our family members. But at the same time, that doesn't mean that we have to be completely indifferent and just treat it as another thing on the line, as it were. Obviously, any connection with another person sort of opens us up to a different way of seeing the world. That's what people do, I think, in relations with us, when we meet someone else, we suddenly see the same thing in a slightly different light or under a slightly different aspect through their eyes, as it were. And this can happen in a relationship that lasts five minutes as well as five hours or five years, and losing that always implies those two tasks will never regain it literally. But we'll be able perhaps to reconcile ourselves to not being able to hold on to those things that we can't access anymore by continuing that relationship, in connecting to the way we've been able to live those moments with that person sincerely.
Dr. Mikolaj Slawkowski Rode: [01:00:24] In a way, death is not even a prerequisite for that sort of feeling. I mean, being separated from someone permanently without them dying can bring about the same sort of dynamic between having to let go on on the one hand and retain something on the other. But at the same time, you might think that the fact that you're separated in this way doesn't mean that you can abandon the other person completely. There might still be some obligations that you have to the other person keeping keeping a word, for example, that you gave them. And I think the same is with death. So if someone dies, I don't think the separation implies that we have no more commitments to that person. And those commitments may be, you know, very complex or as simple as extending the same courtesy that we've extended to them to another person. That can be difficult, of course. I mean, I don't have an answer to this. I think, uh, the job of a doctor is, in all the ways, more difficult than a job of the philosopher. Uh, uh, especially in that regard.
Tyler Johnson: [01:01:30] We could debate that. But for the most part, uh, Nikolai, we I think Henry and I were both very taken with the original OP editor that brought you to our attention. And we are so appreciative for the your generosity and sharing all of the thoughts. We feel like it's a special privilege when we find someone who is not directly involved in the medical field, but who we feel like has a message that can leaven our practice or, you know, that can allow us by thinking about things a little bit differently, as you were mentioning from a little bit of a different perspective, can allow us to hopefully become better practitioners and practice in a way that that is fuller and more meaningful. And so we want to thank you for the many years of study we now have gone in to being able to articulate your thoughts this way, and thank you so much for the time that you've shared with us.
Dr. Mikolaj Slawkowski Rode: [01:02:21] Thank you very much, both Tyler and Henry, for having me. It's been it's been a pleasure and also a fantastic opportunity with me to talk to professionals in the medical field rather than other philosophers, which is, you know, also a way of testing my intuitions that I've expressed in the in the op ed.
Henry Bair: [01:02:43] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the Doctor's Art.com. If you enjoyed the episode, please subscribe, rate, and review our show available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [01:03:02] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient, or anyone working in healthcare who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [01:03:16] I'm Henry Bair.
Tyler Johnson: [01:03:18] and I'm Tyler Johnson. We hope you can join us next time. Until then, be well.