By Giulia Bovassi –
Refined surgical skills and human dexterity are fully manifest in such complex operations as organ transplantations, a difficult intervention and great therapeutic resource. How should we deal with the possibility of a head (or body) transplantation, keeping the patient-person in the center? What risks originate from psychological sciences? Thanks to their professionalism and assisted by well-known cases in literature, several experts helped to shed light, from the psychotherapy’s point of view, on its plausible consequences.
The round-table seminar, part of the Masterclass in Neurobioethics, hosted three major psychotherapy schools and five experts in the field to undertake an interactive experience for mutual exchange and in-depth training on the Masterclass main topic, the so-called “head transplantion” on the human being. The meeting, coordinated by Prof. Alberto Carrara and introduced by Dr. Maria Luisa Pulito, psychiatrist, neurobioethicist and former GdN member, joined the psychological perspectives essential to correctly examine the above-mentioned surgical project. The patient’s psychological rejection, after the transplantation of visible parts of the body, is not a hypothetical deduction, but an objective datum the scientific community must consider. These patients express discomfort towards their new organ in various ways: as highlighted by Dr. Pulito, they feel their integrity undermined and consequently need to assimilate the deconstructed image of themselves again; they are sad for the lack of that particular lost reference of their body; they are animated by anguish, paranoia, sense of persecution and extraneousness towards that novelty applied to their figure; all of this contributes to the expression of that psychological rejection, decisive for that patient called to reassess his own history. Precisely about this story, Dr. Pulito, using the formula coined by P. Ricoeur, «synthesis of the heterogeneous», shows how much the narrative experience and temporality, which determine the “specific” of each human being, are dense synthesis that invests us with its features in the union between the temporal and historical permanence of the personal identity, defined largely by the relational interaction. A balance between permeance and change. In the end, making precise reference to the potential patient, result of a hypothetical fulfillment of the “body-to-head transplantation”, Dr. Pulito asks herself: «Will the impression left in the brain circuit of the original body be felt in the new one? Which synthesis of the heterogeneous will be possible through the head transplantation?».
Dr. Massimo Cotroneo, hypnosis and Ericksonian psychotherapy’s specialist, supports the structuring of hypothetical predictions, starting from already illustrated cases of difficult cohabitation between the patient and his new transplanted organ or limb. Face or hand transplantation experiences, for example, have been subject matter of the verification of the psychological and psychosocial responses of the individuals, who, although gaining evident improvements in their quality of life, had to face many difficulties in the representative identity and in the systemic-relational implications. Despite the increased functional benefits, technically healthy patients developed mental-psychological pathologies that were difficult to ignore and probably already nourished when they joined the intervention. The expert questioned the veracity of the awareness to the consent of a head transplantation, a choice without any return possibility. Here is the Ericksonian approach’s contribution, where the person resides at the center, both in the constitutive globality and in the uniqueness that characterizes it, namely considering her, every time, different from her equals. The effort to consider the set of implications that could arise before and after the intervention, allows practices such as hypnosis to work, thanks to the access to special states of consciousness, «on the deep aspects of consciousness and psycho-corporeal matter, sometimes masked by non-functional choices». The added value of the hypnotic session lies in the access to highly conflictual and complex places, often autonomously unsearchable, that would lead the patient after the intervention to highly uncomfortable conditions. This tool is equally strategic when doubts arise regarding the authenticity of the consent: the transplantation idea could induce confusion or obsessive feelings dictated by the minimum effective experience with similar imaginative representation of the surgery. The integration between subjective experience and the experimentation of an arduous and, sometimes, alienating path, as the weight of the head transplantation, is a contact that can be experienced through hypnosis and it would be, without a doubt, advantageous to support the human aid to the patient.
The director of the S.I.S.P.I., the International School of Specialization on the Imaginative Procedure, Dr. Alberto Passerini, proposeed, together with his colleague Dr. Manuela De Palma, psychologist and psychotherapist, hypothetical considerations on the implications related to the head transplantation, founded on what has already been learned in the Imaginative Experience. Dr. De Palma highlighted how much a transplantation, which is considered “routine” nowadays, already breaks into the recipient’s psychic life, arousing adjustment, assimilation and accommodation’s trends. This transversal impact induces different symptoms, including anxiety, stress, depression, which cause on the patient a crisis due to disturbances in his own body image, self-representation, identity, in addition to the already mentioned obstacles in the perception of his new self-belonging to the transplanted organ (psychological rejection). The body image, as our own body’s psychic representation, lasts despite the change (we modify the image of our body even during the pain and the suffering; yet still the identity, the biographical answer we give to ourselves, remains within the alterations). The relationship between the Corporeal-Imaginary Ego and the Psychic Ego is profoundly changed because of the dissociation between bodily and psychic images (we can understand it if we examine the psychosis cases). The muddled mental adjustment, within the transplantations, involves two phases: first, when the familiar piece has been removed (sorrow), as deprivation of a belonging; second, which is characterized by an oppressive sense of guilt caused by possessing something unduly (because it is property of someone else, who is deceased).
It’s here that Dr. Passerini’s relation, entitled “The inhabited body”, begins, opening with the concept of “accorporation”, recalled at the end of her speech by Dr. De Palma; “accorporation” is the union between integration and incorporation, using Dr. Passerini’s words, a proper junction of a sentient being; it’s that precise indissoluble meeting point between interiority and exteriority, because he is not only appointed to a body but he is his own body (this is glaring in psychosomatic patients, who falsify, in their pathology, every dualism because they use the body to stage inner conflicts). The patient, through the imaginative procedure, pours into the somatization the traumatic psychic experience, as evidence of the Self Relational Ego, related to himself, to the others and to the environment. Holding firmly the information explained until now by the speakers, how could one consider “a healthy patient” a patient whose body no longer has any factor in common with his history? The problem of identity, right from the first lesson of the Masterclass, appeared central in the debate inherent the attempts of the Turinese neurosurgeon. Even under the articulations of the psychological sciences, it’s metaphorically assimilated to a sort of Commonwealth where the members vary, but the substantiality, completely incorporated in the relationship between the parts, is rooted. The fear is to return to a patient, in order to make him feel healthy through a body different from his own, an existence strongly torn in psychotic conditions, where the bodily condensations recombine the identity as sum of history, temporality, biography, otherness and corporeality. It could be wondered if it would be acceptable a proportion of risks / benefits where, on a scale, weighs the well-founded fear of a “delirium of de-personalization”, due to the perception of a split, foreign, recombined body?
According to some mindsets, the human being could be reduced to cerebral activity and content or, by other means, to the information inscribed in his genes, from which what so many call “genomania” was born. These are penetrating linguistic twists, descriptive of a specific type of man, which the experts Dr. Chiara D’Urbano and Dr. Pasquale Ionata, psychologists and psychotherapists, scatter thanks to the psychodynamic experience. Dr. D’Urbano sums up the dense and rich picture until now analyzed both in the round-table seminar, that has seen so many professionals participating, and from the opening of the Masterclass itself. Dr. D’Urbano offered a reflection whose principle is exquisitely anthropological and philosophical, referring to the first introductory lesson on the Transhumanist and Posthumanist movements. It is useful to remember the principles since they themselves demonstrate the ambivalence on which a great part of contemporary society is culturally nourished: the exaltation of the body and of aesthetics until its empowerment and, at the same time, the mortification of corporeity in favor of the cerebral matter alone as summary of the human being himself. The patterns of attachment, the synergy between mind-body and the brain, and relationality, are examples of how life, since its origins, is a path of adherence and adjustment in view of an inexhaustible construction of the identity and of our self-understanding. “Mentalizing”, or “keeping the mind in mind”, indicates exactly the amount of literature that a good reader, as we are with ourselves, must accomplish by looking at himself in his own entirety.
In a head transplantation situation is it plausible to suppose disintegrative states of personality? Asking this question, Prof. Ionata addressed the participants at the end of his report on the exchange between the three brains of man: the cerebral one (whose highest expression is creativity), the cardiac one (whose highest expressions are compassion and love), the enteric one (whose highest expression is courage). These three brains communicate with each other through the vagus nerve, at the point that it has been shown that the greatest quantity of informative material performs movements from the bottom to the top, and not vice versa. The importance of not looking at the person as an assembly of parts and components, as if they were roommates each having its own privacy, refines the critical gaze, so that it cannot be unprepared in cases such as those presented by the professor, for example those following cardiac transplantations. The intrapersonal relational mind is the ability to make the unconscious conscious; to grasp the wisdom that flows from the dialogue between the conscious and the unconscious mind. The activation between the three brains restores consistency to our somatic relationship with the mind, which is very often paraphrased with “psychic abstraction”, while it is actually the unity of an integrated whole. If we consider the dynamism unveiled by enteric or cardiac dreams, how do we guarantee a permanence, a stability to the relationship, in a body transplanted on a cerebral brain which is extraneous to the other two new correspondents brains? A chaotic nothingness is the more plausible and realistic scenario, aggravated by a nonexistent memory, in a patient who would find himself impaired in his ability to respond to himself.
Such a dense experiential content demands in turn for a weighted metabolization, in order that a new piece can be added to the interdisciplinary mosaic that the Masterclass is proposing; but it is equally true -as suggested by Dr. Viviana Kasam- which immediately urges a curiosity about the limit of human action, stimulated precisely by its relapses. These are the questions that Dr. Kasam, president of BrainForum Italy, extended to all those who, faced with the rapid advance of technology, perceive the duty to dwell on this dynamism with a critical gaze. The launch of the second edition of “Cinema & Brain“, which this year will take place in Milan, through the initiative “Neurofiction. A plausible future?“, is functional for this purpose, in so far as there will be a debate, on the occasion of the screening of the film “Frankenstein Jr.” (1974), between the coordinator of the GdN, Alberto Carrara, and the neurosurgeon Sergio Canavero, which will summarize the main theme of our Masterclass: “Head transplantation: the hunt for immortality“. Recalling Prof. Carrara’s initial thought on the posthumanist inspired scenes presented at the recent Gucci’s runway show – cinematography, art, fashion are channels for solicitations and a socio-cultural effect quite in line with the more widespread common feeling. Therefore, through the provocations launched by the Milanese event, we will find further pressure to ask ourselves where the limit is and when the reliability of our awareness is put into crisis by the power that a decision, such as the consent to the head transplantation. The UNESCO Chair in Bioethics and Human Rights is carrying out extensive research on consent, so that the network woven by a man’s decisional freedom can be said to be protected in times of vulnerability.
By Giulia Bovassi –
Neurosciences’ field of action surprises in depth, involvement and extension, as evidenced during the Interdisciplinary Neuro-bioethics Research Group (GdN) last meeting, held last 9 February, having as its protagonist the hypnotic experience in psychotherapy and in the palliative care field.
Dr. Patrizio Borella, President of the Research Center for Clinical Psychology; dr. Costantino Casilli, Scientific Director of the four-year School of Specialization in “Cognitive Hypnotherapy” and, in closing, Dr. Maria Paola Brugnoli are the three voices that chaired the substantial discussion held last 9 February, entitled «Hypnosis and cognitive hypnotherapy. The hypnotic experience in psychotherapy and palliative care”. The meeting, organized by the Neuro-bioethics Research Group (GdN) of the Ateneo Pontificio Regina Apostolorum (APRA), introduced by the coordinator of the Group, F. Alberto Carrara, in collaboration with the UNESCO Chair in Bioethics and Human Rights and the Science and Faith Institute, aroused curiosity, stimulating medical, psychological, ethical and spiritual questions about the interaction between the hypnotic experience and the suffering person.
As emerged from the introductory notes of the study session, dictated by the reflections of the Rector of the European University of Rome, F. Pedro Barrajón, together with the Director of the UNESCO Chair in Bioethics and Human Rights, prof. Alberto García, the common impact, facing those who apply hypnotic techniques, is a widespread sense of fear typical of those who, for this therapeutic approach more than for others, feel not to fully understand its modalities and effects. Many people tend to generalize the mislead and distorted uses of hypnosis, combining them with a concession, a power conferred, or suffered, by the one that performs it, who deprives the patient of the full control over his person by entering, precisely for this reason, in his inner and more intimate part. This “resistance”, as rightly pointed out by prof. García, is often caused by a “to not know”, turned into a “to know to not know” during the experts’ reports. It is intuitive to legitimize such concerns if we lower this state of mind in the cultural “humus” and in the forma mentis of societies tightened in the grip of the necessary control over every element of one’s own existence; just as it is equally evident how the problem of the mistrust in the doctor-patient relationship, verifiable without difficulty, is amplified within a practice in which abandonment and presence coexist in such an intense manner.
Dr. Borella, describing modalities and curriculum of the four-year School of Specialization in “Cognitive Hypnotherapy” based in Florence, which is the unique school in Italy qualified to teach the cognitive hypno-therapeutic model, took care to remove some barriers, such as the media influence on the understanding of hypnotic therapy, considered just like the therapist’s passive conditioning on the patient, when instead the second one radically works on the interaction and his participatory presence in the investigation executed on himself; reason why the model taught in the Florentine School does not split theory and practice in two independent blocks.
As underlined, relying on what he personally learned during his clinical experience, by the Scientific Director of the School, the specialist Costantino Casilli, it’s fundamental not to scientifically convince towards the hypnotic practice, but to move urged by the interest for the person and the absolute centrality that he occupies in this sector. The task of the hypnotist is to approach the person by understanding how this helpful relationship can be useful to the discomfort bore by the patient, on which one it is operated through the alteration of the states of consciousness (comparable to conditions of meditation or strong concentration), defined also “dis-perceptive phenomenon” or temporal suspension. Hypnotic induction can follow three distinct modalities: classical induction; imaginative techniques; Ericksonian techniques. The last of these different methodologies is the most functional, apt to guarantee an autonomous mastery to the patient on the path he performs together with the therapist.
This entourage, therefore, is different from the binomial order-execution, so much that it could be confirmed the guiding role of the patient on the orientation given to the therapist in the trance condition, which is already defined, adopting a broader view, the driving force that leads the patient to expose his inner conflict, by whom he is smothered, towards another human being, a stranger, who is dragged into spaces from which the patient himself is hiding. The examples of obsessive or phobic people, with whom hypnosis requires very accurate analysis, have shown the concern for the single problematic experience, adopted by a professional able to carry out an healthy work of discernment both on the patient’s structure and on his own, in order to remain firm in the privacy of a world in which he always enters as a guest.
It has been highly involving and rich in bioethical references, the research lead for many years by the expert Dr. Brugnoli, palliativist, anesthesiologist-resuscitator, with a Ph.D. in Neurosciences and the GdN membership. What has been anticipated during the presentation, namely that the focal point of this round-table lies in the centrality of the person, finds here a very delicate sensitivity, both because of the “care provider-patient” interrelation existing in conditions in which pain, suffering are made more acute and unbearable, and because of the renewed awareness, the healthcare staff is called to make its own every day, to stop not at the feet of a pathology, but of a sick person, protected in the complexity of body, psychic and spiritual dimensions. Three components also affected by the torment of an unbearable evil: physical pain sometimes becomes psychosomatic suffering and this two drag the patient towards the question of meaning, raising it to meditative, spiritual places that offer unique experiences where the mystery of the human being could be approached. Many studies confirm the occurrence of identical brain reactions during hypnosis and meditative conditions, situations in which the brainwaves tend to progressively slow down; there is even the feeling that the brain, from a functional point of view, temporarily switches off, which is what we read in many religions in relation to mystical experiences. It provokes our intellect that the higher stages of inner awareness, the most beautiful mystical experiences, have occurred together with very slow brainwaves, perhaps because, like approaching death, they hide that feeling of the immortality that inhabits the soul.
Within this scenario, hypnosis propose itself as means of relief from agony over the usual remedies, and it is interesting how the study of the interaction between hypnosis and pain brings the attention on the unity-entirety of the person, including a body which, due to illness, no longer finds perfect correspondence in what its history narrates. For this reason, Dr. Brugnoli specified that hypnosis opens transversely to the spiritual dimension.
Pedro Barrajón, in his opening consideration, underlined the contact between science, technique, human intelligence and the service they grant in order to aid the human being, specifically the ability to tolerate pain, finding, during its happening, the finiteness itself of the creature; but, at the same time, the right of the individual to use ethically licit means to endure it and soothe it. Adopting this perspective, remaining loyal to the principle of precaution, hypnosis as “support for the physician”- as classified by Pope Pius XII – figures as soothing help for the person who suffers.
It would be simplistic to consider what the experts exposed as pure notion: there has been a central idea, from prof. García’s immediate appeal to the person, towards the origins of bioethics as a bridge between individual knowledge, never totally autonomous in the responsibility to which, together, they are called to account in their work. A super-structural perspective is given, beyond religions, beyond the cultural and philosophical differences, firm as it respects diversity: we have to listen to vulnerability, alarm bell of universal domain, reminder of humanity, aware that, even for those who feel themselves exhausted, fragility becomes nourishment, if it’s cared by charity.
By Dominic Farrell LC –
Two professors from the Pontifical Athenaeum Regina Apostolorum, Dominic Farrell LC (Faculty of Philosophy) and Joseph Tham LC (Faculty of Bioethics), took part in an International Workshop on Public Reason and Bioethics at Chinese University of Hong Kong (4-5 January 2018). The workshop was organised by the Department of Philosophy and Centre Bioethics of CUHK, and supported by a GRF grant.
The concept of public reason has come to the fore of political philosophy since the 1990’s, largely due to John Rawls influential writings. In increasingly pluralist societies, it is necessary to find reasons which all members of the public can endorse when it comes to important political decisions, including those on bioethical matters.
Prof. Alastair Campbell (Visiting Professor in Medical Ethics and Emeritus Director of the Centre for Biomedical Ethics, National University of Singapore) provided an introductory explanation of how bioethics has come to have some need for the concept of public reason.
The central part of the workshop consisted of the presentation and discussion of three rival versions of public reason, and each one’s bearing on bioethical issues.
The case for a liberal conception of public reason was made by Prof. Terence Hua Tai (Distinguished Professor, National Cheng Kung University, Taiwan) and Prof. Hon-Lam Li (Department of Philosophy and Deputy Director of the Centre for Bioethics, Chinese University of Hong Kong). Prof. Tai outlined Kant’s conception of public reason, explaining how it differs from the standard liberal accounts of public reason and proves more flexible than is commonly imagined. Prof. Li proposed that T.M. Scanlon’s contractualism provides the best available basis for public reason and for addressing the issue of physician-assisted death.
Prof. Ruiping Fan (Chair Professor, Department of Public Policy, City University of Hong Kong) assessed the proposals, made by several scholars, of a Confucian conception of public reason. He argued that the only viable Confucian conception of public reason is a reconstructionist one, that is, one which draws exclusively on the Confucian tradition’s own internal resources. He also considered how Confucianism would address the issue of physician-assisted suicide.
Prof. Dominic Farrell and Prof. Joseph Tham argued that the natural law tradition provides a sophisticated account of public reason. By conceiving public reason as a shared truth-directed enquiry regarding the common good of political society, it does not bracket but acknowledges the second-order issues which legislation on bioethical issues must inevitably address. Political liberalism, by bracketing these issues, runs the risk of making arbitrary legislative decisions on important bioethical issues. Furthermore, the natural law tradition’s philosophy of law provides reasons for restricting the scope of legislation on such issues.
Dr. Michael Campbell (Researcher, Centre for Ethics as Study in Human Value, Department of Philosophy, University of Pardubice, Czech Republic) provided a critical assessment of the concept of public reason, recognising the need for it, but also pointing to the problems surrounding it.
Due to the friendly and reasoned exchange of views, the workshop was, much to the credit of CUHK, a miniature exercise of public reason in bioethics.
By Michael Baggot –
UNESCO Chair Fellow Joseph Tham presented the book Religious Perspectives on Bioethics and Human Rights at the Baptist University of Hong Kong on January 3. The work is based upon texts presented and discussed at the same university in December 2013. The various contributions all analyzed Article 12 of UNESCO Declaration on Bioethics and Human Rights on respect for cultural diversity and pluralism, which states: “The importance of cultural diversity and pluralism should be given due regard. However, such considerations are not to be invoked to infringe upon human dignity, human rights and fundamental freedoms, nor upon the principles set out in this Declaration, nor to limit their scope.”
Tham offered a general overview of the process of discussion that gave rise to the book. He noted the unique dynamic of the Bioethics, Multiculturalism, and Religion workshops by which participants both present their research and receive substantial feedback from colleagues so that their final printed essay might benefit from the insights of others. He also discussed the different problems faced in the areas of human rights and cultural diversity discussed by various papers in the book. In particular, there tends to be a fundamental divide between those who take a thin or practical approach to the universality of the human rights and those who take a more thick or substantive approach. The former usually promote a minimalist ethic, secular reasoning, pragmatic agreements, rights language, and decry ideologies. The latter, on the other hand, normally promote a richer ethical discourse, address the importance of metaphysics and religious faith, admit religious particularity, and emphasize duties.
Prof. Kai Man Kwan, a co-editor of the book, spoke on human rights from a Christian perspective, tracing its roots and mentioning the importance of what the first-generation of human rights advocates promoted as basic rights. He then traced the historic developments that have led to unjustified attempt to multiply dubious rights. Prof. Ellen Zhang spoke about the difficulties faced in Buddhism regarding the rights language, since it is a tradition more interested in spiritual liberation than individualistic claims. Prof. Jonathan Chan, another author of the book who was present, spoke about Confucianism its great difficulties accepting human rights. A lively question and answer session confirmed the relevance of the book’s subject and the need for ongoing dialogue and debate.