Monthly Archives: July 2014

Jul 27 2014
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You Betcha

We’re either all going to Heaven or we ain’t. – Sonny Steele

When the end comes to this old world,

The righteous will cry and the rest will curl up,

And God won’t take the time to sort your ashes from mine,

Because we zig and zag between good and bad,

Stumble and fall on right and wrong,

Because the tumbling dice and the luck of the draw,

Just leads us on. – Dave Lowery

Pascal’ wager is an oft-dismissed argument for belief in God. On the face of it, the wager in question does look pretty silly. It also seems like a real statement on risk assessment, on the face of it. It is neither. Pascal’s wager is an argument about knowledge and its relationship to truth, and by extension, an argument about the potential relevance of belief in God. The bet is this: if we can’t know whether or not God exists, then we might as well believe that it does, because belief in God’s existence is the more consequential option. The wager admits the God-concept only as a possibility. That is, it is something we can construct from our logical conventions in a rudimentary way. Whatever else you may think of God, it is a concept served by conventions like time and location – or at least, their corollaries, and it is a convention itself in cosmology. We experience a world which permits logic and also surprises us. God provides a possible means of describing our experience. The terms of the wager then bypass the question of God’s actual existence, for reasons which will become apparent. The bet turns instead to the question of consequences. What do you stand to gain or lose when you bet on how you talk about what you know? If there is an actual infinite, timelessness or universality, we won’t notice. Nor will we bat an eye over the truth of our more conventional conventions. In physics, we use meters and seconds to tell the story of motion. You may claim that meters are bogus, but I will still see you standing one meter away from me if you stand one meter away from me. You want to say we can’t do without seconds, that they are written into the universe, fine. Time will still seem to pass for us, but not for the tunneling electron. The case remains the same, even when the conventions appear to make the whole story. In painting, brush strokes serve the role of meters and seconds in physics. The Mona Lisa is the Mona Lisa due to the genius of Leonardo’s brush-work. But if you claim that there is no true art without Leonardo’s technique, the fans of pointillism suffer no calamity. All bets on the absolute truth of our conventions are bets with play money. We may feel the effects of the adequacy of our depictions as a whole. An astronaut may be quite concerned that our meters-and-seconds story about motion makes a good prediction. An admirer of the Mona Lisa can make a pretty good case that it is better art than a child’s stick figure. But the meters, seconds and brush strokes themselves, cut from the story and laid on the table? Those are fluff. Go all in with them. Who cares? Those ideas have meaning – are true – locally, in context. We can’t parley them into larger, certain truths.

But the mechanics of the bet are only half the story. Because, Pascal’s Wager can be taken not just as a commentary on our grasp of truth, but as a description of what we actually do. It accuses us of being vulnerable to its appeal. We have the gall to reasonably expect the posited base of all being to consider our existences in a way which is at all comprehensible to us.

If there is a God, he is infinitely incomprehensible, since, having neither parts nor limits, he has no affinity to us. We are incapable of knowing either what he is or if he is…Reason can decide nothing here. – Pascal

Pascal recognized the absurdity of the situation. Yet, with his (very French) apprehension of the absurd, he recognized the license which absurdity grants. Staking a claim on the incomprehensible is just as insane as declaring war upon it. Our hope in God’s grace is absurd, but hope is something to have, as opposed to everything else at issue in his wager. There is something to gain after all. The real problem is: hope is merely a Pollyanna story. It’s the sunny substitute for a more troubling, and more complete, description of a quality which we really need. We can find some clue about the true nature of what hope papers over in hope’s intransigence. We admire the cancer patient’s noble ability to endure horrible treatments in the name of a brighter future which may never come. The same hope has nestled in the hearts of all those who ever proposed a war to end all wars. Somewhere on the edge of a North African desert, a mother loads her infant on her back, takes her small child by the hand, and sets off from her barren village for another country. This person is not motivated by hope. Her situation is too absurd. Her children will die in her hut, or they will die in the desert. What she exhibits is defiance. Her walk is an empty gesture, an expenditure of life with no other reason behind it. The admirers of hope only flirt with the deep truth of human psychology which she has found at the end of all options. Defiance moves us, though we are loathe to acknowledge it. We can’t gussie-up defiance like we can hope. Defiance is not smart, not sublime, and not rational. It is myopic and has teeth. We can’t blame Pascal and his fellow religious adherents for preferring hope when offered it in lieu of the whole truth. But hope is finally an inadequate convention and not something to have. It is arrogant, and brings the errors of arrogance with it. It makes the woman’s walk into the desert quaint. It readies us for the next war to end all wars. So, we must abandon Pascal’s hope. It is not a worthy prize, for it will betray us in the end. In the light of a wider window on ourselves though, there is another bet to make. Either our existence is somehow concordant with some incomprehensible entity or it is not. If it is, then we live in defiance of an eternal other, and incomprehensible, existence which is our final fate. If it is not, then we live in defiance of an incomprehensible judgment. Either way, we carry on as we were, in defiance. Our best bet is that God is irrelevant.

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Jul 05 2014
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climbing

Vedauwoo

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“What did you do today?” I asked.
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“Got my ass kicked,” he replied with a smile.
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I just laughed. Only from climbers do you get such an honest answer to that question, with no attached complaint.
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I was glad to get my ass kicked too. We all expect it at Vedauwoo.
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It isn’t the offwidths or even the rough, yet slick rock. It’s the thorough tradiness of the area. It’s a place where anchors have been consolidated and ratings have been downgraded. It’s a place where your two pitches of straight-forward climbing are complicated by thunderstorms and brutal wind.
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It’s a spectacular place. It kicks your ass like a neat glass of Laphroaig. From the Rat Brain (go see it – pros, mes, and telencephalon made of stone), to the parking lot wildlife, to the battling guitars of the Kolorado Kampground Kids, it’s charm is unique, and it will own you.

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Jul 04 2014
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medical ethics, medicine, philosophy, psychology

They Solved It! They Solved It!

Geriatricians have solved the hard problem of consciousness! From the July 1st issue of American Family Physician: “Some validated scales, such as Pain Assessment in Advanced Dementia…use objective measures to assess pain intensity and response to intervention.” The objective measures: abnormal breathing pattern, increased vocalizations, observed tension in the face and body, and capacity to be calmed by caregiver voice and touch. In short, agitation is synonymous with pain. And how do we know this? Because the researchers have observed that opiates attenuated agitation in their subjects with advanced dementia. That’s how the scale and its underlying assumptions were validated at once.
Many have questioned the utility of philosophy. Well, here it is. The PAINAD scale is valid, no doubt. This is something that can be determined by definition. If two different people observe the same demented patient, it is quite likely, predictably likely, that the observers will come up with the same score on the scale. But that begs the question. The real problem is not coherence. Coherence does not make truth. The real problem is the truth of the claim that agitation represents pain in a person with advanced dementia. Such information is not available to us, at least not in the defined, quantifiable way which we would prefer.
We can’t know anybody’s pain, really. That’s because it is everybody’s pain that gives us the concept of pain in the first place. The sensation I experience when I grab an electric fence, for instance supervenes on the action of the fence charger, the conductivity of my body and the ground, activation of peripheral nocioceptors, mediation by inter-neurons in my spinal cord, and finally my thalamus and cortex where it is contextualized as my very own experience of shock. My experience of the shock from the fence, indeed all my pain experience, is unique. In the case of a shock from the electric fence, my experience is trivially unique – to the extent that I can predict my friend’s response if I tell him why he shouldn’t touch the fence. But the pain-concept supervenes on all those unique experiences in the same way that my own experience supervenes on the collection of events surrounding my hand’s contact with the wire. A thing called pain doesn’t appear out of the process. If that were so, I should have ready access to it and the PAINAD scale would be unnecessary. I would just slap some electrodes on the patient’s skull and watch for the pain signature in his cortical electrical activity. But I can’t, nor will I in the future, though I might have such a tool. Cortical electrical patterns might be the narrow point in the pain experience, the place where the difference in my experience and the patient’s is most trivial. But I must still correlate the activity with some report from the individual or a set of individuals in a similar condition. Some kind of PAINAD-type analogy will always be the best that I can do.
So what does this application of philosophy to pain treatment tell me? What use is philosophy? First, it tells me that I should not expect to fix everyone’s, or anyone’s, pain by stimulating their opiate receptors. The experience becomes pain-type only when it is put in context. We can easily imagine pain experiences where the opiate receptors play a very different role. Take the poet’s description of the pain of a broken heart. Do we write off his report entirely as a quaint analogy as opposed to our serious ones? If so, how is his report effective in communicating a sense of the experience to us? What do we say when we find out that he used laudanum and found some partial relief? Addressing the mechanisms of pain can only go so far, because mechanisms only go so far in explaining the painfulness of an experience.
The application of philosophy to pain can save me from a different pragmatist’s mistake in treating pain as well. I’ll pick on my surgical colleagues for a moment. On multiple occasions, I’ve had a surgeon tell me, “Nobody ever died from pain.” Inevitably, this little bubble of wisdom surfaces in reference to a patient whose pain management has passed from the surgeon to myself. My knee-jerk response is to point out that nobody ever died from hip arthritis either, but surgeons are still quite happy to replace hip joints. Yet I understand the pragmatic meaning of the statement: people have died from opiate overdoses, so we can’t just capitulate to a person’s demands for ever-increasing doses of opiates to treat their pain. As noted above, the notion that simply stimulating opiate receptors necessarily fixes pain is misguided. But there is a subtext. Death is measurable. Respiratory suppression due to opiates does something, and therefore it is real in way in which pain is not. When you get right down to it, pain can be ignored. But it isn’t that easy. The human condition won’t be ignored anymore than it will be medicated. The hard problem remains hard. It isn’t hard because our subjectivity is some spooky ectoplasm or narcissistic property. It isn’t hard because our experiences will never move a dial or tip a scale. It is hard because things which explain and are explained have a reality to them as much as things which do something, yet we’re stuck working with the functional things, like the observed behaviors in the PAINAD scale. So we have a tightrope to walk. We can only ever come close to helping others with problems like pain, and only then if we act comprehensively. We can never completely succeed. But that doesn’t mean we must fail. We can just never get too sure of ourselves when we do something like suppress a demented patient’s agitation with an opiate – and think we can call it good.

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