Why Publish?

I came across the following post earlier today The Rebbetzin’s Husband: Why Publish?.  He writes about the question of whether there is value in writing another book, as their are so many books out their about almost all topics, many of which become neglected over time.  I was thinking about the dilemma of whether to write or not, let alone to try becoming a published author.

Why do people write?  Some write as a means of expressing themselves on paper.  Others use writing as a form of communication when studying something by oneself.  I personally use writing for both of these reasons as well as a spiritual exercise at times.  Many write professionally, others write as a hobby.  With that said, the value of publishing a book, in my opinion, is not about prestige.  Most publish, especially those writing non-fiction, because the person believes something in their writing has value for others to read.  Writing can be a potential source of extra income, even in today’s world of the digitized book.

I often struggle with the question of whether anyone should care about what I write.  However, I then realize that my true audience is myself first, as I use writing to collect my thoughts and express my ideas in a manner that makes them clear.  If others read it, I am delighted.  If people don’t, I can’t see writing as a waste of time for it still fulfilled my other stated goals.

 

Gates underlines the dangers in the Middle East – The Washington Post

Gates underlines the dangers in the Middle East – The Washington Post.

Gates is discussing a political reality that has I have noticed for many years, starting with Yugoslavia.  Many countries ruled by dictatorial regimes have remained countries through the tyranny and despotism of its rulership.  What we are witnessing now in the Middle East is something that began with the fall of European Communism in 1989 and the removal of Saddam Hussein from Iraq not too long ago.  The wave of “democratic” desire is opening of the Pandora’s box of ethnic and national fervor for the various ethnicities and nationalities occupying these countries.  If we look at Yugoslavia, we see the potential results.  The former states, after years of fighting, have for the most part divided along more ethnic lines to form states run by each of the primary ethnicities of the area.  Iraq and Afghanistan are facing the same problem.  Both nations are having difficulty establishing a solid government because of the fears each group has to allow another nationality lead the way.  This has been one of the major flaws that was started by the League of Nations and the now defunct European empires when realigning the Middle East.

Grief from a Mussar Perspective

In the March e-letter from the Mussar Institute, Alan Morinis writes about grief and despair.  I want to share some of his thoughts (Mussar Institute – Through a Mussar Lens).

As much as we may be tempted to do so, we’re not supposed to seek distraction during shiva because our task at that time is to grieve, and grieving requires that we open up to our sadness.

Shiva, as with all Jewish rituals, is also an opportunity for spiritual practice.  While this is a practice one should not seek to experience, the need to grieve and experience sadness is the crux of Shiva.  Shiva is a time of reflection, not just personally but also communally, and laughter and happiness can be experienced through the lense of sadness of loss.  If you will, the happiness of shiva is the happiness within sadness ala the sefirotic intermingling fo sefirot i.e. Hesed shel Gevurah… 

… A broken heart will not kill us. In fact, we’re taught that a broken heart is a valuable thing.“The sacrifices HaShem desires are a broken spirit; a heart broken and humbled, O HaShem, You will not despise” (Psalms 51:19).

That is not to say that God wants us to be broken-hearted, but that in our times of sadness, it is spiritually beneficial and desirable to allow the heart to break and the tears to flow. We are encouraged to do this from the depths of our hearts. Or, to put it another way, we are taught here that being stoical is not a positive spiritual value in Judaism. When it is time for the heart to break, it is meant to be broken.

Allowing the heart to break is a surrender of will and ego. We try so hard to control our lives and, indeed, in many situations that is ideal. But the process of grieving is not helped along by asserting will over feeling. Giving ourselves over to grief is an act of courage in the face of the strong emotions that arise from loss. Opening wide the gates of tears means not being intimidated by the strength of those feelings. It means recognizing that they are part of the fabric of life, dark threads perhaps, but not contrary to life itself…

When we surrender the heart to its grief, we are being true to love and life. There is a limit, though. Despair is an extreme form of grief that does not bring about healing. Rabbi Yitzchok Hutner (1906-1980, late Rosh Yeshiva of Yeshiva Chaim Berlin in Brooklyn and a student of Slabodka Mussar) clarified the difference between sadness and despair. “Despair,” he said, “is being tired of living.” It’s a hopeless state, and that can’t be an attitude we would be encouraged to embrace on a journey of ascent. Right in the Torah, God says, “I place before you life and death, blessing and curse. Choose life.” (Deuteronomy/Devarim 30:15). To accept despair is to make the opposite choice. No matter how grim a situation that comes upon us in life, the spiritual challenge is to believe in life, to make that choice, and to hope, even as we cry.

 Grieving is a process of letting go of self and allowing one to be overwhelmed by sadness.  Yet, as a process, on some level Judaism makes it time bound to the periods of mourning as prescribed.  This does not prevent from experiencing grief outside the shiva or sheloshim, etc. but it does give one a potential formula for the process of grieving.  The use of this time for the spiritual practice of being broken-hearted and sad must be time bound as a means of framing the periods for practice.  A practice unchecked could be more dangerous than good. 

Here we come to a couple of Mussar practices that show us ways to sow seeds of life even while experiencing the deep pain of a broken heart.

The story is told about the mother of Rav Simcha Zissel Ziv, the Alter of Kelm. The Alter’s mother was renowned for her piety and scholarship. One of her practices was to pass among the crowd at a funeral to collect charity for poor people. When her own small daughter died, she did not change her custom and circled among the assembled during the funeral with her tzedakah box, saying, “Just because I myself am mourning, do the poor of the town have to suffer?”

The custom of giving charity while mourning is well established. The Talmud tells us (Bava Batra 10a) that tzedakah is stronger than death itself and, in that sense, overcomes the loss of death. Non-monetary giving can fit the same bill, if mourners contribute time and effort to helpful causes.

Giving for the sake of others is a “sowing of seeds” that lifts a person out of their sense of isolation and personal loss, bridging the gap from isolated self to another. It’s perhaps with a similar thought in mind that a mourner is not permitted to say kaddish alone, but only with a minyan of at least ten.

Another practice was given to me by my Mussar teacher, Rabbi Yechiel Yitzchok Perr. He once told me that at funerals, he thinks about the person who has passed away and reviews that person’s qualities, seeking to identify a trait in which that person was stronger than he is. Perhaps he sees that the person was more committed to performing chesed (loving-kindness) or patience or generosity stronger than him. It could be anything like that, and surely everyone has at least one such admirable quality. Rabbi Perr then commits to practicing that middah in order to strengthen it in himself. In that way, he honors the memory of the departed in a very concrete way that actually keeps that quality alive in the world. You could say that a part of the person has not died but lives on, now embodied in the person who has undertaken to honor him or her in that way.

Rabbi Eliyahu de Vidas writes in Reshit Chochmah that love is the merger of two nefesh-souls. Loss, then, is a tearing apart of that merged soul, and so the pain is very real. Grief is healing. So, too, are constructive actions taken to connect self to other, even amid the tears. 

The primary lesson from here is that grieving and sadness is a sign of living and experiencing.  While the practices might be challenging when one is a mourner, it is nevertheless of benefit.  The key here is that we should practice before we ourselves face the tragedy that is loss for if we become accustomed to an action, we might find a sense of nechama in that same action when we are grieving.  Grieving is not a time to shut the world out but it is a time to feel the pain and to begin reframing that now broken heart into one’s life.

crossposted at http://steinhospice.blogspot.com/

Kenneth J. Doka: Understanding The Spiritual Needs of the Dying

Kenneth J. Doka: Understanding The Spiritual Needs of the Dying.

Kenneth Doka is the senior consultant for the Hospice Foundation of America.  Every year, the HFA organizes a conference on a topic that relates to end of life care.  This year’s conference will focus on Spirituality and End-of-Life Care.  Excerpted in the Huntington Post is his introduction to this year’s conference. 

Do individuals become more religious as they die? This question has often been debated among academics who study death. Such debate avoids the central issue that the dying process raises profound spiritual concerns of meaning and connection for individuals. Whether those who are dying reconnect, review, or renew prior religious beliefs — or are even open to new religious experiences — they are likely to engage in some form of spiritual searching.

That search may be deeply religious or not, but it is always spiritual, and it can occur whether the person was traditionally religious or followed another belief system, whether the person was a humanist, atheist, or agnostic. Despite this reality, spiritual needs of the dying are often overlooked or ignored by family caregivers, clinicians and even clergy, who may be uncomfortable with spiritual searching by the dying and with conversations that may occur that have strong spiritual significance.

There are certain basic human needs that exist as long as we live — comfort, connection, and care, but there are also three distinct spiritual needs that arise as individuals become aware of their finitude, or the sense that their life is now severely limited.

The first of those spiritual needs is affirmation that the dying individual’s life has had meaning. We all would like to think that our life counted, that it mattered, and that at least in some small way, the world is different and maybe even better, because we were part of it. This often prompts an individual to perform his or her own life review process to affirm that life had meaning and value. For Erik Erikson, a developmental psychologist, a successful life review means that we can view life with “ego integrity,” or a satisfaction that we have lived a worthwhile life. The ultimate goal of life review is that one’s life should be a “good story.” If the life review is not successful, a dying person may perceive that his or her life has been wasted, leaving the individual with a sense of despair as death approaches.

To encourage the reminiscence that is an inevitable part of that life review process, friends and families can offer terminally ill person a gift of sharing old photographs, trading stories, or, if the person’s condition allows, facilitating pilgrimages important to the person’s shared past. For example, a family whose grandfather served in Korea might take him to the Korean War Memorial. A person who enjoyed the ocean can be driven to the beach to watch and listen to waves crash and smell the surf. Someone who enjoyed a particular tradition of a family feast, such as Thanksgiving, can be treated to flavors and smells that exist with that meal. Yet perhaps the greatest gift that can be shared in the life review process requires only honesty and communication and is achieved by letting the dying person know the ways that he or she influenced or affected our life.

In addition to the need for a life review to be a “good story,” the awareness of finitude often engenders concern with a second spiritual need: dying an appropriate death. This need is the desire to die in a way consistent with the individual’s values, wishes, or earlier life. On a practical level, this might mean that a dying individual is intent on instructing their adult children about their estate, advance directives, even their wishes about funerals and other rituals. These conversations can be difficult for families and others at the bedside, as it easy to fall into the “mutual pretense” that can accompany dying — that is, a shared pretense that it is not happening. Yet such a stance can often stifle the legitimate concerns of a dying relative that his or her dying wishes are understood and respected.

It is important to listen to the dying person’s needs and not impose one’s own fears, beliefs, or biases. There is no one way that we should die, because there is no correct way to die. The dying need not “accept” death, nor utter whatever “magic” words others think we might wish to say. Edwin Shneidman, a leading thanatologist (one who studies death), put it wisely — “no one has to die in a state of psycho-analytic grace.” Each individual will find his or her own way to die — consistent with the way he or she lived. To some it may be a peaceful, even graceful, acceptance of the inevitable. To others it may be to bitterly fight to the end — burning and raging, not going gently into that night. Still others will select Woody Allen’s dictum; “I don’t mind dying — I just don’t want to be there when it happens.” We need not impose our beliefs of a good death on those around us.

The third spiritual need of the dying is to find hope beyond the grave. A person may find this in complementary ways by finding comfort in faith, religion, and spirituality. An individual may take comfort in heaven, an afterlife, reincarnation, or some form of transcendence. There may be other ways that the dying reach for a form of symbolic immortality as well, including finding solace in the notion that they will return to the cycle of life or that they will live on in our progeny, work, and accomplishments.

The important thing is to remember the lesson that Dame Cicely Saunders, the founder of the modern hospice movement taught us. Dying is more than a physical event. Rather the experience reaches us on all levels — psychological, social, and of course, spiritual. We cannot neglect the spiritual needs any more than we can neglect the physical needs. Care for the dying is inherently holistic.

When dealing with people facing their own mortality, and by extension one’s family, it is best to provide people space and opportunity to share about life as they experienced.  With that said, for many of those receiving hospice care, they are no longer able to share about what life meant to them and what meaning they have in life.  This is a time when families can also begin the grieving process by reminiscing on how their loved ones affect their lives.  I quote the whole piece because it really speaks to the core of the need for spiritual support in end-of-life care.  Having people trained to help unlock meaning and provide people a space to share that spirituality is the core of chaplaincy.  To merely visit, spend a few minutes and pray, while certainly having value, is not the where chaplaincy really makes its mark. 

Chaplaincy work is the ability to recognize and help people explore their beliefs and their lives in reflection.  It is a role that is designed to close the gaps between the dying and their loved ones when there is a difficulty in communicating each others fears and tears. 

Death is difficult, regardless of one’s spiritual, religious and cultural mindset.  To prevent people from exploring what that difficulty is is a detriment to growth even during these final stages of life.  I often speak to my residents in the Assisted Living facility I work in about how one can continue to strive forward in life, regardless of age.  There is always a place to grow in spirit.  Being more “religious” for most people feels burdensome and is more difficult due to ingrained habits.  To change one’s response to others and how one lives and appreciates life is always something that can be accomplished.

‘They won’t understand how the world can continue’

Rabbi Seth Mandell, whose son was murdered by terrorists, talks about grief, the mourning process and why revenge is not the way.

via ‘They won’t understand how the world can continue’.

I am sharing this piece for two reasons, neither of which is political.  The first is a personal note.  I had the pleasure of learning with Udi when I was studying in Yeshiva Shaarei Mevaseret Zion in 1998-99.  Udi was a member of the Meretz Kollel that we shared the Beit Midrash with.  I remember both him and his wife as warm and sweet people.  It was with him that I first ventured into Nefesh HaHayyim, one of my favorite Seforim to learn.  I am deeply saddened by their murder. 

The second reason is that I found Seth Mandell’s words to the Jerusalem Post to be the most on target of all the responses so far.  Granted, much out their is from anger, which I certainly feel as well.  Yet, Mandell’s main point is that the family that is grieving will have tremendous difficulty in the coming years.  The Fogel’s surviving children and parents will have to live with the loss in a way that all of us who are saddened cannot begin to understand.  The most telling words came from Udi’s brother:

Udi’s brother Motti said: “All the slogans about Torah and settlement, the Land of Israel and the Jewish people try to make us fotget the simple and painful truth: You are gone. You are gone and no slogan will bring you back. Above all, this funeral must be a private event. Udi, you are not a symbol or a national event. Your life had a purpose of its own and your horrid death must not render life into a vehicle. You are my brother and shall remain my brother.”  (20,000 attend Itamar Massacre victim’s funeral) 

Rhetoric in grieving tragic losses often come from outsiders, while those on the inside have to mourn the loss of their own blood.  It is the family that remains when life continues.  My hope and prayer is that the Fogel family find solace in each other and look beyond the politics so that they can truly grieve their tragic loss.

The Cost of Dying: End-of-Life Care – 60 Minutes – CBS News

The Cost of Dying: End-of-Life Care – 60 Minutes – CBS News.

I recommend this clip, about 20 minutes long, about how end-of-life care can be less costly than many of the agressive therapies people avail themselves of in their older years in the attempt to live longer.  I will leave the politics of this clip to others. 

I want to focus on the issue of discussing cost when it comes to people’s lives.  In the medical ethics debates today, two of the principles used in arguing for or against a treatment are the questions of autonomy and distributive justice.  Distributive justice looks at the costs of something in relationship to the society’s ability to absorb the cost.  I always find that in the common rhetoric about hospice/end of life care as opposed to aggressive theraphy, the big point is that hospice care is a means of saving money.  From an emotional, psychological perspective, to talk about the costs of choosing potentially fruitless therapies or hospitalizations is what causes many people to run the other way from hospice care.  The logic is that if one is concerned about the cost of treatment, then it must be that hospice is not going to spend money and just let my loved one die. 

As we know, hospice does not act this way.  The goal of end of life care is not about saving money but it is about a changed perception of what care is appropriate.  Instead of more hospitalizations and treatments which cause physical and emotional stress, a person or family opts to be kept comfortable, meaning kept in a situation in which we care for the pain and suffering part of the terminal illness. 

In other words, people should be educated about hospice as an option when treatment’s are futile or causing more suffering than good.  This is the autonomy principle at work in conjunction with the other ethical principles of beneficence and non-maleficence.  The education about hospice as an option should also include discussion of choice, of how hospice can provide a better quality of life for a person, and how often times people who avail themselves of hospice improve for a while and potentially live longer than someone with a similar prognosis who does not avail themselves of hospice care.

BBC News – New post-mortem method developed

BBC News – New post-mortem method developed.

If this method of autopsy is feasible as a non-invasive method, would halacha now be more willing to allow for autopsy to study disease? “The conventional autopsy process can be distressing for the family and is opposed by some communities on religious grounds.”  For me, both of these points are quite fascinating.  In a time when we are debating the questions of autonomy vs. rationing care, we are still finding that people are working on means to be sensitive to the emotional and spiritual needs of the clientele.