It is no accident that white privilege designed to be both be invisible and weightless to white people. Alison Bailey’s “On White Privilege and Anesthesia: Why Does Peggy McIntosh’s Knapsack Feel Weightless?” extends a weighty invitation white readers to complete the unpacking task McIntosh (1988) began when she compared white privilege to an “invisible and weightless knapsack.” McIntosh focuses primarily making white privilege visible to white people. Bailey’s project continues the conversation by extending a ‘weighty invitation’ to white readers to (...) explore why the metaphorical knapsack, despite the weight of its contents, feels weightless. Here’s the short answer. The knapsack only feels weightless because white people have become anesthetized us to our own brokenness. We are more comfortable considering what white privilege does for us than what it does to us. People of color feel the weight of whiteness every day. The weighty invitation invites white readers to become sensitive to our own insensitivity. To do this Bailey (1) explores white resistance to unpacking the weight; (2) people of color’s testimonies to the daily impact of the weight on their bodies; and (3) how the anesthesia of white privilege distorts our humanity. The article concludes with a McIntosh style list of that the anesthesia of privilege distorts white people’s humanity. (shrink)

General anesthesia provides an alternative to typical laboratory paradigms for investigating implicit learning. We assess the evidence that a simple type of learning—priming—can occur without consciousness. Although priming has been shown to be a small but persistent phenomenon in surgical patients there is reason to question whether it occurs implicitly due to problems in detecting awareness using typical clinical signs. This paper reviews the published studies on priming during anesthesia that have included a measure of awareness or of anesthetic depth. (...) We conclude that perceptual priming, but not conceptual priming, takes place in the absence of conscious awareness. (shrink)

Research on learning under anesthesia has focused on showing that learning is possible in the absence of awareness. However, a simple dissociation between learning and awareness is conclusive only under strong additional assumptions, and the actual state of consciousness of an anesthetized person is difficult to determine. Instead of trying to establish complete unconsciousness, one might employ gradual anesthesia to experimentally vary the level of consciousness in a controlled fashion, checking whether cognitive processes exist that can change in opposite direction (...) to measures of awareness. (shrink)

feelings (brainstem, limbic system). The best scientific synchrony and consciousness.21,27 Anesthesiology, V 105, No 2, Aug 2006.

Little is known about the views of mothers when their children are invited to participate in randomized clinical trials (RCTs) investigating medicines and/or invasive procedures. Our goal was to understand mothers’ perceptions of the processes of informed consent and randomization in a RCT that divided uncooperative children into three intervention groups (physical restraint, sedation, and general anesthesia) for dental rehabilitation.

Anesthesia research has focused on showing learning in the absence of awareness for good practical reasons. Crucially, continued learning during otherwise clinically adequate anesthesia may affect patients’ well-being on recovery. Theoretically, preserved perceptual priming during anesthesia offers a useful starting point for consciousness research by determining the limits of memory function during minimal consciousness. The big question for consciousness research is not to demonstrate absolutely unconscious processing, but rather to map out the cognitive and neurobiological processes that enable conscious experience (...) itself. (shrink)

Alison Bailey’s The Weight of Whiteness: A Feminist Engagement with Privilege, Race, and Ignorance examines how whiteness misshapes our humanity, measuring the weight of whiteness in terms of its costs and losses to collective humanity. People of color feel the weight of whiteness daily. The resistant habits of whiteness and its attendant privileges, however, make it difficult for white people to feel the damage. White people are more comfortable thinking about white supremacy in terms of what privilege does for them, (...) rather than feeling what it does to them. The first half of the book focuses on the overexposed side of white privilege, the side that works to make the invisible and intangible structures of power more visible and tangible. Bailey discusses the importance of understanding privileges intersectionally, the ignorance-preserving habits of “white talk,” and how privilege and ignorance circulate in educational settings. The second part invites white readers to explore the underexposed side of white dominance, the weightless side that they would rather not feel. The final chapters are powerfully autobiographical. Bailey engages readers with a deeply personal account of what it means to hold space with the painful weight of whiteness in her own life. She also offers a moving account of medicinal genealogies, which helps to engage the weight she inherits from her settler colonial ancestors. The book illustrates how the gravitational pull of white ignorance and comfort are stronger than the clean pain required for collective liberation. The stakes are high: Failure to hold the weight of whiteness ensures that white people will continue to blow the weight of historical trauma through communities of color. -/- All rights reserved. No portion of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher. -/- -/- . (shrink)

Bion's unfashionable thought is a challenge for our times in which anesthesia and mass thinking prevail. The themes this book addresses are time and the unconscious. In the present/past, the here and now reveals its relationship with the unredeemable time, which conditions our behaviour and is at the root of a state of hallucinosis in the form of a short-sighted view that is distorted by deep-seated wounds. The book also highlights the resonances with contemporary epistemology and physics that underlie the (...) new paradigm of psychoanalytic field theory. The topic of the unconscious raises questions about its origin and the difference between the Bionian and the Freudian unconscious. In Bion we see an evolutionary, process character emerge, with a double movement of repetition and expansion within a single system in unstable equilibrium, for which there is no conscious feeling that does not also carry with it the shadow of the unconscious. Drawing on psychoanalytic and philosophical concepts this book is essential reading for psychoanalysts, psychotherapists, philosophers and anyone who wishes to understand more fully what it means to be human. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Comme Elle Respire:Memory of Breath, Breath of MemoryFrédérique Berthet (bio)Translated by David F. Bell (bio)La poésie est un système de respiration, c'est fait pour mieux respirer.[Poetry is a respiration system, it's made for breathing better.]—Erri De Luca- Stop!- What?- I can hear you breathing!...- Stop!- Breathing?- Yes!—Paul Thomas AndersonLittle paper-fish cutouts have been placed on the ground, on the carpet.We're in the reassuring '70s stylishness of a doctor's office. (...) The carpet is soft and glistens like in interior decoration magazines, it's with it, in. We couldn't care less about what Dyson vacuum cleaners and "purifiers" boast they can eliminate several decades later: acarids, those microscopic domestic arthropods, human parasites (notably), and airborne vectors of infectious disease (colds, coughs, respiratory distress). No, in the spring of 1975, innocently and self-satisfyingly, the urbane doctor flaunts the opulent carpet with curly pile in his luxury apartment with its state-of-the-art waiting room.In this grand interior of a medical office, a man in a white coat plies his important trade. For example, that day a little girl is re-learning how to breathe. One might think that exhaling and inhaling is learned for life—je t'aime comme je respire, elle parle comme elle respire, il ment comme il respire1—from the very first cry at birth. But in fact, sometimes in life breathing gets stuck between the nasal cavity and the bronchial tubes, between the respiratory tract and the lungs. Progressively, imperceptibly, the organism is short of air, a malicious infection spreads and impairs [End Page 92] alveolar diffusion to the point of respiratory exhaustion: Is it serious, doctor? We must act quickly, very quickly. How to liquify what stopped up the system one day to the point of blocking it—the doctors know what to do.This doctor undertook long, arduous and learned studies. He knows functionally how a living being breathes, how a child lives organically. He can also re-teach the little girl what she no longer knows how to do: inhale, exhale using the full volume of the thoracic cage, regulating the ventilatory flow, solidifying the invisible membranes. In the child's family, everyone knows (and knows how to do) important things, but no one undertook extensive studies, much less studies of the aerial exchanges in the human body. This special knowledge possessed by the doctor (unless special means something else unspoken that would explain why this specific doctor was chosen rather than any other) surrounds him with a padding of respect that creates (and the little girl feels this) a sort of protective continuum between him and the walls within which he sees her, where he practices his kind of calm and slow urbane medicine. It's far from the formidable hospital she has just left, with its spherical apparatus next to the bed aspirating the red and yellow pleural liquid, the "treatment room" where the surgeon, the "butcher" as the nurses call him among themselves, manipulated the drain without anesthesia, with no regard for the child's suffering. The doctor, and his place in the elevated tower, even though they are not to be confused, make for a cozy reception space in which one is comfortable, even in passing.This doctor—who is, in truth, a massage-physiotherapist—is located in a designer high-rise building with a façade decorated by white, pointed features that manifest a will toward an architectural act. On the ground floor, the entrance hall is finished in dark-veined, clear brown marble, and the entry threshold between the exterior and interior is marked by large transparent glass panes that must be manipulated with care. The entrance hall has an intimidating sonority and a useless cold nudity from which one escapes in an elevator where one is surrounded by mirrors and gold buttons and in which one speeds upward silently toward floors, clouds.The designer high-rise is located at the outskirts, the outskirts of a city of recent Olympic stature, where several years earlier Olympic athletes were welcomed and trained to increase their respiratory capacity and... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Chance to CutBruce H. CampbellMy gloved hand reaches for progressively sharper surgical instruments. The prior radiation therapy and recurrent cancer [End Page E3] have made his neck tissues as stiff and hard as an old block of wood; everything appears too dull and feels too dry under the bright operating room lights. I push, dissect, urge, divide, prod, and spread with little effect.The nursing staff keeps to its (...) routine—completing computer entries, retrieving supplies, counting sponges—only intermittently aware that things are not going well at the point of attack. Nondescript music plays softly and the anesthesia machine continues to emit its gentle sounds. The junior resident—assisting me with the first of many neck dissections she will see during her five years of training—grips the retractor as she has been told and dabs the wound periodically to clear any blood or fluid.I glance up to recheck the CT scan. It confirms that this man’s recurrent cancer is just below the next layer of neck muscles. There are also some large blood vessels and major nerves nearby. I am confident, though, that I will be able to expose the mass, protect all of the critical structures, and safely remove the cancer.Curing cancer with surgery is no small feat, mind you. Cancer is, after all, a molecular disease not easily confined to an obvious lump, even though we sometimes refer to a malignant mass being “like a walnut” or “as hard and round as a marble.” The actual disease rests deep inside each cancer cell where the genetic code—the DNA—makes mistake–after–mistake. If cancer is to be cured with a surgical procedure, the surgeon must remove every last cell that is capable of making the same nonsensical, life–threatening error. Given Science’s rudimentary knowledge of cancer cell dynamics and signaling, it’s a miracle that surgery ever works. Yet, we continue to try. And we succeed just often enough to keep on trying.I rearrange the retractors and alter my approach. My mentors would have known what to do next, I imagine. My training included time well–spent with brilliant and technically–gifted surgeons. How would they have approached this case? Their experience and instincts might have told them to open the wound more widely, work the lateral and deep margins first, or position the instruments differently.Perhaps, one of my mentors would have attacked this man’s tumor using the same approach I am attempting but would have known exactly where to exploit some area of weakness that I cannot locate. A few swift, confident moves and he would have held the mass in his hands. “That’s it. We’re done,” he would have said.I met this patient several months ago when his cancer was first discovered and have seen him throughout his course of treatment. Recently, his daughter had accompanied him to the office to review his options. “Treatment has been rugged, Doc,” he reminded me. “The cancer’s still there and they said I can’t get any more radiation. Chemo would only prolong things. I don’t really want surgery, but what choice do I have if I want to be cured?”“Supportive care is an option, but the only curative approach is surgery.”“Well, I’m not ready to quit yet, Doc. I got grand-kids, y’know. I want to watch them grow up.” He nodded to his daughter. “I’m in charge of spoiling her little boys.”The daughter smiled. We crowded around the computer screen to look at the scans. I showed them how the tumor was invading and destroying surrounding structures. I described the surgery and the risks.“There are many things I will not know about your tumor until we are actually in the operating room,” I explained. Surgery in the setting of recurrent disease involves a series of on–the–spot decisions and course corrections. The odds of success are unknowable. “Sometimes, the only way to find out if we can remove the cancer is simply to try.”He took a deep breath and looked at his daughter. “Well then, Doc, if surgery is the only... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:From Impatience to EmpathyStephanie Pierce and Kavita Shah AroraWe gave J.H. a label the first time we met her, as many often do—“Uncooperative.” She was a patient with autism and intellectual delay who had presented to the emergency department (ED) with vaginal bleeding. After receiving the gynecology consult request from the emergency medicine physicians, we were already mentally formulating our recommendations based on the information they told us over (...) the phone. “Does not cooperate with exam,” “no acute surgical intervention is currently warranted,” and “recommend outpatient follow–up.”When we arrived in her room, she was sitting in the hospital bed surrounded by a protective shield of caregivers from her group home. We introduced ourselves as the gynecology team but it was obvious that J.H. could not communicate verbally. Upon speaking with her caregivers we learned that she had Cowden syndrome, a genetic disease that confers significantly increased risks for several types of cancer including endometrial, thyroid, and breast cancers. J.H. had also been having heavy vaginal bleeding, which was difficult for her caregivers to manage, and this was the reason she was brought into the emergency department. After attempting to gain as much information as we could from the caregivers, we started to perform an abdominal exam, which made J.H. extremely agitated. We quickly stopped the exam and the caregivers helped to calm J.H. We remember our mixture of emotions—bewilderment at the agitation and commotion in the exam room full of people, frustration at not being able to complete our exam fully, and annoyance that this “difficult patient” was taking up our limited time between surgical cases. Thankfully, these knee–jerk reactions were quickly replaced by feelings of concern for the patient and the realization of how frightening an experience this must be for her—being in a strange place with white walls and unfamiliar people, unable to communicate her thoughts.J.H.’s mother, her surrogate decision–maker, was not at the hospital that day but the caregivers told us that she had expressed a strong desire for her daughter to have a prophylactic hysterectomy due to her lifetime risk for developing uterine cancer as well as a permanent solution to the bleeding concerns. What had initially started as a simple ED consult was now turning into a complex question. The ethical and legal dilemma was obvious—whether to perform a major surgery that would irreversibly sterilize a patient who could not consent on her own behalf in order to minimize the potential risk of cancer later in life. While medical management could improve the bleeding and potentially reduce the risk of cancer, frequent exams would be necessary [End Page 19] to ensure that the medication was working and that premalignant changes were not occurring in J.H.’s uterus. However, based on our experience in the emergency department, J.H. would need anesthesia for such exams and it was doubtful the medications would completely normalize her elevated risk of uterine malignancy. We knew that in order to address this question, we would need to see J.H. again along with her mother to have a frank discussion about the risks and benefits of such a decision, and so we made plans to see her in our outpatient clinic.Several days later, J.H., her mother, and the group home caregivers arrived in the office. Anticipating a complex discussion, we had requested a representative from the hospital ethics committee to join us at the visit. We didn’t know what to expect meeting J.H.’s mother for the first time but as we sat in the room talking, it was obvious that she was truly trying to act in her daughter’s best interest. Similarly, it was touching to watch the faces of the caregivers from the group home as they nodded in solidarity with J.H.’s mother, also clearly wanting what was best for her and supporting her mother in this difficult decision. J.H., meanwhile, seemed content to sit silently with us during the discussion, surrounded as she was by people who cared deeply for her well–being.After extensive partnership with the ethics consultants... (shrink)

Drug effects on consciousness are powerful probes of how physical processes in the body are connected to conscious experience. Drugs that alter consciousness – producing arousal, sedation, sleep, anesthesia, analgesia, euphoria, amnesia, hallucinations, or psychedelic‐like intensification of perceptions, thoughts, and feelings – have been identified as interacting in various ways with cellular and molecular processes within the nervous system. While the focus has thus far been on synaptic connections between neurons, there is likely to be much more going on in (...) the interaction of drugs with living systems that has not yet been identified. Psychedelic drugs, plants, and fungi are associated with perhaps the most interesting and profound of the drug‐induced alterations of consciousness. Contemporary investigations of psychedelics include renewed interest in the transformational therapeutic potential of these substances, and may also lead to new insights into the nature of consciousness. (shrink)

The Brain Death Reconsidered – Is It a Tenable Concept? Since 1968 it has been recognized in the medical practice that irreversible coma connected with apnea can serve as a criterion of human death. This approach was first introduced in the so called Harvard Protocol. As a result of the work of this commission, the brain-based criteria of human death were quickly legally introduced in America and in most countries in the world. The only symptom on which death can be (...) pronounced is, according to this new definition, the absence of spontaneous brain function. However, the acceptance of the new definition of death did not eliminate the old one completely. In many states both old and new definitions of death are legally valid. Practically, in these countries the alternative definition of death functions alongside the old one and diagnosis of death can be based both on the cardiac/respiratory and brain symptoms. One of the few exceptions proved to be Japan. The law in this country does not provide a uniform answer to the question of what human death is. Instead, it allows people to choose between traditional death and brain death. The law states that if a person wants to be an organ donor after brain death has occurred, he or she must record that intention on a donor card or label beforehand. Those who object to brain death and transplantation do not need donor cards. They are considered to be alive until the heart stops beating. In this way the Japanese law respects the opinion of 20-40% of the society who do not believe in the brain death. The opinion of the same percentage of people in Western societies who oppose BD is ignored by their legal systems. Initially the concept of BD did not cause a lot of controversy but this situation changed in the nineties of the last century. Since then many authors have criticized the validity of the brain-based criteria of death. They maintain that it is impossible to declare the absence of all the functions of the whole brain on the basis of the clinical tests supposed to detect it. There may be present some level of consciousness in brain death (BD) patients and therefore, they may feel pain. It is significant that 27% of the members of the teams which perform the excision of the heart for transplantation think that they are killing a living person and that in many countries during this operation a normal general anesthesia is required because of the vivid reaction of the body of the patient. The opponents of the brain death theory stress that the accurate examination of the so-called brain dead persons shows the persistence of the functions of significant parts of their brains. There are EEG waves recorded in 20-40% of BD patients. Event related potentials (ERP) show the reaction to verbal and non-verbal stimuli and the hormone production by the brain tissue can be detected in many BD people. The proper treatment could not only significantly prolong lives of the BD patients, but around 60% of possible donors with the lowest result of 3 in Glasgow Coma Scale could be restored to normal life if their brain edema is properly treated. This treatment should be based on the therapeutic hypothermia connected with the application of the thyroid hormones, whose level is usually too low in the patients with the brain injury. There is a growing lack of consensus regarding the issue of brain death, especially among physicians. Some regard brain death as a biological one, some as the death of the person but not of the human body, and the rest, as a definition accepted by the society, which doesn’t require other legitimacy than the freely chosen criteria. The brain death concept is also criticized from the philosophical point of view. The strength of the brain death theory was based on the premise that the brain is the integrating center of the body. According to this argument, the death of the brain means that the organism ceases to exist for it is no longer a functioning whole. To this argument the opponents of the brain death concept say that this question is not a question a priori but an empirical one and that the empirical data validate the opposite opinion, which says that the bodies of brain dead patients are alive. Some widely known cases show that even the real death of the entire brain means the death of the body and, therefore, may not signify the death of a human person. The integration of the body is the function of the organism as a whole and not of a single organ, even if this organ is the brain. This point of view can be confirmed by the opinion of St. Thomas Aquinas who says that the soul is primarily and per se connected with the body as a whole as the proportionate perfectible and only secondarily with the parts of the body, according to their ordination to the whole. So, the death of any single organ does not preclude the union of the soul with the rest of the body as a living whole. Moreover, the terms such as “consciousness” and “person” should not be identified. The term such as “human living nonpersons”, proposed by some bioethicists and referring to the people without consciousness has not been accepted in the official documents concerning BD. Bodies of the BD people are alive, therefore, it is not right to use the term “brain death” to describe the state of these patients, but rather the term “brain failure” should be used. As the result, according to some authors, the dead donor rule should be abolished. The Catholic Church stresses the sacredness of the human life from the beginning to the end. Therefore She requires that there be no doubts that the donor in BD is really dead. Because of the lack of consensus among physicians, philosophers and theologians, the popes John Paul II and Benedict XVI decided to continue the scientific research and discussion concerning BD between the representatives of various disciplines. Keywords: brain death, brain edema, global ischemic penumbra, therapeutic hypothermia, consciousness, person, substantial form. (shrink)