Doctors occasionally make diagnoses in strangers outside of formal medical settings by using the medical skill of visual inspection, such as noticing signs of melanoma or the symptoms of hyperthyroidism. This may cause considerable moral unease and doubts on the side of the diagnosing physician. Such encounters force physicians to consider whether or not to intervene by introducing themselves to the stranger and offering an unsolicited medical opinion despite the absence of a formal doctor-patient relationship. A small body of literature (...) has addressed the topic of the unsolicited medical opinion, often with a primary focus on practical advice. This article seeks to establish an ethical-theoretical basis for physicians' ethical obligation to offer an unsolicited medical opinion when they make a diagnosis by visual inspection in a stranger outside of the formal medical context. Using a utilitarian approach, it is argued that, if it is in the physicians' power to prevent a possible loss of well-being, without thereby sacrificing anything of equal value, physicians have an ethical obligation to intervene. (shrink)

State prescription drug monitoring programs (PDMPs) use proprietary, predictive software platforms that deploy algorithms to determine whether a patient is at risk for drug misuse, drug diversion, doctor shopping, or substance use disorder (SUD). Clinical overreliance on PDMP algorithm‐generated information and risk scores motivates clinicians to refuse to treat—or to inappropriately treat—vulnerable people based on actual, perceived, or past SUDs, chronic pain conditions, or other disabilities. This essay provides a framework for challenging PDMP algorithmic discrimination as disability discrimination under federal (...) antidiscrimination laws, including a new proposed rule interpreting section 1557 of the Affordable Care Act. (shrink)

Parts I through III of this paper will examine several, increasingly comprehensive forms of aggregation, ranging from insurance reimbursement “lock-in” programs to PDMPs to completely unified electronic medical records. Each part will advocate for the adoption of these aggregation systems and provide suggestions for effective implementation in the fight against opioid misuse. All PDMPs are not made equal, however, and Part II will, therefore, focus on several elements — mandating prescriber usage, streamlining the user interface, ensuring timely data uploads, creating (...) a national data repository, mitigating privacy concerns, and training doctors on how to respond to perceived doctor-shopping — that can make these systems more effective. In each part, we will also discuss the privacy concerns of aggregating data, ranging from minimal to significant, and highlight the unique role of stigma in motivating these concerns. In Part IV, we will conclude by suggesting remedial steps to offset this loss of privacy and to combat the stigma around SUDs and mental health disorders in general. (shrink)

Most people are completely oblivious to the danger that their medical data undergoes as soon as it goes out into the burgeoning world of big data. Medical data is financially valuable, and your sensitive data may be shared or sold by doctors, hospitals, clinical laboratories, and pharmacies—without your knowledge or consent. Medical data can also be found in your browsing history, the smartphone applications you use, data from wearables, your shopping list, and more. At best, data about your health might (...) end up in the hands of researchers on whose good will we depend to avoid abuses of power.2 Most likely, it will end up with data brokers who might sell it to a future employer, or an insurance company, or the government. At worst, your medical data may end up in the hands of criminals eager to commit extortion or identity theft. In addition to data harms related to exposure and discrimination, the collection of sensitive data by powerful corporations risks the creation of data monopolies that can dominate and condition access to health care. -/- This chapter aims to explore the challenge that big data brings to medical privacy. Section I offers a brief overview of the role of privacy in medical settings. I define privacy as having one’s personal information and one’s personal sensorial space (what I call autotopos) unaccessed. Section II discusses how the challenge of big data differs from other risks to medical privacy. Section III is about what can be done to minimise those risks. I argue that the most effective way of protecting people from suffering unfair medical consequences is by having a public universal healthcare system in which coverage is not influenced by personal data (e.g., genetic predisposition, exercise habits, eating habits, etc.). (shrink)

Introduction -- Waking up -- Getting ready -- Travelling to work -- Being at work -- Going to the doctor -- Having lunch with your parents -- Bunking off -- Shopping -- Booking a holiday -- Going to the gym -- Taking a bath -- Reading a book -- Watching TV -- Cooking and eating dinner -- Going to a party -- Arguing with your partner -- Having sex -- Falling asleep and dreaming.

Introduction -- Waking up -- Getting ready -- Travelling to work -- Being at work -- Going to the doctor -- Having lunch with your parents -- Bunking off -- Shopping -- Booking a holiday -- Going to the gym -- Taking a bath -- Reading a book -- Watching TV -- Cooking and eating dinner -- Going to a party -- Arguing with your partner -- Having sex -- Falling asleep and dreaming.

In lieu of an abstract, here is a brief excerpt of the content:418 Feminist Studies 43, no. 2. © 2017 by the estate of tatiana de la tierra. Ode to Unsavory Lesbians i love an ugly lesbian one who walks with a limp talks with a lisp leaves her dentures out overnight by the bathroom sink wears polyester pants and men’s cologne, the cheap kind has a beard so long she steps on it sprouts warts on her toes, all twelve (...) of them carries a spittoon in her breast pocket chortles at church people i dream of a lesbian who’s always broke she doesn’t own a car, walks streets barefoot, near and far washes all her clothes by hand steals from walmart scams the business-suited man lights matches on her wooden leg barbeques freshly plucked birds on her shopping cart seasons them with salt, that’s all licks her fingers in the moonlight i crave a lesbian who’s fat and fleshy so big she can’t fit through the door at starbucks and they set up an outdoor café just for her so fat she wears bangles on her fingers her belly is a boom box her stretch marks are hieroglyphic etchings she’s so heavy, tectonic plates shift beneath her feet so huge, lake erie is her bathtub tatiana de la tierra tatiana de la tierra   419 i lust after an unsavory lesbian she blows away my lackluster day leads me in a lambada, lights lantern between my legs lays my head down on lace pillows humps me like a lamppost lacerates me with leather lust lacquers my body with blue latex paint logs the forest for prime wood builds me lakeside throne sets me there and worships me —goddess in blue— lines my path with lady slippers ravishes me with sex words pets me like a little lamb wins me by a landslide To My Kidneys i had no inkling of your existence those summers when i swam in waters at the turkey point nuclear power plant a mile from home was proud of the organic salad tomatoes and the steaming peppermint tea that came from backyard garden a block from the rex chemicals plant life at 29822 SW 147th avenue in leisure city was anything but leisurely 420 tatiana de la tierra it was all screaming and fighting and cursing hijueputa this and hijueputa that poverty pissed me off i drank too much high fructose corn syrup not enough purified water snorted cocaine smoked dope lived all toughed out while you worked silently on my behalf filtering purifying regulating i was an angry girl but i blew up no buildings killed no one i was all hot air exploding inside letting carnage settle harden at twenty-nine something was wrong the damage was done your tubules were atrophying glomeruli were dead and dying you were inflamed and irate i had twenty-four grams of protein in the urine all swollen and freakishly feverish pouring my fluids into vials and beakers tried to recollect every sun burn those little red dots on my childhood skin tatiana de la tierra   421 i was a medical mystery for months until the day doctors made a diagnosis: lupus-mediated membranous glomerulonephritis now, eighteen years later you’re all i’ve got my future is in the capillaries of your glomeruli i’ve taken pills done prayers of all kinds even injected myself with german baby’s umbilical cord to keep you going yet you falter healers put the blame on all kinds of things deep-seated fears petrochemicals lead cadmium karma white flour self-hatred seriousness we’re in this together, you and i let’s go get sunshine drink green tea grow tall and strong wade in waters up to our knees like the cypress in the florida swamps gracing riverbanks and wetlands roots filtering flowing waters branches stretching to the skies with their durable and eternal woods 422 tatiana de la tierra Topanga Canyon i had forgotten trees how they claim earth and sky a herd of elephants standing in place reaching up with their trunks carrying torches of green leaves that breathe after death crushed at my feet trees splayed out like spent lovers legs open... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Oranges from SpainDavid Park (bio)It's not a fruit shop any more. Afterwards, his wife sold it and someone opened up a fast food business. You wouldn’t recognize it now—it's all flashing neon, girls in identical uniforms and the type of food that has no taste. Even Gerry Breen wouldn’t recognize it. Either consciously or unconsciously, I don’t seem to pass that way very often, but when I do I (...) always stop and look at it. The neon brightness burns the senses and sears the memories like a wound being cauterized; but then it all comes back and out flows a flood of memory that nothing can stem.I was sixteen years old and very young when I went to work for Mr Breen in his fruit shop. It was that summer when it seemed to rain every day and a good day stood out like something special. I got the job through patronage. My father and Gerry Breen went back a long way—that always struck me as strange, because they were so unalike as men. Apparently, they were both born in the same street and grew up together, and even when my father's career as a solicitor took him up-market, they still got together occasionally. My father collected an order of fruit every Friday night on his way home from work, and as children we always talked about ‘Gerry Breen's apples’. It's funny the things you [End Page 249] remember, and I can recall very clearly my mother and father having an argument about it one day. She wanted to start getting fruit from the supermarket for some reason, but my father wouldn’t hear of it. He got quite agitated about it and almost ended up shouting, which was very unlike him. Maybe he acted out of loyalty, or maybe he owed him some kind of favour, but whatever the reason, the arrangement continued.If his name is mentioned now they never do it in front of me. It's almost as if he never existed. At first it angered me—it was almost as if they thought I would disintegrate at its sound—but gradually I came to be grateful for it. I didn’t even go to the funeral, and from that moment it was obvious my family sought to draw a curtain over the whole event. My mother had taken me away for a week's holiday. We stayed with one of her sisters who lives in Donegal, and I’ve never had a more miserable time. Inevitably, it rained every day and there was nothing to do but mope around and remember, trapped in a house full of women, where the only sounds were the clink of china cups and the click of knitting needles. It was then the dreams started. The intervening years have lessened their frequency but not their horror. When I woke up screaming for about the tenth time, they took me to a special doctor who reassured them with all the usual platitudes—I’d grow out of it, time was a great healer, and so on. In one sense I did grow out of it—I stopped telling anyone about the nightmares and kept them strictly private. They don’t come very often now, but when they do only my wife knows. Sometimes she cradles me in her arms like a child until I fall asleep again.I hadn’t even really wanted a job in the first place. It was all my father's idea. He remembered the long weeks of boredom I had complained about the summer before and probably the nuisance I had been as I lazed about the house. I walked right into his trap. He knew I’d been working up to ask if I could have a motorbike for my next birthday. The signs weren’t good, and my mother's instinctive caution would have been as difficult a barrier to surmount as the expense, so it came as a surprise when my father casually enquired if I’d be interested in starting to save for one. I took the bait... (shrink)

Don't tell terrible stories—everyone here has enough of their own. Everyone here has a whole bloody sack of terrible stories, and at the bottom of the sack is a hammer the narrator uses to pound you on the skull the instant you dare not believe your ears. Or to pound you when you do believe. Not long ago I saw a tomboyish girl on Khreshchatyk Street demand money of an elderly woman, threatening to bite her and infect her with syphilis. (...) Don't stroll through Volodymyr Hill Park, don't stroll around the botanical garden, and especially don't stroll on Kontraktova Square. Don't stroll anywhere. Don't go to the pavilion with the Golgotha panorama near St. Alexander's Church. Not even the twelve-meter-tall crucified Christ will save you. Don't go outside when it's dark and people turn into shadows a shade darker than dark. Also don't go where you can be seen from far away. Not to imply that people used to be like a bunch of lilies, but now they stink like a cellar of cabbage.The city, which earlier might have had some fun, is now going crazy. It's like a fish in warm water: it doesn't react to anything, swims slowly like it doesn't care if it swallows a hook or not. The excitement and exaltation pass into oppression, just as our necks have sunk into our shoulders, our shoulders into our lumbars, our lumbars into our nether regions. The holiday turns into a funeral, the parades into explosions, depression into mania. Winter passes into summer, people turn into beasts, the hours into ages, and the ages into hours. It's worth simply walking around the city to see a soldier from an unknown army taking a piss near the opera. Farther on is a row of identical old widows selling ball gowns and candelabra. Then there are the aristocrats and manufacturers who throw so much at the prostitutes that they'll soon be richer than their wives.I returned late through the Kyryliv Wood, not heeding all the warnings that I myself have given here. It really is dangerous—the place is famous for it. There's a madhouse nearby, caves where criminals and the sick can hide out. Also, once upon a time, as they say in fairy tales, the great dragon Zmei Gorynich lived here beside the Puchai River. The stench in these places drives away the most committed misanthropes and even one type of philanthrope—that is, perverts. It sounds dumb, but the stench is cleansing. I don't know where it comes from. After the operating theaters and the rooms with amputees, the stench no longer repelled or attracted me; it just was. And this was a great place to think. As I walked, I considered an incident with our patient.The patient, a respectable individual whose name carries too much weight for me to state it directly, one day began to assault people. He nearly strangled a merchant who he believed asked too much for a beaver coat. He likewise wanted to kill his business partner when he didn't say hello loudly enough. But the worst was, he lost all shame of his own nakedness. At first it was the police who took care of it. When our future patient slipped off his pants and undergarments, he was taken to Kyrylivska, which has had means for dealing with such cases dating back to the day when unhinged Cossacks and composers from Kyiv Mohyla Academy were taken there.During the examination we determined that the patient was experiencing a severe breakdown. His wife added that lately, more than once, he had allowed himself strong words in front of the children and often suffered from ennui. Furthermore, she said, the patient had been undergoing treatment for “the French disease” for some years—which was, obviously, where we needed to start.“Syphilis!” Skorsky spat out the matchstick he was chewing on. He was a specialist on the psychological aspects of diseases related to the venereal. “Tertiary syphilis! When poorly treated, over time ‘the French disease’ can destroy the central nervous system. Hence the patient's chicanery. Such theater!”Skorsky and I had not spoken since the incident at Bilinsky's. Meanwhile, something significant had happened to him. The most boring person on earth, Skorsky had simply caught fire. He said hello and kibitzed. I even heard the doctor got drunk alone in his office, then wandered through the forest. Could he be using narcotic substances?“Cocaine!” was the doctor's second proclamation. It was his favorite treatment for the psychological complications of syphilis. Skorsky himself never took what he called “the universal drug”—good for alcoholism and toothaches, neuroses and morphine dependency—though he had read in an article by a respectable Viennese physician, who used cocaine as a panacea, that it was not addictive. That doctor subsequently recanted, but Skorsky paid no attention. He believed the retraction was made under pressure from pharmacologists who had no incentive to cease production of the medications that cocaine might supplant. Their representatives either paid or threatened the Viennese to repent.As the patient was escorted to his room, he assaulted the orderly, Alevtyna. They tried pulling him off her, but, though he released his fingers from her neck, he buried his teeth in her leg. The poor orderly, who had not until then been attacked by a psychotic, nearly died of fear. Later, panic set in over Skorsky's diagnosis. He told her about the consequences of syphilis: grotesque patterns on one's face due to infection of the skin, mucous membranes, cartilage, and bones. He went on about the devastation to the central nervous system, which they had just observed in real life: “The face starts to look like lace some mangy dogs fought over before rolling in the mud.”Alevtyna, who had not yet regained her faculty of speech, straightened up. Ignoring the slavering male orderlies, she bared her leg to get a better look at the wound. She then ran down the hall and out into the garden, where she fell on the ground to rip up grass and small bunches of daisies. Alevtyna ate them along with the soil in their roots.“Minor hysteria. She needs fifteen milligrams of cocaine.”Skorsky took a snuff box out of his pocket and scooped up some white powder with a toothpick made from a goose feather. He gave the order to close Alevtyna's mouth and one of her nostrils, forcing her to snort the medication.We fretted over her so long that evening fell. I decided to walk down, along the ravine, behind the church.It was unlikely there were any large beasts there, but something was rustling. The pits and mounds, ravines, paths, graves of witches whose living sisters flew in the treetops from time to time, the whispers of the forest spirits, the spirits of the nutcases who died in the hospital, the spirits of the monks from the St. Cyril Monastery, Zmei Gorynich and the bogatyrs who wanted to defeat him. The city would be calmer without this forest. I saw the gaps between the trees and went off in the direction of the tram tracks.As I was coming out of the forest, there was a patch of Amanita muscaria that had been trampled into porridge. A bit farther on, the body of Professor Bilinsky lay killed in the blackberry bushes. The way he was lying it looked as though he had not struggled before death. I quickly examined his body but saw nothing out of the ordinary. There were no wounds, no dirt under the fingernails. Animals had not yet smelled the carrion, but swarms of various insects covered him. Oh, why did I have to find the putrid body?The best thing would be to take the tram to his house to inform his relatives. The doors closed, and I noticed my own calm. This death had not evoked any emotions in me other than a feeling of responsibility, the need to tell the family. But also—some alarm at the thought of who the murderer could be. I knew that it was murder.“Your nose is bleeding.” A woman as round as an onion, carrying two baskets full of strawberries, offered me an ironed and starched handkerchief.“Have I dirtied my shirt?”“No, it's as neat as a pin. It's just your nose that's dirty. Wipe it now before you spray blood on my strawberries.”“No one will see the red on red.”“Ah, but it's salty!”“You know why it's not sweet? We'd drink it like syrup.”“Those with Christ in their heart do not talk that way.”“Are your strawberries expensive?”“Why? What?”“I'm checking to see if you have God in your heart.”“Child, if you knew how I have to work for this berry! I have to weed it a hundred times. In a week, the quitch grass grows as high as a horse. And I water it with water I carry from the stream, it kills my arms... ”“How much are the berries?”“They're not for sale. Anyway, soon money won't mean a thing. Soon all money, all these papers made from the skins of sinners on their satanic presses will be annulled. What matters is how we treat each other.”“So if I try your strawberries for free, my ‘thank you’ will be enough?”“Hands off!” she said and thwacked my fingers.I heard loud laughter behind me—same laughter as from the café near the Continental. There was no one sitting near Alina. (This is what fate looks like, remember.) Without asking, I sat next to her, away from the old lady.“Excuse me, but the night before last didn't you, yes, didn't you intrude on my privacy?” She started right away.“I saw it a little differently. Who was that young man with the mustache who paid me for you?”“Are you checking to see if you can flirt?”The tram stopped. People got on and off.“Are you coming back from the hospital?” she asked. “Don't be shocked. My uncle works there. He's told me all about you.”“An uncle by the name of Skorsky?”(Remember: this is what fate looks like.)“Yes. Skorsky's been strange recently—says things that make me wonder if he hasn't lost his mind. Have you noticed anything?”“I don't know.”“You know perfectly well.”“Where are you going?” I tried to change the subject.“I have to send something to my theater friends in Odesa. By the way, they'll be putting on Oedipus Rex soon in Kyiv—in Ukrainian.”“Greek tragedy in Ukrainian! That's a first.”“Exactly. The troupe is rehearsing now in Odesa. The theater where they will perform this fall is being remodeled.”“Wait. Now I remember where I've seen you before—it was at a performance! Vynnychenko's Black Panther and White Bear, at the Bergonier on Fundukleivska.“The same director is doing the Oedipus. He's my friend.”“He's your friend in what sense?”“Again with that tired subject. By the way, I've been thinking about you.”“And I about you.”“That's good. I was thinking not about you, to be precise, but about that elevator you invited me on.”“Who was that man with you?”“Like a broken record! Even if he had been my fiancé, I'm not bought or inherited. I'm not a brooch or a hundred acres of land, and I'm not a house in Kaniv!... Who was with you when you saw Black Panther?“Ah, so.”“Answer!”“That was my mother. She looks very young. She is coming to Kyiv the day after tomorrow. I can introduce you.”“Oh, this is my stop.”I looked out the window and realized that I had long since passed the stop for Bilinsky's.“Can we see each other again?”“We can. But you have only one chance.”Alina the anarchist wrote something on a scrap of paper and handed it to me.Morning, not morning but a thick porridge (I hate porridge). Dew, thick spit, crushed fruits, urine, all on the sparkling cobblestones. The sun, just barely having made its appearance, is already scorching. The human masses scurry and grumble like poorly digested food inside a stomach.I walked diagonally across St. Sofia's Square, then along the perimeter, then one edge, then again diagonally across. I went underground. The basement café of the Continental Hotel was practically empty. I again asked the server to bring the cloth with the embroidered portrait, but I couldn't remember the musician's last name, only that it ended with -sky. The server said that -sky was currently in the southern cities of Yalta and Odesa. I added that Kurbas, the director, Alina's friend, was also in Odesa, rehearsing Oedipus Rex, and that he'd previously put on Black Panther.I was bored, so I walked along Khreshchatyk and then headed down, calling to mind all the Kyiv churches of Podil: there's Birth of Christ, St. Nicholas on the Shore, Intercession, Pyrohoshcha, Holy Presentation, St. Dymytrii Rostovsky, St. Illia's. And also the Epiphany Brotherhood Monastery, Ascension Convent, and St. Katherine's, all these whipped-cream churches on the waffles of our streets. A few of them reminded me of themselves by appearing suddenly out of nowhere.The smells on Kontraktova Plaza where commerce buzzed were like multicolored light bulbs turning on one after another. Here you could catch the aroma of Balabukha jam, which blended with the next smell, English shoe polish at the Raiskys’ shop. Then the crunchy-smelling cabbage from old women standing in a row like herons and spitting out the shells of sunflower seeds. Farther on, the stench of a good-sized rat that crawled under Mrs. Shevchuk's shop where she sells broadcloth. Oh, she can't scream: no, she'll quietly dig that rat out herself so as to not scare off her clients.I bought a paper and two pairs of underwear. I asked two laughing young chambermaids who were secretly puffing in a grape-filled yard for a smoke. I wandered around Podil until evening when I came across a sawmill near the Dnipro that surprisingly smelled pleasantly of mazut fuel oil. The weather was dry, yet in the middle of the road was an enormous puddle, a deep dark black. A forty-year-old woman in a pale pink dress stood near it. The theatricality of it all provoked me to pose her a question,“Ma'am, what should I do?”But she paid me no attention. I shouted,“What should I do?”“What to do, what to do?” she said in Polish. “Jump in the water and swim so far away that you cannot return.”I quickly crossed a section of the forest. The wind brought a mixture of unpleasant air, like a stinky handkerchief held under one's nose. Passing the trees, I saw light in the spaces between them and exited at the hospital.Outside the windows, two orderlies lay in chairs with their heads thrown back. Two others—fools—ran around the yard in different directions, peering out at... something. The lights on the first floor of the hospital were on, and the staff milled about.“You're just in time!” said Ivan, a tall, young orderly.“For what?”“Your patient ran away! We went into his room and he wasn't there.”“What patient?”“The one who bit Alevtyna,” said Danylo, the other orderly, short and middle-aged.“That's Skorsky's patient, not mine.”I had no intention of helping them. This was all history—like my family, Kyiv, and my previous life. I had no intention of thinking about it. I wanted to go to my office, pack up my field surgery kit, and get out. So what? Their psychotic syphilitic ran away—it happened.Of course, that patient could have something to do with Bilinsky's murder. But that was no longer my problem.“What a strange coincidence!” the doctor on duty said. “Comrade doctor, the other one responsible for this patient was just here.”“And where is he now?”“He took off toward the church to look for the patient.”“Didn't the patient escape earlier?”“Don't know.”“How do you not know? You had better call the police, moron, before he kills someone. And get those sleeping orderlies to look for him.”“They can't... ”“Why not? Should I go wake them?”“They're on morphine.”“And you, I can see, have lost your mind. Go, catch your psycho! If it turns out that he killed Bilinsky—and on your watch—you can't imagine what's in store for you.”I adjusted my homburg and set off in the direction of St. Cyril's, that unwelcoming monolithic cube. I glanced around—what if our escaped syphilitic were to jump out of the bushes and bite or strangle me. I looked around because I wasn't sure of my actions, wasn't sure of my choices. Tripping over a clump of clover, I reached the open doors of the church. I couldn't stop myself from going in.The walls and ceiling were covered with frescoes. There was what used to be an angel rolling up the sky on the southern column of the narthex. But also graffiti: people scratched their names on it so as not to be forgotten—their idea of eternity. Prince Volodymyr the Great compared this activity to the desecration of graves. The vandals paid a fine and were beaten with canes. During the raids of Batu Khan, the church was deserted and cracks appeared all over it. Wild martens and feral dogs sought shelter here; insects swarmed under the ceiling with its red mosaics. Birches grew in its midst. Water seeped in the cracks, the water became ice, the ice widened the cracks, more water seeped in the cracks, becoming more ice that further widened the cracks, the wall split and nearly fell over, and then the wall fell over. Yet the angel is still rolling up the sky... When I reached the exit, I heard a rustling behind me. I turned after I stepped outside: in the depths of the church, like a stick in a pot of tar, stood a man with a large bag thrown over his shoulder and a revolver pointed right at me.“Is that you, Doctor?“Don't move!”“What's... Skorsky, what's with you?”“Don't move, I say!”“What are you doing here?”And finally I understood... Skorsky was himself the psycho! (Really, I had known for a while.)“You are the murderer! I knew it! But—why?”“Shut up.”“It was you. You! The stolen cigarettes, the strange behavior, Bilinsky. If I shout, everybody will come running. They've already called the police!”There was heavy breathing behind me. And then a gun rang out.The city is overgrown with new buildings. They encircle everything that was once on the periphery. Kyiv has become an old lady that can no longer restrain herself in the face of pastries. The city climbs farther. It steps over the swamps, turns the old rivers into a series of lakes; the other bodies of water it drives into canals. The grain that falls from the wild wheat is black. When the sun heats it, the grain melts and trickles into the earth. St. Cyril's stands indestructible. No one spackles the small cracks in its walls with either expensive putty or glues, nor with cheap cement and whitewash. One day a small fox appears in the doorway. It runs inside and along the floor of simple gray tiles. The gods watch from the walls, watch and fall into ruin. The fox runs to the iconostasis. Before it is a time-darkened Virgin Mother and Child in oil on sheets of zinc. The fox runs the metal steps that wind up to the second floor. The fox runs past all the vaults, naves, all the frescoes. A buckthorn seed flies in through a broken window. It will be the first. Soon the buckthorn will grow everywhere. A dumb hare will make its nest in the buckthorn bushes and nightingales will settle in the upper branches to sing until the end of the world. The fox runs between the thick rays that penetrate the windows. It catches one of the rays, squints its eyes, and warms itself in the sun.The shot rang out, but I did not fall. I looked around—and on the church threshold was our syphilis patient bearing a rod. His head lay on the rocks by the doorway.“If only he'd been at the stage of nose deformity! Just imagine: a hole instead of a nose plus a hole from the bullet—like an extra pair of eyes!” Skorsky laughed at the corpse.“We need to call the orderlies.”“They heard the shot. They'll run here on their own. You see, Professor Bilinsky believed it would take two or three years to wrap up this patient's case,” Skorsky told me. “But I took care of it much faster!”“Excuse me, but I'm going crazy in this city. I thought that you were Bilinsky's murderer.”“Just so. Why not? I am Bilinsky's murderer.”“Don't tease. You've changed a lot recently, so... ”“Yes, I've started killing people. You might term such a change significant.”“You have the right to irony.”“I am not being ironic.”“Let's call it sarcasm.”“It's the honest-to-God truth.”“And yes, you have the right to mock me.”“Well then, let's be done. To the horses!”“What horses?”“Alina's waiting!”Alina, her uncle Skorsky, a few others I didn't know, and I rode like the wind that ripped off my homburg and carried it back to Kyiv.“There's a fresco in the choir loft at St. Cyril's where Vrubel painted himself and patients from the hospital as the apostles. When I came across it by accident, I really believed they were saints,” Alina said.“I've never been up there. I've only seen the church from below.”“Remember the way back so you can see it sometime.”“The Puchai River used to flow here. You shouldn't trust the landscape,” Skorsky said, reaching for something, perhaps his bag, just when we left the darkness of the trees and saw the endless steppe ahead of us.We rode all night without stopping. Though no one was chasing us. Though we had nowhere to be. We rode like beasts released from a cage. The promises of the horizon turned what we'd left behind into a cage fit for those from whom freedom had been severed, like an anomaly, at birth.The pre-morning sky looked at first like a sack of turnips—filled with something heavy. But with each verst, the sky became lighter. When it was finally light enough to see clearly, we arrived at a knoll at the foot of a stone wall that from a distance had appeared to be a gigantic piece of halva. The exterior ruins of the castle gave no hint of how it was when all was fine here, when people defended themselves successfully from the nomads’ raids. From far off, the wreckage looked like a natural agglomeration of stones—a rocky elevation, no more: a cluster of cliffs. It would rain a few hundred more times, a few hundred more winds from a few hundred directions would blow on this heap, and it would collapse as though nothing had ever been here.A few stalks of wheat grew from one of the rocks. Someone had probably cast a handful of grain here for some birds that forgot to eat it.“Who could this castle belong to?” I asked Skorsky.“I reckon the Swan Princess,” the doctor rejoined, hoping to sound knowledgeable.From behind one of the piles of gray sandstone emerged a young man in a black reptilian coat and a white papakha as lush, bright, and out of place as a dahlia. His name was Artem. The heat was melting our brains, but he was dressed like that, in rooster fashion, which was popular among the otamans. Artem helped Alina dismount her horse and tried to kiss her on the lips, but she offered him a cheek instead.Had she been racing to see this clown?We entered the yard—the ruins had fashioned an internal space that was more or less protected, at least from strangers’ eyes. It turned out that there were even places where it was possible to hide from the rain, and from there the ruins didn't look half bad.In the center of the court was a table, and on it a wooden bucket with pink gladiolas. How romantic! It all looked like it came from outer space. Where on earth, in the middle of the steppe, far from any village or town, did this table, this simple table, come from? And the gladiolas? The steppe hadn't been plowed in so long that any cultivars would have gone wild, degenerated, dried up completely.A campfire crackled nearby—a little preview of what we would soon do to the houses, villages, and cities. Artem the otaman brought over a cezve from the fire and poured the first portion into a small, copper cup for Alina. He also got out a porcelain cup with images of rosy cherubim—but how...?“Who else would like coffee?”Only Skorsky and I responded. The question excited me, even distracted me from the thought of the kiss I had recently witnessed and the Kyiv I had recently left.“It's obvious who the professors here are; cultured people drink coffee. Are you both doctors?”“Uh-huh.”“For wolves of the steppe, like us, doctors are gold, even more precious than gold. Actually, a Hippocrates like you should eat more, because those in your profession will soon be worth your weight in gold. Work on your figures, both of you.”“Who will take pity on the horses that have to carry us?”“We'll find the horses. And very large doctors can be transported on machine-gun carts. We'll need to seat the otamans near you. Only a fool would shoot at a doctor.”“I think we'll find quite enough fools here.”“With your beard, Doctor, you look like Tsar Nicholas II. But even so you won't be shot. You might even be canonized!”“We've only just arrived and you're going on about executions,” Skorsky grumbled and checked to make sure that he still had his bag.“Apologies, apologies, pardonnez-moi. But you are not merely a doctor. A venereologist! Skorsky, you're a specialist! A venereologist is the most important person in wartime. The most valuable! You are the botanists of war. You can't imagine what varieties of flowers grow here, and these beds have long awaited a proper gardener. Or even just a man with a scythe!”“Bite your tongue,” Alina said. “I don't need to listen to this.”“Yes, yes, of course. Excuse me, my r—. ” He almost said “rose.”We rested all day. We went down to a surprisingly close river overgrown with lilies. We rowed the boats left by fishermen. I talked to Skorsky. He took his bag everywhere, refusing even to swim so he wouldn't have to part with it. I asked him what he had in it, but he said it wasn't my damned business.Alina rowed with the otaman to the middle of the river. They were having a loud discussion. She was waving her hands. The current carried their boat downstream slowly and smoothly. What a nuisance, that current!I tried to meet with Alina one-on-one, but she was avoiding me. In the morning I was confused, by lunch I was sad, and after lunch I got angry.In the evening, I lay on the hot grass and drank another cup (I have no idea where they got such good coffee), which had no effect at all on my sleep. I watched the Perseids. Every year, the Earth passes through the tail of Comet Swift-Tuttle. People can see the meteor shower and make a wish. I wished. I counted forty-seven falling stars. All forty-seven of my wishes were for the same thing.Around the campfire, they were sitting, talking. I saw how he tickled her face with a piece of grass and she brushed him off in annoyance. Then they were screaming at each other. Later they again spoke kindly, after which they again quarreled. My joy grew after each tiny mistake that Artem made. I wanted him to show the worst he was capable of.They were screaming at each other, but all I could hear was beautiful opera singing. The stars fell to the sound of their screaming. The stars blessed my joy.Then this happened: Alina kicked the fire, scattered burnt kindling, and burned some of the grass. Artem grabbed her by the arm, but she broke away from him and ran off to the horses.“Go then! I guarantee you'll get to Katerynoslav and return with your tail between your legs.”“I'm going to Huliai-Pole! To Father Makhno!”I jumped up and ran after her.“Where do you think you're going?” Artem shouted.Really—where was I going? I was going after her: to Huliai-Pole, to Katerynoslav, to Rome, to Washington, to Istanbul, to Montevideo... “Go to sleep,” he said. “Come morning, this coquette will be here, right as rain. We've already been through this show. Tomorrow she'll be right here next to my boot!”... No, she won't.In some sort of shape we entered some town. There were some buildings that were some colors, some trees, some streets, some roads, and some signs. Posts, flustered birds’ nests, echoes, colors, shapes—each of some kind. A wedding procession was coming toward us. If you want to make orange, you need to add yellow to red, and then bam—it's black. If you want to salt the soup, shake in a little, and then bam—two handfuls. You want to say a kind word, and then bam—a punch in the face. I was rocked around like a watermelon on a boat and threw up my breakfast straight into the horse's fluffy mane. Sanko found this hilarious, but I said I'd pulverize him. So Sanko sped ahead.No one knew anything about Alina. The daytime sky was like a poorly washed bowl. The sun was a squashed, rotten apricot. The night sky looked like the sole of a boot to me. The moon was a dirty cheap copper coin that had gotten stuck to the sole. Everything seemed spoiled to me, irrelevant, unnecessary. Without her, this journey was a waste of time.“You'd better stay away from everyone,” Artem said. “You'll infect us with your pining, and pining is worse than the clap.”The wedding procession was before us. The young couple, still utter children, walked so calmly it was as if they didn't see us. As if we were made of a light breeze—our bodies, clothes, our horses and their iron shoes—of the lightest gasses. As if we were visible only to ourselves and the coal-black dog that barked, panting and gasping.The wedding was headed straight for us. We were in the middle of the road, and so were they. We approached each other slowly, a wave going toward a wave. Some ten meters before their indifferent faces, I noticed the color of the bride's eyes. And the coral-colored tulips that fell on the road before her. Round goose eggs on meaty stems, the flowers were falling and falling before her. The bride's eyes were almond shaped.“Hey there,” Artem shouted at me. “Wake up!”I came to and saw the whole village, everyone there, not realizing my group had turned left onto a side street away from the procession. The tulips disappeared—where'd they get tulips in the fall? I was sitting alone on my horse in the middle of the road, and the entire wedding procession came to a stop. I moved to the side, and the throng marched on, cutting off our escape route. We rode a few more meters and came across the synagogue.“You know what, you're right,” said the otaman.“Who is?”“Oleksii is the only one here who's right.”“About what?”Artem turned his horse and raced back. Everyone stood still while he ran his horse into the crowd and began firing his revolver. People scattered in all directions. Artem trotted, cackling like an imbecile. The horse kicked an old guy in the mouth. The man fell, spitting out his gold teeth. We rode up to the commotion and formed ranks, but none of us wanted to join the otaman.The bride stopped in the middle of the street. On both sides were buildings and trees, as well as dust, sky, and sun. She stood still, beautiful, as if nothing had happened. Then she adjusted her garland and walked calmly on.“Well, should we get some sugar now?” Artem laughed, looking at the bride, and off he went toward the sugar factory.It was then I noticed that all of the houses had shutters—fuchsia, blue, ocher—and that all the shutters were closed.We flew toward the dirty building, whistling and shouting. If there had been aesthetes among the otamans, they would certainly have razed the abomination in this field after seizing it. They would have spread soil on top and sown buckwheat. Long live buckwheat!, that wonderful crop. Like hunting dogs hot on the trail, we raced to our defenseless victim, with the baying of hundreds of hounds behind us. The field shook beneath us. We became an artist's canvas, evolving from Realism to Romanticism, Romanticism to Expressionism, Expressionism to Suprematism. If we had been painted in black and white, we would have been splotches (until the ink ran, annihilating all remaining patches of white).Two men stood near the gate—unarmed and undressed, in nothing but their undershirts and boots. Our fervor, our kinship with the elements, our entirety, were all for naught.“Jesus Christ! What bores!” Artem exclaimed. “How boring you are!”“Maybe boring for us, but fireworks for them,” Sanko said, dismounting his horse.“The fear of death engenders creativity,” our otaman—a distinguished philosopher of the early twentieth century, that demonic breed—prophesied.He went on, “Excuse me, but with all due respect, we are not going to search you. Just show us right away where the money is. Why are there so few of you? Don't say there's not much money. I want piles and piles of money! If you don't show it to us, we'll print our own on your skin. Believe me, we will.”We entered the factory grounds. There were no workers, only an enormous mountain of sugar beets that looked like a pile of coal from a distance and a pile of dead rats from up close.“So, did you have a good year?” Artem asked a man in an undershirt.“Not really—too dry.”“Nah, that's fine. You wouldn't have been able to gather most of the harvest this year anyway. There's a fire burning across all of Ukraine, all of Russia. The whole world!”While Artem tossed thoughts like well-chewed sunflower seeds into the crowd, the two men quietly stepped aside and then ran fast ahead to the factory's main hall. The gigantic door slammed shut. The gate was locked behind us! The windows were smashed! The factory roared from inside like a cumbersome machine starting up. Bullets whirred through every window.“Bastards! It's a trap! Quick, after me!”Still on horseback, Artem bounded over to a vast window, low to the ground, and smashed it mercilessly. He broke the frame and jumped inside on his horse. I and a few others followed. We broke into their lair, threw open the doors, and let the other warriors inside.Iron vats of hot sugar were steaming, pipes were clattering; machinery groaned.“Parasites!” Artem gritted his teeth. “I'll get you. I'll get you red sons of bitches. Painted whores!”At the word “painted,” his horse fell to the ground. Lying prone, Artem continued fighting, but the red soldiers wouldn't let him stand. Fighting nearby, I rode over to assist but did not know where to aim. Artem got up, ran forward, and brought his sword down on the head of the closest soldier, all the way to the middle of his skull, to the bridge of his nose. It was like butchering a pig. Artem thrust the sword into the buttock of another who was fleeing and cut off his leg at the bend in the knee.“I'll cut off every last one of your asses! Cut off your asses!” Artem bellowed.A half hour later, the dead were lying, the captured sitting, and the victors doing anything they pleased.“Skorsky, are there a lot of casualties?” I asked the doctor, whose hour it was. I hoped not, because I was too tired to help him.“Just a few. The dead are already dead, and the wounded are not ours.”Though Skorsky rarely asked my help, and though I'd become an ordinary soldier, the doctor in me was still present in the most unpleasant attribute—knowledge. Others saw an eviscerated man, pieces of dusty flesh smeared with clay, soil, sand, and straw. I saw a perfectly formed kidney hanging perfectly from the rest of its body like a child's mitten from its coat. You could try this death on for size. Wear it like a sanbenito of the Inquisition.Artem counted the money and then lay on the floor alongside the gigantic sugar mountain in the middle of the room. From time to time, the crystals rustled as they fell.“I didn't think you'd be such a fighter!” the otaman said without turning toward me. “I thought you'd be healing us. You'd keep to the rear and we'd hide you like a girl. But here you are, in the vanguard, like a lion!”“I got excited,” I told him, choosing not to react to the “girl” part.“’Cause Alina said there was no sense counting on you to fight.”“Really?”“Does that sting?”“Why would it? I'm a doctor—not everyone is. It requires a brain. Unlike waving a sword.”“Yeah, yeah. I gave her gladiolas. We were lying in the boat near that castle, doing all manner of things, and she told me all about you. How you met.”“You were lying in that boat talking about me?”“It was the day before you left Kyiv. You agreed to go with the anarchists so quickly!”“Were you surprised? Doctors make fast decisions.”“But you probably had great prospects. Your parents are rich, right?”“And who are your parents?”“Probably all your relatives fled abroad—bourgeois. Why did you stay?”“What the hell's your point?”“Alina, by the way, died a while ago. Probably.”“Don't jinx her.”“Listen here,” he said, staring at the ceiling. “And listen good. If you have designs on her—dead or alive—it's best you castrate yourself now.”“After you.”“If I want to kill somebody, you know, I just do it.”At last he looked at me. I was lying on the floor nearby and looking in his direction, sweaty and relaxed, my appearance complemented by my disdain for his opinion, his authority, his stupid hat. His everything.Artem raised his arm above his head, stuck a finger in the sugar mountain, and licked it. We both got up. Had I anticipated this turn of events, I would have readied a gift for him. Artem held his revolver. Under my hand I found a knife the workers used for gathering beets: it was a deliberately sharpened arc they sank into the swollen brassicas. I jumped up and quickly stepped around the sugar mountain.Artem's bullet hit a pane and broke the glass.“Not man enough for hand-to-hand?”The otaman shot again.“You should've challenged me to a duel, you romantic!”Encrusted with white crystals, I charged Artem from the sugar mountain. We fell in, and the sugar stuck in our hair, mustaches, nostrils, armpits.The gang ran in to get us apart, then backed off because it had nothing to do with them. By now the sugar mountain had burst its banks. Of the once perfect pyramid, a deformed mound remained.Wounded, Artem fell on the sugar mound, turning the white red.I stood before the gang sugar-coated and holding a bloody hook. The old otaman was drawing his last breath. Blood trickled from the corner of Artem's mouth and streamed from the left side of his breast.“What's the commotion?” Old Roman had just come in.“Be quiet,” the boys told him. And a good thing they did.“You killed him? You killed the otaman!”“Shut your mouth,” the boys told him.“You... ”I slugged Roman's stinky herring mouth. How did that son of a bitch find pickled herring in a sugar factory? My fist was now bigger and stronger than ever before, a steel anvil that could split nails and shatter memorial plaques. The unfortunate man's jaw twisted like an upper millstone that had gone off track from the lower.“Let's get out of here and go to Makhno's camp,” I gave my first order.We galloped so fast the grass burned beneath us. The birds and bugs had no time to fly out of the way; hooves trampled the burrows of rodents who didn't dare crawl out of their holes for a long time after. We raced like no one had ever raced before.The steppe, that sly fox, pretended to be an innocent fool. The steppe said, “I'm like Adam: I don't even know my own name.” But its grass harbored the tracks of thousands of armies and the heels of Herodotus, the crunch of Trypillia vessels, and the smell of Scythian hemp, Roman coins, clay figures of wolf people, the chevrons of Denikin's army, glass from the Chekists’ ruby stars, traces of uranium from flying saucers. I threatened it: “Steppe, show me your layers, or I will burn you, plow you under, flood you.” But it just replied: “I'm like Adam: I don't yet know my name.”I lost geography as if it were a silver coin. It fell out of my pocket and rolled through the feather grass that blanketed the steppe in white foam. The open space ahead was so endless that the whole world might as well have been steppe. If people ended up here from somewhere else, they would conclude they were on another planet. The coin fell and became an argentum, became one with the ring on the hand of the princess who had one green eye and one blue, with the twisted candlestick at the monastery on the other side of the steppe, with melted ingots. It broke down into simpler elements, simpler and simpler yet. The horse carried me spreading the seeds of northern plants to the south, just as southern riders had once brought flowers and weeds to the north. And then I turned back. Just as I had no geography, I had no time. Every night I fell asleep with the thought that the next day I would again race. Through all spacelessness, all timelessness. I exchanged one horse for another, got on a train, on a boat, traversed forty versts on foot—in rain that brought the river up to the road, in heat that overturned cattle. The earth I walked on became mine. Mine was the water in the lakes and springs, clean water, dirty water, enlightened water, contaminated with oil, stinking of algae, of fish that died in wells, stinking of the memory of atrocities, water as clean as broken bread. The water did not become Alina.I was doing this for her: I got the basturma out from under my saddle, sodden with the horse's sweat, sliced the throat of a rich man whose daughter I had danced with at a ball, climbed into a vat of beet juice and took a sugar bath, carried out the expropriation of the savings banks, wiped the sweat from my face with my shirt—and the cloth turned red; I didn't know from what. If it was someone else's blood, I didn't care; if it was my own, even less.We mostly came across Reds. We scraped them up like old red paint on a door in order to repaint the boards black. Black looked better. Red is tasteless, but black has style. Healthy men died before us of myocardial rupture like bunnies found in the nest. The ones whose hearts were sewn of steel wire envied the deceased. Seizing estates, banks, distilleries, and prisons reminded us of gathering in the harvest. If you're too lazy to pick an apple, you can shake the tree; some of the fruit gets bruised when it falls. We seized buildings like we were shaking apple trees. No one picked the fruits, we just shook: shook under the beds, under the tables, behind the curtains. No, there was no picking. We just shook until the red juice spurted from the apples.Near the Khorol River with Father Makhno and me in charge, we captured sixteen machine guns and four cannons, as well as five hundred prisoners who immediately came over to our side. The villagers voluntarily gave us bread and cheese, chickens and kvas. People joined us. The front of the machine-gun cart said “You can't run,” and “You won't catch us” at the back. We took factory after factory. Millions of karbovantsi, thousands of poods of sugar, weapons. We smashed the telephone exchanges and captured the telegraphs. We made alliances with some and then with others. Lenin, Wrangel, Frunze, the Germans, Chinese, Australians, Kaiser Wilhelm II, Cleopatra, Maria Theresa Walburga Amalia Christina. We ran the steppe. There were a hundred thousand of us. There were three hundred thousand of them. There were three hundred thousand of us. There were a million of them. There were two million of them. We were all of humanity. We were so many that we were none.The nobles’ estates were long ago forsaken. In the people's deepest trunks lay silks and guipure laces that were once perhaps used only to cover a table. Five steps from the barn in the direction of the pear tree, some silver candlesticks are buried; there's a plaster figure of an angel in the chicken coop, covered with shit and feathers.I was reluctant to be going to my home, but I didn't see any way out. Fate intended me to be a different being from the one I was before.Here my grandfathers and great-grandfathers were born. Here the ones who caused my grandfathers and great-grandfathers to flee had stopped. When we were still far off I noticed that someone was in the house. It was our men—Skorsky had brought them here, about twenty in all. I asked Sanko, whom I had walked with side by side more than once, where the doctor was now. All the men answered that he was around somewhere, but I didn't see him that evening.In 1918, the spirit of my great-grandfather Stepan, along with my mother and uncle, had gotten into a britzka and scrambled off to Paris, to Napoleon, against whom my great-grandfather had fought with the Cossacks, to whom the Russians promised to return self-rule. Following him in the cart went the soul of Grandpa Oleh, who lost a finger when he cut down the old linden near the house; his second finger was blown off by a cannonball near Balaklava, and later his entire hand was cut off by some Turk. Next went the spirit of my father, also Stepan, who did not take part in any war but died of measles at the age of forty. They all got the hell out of here. First, they went to Kyiv, led by my mother, Tamara Makarivna, in order to collect Uncle's family and me, their son. And their son, it turns out, has now come back to rob his own home (I didn't drive my war buddies away, did I?). It's a shame that I didn't know where the bathtub was, or whatever they bathed me in when I was small. It would have been good to walk through the ranks of anarchists with that basin and tell them all to spit into it.Remembering every room, I carried Alina upstairs to my mother's bedchamber. There was no longer furniture or pictures, only bare walls. The bed and mattress remained, but that was enough. Mother hated noise, so she set up her room far away from the running in the halls and the creaks on the stairs. I adjusted the mattress; in a gap, looking like a stalk of wheat, there lay a gold bracelet that she lost in the haste and that the thieves could not find in the mayhem. I tucked it into my pocket.The place could still be saved. It was strong, built under the leadership of my grandfather, who knew how to do it right. He built a sawmill, a gristmill, a dress factory (today it's probably been ransacked, maybe even by our own men).Alina had a complete, displaced break in her right fibula. We needed water first. I went downstairs—the guys were dragging out the piano like an old cow to the slaughter.“What are you doing with that?”“Taking it out.”“Why?”“What's it to you? We want to have fun.”“Can you play?”“We're not your bourgeois lily-handed bitches.”They couldn't play, but they were famous at destruction. “Noise is the music of the new time,” one of the smarter among them might have said. “But noise is the opposite of music. Just as a rose is the opposite of your ugly mugs,” I'd have responded if there was anyone to say it to. I could also have said that this was a Bosendorfer grand piano, that it was very valuable—but do the guys not deserve such a luxury?“Why are you so boring? We're relaxing.”“Then let me play a little first.”“Go ahead, but fast. One-two.”So I played. As before. My fingers ran up and down the black and white keys, which weren't simply keys of these, the simplest, colors. These were the keys that remembered my fingers specifically—achieved by that slovenly German Katerina, our governess. She knew a bundle of languages, could play the piano, and was interested in the latest scientific discoveries. But she had not an ounce of sympathy for anyone who couldn't master anything on the first try. More than once she hit my pinkie against the black key that remembered every one of its four thousand touches. She would pound it on the key and shout, “Si bémol! Si bémol,” and later bang my fingers and translate, “B flach! B flach!”I played. I could not expose myself, so the only thing I could do was believe in miracles. What if these coarse men saw value in this bit of furniture so unintelligible to them? And what if they didn't destroy it, this emblem of my childhood, my land, my air, which I could protect in no other way? My air. My water.“Shchedryk, shchedryk, shchedrivochka,” one of them who recognized the tune began to sing along.“Look at you.” They did not expect music from me, who had until recently been drinking blood like water.They said, “Again, again!”A group of curious men gathered around me. They were ordinary farmers, thieves, and recidivists, peasants and workers, everyone except for Skorsky. They needed this music as they needed baths. The music cleansed them from the inside, perhaps. They had not heard anything besides the whistle of a bullet, the neighing of a horse, or the knocking of a chisel and the whirring of a saw, amputating limbs, for a long time.But it could not go on long. I did not close the piano lid, just stood and went to fetch water for Alina, leaving the unfinished song for later. The well was to the north—that is, at the “Head.” My father once promised to give me a compass if I could learn to identify the ends of the earth by means of the sun. And to make it easier to remember, I gave each one of them a name: the east where the day begins was “Right” (my right hand), the west “Left,” the north “Head,” and the south “Feet.” Back when I could still do whatever I wanted all day long, I would wake in the morning and say: I'm going to the Feet. The mound was at the Feet, Left had the river, Right had the forest. It was only to the Head that I rarely went, because a village was located there. When the villagers saw me, they would speak in whispers and avoid the master's son.... I wiped her brow and her burning, sunken cheeks. I lay down next to her to feel the heat of her skin.When the fire in Alina calmed slightly, I went out into our orchard. My father had once been given a gift from Japan—a tulip tree that blossomed with yellow-green flowers. It had to have grown in the time that I was away. It would have been fatal had it been cut down. I again took the stairs down into the drawing room and came across nobody—they had all disappeared in search of food or were hidden away in their burrows. In the middle of the hall, like an opened rib cage, was the piano, irreparably shattered.B Flach! B Flach!Translation © Ali Kinsella 2022. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 37.3 (2003) 58-77 [Access article in PDF] The Ethics of Care and the Private Woodwind Lesson Nancy Nourse Jeremy's family was getting ready for the concert. It wasn't that he was tired of watching his father conduct. He loved his father and he loved the concerts. But people were always asking Jeremy the same question and that question didn't seem to have an answer....They (...) weren't even inside the concert hall before the doorman smiled at Jeremy and asked, "Well, young man, do you think you'll be a conductor like your father?" 1Children like Jeremy, situated in the world of established music-making, are routinely subjected to stereotypical expectations, often not seen for who they are themselves, but for the qualities of their situatedness. Jeremy, as a result, found himself continually bombarded with this question which spokein fortissimo tones that the inquirer was impressed by the stature of his maestro father, but really did not seem to care to see the young boy as a person in his own right. The dreaded question, that he so frequently faced, festered in him, shouting of his own lack of personhood in its flagrant assumptions. But what voice did he have? After the concert: a lady in a long gown and a huge strand of pearls came in next [backstage]...."So this is your little son," she cried. Jeremy blushed as she kissed the top of his head and squeezed his face so that he looked like a fish. "Tell me, young man, are you going to be a conductor like your father?" 2Of course stories such as Jeremy's in which individuals suffer because others have not been truly caring, are not unique to the world of music. Such thoughtless pleasantries are nothing more than symptoms of the widespread absence of knowing and care experienced in day-to-day living. While Patricia Benner and Suzanne Gordon suggest that there are few people who would wish to be perceived as uncaring persons, there are often spoken platitudes about care, especially about large institutions, that seemshallow and meaningless. 3 Take, for example, a hospital whose slogan claims [End Page 58] it is caring, but is only really interested in research or profit, or the doctor who quadruple books patients for appointments all the while insisting that he really does care about his patients. The obstacles to true understanding about care include the view that care is merely a sentiment that need be expressed, but not the thoughtful planning out of means to create ample opportunities to enact deeds of caring. 4 In day-to-day situations of modern living with big corporations, governments, and institutions, there may be individuals who claim to care, but there are no features in these organizations' blueprints that ensure and take responsibility for providing care. Care must extend beyond sentiment into action.In the name of superior curriculum and specialist teachers and programs,tiny rural schools were abandoned and students were moved into bigger and bigger schools. As schools and educational institutions have greatly increased in size over the past century, teachers have found it more and more difficult to connect to the larger and larger number of students found on their class rosters. Beyond their class lists how can teachers really be responsible for the sea of faces for whom they cannot even supply names? In The Students are Watching, Theodore and Nancy Sizer ask: Do [current] conditions in the school allow each student to be known well?...Anonymity is the curse of good teaching and inevitably contributes to corner-cutting. If no one knows the students in a high school, it is easy for them to drift through. 5Benner and Gordon cite the shop program in a vocational school as an ideal setting in which teachers have the opportunity to develop caring relationships with their students since the settings are informal, class time is significantly extended, and the teachers work with the same students over several years. 6 Special education teachers as well usually... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 37.3 (2003) 58-77 [Access article in PDF] The Ethics of Care and the Private Woodwind Lesson Nancy Nourse Jeremy's family was getting ready for the concert. It wasn't that he was tired of watching his father conduct. He loved his father and he loved the concerts. But people were always asking Jeremy the same question and that question didn't seem to have an answer....They (...) weren't even inside the concert hall before the doorman smiled at Jeremy and asked, "Well, young man, do you think you'll be a conductor like your father?" 1Children like Jeremy, situated in the world of established music-making, are routinely subjected to stereotypical expectations, often not seen for who they are themselves, but for the qualities of their situatedness. Jeremy, as a result, found himself continually bombarded with this question which spokein fortissimo tones that the inquirer was impressed by the stature of his maestro father, but really did not seem to care to see the young boy as a person in his own right. The dreaded question, that he so frequently faced, festered in him, shouting of his own lack of personhood in its flagrant assumptions. But what voice did he have? After the concert: a lady in a long gown and a huge strand of pearls came in next [backstage]...."So this is your little son," she cried. Jeremy blushed as she kissed the top of his head and squeezed his face so that he looked like a fish. "Tell me, young man, are you going to be a conductor like your father?" 2Of course stories such as Jeremy's in which individuals suffer because others have not been truly caring, are not unique to the world of music. Such thoughtless pleasantries are nothing more than symptoms of the widespread absence of knowing and care experienced in day-to-day living. While Patricia Benner and Suzanne Gordon suggest that there are few people who would wish to be perceived as uncaring persons, there are often spoken platitudes about care, especially about large institutions, that seemshallow and meaningless. 3 Take, for example, a hospital whose slogan claims [End Page 58] it is caring, but is only really interested in research or profit, or the doctor who quadruple books patients for appointments all the while insisting that he really does care about his patients. The obstacles to true understanding about care include the view that care is merely a sentiment that need be expressed, but not the thoughtful planning out of means to create ample opportunities to enact deeds of caring. 4 In day-to-day situations of modern living with big corporations, governments, and institutions, there may be individuals who claim to care, but there are no features in these organizations' blueprints that ensure and take responsibility for providing care. Care must extend beyond sentiment into action.In the name of superior curriculum and specialist teachers and programs,tiny rural schools were abandoned and students were moved into bigger and bigger schools. As schools and educational institutions have greatly increased in size over the past century, teachers have found it more and more difficult to connect to the larger and larger number of students found on their class rosters. Beyond their class lists how can teachers really be responsible for the sea of faces for whom they cannot even supply names? In The Students are Watching, Theodore and Nancy Sizer ask: Do [current] conditions in the school allow each student to be known well?...Anonymity is the curse of good teaching and inevitably contributes to corner-cutting. If no one knows the students in a high school, it is easy for them to drift through. 5Benner and Gordon cite the shop program in a vocational school as an ideal setting in which teachers have the opportunity to develop caring relationships with their students since the settings are informal, class time is significantly extended, and the teachers work with the same students over several years. 6 Special education teachers as well usually... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Shame is Not an Effective Diet PlanJudith BrukThe stigma of being obese is so strong that it is assumed that anyone with the condition is (or should be) deeply ashamed. After all, it’s really easy to lose weight, right? Just cut out dessert and walk around the block three times a week. If you can’t even do that, then you are definitely a moral failure, have succumbed to Gluttony (...) and Sloth, and deserve to be shunned by society.The problem is that shame is not a very effective diet plan; quite the opposite. It’s no surprise that recent research shows that shame leads to depression that leads to isolation, which, in the morbidly obese, leads to a suicide rate twelve times that of healthy–weight people.Unfortunately, it is indeed true that many obese people feel a great deal of shame, even if we occasionally put on a façade of bravado or seeming shamelessness, e.g., the “large and in charge” sitcom staple trope. The bottom line is that our shame about our weight does keep us from engaging with other people, limits our willingness to participate in physical activities, and generally makes us reluctant to simply exist out in public. None of these are behaviors conducive to positive lifestyle changes.For years I engineered my life so I would only go out of my house when absolutely necessary: grocery shopping and the occasional meeting at work were pretty much it (I usually work from home). I went for years without going to a movie, shopping for clothes in a store, eating in a restaurant, gardening, or any of the other activities I once enjoyed. I was ashamed to be seen. And since I had tried and tried and tried and tried to lose weight for three decades and only ended up more overweight as the years went by, I finally, truly gave up. I convinced myself my psychological makeup was so flawed (or was missing whatever ingredient it was that made someone succeed at sustained weight loss) that I just hoped my inevitable heart attack would be instantaneously fatal. This thinking is irrational, or at least unhealthy. (I am an otherwise fairly smart person with an advanced degree and am professionally employed.) Yet, it is basically the path that both societal attitudes and medical treatment lead us down at this point in time.Here are a few examples that illustrate how the path to irrationality evolved for me.About twelve years ago, I decided to see a psychotherapist to get to the bottom of my subconscious psychological issue that was keeping me overweight. This therapist suggested I see a nutritionist who gave me a list of detailed thyroid tests to take to my doctor so she could order the labs and we could get a full profile of how my thyroid was functioning. Upon presenting the list to my doctor’s PA (my doctor was not available that day), she rolled her eyes, gave a very deep sigh and said to me, “Every fat woman wants to believe it’s because of her thyroid and it never, ever is.” I was so embarrassed for having even brought the subject up that in an effort to save face, I reacted to my shame by replying, “Yeah, I just assume my extreme lack of energy and excess weight is simply because I eat too much.” She said, “Right, so let’s not even bother running these tests.” It was at least ten years later that I finally had the thyroid panel run and found out it was very low functioning.After about a year of seeing that shrink, she declared me “cured” and sent me on my way, though I had not lost any weight. It was about this time I first began thinking that throwing in the towel [End Page 91] was a good option. That didn’t mean that I went out and ate pizza and ice cream every day. Not at all. In fact, given the fact that I had been vegetarian and general health–food freak beginning in my mid–twenties, I rarely had anything in the house that contained sugar... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:418 Feminist Studies 43, no. 2. © 2017 by the estate of tatiana de la tierra. Ode to Unsavory Lesbians i love an ugly lesbian one who walks with a limp talks with a lisp leaves her dentures out overnight by the bathroom sink wears polyester pants and men’s cologne, the cheap kind has a beard so long she steps on it sprouts warts on her toes, all twelve (...) of them carries a spittoon in her breast pocket chortles at church people i dream of a lesbian who’s always broke she doesn’t own a car, walks streets barefoot, near and far washes all her clothes by hand steals from walmart scams the business-suited man lights matches on her wooden leg barbeques freshly plucked birds on her shopping cart seasons them with salt, that’s all licks her fingers in the moonlight i crave a lesbian who’s fat and fleshy so big she can’t fit through the door at starbucks and they set up an outdoor café just for her so fat she wears bangles on her fingers her belly is a boom box her stretch marks are hieroglyphic etchings she’s so heavy, tectonic plates shift beneath her feet so huge, lake erie is her bathtub tatiana de la tierra tatiana de la tierra   419 i lust after an unsavory lesbian she blows away my lackluster day leads me in a lambada, lights lantern between my legs lays my head down on lace pillows humps me like a lamppost lacerates me with leather lust lacquers my body with blue latex paint logs the forest for prime wood builds me lakeside throne sets me there and worships me —goddess in blue— lines my path with lady slippers ravishes me with sex words pets me like a little lamb wins me by a landslide To My Kidneys i had no inkling of your existence those summers when i swam in waters at the turkey point nuclear power plant a mile from home was proud of the organic salad tomatoes and the steaming peppermint tea that came from backyard garden a block from the rex chemicals plant life at 29822 SW 147th avenue in leisure city was anything but leisurely 420 tatiana de la tierra it was all screaming and fighting and cursing hijueputa this and hijueputa that poverty pissed me off i drank too much high fructose corn syrup not enough purified water snorted cocaine smoked dope lived all toughed out while you worked silently on my behalf filtering purifying regulating i was an angry girl but i blew up no buildings killed no one i was all hot air exploding inside letting carnage settle harden at twenty-nine something was wrong the damage was done your tubules were atrophying glomeruli were dead and dying you were inflamed and irate i had twenty-four grams of protein in the urine all swollen and freakishly feverish pouring my fluids into vials and beakers tried to recollect every sun burn those little red dots on my childhood skin tatiana de la tierra   421 i was a medical mystery for months until the day doctors made a diagnosis: lupus-mediated membranous glomerulonephritis now, eighteen years later you’re all i’ve got my future is in the capillaries of your glomeruli i’ve taken pills done prayers of all kinds even injected myself with german baby’s umbilical cord to keep you going yet you falter healers put the blame on all kinds of things deep-seated fears petrochemicals lead cadmium karma white flour self-hatred seriousness we’re in this together, you and i let’s go get sunshine drink green tea grow tall and strong wade in waters up to our knees like the cypress in the florida swamps gracing riverbanks and wetlands roots filtering flowing waters branches stretching to the skies with their durable and eternal woods 422 tatiana de la tierra Topanga Canyon i had forgotten trees how they claim earth and sky a herd of elephants standing in place reaching up with their trunks carrying torches of green leaves that breathe after death crushed at my feet trees splayed out like spent lovers legs open... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pairing breaths:Rabah Ameur-Zaïmech's Terminal Sud (2019)Marion Froger (bio)Translated by David F. BellAsphyxiaNever had I felt such a sense of suffocation watching a film by Rabah Ameur-Zaïmeche.1 The poisoned atmosphere of Terminal Sud (2019) recalls the atmosphere of the Algerian War (1955-1962) and that of the decade of darkness (1991-2002) in that country. The filmmaker chose not to make a historical film, however, but rather a dystopia that fuses together (...) periods and places. The story appears to be contemporary, in a country bathed in the colors of southern France, apparently in the grip of all the violence that French and Algerian memories are nowhere near forgetting.2 Bandits wearing combat uniforms, policemen wearing outfits sporting an acronym that strangely resembles one used by Islamist Algerian groups,3 and generals evoking the French putschists of 1961 all fight against each other—ransoming, threatening, kidnapping, killing, and torturing the local population. Meanwhile, out in the countryside, guerrillas (maquisards4) try to care for their dying leader, like North African freedom fighters (fellagas) were doing before them, and this in turn evokes French Resistance fighters in the 1940s. The film's work on confused memories, which, according to Thierry Kuntzel, is related to the condensation, overdetermination, and displacement of dreamwork, transforms being out of breath into a symptom that hounds the doctor, played by Ramzy Bédia ("Inhale…Exhale…Inhale again…Hold your breath…Exhale"), a state of the world in the form of a trap that threatens to suffocate him—and launches the quest for a filmic poetics of calm through the pairing of breaths.Peeling façades with tightly closed doors, lowered metal shop shutters, narrow and tense streets: the doctor, his wife Hazia, and their family slip outside in fear of kidnapping and gunfire, climb up stairs breathing heavily, anxiously await by the window, their bodies obscured in starkly contrasting shadows cast by glaring light, hug each other with endless sighs. As they share their grief, they have barely enough breath left to sing to the memory of someone who has disappeared,5 as if after an argument, [End Page 244] when everything has been said and all that remains is a strangled sob serving as last farewell.The film opens with an attack on a minivan used for public transportation: bandits, who could be soldiers, steal everything from the passengers and driver. The doctor sees his patients in a rundown hospital, treats a woman whose breathing is raucous, her voice taut with anxiety, and who speaks about the disappearance of her husband. Back home, he finds anonymous letters containing death threats and, to calm down, he searches for his breath by taking a deep drag from a cigarette and a swig of whiskey. "I can't take it any longer, I can't even stand up, I can't do anything, I'm at the end of my rope, I'm tired […] Is that what our country has become?" he confides to a friend several hours before losing, in the emergency room, his wife's brother, a journalist assassinated in front of his house. "Stay with me," he says as he runs beside the stretcher calling for help, "Breathe, breathe."The spasmodic breathing of Ramzy Bédia, provoked by the fear, effort, and pain that define his character, intensifies as the film progresses. He barely breathes in the car taking him to treat the rebel leader; he is running out of breath beside the leader's bed as we hear the death rattle and as Bédia shouts to the leader's comrades, "Give him some air, everyone get out!" Later, one of the policemen standing guard at the entrance to the hospital will be mortally wounded by a kamikaze attack and will die on the operating table despite the doctor's exhausting reparatory manipulations. Asphyxia will ultimately directly threaten the doctor after his arrest. Tied to an old bedspring, he will be tortured by electroshock,6 will attempt one last time to justify himself to a soldier who wants to know everything about the rebel leader the doctor has treated, and will nearly suffocate in his... (shrink)

Matthes and I both hold that the central ethical harm of continuing to engage with the work of immoral artists lies in what doing so inadvertently expresses to others. (Matthes, 2021; Matthes, 2022; Willard, 2021; Willard, 2022). We also agree that there’s little wrong ethically with continuing to engage the work of immoral artists in private or within interpretive communities poised to place the ethical and the aesthetic in dialogue with each other. Matthes (2022, p. 523) notes that part of (...) his motivation for writing the book was the countless conversations he had with friends, colleagues, and strangers about the problem of immoral artists, and my experience–—everywhere from the doctor’s office to the classroom to the bike shop—was similar. Interpretive communities reappraise immoral artists’ art together.Outside of those contexts, we both advise caution. Liao (forthcoming) suggests that doing so comes at an unrecognized cost to our aesthetic agency because the source of aesthetic value is social. In response, Matthes (2022) argues that attending to the social expression of one’s aesthetic pursuits does not compromise our aesthetic agency. This seems right. Any reasonable account of the value of aesthetic agency should presumably allow for ordinary human decency to restrain one’s public expression of one’s aesthetic loves. The proper exercise of aesthetic autonomy requires not unbridled freedom, but sensitivity to the right kinds of reasons. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Time of the Magicians: Wittgenstein, Benjamin, Cassirer, Heidegger, and the Decade That Reinvented Philosophy by Wolfram EilenbergerDavid HermanTime of the Magicians: Wittgenstein, Benjamin, Cassirer, Heidegger, and the Decade That Reinvented Philosophy, by Wolfram Eilenberger, trans. Shaun Whiteside; 432 pp. New York: Penguin Press, 2020.Is it possible to write a deeply researched and technically precise contribution to the history of philosophy that reads like a gripping novel? Time of (...) the Magicians, originally published in German in 2018 as Zeit der Zauberer, convincingly demonstrates that this feat can indeed be accomplished. However, it may be achievable only by the rare expert who, like Wolfram Eilenberger, combines a thoroughgoing knowledge of the field, an unstinting commitment to recreating a public forum for philosophy, and a gift for the exposition—and dramatization—of philosophical debates, the broader circumstances in which they took place, and the motivations and aims of those who participated in them.The book, stylishly translated by Shaun Whiteside, begins by plunging us into the middle of things. Eilenberger provides snapshots of what his four focal thinkers were up to in 1929, before backtracking, in subsequent chapters, to cover key events in the decade that brought them to this point. Then, in the epilogue, he briefly sketches their post-1929 lives and careers. The book's readability is further enhanced by the way the text is broken up into short sections with eye-catching titles ("A Hut of One's Own," "Existential Health Check," "Self-Fashioning through Openness").The opening pages center on June 1929, when Ludwig Wittgenstein, having previously renounced his portion of his family's fortune and taught for several years at primary schools in rural Austria, undertook an oral defense of his doctoral thesis at the University of Cambridge at age forty. Wittgenstein's "thesis" just so happened to be Tractatus Logico-Philosophicus, the influential, sometimes gnomic book he had published in 1921; and at the conclusion of the defense, the candidate is rumored to have said to his examiners, Bertrand Russell and G. E. Moore, "Don't worry, I know you'll never understand it."In fact, as Eilenberger discusses in a later chapter, by 1929 Wittgenstein's own thinking was no longer where it had been when he wrote the Tractatus. The [End Page 492] philosopher's primary concern had shifted away from identifying the logical structure of meaningful propositions; instead, he had become interested in how meaning emerges from the way language is used in particular, concrete contexts. Apropos the evolving nature of Wittgenstein's ideas, one of the funniest parts of the book describes the philosopher's meetings with members of the Vienna Circle, a group that, in seeking to reorient philosophy around the natural sciences, had come to see the Tractatus as a touchstone for their work. During his first meeting with the group, in 1927, Wittgenstein, instead of talking shop, recited poems by Indian poet Rabindranath Tagore, standing with his back turned to the audience. Later discussions did involve philosophy, but eventually, as Eilenberger puts it, although the "Vienna Circle had hoped for something that coincided with their ideal of objective research," they "were instead left to grapple with an extremely idiosyncratic style of thinking that, in both execution and results, seemed directly contrary to it" (p. 274).Meanwhile, a few months prior to Wittgenstein's defense of a thesis that no longer reflected his real tendencies of mind, two of Eilenberger's other focal thinkers, Ernst Cassirer and Martin Heidegger, engaged in a much-anticipated public debate at the Grand Hôtel Belvédère in Davos, Switzerland. When he first mentions it, Eilenberger furnishes just enough detail to whet readers' curiosity about this epochal contest between the eminent neo-Kantian Cassirer, whose reputation for encyclopedic erudition had just been sealed by the publication of the final volume of his masterwork, The Philosophy of Symbolic Forms, and the considerably younger Heidegger, a one-time student of Edmund Husserl who had made a radical departure from Husserlian phenomenology in Being and Time.By the time readers return to the debate, some three hundred pages later, Eilenberger has provided a decade's worth of historical context, which casts a... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Time of the Magicians: Wittgenstein, Benjamin, Cassirer, Heidegger, and the Decade That Reinvented Philosophy by Wolfram EilenbergerDavid HermanTime of the Magicians: Wittgenstein, Benjamin, Cassirer, Heidegger, and the Decade That Reinvented Philosophy, by Wolfram Eilenberger, trans. Shaun Whiteside; 432 pp. New York: Penguin Press, 2020.Is it possible to write a deeply researched and technically precise contribution to the history of philosophy that reads like a gripping novel? Time of (...) the Magicians, originally published in German in 2018 as Zeit der Zauberer, convincingly demonstrates that this feat can indeed be accomplished. However, it may be achievable only by the rare expert who, like Wolfram Eilenberger, combines a thoroughgoing knowledge of the field, an unstinting commitment to recreating a public forum for philosophy, and a gift for the exposition—and dramatization—of philosophical debates, the broader circumstances in which they took place, and the motivations and aims of those who participated in them.The book, stylishly translated by Shaun Whiteside, begins by plunging us into the middle of things. Eilenberger provides snapshots of what his four focal thinkers were up to in 1929, before backtracking, in subsequent chapters, to cover key events in the decade that brought them to this point. Then, in the epilogue, he briefly sketches their post-1929 lives and careers. The book's readability is further enhanced by the way the text is broken up into short sections with eye-catching titles ("A Hut of One's Own," "Existential Health Check," "Self-Fashioning through Openness").The opening pages center on June 1929, when Ludwig Wittgenstein, having previously renounced his portion of his family's fortune and taught for several years at primary schools in rural Austria, undertook an oral defense of his doctoral thesis at the University of Cambridge at age forty. Wittgenstein's "thesis" just so happened to be Tractatus Logico-Philosophicus, the influential, sometimes gnomic book he had published in 1921; and at the conclusion of the defense, the candidate is rumored to have said to his examiners, Bertrand Russell and G. E. Moore, "Don't worry, I know you'll never understand it."In fact, as Eilenberger discusses in a later chapter, by 1929 Wittgenstein's own thinking was no longer where it had been when he wrote the Tractatus. The [End Page 492] philosopher's primary concern had shifted away from identifying the logical structure of meaningful propositions; instead, he had become interested in how meaning emerges from the way language is used in particular, concrete contexts. Apropos the evolving nature of Wittgenstein's ideas, one of the funniest parts of the book describes the philosopher's meetings with members of the Vienna Circle, a group that, in seeking to reorient philosophy around the natural sciences, had come to see the Tractatus as a touchstone for their work. During his first meeting with the group, in 1927, Wittgenstein, instead of talking shop, recited poems by Indian poet Rabindranath Tagore, standing with his back turned to the audience. Later discussions did involve philosophy, but eventually, as Eilenberger puts it, although the "Vienna Circle had hoped for something that coincided with their ideal of objective research," they "were instead left to grapple with an extremely idiosyncratic style of thinking that, in both execution and results, seemed directly contrary to it" (p. 274).Meanwhile, a few months prior to Wittgenstein's defense of a thesis that no longer reflected his real tendencies of mind, two of Eilenberger's other focal thinkers, Ernst Cassirer and Martin Heidegger, engaged in a much-anticipated public debate at the Grand Hôtel Belvédère in Davos, Switzerland. When he first mentions it, Eilenberger furnishes just enough detail to whet readers' curiosity about this epochal contest between the eminent neo-Kantian Cassirer, whose reputation for encyclopedic erudition had just been sealed by the publication of the final volume of his masterwork, The Philosophy of Symbolic Forms, and the considerably younger Heidegger, a one-time student of Edmund Husserl who had made a radical departure from Husserlian phenomenology in Being and Time.By the time readers return to the debate, some three hundred pages later, Eilenberger has provided a decade's worth of historical context, which casts a... (shrink)

Doctoral programs at U.S. universities play a critical role in the development of human resources both in the United States and abroad. This volume reports the results of an extensive study of U.S. research-doctorate programs in five broad fields: physical sciences and mathematics, engineering, social and behavioral sciences, biological sciences, and the humanities. Research-Doctorate Programs in the United States documents changes that have taken place in the size, structure, and quality of doctoral education since the widely used 1982 editions. This (...) update provides selected information on nearly 4,000 doctoral programs in 41 subdisciplines at 274 doctorate-granting institutions. This volume also reports the results of the National Survey of Graduate Faculty, which polled a sample of faculty for their views on the scholarly quality of program faculty and the effectiveness of doctoral programs in preparing research scholars/scientists. This much-anticipated update of such an essential reference will be useful to education administrators, university faculty, and students seeking authoritative information on doctoral programs. (shrink)

Star Wars Episode VII: The Force Awakens is not the hero’s journey as George Lucas previously conceptualized it. Instead, the story line of The Force Awakens leads me to believe that it creates a new iteration of the hero myth. It follows the contemporary heroine’s journey while conforming to the essential construct of the hero monomyth. First, the contemporary heroine’s journey focuses primarily on the greater good and secondarily on her own personal journey, which is the converse of the traditional (...) hero’s journey. Second, the contemporary heroine’s self is awakened and called to adventure in a different way than the traditional hero. Third, the traditional hero receives guidance on his journey, while the contemporary heroine pushes ahead alone, striving to save her society from despair. (shrink)

Based on newly discovered texts, this book explores the barely known but tremendously influential thought of the Tibetan Buddhist teacher, Mabja Jangchub Tsöndrü.This Tibetan Buddhist master exercised significant influence on the interpretation of Madhyamaka thinking in Tibet during the formative phase of Tibetan Buddhism and plays a key role in the religious thought of his day and beyond. The book studies the framework of Mabja’s philosophical project, holding it up against the works of both his own Madhyamaka teachers as well (...) as those of central authors of the later "classical period". The emerging account of the evolution of Madhyamaka in Tibet reveals a striking pattern of transformative appropriations. This, in turn, affords us insights into the nature and function of tradition in Tibetan religious culture and Mahāyāna Buddhism at large. Innovation is demanded for both the advancement and consolidation of tradition. This ground-breaking book is an invaluable contribution to the study of Tibetan philosophy. It is of great interest to Buddhist practitioners, specialists in Buddhist philosophy and Tibetan Buddhism. (shrink)

In the Nyāya school of Classical Indian Philosophy, the concept of word meaning is described in detail; however, the theory of metaphor seems to clash with the theory of word meaning. This paper explores the theory of meaning in the early Nyāya theory and whether metaphor is compatible with it. The Nyāya theory of meaning is a 'basis for application' (pravrttinimitta) model: words pick out references because of the conventions and practices of use. Yet, these words can come to refer (...) to something completely different by pushing off its conventional usage and taking on a metaphorical meaning. If the referent is determined on the basis of the properties it possesses, how it is possible that only some properties are applied to a referent in metaphorical cases when, conventionally, a referent must possess all of the properties before the word is applied to it? This paper will investigate three main questions: 1) what is the nature of a referent according to the Nyāya?; 2) what is the mechanism for metaphorical transfer that allow some properties to transfer and not others?; and 3) what are the philosophical implications of the Naiyāyikas understanding of meaning? (shrink)

This chapter suggests that Sellars' account of subjectivity as socially constructed, and hence conceptual at its illusory roots, presents a crisp and compelling perspective on cognitive life that captures Buddhist conceptions of transformative non-duality.

As a Madhyamaka philosopher, Taktsang Lotsawa Sherab Rinchen 1 is perhaps most widely known for his claim to have identified eighteen major contradictions in the thought of Tsongkhapa Losang Drakpa, a polemic discussion that appears in the Madhyamaka chapter of his encyclopedic Freedom from Extremes through Comprehensive Knowledge of Philosophy.2 In this article we will not pursue this critique, both renowned and infamous, but instead focus on Taktsang Lotsawa's own pragmatic hermeneutics of emptiness in context. Taktsang Lotsawa argues that *Svātantrika (...) 3 Mādhyamikas, in their drive to furnish the two... (shrink)

In this case-study, I examine examples which fall within the five categories of the re-use of texts in the Nyāya Sūtra, Nyāya Bhāṣya, and Nyāya Vārttika and note the form of quoting and embedment. It is found that the re-use of texts is prominent and that the category and method of embedding the re-used passages varies from author to author. Gautama embeds the most interlanguage quotations without acknowledging his sources and Uddyotakara re-uses the most quotations and paraphrases while acknowledging his (...) sources. Vātsyāyana re-uses the most direct quotations but only acknowledges his sources about half the time. Each author re-uses textual material for two reasons: to demonstrate his authority in this field; and to support his own arguments and to critique objections and opposing theories. Differences crop up in the methodologies of Gautama, Vātsyāyana, and Uddyotakara as the concept of an authority shifts over time, as the body of literature grows, and as new objections and opponents arise. (shrink)

In the acquisition of verbal knowledge, the Nyāya school outlines four conditions of a linguistic utterance that must be met: āsatti (temporal proximity), ākāṅkṣā (syntactic expectancy), tātparya (speaker intention), and yogyatā (semantic fitness). I will follow the traditional Nyāya view that is it one of the four necessary conditions that enable a hearer to gain verbal knowledge. The reasoning behind retaining tātparya as a condition (or cause) of verbal knowledge, is that it provides a resource with which to clarify ambiguity (...) when contextual factors cannot. It also provides a context for a hearer so that the primary (abhidhā) or secondary (lakṣaṇā) meaning of the word, or sentence is understood. In this sense, tātparya imparts the meaning of a work. Examples such as “Bring saindhava” or “Hari” make the case for the importance of tātparya in that the meanings of these terms are ambiguous unless the context is provided or the speaker intends to mean one referent rather than another. In this paper, I present the case that tātparya is the most important component of an accurate paraphrase, and it must be retained in order to preserve the original intention of the work. In other words, tātparya should be the primary constraint of an acceptable paraphrase. As a side comment to my aim, I discuss the notion of why paraphrase only needs to be sufficiently similar to the original work. (shrink)

Best known for his contributions to the development of contemporary intersubjectivity theory, Bernard Brandchaft has dedicated a career to the advancement of psychoanalytic theory and practice. Continually searching for a theoretical viewpoint that would satisfactorily explain the clinical phenomena he was encountering, his curiosity eventually led him to the work of Heinz Kohut and the then-emerging school of self psychology. However, seemingly always one step ahead of the crowd, Brandchaft constantly reformulated his ideas about and investigations into the intersubjective nature (...) of human experiences. Many of the chapters in this volume have never before been published. Together, they articulate the evolution of Brandchaft's thinking along the road toward an emancipatory psychoanalysis. Moreover, commentary from Shelley Doctors and Dorienne Sorter – in addition to Bernard Brandchaft himself – examines the clinical implications of the theoretical shifts that he advocated and provides a contemporary context for the case material and conclusions each paper presents. These theoretical shifts, both clear and subtle, are thereby elucidated to form the grand narrative of a truly visionary psychoanalytic thinker. (shrink)

The centrality of trust in traditional doctor–patient relationships has been criticized as inordinately paternalistic, yet in today's discussions about medical ethics—mostly in response to disruptive innovation in healthcare—trust reappears as an asset to enable empowerment. To turn away from paternalistic trust‐based doctor–patient relationships and to arrive at an empowerment‐based medical model, increasing reference is made to the importance of nurturing trust in technologies that are supposed to bring that empowerment. In this article we stimulate discussion about why the move towards (...) patient empowerment may not be able to keep clear of the criticism of trust in traditional patient–doctor relationships. First, we explore how such a shift in trust dynamics might corrode patient empowerment in the name of patient empowerment. Second, we examine how a translocation of trust may at best push the “trust issue” elsewhere and at worst make it harder to evaluate trustworthiness. (shrink)

The following pages sketch the outlines of “a Canaanite reading” of the health system. Beginning with the Black person—African, Afro-diasporic, Aboriginal, and Torres Strait Islander—who is seen by a health professional, the functions and effects of the racializing gaze are examined. I wrestle with Al Saji’s understanding of “colonial disregard,” Whittaker’s insights into the extractive disposition of settler institutions vis-à-vis Indigenous peoples, and Saidiya Hartman and Fred Moten’s struggle with the spectacular. This leads me to conclude that the situation of (...) the Black within the health system is a tragic one. The prescription for the path out of this tragedy that I settle on, responding to Okiji’s opening call, is found in Vernon Ah Kee’s “Unwritten” series. (shrink)

Most people know precious little about the risks and benefits of participating in a clinical trial--a medical research study involving some innovative treatment for a medical problem. Yet millions of people each year participate anyway. Patients at Risk explains the reality: that our current system intentionally hides much of the information people need to make the right choice about whether to participate. Witness the following scenarios: -Hundreds of patients with colon cancer undergo a new form of keyhole surgery at leading (...) cancer centersnever -Tens of thousands of women at high risk of developing breast cancer are asked to participate in a major research study. They are told about the option of having both breasts surgically removed but not told about the option of taking a standard osteoporosis pill that might cut the risk of getting breast cancer by one-half or more. Patients at Risk written by two nationally prominent experts, is the first book to reveal the secrets that many in the research establishment have fought long and hard to keep from patients. It shows why options not commonly knownincluding getting a new treatment outside of a research studycan often be the best choice. It explains how patients can make good decisions even if there is only limited information about a treatments effect. And it does this through the eye-opening stories of what is happening daily to thousands of people. Day after day, we are learning how little we know about what really works. Headlines regularly announce that a previously unquestioned treatmenthormone replacement therapy, drugs such as Vioxx or Celebrexmay now be much riskier than we thought. The latest book in a surge of recent books criticizing the medical establishment (but the first to look at clinical trials specifically), Patients at Risk helps to empower patients to survive in a world of medical uncertainty, and makes positive recommendations for systemic reform. (shrink)

Embedded pragmatic clinical trials (PCTs), like other types of randomized comparative-effectiveness research (CER) studies, are sometimes conducted without informed consent. Indeed, authors of both...

Objectivism is the view that how an agent ought to act depends on all kinds of facts, regardless of the agent’s epistemic position with respect to them. One of the most important challenges to this view is constituted by certain cases involving specific conditions of uncertainty—so-called three-options cases. In these cases it seems overwhelmingly plausible that an agent ought to do what is recommendable given her limited perspective, even though the agent knows that this is not objectively the best course (...) of action. The standard objectivist response to this challenge relies on a distinction between what one ought to do and what would be blameworthy or unreasonable to do. This response is affected by several problems. In this paper I introduce and defend an alternative objectivist response to the challenge. My proposal admits that in the relevant cases the agent ought to do what is recommendable given her perspective, but maintains that this diagnosis of the cases is fully compatible with objectivism. I argue that this proposal has several advantages over alternative accounts of the cases. (shrink)

On 11 September 2019, the verdict was read in the first prosecution of a doctor for euthanasia since the Termination of Life on Request and Assisted Suicide Act of 2002 was installed in the Netherlands. The case concerned euthanasia on the basis of an advance euthanasia directive for a patient with severe dementia. In this paper we describe the review process for euthanasia cases in the Netherlands. Then we describe the case in detail, the judgement of the Regional Review Committees (...) for Termination of Life on Request and Euthanasia and the judgement of the medical disciplinary court. Both the review committees and the disciplinary court came to the conclusion there were concerns with this case, which mainly hinged on the wording of the AED. They also addressed the lack of communication with the patient, the absence of oral confirmation of the wish to die and the fact that the euthanasia was performed without the patient being aware of this. However, the doctor was acquitted by the criminal court as the court found she had in fact met all due care criteria laid down in the act. We then describe what this judgement means for euthanasia in the Netherlands. It clarifies the power and reach of AEDs, it allows taking conversations with physicians and the testimony of the family into account when interpreting the AED. However, as a practical consequence the prosecution of this physician has led to fear among doctors about prosecution after euthanasia. (shrink)

Medicine has undergone substantial changes in the way medical dilemmas are being dealt with. Here we explore the attitude of Israeli physicians to two debatable dilemmas: disclosing the full truth to patients...