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What really matters
GLBH 148. Class 9
Kleinman: What
Really Matters
¬ Dangers and uncertainties are an
inescapable dimension of life… and they
define what it means to be human.
¬ Kleinman centers the term “moral
experience”
¬ “Just carrying on our existence, negotiating
important relations with others, doing work
that means something to us, and living in some
particular local place where others are also
passionately engaged in these same existential
activities—all this is, by definition, moral
experience.”
Kleinman: What
Really Matters
¬ Is it possible to separate our own morality from
the “moral environment” that we live in?
¬ “Moral experience” doesn’t mean a quest to do the
right thing, it means the universal struggle to
hold on to what means the most to us and
to navigate and adapt to the variety of
challenges we are presented with that will
make it difficult to hold on to “what really
matters” to us.
¬ Moral life is closely connected to the idea of
ethics, by which we mean we aspire to
values that transcend the local and that can
guide us in living a life.
Kleinman: What
Really Matters
¬ This also extends to our own
bodies, and confronting the
challenges of its inevitable demise
Kleinman: What Really Matters
Beyond the immediacy of a joyous occasion, the periodic yet magical feeling of ebullience, and
even long-term happiness and the sheer distracting routine of one darn thing after another lies
what the great American psychologist and philosopher William James called “genuine
reality.” And it is life’s trials—bad luck, suffering, and even calamity—that teach us
endurance and acceptance of genuine reality.” P. 9
Kleinman: What
Really Matters
¬ Kleinman says that today, our view of
genuine reality is increasingly clouded
by professionals whose technical
expertise often introduces a superficial
and soulless model of the person that
denies moral significance.
¬ What would be an example of this?
¬ Medicalization of trauma and mental
illness
¬ The mental health and social costs of
social distancing in response to Covid-19
What Really
Matters
The premise of Kleinman’s book is that for many
people, many years have passed without any major
events occurring that constitute existential risk or
danger
This feeling of security was punctured on 9/11, but
this event did not usher in any major reorganization
of society or significant changes in our culture.
Implicit in his argument is the notion that as a society
we choose to ignore existential risk, choosing instead
to live “a big lie” that enables us to carry on our daily
routines without confronting these deeper questions
of our own mortality and the dangers we face daily
¬ Getting a handle on what really matters for us requires a self-critical stance
toward our emotions and values in which we try to step aside from (or, really, outside)
our taken-for-granted world and sense of self.
¬ Ethics, a set of moral principles that aspire to universal application, must be seen
in the context of moral experience, which is constantly changing and usually
uncertain, to provide a more adequate vision of societal values and how to
respond to their clash and change.
¬ Individuals’ efforts to live a moral life in the circumstances of moral experience can
lead them to formulate ethical criticism of those circumstances as well as to aspire
ethically to values that go beyond the local reality and seek universal support.
Asylum seekers’ uncertainties
¬ Each time Lucia had a court date, she would cycle through diverse emotions and the uncertainty
seemed to sharpen, not just with respect to her case but to the way she might react during the interview, because all
her worries about the present and her future possibilities would converge in that moment of uncertainty: “All
this [worries, possibilities, and desires]makes you feel, when you get to court, like ‘ what am I going to say
now, how are my nerves going to mess me up or help me or betray me?’” When she was about to have her fourth
court date, Lucia felt desperate and experienced recurrent desires to return to her place of origin, even just to die.
She went on a series of fasts to ask God for her asylum to be denied so she would be deported to El Salvador,
which did not happen.
¬
¬ On the contrary, the lawyer in charge of her case succeeded in merging her asylum request with that of her son.
After that, she decided that it was God’s will she should not return to her country, and she had to accept this, which
she tried to do through prayer: “When I pray it calms me down, I accept things and say, okay, if I’m here [in
Tijuana] it’s because God permitted it to be that way so that nothing happens there [in El Salvador] . . . because
maybe if God had not been there with me, we would not have come out alive.” Lucia’s appeals to God through
prayer and fasting were strategies to which she had recourse to make sense of the situation in which she found
herself. Contact with the intimate sacred, which dwells within her in existential terms thanks to her maintenance of
a relationship with God through religious practices, became a resource for making sense of her experience and,
sometimes, getting out of the state of uncertainty and ambivalence she was living in the present and projecting
into the future.
¬ Failure and catastrophe empower religion; religion, in turn, empowers people faced with
adversity to overcome self-doubt and fear of failing, and to act in the world.
¬ Acknowledging the always unequal struggle between where the world is taking us and where
we aspire to go does not at all mean accepting a glum perspective; rather, it involves
developing a deeper and more fine-grained appreciation of what the moral experience of
communities and the moral life of the individual are about, and why both are so important.
What Really
Matters
Discussion
¬ What is the “big lie” that Kleinman speaks
of?
¬ What does he suggest we confront instead of
living out the “big lie”?
¬ Why does Kleinman think it is essential for
us to confront existential risk?
¬ You all are growing up in an environment
with different forms of existential risk
(Covid, of course, but also things like
climate change).
What Really Matters Discussion
¬ Thinking about the pandemic we have just had, experiencing existential danger from Covid-
19 and witnessing massive and at times intrusive social and political interventions into our
daily lives….
¬ Do you think that anything fundamentally changed in our daily routines, in our politics, or
how our society is structured?
¬ Or do you think that we kept living the “big lie” and finding ways to cope with and adjust to
danger that keep the current system intact?
Medical
Humanitarianism:
Research insights in a
changing field of practice.
Closing Health
Gaps
¬ What are our obligations to act if we see
gaps in health between populations?
¬ Between populations around the world?
¬ Gaps between countries much
wider than gaps between
populations in the United States
¬ Does this mean we should focus
more on global health disparities
and less on domestic health
disparities?
Closing Health
Gaps
Where/How to intervene?
– Class inequalities, Access to
Care, Structure of Health Care
System?
– Identity based inequalities, lower
quality of care for racial and
ethnic minorities, even those
who have great access and are
high SES
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5/27/24 Sample Footer Text
Humanitarianism
Humanitarianism is the term we used to describe the impulse to intervene to close health gaps
between populations both within the US and around the world
– Is Humanitarian intervention always a good thing?
– What are some ways that humanitarian intervention can go wrong?
– Main message of the class is that health and health care is not separate from culture, the
economy, or from politics. This means that our humanitarian interventions or global health
engagements will have their own medical culture and logics, that they will be shaped by these
larger forces.
