Wednesday, August 30, 2017

The 'Primum Non Nocere' Principle

Nancy Carter Pennington & Lawrence H. Staples

If you like fiction, you might try the obituary page. While it’s not great fiction, it definitely is fiction, although it lacks drama. Clearly missing are many of the literary elements that produce dramatic impact: contradictions, point and counterpoint, the play of opposites, and change of pace, to name a few. Instead, obituaries tend to be linear and one-sidedly positive. Rarely revealed are the dark and shadowy sides of the decedent. After the initial glow of a gushing obituary has faded, we may begin to feel some discomfort. We may begin to compare the radiant claims of virtue and good character revealed publicly in the obituary with what we know privately about ourselves, what we conceal inside. We see that our private view of what’s inside us doesn’t compare very favorably with the very public lauding of another’s sterling qualities, the polished part they showed the outside world. Of course, we can only guess at what the interior truth about their lives may have been. But if we assume they were really anything like their obituary claims, we may feel bad about ourselves, perhaps even depressed.

There is a very powerful taboo against criticizing the deceased. We remember a patient whose mother called to let him know his paternal grandmother had died. His mother talked about what a wonderful person his grandmother, her mother-in-law, had been. At some point, our patient stopped his mother and said, “Mom, stop it. You know grandmother could be a real bitch and often treated you like dirt. Are you forgetting when she called you ‘K street trash’ to your face or accused you of being the hussy who married dad for money and security?” His mother couldn’t bring herself to criticize his grandmother except to add, “Well, maybe she wasn’t perfect.”

Our patient’s conversation with his mother exemplifies the taboo. To speak ill of the dead feels somehow blasphemous. It violates some more-or-less unconscious, sacred boundary. We worry we’ll be punished, as if we’d taken God’s name in vain.

We can wonder why talking about someone’s dark side in an obituary is so taboo. After all, they are dead. Perhaps the answer has something to do with our need to love and be loved. For example, if an important challenge of love is being able to accept and tolerate others as they are and ourselves as we are, perhaps the death of another allows us to love in ways we couldn’t when the other person was alive. And, since we also have similar dark qualities, our willingness to overlook someone’s faults after their death could help edge us along the road to accepting ourselves.

Whatever the reason, obituaries have probably always tended to reflect the bright side of a two-sided moon and will likely continue to do so. It isn’t so much that the bright side isn’t true; it’s just that it’s a half-truth. It’s as unreal and inauthentic as someone who casts no shadow on a sunny day. The obituary is our last act of presenting ourselves in a way that reflects how we presented ourselves all our lives. During our lives, we hide as best we can the dark stuff, the dirty stuff, the outrageous stuff, the immoral stuff, the selfish stuff, the irresponsible stuff, the lazy stuff, the neglectful stuff, the cheating stuff, the cruel stuff, the sadistic stuff, the illicit stuff, the dumb stuff, the insincerity, the cowardice, the betrayals, the failures, the thoughtlessness, the insensitivity, the depressions, the addictions, the unhappiness, the adultery, the anxiety, the bad habits, the avarice, the stinginess, the incest, the perversions, the meanness, the hate, and the evil. And, long as this list may be, it is likely a short catalogue of what may be hidden on the dark sides of our reflected moons. If we can’t completely hide our dark stuff, we, at least, try to touch it up, photo shop it, so to speak, or give it the best spin we can invent.

We hide our darkness because we aren’t dummies. We know what happens if too much of who we are is too widely known or gets into the wrong hands. We hide it or we fail. If we want to be successful in conventional terms, we have to put our best foot forward, inauthentic and unreal as that picture of us may be. We say “successful in conventional terms” because it would seem impossible in conventional society to be considered successful if much of the dark stuff were to be revealed or exposed. Of course, there are rare exceptions.

Real honesty, as coldly objective about our “shit” as we can be, can bring healthy psychic relief when we express it, just as good bowel movements bring us healthy physical relief. But like bowel movements, it’s much better to do it in private. If we are lucky, we may find a friend or spouse or partner who loves us enough to hear our stories without rejecting us. When we talk about intimacy in relationships, this is what we mean. The degree of intimacy in a relationship depends upon how much of our dark side we can share with each other without being judged or rejected by the other. Still, while we may be able to reveal much of ourselves to such loving friends, they are still human, and no matter how much we feel they love us, we may fear revealing some aspects of ourselves. There may be things we cannot tell them, either. We may not be able to tell them, for example, if we did something utterly taboo, like screwing a goat. With the right therapist, though, we could probably get away with that one. It’s the hateful things we feel toward our spouses, partners, friends, and neighbors—and even our therapists—that we usually feel inhibited about revealing.

Neither truth nor lies monopolize the halls of goodness. Truth, however, gets much better press and is more respectable. While truth, indeed, has much value, lies have value as well. Churchill recognized this when he remarked, “The truth must be protected by a vast bodyguard of lies.” Most of us accept the value of lying to our enemies. Less recognized is the value in lies to friends that are offered in peace. If we are to grow and protect ourselves, we need to be able to practice truth and lies appropriately, rather than compulsively. A compulsion to tell the truth can handicap us at times. In the grip of a compulsion, we lose ourselves— even if our compulsion concerns righteous things.

The phrase brutal honesty is not part of our language for nothing. Truth can be mildly destructive, like learning the facts about Santa too soon. Or it can be truly destructive, as in Ibsen’s play, The Wild Duck,[i] about a blind little girl who dearly loves her doting father, whose mind is poisoned by a meddlesome friend who poses as a crusader for truth founded on the claims of an ideal where life is lived “free from all taint of deception.”[ii] The friend knows that the girl‘s father is not really her father and makes sure that this devastating truth becomes known. The disclosure leads to the father’s rejection of the little girl, who kills herself in her grief. Lies and truth can be destructive as well as kind.

In Christian theology, lies are the province of the Devil, while truth is the province of God. From that point of view, then, lies are bad and truth is good. One could make the case, however, that lies are the prima materia of the truth, just as chaos is the prima materia of order and creation. Without lies to see through and to find wrong, there would be no point in truth and no growth that leads to new truths that encompass wiser, more expansive points of view. Consider this example: As young children, we await the arrival of Santa Claus. Then, one day, we learn that Santa doesn’t exist. Children are likely to respond, “You lied to me!” As we grow older, though, we discover that really, there is a spirit of Santa Claus, and he lives in every parent who sacrifices to give a moment of delight to his child. When children learn this, of course, they also discover their own generosity.

Viewed this way, the new truths we learn become the “enemy” of our old ideas of truth, because the new truths expose the inadequacies and untruth of our old worldview. When one experiences the joy of insight into a new lesson, he could justifiably be grateful for the existence of the lie he was able to see through, in much the same way as we look back with a smile on the dogmatic beliefs of our youth with the wiser eyes of maturity. Without such old, untrue oversimplifications, the new, hard-won truths we later discover would lose much of their meaning. In fact, one of life’s profoundest secrets may be that neither the lies nor the truths have meaning without each other.

So, if we or our families were to consider making our obituaries more complete, honest, and authentic, we also need to ask, “What are the consequences?” Who is helped and who is hurt? For the deceased, we can assume the answer is likely neutral. For surviving spouses, family members, friends, and neighbors, the effect could be devastating or even ruin them. If a less-than-positive obituary that revealed much dark along with the light were to appear in the newspaper, think of the humiliation, embarrassment, and pain as spouses and family encounter the frowns, the bewildered looks, and the cold stares of friends, neighbors, and townspeople. There may, however, be some benefit to others who read the more truthful obituary and in the process feel less bad about themselves as they see confirmed that they are not the only ones with a lot of “shit” in their lives.

Since the practice of presenting positive obituaries has endured through the ages, we can assume that they protect some value both individuals and society believe to have great worth. It may support a belief that there may be something more important at work than either truth or lies. Maybe it’s the potential effect on those we leave behind that is the key factor. As Jack Nicholson says in A Few Good Men,[iii] “You can’t handle the truth.” Since it’s hard to imagine a truth so complete that it couldn’t be expanded upon by discussion of additional facets of the problem, why should we kid ourselves, and, especially, why should we reveal this fact at all if it hurts, humiliates, embarrasses, or debases others? If we do this, we’ve made truth more important than kindness, sensitivity, or thoughtfulness. Perhaps more important than truth or lies is the principle of primum non nocere, found in the Hippocratic Oath and meaning, “First, do no harm.” Maybe primum non nocere is the reason behind what we refer to as “white lies,” lies dressed in white, like doctors and nurses whose purpose is to heal and not harm.

The story from The Wild Duck[iv] in which a little girl kills herself, noted earlier, is an example of a situation that cries out for the telling of a kind and gentle white lie instead of the brutal truth the child was told. In the movie, The Choice,[v] we see a situation that calls for a white lie and gets it. In the movie, a little girl had brought her sick pet lizard to a veterinarian. The vet is standing by a glass cage and is reaching his hand into it. The vet’s son, who is also a vet, is standing nearby, watching his father. They have the following exchange:

Son: What the hell are you doing?

Vet: What does it look like?

Son: Well, it looks like you’re swapping out a dead lizard for a live lizard.

Vet: That’s right. It’s for that little girl in there.

Son: Don’t you think there’s a little more ethical solution here?

Vet: Well, what do you suggest? CPR?

Son: No, you know, like the truth, doctor.

Vet: The truth? You want to go tell that sweet little girl her lizard is dead? She’s ten years old. She doesn’t even know what death is. You want to explain death to her? You might as well tell her Santa Claus and the Easter Bunny don’t exist while you’re at it. I don’t think you should make a habit of it, but if you get a chance to protect a kid from the heartbreak this world deals out so generously, I think you should seize it. Because there’s a lot more where that comes from.

Son: Me? You want me to do it?

Vet: Yes, because I want you to get used to this situation.

After much thought and reflection about obituaries and their relationship to truth and lies (as well as many other situations in life where a white lie may serve a higher value than truth alone), our advice is to keep fooling ‘em, to the extent we can. We’ve spent much of our lives painting the best-looking portrait of ourselves that we could. Why fritter away at the end our long and expensive investment in our art? Why intentionally throw dirt on it and besmirch that portrait at the end? Let our obituaries be our last hurrah. Let the last act of maintaining our public image be our most creative one. And, following the principle of primum non nocere let it, as we pass into oblivion, perhaps, continue to be the kinder, gentler way for ourselves and others.

In the end, however, let us be sure to distinguish between fooling them and fooling ourselves. While there is much practical wisdom in concealing from public view the shadowy sides of ourselves, there is equally practical wisdom in our becoming as conscious as possible of what we conceal in that shadow. Knowledge of our darker side makes us increasingly modest and less judgmental, qualities that can actually improve our relationships with others.

Nancy Carter Pennington, MSW, Psychotherapist, co-author with Lawrence H. Staples of Our Creative Fingerprint and The Guilt Cure.

Lawrence H. Staples, PhD., Zurich trained Jungian Analyst, retired. Author of: The Creative Soul: Art and the Quest for Wholeness; Guilt with a Twist: The Promethean Way; co-author with Nancy Pennington of The Guilt Cure and Our Creative Fingerprint.

[i] Henrik Ibsen, The Wild Duck: And Other Plays (New York: Modern Library, 1961).
[ii] Henrik Ibsen, The Wild Duck: And Other Plays (New York: Modern Library, 1961), Act 4.
[iii] A Few Good Men, directed by Rob Reiner (1992; Culver City, CA: Sony Movie Channel, 1997), DVD.
[iv] Henrik Ibsen, The Wild Duck: And Other Plays (New York: Modern Library, 1961).
[v] The Choice, directed by Ross Katz (2016; Santa Monica: Lions Gate Entertainment Inc., 2016),,

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