Ethics of Care in Time and with Time - or a Sketch of a “Care of Temporality”

Time is both a content and a container, the flow and the framework of flow. It contains time to better let it go. Faced with death, the order of linear time explodes under the onslaught of the emotions that overwhelm us. The guts of time explode. With imminent death, the dramatic nature of time appears in a furious way: time pushes us, sword in our back, towards the precipice, it nibbles away our capital of life every day. The blackout is coming soon. What to do to live the moment yet to be lived? Above all: take care of time. My ambition is what I call here “care of time”. Take care of time before taking care of body and soul. Wait for time to better live what remains to be lived.

Introduction

“Let the hours sleep

Time is no longer for the taking

Death is impatient to wait...”

By Anne Perrier [1].

When Hamlet is confronted with the ghost of his Father (the son now knows that his father was murdered by his uncle, the current king), he says, “The time is out of joint”! [2] When the horizon of death narrows and becomes a wall into which the patient will soon be embedded, the patient loses patience. Time then leaves its quiet bed - the bed of the river and the bed of restful nights. Anguish overflows everything. Time, which is also a conduit, a tunnel, goes haywire. It disarticulates and loses its joints, its binder. Time is both content and container, flow and frame. It contains time, the better to let it go. Then, the order of linear time explodes under the onslaught of emotions that overwhelm us. Time’s guts explode. What do we do when there’s nothing left to do? Is this the end, the real end? A break in consciousness occurs: death is no longer the vague (philosophical) feeling of hypothetical mortality, but the (psychic) horror of everything coming to a halt. When death is postponed to the end (which is our usual experience), time doesn’t exist. In “normal time”, time disappears beneath its normality. It passes through us unnoticed. It flows away from our consciousness. It forgets itself and knows how to make itself forgotten - if not by our watches, the speed of appointments, the chain of “reminders to order” of this comminatory electronic order that has taken hold with cell phones - with the pack of SMS, emails and other injunctions to have to respond at the moment. But, with imminent death, the dramatic nature of time appears in a furious way: time pushes us, sword in our backs, towards the precipice, nibbling away at our life capital every day; it no longer flows nonchalantly (as we believe it does “in normal times”) but reveals itself to be a countdown. Then, for good, comes the end of the line, the time of the final deadlines. It’s time to settle accounts, settle positions taken, and settle emotional attachments. The blackout is just around the corner. Up until now, life has given us credit. We lived on credit. Here and now, death mercilessly demands that we pay our debt - the debt of life, at the cost of our own lives. It’s no longer a question of postponing this ultimate rendezvous until St. Glinglin’s Day. It’s here. The angel of death is here. The battle has already begun. Death will soon have the last word. Time emerges in all its horror. We no longer hold on to it, it drains us of our vital substance. We lose our living energy in an inexorable drip, drip, drip.

A) Of course, it’s always possible to see death as an extension of life. It’s part of life, an integral part of our existence. But when death is imminent, it is experienced as a cataclysmic accident. There is a break in consciousness - in the sense of both a break in our awareness of the nature of time and death and a break in the way our consciousness functions. Before, death was at best a kind of dark shadow within us, the better to reveal the clarity of the world. This chiaroscuro of consciousness is over. From now on, death is the enemy that will eventually kill us. And time becomes an accomplice in this murder - which resembles biological suicide in that cancer, for example, is a vast conspiracy of cancer cells against healthy cells.

So what can we say about this ambition to care for time - what I call here the “care of time”?

It implies:

- Considering the shift in our awareness of time - from a regime of temporal tranquility to one of anxiety, from oblivion to anguish.

- To see that there is a kind of overheating of temporality - time is advancing alone against us towards death, while we have both feet on the brake and would like to suspend the inevitable. So the brakes heat up - in other words, our entire psychic protection system, which, as Freud tells us, establishes a belief in our own immortality.

- To consider curing the anguish of limited time and thus reducing the accelerated pulse of our time consciousness. How can we “lower the pressure” of time and try to get the flow of time back into its own bed?

- To find ways and means of creating a calmer time, of leaving the agitated torrents of urgency for the gentleness of slow-moving rivers. Only this new-found gentleness is conducive to listening, speaking, and caring for body and soul.

- All this work overtime, with time and in time, is another way of laying a protective and resuscitating cloak over the patient, to help him or her cope with the inevitable deadlines that lie ahead. Let’s remember that “palliative” is, etymologically, a pallium, a cape, a cloak, and, in the Catholic tradition, a liturgical ornament. The cloak protects, the mantle warms, and the liturgical ornament makes us feel sacred. Here, alongside the oxygen tent, the palliative ambition is to set up a tent of dignity by establishing a tent of deceleration of time to create another time - the time of dying with palliative dignity. To regain dignity, we need to enter a kind of time decompression chamber. Thus, the watchword of palliative care would be Lamartine’s: “O time, suspend your flight!”[3]- Especially when that flight pushes us, as indicated at the beginning of Le Lac, “into the eternal night, carried away without return”, and when it is important to “drop anchor” for at least “one single day”.

B) In this “care of the temporal”, in this awareness of death announced as a vast pile-up of times, let’s stop to consider some points of vigilance. I see three in particular.

Those confronted with death see time in its plurality, not in its factitious uniqueness

To protect ourselves, our psyche sets up necessary fictions. One such fiction is that of a time that is joined, flows without us, and stands within itself (like a river in its bed). Now, faced with death, we experience a kind of temporal hemorrhage. It is now “out of joint”. It overflows into us and no longer holds us together. Its plural nature appears - like a light that, in rainy weather, becomes a rainbow. Under normal conditions, time has only one surface unit, or “gut” as we would say. In times of tears, when the single light becomes a rainbow, time appears as itself: as a set of layers, climates, temperaments, and moods. When the catastrophe of a countdown begins, it is diffracted by the weight of tears. It then appears as an immense mille-feuille of temporalities. The moment death becomes imminent, it knocks time off its hinges, stripping it bare (like a wire being stripped bare). Generally speaking, let’s say that time doesn’t exist in the massive, self-evident, rhythmic uniqueness of clocks. It’s a fiction. An indispensable fiction for organizing things, holding the world in unity, and calming human consciences.

In reality, if we examine it closely, it’s a compound of different temporalities: the temporality of clocks, the temporality of the psyche, the temporality of the curative, riddled with uncertainties, the affective temporality, regrets, concern for the future, the desire to be as immortal as our unconscious says, the time for reflection. How do we manage this temporal plurality? How can we relativize panic-stricken times (those linked to emotions) in favor of times of regulation, to allow the time of gratitude to emerge, and with it the time of farewell? A good electrician knows all the wires of a large electrical cord. A good palliative electrician needs to know all these temporalities and manage them to the benefit of the cause he serves - the cause of humanity on the brink of a precipice that remains until the last hour.

Time is not linear

Duration, according to Bergson, is of a different nature from clock time. It is consciousness. Time is both a life support and an experience. This consciousness adds to the diversity of temporalities and a diversity of temporal rhythms. Some temporalities move fast, while others drag on. Some temporalities (such as the affective) are loaded with memory, while others are thin. Some are more inclined towards the future, while others have their center of gravity backwards. Above all, when death is announced, resistance mechanisms emerge. Resistance, blockages, bottlenecks, pain, refusal to forget. Resistance means that the subject hears without hearing, and is informed without wanting to understand everything. Blockages appear, which do not accept, which cannot accept, which consider that certain truths “are not good to say” [4]- and therefore not to be heard. Some sort of psychic “automatic brakes” (as when a train is going too fast) resist the destructive powers of truths that are too radical, too violent, and too destructive in that they would destroy the “desire to live” and annihilate human dignity.

It is therefore important to work overtime (I insist on this) to develop adaptive strategies, to bring together the vital palpitation of an individual and the truth of inevitable situations. When a truth (like the announcement of an unresolved cancer) is ignored, due to lack of time taken by the doctor to prepare it, when it is delivered brutally, unceremoniously, like a slap in the head, it can destroy a patient, weaken his resistance, lead him to a deep depression. When the latter understands well that the doctor “must” tell him his diagnosis, so as not to expose himself to “professional misconduct”, and does so with tact, then he knows well that the truth contains in itself a dose of poison – but only one dose. You still have to know how to bring it. The truth is less in the saying than in the way of saying it. Delivered like a punch, it is not heard. Consciousness becomes hermetic. Arranged, it penetrates into consciousness. It is, therefore, above all, a modality, a way of being said. In a song about Fernand [5], and his death and burial, Jacques Brel says that “the good Lord” should not be “very proud”, and adds: “there is a way”. It’s all in the manner. For the “good Lord”, for doctors, for all those who deal with death and have to announce it and seem to be responsible for it. Who says “way” says a certain way of doing things, a way of being, a know-how that allows us to embrace time to better let this truth of death blossom within it. The way takes time into account, it works on it from the inside.

Therefore, in this economy of care, of the care of temporality, in this ethics, (considered as a manner, a know-how, an ultimate politeness in the face of suffering otherness), should we not implement a strategy of announcement, of dampening the cascading effects of an announcement, of counterfires, of firewalls, of slow distillation of the truth - and of a truth which is indicated, which comes almost of itself rather than being attacked? Yes, obviously. The announcement must be able to adapt to time, and time must allow the announcement to blossom.

For this gentle management of the truth when it becomes one with time, we must activate different ethical vigilances, and therefore 1) appreciate the different temporalities of a person and understand the natures of “hot” temporalities and “cold” temporalities - those which are more porous to words of truth 2) give yourself the time to carefully manage compensatory care in the face of death, of everything which attenuates the destructive effects of a staggering certainty 3) consider time like an adventure, a story, a modulation to better appreciate the “right moment” when it is allowed to say something or make a gesture. Appreciate the knots of temporality – when consciousness blocks itself, tenses up, and no longer lets anything pass. Detecting the right requirement for truth – that which strikes the conscience (with the announcement) and that which must be able to be said to potential “survivors”.

- The palliative is above all the management of a temporal conflict. Palliative care is emergency care to regain calm – and therefore dignity. They are necessary after the shock, the accident, the pile-up – which is also a temporal pile-up. How, then, can we manage these different clashing, intertwined, tangled times? How can we extricate the patient’s psyche from the mass of temporalities? How can we get him out of the hustle and bustle and give him a temporal perspective? How can we enable him to regain his footing on the ground when he is drowning, to resume speaking with others when he is voiceless, to escape from destructive astonishment?

Two principles appear:

1. Retune time – as one retunes a piano – to avoid this temporal cacophony and allow us to rediscover the “cloak of time” – as sung by Charles of Orléans, “cloak of wind, coldness and rain” [6]– cloak lost by the anguish of death and which the pallium of the palliative will make it possible to find.
2. Regain a taste for tense conjugation. Imminent death combines everything with the present, with the moment, condemns the future, and charges the past with nostalgia and regrets. There is here a negative reconfiguration of the three stages of time, a revisitation in the darkness of a condemned future, of a present on edge, and of a past examined with the trebuchet of bad conscience. Taking care of time also means fighting against these darkening revisits, fighting against this risk of overwriting all time on the present moment alone, fighting against these attacks of bad conscience [7] which lead to memorial self-flagellation, to immense depreciation of the subject, to an immensely negative judgment on loved ones and family.

How to successfully restart the three-stroke engine of the combination? How can we re-envision a future, even a short one, and prepare for the final encounters to better (if possible!) learn to leave each other? How to look back on the past with gentleness? When the trouble is there, how can we find the tenderness of a peaceful duration? Because, this reinstallation in the time of personal conjugations is the sine qua none condition for relief of the mourning that is emerging, especially when everything is confused in a family, when nothing has ever been said, when the unsaid things are powerful and corrupt the links [8]. The transition from one generation to another also occurs with all the stowaways who “skip” generations, passing from one boat to another, without everyone knowing. What are we talking about? Different “family secrets”, memory knots, and emotional thromboses. Why insist, in this way, on the “end of life” (or rather on life in the process of ending) and the final essential negotiations? To lighten the “bag of knots” for survivors.

1. Périer A. Let the hours sleep. Paris: Éditions XYZ; 2010.
2. Shakespeare W. Hamlet, Act 1, Scene 5. In: Wells S, editor. The complete works of William Shakespeare. Oxford: Clarendon Press. 1986;672.
3. Lamartine A de. Le lac. In: Méditations poétiques. Paris: Garnier Frères; 1820.
4. Bergson H. L'évolution créatrice. Paris: Félix Alcan; 1907. p. 4 and 11. In: Œuvres. Paris: Presses Universitaires de France. 1959;498 and 503. Available from: https://archive.org/details/lvolutioncra00berg/page/n5/mode/2up
5. Brel J. Fernand. In: Les marquises. Barclay; 1969.
6. d'Orléans C. Time has left its coat. In: Poems. Champion P, editor. Paris: Honoré Champion.; 1923;45.
7. Le Guay D. 41 spiritual hygiene exercises. Salvador; 2020. Available from: https://editions-salvator.com/developpement-personnel/1334-41-exercices-dhygiene-spirituelle-comment-se-developper-personnellement-avec-des-exercices-spirituels-concrets-damien-le-guay.html
8. Le Guay D. The end of life: against evil, die in France. Deer. 2014. Available from: https://www.laprocure.com/product/160985/le-guay-damien-le-fin-mot-de-la-vie-contre-le-mal-mourir-en-france