In many ways it is wrong to publish work one has not finished publically – however, the precariousness of my present situation is too great not to attempt to lessen it by posting this, which is an essay about the inappropriateness of the way cancer and its causes are currently understood. I would not write it now in the same way in which I was when I was still trying to finish it (which is something I stopped doing in late June or early July), but its main points seem to me sufficiently valuable, even if they should be developed further, for it to be included here. I did not make changes to the form or content of the essay aside from choosing which sentences, paragraphs and their different versions that I had written to include – although even this assembly is something I had done, in a similar or perhaps even identical way, at the time when I was originally writing the essay.
In an article published on Human Rights Watch’s website on April 20, 2016 Diederik Lohman, HRW’s associate director for health and human rights, wrote of the requirements necessary to meet in order to get pain reducing substances in Guatemala:
“Doctors must write prescriptions on special forms, which can only be obtained from a single office in Guatemala City, 25 at a time, and each prescription must be approved by the Ministry of Health. Imagine: each time someone needs an opioid prescription filled they must travel to the ministry office in Guatemala City – often hundreds of miles away – during business hours and obtain a validation stamp. Only then can they go to a pharmacy to fill it.”
Another article, published on July 14, 2015, describes a similar situation in Armenia.
“Oncologists can prescribe opioids only after multiple doctors have visited the patient at home and signed off on the decision”. For every prescription, the person or his or her family member or relative must then get a further 3 signatures and 4 stamps.
“After opioid analgesics are prescribed, cancer patients or their caregivers must collect the prescription at their local polyclinic, fill it at large regional medical centers or, in Yerevan, at the only pharmacy that carries it, and return the empty ampoules before a new prescription is issued. They must repeat the process every other day or in some cases every day because in practice doctors will prescribe only enough strong opioids to last 24 or 48 hours.”
Another article gives the latter duration as up to three days, nevertheless it is clear that numerous requirements must be fulfilled before a person is allowed to acquire pain reducing substances.
The articles, however, reflect a poor understanding of the situation with the changes the authors are calling for – such as requiring the governments to ease access to pain relieving substances – being extremely misguided.
A person develops cancer as a response to a complex set of interactions. The person is both indebted, to a family member or someone else to whom he or she is significantly attached, and, at the same time, due to some other influence severely restricted in opportunities to repay the debt.
The person incurs the debt – and in practice this is likely a common event – every time he or she receives something of value from the family member. Reception of any thing the acquirement of which depended on the family member having earned it results in the person becoming, to a smaller or greater degree, indebted. This applies not only to being given things like food or money, but also to any instance where a person uses something which was provided by another (such as using a lighting device or trash bin once, if they, or some other thing necessary for their use such as electricity or garbage bags, were paid for or maintained in some way by another person), although it is only in severely strained situations that a person starts attending to receiving things of comparatively little value.
Any such exchange of objects or other kinds of help is also a transfer of wishes from the benefactor to the receiver, wishes being constituent elements of the total debt. If a person gives money then one way in which he or she might have obtained it is by exchange for some activity whereby he or she transformed an amount of libido into some socially desired result. A person might be paid for weaving baskets out of twig, for example. When he or she weaves, he or she uses incremental amounts of libido for the occurrence and carrying out of a large number of, some of which are marked by a rather high degree of complexity, inner and outer processes and actions. All of them require a renunciation of the wish to experience pleasure at present and a postponement of it till later. As a person weaves, libidinal energy is transformed into an inner representation of what is being created. Since libido arises out of responses of the nervous system to cellular disturbances elsewhere in the body and is experienced by the person as a need in his or her psyche, the representation into which it was transformed is a kind of container in which a person’s wishes are stored for future fulfillment. If the person loses what he or she created, the wishes in its inner representation can no longer be fulfilled which leads to the person experiencing a feeling of loss. If someone uses the creation, or money received in exchange for it such as a part of a person’s monthly salary for basket weaving, then the person expects to have his or her wishes met in return. He or she need not communicate this directly or verbally, but in some way, perhaps even among people interacting for the first time and not having spoken with or seen each other before, it is communicated. A person who receives the result of another’s effort therefore acquires the latter’s wishes.
If a person is significantly restricted in opportunities to fulfill the wishes acquired during an exchange with another, he or she might respond to them in a way which causes cancer to arise. A response which leads to cancer is one where a person attempts to oppose the wishes, not expressing them in almost any socially desirable and individually acceptable way. An inner interaction of such nature shows that the person might interact towards the family member in actual reality in a similar way, that is, to attempt to oppose the family member. If the person does this and is at the same time indebted, it is likely to cause affliction to him or her, cancer being a bodily form of it of a severe degree, and also harm to the family member.
Any interaction with a person in such a situation – as with any other person – requires deciding what rights to pass the debt on or duties not to do so the person has. Permitting the person to acquire substances for pain relief with easy to meet conditions or no conditions at all means incurring part of his or her debt on oneself, which, given that cancer is a problem of a severe degree and, therefore, reflective of a large amount of debt not hitherto repaid, is a source of significant tension for the person lessening any existing requirements. To the extent that people working in the governments of Armenia and Guatemala allow any pain relief at all, except for cases where the seriousness of the situation is such that pain relief can be shown to be a necessity, they incur some amount of debt and the requirements they pose onto others are an attempt to pass it over or back. Requirements to frequently travel away from home and engage in interaction with people working in hospitals, pharmacies, ministry of health offices and so on have the effect of, on the one hand, decreasing – even if temporarily – the probability of the person who is affected by cancer accruing more debt and, on the other, impelling him or her to repay some of it him or herself (although he or she will incur more of it if it is the family member who travels and carries out other requirements). What the people who wrote the HRW articles are calling for is something to require which is to go in the extreme wrong direction, attempting to get the people working in Guatemalan and Armenian governments to facilitate access to pain relief equal an effort to a request for them to take on part of the debt – debt of the person affected by cancer – on themselves, which, if experienced on the level of the psyche, would be felt as a tension of a high degree.