Saturday, January 5, 2013

Leibniz's Law


G.W. Leibniz (1646-1716) says in Section IX of his Discourse on Metaphysics (Discours de Métaphysique, 1686) that no two substances can be exactly alike. This is known as Leibniz's Law. Another way of expressing this is: No two substances can be exactly the same and yet be numerically different. If two substances were exactly the same, then they would be the same substance and would not be two separate substances. 
      Leibniz's Law (that no two things can share all their properties in common) can be expressed in a positive way as follows: if two things are identical, then they share all their properties in common (this metaphysical principle is called the indiscernibility of identicals), and conversely, if two things share all their properties in common, then they are identical (this metaphysical principle is called the identity of indiscernibles). According to the indiscernibility of identicals, if two things are identical, then no difference between them is discernible, and according to the identity of indiscernibles, if no difference is discernible between two things, then they are identical.
      An objection that might be raised to the identity of indiscernibles is that if two things are superimposed on each other, then they might temporarily share all their properties in common and yet not be the same. It might not be possible to discern that they are two things, rather than one. An objection that might be raised to the indiscernibility of identicals is that if two things are, to any means of detection, identical, then they might still differ from each other in a property that is undetectable. It might not be possible in practice to detect any difference between them. 
      Thus, a distinction may need to be made between theoretical and practical discernibility. The difference between two nonidentical things may in some cases not be practically discernible or verifiable. Similarly, the sameness of two things may in some cases not be practically discernible or verifiable.             
      Leibniz's Law can be expressed symbolically as (x)(y) [x=y → (F)(Fx ↔ Fy)], which may be read as "for every x and for every y, if x is identical to y, then every property F that is possessed by x is also possessed by y, and every property F that is possessed by y is also possessed by x" (this is the indiscernibility of identicals), and conversely as (x)(y) [(F )(Fx ↔ Fy) → x=y], which may be read as "for every x and for every y, if every property F that is possessed by x is also possessed by y, and every property F that is possessed by y is also possessed by x, then x is identical to y" (this is the identity of indiscernibles).
      The philosopher Max Black (1952) offers several arguments against the principle that if no difference is discernible between two things, then they are identical. He argues that two things cannot be identical, since if they were, then they would be only one thing, and not two. If we say that a is identical to b, then we are merely using two different names to refer to the same thing. And if a and b are merely two different names for the same thing, then when we say that "a is identical to b," we are merely saying that "a is a," which is a tautology. The principle that "If there is no difference between a and b, then they are the same" is trivial. And if there were a universe consisting of two exactly similar spheres, then conceivably two things could share the same properties and still not be the same, and thus the identity of indiscernibles would again be put into question.
1
      It may, however, be worth noting that two things may be similar to, or the same as, each other in possessing many distinct kinds of properties. Identity between two things may involve material, formal, spatial, temporal, relational, and other kinds of properties.
      Can an exact duplicate or replica of something be properly called "identical to" or "the same as" that thing? If so, why may there still be some doubt or uncertainty about whether the two things are alike in every respect? What may happen to the identity of the two things as they change over a period of time?
      Do changes in the properties of things always change the natures of those things? Moreover, do changes in the physical, intellectual, emotional, or social attributes of a person always change the nature of that person?  Are you the same person that you were 5 minutes ago? 7 days ago? 5 years ago?
      Surely, there must be some properties that are relevant to sameness, and some that are irrelevant. Should we then relativize or qualify the indiscernibility of identicals by saying that in order for two things to be the same, they must share all properties that are essential or relevant to their sameness? Some properties may be essential to the identity of two things, while other properties may be unessential. 

1Max Black, "The Identity of Indiscernibles," in Mind, Vol. 61, No. 242 (April, 1952) pp. 153-164.

Tuesday, January 1, 2013

Moral Agency and Personhood


In an article published in the February 18, 2010 edition of The New England Journal of Medicine, Martin Monti et al. reported that functional MRI scanning may detect awareness and cognition in some patients with severe brain injuries who have no other evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli. Thus, a small proportion of such patients who have severe brain damage and who appear to be unconscious or only minimally conscious (with wakefulness but without awareness) may actually have some level of awareness as detected on functional MRI scanning, and may in fact be able to communicate by willfully modulating their brain activity.1 
      In an editorial in the same edition of the NEJM, Allan H. Ropper noted that "The unfortunate term 'vegetative' has been used to describe patients whose eyes open after a period of coma but who lack any meaningful responses to stimuli. Open eyes give the impression of normal alertness, but the patient's behavioral repertoire is limited to reflexive actions such as posturing or purposeless movements, roving eye movements, swallowing, and yawning."2 
      The term "persistent vegetative state" (PVS) has been used to refer to prolonged states of unconsciousness (due to traumatic or non-traumatic brain injuries, degenerative or metabolic brain disorders, or severe congenital malformations of the nervous system) in which the patient is completely unaware of self and of the environment but has sleep-wake cycles, with preservation of hypothalamic and brainstem autonomic functions. Such patients "show no evidence of sustained, reproducible, purposeful or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli; show no evidence of language comprehension or expression; have bowel and bladder incontinence; and have variably preserved cranial nerve and spinal reflexes."3 They may be able to exhibit such behaviors as blinking, swallowing, groaning, grimacing, breathing spontaneously, and reflex posturing of the limbs, but they are unable to eat, drink, talk, or make purposeful limb movements. As a result of being permanently confined to bed or chair, they also tend to develop such complications as muscle wasting, limb and joint contractures, skin breakdown, pressure sores, recurrent urinary tract infections, and pneumonia.4
      However, the term "vegetative" has pejorative connotations, and implies that the patient who is in this state of unconsciousness is merely vegetating or is merely a vegetable. The term diminishes the personhood of the person who is in this condition.
      The study by Monti et al. in the Feb. 18, 2010 edition of the NEJM demonstrates that a small proportion of patients who have been previously diagnosed as having entered a "persistent vegetative state" may actually have some awareness and cognition. They may be able to respond to auditory stimuli, and they may be able to voluntarily modify their brain activity in order to perform simple communicational tasks.
      Are individuals with depressed levels of consciousness who are minimally aware of their environment but unable to make any behavioral responses able to retain their moral agency? Are individuals who are fully aware of their environment but unable to make any behavioral responses (such as completely paralyzed individuals, or individuals with the "locked-in syndrome," as originally described by Plum and Posner in 1966)5 able to retain their moral agency? Such individuals obviously retain their personhood, but can they still function as moral agents? Are they still responsible for whatever thoughts and feelings they may have? 
      What are the criteria for moral agency? Moral agency is a contributor to, but not a requirement for, personhood, since some persons (such as small children and the mentally impaired or handicapped) may not have sufficient voluntary control over their actions to be held morally responsible for them. The proper definition of personhood is quite controversial, since legal recognition of personhood conveys various rights and responsibilities upon any being who is legally considered to be a person. Thus, the politics of personhood has complicated the development of consensus regarding such issues as the nature of reproductive health rights, the legitimacy of end-of-life decision making, the nature of corporate personhood, and the nature of animal rights. 
      Any attempt to establish a definite set of criteria for personhood may be problematic, insofar as any such set of criteria may not be sufficiently inclusive. Every human being is a person. Whether non-humans can also be considered persons is a matter that has been much discussed elsewhere (e.g. Peter Singer, Practical Ethics, 1993; Sarah Chan and John Harris, "Human Animals and Nonhuman Persons," in The Oxford Handbook of Animal Ethics, ed. by Tom L. Beauchamp and R.G. Frey, 2011). Every person has a personality, i.e. a set of physical, cognitive, perceptual, mental, emotional, and social traits or characteristics that define him/her as a distinct individual. The identity of each person is also defined by his/her relations with other persons.
      Agency may be defined as the state of acting or of having the capacity to act (independently or in cooperation with other agents). An agent may be defined as an individual or collective entity that acts or is capable of acting. An agent may act autonomously or in cooperation with other agents--in, upon, through, because of, by means of, for the purpose of, or in behalf of some other agent or entity. 
      Moral agency may be defined as the state of acting or of having the capacity to act, such that the agent is in a position to be held morally responsible for their actions. In order to be held fully responsible for their actions, an agent must have sufficient autonomy (or freedom of choice) to be held fully responsible for their actions, their actions must be voluntary and under their own control, and the actions must be intentional.
     There may be many kinds of agency, including physical, moral, human, non-human, rational, legal, and professional agency. Physical agents include biological, chemical, environmental, radiologic, and thermal agents. Legal agents include law enforcement officers, attorneys, legal guardians, legal representatives, executors, contractors, brokers, and lobbyists. Business and professional agents include literary, theatrical, sports, travel, insurance, booking, sales, and real estate agents.
      Agents acting jointly or collectively may share a moral responsibility for their joint or collective actions. The nature of the responsibility of each agent for a joint or collective action may depend on whether each agent is a willing participant in the action, whether each agent is aware of the possible consequences of the action, and whether each agent has the ability to promote, prevent, or modify the expected or actual outcome of the action.


1Martin M. Monti, et al. "Willful Modulation of Brain Activity in Disorders of Consciousness." N Eng J Med; 362: 579-589, Feb. 18, 2010.
2Allan H. Ropper. "Cogito Ergo Sum by MRI." N Engl J Med; 362: 648-649, Feb. 18, 2010.
3The Multi-Society Task Force on PVS. "Medical Aspects of the Persistent Vegetative State." N Engl J Med; 330: 1499-1508, May 26, 1994.
4American Hospice Foundation. "Coma and Persistent Vegetative State: An Exploration of Terms." 2005, at http://www.americanhospice.org/articles-mainmenu-8/caregiving-mainmenu-10/50-coma-and-persistent-vegetative-state-an-exploration-of-terms.
5Fred Plum and Jerome B. Posner. The Diagnosis of Stupor and Coma. Philadelphia: F.A. Davis and Company, 1966.

Saturday, December 22, 2012

The Physician Philosopher


Describing oneself as a physician may be something that is more easily understandable to most people than describing oneself as a philosopher. If one were to list one's occupation on a job application as "physician," for example, most people would have a much clearer understanding of what one meant than if one were to list one's occupation as "philosopher." However, if the meaning of the term "philosopher" is restricted to "professional philosopher," i.e. to an individual who has an advanced degree (such as a Ph.D.) in philosophy and who earns their living as a professional philosopher, teaching and writing in the field, then the term becomes somewhat clearer and more comprehensible. But what about those students, writers, thinkers, and other laypeople who engage in philosophy but are not professional philosophers? Can public philosophy be meaningfully engaged in only by professional philosophers?
      I'm a physician and also an aspiring philosopher. I suppose that my ambition to become a "physician philosopher" began a number of years ago when a friend graciously, and quite surprisingly, referred to me as such. I'll leave it to others to judge whether my aspirations are mere pretensions. My profession is that of physician. However, I feel a calling to both medicine and philosophy. Which is the higher calling? Is there a higher calling than that of healing the sick and helping the needy (as in the case of medicine)? Is there a higher calling than that of discovering the meaning of truth and justice (as in the case of philosophy)? Does the career pathway that I've chosen mean that I can never become a "real philosopher"?
      And what exactly is a "physician philosopher"? The question may be an important one, because medical decision-making may in some cases require a physician to be able to think philosophically as well as scientifically. Practice in philosophical thinking may to some degree enable an individual to become a better physician. Indeed, it may be argued that the philosophy of medicine is founded on the premise that philosophical thinking may be useful in analyzing the practice of medicine and the treatment of medical problems; thus, engagement in the philosophy of medicine can yield insights that will lead to improved practice and treatment.
      Perhaps the best answer that I can give to the question, "What is a physician philosopher?" is that a physician philosopher is a person whose vocation is to be both physician and philosopher, inspired by love of both vocations (medicine and philosophy). A physician philosopher is a physician who has qualified as (or been certified or recognized as) a philosopher by virtue of their work (writing, teaching, research) in the field. A physician philosopher may also be a philosopher who is engaged in the practice of medicine, or a physician who does philosophy in an academic setting, or a physician who specializes in the philosophy of medicine, biomedical ethics, the philosophy of neuroscience, the philosophy of psychiatry, or some other related field.
      How can one become a physician philosopher? Simply put, one can become a physician philosopher by obtaining academic degrees in both medicine and philosophy. Many schools offer dual degree programs in medicine and philosophy. Bioethics training may also be available in relevant fields, such as clinical bioethics, research bioethics, public health ethics, global bioethics, health care economics, and health care resource allocation. Job opportunities for physicians with training in clinical or research bioethics may include employment as a board member or ethics consultant for a hospital ethics committee, employment as a compliance officer for an institutional review board (IRB) overseeing scientific research, employment as an instructor in bioethics at a health care institution (hospital, school of public health, medical school, or nursing school), and employment as a faculty member (academic bioethicist) at a center for bioethics. Websites that offer information regarding careers in bioethics may be found at http://www.nature.com/nbt/journal/v22/n2/full/nbt0204-247.html, and at http://www.bioethics.net/jobs/.
      What kind of person should a physician philosopher be? Perhaps the best answer that I can give to this question is that the ideal physician philosopher is a person who has a (moral, intellectual, and social) commitment to, and engagement in, both vocations, and who does not view philosophy as a means to practice medicine or medicine as a means to engage in philosophy. An ideal physician philosopher is a person who has a love for medicine (a love for curing illness and alleviating suffering, not out of any sense of paternalism or superiority in relation to those in need of medical care, but out of a selfless need to help and care for others, and out of a sense of wanting to serve humanity and contribute to human well-being), and who has a love for philosophy (a love of wisdom, clarity, precision, intellectual discipline, and discovering the true nature of things). An ideal physician philosopher is a physician who is engaged in philosophy not merely for its medical applications, but for its wider applications to human knowledge, understanding, and well-being. 
      What role should a physician philosopher play in society? One of the most useful roles that a physician philosopher may play in society is that of questioning and clarifying unspoken assumptions about the nature of human life and existence that impact care for the sick, the helpless, and the needy. The physician philosopher may attempt to clarify and answer epistemological, ontological, ethical, linguistic, social, and political questions that influence our response to sickness and health. 
      Another role that the physician philosopher may play is that of clarifying the meaning of good health, disease prevention, distributive justice in health care, etc., and providing an analysis or explanation of how these goals may best be achieved.
      The following is a list (admittedly, very incomplete) of noted physician philosophers: Galen, Sextus Empiricus, Ibn Sina, Ibn Rushd, Al-Kindi, Moses Maimonides, John Locke, William James, Sigmund Freud, Karl Jung, Albert Schweitzer, Maria Montessori, Karl Jaspers, Victor Frankl, Frantz Fanon, Thomas Szasz, R.D. Laing, Walker Percy, Edmund Pellegrino, Nawal El Saadawi, Antonio Damasio, Nayef Al-Rodhan, Drew Leder, Leon Kass, Daniel Sulmasy, and Deepak Chopra.
      It should be noted that there may in some cases be a closer link between medicine and philosophy in Eastern society (e.g. China, Tibet, Korea) than in Western society. Traditional Chinese medicine, for example, may be more holistic in its approach than Western medicine and may place a greater emphasis on the relation between spiritual and physical healing. The role of the physician as philosopher (or at least as the vehicle of a particular philosophy) may in such cases be a potentially more integrated one than in cases (in the East and West) where there is a more scientific, technological approach to medicine. The latter approach may sometimes make it more difficult to define the proper relation between medicine and philosophy.

Wednesday, December 12, 2012

Medicine and Philosophy


What do medicine and philosophy have in common? Why should philosophy as a mode of inquiry be of interest to physicians? How can philosophy be a productive and rewarding endeavor for physicians? How is philosophy relevant to the practice of medicine? What can philosophy contribute to the practice of medicine?
      Medicine and philosophy may mutually support and enhance each other in a number of ways. Philosophy has traditionally included such fields as epistemology, metaphysics, ethics, aesthetics, logic, and political philosophy, and each of these disciplines may have practical applications to medicine.
      Epistemology may clarify the way in which health care providers (individual practitioners as well as group providers, administrators, and hospitals) form beliefs and opinions, make decisions, and respond to various sources of evidence. Social epistemology may also reveal the social dimensions of knowledge and information, and it may clarify the relevance of social institutions (such as scientific journals, hospital committees, professional licensing boards, and government agencies) to knowledge.
      Metaphysics and ontology may provide models of social reality that are useful in analyzing various kinds of interactions between physicians and patients, between patients and physicians and third parties, and between physicians and society.
      Ethics (particularly, biomedical ethics) is relevant to the practice of medicine, because it addresses such questions as: What ethical principles should guide the physician-patient relationship? Do physicians in private practice have a moral obligation to provide services to patients who cannot afford to pay? Do physicians entering private practice have a moral obligation to practice in geographic areas that are underserved with regard to the availability of health care services? Do physicians in private practice have a moral obligation to accept public health insurance payments as full reimbursement for services provided?
         Other ethical questions regarding health care that are of great concern to society include: How can equitability of access to health care best be achieved? Should an individual's access to health care be based on their medical need rather than their ability to pay? What constitute fair and just principles of health care resource allocation? What corrective measures should be taken to address health care inequities? What should be done to prevent wasteful and unnecessary overutilization of medical services? What should be done to ensure that services are appropriate, timely, and cost-effective? What responsibilities do wealthy nations have to address global health care needs? 
         Biomedical ethics is also an important field of study for physicians because it addresses issues of professional conduct, such as appropriate prescription writing, appropriate provision of services, adherence to reasonable standards of care, respect for patient dignity, respect for patient privacy and confidentiality, respect for the patient's right of informed consent, adherence to standards of professional integrity, and fulfillment of the responsibility to maintain professional competence.
      Aesthetics (specifically, medical aesthetics) is relevant to such fields as dermatology, plastic surgery, reconstructive surgery, and prosthetics.
      Political philosophy is relevant to the practice of medicine insofar as it may be concerned with such questions as: What is justice? How can social justice best be achieved? What constitutes justice with regard to access to health care? Does a just society provide universal access to health care? How can justice in health care delivery best be achieved? 
      The philosophy of language may be relevant to medicine insofar as it may explore styles of communication (among health care providers, between providers and patients, and between providers and the general public), and it may clarify issues related to cultural competence, workplace communication, and peer to peer communication. It may also be useful in determining how scientific problems can be presented more cogently and understandably to the general public. Medical semiotics (the recognition, interpretation, and evaluation of medical signs and symptoms) may also be an area of intersection between medicine and the philosophy of language.
      The philosophy of medicine may be relevant to the way in which physicians view the practice of medicine, and to the way in which they view themselves as practitioners. It may be concerned with such questions as: What is medicine? Is medicine an art or a science? What is good health? What is an acceptable quality of life, from a health standpoint? How can health care providers enable patients to attain their best possible quality of health? How can a patient best be recognized as a whole person, rather than as a collection of disease processes?

Saturday, December 8, 2012

To Elsewhere and Forever: a Dream about the Metaphysics of Time

Let me tell you about all the things that happened in my dream. I was in a room with no windows. There were designs on the walls, and the designs were moving. An inscription on one of the walls was printed in short letters, and it said, "Here is where there is ever after." The inside of the wall had a resonance that unlocked the meaning of what had been written. But then I discovered that the inscriptions were my own thoughts that had been written on the walls. I saw another inscription that said, "The ever after is the forever not here." There were scorpions crawling on the walls. The scorpions that ate were the ones I played with. The walls were moving. The colors in the room were running into each other. Orange was turning into red. Black was turning into crimson. Crystal violet left stains on my hands. Red was turning into yellow, and yellow was turning into orange and gold.
      I saw someone at the door who was wearing dark glasses and holding an electric saxophone. He started playing, but he was laughing as much as he was playing. His slurfox grin broke spangles into statements of rhyme. His horn was swaying, and he was striking sparks into flash candles. The notes he played started bursting in my head. His glasses had stars on the edges that glittered. He was striking twilight into dynamite. I looked at the glasses he had on. It was a pair of dark glasses that reflected faces, but I couldn't see the eyes behind them. I could only see the colors in the mirrors of his lenses. The horn player was moving, and he said "You can do the four corners."
      Another door started to open, and I walked through it. There was a wooden horse in the center of the floor that could only turn in one direction. Rocking horse steady faced one way. A pocket watch that was four or five feet in diameter had been left on the floor, and it could only tell spare time. A birdcage was huddled in a tight corner. There was a door that said ELSEWHERE, and I could see halfway through it. A man in the next room was holding a searchlight. His shadow was very long, and he stood beside a giant pair of tweezers that was about to pick him up, but it picked up his shadow instead. He said that he lived in a world of machines. He asked me whether you can live with machines and not become a machine.
      "There are as many machines as human beings," he said. "But the machines I know of are run by human beings. I want to live in a world of human beings."
      His arms were covered by needle tracks. He had used pain medicine at the root of a twisted nerve. His treatment had included freeze therapy and the use of wrestling techniques. But he had found that he could not feel anything. He looked into a cup of water that was electrified. He said that he didn't want to spill it, because he wanted not to forget anything in it ever again. Cryptic statements were written on his forehead. "There is a needle in my head that will end the deadness in my mind," he said. "I'm losing the numbness in my head. I'm starting to feel something."
      He said that there was a window in his room. I looked through it, and he said that yesterday the snow had been falling. There was a bush with spines on it outside his window. The spines were covered by ice, and snow was covering the stems. The spines looked like teeth, but the stems of the bush did not look like it was alive. 
      He held his searchlight in his right hand, and he said that he couldn't remember what the courtyard outside his window had looked like before the snow had fallen. He couldn't remember anything without snow on it. His flashbacks were in winter. Jasmine was what he touched in his dreams.
      "I can't find the answer for anything," he said. "The only answers I can find are my own, and I can't find any."
     "Is there an answer for everything?" I asked. Can't there be problems that have no answers? Does every problem necessarily have an answer? Maybe that's the case only if we say that there are problems for which the answers are that there are no answers."
      "If there isn't an answer for a problem," he replied, "does that mean that the problem isn't logical? If you want to find an answer for a problem, can you find an answer for it only insofar as the problem is logical? And what does logic have to do with truth? If some thing or event is logical, does that mean that it has its own truth? If something that has nothing to do with truth can have its own logic, then how is logic involved in defining what truth is? If something is valid, does that mean that it has its own truth? Can something be logical that isn't valid? Can something be valid that isn't logical? Can there be truth in things that aren't logical? Is truth logical? The only answers that I can find are my own, and I know that I can't find any."
      "How does one determine what truth is?" I asked. "If someone makes a statement, doesn't probability theory have to enter, in some way, into whether the statement is true?"
      "If everything is a matter of probability," he replied, "who or what is making the odds? Is there an absolute or only a relative probability of any given event occurring in one way and not another? And is probability merely a measure of uncertainty? If probability is a measure of uncertainty and it can therefore be changed, is there anything that cannot be other than it is? If anything can be changed, then we live with uncertainty. So, if we change something, do we also give it a new probability, namely, the probability of being whatever it is? Are there things that can't be expressed in terms of probability? If we talk in terms of certainty, are we talking any longer in terms of probability? Is uncertainty the law of the universe?"
      While he was talking, I stood two-thirds of the way up. It wasn't possible to stand up straight. He told me that the room had been constructed so that any person standing in that room, regardless of how tall that person was, could only stand two-thirds of the way up. The architect of the building had not felt that it was necessary for anyone to stand all the way up, and had thus imposed a discipline on whoever tried to stand up straight.
      I walked around the room, and found another door. I opened it, and found that the door led into a closet. A mirror in the closet reflected the image in the window on the other side of the room, so that as you looked into the mirror you could see the image in the window. I asked the man with the searchlight, "What's real, the image that I see in the mirror or the image that's projected into it?"
      He said, "You can find the answer inside the door." 
      I looked into the closet, and found a machine that had a handle on it. The machine had instructions on a decoder panel, saying that the machine was nuclear powered. I climbed inside the atom smasher, and reached for the handle and pushed it forward. I couldn't throw the gear change into reverse, because it was only semi-automatic. I could feel myself suddenly moving faster. Microcircuits were being activated. I could see reflectors streaking in square semicircles incredibly fast. Impulses in me that I couldn't control or contain were being converted into electrical energy. The impulses that I couldn't hold in my head suddenly went down to my feet, and the floor started burning. I grinned until my face was hurting. My left hand got caught by my right hand, and I couldn't let go. 
      The man with the searchlight said, "The bones in your hands are showing." I saw someone in the mirror who was trying to get out. I felt another surge inside my head, and the glass prison was broken. The philosopher was blasted into another level of mind. The councils of scions were arrested by arguments of suggestion. Contemporary psychology was driven by cognitive intuition. I could see my life accelerating on a movie projector. It sped past the light ray and the abscissa.
      I climbed out of the atom smasher. Another door opened, and we walked through it. A circular staircase led into an antechamber. We walked around for a moment, and then passed through another doorway that led into other passageways. We came into a hallway that was only a few feet in width. It was lined by stained glass windows. We heard knocking on the door at the end of the hallway, and we went through the doorway and found that a man had been knocking his head on the door. Women in white robes were standing behind him, their faces half-covered by their vestments, so that only their eyes and foreheads were exposed. They were wandering about, and ethereal hymns were playing. The music was given to the underground. I could not remember beats of it. There were huge cracks in the floor where spirits from the past had broken into the present. We climbed down through the crevices in the floor, and we landed about ten feet below in another chamber.
      One of the women in white robes came down behind us and introduced herself. "There are sounds that state what my name is," she said. "The sequence of sounds that state who I am." Her image slowly folded out of an ironing board. She started to walk with very short, halting steps. Then she turned on a strobe light and opened a newspaper that was decades old. She said that she had to notify the timekeeper of the human condition. She had a slide machine in her dark room, and it had already been turned on. There were vents on the machine that looked like blinds. She said that the blinds were talking to her, and that she must close them to stop that talking. I could see her face in the dark. Her lipstick was shining, and it was uneven, with the right side higher than the left. She asked us, "If there is balance in the world, is there someone who balances it? Let your voice answer fully with an answer-gram."
      The man with the searchlight replied, "If I give you an answer with words, is it because you have faith in their meaning? Do you give words meaning, or do words have their own meaning?"
      She answered, "What is faith? What does faith have to do with meaning? Is faith merely a belief in a higher principle of being? Is having faith something that's necessary only for someone who's confronted by arguments for the absence of God? Is having faith the same as believing in God? If faith is something that's achieved in the face of evidence that there's no logical way of proving something, does it have anything to do with God? Is faith an expression of submission to a higher principle of being? And what does faith have to do with reason? What does faith have to do with truth or falsehood? What does it have to do with right or wrong? What do right and wrong have to do with God? Do right and wrong have anything to do with the evolution of the universe? If we describe God as the first cause of the universe, is it possible for us to know God? If we can't actually know God, then is faith as close as we can come to knowing God? If we say that we can know God by faith, then what is faith?"
      We found a doorway, and walked out of the darkness, and found ourselves in the street. An orion was breaking into a light fantastic. There was so much light in the street that all forms seemed to be in negative contrast. The images of our shadows seemed to be burned into the street. The lunar calendar had been dated backwards. There had been a meteor shower that had not fallen to earth. The outlines of human beings were highlighted by neon. Stars and asteroids were shattered overhead. A beam in a spectrum was passing through arcs of light. Three rainbows were being transmitted from power centers in the same city.
      We talked with a woman who was making some sketches of people in the street. The crayons she held in her hand were bleeding. She said she had majored in ancient history. She was in command of many dead languages. The words inside her head could not be pronounced, they were dead words. She said that when she tried to write down her thoughts, she looked down, and there was blood on the page. She said that she wanted to unwind in a paperback store. We went with her, and searched for a book on how to stop the bleeding. We met a young woman who was looking at books in the store, and who was wearing a sweater and a leather jacket. She told us that she had an answer for our problem. She said to mix one part moonbeam with one part African wheat. Her sweater had a gold flame on it, and she was lit by a psychedelic underglow. She said she had learned her magic from the stars. She was full of circles: circles of light and circles of love. She was transfused with light.
      We walked outside with the artist who was holding her crayons, and she took some of the sketches out of her notebook. She showed us all the people she had been seen in the street. A saboteur had been running away from an auto factory. Battalions of stormtroopers had been pursuing him through dead end streets. There had been a spy in googles who had pretended to have some knowledge of archaeology. A glider pilot had left his resumé. A sailor had punched out a wine-soaked detective. A pipe cleaner had been folded over by a garage salesman. Men in uniforms had been loading iron bars into armored trucks. The garbage man had wiped the water from his eyes. The gaze-catcher had hoarded old looks. The sorcerer had been instructed by someone from fright college. The tap dancer's steps had rung out on Barnaby Street. There had been a man named Alphabet Sorry who'd been listening to the boogaloo man.
      We walked along the street. A metal trash can was on the corner. The wind blew a plastic bag out of a dumpster. A man who was wearing a t-shirt was kicking empty beer cans into the street. Some teenagers were sitting in a doorway. They saw a man who was wearing dirty clothes pick up a smoldering cigarette off the street, and he started to smoke the cigarette, and they started to laugh. A lot of traffic cones were sitting on the street. A man was eating a hot dog, and it fell out of his hand and dropped into a gutter, and he cursed. A short woman wearing a cowboy hat was standing nearby and laughing. She could only look to the right, and not to the left. She was carrying around a cardboard poster of herself. A man with a stiff leg was walking unevenly toward her. He had a radio on his belt that was playing country music. He looked up at a black balloon over his head. He tried to reach it, but it floated away. It was not round, but was shapeless, and seemed to be always changing shape. It had lumps in it. A man who was leaning out of a window in a four-story building nearby had a needle that he was using to skewer an apple. The balloon floated up to him, and he punctured it instead.
      A newspaper in a rack at the street corner had a headline saying that there was a sale going on at a department store. The classifieds were advertising electric toasters. A bottling company was sponsoring racing machines. We walked over to a retail outlet, and looked in through the window. We could see a stereo set that had a record, half-chrome and half-vinyl, on the turntable. A mannikin was standing behind the stereo, and was wearing brunette hair and a headband. The mannikin was leaning slightly forward, and one of its arms was holding a wooden utensil in a salad bowl, while the other was flexed and holding a cigarette in front of its mouth. It was staring vacantly, but I thought that it looked vaguely unhappy. It had deep-set, glass eyes that seemed to drip glass tears. 
      We walked to a warehouse and to another retail outlet. A wall of freezers was set up in one of the departments. I imagined myself as a goalkeeper in a supermarket. People were shooting cheeses at me with their hockey sticks. A machine in the store had an orb that promoted sleeplessness. The man who had turned it on had red suspenders and a dry sense of humor. The ideas he had were rated by a positron.
      We met a bus driver who took us on a drive out of the city. He looked through the windshield, and said that he could see for miles. We came to an airfield. There was an observation tower that had fences around it. A biplane was flying overhead. We met a pilot who offered to take us on a flight. The skywriter had an alibi for last Thursday. He said that he had not been flying because his prop had been broken. So the mechanics had replaced it. Metal bits had been cut into a crankshaft that was ready to get moving. The landing gear of the plane was driven by remote controls. We climbed into the plane, and put on our safety belts. A propeller was turning, and the machine moved forward. We went flying for about an hour, and then the plane came down in a canyon. The wind was blowing a lot of sand over the airstrip. We could hardly see the runway. Cactus passed the highway by. Passageways under the sand were connected with each other. Tunnels had been constructed from planks of wood. Trestles supported an incline that had auto wrecks underneath. A well had been drilled into the sand, and we looked down into it. The well was lined by a smooth wall. The wind was blowing sand into it, but it was getting deeper as if it were falling into the earth instead of having the sand fall into it. The earth was thirsty, and it never had enough to drink. The well wasn't empty, but we couldn't see what was in it.
      We walked out of the canyon, and came out on a mesa. I let myself fall down on the ground to take some rest for a moment, and dust flew up where I fell. I let my fingers dig deep into the ground. Dandelions were growing around a tambourine. The sirens of locusts were whining around us. A dragonfly was gliding by, and I could see through its wings. I stood up, and looked out over the mesa. In the distance, I could see a valley. Water was falling from a stream into a river. The stream was flowing from rocks, and miners were working nearby. Coal was being piled into loading bins. Dirt was rolling out of a tunnel and down a ramp into a waterfall below. We crossed the mesa and walked down into the valley to where the river started. I dipped my hand into the river, and tasted the metal in the water. We climbed toward the opening of the mining tunnel. One of the miners held a kerosene lamp, and he took us inside. It was very dirty, and he started coughing. He thought that biting the dirt had given him the ague. He wiped his hand across his chest, but his hand was covered with soot, and it left a mark on his chest. Dirt was choking the breath in our bodies. Night light was all that we could see the shadows by. Earthstuff was growing under fluorescent light. Snakes were crawling in the undergrowth beneath us. A snake had turned itself inside out, and the juice from its belly was burning into the floor of the tunnel. The snake had a backbone with many compartments. The miner bent over it, and he said that it had been heading toward the end of the tunnel. He looked at the other snakes crawling on the floor of the cave, and he said that he had no fear of them. 
      "I'm a survivor," he said. "That sidewinder was closer to the backdoor than I was. All that it wanted to do was to keep going. Yeah, I know the creatures from the river. My brother, he wrestled wolves in the outback. He had a dagger bright." 
      But then he looked around, and asked us, "Did you think you saw a polecat?"
      We came out of the cave onto a road that led to an area of brushland. Rainbirds were flying at low altitudes. A braintree stood in the center of a clearing that was surrounded by mud and clay. It was bare and had no branches, and it emoted its thought. Dried stalks were standing upright in a dirt field. Insects were flying about, gray riders and black riders. A forest beyond the clearing was full of tall trees. Ladder branches were made by trees that stood forever. The miner had told us that some people lived to cut down the trees. Some people lived to use the wood that was cut down. But the people did not live on. The only things that lived on were the trees that had not been cut down.
      A large crater blocked our path, and steam was rising out of it. A hollow tree had been cut off about two feet above the ground. Water, and then smoke, intermittently spurted out of it. A black beetle was crawling on my hand, and I brushed it away. I picked up a stone that was as smooth as glass, and the stone was warm, and it almost burned my hand. The earth all around us was warm. A woman with long black hair stood next to the tree stump that was smoking. She had chalk across her face. She showed me a cloth that had colors woven into a black background. The colors formed a circle like a bracelet on the cloth. She gave me the cloth, and I wore it under my belt as we advanced into the forest.
      We came to a glen that was filled with still water. The water reflected the trees. A tree had been cut into by an axe and had reddish fluid oozing from its wounds. Men nearby were hunting with spears. The spears had blood on them. An empty boat was drifting into the glen, and some of the hunters climbed into it. Trembling passages were marked by discoverers of tribal ritual. That current of sweat that told them that their legs were shaking. They had waded into the water up to their chests, and the silt in the water was still clinging to them. They held arrows over their chests, and they said that they were free. An oar had been lying inside the boat, and was left behind in the mud. Slugs were floating in a shallow pool of dirty water. A man who was sitting beside the bank was playing a stone pipe. Chilblains made him fold his limbs. He said that he had been having dreams about insects flying around his head. He decided to leave his scepter to the sailing party.
      The man who had been playing the instrument watched the boat filled with the hunters moving away. He looked back into the forest, and said that the trees could live forever. He asked us, "If the universe is infinite, does it have a beginning and an end? What, if any, are the limits of time and space? What do time and space have to do with the universe? If the universe is infinite, can it expand and contract? If the universe can expand and contract, can it expand or contract infinitely? If the universe is finite, what are the dimensions of the universe? If the universe is finite, what is outside it? And what does the universe have to do with matter and anti-matter? If in a place there is or is not matter or anti-matter, does that determine whether it is part of the universe?"