Being with Cyril: can Heideggerian language do justice to the experience of supporting a severely disabled individual?
This paper offers an account of experiences felt when supporting a
severely disabled individual. It discusses the dilemmas that these
experiences raised and attempts to explain them using Heideggerian
language: Is this individual a 'Dasein' or simply another
entity, did this individual 'leap ahead' and open up the
author's possibilities of being?
Disability, being, existential, Heidegger, psychotherapy, leaping in, leaping ahead.
Disabled persons (Psychological aspects)
Language and languages (Psychological aspects)
Language and languages (Social aspects)
Existential psychology (Research)
|Publication:||Name: Existential Analysis Publisher: Society for Existential Analysis Audience: Academic Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2012 Society for Existential Analysis ISSN: 1752-5616|
|Issue:||Date: Jan, 2012 Source Volume: 23 Source Issue: 1|
|Topic:||Event Code: 290 Public affairs; 310 Science & research|
|Geographic:||Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom|
I have been struggling with being for as long as I can remember. It is a personal struggle, which involves trauma, suffering and joy, and without any doubt will continue to do so before my time has been spent. It seems to me that meaning is an integral component of existence. I decided to start work as a support worker for adults with learning disabilities to try and find a greater depth of meaning. To try and expand my understanding of being human, open up my understanding of suffering and joy, and appreciate the suffering and joy that I have been fortunate enough to experience. I believed that this work would help me reach an improved understanding of what a relationship means to me and what I mean to a relationship. Even though I considered these objectives and thoughts, it came as a complete surprise that I had to face questions of my own and other's existence.
I became the support for a man whom I have called Cyril to protect his identity. Cyril is in his 50s, has severe cerebral palsy, quadriplegia, is nonverbal, partially sighted and requires full support with day-to-day living. His temperament is extremely mild and he is very quiet and seemed shy. I have attempted to honestly articulate the challenges I faced when confronted with the meaning of my being, which only Cyril to this day managed to elicit within me. Or in more favourable terms: how Cyril and I confronted the existential dilemmas we encountered together. At the time of experiencing these challenges I had read very little of Heidegger's work.
Only after reading Being and Time (1962) did I realise the striking comparisons of how I had felt and the concepts Heidegger postulated. In this paper I intend to explore, challenge and validate some of Heidegger's key thoughts by contrasting them with my experiences of and attitude towards Cyril. Did my attitude alone enable me to be with Cyril where others had fallen short? Did Cyril's being highlight to an even greater extent my own frailties and being? However, first of all I want to discuss Cyril as 'Dasein', and to try and hypothesise how Heidegger would refer to Cyril. Taking all of the latter into account I aim to emphasise the importance of Heideggerian principles in relation to psychotherapeutic practice.
Dasein or not Dasein
When I first met Cyril I immediately had uncomfortable thoughts about his existence and whether his life was worth living. These thoughts were disturbing because of their resonances to the atrocities committed by man on his own kind throughout history. A recent example is Nazism, which condoned the extermination of different ethnicities as well as many severely disabled men and women, citing purity as its objective (Johnson et al, 2006). Encountering Cyril made me question whether keeping him alive was for his best interest or through keeping him alive the interests were purely financial, in favour of the care provider who oversaw his day-to-day care.
At times I would wonder if his life or his existence could ever be as meaningful and enriching as my own. I thought that although he was human, his being could never be as complicated or purposeful as mine. These thoughts could in fact be termed primitive, ignorant and self-righteous. Fortunately I had the presence of mind to realise this and question the validity of my initial theory on Cyril's being. The reason I became aware that my thoughts were derisory, was due to the sickness felt in the pit of my own sense of being. Not only was I faced with a human contending with such horrendous challenges, I also had to contain the deafening screams of my own being directed at itself for entertaining these offensive thoughts. I had to cope with the realisation that all the faults I propelled towards Cyril's being were in fact my own.
Considering Heidegger's controversial association with Nazism (Young, 1998) one begins to wonder, although Heidegger explicitly rejected biological racism, how would he view or categorise Cyril? Cyril is a human devoid of written and spoken language. He is a man who has no ability to care for himself or others. He is an entity with restricted cognitive skills and a very limited aptitude to communicate effectively with others. So how would Heidegger value Cyril's being?
For Heidegger the world is full of entities and Homo sapiens are one of those entities. All of these entities have a type of being, but only humans have the type he called Dasein: Being-there. Dasein is distinct from other entities in that 'its very Being comports itself understandingly towards that Being' (Heidegger, 1962: p78). Dasein has an awareness or understanding of itself, but this understanding depends upon its concern for and relationship to the world and other entities it encounters. 'The Being of Dasein ... has Being-in-the-world as its essential state' (ibid: p80).
With regards to the above it is extremely problematic trying to ascertain Cyril's position. Cyril seems deeply engrossed and concerned for the world he occupies and the other entities he encounters. Cyril was far from being unaware of his surroundings, but what he understood of them is inconceivable for others. It seemed that Cyril could sense when someone entered the room. From shaking his head from side to side bearing a captivating smile, he would turn pensive in an instant. If he recognised the presence before him he may have sniggered or bowed his head as if he were waiting to be touched. Cyril would follow my movement as I crossed the room and turn away if I stopped to engage. When I left the room he would then force out what seemed to be a scream of delight. I would return flustered and concerned to find him proudly sniggering to himself. Was Cyril playing a game with me?
'Can we call Cyril a primitive Dasein? Is his being fundamentally different to mine?' These were questions I asked myself and struggled to understand where they came from. Indeed, naming or thinking another human being as primitive caused me to feel deeply saddened with myself. However, I had to confront these thoughts and feelings before I could understand where and why they had surfaced. Acknowledging these thoughts allowed me to hear how arrogant I was being. How self-righteous and superior I thought I was in the face of encountering a man different to me.
Heidegger (ibid: p150) states that 'Dasein is an entity which is in each case I myself; its Being is in each case mine'. Therefore his being would be ontically different from mine even if his essential way of being is Being-in-the-world. However, according to Heidegger (1962), understanding, awareness and relating to the world are intrinsically linked, so what impact does one of these parts have on the others? To refine the question: does Cyril's understanding of the world determine his kind of being? Could he be categorised as Dasein even though he has a limited understanding? Let us consider Groth's (1996: p59) statement on how 'examples of feral children show, instances of how Homo sapiens reared apart from other human beings does not become a human kind of be-ing'. According to Groth (ibid) we become human 'beings' by acts of 'existential validation'. Being with other humans makes us Dasein, or in other words, human kind of be-ings. Groth (ibid) concludes that a feral child is genetically human, 'as an example of Homo sapiens ... but existentially, it is not'. Does this imply that as entities we become Dasein? As Dasein we comport ourselves towards being, but that tendency ceases if we don't encounter other similar entities to validate our existence. According to Heidegger (1962: p85) Dasein 'gets its ontological understanding of itself in the first instance from those entities which it itself is not but which it encounters within its world, and from the being which they possess'. This suggests that Heidegger would disagree with Groth's assumption about a feral child's being. I suggest that that child adapted to its environment for survival and primordially understands its own being.
In my opinion Cyril is a far more complicated entity that requires further thought. How would the above apply to Cyril? Does Cyril know he is a human being? If a dog walked into his room could he determine that the dog is fundamentally different from him? Unfortunately Cyril does not have the capacity to answer these questions. The complication is that Cyril has been cared for and supported all his life by other human beings allowing validation to occur. However, Cyril must know he is being validated and be able to interpret the meaning behind this validation. Does Cyril know what or how to interpret it? It seems like a futile task to try and understand Cyril's world or guess what he might know. Heidegger (ibid: p33) states that 'Dasein always understands itself in terms of its existence in terms of a possibility of itself: to be itself or not itself. Dasein has either chosen these possibilities itself, or got itself into them, or grown up in them already'. Cyril comports himself towards the being that only he understands and calls mine. Perhaps one could say that ontic manifestations of being adapt in situ and are impossible to compare. Similar to Sartre's concept of choice (1957: pp570-571) in which he states 'the situation of the slave cannot be compared to the master. Each of them in fact takes on its meaning only for the for-itself in situation and in terms of the free choice of its end'.
Being-with-others: being with Cyril
Setting aside the complicated nuances that have been revealed, I would say that in my opinion Cyril's being is that of Dasein. Therefore what was it like being with Cyril? As mentioned previously, I did feel an undercurrent of disturbance when I encountered Cyril. Whether I was feeding him, providing personal care or just sitting with him, I felt a plethora of feelings. Anxiety, guilt, sadness, frustration and anger reared their heads on each encounter. Can these feelings be explained using Heideggerian language? Dasein is a Being-with-others within a world and, as Heidegger states: 'even if Others become themes for study ... they are not encountered as person-Things present-at-hand: we meet them ... primarily in their Being in-the-world' (1962: p156). I did not meet with Cyril as a Being-in-the-world; I met Cyril as a being I did not wish to know. On feeding and personal care I found myself treating Cyril as something ready-to-hand ... a tool that disclosed itself. Yet in spite of this stance I still questioned my reaction because of the guilt, anger and sadness felt in treating a Dasein this way. Although I tried to deny the fact that Cyril's 'Being' was familiar to my own by treating him differently, I could not escape from the understanding of which Dasein 'is primordially familiar' (ibid: p119). I began to realise how similar Cyril's being was to my own. This insight prompted me to ask myself the question 'is Cyril a primitive Dasien?' The realisation of the similarity between Cyril and I was disturbing, because it highlighted how vulnerable I was and still am. In an attempt to disperse this vulnerability I opted to think of Cyril as an entity far from my own. In this case, the sense of arrogance and superiority felt was a primitive attempt to cope with the profound realisation of human vulnerability. Simply a defence. I saw my own reflection in Cyril, which frightened me to the point of disowning it. These emotions were not echoed remnants from the past, but simply Cyril affecting me in the present. It seems that however hard I tried, Cyril and I, our beings were with each other and affecting one another.
The above experience coincides well with Heidegger's (1962) concept of solicitude, which is firmly couched within his concepts of care and concern. Unfortunately the link and dependency between sorge (care), fursorge (solicitude) and bessorgen (concern) is lost in the translation from the original text. These terms are ways in which Dasein interacts with entities it encounters directly or indirectly and with either a positive or indifferent attitude. The indifferent modes of solicitude would include being against one another, passing others by, or not mattering to one another. The positive modes of solicitude have two extreme possibilities of leaping in, which takes over the responsibility of the other and of leaping ahead, which refrains from taking over responsibility in order for the other to take accountability for it and face the possibilities that lie ahead. Solicitude is contextually accurate for this experience, because Heidegger also uses it to explain a type of care similar to social welfare work. For example, although Cyril is incapable of caring for himself, my attitude towards him was one which took away care from him. Duty of care dictates that Cyril's teeth should be cleaned, despite his protest, for the good of the client. In enforcing a cleaning regime on Cyril, he 'is thus thrown out of his position' (Heidegger, 1962: p158) and becomes dominated and dependent. Heidegger (ibid: p158) states that leaping in and taking away care 'is to a large extent determinative for Being with one another, and pertains with the most part to our concern with the ready-to-hand'. If this is the case, why did this come to my attention? What did Cyril contribute to the encounter that allowed this phenomenon to become conscious? Is it possible that Cyril's being authentically leapt ahead of me and gave back my care? It seems to me that Cyril would be in an ideal position to do this, because paradoxically his disability enabled him to be authentic in his care. Cyril seemed authentically concerned and curious about my existence and this helped me become transparent to myself in my care and be free for it (ibid).
How did Cyril manage to leap ahead of me? When feeding Cyril, I found myself becoming frustrated with his reluctance to cooperate with how I thought he should feed. I was concerned that if he did not eat, he would become weak and wither away. Cyril maintained some control and reminded me that he was a Dasein and he would not let me forget this detail. Cyril would fasten his lips closed at every attempt I made to offer him a spoonful of blended food. Cyril would turn his head away from the spoon in a manner that screamed disgust and contempt. I endeavoured to try and make the meal as appetizing as possible, but still his reluctance to eat prevailed. Finally when I relinquished control and almost gave up he would open his mouth. Cyril was in his way taking some of the control back. Again this behaviour reminded me of how similar our beings were. I could not escape this fact, because Cyril demanded I treat him as a being in his own right. In his reaction to my care he highlighted how bad I was at being with him. It felt like he was holding a mirror up to me and I could see how my care was inauthentic and inadequate. I could not escape these reminders he eloquently delivered and I had to be responsible for my own behaviour. How could I blame Cyril? A man devoid of verbal expression and of limited physical ability could not be blamed for me feeling frustrated and bemused. Only he and I were in the room. Perhaps I could have blamed him and deceived myself. However, Cyril's consistent behaviour encouraged me to try and be different and find a way of caring and expressing my concern for him. In adopting a calm approach to feeding times I noticed Cyril allowing me to feed him, because through patience I demonstrated respect. Cyril leapt ahead of me by not giving up fighting for his right to eat at his own pace and in the way he chose. He refused to be treated less than he deserved to be. His facial expressions of grimacing, frowning and gazing right through me, resonated with me, because they were expressions I found myself doing when I felt out of control, lost or bewildered. This highlighted my inauthentic and hypocritical attitude, because I knew I did not want to be treated in this way. Only I was responsible for this behaviour and Cyril enabled me to see this by persisting in his way of being-with-me. Cyril leapt ahead and showed me how my care was inauthentic and encouraged me to open up the possibilities of how I showed my concern. My concern was genuine, but how I demonstrated that concern was inauthentic, because I expressed it through my own requirements rather than Cyril's needs.
Bathing and providing personal care to Cyril also proved to be enlightening experiences. While I wiped his private parts he giggled and sniggered with an innocence that provoked compassion in me. Other times he would just gaze in the direction I rolled him that enabled me to clean him effectively, and that gaze seemed to hold a patience that I could only hope to achieve. I felt jealous witnessing the way in which Cyril lived with his condition. I tend to moan and turn away from my own problems, but Cyril seemed to contain, accept and continue to live through them. This set an example for me to gain the courage to face my own possibilities and the torments that moor themselves in these possibilities. Only then, like Cyril, could I be free and be closer to my own truth and accept the suffering of that truth. I would constantly remind myself that 'If Cyril does it so can I!'
There was something he had that I did not posses. His gentle face expressed moments of peace that only seemed possible because of the way he accepted his moments of anguish. He did not deny his pain, but lived every moment of it. Through cleaning, bathing, feeding and being in silence with Cyril, I noticed his powerful expressions of peace and despair and how he surfed their relentless waves.
In many ways Cyril's appearance reminded me of a baby, a baby that looked like an old man. How similar were Cyril and I to a primary caregiver and their baby? I wonder whether in a mother/infant dyad one could argue that both mother and baby learn from each other. At a Scientific Meeting of the British Psycho-Analytical Society (circa 1940) Winnicott stated 'there is no such thing as an infant'. He meant that where you find an infant there will be maternal care and without maternal care there would be no infant (Winnicott, 1965/2007). The infant is an integral part in this relationship and provokes the maternal instinct. Does this relationship involve a mutual learning from each other? Does the infant show the mother how to care? Is an infant capable of leaping in or ahead of its mother to provide the cues? Is an infant capable of being the teacher? One could argue that to leap ahead one has to have the intention to do so and be capable of leaping in too. Both concepts rely on each other and are at opposite ends of a spectrum. If a baby has the capacity to form a relationship, learn from and teach his/her mother, is it too far fetched to suggest that Cyril is also capable of the latter? Unfortunately I believe these questions are perhaps impossible to answer, even though we know how influential the mother/infant relationship is for psychological development.
I am not suggesting that Cyril intentionally 'leapt ahead' of me. Perhaps this is why he seemed to do so with such a dramatic effect. I suggest that just accepting your own being and the plethora of feelings that encompass it, is a more effective way of leaping ahead than intending to leap ahead. Something more seems lost when you are being-with-others disingenuously. Thinking of leaping ahead is in fact just leaping in. Leaping ahead as Cyril demonstrated to me, involves no intention, but rather being willing to be with yourself and others as simply as your being will allow. In a way my intellectual ability proved to be my disability, because it prevented me from leaping ahead effectively. Cyril's disability enabled him to be human in the most authentic way and achieve the art of leaping ahead. There was no cognitive precursor in Cyril's comportment. All of the above had an impact on my being, because it illustrated to me the possibilities of being human and how Cyril reached his possibility through pure acceptance. Cyril was not taught this, but he became a great teacher by the example he set. An infant is not taught how to interact by his/her mother, but rather they both learn how to be through each other.
From this point our relationship shifted and we seemed to understand each other. I began to strip away all that I knew and embarked on seeing Cyril as a unique being. To some extent we embarked on a quest to be with each other and, as Heidegger states:
How did I contribute to this new understanding? Wilberg (1996: p132) emphasises the importance of listening when being-with-others, which he terms maieutic listening. A type of listening that goes beyond just verbal or physical communications and embraces the importance 'to be with others in silence and to bear the pregnancy of that silence'. Wilberg (ibid: p135) explains how the individual who listens maieutically does so by 'learning not only to hold others in our inner gaze of our listening but also learning to touch and handle others silently with our "listening body"'. Maieutic listening involves 'tuning in' to the silence of the other's being. As explained previously Cyril is non-verbal so the majority of time I spent with him was in silence. To begin with I would constantly play music or talk to Cyril. However, I noticed when we were in silence there seemed to be a meditative quality to it, which encouraged me to spend more time in silence with Cyril. In these times of silences I feel I was learning how to use my 'listening body'. To some extent I had to learn or adjust to Cyril in order to be with him effectively. Similarly 'when a woman is pregnant, she needs to adjust her physical posture and comportment in order to accommodate her big belly and her lowered centre of gravity' (ibid: p133). I believe maieutic listening enabled me to be with Cyril with greater efficacy. Eventually I became so adjusted to Cyril that it felt as if I could sense when he was becoming ill and could make the appropriate actions before any visible signs of deterioration were apparent.
Implications for psychotherapy
A criticism of the above account is that it relies only on my own 'subjective' experience. It is very hard to prove that any of the phenomena occurred and even harder to prove that my being with Cyril elucidated any beneficial outcomes for him. In my opinion the latter is similar to psychotherapeutic practice in that it is hard to establish what approaches hold a greater level of efficacy (Cooper, 2010). However, the influence of being with Cyril has had an effect on how I practice as a psychotherapist. I now realise with even greater potency the importance of treating each individual I encounter as a unique being. I learnt this by having to strip away at my own understanding of being when meeting Cyril. I realised that fundamentally we were similar, but unique despite that similarity. What I perceive as ready-to-hand is different to what Cyril perceives, but it is still there for his attention and just as important to him. I had to adapt to Cyril and come to terms with a wordless language. The space we occupied together was not going to be a duplicate of another, but again unique and created together with both of our beings contributing. Although challenging, these lessons were easily extrapolated, because of Cyril's severe disability and how this disability affected his way of being. In turn, his way of being reverberated so powerfully towards mine that I could not ignore its force and had to reflect on my own being as well as his. This emphasises the importance of facilitating a therapeutic relationship by being with a client as opposed to an observer/client dyad. Being-with encourages a joint exploration. A relationship framed by observing an individual closes down the possibilities of being, because 'The Being of Dasein ... has Being-in-the-world as its essential state' (Heidegger, 1962: p80) and therefore thrives when the latter is acknowledged.
According to Wilberg (1996), psychotherapy training institutions should direct their primary concern towards the nature and development of the trainee's listening repertoire. He suggests that trainees, as well as other listening professionals, should enrol in maieutic analysis sessions to hone these essential skills. I would agree with Wilber's sentiments, but not necessarily the proposed execution. I challenge trainees, qualified psychotherapists and counsellors, as part of their training or personal development, to volunteer with individuals who have severe disabilities. I have learnt invaluable insights through working as a support worker, because I encountered individuals who not only challenged my assumptions on how I presented myself, but also on what it meant to exist. These encounters gave me the opportunity to 'tune in' to my 'listening body', because I could not rely on conventional senses. I increased my knowledge and experience of what a relationship could mean and realised the intensity of emotions that could be elicited within a professional relationship. Apart from gaining invaluable experience, trainees may also gain encouragement to undertake research projects and help increase the limited research that is available on 'the appropriateness of psychological therapies for people with severe levels of disability' (Mason, 2007: p244).
In writing this paper I had concerns over the ethical implications of speculating what Cyril may or may not have understood or thought. My efforts were an attempt to engage with Cyril empathically and should by no means be thought of as truth. Empathy was an integral aspect of our relationship and is an area I would like to address in a separate paper focusing on the work of Stein (1989) and Heidegger (1962). I could have omitted my speculations about Cyril's thoughts or meaning, but this process and my attempts to understand Cyril added to the experience as a whole.
Some of the language and expressions I have used may cause distress or offence, but this was not my intention. I want to highlight the weaknesses within myself that could have prevented me from understanding Cyril. This is why I have tried to use language that is raw and as close to the original thought and experience as possible. On reflection some comments seem harsh or degrading, but this was part of a process that resulted in a deeper understanding of myself and I feel it is important to acknowledge these aspects. I had to face them and realise the chinks in my outlook, and I feel this occurred not only through self-reflection but also Cyril preventing my arrogance, control and frustration to take precedence. I hope I have shown how Cyril stood up to me and guided me in an understanding of being.
From a phenomenological perspective one could argue that there are many possible interpretations of the above account. However, my time with Cyril has profoundly demonstrated to me that we are Beings-in-the world-with-others and how insightful relationships can be when this is acknowledged. Working with Cyril involved supporting him in his day-today life and was not therapy. However, there were therapeutic aspects to the relationship, specifically with regards to Heidegger's (1962) concept of leaping in and leaping ahead. Initially one might have assumed that Cyril was in an unlikely position to be 'leaping ahead' and handing my care back to me, but this is how it felt. Whether or not Cyril intended to leap ahead is a question open for debate. However, I feel Cyril inadvertently leapt ahead and did so by defying my attempts at leaping in. This phenomenon demonstrated to me how leaping ahead can be an insightful learning experience. On closer inspection I would argue that Cyril's disability prevented him from leaping in and taking away my responsibility, but enabled him to leap ahead and in doing so opened up the possibilities of my being. Cyril may not have intended to but he did not allow me to disown any responsibility. I had to face the existential challenges of being that he provoked within me. Individuals such as Cyril need to be valued and acknowledged for the invaluable lessons they can teach us about being-with-others.
I feel indebted to Cyril for helping me realise the above, but also for helping me understand the importance of disclosing my being as a therapist and undertaking a joint exploration with a client. I can appreciate now how it is impossible to assume anything about someone's life, and that the art of listening goes far beyond physical or verbal communications. I have no idea if Cyril feels his life is worth living, but I am sure his being is unique, profound and integral for others to become aware of their own. From reviewing this account I feel I have not done justice to the experience of working with Cyril. Words are simply not adequate to articulate how illuminating the encounter was. A kindly reminder of how language enables us to communicate but simultaneously has the capacity to obscure (Heidegger, 1962). Ironically Cyril's incapacity seemed to highlight this language paradox and at times it felt as if Cyril was supporting me in the struggle of being.
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Titos Florides is a trainee psychotherapist, working as an honorary psychotherapist in the NHS and in private practice. He has established and runs a befriending service for adults with learning disabilities.
Contact: 136 Bramley Road, London, N14 4HU
when they devote themselves to the same affair in common, their doing so is determined by the manner in which their Dasein, each in its own way, has been taken hold of. They thus become authentically bound together, and this makes possible the right kind of objectivity, which frees the Other in his freedom for himself.' (1962: p159)
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