December 2006 / January 2007

REVIEWS

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FINAL CROSSING: Learning to Die in Order to Live
BY SCOTT EBERLE
Lost Borders Press, 2006, $20, 187 pp.,
ISBN 0977763218.
Reviewed by Rick Flinders

I once read a book about Zen which began: “If you like sweets and easy living, don’t read this book.” At the age of 19, I liked sweets and easy living, but I read the book anyway. It was one of the most influential books I’ve ever read.

Final Crossing, by Dr. Scott Eberle, is a serious work about a serious subject: death. Indeed, is there any subject more serious? Perhaps, the author himself might argue, there is only one: life. And it appears to be Eberle’s intent, by exploring one man’s conscious journey through the dying process, to cast light and understanding on the process of how we might more consciously live.

This is not a superficial tourist’s guide. For more than 20 years, Eberle has worked with the dying as a physician, teacher, and companion. He writes with an experience and authority that can come only from someone who has done the work. Like the Zen book I read 40 years ago, Eberle’s volume entails some hard work and self-reflection. But it is well worth reading, and it leaves lessons in life for years to come.

Scott Eberle has been a family physician in Sonoma County, California, for the past 20 years. He trained in Community Hospital’s (now Sutter’s) Family Medicine Residency in the mid-1980s, on the crest of the first great wave of the AIDS epidemic. He became an early leader in developing the county’s network of services for people with HIV diseases, and he helped found the HIV Early Intervention Clinic, which still exists.

Eberle forged his physician’s skills and temperament literally at the bedside of hundreds of dying patients. What he heard and saw guided the arc of his career toward a nearly singular expertise in endof- life work. He has directed medical services at Hospice of Petaluma, founded his own Center for Wellness in Medicine, taught courses and workshops for providers and caregivers, conducted wilderness retreats, and become co-director of the School of Lost Borders. He says of his work, “It’s not just about death. It’s about life, and all life’s transitions.”

In Final Crossing, Eberle distills his experience into the form of an intimate case study. The case introduces and illustrates a model for life’s “Great Transition” that, in my opinion, enlightens even the best work of Elisabeth Kubler- Ross.

The book is structured on four house calls Eberle makes to his patient—who is also a dear friend and his former teacher— during the last six months of the patient’s life. Between visits Eberle narrates, educates, and explains his model, a metaphor for the four stages of the classic human journey: severance, threshold, transition, and re-integration. The model is based on ancient Native American ritual and practice, first known among the Mayans in 1500 BC and later modified by tribes among the Northern Cheyenne. It is a familiar hero’s journey. Odysseus, Arjuna, Black Elk, Siddhartha, and the “Hero with a Thousand Faces” all come to mind. Eberle brings his own understanding and experience to the interpretation of each stage.

The heart of this book beats loudest in the home visits, where Eberle encounters the dying man. More than anything else, Eberle listens, and he constantly re-invokes himself to be present. It is hard not to relate to these visits as a physician, and there are innumerable lessons to be learned. While I’ve spent my hours at the bedside of dying patients, both as family and hospice physician, I marvel at the experience and wisdom Eberle brings to the encounter. In the end, Eberle implicitly asks the reader to see him not as a physician, but only “as a fellow human being peering into the great mystery of death.”

“Doc, I’m not afraid of death,” his patient tells him. “It’s the dying that scares me.” I was reminded of the line from Woody Allen, whose humor is never just funny: “I’m not afraid of death. I just don’t want to be there when it happens.” Awareness of death and acknowledgement of our mortality is the first stage of the journey. As Bob Dylan wrote in his liner notes for Bringing It All Back Home, “I do know that we’re all gonna die someday an’ that no death has ever stopped the world.”

That between-the-eyes realization comes to us all in different ways, at different times. In the ancient model, this is called “Decision Road,” and it begins the journey to our final crossing. Eberle writes of his work in guided wilderness experiences as a way of awakening this awareness, and of the power of pristine nature in helping to remove the cloak our civilization has placed over death and anything to do with it. This cloak has been called the “Great Forgetting” by other cultures, perhaps a kinder term for mass denial.

At one visit, the patient negotiates his plan of care. He gives Eberle a coin, a German penny given to him by a grateful student from a past profession, symbolizing his fare to the ferryman Charon who, in Greek mythology, accompanied mortal passengers across the River Styx to the world beyond. The patient makes Eberle promise to be present at his death. Eberle agrees, but with condition that I’ll let you read the book to discover.

As the patient’s health fades and the visits continue, Eberle depicts sequential stages of the journey toward death, during which the traveler comes to terms with his relationships with family and community and, eventually, the world. Finally, in the grand arena the Mayan ancients called “The Great Ballcourt,” the traveler engages in a contest with death itself. Death, of course, always wins; but the traveler experiences both transcendence and discovery in the process of letting go.

In the background of Final Crossing is the societal awakening that death is not to be denied or ignored. Since the 1970s—thanks to the work of pioneers such as Kubler-Ross and Stephen Foster, and writers such as Joseph Campbell and Carlos Casteneda—the cloak of “Forgetting” has been lifting. In 1974, the same year Eberle’s patient began his career in life-transition counseling, the first American hospice chapter opened in Marin County, California. Death is no longer as secret or hidden as it was back then; people are allowed to die at home. In modern medicine, death is not always the enemy. Often the enemy is dying in a sterile and alien environment, surrounded by futile technologies and separated from the ones we love and the surroundings we are “at home” with. What does it mean to die “with dignity”? Thirty years ago we couldn’t even ask the question, much less allow patients and families to acknowledge and participate in the greatest of all life’s transitions.

Also in the background is Eberle’s own personal transition. Defined as an AIDS physician for more than 15 years, he struggles with the commitment to a pioneering field of work, leaving behind the comfort and security of a more defined specialty. The same year his friend and patient dies, he leaves behind his AIDS work and becomes a specialist in transition and end-of-life care.

At one point, Eberle quotes from an elderly man who faces a potentially life-threatening diagnosis. The man reorganizes his life. He assesses his values. He reconciles and enriches every one of his personal relationships and considers what work is most meaningful to him in the time he has remaining. While his outcome is still in question, he remarks to his daughter, “You know, whether I live or die, I’ve still got to make the same changes.” Eberle’s thesis, based on a career’s experience, and illustrated intensely and personally throughout his book, is not easy. But it is simple. There are lessons in the final crossing. Do we have to wait until we die to learn them? [Reprinted from Sonoma Medicine, Fall 2006.]

RICK FLINDERS, M.D., is director of the Family Medicine Residency Program at Sutter Santa Rosa, and serves on the Editorial Board of the Sonoma County [California] Medical Association, which published this review in its magazine Sonoma Medicine.
http://www.scma. org/magazine/scp/Fall06/flinders.html

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SUEÑOS: Como Interpretar sus Mensajes
BY ALEJANDRO PARRA
Kier Editorial, 2005, 160 pp., $7.50,
ISBN: 9501770400.
Reviewed by Carlos Adrián Hernández Tavares and Stanley Krippner

Sueños: Cómo Interpretar sus Mensajes [Dreams: How to Interpret their Messages] is a Spanish-language book that presents to its readers a varied and focused introduction to dream working, as well as an interesting review of several ancient traditions that developed a form of dream interpretation. It provides examples of the role played by dreams throughout human history, from tribes and clans, to the great Egyptian, Asian, and European empires. Modern scientific studies are cited that have influenced popular notions of this very important aspect of human experience. The book’s author, Alejandro Parra, an Argentine scholar, writes in a reader friendly manner, describing important contemporary explanations about the different faces that dreams can present, from nightmares, to dreams that serve a creative purpose, to those that may facilitate communication with transpersonal sources. His knowledge about dreams and dreaming in different parts of the world is admirable, and his bibliography of selected books is excellent. Parra cites studies that have attempted to unravel some of dreams’ mysteries as well as their possible application to our daily lives. Among those mentioned are explorers wellknown to readers of this journal, e.g., Sigmund Freud, Carl Jung, Stanley Krippner, Robert Van de Castle, Montague Ullman, and Clara Hill. Parra also outlines a variety of dreamworking techniques that can be used in counseling children and adolescents, as well as exercises that can easily be used independently or in group. In this book, readers can find guidelines for joining and participating in dream workshops, not just to make intellectual interpretations of their dreams, but to utilize their valuable messages in the resolution of everyday problems. Parra even includes ways the dreams can be utilized for spiritual development, enlightening dreamers in their relationship with “eternal sources.” Sueños: Cómo Interpretar sus Mensajes is an important book for Spanish language readers; it presents authoritative information in an interesting and understandable fashion, material that can be of great help to those that have the deep motivation to experience waking life to the fullest.

CARLOS ADRIÁN HERNÁNDEZ TAVARES was a presenter at the 2006 Psiber Dream conference of the International Association for the Study of Dreams, and has reviewed other books for the AHP Perspective magazine.

STANLEY KRIPPNER, PH.D., is the Alan Watts Professor of Psychology at Saybrook Graduate School in San Francisco and a former president of AHP.

INTEGRAL SPIRITUALITY: A Startling New Role for Religion in the Modern and Postmodern World
BY KEN WILBER
Integral Books, Shambhala, 2006, 313 pp. $22.95,
ISBN: 1590303466.
Reviewed by Daryl S. Paulson

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Integral Spirituality is Ken Wilber’s most recent book, and it consists of an introduction, ten chapters, three appendices, and an index. Although rather thin in size, the book is packed with new concepts that expand Wilber’s integral approach to interpreting the world. It is extremely well-written, provocative, and quite accessible to those who have never read any of Wilber’s previous work.

The book’s introduction provides an overview of Wilber’s integral perspective, and in it Wilber presents complex ideas with his usual clarity and conceptual simplicity. His integral program is grounded in five core concepts: quadrants, levels, lines, states, and types.

The quadrants delineate the subjective and objective perceptions of both the individual and the larger collective —group, community, and society. Levels are stages of development that occur within each of the four quadrants. Lines are specific areas of development —moral, interpersonal, cognitive, and spiritual—that are available to humans, often viewed as multiple intelligences. A state, as in states of consciousness—waking, dreaming, and deep, formless sleep—also includes meditative, altered, and peak experiential states. Finally, types of development are mainly gender role, such as masculine and feminine. Wilber concludes the introduction by discussing several examples of how his theoretical system has been applied in the practice of medicine, business, spirituality, and ecology.

In Chapter 1, “Integral Methodological Pluralism,” Wilber presents two views of each of the four quadrants—a total of eight views. The upper left quadrant, the individual’s subjective or interior life world, can be viewed from an interior perspective (phenomenological) or from an exterior perspective (structural). One’s felt experience of a sunset is the interior perspective (phenomenological) of one’s subjective experience. Yet, one can also view an experience from an external perspective of the firstperson interior view, which leads to a stage, or structural view.

In Chapter 2, “Stages of Consciousness,” Wilber discusses stages of consciousness. Stages are not actually experienced directly by a person in terms of a stage but can be categorized through a structural or developmental view. For example, one can experience relaxation without consciously perceiving the alpha wave state, galvanic skin resistance, or even the level of relaxation one is experiencing. But to go further into a relaxation state/stage, both stage and state must be known, as in biofeedback. Here, one learns phenomenologically (state) the level of relaxation via stage feedback—the alpha wave state and galvanic skin resistance. The stage feedback is important in correlating the phenomenological “feel” to that level of relaxation, thereby one becomes more proficient with biofeedback relaxation. By just viewing an instrument’s gauges, a third-person perspective, one can never experience relaxation directly and so has no control of the degree of relaxation. Without instrumental feedback—low-level or high-level —relaxation cannot be controlled. This is also true in meditation. Experiencing individual meditative phenomena from a firstperson point of view and describing it from a third-person view (texts on stages of meditation) provides a more effective strategy for deepening the experience.

In Chapter 3, “States of Consciousness,” Wilber defines states as direct felt experiences by an individual—the first-person perspective of one’s interior view. Wilber discusses natural states of consciousness (waking, dreaming, and deep sleep), as well as altered and trained states of consciousness as experienced by means of drugs or meditation, respectively.

Wilber brings phenomenology (states) and structuralism (stages) together in Chapter 4, entitled “States and Stages,” and his argument is convincing. Both are needed. From a structural, or stage view, Wilber argues that one cannot experience transcendence, but from a state view, although one can experience transcendence, one has Wilber– Combs lattice is a matrix combination of states of consciousness relative to stages of development. Although individuals can have a multitude of state experiences— prepersonal through transpersonal —those experiences will always be interpreted in terms of the developmental level one occupies.

In Chapter 5, “Boomeritis Buddhism,” Wilber presents a spiritual, developmental dysfunction very common in contemporary life, which occurs when stages and states are not both accounted for. Because the stage level is invisible to individuals from their interior, phenomenological perspective, a spiritual experience, particularly for those who are actually at a preconventional level of stage development, will be misinterpreted as a transconventional stage. This is a real problem when basic spiritual teachings, such as being one with God, are translated into terms that support feelings of superiority, self-importance, and specialness. But this is not all. Nonattachment becomes irresponsibility; emptiness becomes nihilism, and no-mind becomes hedonism.

Wilber focuses particularly on the Buddhist view of form and emptiness, because they are dualistically interpreted by Boomers. Boomers attempt to rid themselves of the relative world and live in emptiness. This emptiness is not the “Buddhist emptiness,” but that of the Dharma bums (Ginsberg, et al.) who used this view to act out self-absorbed behaviors, which eventually leads them to living only for pleasure. Wilber argues that a “correct view,” one that incorporates ethics, morals, care, and concern, is needed, which augments structural and phenomenological views of one’s subjective experiences. In Chapter 6, “The Shadow and the Disowned Self,” Wilber describes how the great spiritual traditions have little or nothing to say about defense mechanisms, which are psychological components important to each person’s development. For example, one’s disowned personality components —the Jungian “shadow”—which are critically important to spiritual growth, are invisible to spiritual traditions. Shadow components of one’s personality (impulses, feelings, and qualities) are disowned, because they do not fit one’s self-image, particularly a spiritual self-image. Eventually, shadow components can become dissociated from one’s awareness and projected onto others. The reowning of shadow contents, while not generally the concern of spiritual traditions, greatly affects one’s authentic spiritual development. Integrating the shadow, for Wilber, requires three steps: finding, facing, and reintegrating, which he discusses in detail.

Wilber begins Chapter 7, “A Miracle Called We,” by differentiating an individual, viewed as a collective group of cells, from the social collective, viewed as a group of individuals. A society is made up of individuals, but not in the same way a person is made up of cells. Wilber uses Whitehead’s term, the dominant monad, to expand his point. Whole organisms are dominant monads in that they have near-complete governance of their subcomponents—cells, organs, etc. Cells in each organ do not determine consensually what they will do; they are under the control of a “dominant control function, or monad.” Societies, work groups, animal packs, etc., are not leviathans, a single superorganism functioning in the way that cells function within individuals. Wilber’s point: There is a fundamental difference between individual and social holons.

Wilber also articulates the view of both the interior and exterior of the intersubjective collective world space. The exterior view of the intersubjective collective world space is best understood by studying language, described via semiology, genealogy, archeology, grammatology, and post-structuralism. Notice the similarity encountered here to the exterior perspective of the subjective component of a person, explained by structuralism. Wilber then describes the interior view of the intersubjective dimension of the collective—the shared fabric of the “we.” This fabric is composed of shared feelings, meaning, values, beliefs, and worldviews, described by hermeneutics.

In concluding this chapter, Wilber stresses that God has three faces of equal importance: 1) the “I–I” component (upper left quadrant), approached through contemplative practices and meditation; 2) the “Thou” (lower left intersubjective quadrant), the divine being described in Christianity, Islam, and Judaism whom we serve; and 3) a Great “It” (lower right interobjective quadrant), consisting of the Cosmos, Gaia, ecology, etc. He states that a missing component in many individuals’ lives is a “Divine Thou” to whom we, as human beings, are subordinate.

In Chapter 8, “World of the Terribly Obvious,” Wilber focuses on the objective world of an individual (biological), viewed from both the outside and inside. The inside view of this objective domain can be understood by what Wilber terms biological phenomenology. Using the example of meditation, he discusses actual biochemical—objective—changes that occur in the brain that are correlated to meditative subjective experiences. Additionally, using cognitive science as an example, he presents an argument that one’s subjective experiences are rooted in biochemistry. He next discusses the exterior view of the objective domain of an individual described in terms of behavior, physiology, and anatomy. He also describes the interior/exterior views of the collective objective quadrant (lower left). From the interior view of the collective objective quadrant, he understands social bonding to occur via language. The exterior view of the objective, collective quadrant he describes in terms of systems theory of societies.

In Chapter 9, “The Conveyor Belt,” Wilber presents his diagnosis of violent acts (e.g., terrorism) between people. The fundamental problem, he concludes, is the inability of people to acknowledge vertical stage-by-stage development, occurring in both the personal and collective domains. He brings up many useful suggestions for resolving world tension, mainly through his integral approach, which includes all quadrants and all levels. For example, those groups who are at the premodern level —mythical religions—are squeezed into a no-exit situation by those at the modern level—rational thought. They simply are oppressed to the degree that they go to war against their oppressors—i.e., they become terrorists. Wilber is particularly brutal in his assessment of modern pluralistic liberals in that they claim to be accepting, except of those who are not liberal.

Wilber’s view of a well-balanced integral approach to life is presented in Chapter 10, “Integral Life Practices.” He provides suggestions for balancing one’s development from all quadrant views— eight of them, relying heavily on his own solution. Many humanistic– existential readers may feel uncomfortable with his formulation of an integral practice, for there is really no emphasis on empowering individuals to choose authentically how they will live.

Appendix I, “From the Great Chain of Being to Postmodernism in Three Steps,” offers a very valuable overview of the great chain of being, cultural relativity, the myth of the given, modernity and postmodernity, some of Wilber’s best writings to date. Appendix II, “Integral Post Metaphysics,” is a fine exposition of Wilber’s integral program. Appendix III, “The Myth of the Given Lives On,” is composed of an insightful presentation of the influences of culture on an individual’s view. In this discourse, Wilber critiques a number of authors who do not see the world as does he.

All in all, this book contains some of Wilber’s best writing and I recommend it highly to all humanistic– existential thinkers.

DARYL PAULSON, PH.D., is a scholarat- large in transpersonal and integral studies. He has taught courses in transpersonal psychology, psychosynthesis, and integral psychology. He was a member of Wilber’s Integral Institute, where he served on the core Integral Busness Group. He is the author of six books, and a decorated U.S. Marine veteran who served as a Vietnamese language interpreter.

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