The Grand Inquisitor and the problem of evil in modern literature and theology

This thesis is concerned with the parabolic relationship between evil and salvation. In this thesis I argue that only through recognising evil as inescapably woven into the fabric of our lives, can we construct a theology of hope. I further argue that this identification of evil in the individual is always necessarily something that is achieved through the workings of the apophatic, and can therefore only be realised through the address that reaches exclusively the individual through the unsayable in language. This study centres upon the Parable of the Grand Inquisitor in an inter-textual, literary context and the apophatic tradition. The context in which my discussion of this parabolic relationship operates is the literary environment that allows for the parabolic and the paradoxical. My primary concern is therefore not with the question of theodicy, but with what happens when, through the intellectual struggle, we encounter the boundaries of our understanding in the beginnings of learned ignorance. In the first chapter I have set out to establish the narrative of the thesis, starting with Ivan Karamazov’s articulation of the problem. In this conversation with Alyosha he problematizes the fact that when we accept God’s world, we ought, at the same time to acknowledge the suffering in that world. In this way he exposes the paradox that is inherent in reconciliation itself. However, in the middle of this exchange with Alyosha, Ivan tells the story of the Grand Inquisitor, where the question of reconciliation is addressed in the kiss; suddenly possible in the literary space of the parable. In the chapter that follows I explore our relationship with evil within the space of a literary context. Starting with the fall as the moment at which the human being has put on self-awareness; separating the inner from outer part of the person. With Milton in Paradise Lost, and Dostoevsky in The Brothers Karamazov and The Idiot as my main conversational partners, I offer a reading of the story of the fall in Genesis as a narrative about our alienation from the divine. I argue that this alienation has also become an estrangement from ourselves where the spirit can no longer get to know itself through the body and the body can no longer know itself through the spirit. I argue that this inability to recognise what is other closes off the possibility of a hermeneutical encounter with the Other. The third chapter examines the relationship between the inability to recognise what is Other and responsibility; in conversation with Kafka in The Trial and Kierkegaard’s discussion of Abraham in Fear and Trembling. I argue that Joseph K's inability to engage hermeneutically with the world is the reason why he cannot recognise his own guilt. Abraham is in that respect his opposite; he embodies the parabolic and the asymmetrical, and so becomes a fully responsible individual. In the last chapter I discuss the relationship between the unsayable in language and the coincidentia oppositorum. Here my main conversational partners are Meister Eckhart, Thomas Altizer in The Descent into Hell, and Nicolas of Cusa. I argue that the language of the unsayable is what addresses us in the detached self, as Christ addresses the Grand Inquisitor in his detached self. The kiss, as the climax, is the instant of initiation when the inner and the outer self again become one. At the same time this is the moment of betrayal when all command of our identity seems lost. This disintegration of the self is the descent into hell, and simultaneously the moment of salvation. It is also fundamentally apolitical and through its unsayability can address only the individual

Waldorf Education in the Netherlands

The research question of this study is: How has Waldorf education in the Netherlands developed since the foundation of the first Dutch Waldorf school in 1923? The aim of this chapter is to identify and describe the discourse about Waldorf education in the Netherlands. Currently, there are over 18,500 students at 97 Waldorf primary schools and 27 Waldorf secondary schools in the Netherlands. With solid national rankings, Waldorf education has, in the last decades, been seen by parents as a good school with room for creativity and broad personal identity development of children. What is unique in the Netherlands is that both public and non-public schools are fully financed by the Dutch government. Waldorf education has gained popularity over the years and is accepted in Dutch society. Especially in the last decade, the number of Waldorf schools and students increased. In terms of worldview or the role of anthroposophy, Waldorf education has developed in the last century towards multiple perspectives and interpretations of the core principles or concepts of Waldorf education. The role and interpretation of anthroposophy varies within and among Waldorf schools

Are care staff equipped for end-of-life communication? : a cross-sectional study in long-term care facilities to identify determinants of self-efficacy

Background: End-of-life conversations are rarely initiated by care staff in long-term care facilities. A possible explanation is care staff's lack of self-efficacy in such conversations. Research into the determinants of self-efficacy for nurses and care assistants in end-of-life communication is scarce and self-efficacy might differ between care staff of mental health facilities, nursing homes, and care homes. This study aimed to explore differences between care staff in mental health facilities, nursing homes, and care homes with regard to knowledge about palliative care, time pressure, and self-efficacy in end-of-life communication, as well as aiming to identify determinants of high self-efficacy in end-of-life communication. Methods: Two cross-sectional Dutch studies, one in mental health facilities and one in nursing and care homes (PACE study). Nurses and care assistants were invited to complete a questionnaire in 2015. Multivariable logistic regression analyses were performed to identify determinants of high self-efficacy. Results: Five hundred forty one nurses and care assistants completed a survey; 137 worked in mental health facilities, 172 in nursing homes, and 232 in care homes. Care staff at mental health facilities were the most knowledgeable about the World Health Organization's definition of palliative care: 76% answered 4-5 out of 5 items correctly compared to 38% of nursing home staff and 40% of care home staff (p 36, female, with formal palliative care training, and knowledge of the palliative care definition. Conclusion: Mental healthcare staff knew more about palliative care and had higher self-efficacy in end-of-life communication compared to nursing and care home staff. Educating care staff about providing palliative care and training them in it might improve end-of-life communication in these facilities

Acute symptomatic hypoglycaemia mimicking ischaemic stroke on imaging:a systemic review

<p>Abstract</p> <p>Background</p> <p>Acute symptomatic hypoglycaemia is a differential diagnosis in patients presenting with stroke-like neurological impairment, but few textbooks describe the full brain imaging appearances. We systematically reviewed the literature to identify how often hypoglycaemia may mimic ischaemic stroke on imaging, common patterns and relationships with hypoglycaemia severity, duration, clinical outcome and add two new cases.</p> <p>Methods</p> <p>We searched EMBASE and Medline databases for papers reporting imaging in adults with symptomatic hypoglycaemia. We analysed the clinical presentation, outcome, brain imaging findings, duration and severity of hypoglycaemia, time course of lesion appearance, including two new cases.</p> <p>Results</p> <p>We found 42 papers describing computed tomography or magnetic resonance imaging in 65 patients, plus our two cases with symptomatic hypoglycaemia. Imaging abnormalities on computed tomography and magnetic resonance were uni or bilateral, cortical or sub-cortical. Thirteen (20%) mimicked cortical or lacunar stroke. Acute lesions had restricted diffusion on magnetic resonance or low attenuation on computed tomography, plus swelling; older lesions showed focal atrophy or disappeared, as with ischaemic stroke. The association between the depth or duration of hypoglycaemia, the severity or extent of neurological deficit, and the imaging abnormalities, was weak.</p> <p>Conclusion</p> <p>Imaging abnormalities in patients with hypoglycaemia are uncommon but very variable, weakly associated with neurological deficit, and about a fifth mimic acute ischaemic stroke. Blood glucose testing should be routine in all patients with acute neurological impairment and hypoglycaemia should be included in the differential diagnosis of imaging appearances in patients presenting with acute stroke.</p

FGFR3 mRNA overexpression defines a subset of oligometastatic colorectal cancers with worse prognosis

Metastatic colorectal cancer (CRC) remains a leading cause of cancer related deaths. Patients with oligometastatic liver disease represent a clinical subgroup with heterogeneous course. Until now, biomarkers to characterize outcome and therapeutic options have not been fully established