On a Classical Music Primer…

Monday Musings for January 14, 2019
Volume IX. No. 2/418

no_9

The Joy of Classical Music

 By: Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA*

We are privileged to receive many letters from our faithful readers, a source of much learning and stimulation. Several readers have written to ask our opinion about our favorite top ten pieces of classical music. I found the task of picking favorites very daunting and complicated. I felt like being asked which of my children would I pick and favor. After much thought and listening with both my physical ears and the ears of my soul—metaphysical ears—here is my conclusion: Talking and writing about music and the arts is a delight to me. Thank you all who wrote and asked.

My number 1 pick is Beethoven’s 9th Symphony. It is an elegant piece of not only music, but theology, humanity and spirituality.

Number 2 is Mozart’s Jupiter Symphony in C Major.

Number 3 is Brahms’s Violin Concerto.

Number 4 is Rachmaninoff’s Piano Concerto No. 2. This amazing, technically complex with over 30,000 notes is an exercise in exploring the soul.

Number 5 is Henryk Gorecki’s Symphony No. 3  with soprano Dawn Upshaw.

Number 6 is Mendelssohn’s Violin Concerto.

Number 7 is Tchaikovsky’s Symphony Pathetique (his No.6). This was my late mother’s favorite. A word of explanation: This work is imbued with passages reminiscent of “Marsyeh”, cantorial rendition of a “joyful” mourning and grieving. What a delicious Nietzschean oxymoron! It is the closest thing to Biblical polyglossia. The music speaks in thousands of languages used by children of God from all walks of life, and all religions, all over the planet.

Number 8, Tchaikovsky’s Violin Concerto in D Major, opus 35.

Number 9: Carl Orff’s Carmina Burana and Olivier Messiaen’s Turangalila and his opera Saint Francis D’Assi  (I have had lectures and seminars by Maestro Messiaen in Paris). Robert Chapman played the opera on Classical station, WCPE, one Thursday before Easter Sunday.

Number 10: the music of Wagner’s Tristan and Isolde and Dvorak’s Cello Concerto.

Number 11: Brandenburg Concerti Nos. 1-6

Number 12: Samuel Barber’s Adagio for Strings.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He received Raleigh Medal of Art in 2001, inducted to Raleigh Hall of Fame 2013, elected Lifetime Trustee, North Carolina Symphony in 2015, and 2016 recipient of NC Award, Fine Arts.
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On a Few Things…

Monday Musings for Monday January 7, 2019
Volume !X. No. 1/417

bronze statue of kaibara ekken at his gravesite (kinryū-temple, fukuoka-city, japan)

Bronze Statue of Kaibara Ekken at his gravesite (Kinryū-Temple, Fukuoka-City, Japan)

 

 On A Few Things…

By: Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA*

(Editor’s Note: One of the pleasures of writing ‘Monday Musings’ is the considerable feedback from our learned, curious, and generous readers.  Today is our 9th birthday,  We celebrate it by publishing one such gracious letter.)

Thank you for your kind if not extravagant words.  I am humbled.  Unfortunately, I do not know much about Japanese and Chinese philosophy and cannot offer a scholarly opinion.  I only superficially know the work of Buddha and Confucius to the point that there is much Buddha in Sufism, and much Sufism in Freemasonry (1717)…  And Mozart knew about both!  However,  I know of several things:

I have been involved with the art and craft of polyglossia and translation and interpretation.  There are vast ethical and moral implications and responsibilities  in this profession/craft.  I used to work for the Central Intelligence Agency (CIA) while in medical school (usually after midnight translating documents at Langley) and UN during the summers of my pre-med years (as a simultaneous translator).  I have seen consequential errors and inaccurate translations that endangered the fate of an important ongoing discussion.   I also know that quite a bit of the Bible translated from the original Aramaic, the language Jesus spoke, and the language the Synoptic Gospels were written and later translated into Greek, Latin and finally English (King James Bible 1611: OldTestament: 39 books, 593,493 words; New Testament , 27 books, 181,253; total 884,647 words) are full of errors most likely unintentional that in some instances radically and universally change(d) the meaning of the message.  Not to mention innumerable other bibles such as Vulgate, Wycliffe and many others.   Several years ago, I reviewed the book Secretaries of God in which I pointed out some of these errors.

Now to the question at hand: Who was Ekken, his philosophy and whether the translation form Japanese into English is authentic.  The most prominent translator of Ekken’s work is the linguist/scholar, William Scott Wilson,

Well, Kaibara Ekken, Ekken also spelled Ekiken, original name Atsunobu, (born Dec. 17, 1630, Fukuoka, Japan—died Oct. 5, 1714, Japan) was a remarkable man.  He was originally trained as a physician but left the medical profession in 1657 to study the thought of the great Chinese neo-Confucian philosopher Zhu Xi (1130–1200), under the teachers Yamazaki Ansaiand Kinoshita Jun-an.  He became a recognized neo-Confucian philosopher, travel writer, and pioneer botanist of the early Tokugawa period (1603–1867) who explicated the Confucian doctrines in simple language that could be understood by Japanese of all classes. He was the first to apply Confucian ethics to women and children and the Japanese lower classes.

I also know that William Scott Wilson is an ethical, knowledgeable, and accurate translator who does not sacrifice translation for more attractive interpretation.  Therefore, I fully sympathize with Ekiken or Ekken and his assertion that folks should have read the work in the original Japanese.

I maintain that if one really loves opera, it is a moral imperative to learn Italian and ignore the inadequate and “artificial” subtitles!  Even though he was a blatant amoral psychopath, I’d rather Listen to the words of genius Lorenzo di Ponti as they were minted in his fascinating brain in original Italian (he wrote in Latin also), and not to some accommodating Joe Blow who commercially created the subtitles.

Finally, regarding the related topic of prevention elaborated in Ekken;s writings, I agree with the content of the essay.  Prevention should come first.  On a panel discussion in a town meeting, I asked the North Carolina Secretary of Health and Human Services what percentage of his vast multi-billion dollar budget is spent on prevention.  Answer: less that on half percent, mostly for inoculation, etc.

Love and Joy to all

AM

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is a dramaturge. Received Raleigh Medal of Art in 2001, inducted to Raleigh Hall of Fame 2013, elected Lifetime Trustee, North Carolina Symphony in 2015, and 2016 recipient of NC Award, Fine Arts.

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On the Holy Week…

“Monday Musings” for Monday December 31, 2018
Volume VIII, No. 52/416

Liszt

Lizst at the Piano, by Josef Danhauser

 

Holy Week: Beethoven and Al Ghazali’s Birthdays

By: Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA*

(Editor’s note: There are many Holy weeks throughout the year. Starting with the fall season, there is Raas-ol- Sana (Rosh Hashana), Yom Kippur, Ramadan, Thanksgiving and we just competed Advent celebrated Christmas, followed by Easter. But I submit that there are other Holy weeks, among them Beethoven’s birthday. Beethoven was born on December 16, 1770, and the incomparable Persian Theologian and poet, Al Ghazali was born on December 19, 1058. This edition of Monday Musings, a reprint, is dedicated to Beethoven and his glorious interpreter, our own North Carolina Symphony (NCS) Music Director, Maestro Grant Llewellyn. who conducted Beethoven ninth on several  occasions here in Raleigh which prompted me to write him this note:

Dear Friend, Maestro Llewellyn:

‘…I have deep regards and respect for your talents, dedication to your family and profession, combining knowledge of music with Maazalian precision and Bersteinian facility and passion to communicate. What a marvelous combination. Good for us, your loyal and loving audience.

Throughout of many years of watching you conduct, I believe Beethoven and Mahler extract the most out of you. I am privileged to not only watch you conduct, but also while watching, take a tour of your brain. I write this note to celebrate these delightful tours, your brain and its trillion plus synapses. A brief explanation is in order:

We have powerful instruments for viewing what is going on inside of the skull, namely visualizing the anatomy of this truly wonderful but mysterious organ, the two to three pound brain. These instruments are Magnetic Resonant Imaging (MRI), Positron Emission Tomography (PET) and functional MRI (fMRI) which not only enable us to view the anatomy of the brain but see and learn how the brain functions, NO, it is NOT with these instruments that I view your brain fully engaged while you conduct, but with the knowledge of neuroanatomy and neurohormonal circuitry of the brain.

It is an enchanting and marvelous site to see your brain’s biochemical neruonic interplay and the anatomical juxtaposition of your brain’s vital organs, such as the Limbic system, thalamus, hypothalamus, amygdala, hippocampus, fornix, mammary bodies and the length of your corpus colosseum. Watching you conduct,, especially the music of Beethoven and Mahler, infuses the viewer with spirituality and invites entrance to the ether of transcendence…What a feat! Thank you for those fascinating tours and thank you for bringing your gifts to North Carolina by being Music Director to our most talented and admirable NC Symphony artists/musicians. Below is for your reading enjoyment,,,’

Love, Joy and Blessings

AM

 

Beethoven 9 Connects my soul with deepest humanities. Here is an explanation:

The next time you go to Musee d’Orsay in Paris, that unpleasant piece of railroad station, that the former Minister of Culture of France, the late Andres Malraux, transformed into a magnificent museum, go all the way down the hall to the last gallery on the left. There, you will see several paintings of various groups. One of them that stands out is a painting by the 18th century French painter Danhauser. It is the picture of a Parisian salon in the 1830s. It shows Franz Liszt at the piano, and at his knee with her face covered is Countess Marie D’Agoult, a socially prominent Catholic lady who left her husband and children to be one of many Liszt’s mistresses-scandal galore– Next to Marie is Alexander Dumas, next Chopin and his inseparable girlfriend Aurore Dudevant (George Sand) smoking her fat cigar; next to her, the violinist magician contortionist Nicholas Paganini; next, Rossini, the bell canto opera composer (he composed Barber of Seville in 1816), and Victor Hugo. They are all gathered to hear Liszt play Beethoven, and way on top above everybody’s head is a bust of Beethoven in the background of clouds roiling into infinity. Yes, the painting shows Beethoven high above with the Gods…This is how Beethoven was worshipped after his death.

Ludwig van Beethoven was born December 16, 1770, fourteen years younger than Mozart. His childhood was dreadful. Almost every night, he and his brothers, Kasper (Karl) and Nickkolaus had to go on the streets and cajole their drunken father to come home. The gentleman was a severe alcoholic and on a church pension. The family was one step ahead of welfare. Beethoven fought suicidality most of his life and at one point after becoming deaf he actually planned suicide. He wrote a long letter, Heiligenstadt, complaining bitterly about his miserable life and reasons for ending it. But thankfully, he did not go through with his plans. It was after 1799 that he began composing his famous nine symphonies culminating in the incomparable Ninth. Beethoven’s music is not classic, it is not romantic, it is just Beethoven, expressive, full of power, full of life and full of promise and possibilities, something like the writings of Paul and Pauline theology.

Beethoven’s immortal 9th Symphony composed in 1824 is a summation of his life, a summation of all he had learned and had lived for. Almost anywhere in the world, reference to the 9th is without doubt or question Beethoven’s 9th. It is NOT any of the other symphonists such as Schubert, Bruckner, Mahler, etc. It is always Beethoven’s Ninth. No matter where on earth from Ethiopia, Sub-Saharan Africa, to countries of Eastern and Western Europe, and to the countries of South America and down under, Australia, in the circles where there is the slightest familiarity with classical music, when you mention the 9th Symphony, the listener will reflexively say Beethoven. They might not know his full name, they might not know how to spell his name, they might not know anything about his birth date, birth place, the miserable childhood he had with a drunken father, a long suffering violated and abused mother and several younger brothers, but they know it is Beethoven! The 9th Symphony became immortal when it was chosen/adopted to be the National Anthem of the United Europe in 1989 after the fall of the Berlin Wall. Later, because of the national pride and momentum of the newly adopted National Anthem, the currency of Euro was created which is now being used by 320 million people. Beethoven’s nine symphonies are eponymous with might, excellence and inimitability of Beethoven style. In word association games, tissues are associated with Kleenex, cars with Chrysler, psychoanalysis with Freud, chewing gum with Wrigley and yes the 9th with Beethoven. The dean of music critics, Joseph T. Kerman, ordinarily parsimonious in praise and use of adjectives, refers to Beethoven “as belonging to the same salon with Gods, and merging with Gods.”

In the annals of human history, the power of Beethoven’s music, especially his symphonies, most of them curiously composed in minor key, is unparalleled. His9th is indeed the apotheosis of vigor, vitality, hope, redemption, and possibility, yet it is imbued in sublimity, transcendence and beauty. Reviewing other notables’ remarks about Beethoven’s 9th is equally interesting. Hector Berlioz, a failed medical student, yet brilliant composer and writer, admitted that in some ways the 9th “remained unfathomable to me.” He continued, “In composing the 9th, Beethoven broke some musical laws, and frankly it is so much worse for the law!” Stuart Isacoff, a contemporary NY music critic suggests that “Beethoven’s new forms, new visions, explored new ways in what music could do and what music could say. Beethoven had begun early in his career to construct his compositions out of small cells, which are organically, as if governed by a kind of musical DNA, matured. The 9th unfolds a psychological drama in which themes are declared only to become subsumed in the flame of heavenly bliss.”

The NC Symphony recently performed the 9th under the baton of its talented and energetic music director, Maestro Grant Llewellyn. Beethoven’s 9th, with its final movement for chorus, four vocal soloists and orchestra set to Fredrick’s Shiller’s poem “Ode to Joy,” left the audience ecstatic with extended spontaneous ovations. The RTP audience was blessed by the hundreds of voices of the NC Master Chorale, directed by Dr. Alfred Sturgis, and the Choral Society of Durham Chamber Choir, directed by Rodney Wynkoop, and the four soloists, soprano Jane Jennings, mezzo-soprano Stacey Rishoi, tenor Richard Clement and bass Raymond Aceto. When the celestial voices of the Chorales were singing “Freude, Tochter of Elyzium, deine Zauber binden weider was die Mode stren geteilt; alle mencchen werden Bruder who dein sanfter weilt.” “Joy, daughter of Elysium, your magic again units all that custom harshly torn apart, all men become brothers beneath your gentle hovering wing.” I felt like I was floating among myriads of angels of hope, comfort, promise and beauty. The magic of the 9th approaches Biblical mystery of how miracles occur.

The extensive literature compiled by theologians of repute, among them Dietrich Bonhoeffer (the German theologian imprisoned and executed by Hitler in Flessenburg Concentration Camp at age 39) and the late Paul Tillich of Harvard University, refer to Beethoven’s music as an essential intellectual tool to understand how “magic” turns into “miracle.” The miracle is described as a man, Beethoven, in 1824, at age 53, in spite of his deafness, cantankerous and increasingly world weary and clinically depressed, living in an apartment with leaky roof and minimal toilet facilities, “he bared his soul in a work so stunning in originality, scale and emotional power that virtually every great composer who followed has lived under its shadow.” And in my view, the miracle continues the shadow cast by the 9th is protective and not destructive. It is nurturing and not condescending, it is life giving and not burdensome. That is the miracle of Beethoven’s music. Some theologians compare Beethoven’s personal life to the life of Job, the violated, abused and tortured soul in the old Testament. Yes, Beethoven’s music, especially his 9th, is a miracle.

I have been fortunate to have heard the 9th since my childhood conducted by greats of the music world, Eugene Ormandy, George Szell, George Schulte, Arturo Toscanini, Leonard Bernstein (he conducted the 9th in 1989 when the Berlin Wall came down), Loren Maazel, just to name a few. I believe what Llewellyn and the NC Symphony musicians and the combined Raleigh and Durham chorales produced in Raleigh’s Concert Hall with its superior acoustics, was a memorable and transcendent experience, comparable if not superior to other programs.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is a dramaturge. Received Raleigh Medal of Art in 2001, inducted to Raleigh Hall of Fame 2013, elected Lifetime Trustee, North Carolina Symphony in 2015, and 2016 recipient of NC Award, Fine Arts.

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On Jesus…

Monday Musings for Monday December 24, 2018
Volume VIII, No. 52/416

GustavoDoreJesusesbajadodelaCruz

Gustave Doré

 

To Ponder the Birth, Life, Death and Resurrection of Christ

By Assad Meymandi, MD, PhD, ScD (Hon.), DLFAPA*

[Editor’s Note: to observe with reverence the birth of Christ, we are reprinting below article which was originally written and published in the Fayetteville Observer on Christmas Day 1966. It has been reprinted in several publications, including ‘Monday Musings’, every year since then.]

From the nostalgic days of the Sorbonne where I was a student of arts and literature, a memory stands out. A professor assigned to our class to visit the Louvre Museum and report to him, in written form, our impressions.

One morning I went to the museum and spend many hours looking at the masterpieces for which the Louvre is so well-known. Naturally, walking through the aisles and various levels of the Sully building, where old masters were displayed, appropriate notes were made to report to the professor. At the end of the day, somewhat enchanted, somewhat tired and thoroughly bewildered by the majesty of so much collected beauty and august artistry under one roof, I packed my notebooks and set out to leave the door. Near the exit of the Mezzanine level there was a simple portrait which was partially hidden behind the curtain and the hanging branches of a plant. I approached the painting, exposed it to my sight, and began to study its content. After a few minutes of scrutiny and concentration, I was overwhelmed by a feeling of power, awe and respect.

The painting was done by a 17th century Eastern European artist who had never gained worldwide fame. The very position of the painting in the museum was reminiscent of this fact. The content of the picture was just as simple and unassuming at its frame and the place where it was hung. It showed an emaciated man whose cheeks were hollowed, whose eyes were sunken, whose ribs could be counted one by one with clarity, semi-clad and semi-naked. This man the portrait showed was struggling diligently and arduously. An observer could see the burden of time and the pressure of public opinion written across his furrowed forehead. His lips were dry, but pursed and determined his arms were naked and the flesh was pushed through with the gripping huge fingers of two Roman soldiers who were, holding the picture, holding him? The Roman soldiers were enormous, steady, and through the masterwork of the artist, conveyed an air of contempt and hatred for the man they were holding. On the right side of the tableau, the artist had drawn the picture of a cross. So far, this work of art, like any other, is nothing unusual to chill the spine and overpower the observer. It was, indeed, the picture of Christ being carried to the cross.

This is a known historical fact, and depicted by thousands of artists in various ways. But the thing that made this pictures so powerful and different from any other concept of crucifixion was that the artist with his transcendent imagination, and I am sure, realization of the devotion of Jesus, had inserted a basic difference in this work, the difference was in this picture Jesus was struggling to go toward the cross, not as one would expect to struggle to get away from the cross. The propitious occasion of Christmas, the Lord’s birth, makes the recounting of the memory as a gift to our reader that much more meaningful. In His birth, death and resurrection, he exemplified love, hope, reason and commitment to all mankind.

May we all be good learners and a Merry Christmas to everyone.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is a dramaturge. Received Raleigh Medal of Art in 2001, inducted to Raleigh Hall of Fame 2013, elected Lifetime Trustee, North Carolina Symphony in 2015, and 2016 recipient of NC Award, Fine Arts.

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On Holy Days…

Monday Musings for Monday December 17, 2018
Volume VIII 51/416

Oryan

Baba Taher Oryan

 

Yalda, Hanukkah, Christmas, and King James Bible (1611-2011)

By Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA*

This week and fortnight thereafter portend three events carefully choreographed by aligning stars to produce a cosmic feast. The first event, of course is Christmas on December 25. The other two events occurring on the same day are winter solstice, the longest night of the year and shortest day of the year, and Hanukkah, the festival of lights. Although not a religious holiday, like Yom Kippur, Hanukkah is about rededication to the will of Yahweh. Reading religious holy books including Zoroaster’s Avesta; Hindu’s sacred and magnificent book, Bhagavad Gita; Moses’ Torah, Christians’ Bible, especially Paul’s letters in the New Testament; and Islam’s Qur’an, one becomes acutely aware of commonality of the message of these books: love, duty, responsibility, redemption, promise and possibilities for all humans, for all children of God. Here are some thoughts on some of these matters:

I.  SHAB-E YALDA

December 21 is the longest night of the year. In Mede and Persian history and Zoroastrian tradition, it is a holy night, “Night of Birth”, the birth of Mithra, the God of illumination and salvation. The birth of Ahura Mazda.

Persian poets have written extensively about the night of Yalda (Shab-e-Yalda). Here is a stanza from Baba Taher Oryan (950-1019), the mystical Persian poet who roamed the mountains of Hamadan naked

“Shab-e-Yalda is the longest night of they year,
To have more time to read and learn…
To have more time to worship….
To have more time to reflect…
To have more time to connect with the beloved and
To have more time to nurture one’s soul…”

We know that Plato wrote extensively about the soul, Zoroastrianism, and the night of Yalda…

May you have a fruitful and joyous Yalda night.

II.  A Few Words about Christianity: Commercial vs. Spiritual

Christmas as a religious observance and Christmas a secular event may co-exist, woe unto the cynics and to the intolerants. In ancient days of Egyptians, Persians and Romans, they celebrated the winter solstice called the Saturnalia which ran December 17 to 24. They closed offices and exchanged gifts. This is the time when the sun reaches its lowest point and begins to climb, once more, in the sky. In its earliest days, Christianity did not celebrate the Nativity at all. Only two of the four Gospels even mention it. Instead, Easter was the most important day in the Christian year. In 325, when the Church fathers convened in Nicea, they focused on this issue and decided that Easter should fall on the Sunday following the first full moon of the spring, making it a moveable feast. In 354, the year Saint Augustine of Hippo was born, Pope Liberius decided to add the Nativity to the Church calendar. So, it was he who decided to celebrate the birth of Christ on the fixed day of December 25. It was not until the 1800s that commerce got a hold of Christmas and resurrected the ancient gift giving of the Roman Saturnalia. In 1828, for example, the American Ambassador to Mexico, Joel Robert Poinsetta, brought the plant poinsettia to the US. It has been associated with Christmas ever since. We have room to celebrate the secular feast of Saturnalia, Winter Solstice, on the 25th of December. To get us closer to God, eternity and spirituality, observe the mystical and holy phenomenon of the birth of Christ religiously both at the same time. It is unhealthy to engage in extremes of either or and to be cynical and intolerant of others. After all, Christmas and Saturnalia are to enhance love and understanding.

III-Reflections on the end of the year:

To the thousands who read us and hundreds who write us from across the globe, we offer our thanks. We will, from time to time, publish some of the issue-centered letters that deepen our understanding and elevate the level of discourse. After all, that is the primary purpose and the etymological meaning of education, from Latin educata: to uplift and elevate knowledge and understanding…
My greatest regret is that 2018 ended without writing an essay on the King James Bible. In 2018, the Holy Book became 407 years old. In 2011, there were quadricentennial observances of the birth of the Bible throughout Europe. In my view, the King James Bible translated and written by “Secretaries of God” (see my review of the book by the same title in Wake County Physician magazine , Volume IX, July 2004) is a work that ennobles your soul. The accuracy, elegance, and lapidary Elizabethan English and the Shakespearian stylistic influence on the translators are unparalleled. Watch for the essay on King James Bible in 2019.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is a dramaturge. Received Raleigh Medal of Art in 2001, inducted to Raleigh Hall of Fame 2013, elected Lifetime Trustee, North Carolina Symphony in 2015, and 2016 recipient of NC Award, Fine Arts.

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On the Mind…

Monday Musings for Monday December 10, 2018
Volume VIII. 50/414

Freud_head_shot CGJung

Sigmund Freud                                       Carl Jung

Thinking About Thinking, Episteme, Chrestomathy,

Twenty First Century: The Age of Mind, PART II

By Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA*

In preparing for this essay, obviously I was drawn to psychoanalytic literature of the late 19th and early 20th century. But the further I dug, the more it became obvious that psychoanalysis did NOT start with Freud. Many of Freud’s teachers and predecessors had expounded on the theory of unconscious. Plato, Shake­speare, Kant, Schopenhauer, Nietzsche have all dealt with and expounded on the possibility of the unconscious, the soul and metaphysics. Yes, I was taken all the way back to Aristotle, a student and rival of Plato, whose writings are so very organized and detailed, making the reader feel like they are biting into stone. Aristotle had a lot to say about psyche (soul), God, ether and metaphysical phenomena. Psychoanalysis thrived in the first 60-70 years of the 20th century, but experts fear the threatened demise of the field.  What is the answer? The answer lies with uniting psychoanalysis with biological sciences. Let me elaborate:

In a recent discussion with an academic colleague who was identifying the twentieth century’s greatest achievement as the discovery of the atomic bomb, I argued rather forcefully that the contribution of the twentieth century was advancement of Father Gregor Mendel’s genetics through the discovery and understanding of RNA and DNA by James Watson and Francis Crick in 1953. They were awarded Nobel Prize for Medicine or Physiology in 1962. We celebrated at the University of North Carolina and Research Triangle Park, in 2003, the 50th anniversary of the discovery by having Dr. James Watson amongst us. The understanding of DNA and subsequent expansion of the knowledge and advancement of human genome project which was completed in 2003 by Dr. Craig Venter, Director, The Institute for Genomic Research, in my opinion, was the greatest achievement of the 20th century.

Now, facing the 21st century, with wars going on every corner of the globe, humans killing humans for a few pieces of mud prized as land, the need for understanding human behavior makes psychoanalytic research more urgent.  And I believe we have the opportunity to develop further understanding of ourselves, the new science, the science of mind, provides us with a powerful instrument for further development of the field. If the 20th century was known for the discovery of DNA, genomics and epigenetics, the 21st century will be known for the discovery and understanding of the science of mind. And the promise of establishing such a discipline rests with espousing psychoanalysis with biological sciences, neuroscience and neurobiology. Of course, the concept of scientific understanding of mind is not new. Sigmund Freud in “Beyond the Pleasure Principle” wrote an increase in plasma ACTH and glucocorticoid is a response to stress as adults. Thus, differences in an infant’s interactions with his/her mother–differences that fall in the range of naturally occurring individual differences in maternal care– are crucial risk factors for an individual’s future response to stress. In the same book he further elaborated, “The deficiencies in our description would probably vanish if we were already in a position to replace the psychological terms with physiological or chemical ones….we may expect [physiology-and-chemistry] to give the most surprising information and we cannot guess what answers it will return in a few dozen years of questions we have put to it. They may be of a kind that will blow away the whole of our artificial structure of hypothesis…” Further reference: in his classic paper “On Narcissism” he wrote, “We must recollect that all of our provisional ideas in psychology will presumably one day be based on an organic substructure.” On the cusp of 21st century, we really need a contemporary Freud to orchestrate the disparate parts of the symphony of life, psychoanalysis, biological sciences, genomics, neurosciences and neurobiology to produce the rich symphony of better understanding mind and ultimately life.  Well, we do have a few contemporary Freuds, one is Eric R.Kandel whose most recent book, “The Science of the Mind”, we reviewed in this space. Dr. Kandel who is a Nobel Laureate psychiatrist and professor at Columbia University insists that to save psychoanalysis and pump vigorous life into this elegant field, we need to bring about fusion of the two disciplines of psychoanalysis and biology. Otherwise, there is a wide spread concern about viability of psychoanalysis as a scientific discipline. For example, Jonathan Lear. Others have argued that psychoanalysis and psychoanalytic literature from Freud to Hartmann to Erickson to Winnicott, will be read as a modern philosophical or poetic text alongside Plato, Aristotle, Shake­speare, Kant, Schopenhauer, Nietzsche, and Proust (the literature I went through for preparation of this essay). On the other hand, if the field aspires, as I believe most psychoanalysts do aspire, to be an evolving, active contributor to an emerging science of the mind, then psychoanalysis will survive. There is no doubt that psychoanalysts could and did make many useful and original contributions to our understanding of the mind simply by listening to patients. We must at last acknowledge that at this point in the modern study of mind, clinical observation of individual patients, in a context like “the psychoanalytic situation that is so susceptible to observer bias is not a sufficient basis for a science of mind. Psychoanalysis research is depleted from opportunities to add more knowledge,” so say the late Kurt Robert Eissler (1908-1999) and Hartvig Dahl (1924-2007). Marshall Edelson in his book “Hypothesis and Evidence” offers a persuasive argument that the holy marriage between psychoanalysis and biology must take place: “we must bring psychoanalysis and biology together.”

Psychoanalysis is based on the concept that individuals are unaware of the many factors that cause their behaviors and emotions. These unconscious factors have the potential to produce unhappiness, which in turn is expressed through a score of distinguishable symptoms including disturbing personality traits, difficulty in relating to others, or disturbances in self-esteem or general disposition. As I have suggested earlier, most biologists believe that the mind will be to the twenty-first century what the gene was to the twentieth century. I have briefly discussed how the biological sciences in general and cognitive neuroscience in particular may contribute to a deeper understanding of a number of key issues in psychoanalysis.

As things stand now, psychoanalysis is falling behind biology. Psychoanalysis and biology must marry to reinvigorate the exploration of the mind. I should say at the outset that although we have the outlines of what could evolve into a meaningful biological foundation for psychoanalysis, we are very much at the beginning. We do not yet have an intellectually satisfactory biological understanding of any complex mental processes. In the next century, biology is likely to make deep contributions to the understanding of mental processes by delineating the biological basis for the various unconscious mental processes, for psychic determinism, for the role of unconscious mental processes in psychopathology, and for the therapeutic effect of psychoanalysis.  Biology has the potential to enlighten these deep mysteries at their core.

We have seen that one point of convergence between biology and psychoanalysis is the relevance of procedural memory for early moral development, for aspects of transference, and for moments of meaning in psychoanalytic therapy. We have considered a second point of convergence in examining the relationship between the associative characteristic of classical conditioning and psychological determinacy. Here, I want to illustrate a third point of convergence: that between Pavlovian fear conditioning, a form of procedural memory mediated by the amygdala, signal anxiety, and post-traumatic stress syndrome. Psychoanalysis and cognitive neuroscience would accomplish two goals, one conceptual and the other experimental. We must recollect that all of our provisional ideas in psychology will presumably one day be based on an organic substructure.

The American psychologist best known for his maternal-separation and social isolation experiments on rhesus monkeys, Harry Harlow, demonstrated the importance of care-giving and companionship in social and cognitive development. He conducted most of his research at the University of Wisconsin-Madison, where where humanistic psychologist Abraham Maslow worked for a time with him. As an aside, the etymology of the word companionship comes from Latin for bread—PAIN—nutrition.  Another psychologist, Hans Selye, had pointed out as early as 1936 that humans and experimental animals respond to stressful experiences by activating their hypothalamic-pituitary-adrenal (HPA) axis. The end product of the HPA system is the release of glucocorticoid hormones by the adrenal gland.

The prefrontal cortex association  has two major functions: it integrates sensory information, and it links it to planned movement. Because the prefrontal cortex mediates these two functions, it is thought to be one of the anatomical substrates of goal-directed action in long-term planning and judgment. Patients with damaged prefrontal association areas have difficulty in achieving realistic goals. As a result, they often achieve little in life, and their behavior suggests that their ability to plan and organize everyday activities is diminished.

What To Do?  What is Next?

For one thing, we must transcend territorial imperative, and learn to speak each other’s language– neuroscientists the language of psychoanalysts, and psychoanalysts the language of neuroscience. For many years both the Association for Psychoanalytic Medicine at Columbia and the New York Psychoanalytic Institute, to use but two examples, have instituted neuropsychoanalytic centers that address interests common to psychoanalysis and neuroscience, including consciousness, unconscious processing, autobiographical memory, dreaming, affect, motivation, infantile mental development, psychopharmacology, and the etiology and treatment of mental illness. The prospectus of the New York Psychoanalytic Institute now reads as follows: “The explosion of new insights into numerous problems of vital interest to psychoanalysis needs to be integrated in meaningful ways with the older concepts and methods as do the burgeoning research technologies and pharmacological treatments. Similarly neuroscientists exploring the complex problems of human subjectivity for the first time have much to learn from a century of analytic inquiry make a significant fraction of psychoanalysts technically competent in cognitive neuroscience and eager to test their own ideas with new methods.” The challenge for psychoanalysts is to become active participants in the difficult joint attempt of biology and psychology, including psychoanalysis, to understand the mind. If this transformation in the intellectual climate of psychoanalysis is to occur, as I believe it must, the psychoanalytic institutes themselves must change from being vocational schools- guilds, as it were- to being centers of research and scholarship.

We have precedence, the Carnegie Foundation commissioned Abraham Flexner to study medical education in the United States. The Flexner Report, which was completed in 1910, emphasized that medicine is a science- based profession and requires a structure education in both basic science and its application to clinical medicine. To promote a quality education, the Flexner Report recommended limiting the medical schools in this country to those that were integral to a university. As a consequence of this report, many inadequate schools were closed, and credentialed standards for the training and practice of medicine were established. To return to its former vigor and contribute importantly to our future understanding of mind, psychoanalysis needs to examine and restructure the intellectual context in which its scholarly work is done and to develop a more critical way of training the psychoanalysts of the future. Thus, what psychoanalysis may need, if it is to survive as an intellectual force into the twenty- first century, is something akin to a Flexner Report for the psychoanalytic institutes.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is a dramaturge. Received Raleigh Medal of Art in 2001, inducted to Raleigh Hall of Fame 2013, elected Lifetime Trustee, North Carolina Symphony in 2015, and 2016 recipient of NC Award, Fine Arts.

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On Handel’s “Messiah”

Monday Musings for Monday December 3, 2018
Volume VIII. 49/413

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NC Symphony at the Meymandi Concert Hall

A Few Thoughts on Messiah and Maestro Handel

By Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA*

Every year, The North Carolina Symphony and the North Carolina  Master Chorale perform Messiah with authority, power, transcendence and luminosity that the piece deserves.  Here are a few thoughts about Messiah and our beloved octogenarian NCS:

Messiah is special in many ways:

1)     Handel (George Frideric) and Bach (Johann Sebastian) were born in Germany the same year, 1685.  Handel in Halle, and Bach in Eisenach, about fifty miles apart.  They followed different paths, different careers, and different life styles.  Probably never met.  Handel spent a lot of his professional life in England and wrote music for George II, former Elector of Hanover of Germany.  Handel was working for the Elector as a Kapellmeister.  He left Germany for Italy to further his musical education without the Elector’s permission. The Elector, who later became George II, King of England, was not very pleased.  Handel approached George II in London and apologized for abandoning his post.   Handel was forgiven by the king who commissioned the Maestro for many pieces of music, among them The Water Music. George II became very fond of Handel’s music.  It was Handel who composed music for the King’s coronation in 1727.  Obviously by 1727, Handel was well forgiven by his majesty.

2)    It is variously reported that Messiah was written by Handel in fewer than 30 days.  A true miracle.  His knowledge of the Bible was astounding.  His creative genius of musical composition was unparalleled.  Handel was a big man.  He did not mince words.  If he did not like a minion’s behavior, he would let his displeasure be known by beating up the irritant. Wonder if King George II was intimidated by Handel’s heft and bulldog demeanor?

3)    Messiah opened 276 years ago, in 1742.  King George II was in the audience at the performance premiere.  He became so excited by the majesty of the music that he rose during the Alleluia chorus.  Of course everyone else rose.  When the king rises no one stays seated!  The music touched him very deeply.  And that is why, to this day, audiences throughout the world follow what has become the cultural tradition and accepted decorum. We all rise when Alleluia chorus is sung.  Since 1742, Messiah has played continuously without cessation, in war, in peace, in famine and in abundance.  It has been played every year for the past 270 years.

4)    The only other musical lasting and playing continuously is Ibn Khaldoun’s Talavat of Qur’an passages. Ibn Khaldoun was born in Tunis in 1332.He was a brilliant Muslim economist, philosopher, theologian, polymath and music lover.  He wanted to bring music back to Islam, a religion that had banned music. Khaldoun wrote to the reigning Caliph suggesting and arguing that since it is acceptable to sing the passages of the Holy Qur’an, by fatwa, the Caliph should allow singing and music in Islamic nations. The Caliph agreed. Khaldoun started an annual singing competition for Islamic countries which continues to this day. It is very much like our Oscars or the Emmys. All Islamic nations send their best singers to participate in Talavat competition. I believe Nigeria holds the current championship. Talavat started in 1355 when Khaldoun was 23 years old. In the history of music, there are no other compositions known to have continuously played.

As an aside: Ibn Khaldoun forwarded the concept of trickledown economics.  One might recall that in 1981, Robert Mundell, Chairman of the late President Reagan’s Board of Economic Advisers, introduced trickledown economics.  He had studied Ibn Khaldoun.  In his writings, Mundell has made numerous references to the 14th century Arab economist.  A Columbia University professor of economics, Mundell conceived and created the Euro.  He is now working on a currency for the Middle East and the Arab world. Any suggestion what it might be called?  Mundell won 1999 Nobel Prize in economics.

Symphony No. 7 by Dmitri Shostakovich, performed by NC Symphony

The NC Symphony has reached a degree of maturity, predictable excellence, and incredible versatility that is gratifying and admirable.  Faithful fans of the NCS recall magnificent performances such as the back to back the relatively short Mozart Symphony No. 25 in G minor followed by the 75 minute technically demanding and colossal Dmitri Shostakovich Symphony No. 7.  The 104 piece symphony with 26 violins, nine violas, nine cellos, six basses, 13 French Horns, two harps and a complement of piccolos, flutes, oboes, with 10 additional trombones and trumpets housed in the chorale loft of the concert hall, along with an impressive array of percussive instruments, provided a memorable evening.  The music depicted storm of war, softness and tranquility of peace, conflict, and human indignity.  The composition brought to mind synesthetically, Picasso’s painting the famed Guernica and the tumultuous narrative of Leo Tolstoy’s War and Peace. Guest conductor Carlos Kalmar’s mastery of the music brought Maazelian exactitude and  excellence which allowed for the majesty of the talent of the NCS’s musicians to be fully expressed. This past weekend the symphony played Schubert’s music along with Mozart Mass in C minor, “The Great,” K 427.

We have professional sports such as football and basketball that get full weekly coverage in the local media.  I wish we would offer equal recognition to our NCS team.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is a dramaturge. Received Raleigh Medal of Art in 2001, inducted to Raleigh Hall of Fame 2013, elected Lifetime Trustee, North Carolina Symphony in 2015, and 2016 recipient of NC Award, Fine Arts.

 

 

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Monday Musings for November 26, 2018
Vol. VIII, No. 48/412

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Sir Laurence Olivier’s Hamlet

SHAKESPEARE’S HAMLET

by Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA*

Our beloved city, Raleigh, North Carolina, is going through a seismic mania, nonetheless a pleasant sort of mania, in that cultural, artistic, literary, humanitarian and humanistic activities are exploding.  The most exciting new addition is the development of Dix Park, 303 acres of prime land located minutes away from downtown.  I want to highlight opera.  There are 200 operas based on the work of Shakespeare.  Maestro Giuseppe Verdi (1813-1901), The premier opera composer had a special fascination for Shakespeare.  Besides the three operas he took from him—Macbeth, Otello (opera is Othello) and Falstaff—he considered doing a Tempest or Hamlet or Romeo and Juliet. But to me Hamlet is the most encompassing of all Shakespeare’s plays.

Reading, re-reading, not only in English, but some half of dozen other languages; watching, and re-watching the bard’s plays, I must confess that one stands out. This one play of my choice is daunting and all consuming. It is Hamlet. Hamlet could be addicting. But it is not an unwelcome or a bad form of addiction. The arts in general, and the opera and classical music, in special, are good addictions to have. Addiction to opera is life giving, uplifting and almost transcendental. So let me say a few words about Hamlet as a play, and Hamlet as an opera.

Why Hamlet?

The play Hamlet is the Elizabethan intellectual maturity to the fullest. Cloaked in a tragedy, it unfurls the mystery of the universe. It speaks to today’s life as it did when it was first performed at the Globe Theatre in 1602, and perhaps before that as early as 1200, the Thomas Kyd’s (born 6 November 1558) production, The Spanish Tragedy of a Ghost.

The Tragicall Historie of Hamlet, Prince of Denmarke is a play by William Shakespeare. It is one of his best-known works, and also one of the most-quoted writings in the English language. Hamlet’s delicious language, poetry, rhythm, sequence, presentation has such power and intensity to absorb, to intimidate, to engage and ultimately to transform. The rhythm and construction give us the obliquity, the solidity and clarity which are the hallmark of Shakespeare’s genius. Reading Hamlet repeatedly is never boring. There is always the unknown, the unpredicted, and the unforeseen fresh events, and heretofore unknown facts that jump out of some dark corner, ambush and thrill us. Hamlet’s humanity reminds us of Pico della Mirandola’s Oration on the Dignity of Man, yet it depicts the tragedy of ambivalence, consuming revenge, and pre-occupation with death, killing and incest. The presentation of the ghost of King Hamlet in Elsinore is intriguing. It displays the struggle between the medieval concept of God in the Catholic Church and the renaissance/protestant concept of God, doing away with the intermediaries, the Popes, the Cardinals, the Bishops, and dealing directly with God. The play sets the scene for the teachings of the likes of Martin Luther, Professor of Theology at Wittenberg and emergence of northern German disciplined and dispassionate thinking of that region. Wittenberg University was established by the Elector of Saxony (Fredrick the Wise) in 1502. It developed a curriculum strong in matters related to renaissance and protestant theology.

And finally, We like, read, and watch Hamlet in live plays and movie productions, celebrating and showcasing the performances of theatre luminaries such as Sir Lawrence Olivier, Derek Jacobi, Kenneth Branagh, Christopher Plummer, Richard Chamberlain and Franco Zeffirelli, because the events speak to us directly. The exquisite language, syntax and elegance of stringing words together like a jeweler producing a masterpiece lift our heart, and satisfy our intellect.

The Psychoanalytic Implication of Hamlet

In the service of clarity, we must elaborate on Hamlet, the father, the King of Denmark who was killed by a usurping brother, Claudius. Then, there is Hamlet the son, an intellectual and lofty student at Wittenberg who is on his way back to Denmark, and Hamlet, Shakespeare’s play. Not enough can be said or written on the elegance of style and all-consuming literacy of the writings of the Bard. The first soliloquy of five lines in iambic pentameter appears with words, subjunctives and no verb. Hamlet’s subsequent speech, 30 lines long, in unparalleled eloquence and beauty, belittles the “low habit of Danish drinking.” and Denmark’s reputation for drunkenness. It is followed by another 14 lines of convoluted syntax in which Claudius’ drinking is blamed. The mere talismanic language, appealing rhythm, and unerring choice of words, pamper one’s intellect and deepen one’s emotional engagement.

While psychoanalysis deals with the unconscious, it equivocates with issues of ghosts, astrology and fate. However, Shakespeare, like some of the literary giants who preceded him, namely, Saint Augustine of Hippo and Saint Thomas Aquinas, refers repeatedly to the Aristotelian concept of “tragic flaw.” The theory suggests that one fault, like addiction to gambling or alcohol may ruin the otherwise pristine life of an individual. The question of evil, its genesis and why God allows for evil to exist, is another important matter. Hamlet, the Wittenberg student forges a document and uses his father’s stolen seal to give the document authenticity, which leads to the death of Rosencrantz and Guildenstern, his childhood friends and schoolmates. The young Hamlet, a brilliant intellectual and student at Wittenberg University, is troubled by “doubt, ambiguity and evil.” He often contemplates how “A dram of evil destroys all…” Hamlet and his close friend, Horatio, are studying philosophy, but it does not help him resolve his indecision and lust for revenge, which eventually leads to his killing of Polonius.

Psychoanalytic theory, invoking the Oedipal triangle, presumes that young Hamlet’s thirst for revenge is his ever escalating anger and jealousy of Claudius. Claudius married Hamlet’s mother and did not give Hamlet a chance to marry his mother (just like Oedipus Rex.) Hamlet, encouraged by the teachings he is receiving at Wittenberg, is intrigued by introspection. “To thy own self be true” is his motto. He wants to know himself better. In the process of his intense self-examination, he becomes extremely depressed, even suicidal. He asks/informs his friend Horatio, “I have lost my wit. I see man, noble in reason, infinite in faculties, expressive and admirable in action…yet useless and melancholic…”

At the end of the play, Hamlet kills Claudius with a poisoned foil and makes him drink poisoned wine. Hamlet himself dies of injuries. When Hamlet dies, Horatio says, “Flights of angels sing thee to thy rest.”

Psychoanalytic theory is one of many ways of looking at Hamlet’s actions. Freud and other theorists were able to take the play and analyze it scene by scene, giving a more in-depth meaning to the actions of the characters. In a sense, Shakespeare wrote two plays in one; one play dealing with a tragedy, leaving the stage with many corpses; the other standing the test of time, in a captivating exploration into an unconscious world of the unknown.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is a dramaturge. Received Raleigh Medal of Art in 2001, inducted to Raleigh Hall of Fame 2013, elected Lifetime Trustee, North Carolina Symphony in 2015, and 2016 recipient of NC Award, Fine Arts.

 

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On Thanksgiving

Monday Musings for November 19, 2018
Vol. VIII, No.47/411

 

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THANKSGIVING 2018

by Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA*

To My Dear Family, Friends, Colleagues and Readers:

Thanks for being

Thanks for becoming

Thanks for all the good inside of us, intellect, trillions of neuronic connections

Thanks for our ability to feel love, compassion, and presence of God in us

Thanks for the arts, the humanities, flowers, music, and trees

Thanks for poetry, dance, ballet, ballads and symphony and

Thanks for science and the universe

Thanks for Socrates’ elenchus

Thanks for Aristotle’s entelechy

Thanks for Zarathustra, Buddha, Rumi, Mohammad, Ferdowsi, Avicenna, Goethe,

Jesus, Gandhi, Mozart, Moses and Abraham. Thanks for Hanukah, Easter, Purim and BiShvat(Hebrew: ט״ו בשבט)

Thanks for my own mother, for Mother Teresa, Joan of Arc, Catherine of Siena, Virgin Mary, Sappho, Matilda Maud, Susan B. Anthony , Queen Melisandre of Jerusalem and Dorothea Lynde Dix.

Thanks for the gift of time. Time for study, research, introspection, enjoyment, creating, thinking……the list is endless as witnessed by your diversity of intellectual pursuits.

Thanks for the billions of microbiomes that keep our brain and body functioning (we carry 2.5 pounds of useful bacteria in our bodies that are life giving and probiotic)

Thanks for family and connectedness

Thanks for the World

Thanks for eternity

Thanks for transcendence

Thanks for America

Thanks for life, and oh, yes

Thanks for timely death

But although humanity has come a long way, we have ways to go as reflected below.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He received Raleigh Medal of Art in 2001, inducted to Raleigh Hall of Fame 2013, elected Lifetime Trustee, North Carolina Symphony in 2015, and 2016 recipient of NC Award, Fine Arts.

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On the Mind

Monday Musings for Monday November 12,2018
Volume VIII, No. 46/410

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        Marcel Proust                                 Sigmund Freud

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        Mauro Mancia

The Science of Mind,  21st Century Perspective

By Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA*

 (Editor’s Note:This column is devoted to bridging the gap between basic sciences, medicine, the arts, and humanities.

In preparing for this essay, I was drawn to the psychoanalytic literature of the late 19th and early 20th century. The further I dug, however, the more it became obvious that psychoanalysis did NOT start with Freud. Many of Freud’s teachers and predecessors had expounded on the theory of the unconscious. Plato, Shakespeare, Kant, Schopenhauer, and Nietzsche have all dealt with and expounded on the possibility of the unconscious, the soul, and metaphysics. In fact, I was taken all the way back to Aristotle, a student of Plato at Plato’s Academy and later a rival of Plato when Aristotle became angry and established his own school, the Lyceum. Aristotle’s writings are very organized and detailed, making the reader feel as if he or she is biting into stone. Aristotle had a lot to say about the psyche (soul), God, ether, and metaphysical phenomena.

Psychoanalysis is based on the concept that individuals are unaware of the many factors that cause their behavior and emotions. These unconscious factors have the potential to produce unhappiness, which in turn is expressed through a score of distinguishable symptoms, including disturbing personality traits, difficulty in relating to others, or disturbances in self-esteem or general disposition. Psychoanalysis thrived in the first 60 to 70 years of the 20th century, but experts fear the threatened demise of the field. What is the answer? The answer lies with uniting psychoanalysis with biological sciences.

In a recent discussion with an academic colleague, who identified the 20th century’s greatest achievement as the discovery of the atomic bomb, I suggested rather forcefully that the most significant contribution of the 20th century was the advancement of Father Gregor Mendel’s genetics through the discovery, by James Watson and Francis Crick in 1953, of ribonucleic acid (RNA) and deoxyribonucleic acid (DNA). Watson and Crick were awarded the Nobel Prize for Medicine or Physiology in 1962. In 2003, we celebrated the 50th anniversary of the discovery of DNA at the University of North Carolina and Research Triangle Park by having Dr. James Watson among us. In my opinion, the understanding of DNA, and subsequent expansion of the knowledge and advancement of human genome project, which was completed in 2003 by Dr. Craig Venter from the Institute for Genomic Research, is the greatest achievement of the 20th century.

Now, in the 21st century, with wars being fought all over the globe and with humans killing humans for a few pieces of mud prized as land, the need for understanding human behavior makes psychoanalytic research more urgent. I believe we have the opportunity to develop further understanding of ourselves through an exciting new science, the science of mind. Studying the science of the mind can further the development of the transdisciplinary approach to understanding what it is to be human. If the 20th century was known for the discovery of DNA, genomics, and epigenetics, then the 21st century will be known for the discovery and understanding of the science of mind. And the promise of establishing such a discipline rests with espousing psychoanalysis with biological sciences, neuroscience, and neurobiology.

Of course, the concept of scientific understanding of the mind is not new. Sigmund Freud, in Beyond the Pleasure Principle, wrote there is an increase in plasma adrenocorticotropic hormone (ACTH) and glucocorticoid in response to stress. Thus, differences in an infant’s interactions with his or her mother—differences that fall in the range of naturally occurring individual differences in maternal care—are crucial factors for an individual’s future response to stress. In the same book, Freud further elaborated, “The deficiencies in our description would probably vanish if we were already in a position to replace the psychological terms with physiological or chemical ones….We may expect [physiology and chemistry] to give the most surprising information and we cannot guess what answers it will return in a few dozen years of questions we have put to it. They may be of a kind that will blow away the whole of our artificial structure of hypothesis…” In his classic paper, “On narcissism,” Freud wrote, “We must recollect that all of our provisional ideas in psychology will presumably one day be based on an organic substructure.”

A little over 100 years ago, Freud was invited, along with his colleague Carl Jung, to Clack University, in Worcester, Massachusetts, to give a series of lectures entitled, “Psychology and Pedagogy.” He met many American academicians, including Adolph Myers of the Johns Hopkins University and Harvard neurologist J. J. Putnam. We know that Putnam became the first president of the American Psychoanalytic Association, suggesting strong organic and scientific propensity of early psychoanalytic endeavors. After the lectures, Freud and Jung spent four days at the Putnam camp in Adirondacks with Putnam, which guaranteed the wide spread of psychoanalysis in America. The roots of American psychoanalysis are indeed deeply rooted in biological soil.

In 1966, when I was the director of Cumberland County Mental Health Center, I applied for a grant for the Head Start program. I used a study by Karolinska Institute, which was published in the Acta Physiologica Scandinavica and The Lancet demonstrating that fetal central nervous systems (CNS) exposed to excess secretion of maternal catecholamine, especially the powerful metabolites, metanephrines, vanillyllmandelic acid, and 3-methoxy 5-hydroxyphenylglycol (MHPG), produce babies that are more irritable, scrawny, cranky, susceptible to attention deficit hyperactivity disorder (ADHD), and prone to anxiety, phobia, and social maladjustment. President Kennedy, having had mental illness and mental retardation in his family, launched an extensive program of community-centered care for patients. President Johnson, who followed Kennedy, established the “Head Start” program, which encouraged the community to reach out to at-risk children at a very young age. Being armed with the knowledge out of Sweden, my team and I wrote a grant request and sent it to the President. In the grant, we stated that age one or two years is too late. We proposed a program we dubbed “Intrauterine Head Start Project.” The then President Johnson liked the idea. We were given a large grant that ensured Cumberland County of being the first center in North Carolina to have a comprehensive community mental health program. The result was a book, The First Two Hundred Days, published in 1967 with subsequent multiple prints.

There are many areas and precedence where psychology and biology have cooperated and converged. The neuroscientific interest in dreams, which started in 1953 with the discovery of rapid eye movement (REM) sleep by Aserinsky and Klietman, is a good example of where psychophysiologic findings were woven into the tapestry of biology. There are many exciting discoveries in the area of psychoendocrinology of dream and memory coming out through many sources and laboratories both in the United States and abroad. In fact, an article by Mauro Mancia, sage of the Italian academia, neurobiologist, and psychoanalyst, was recently published in the American Journal of Psychiatry entitled, “The role of the interrelation between serotonin (5-HT), muramyl dipeptide, and interleukin1 (IL-1) in sleep regulation, memory, and brain.” Dr. Mancia is also the editor of one of my most recent reads, Psychoanalysis and Neuroscience. Dr. Mancia is Professor Emeritus of Neurophysiology, University of Milan, Italy, and Training Analyst of the Italian Psychoanalytical Society and has written extensively on the subjects of narcissism, dreams, sleep, memory, and the unconscious. The book is in-depth exploration of the possibilities and hope to bring psychoanalysis and biology to dine at the same table.

Neuroscientific knowledge of the essence of what memory is has been enhanced by the mapping of the brain’s limbic system responsible for housing emotions. These anatomical related structures demonstrate the common neuronic pathway of memory and emotions. It was Paul D. McLean in the 1940s, while mapping specific components of the limbic system, who invoked the romantic notion that the limbic system is “the anatomy of emotions.” The limbic system consists of thalamus hypothalamus, amygdala, hippocampus, mammallary bodies, cingulate gyrus, fornix, association cortex, and pituitary. After delineating various nuclei of hypothalamus, McLean introduced, through a stereotype technique, a microelectrode into the paraventricular nucleus of the hypothalamus and ran 70 millivolts of electricity through the area. The subject would arise with anger, dilated pupils, engorged neck veins, and sympathetic system overtake. Next, McLean would stimulate the ventral nucleus of hypothalamus, just a few millimeters caudally from the first site. By stimulating this region, the subject would then relax, take a deep breath, smile, and demonstrate the physiological manifestation of the parasympathetic discharge. The future possibilities of psychoanalysis working together with neurosciecnes and biology is dazzling.

Now that we are in the 21st century, we need a modern Freud to orchestrate the disparate parts of psychoanalysis, biological sciences, genomics, neurosciences, and neurobiology to produce a better understanding of the rich symphony of mind and ultimately life.

We do have a few contemporary Freuds—one is Eric Kendal, whose most recent book, The Science of the Mind, I reviewed two years ago in the pages of this journal. Dr. Kendal, a Nobel Laureate psychiatrist and professor at Columbia University, insists that to save psychoanalysis and pump vigorous life into this elegant field, we need to bring about the fusion of the two disciplines of psychoanalysis and biology. Otherwise, there is a widespread concern about viability of psychoanalysis as a scientific discipline. For example, Jonathan Lear and others have argued that psychoanalysis and psychoanalytic literature from Freud to Hartmann to Erickson to Winnicott, will be read as a modern philosophical or poetic text alongside Plato, Aristotle, Shakespeare, Kant, Schopenhauer, Nietzsche, and Proust (the literature I went through for preparation of this essay). On the other hand, if the field aspires, as I believe most psychoanalysts do aspire, to be an evolving, active contributor to an emerging science of the mind, then psychoanalysis will survive. There is no doubt that psychoanalysts did and can make many useful and original contributions to our understanding of the mind simply by listening to their patients. We must, at last, acknowledge that, at this point in the modern study of mind, clinical observation of individual patients must occur. As Eissler (1908–1999) and Dahl (1924–2007) once said, “the psychoanalytic situation that is so susceptible to observer bias is not a sufficient basis for a science of mind.” Psychoanalytic research is depleted from opportunities to add more knowledge.

Marshall Edelson in his book Hypothesis and Evidence offers the persuasive argument that the holy marriage between psychoanalysis and biology must take place— “We must bring psychoanalysis and biology together.” All of these pioneer psychoanalysts follow the notions of Freud and recommend, or dream (pun intended), about congruence between psychoanalysis and biology. Many argue passionately that psychoanalysis is falling behind.

Biology carries the promise of reinvigorating the psychoanalytic exploration of mind. I should say at the outset that although we have the outlines of what could evolve into a meaningful biological foundation for psychoanalysis, we are very much at the beginning. We do not yet have an intellectually satisfactory biological understanding of any complex mental processes.

In the next century, biology is likely to make deep contributions to the understanding of mental processes by delineating the biological basis for the various unconscious mental processes, psychic determinism, the unconscious mental processes in psychopathology, and the therapeutic effect of psychoanalysis. Biology will not, however, immediately enlighten these deep mysteries at their core.

We have seen one point of convergence between biology and psychoanalysis, which is the relevance of procedural memory for a child’s early moral development, for aspects of transference, and for moments of meaning in psychoanalytic therapy. We have considered a second point of convergence in examining the relationship between the associative characteristic of classical conditioning and psychological determinacy. Here, I want to illustrate a third point of convergence: Pavlovian fear conditioning, a form of procedural memory mediated by the amygdala, signal anxiety, and posttraumatic stress syndromes in humans.

Psychoanalysis and cognitive neuroscience would accomplish two goals for psychoanalysis: one conceptual and the other experimental. We must recollect that all of our provisional ideas in psychology will presumably one day be based on an organic substructure.

The American psychologist, Harry Harlow (1905–1981) was best known for his maternal separation and social isolation experiments on rhesus monkeys, which demonstrated the importance of caregiving and companionship in social and cognitive development. He conducted most of his research at the University of Wisconsin–Madison, where humanistic psychologist, Abraham Maslow, worked for a time with him.

Hans Selye had pointed out as early as 1936 that humans and experimental animals respond to stressful experiences by activating their hypothalamic-pituitary-adrenal (HPA) axis. The end product of the HPA system is the release of glucocorticoid hormones by the adrenal gland.

We know the effect of phyenylethylamine in erotic arousal. Psychoanalyst Sir Martin Roth, the first President of the Royal College of Psychiatrists, Emeritus Professor of Psychiatry in Cambridge, and the most eminent British psychiatrist of his generation, described pseudoneurotic schizophrenia in the 1940s, and in mid-50s published a series of papers about research conducted in his biochemistry laboratories. These papers suggested that famous movie stars with supernumerary marriages (Marilyn Monroe, Elizabeth Taylor, and Za Za Gabor, to name a few) carry a high level of PEA in their circulation. He suggested another brand new diagnosis, hysteroid dysphoria, to clinically describe these people’s hyper-erotocism. I could literally write a book about the cordial and rich history of psychoanalysis and biology both in Europe and America.

The prefrontal association cortex has two major functions: it integrates sensory information and it links it to planned movement. Because the prefrontal cortex mediates these two functions, it is thought to be one of the anatomical substrates of goal-directed action in long-term planning and judgment. Patients with damaged prefrontal association areas have difficulty in achieving realistic goals. As a result, they often achieve little in life, and their behavior suggests that their ability to plan and organize everyday activities is diminished.

For many years both the Association for Psychoanalytic Medicine at Columbia and the New York Psychoanalytic Institute, to use but two examples, have instituted (with the help of my colleague, James H. Schwartz) neuropsychoanalytic centers that address interests common to psychoanalysis and neuroscience, including consciousness, unconscious processing, autobiographical memory, dreaming, affect, motivation, infantile mental development, psychopharmacology, and the etiology and treatment of mental illness. The prospectus of the New York Psychoanalytic Institute now reads as follows:

“The explosion of new insights into numerous problems of vital interest to psychoanalysis needs to be integrated in meaningful ways with the older concepts and methods as do the burgeoning research technologies and pharmacological treatments. Similarly, neuroscientists exploring the complex problems of human subjectivity for the first time have much to learn from a century of analytic inquiry.”

The challenge for psychoanalysts is to become active participants in the difficult joint attempt of biology and psychology, including psychoanalysis, to understand the mind. If this transformation in the intellectual climate of psychoanalysis is to occur, as I believe it must, the psychoanalytic institutes themselves must change from being vocational schools—guilds, as it were—to being centers of research and scholarship.

To examine this problem, the Carnegie Foundation commissioned Abraham Flexner to study medical education in the United States. The Flexner Report, which was completed in 1910, emphasized that medicine is a science-based profession and requires a structured education in both basic science and its application to clinical medicine. To promote a quality education, the Flexner Report recommended limiting the medical schools in this country to those that were integral to a university. As a consequence of this report, many inadequate schools were closed, and credentialed standards for the training and practice of medicine were established.

To return to its former vigor and contribute importantly to our future understanding of mind, psychoanalysis needs to examine and restructure the intellectual context in which its scholarly work is done and to develop a more critical way of training the psychoanalysts of the future. Thus, what psychoanalysis may need, if it is to survive as an intellectual force into the twenty-first century, is something akin to a Flexner Report for the psychoanalytic institutes.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is a dramaturge. Received Raleigh Medal of Art in 2001, inducted to Raleigh Hall of Fame 2013, elected Lifetime Trustee, North Carolina Symphony in 2015, and 2016 recipient of NC Award, Fine Arts.

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