On Alzheimer’s…

“Monday Musings” for Monday July 24, 2017
Volume V, No. 30/342

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Alzheimer’s Disease, The Latest

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

Science Series
No. 86

Alzheimer’s Disease is a heart breaker. In spite of mountains of research we do not have any answer to this merciless killer.  Some reflections,  but first a bit of history:

Brief History:

Alzheimer’s disease is the most common form of dementia (forgetfulness/inability to recall) that afflicts more than 100 million worldwide, and five million in America. The dementia-causing brain disorder is named for its discoverer, German psychiatrist and neuropathologist Aloysius (Alois) Alzheimer (1864-1915). The first case of Alzheimer’s disease was, of course, presented in the form of a scientific paper to the Conference of Southwest German psychiatrists in Tubingen, Germany, on November 4, 1906.

Dr. Alzheimer discovered little bits of goo, starch-like substance, the chemical composition of which we now know to be amyloid, accumulated around the nerve cells (neurons) in the brain. These bits grow and coalesce into bigger pieces called plaques and later on neurofibrillary tangles, all of which disrupt the works of the brain which are primarily memory, intellectual functions, such as thinking, and communication. As the result, nerve cells die (are choked to death) and the brain literally shrinks in volume. The patient with Alzheimer’s disease experiences loss of memory, both for recent and distance events, as well as deficit in perception, mental processes, cognition and comprehension in a progressively worsening mode, until the patient dies. Alzheimer’s disease is a slow but major killer. In mid to later stages, the Alzheimer’s patients do not even remember or recognize their children and other close members of the family.

Clinical course:

Alzheimer’s disease is brutal. It robs the afflicted of experiencing joy, communication, and connection with life. The patient turns into a zombie. Most important loss is loss of dignity and nobility of the soul preceded by urinary and fecal incontinence. We now have five million Americans suffering from this disease (worldwide over 100 million). It is more prevalent in women because of female hormonal and body chemistry. There may be accompanying mood disorder, such as depression, or behavior disorder such as violence, and thought disorder, such as paranoia and delusions.

Interpersonal relationship, let’s say between a husband and wife, is based on ability to talk (communication). Talking is about communicating memories of the past, plan for the future and enjoyment of here and now. After attending a party, we chit chat about whom we saw at the party and who said what…And plan for the future, trips, vacations, grandchildren, etc.  With Alzheimer’s all this is taken away in a brutal and irreversible manner. Conversations are reduced to asking and answering the same questions limited in scope and variety, repeatedly, randomly and aimlessly. The “conversation”/exercise soon becomes exhausting. In Alzheimer’s disease, meaningful communication, the central alchemy of relation and love, is one of the first things to disappear.

Diagnosis and treatment:

Diagnosis is through neuropsychological testing, mental status examination and brain scans. Besides magnetic resonance imaging (MRI), we now have other radiological instruments such as positron emission tomography (PET scan) and functional MRI (fMRI) that not only visually demonstrate existence of the plagues and the amyloid bits, but can measure the physiological function of the brain. It is now well known that Alzheimer’s-related changes in the brain begin 10-15 years or more before people show signs of detectable memory loss. Scientists at University of Pittsburgh and the Johns Hopkins University have developed a BIOCARD, which study and predict onset of the disease in volunteers through long term monitoring and testing. Therefore, diagnosis leads to a treatment course primarily consisting of brain exercise by reading, memorizing, classical music, doing crossword puzzle, Sudoku puzzle, and through physical exercise and activities, staying socially active, interactive and engaged.

Chemical Treatment:

In the past few decades, we have had a number of chemicals, among them Aricept and Namenda. These drugs are designed to fight the progression of the disease and bring symptom relief. In essence they slow down the deterioration of the brain, but, unfortunately, not very successfully. More recently, a new group of drugs–the Zumab family of drugs—have been introduced with the promise that they attack the plaques directly by dissolving and removing them from the brain. They belong to a group of chemicals called monoclonal antibodies. Their expected function is to just like a chemical vacuum cleaner get in the brain and sweep away the goo, the plaques and the neurofibrillary tangles. The Zumabs (category of chemicals known as monoclonal antibodies) supposedly  are those chemical vacuum cleaners. The first one of these drugs Bapineuzumab which is still in trial has not shown glorious results. The fuss last week in Washington, DC was over another drug from the same family, Solanezumab, a drug made by Eli Lilly & Co. The first clinical trial of the drug is near completion, and the preliminary results offer some promise. More and bigger clinical trials are on the way. Now, critics, pharma pundits and stock market analysts alike, are awaiting with bated breath the results from Solanezumab- the second antibody-based vaccine drug marketed by Eli Lilly, currently in clinical trials. The hopes and dreams of a worldwide population of nearly 100 million (and growing) people with AD rides on these trials. A lot of money rides on these trials, too, given that the number of people with AD is steadily growing. The profits for any company that comes up with a reasonable drug for AD would be unimaginable. With all the hype in last week’s global conference on Alzheimer’s Disease, it remains unclear how Solanezumab will fare in subsequent clinical trials. Hot on the heels of the failed Bapineuzumab  trials, the Solanezumab trials carry the burden of possible failure and extra scrutiny.

Personal Thoughts, Not Only As A Practicing Psychiatrist, Teacher, But As A Care Giver: 

It was a distinct privilege to care for a beloved afflicted with Alzheimer’s (unfortunately, she died eight months ago). The opportunity to be exposed to deeper strata of love is unique and instructive. One learns patience, compassion, and care—feeling for—the victim with relentless constancy. There is nothing like experiential learning…However, personally, I believe that with the American ingenuity, and the vast resources of a mature capitalist society at our disposal, we will find a cure for Alzheimer’s.  Remember in 1981 when the first case of auto-immuno-deficiency syndrome  (AIDS) was diagnosed. In the 80s and 90s, tens of thousands died because of AIDS. Well, again this past week, at another scientific meeting re: AIDS, the speakers including our own Myron Cohen of UNC School of Medicine and Health, were talking about not only control of AIDS and minimizing mortality but curing AIDS. We are today with Alzheimer’s where we were with AIDS in the mid-1980s.

I am reminded of St Thomas Aquinas (1205-1275) view of science: “Believing is good. Knowing is better.” What a privilege to be alive today, especially in America, and enjoy the experience of explosion of knowledge.

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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 Medicine

Monday Musings”  for Monday July 17, 2017
Volume VII, No. 29/341

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Thinking Things Through: Health Related Issues

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

(Editor’s Note: we are sharing  a  few of our letters to mostly medical publications)  

I Journals of Consequence

For about the half of a centruy that I have dwelt in the holy house of science and medicine, I have been most intrigued, gratified, enchanted and awe stricken by three publications.  I read them faithfully, and keep them all over the house and in my office.  These publictaions print articles by future Nobel Prize winners.  You can bet on the next crop of Nobel Laureates in science, medicine, chemistry and physiology by carefully reading these journals.  No, they are NOT the New England Journal of Medicine, not Lancet, not JAMA, and none of the Archives or the Scandinavian Acta series…

Well, you are anxious to know their names.  They are ScienceNature and Cell.

More recently, a fourth journal has joined this elevated pantheon-like club.  It is the Journal of Stem Cells.  Articles such as “Generation of Insulin-producing Islet-like Clusters from Human Embryonic Stem Cells” bring the reader hope, awe and fascination. the authors report the use of  embryonic stem cells to form clusters like pancreatic islets that make insulin in measurable, if not abundant amounts.

Wow!  We are really getting there.  I would like to be alive in 2040 to see how medicine is practiced!

Assad Meymandi, MD, PhD, DLFAPA
Raleigh, N.C.

II Mental Exercises Counter Chemotherapy

I am writing with regard to the excellent article “Cognitive Damage May Appear After Treatment Ends” in the January 5 issue.

Being a survivor of colon cancer, stage III with 11 nodes, and having gone through the ritual of “cutting” (surgery), “burning” (radiation therapy), and “poisoning” (chemotherapy), I can attest to the danger of drastic decrease in cognitive functioning with standard cancer treatment. The chemotherapy agents “carpet bomb” all cells; they do not spare the very sensitive neurons. I wish research would accelerate on finding chemotherapeutic agents that target cancer cells only and not the rest of the body.

As a patient, it is imperative to be aware of this cognitive devastation and devise and implement measures to counter the poisoning of the brain and killing of brain cells. My strategy was to devote an hour or two each night before going to bed to memorize material of interest. I memorized many of Lorenzo Da Ponti’s rich repertoire of Latin poetry, Greek texts by Aristotle and Homer, and the epic poetry of Persian poets Ferdowsi and Rumi.

In my experience, memorizing is a very effective method of keeping neurons exercised and alive, and I felt I was successful inwarding off the ills and side effects of my treatment.

Assad Meymandi, M.D., PH.D., DLFAPA
Chapel Hill, N.C.

III Marketing Advice Article Desecrates The Proper Practice of Medicine
Regarding “Creating buzz: New approaches to Marketing”:

I disagree with the content, intent and suggested practice of “marketing” one’s practice reflected in your article. Medicine is not a commodity, it is not a business and it ought not to be regarded in mere secular terms. Medicine is a priesthood, and those of us privileged to enter its holy temple should take vows of service and altruism, above all. The idea of promoting business in medicine and having a business model of advertising one’s services is a desecration of what Sir William Osler taught.

In recent years, we have seen the lofty position of physicians eroded in American society. I believe if a physician is knowledgeable and skillful, and combines those earned attributes with compassion and a spirit of service, advertising is not needed. People will flock to your door without the slick and ethically challenged manners your article suggests.

Let us not desecrate the holy house of medicine with commercial and cheap schemes.

Assad Meymandi, MD, PhD, DLFAPA
Raleigh, N.C.

IV More On The Unwelcome And  Ugly Word of “Marketing” in Practice of Medicine

Dear Sir:

I am appalled by your article in the “Business” section of AM News.  Once again, with total disregard for the dignity of our profession of Medicine, the sanctity of its calling and priesthood of its mission, you have lowered the practice of medicine to the level of selling a commodity, dealing in a business, and reducing it to a common place “thing” that you pick up at a store on your way home…

Medicine has enough detractors and enemies that are dedicated to stripping it form the respect it deserves.  We do not need for AM News, a newspaper that is the official public face of American medicine, to further push us to the brink.

I believe we must do all we can to preserve and protect the dignity of our profession and discourage advertising.  It is an abomination and a literal prostitution of our profession when we join with a bunch of merchants who push their goods.  In practice of medicine, if we are knowledgeable and compassionate; if we follow the holy teachings of Sir William Osler and strive for excellence; patients will tear our door down and seek us out.  Soliciting, advertising and merchandising our skills and art are foolish and should not be tolerated by AMA, much less touted as you do in your Business articles in AM News.

Sincerely,
Assad Meymandi, MD, PhD, DLFAPA

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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 Pride, or Shame, of Heritage

Monday Musings” for July 10 2017
Volume VII. No. 28/340

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Sulgrave Manor, a Source of Pride or Shame

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

Around my house, we are purists. We celebrate and observe Lincoln’s birthday on February 12, and pay homage to the father of our country on his natal anniversary on February 22. Today’s “Monday Musings” was written on July 4, 1973 after a visit to Sulgrave Manor in Northampton, England, and has been reprinted every year since.

Sulgrave, a hamlet, population 58, houses one of the most significant pieces of American and British history, unbeknownst to many Americans and certainly British. Sulgrave Manor, the ancestral home of George Washington, the father of America, lies 14 miles southwest Northampton, a busy city of 120,000. No, you won’t find it in the Northampton city directory, nor does it appear on the county or “Shire” map. The Chamber of Commerce of Northampton politely said “We do not know, Sir” to my telephone inquiry as to the whereabouts of Sulgrave Manor. No place in London, including the eager to please Bureau of Tourism, acknowledged its existence. Like an in- house secret shrouded in mystery, it eluded my persuasive curiosity.

My host, Dr. Michael O’Brooke, a consultant psychiatrist at Saint Andrews Hospital in Northampton, almost changed the subject when I asked about Sulgrave. Somehow we ended up talking about the newly discovered oil off the Britain’s coast. Finally I pinpointed him, and demanded an answer. With his genuine English wit he snapped “Oh, yes, I will have my driver to take you there…” He made it clear in his elegant old Anglo-Saxon, non-verbal but piercing way, that he did not wish to discuss the matter any further.

I rode through the bustling streets of Northampton. It belied that it was July 4th. No picnic, no American flags and no Happy Birthday! Total oblivion of the importance of America’s birthday enveloped this industrial city which lies 70 miles southwest of London.

Finally we arrived at Sulgrave. It was a bright and sunny afternoon. A fairly short, thin gentleman whose bushy eyebrow literally covered his eyes, with graying full head of hair combed straight back giving ample space for a high forehead, looking like a character just stepped out of one of F. Scott Fitzgerald’s novels, greeted me with a simple but eloquent Churchillian deep voice: “Good afternoon! I am Mr. David Robbins, your guide.” We talked a bit. I felt like he was genuinely happy to see me breaking his loneliness, somehow reminding me of the British version of the Maytag repairman commercial.

The layout of Sulgrave Manor was elegant. Eight courtyards, a vegetable garden, and immaculately kept manicured yards and shrubs took me back 350 years. Foxglove of several colors graced all sidewalks. A British and an American flag were flying on the sides of the building. Mr. Robbins gave me a quizzical look upon finding that I might write up the Sulgrave experience for my fellow Americans. He briefly disappeared, soon to reappear with brilliantly printed brochure. He wanted to be sure that the facts were accurately reported…As Mr. Robbins and the brochure have it: the main part of the house was built of stone and he made sure I understood that it was the original structure, and not like the wooden colonial houses which were burnt and re-constructed—a mere replica—this house was built by Lawrence Washington in 1560. General George Washington was the 7th descendant of Lawrence Washington, who incidentally, was the mayor of Northampton in 1539 and again in 1545. Mr. Robbins took me around the building with utmost care, explaining that the perpetual Board of Trustees of the manor consists of the British Ambassador to US and the American Ambassador to England. The manor and the grounds belong to both countries. The cost of maintenance, conservation and purchase of pieces of land are bourn directly by both countries.

There was an air of ambivalence inundated by moments of awkwardness as Mr. Robbins’ basic loyalty to his own country and crown saw George Washington as a rebellious rash soldier with poor manners who committed an act of treason by fathering America, along with the pride that he finally acknowledged for the American experience, offered twinges of cultural/patriotic schizophrenia. Here I stood, on a 4th of July, my country’s birthday, proud to be an American and concerned about my host’s mixed feelings. I empathically told him that if I were in his place I, too, would be most uncomfortable. There was a sudden glitter in Mr. Robbins’s eyes. After so many years of working there, he had found a person who looked at and talked with him as a person with feelings. He looked me in the eyes and invited me to the afternoon tea. As we were sipping the tea he asked me about my work. “Psychiatrist” I said. “Oh Lord, I should have known not to ask…” he said in reply.

I saw not only the most proudly and secretly kept historical monument in England, but also had made a good friend in Mr. Robbins, the official host/guide of Sulgrave Manor.

Mr. Robbins and I kept in touch. He was scheduled to come to US for a visit but died of a sudden heart attack in the mid-eighties. He was 80 years old.

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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 serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

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On July 4

“Monday Musings” for Monday July 3, 2017
Volume VII. No. 27/339

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Happy July 4th! Natal Anniversary of America and Mortal Anniversary of John Adams Thomas Jefferson -What Kind of Music Uncle T.J. Liked?

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

Happy 241th birthday to our beloved nation. We thought it is fitting to honor the US flag by flying it in today’s “Monday Musings”. On July 4, 1826, on the 50th golden anniversary of signing of the Declaration of Independence, John Adams died. Historians put his death at around 9:00 AM.  Adams and Thomas Jefferson, political arch enemies for decades, had reconciled and become good friends and pen pals in the last two decades of their lives. They exchanged more than 300 letters before that fateful day, July 4 1826. According to reliable history, Adams’ last words were “Thomas Jefferson still survives…” not knowing that Thomas Jefferson too had died that morning at age of 83.

Tuesday July 4, 1826 was a very hot day. The sun seemed to have a notion of what was happening, since it hurriedly rose and climbed to the top of the sky in mid-morning. No wonder, two US Presidents, both belonging to the super exclusive club of the “Founding Fathers of America”, both signatories to the Declaration of Independence, and one the actual author of that sacred document, died that morning on the same day.

Faithful readers of this space recall that we have examined the books the founding fathers read.  In this essay and subsequent ones we will examine the music they loved and played.  We will start with Thomas Jefferson. In a way, we celebrate July 4 by getting to know the musical taste of staggeringly curious and intellectually superior polymath of all time, Thomas Jefferson, the third President of our beloved nation.

Thomas Jefferson was an accomplished violinist. He even bought a pocket fiddle that accompanied him wherever he went. He was an active member of chamber music that played for the royal governor of Virginia. Jefferson loved and admired Corelli, Haydn, Gluck, Handle, Vivaldi, Pergolesi, Boccherini, Johann Stamitz, Clementi, and J. C. Bah (J. S. Bach’s youngest son).  The 6500 volumes that Jefferson sold to the government which formed the nucleus of the Library of Congress, in addition to work of the above composers, contained sheet music by lesser known composers such as Padre Martini, Gaetano Pugnani, Ignaz Pleyel and Italianized German composer, Giovanni Adolfo Hass.  Thomas Jefferson fell in love with a patrician beauty, a rich young widow, Martha Wayles Skelton whose favors he won in a competitive race with two other suitors by playing his violin when he courted her. Jefferson continued to practice daily and play his violin which Martha thoroughly enjoyed.  He wanted to commission a piece to honor his beloved wife after her death. He was aware that Mr. Goldberg paid JS Bach to compose the Goldberg Variation. He even had a brief meeting with Mozart to discuss the matter, but somehow the commissioning never materialized. Jefferson’s not being fond of Mozart, because of Mozart’s “conduct” may have had something to do with the project not materializing. However, Jefferson recognized Mozart’s genius and loved his music.

Also, Jefferson liked Handle’s Messiah, Hayden’s solo cantatas, John Gay’s “the Beggar’s Opera” and many American folk songs and music of emerging American composers such as his fellow Declaration signer, Francis Hopkinson. In the writings of Jefferson’s grand daughter, Ellen Coolidge, who lived in Monticello, there are many references to Jefferson’s love for music.  As the former president became older, he wrote more about music and spent more time collecting, humming and playing his various favorite composers.

Happy 4th to All. There is no place on earth like America, where the beacon of freedom continues to shine, where the flame of liberty continues to illuminate the landscape of humanity, where the rule of law and not the whim of Shahs, Mullahs and dictators is supreme. God Bless America.

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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; Life Member, American Medical Association; Life Member, Southern Medical Association; and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is a Raleigh, North Carolina writer and dramaturge.

 

 

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On Continuation of Brain Series

Monday Musings” for Monday June 26, 2017
Volume VII, No. 26/338

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Brain and Behavior, Part IV

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

(Editor’s Note: This is part IV of a four part series on Brain and Behaviour. In Part I, the general topography and physiology of the brain was discussed. In parts II and III, Memory and Post Traumatic Stress Disorder were explored. Today, Part IV, we are exploring the emergence of ‘Age of Mind’ by presenting the review of a book by Nobel Laureate American psychiatrist and Nobel Laureate Dr. Eric Kandel. Next week, in Part V, we will examine the issue of the holy marriage between psychoanalysis and neurosciences.)

IN SEARCH OF MEMORY

THE EMERGENCE OF A NEW SCIENCE OF MIND

By Eric R. Kandel, Psychiatrist
2000 Nobel Laureate for Physiology or Medicine
429 pages of text. 23 pages of glossary. 31 pages of notes and sources. 26 pages of index. Total: 510 pages.
W. Norton & Company, NY. London

Since Benjamin Rush, a framer of the US Constitution, and father of American psychiatry, there have been two psychiatrists who have won the Nobel Prize. The first winner was Julius Wagner-Jauregg, Psychiatrist (b. Wels 1857, d. Vienna 1940). He invented “Malaria-therapy” for the treatment of progressive paralysis, especially tertiary syphilis. He was awarded the Nobel Prize for Medicine in 1927. It took seventy three years before psychiatry had a second Nobel Prize winner. He is Eric R. Kandel, a University Professor at Columbia.

Dr. Kandel received his psychiatric training and training in psychoanalysis at Massachusetts General Hospital and McLean Hospital. Before entering medical school, he was interested in literature, the arts and humanities. He also found himself intrigued by the work of Freud and the relationship between neurology, biology, id, ego and superego, all components of Freudian theory of psychoanalysis. However, realizing that he needed to be a medical doctor to pursue his psychiatric ambitions he entered NY University Medical School where he received his MD. As a medical student and clinician, he became more interested in biology, physiology and cell, especially nerve cell (neuron), communication. Pun excused, he became more interested in “neuronics” rather than “neurotics.” His fifty years of work produced many books and seminal articles published in Journal of Nature and Science, reflecting his groundbreaking work on the cellular and molecular process of memory. This work ultimately earned him the Nobel Prize in Medicine or Physiology in 2000.

Reading this book is a sheer joy. Parts of it are heady and heavy neuroscience and neurobiology. But it is a page turner. Also, it is a kind of a book one wishes to re-read. The volume is autobiographical, weaving personal life experiences from childhood through student and professional life into a rich tapestry of words, syntax, and composition in an exquisitely readable and entertaining style. Dr. Kandel’s writing style is reminiscent of the writings of Freud. As I read and re-read parts of this enormously appealing book, through synesthesia, I kept hearing the complex and rich bouquets of baroque music of Bach and Telemann alternating with melodic symphonies of Haydn, Sibelius and the triumphant Mozart’s Jupiter Symphony in C major. While reading his words, I also saw a rich display of paintings of the masters, Michelangelo, Leonardo de Vinci and the smooth amorphous impressionist masters, like the work of Monet and Pissarro. It also reminded me of a recent symphony I heard conducted by Lorin Maazel. It has that characteristic Maazelian blend of incandescent colorings, unerring execution and cool brilliance.

The book starts when the author was nine, and a student at a neighborhood school in Vienna. Being Jewish, his parents, his brother, Ludwig (later Lewis), and he were expelled from his country by the Nazis. They came to America where Eric received a superb education in New York. In Vienna, his father had owned a small toy store. His mother was a stay at home Mom. At age 9, he recalls getting a shiny new battery operated toy car with a remote control from his father, which he brought to the United States. It is like “rosebud” and Hurst in the movie Citizen Kane. This illustrates the author’s understanding of object relation which is so important in psychiatry.

The science part of the book starts with Dr. Kandel’s introduction to the leading US biologist, University of Columbia’s Dr. Grundfest (Kandel later became Director of that laboratory). At that time Dr. Kandel developed techniques to micro puncture almost every cell of hippocampus, the seat of memory, as he put it “one neuron at a time.” He recorded the action potential of the cells and studied how the cells communicate with one another–how the messages (conversations) are transmitted from hippocampus to amygdala and other parts of the limbic system (thalamus, hypothalamus, mammary bodies, para-median gray and fornix). He identified the role of chemicals, the proteins and the cyclic AMP (cyclic adenosine-3’,5’- monophosphate) discovered earlier by another Nobel Prize winner, pediatrician Dr. Earl Sutherland of Vanderbilt, in cell transport.

The book is an elegant exposition of ethology, the study of animal behavior in its natural environment. It is also an in depth probe in molecular biology, the chemicals, proteins, neurotransmitters of memory, and the process of storage and recall of knowledge. It explains how the ionotropic receptors, the proteins that span the cell surface membrane and contain transmitter-binding sites and channels through which ions can pass and send messages to the next neuron.

This highly readable and delightful book also carries a compendium of people of note who have contributed to neurobiology and understanding of the central nervous system and how commands are generated by the cranial nerves and carried out by the peripheral network of neurons. The impressive pantheon starts with the work of Santiago Ramon Y Cajal, and Camillo Golgi to whom all of us were quickly exposed to in our first year of medical school. It continues to develop a rich anthology of all the names and a brief description of their contributions. Of course, the list starts with Aristotle. Here is an example of the author’s skillful writing bringing the ancient and the new together:

“Aristotle, and subsequently the British empiricist philosophers and many other thinkers, had proposed that learning and memory are somehow the result of mind’s ability to associate and form some lasting mental connection between two ideas and stimuli. With the discovery of NMDA (N-Methyl-D-Aspartate) receptor and long-term potentiation, neuroscientists had unearthed a molecular and cellular process that could well carry out this associative process.”

With clarity and eloquence, Dr. Kandel explains various forms of memory, such as habituation, sensitization, classical conditioning, short and long term, somatic, procedural, and verbal memory and the biological basis of individuality. He makes the reader feel a participant in the conversation between nerve cells.

We expect our educators from Kindergartens to Universities to teach their students the essentials in critical thinking. This is the ultimate goal of education. It is exciting to learn the molecular biology of critical thinking and memory. As one who has been doing book reviews for over 50 years, I have become accustomed to examine the down side of books reviewed. It is astounding that I can say nothing negative about this most impressive and seminal work. I recommend the book to all ages, even grammar school children. I plan to read parts of it to my grandchildren.

Finally, I believe people like Eric Kandel are saints. Eric is my kind of a saint. The kind of a saint who KNOWS, yet lets his knowledge get marinated in the elixir of spirit, faith and transcendence, giving it the lofty status of being in the presence of God and better yet, dining with God on an infinitely rich intellectual diet. And yes, Eric is a Jew, who escaped from the Nazi’s grip and emigrated to America, where he received the opportunity to learn, to study, to create knowledge and to earn a Nobel Prize. Like many of us who are Americans by choice and not by birth, Eric appreciates America’s rule of law, freedom of speech, worship and pursuit of one’s passions. Yes immigrants are blessed by America, and America is blessed for having so many living saints, like Nobel Laureate Eric R. Kandel, a psychiatrist for all ages.

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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 Memory

Monday Musings” for Monday June 19, 2017
Volume VII. No. 25/337

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Post-traumatic Stress Disorder (PTSD)

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

(Editor’s Note: Last week we interrupted the “MM” science series on Memory and Post Traumatic stress Disorder to observe Father’s day.  We resume the series toady, Part II concentrating on the topic of PTSD.

Science Series. Part  II:  Memory and PTSD

In her memoirs, Jacqueline Kennedy Onassis wrote of her flashbacks of the November 22, 1963 assassination of her late husband. She was suffering from PTSD. The official description of PTSD, or Post-traumatic Stress Disorder, published by Veterans Affair is “a psychiatric disorder that can occur following the experience or witnessing of a life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood.”  Most survivors of trauma return to normal given a little time. However, some people will have stress reactions that do not go away on their own, or may even get worse over time. These individuals may develop PTSD. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person’s daily life.

People with PTSD experience three different kinds of symptoms. The first set of symptoms involves reliving the trauma in some way such as becoming upset when confronted with a traumatic reminder or thinking about the trauma when you are trying to do something else. The second set of symptoms involves either staying away from places or people that remind you of the trauma, isolating from other people, or feeling numb. The third set of symptoms includes things such as feeling on guard, irritable, or startling “easily.”

It is estimated that 8 percent of Americans will experience PTSD at some point in their lives, with women twice as likely as men to develop PTSD. About 3.6 percent of U.S. adults aged 18 to 54 (5.2 million people) have PTSD during the course of a given year. This represents a small portion of those who have experienced at least one traumatic event. The traumatic events most often associated with PTSD for men are rape, combat exposure, childhood neglect, and childhood physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.

What does science have to offer?

In my daily reading diet I value several publications which include ScienceNatureNew England Journal of Medicine (NEJM) and Lancet.  Lately, I have been impressed by another journal PLOS ONE, a peer-reviewed open access scientific journal published by the Public Library of Science (PLOS). It is a publication that translates experimental laboratory data into clinical practice. It is one thing to accomplish or make discoveries in the laboratory with animals. But it may take years and years before the results are applied in clinical practice to humans. In that sense PLOS is unique. It is a truly translational journal. Its purpose is to speed up the process of applying laboratory discoveries into bedside patient care and clinical practice.

Published studies by Marc J. Kaufman, PhD, Director of the McLean Hospital Translational Imaging Laboratory and colleague Edward G. Meloni, PhD, are of seminal value and promise to have lasting benefit. In these studies, the scientists discovered that rat exposure to Xenon, a noble (inert) gas blocks traumatic memories. It becomes very useful to block bad memories in individuals suffering from PTSD. The chemistry is fancy but simple. Memories are stored and transmitted in specific parts of the brain called amygdala, hippocampus and frontal cortex. They are transported by many neurotransmitters in the brain from the memory centers to other parts of the brain. The most prevalent neurotransmitter charged with transporting memory is N-Methyl-D-Aspartate (NMDA). Just a word about what is a neurotransmitter– a neurotransmitter is like a bus or a car that carries instead of passengers, messages from one nerve cell (neuron) to other parts of the brain. The key to interfering with transmission of memory is to interrupt the neuronic flow mediated by NMDA. In essence, take a chemical scalpel and cut off or tie off the flow of NMDA. Well, the Boston scientists have hit the pay dirt. They discovered Xenon is the chemical that accomplishes the task and chemically interrupt or cut off NMDA transmission in rats. Here is an abstract of the publication.

Xenon (Xe) is a noble (inert) gas. These gases belong in group O of the periodic chart.  The group includes radon, helium, neon, argon, and krypton. Xenon gas has been developed for use in people as an inhalational anesthetic and in diagnostic imaging procedures. Xenon inhibits receptors involved in learning and memory and affect those parts of the brain, namely amygdala and hippocampus, responsible for memory formation and information storage. When Xenon is administered after memory of a trauma is formed (they call it fear memory), the memory disappears after the Xenon is administered. Male rats were used to develop this elegant animal model of PTSD they call fear-conditioning. The rats were trained to be afraid of environmental clues that were paired with brief foot shock. The researcher found that a single exposure to the Xenon gas blocked memory formation in the brain, dramatically and persistently reducing fear responses up to two weeks. The researchers are planning to apply the work to humans. The research holds much promise for those millions suffering from PTSD.

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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 Father’s Day

“Monday Musings” for Monday June 12, 2017
Volume VII. No. 24/336

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Hagar and Ishmael Banished by Abraham, Pieter Jozef Verhagen,(1781)

 

 Father’s Day

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

We interrupt our series on Neuroscience, Memory and Post Traumatic Stress Disorder (PTSD) to observe Father’s Day which is coming on Sunday, June 18, 2017. We will resume the neuroscience series next week.  Now a few reflections on Father’sDay:

Brief History

Arkansas has not only given us the Clintons and the perennial presidential contender, the Reverend/Governor/evangelist/guitar picking/author Mike Huckabee, but it has given us also Sonora Smart Dodd who literally created Father’s Day back in 1910. She celebrated the first Father’s Day in Spokane, Washington to honor her father, the Civil War veteran William Jackson Smart, a single parent who raised his six children single-handedly in Arkansas. Sonora was moved to recognize her father’s contribution by proposing a day to honor all fathers. However, it was not until 1972, 58 years after President Woodrow Wilson made Mother’s Day official, that the Father’s Day became a nationwide holiday in the United States.

Father vs. Dad

It is so easy to be a father. All it takes is a willing partner and nine months later a child is produced. But it takes a whole lot of preparation and commitment to be a dad. One of the main reasons we have more per capita prison/jail inmates than anywhere else in the industrial nations is this very simple notion: plenty of fathers who bring children to the world have no preparation or commitment to be or become a dad. Recent statistics point to the fact that the rate of imprisonment in the United States more than quadrupled during the last four decades. The U.S. penal population of 2.2 million adults is by far the largest in the world. Just under one-quarter of the world’s prisoners are held in American prisons. The U.S. rate of incarceration, with nearly 1 out of every 100 adults in prison or jail, is five to 10 times higher than the rates in countries of Western Europe and other democracies. The reason is simply too many men, like sex machines, reproduce and abandon. Most prisoners grew up without love, care and devotion of a dad. And our government seems to reward this delinquent behavior by giving incentive in expanding the welfare state. It is an abomination that so many single mothers of four or five, and so many children who have never met or known their fathers…

Dads love, care, provide, and offer moral leadership to, and role models for their children. Dads are selfless, giving and loving. Dads offer security, permanence, and they are there for their children forever. To be a dad is the most responsible job on earth. No, I am not suggesting to cut resources of, and services to, the children. On the contrary, we need to pump in love and all resources necessary to make sure the children who are already here have what it takes to become responsible citizens. I am saying that family planning should be emphasized and through education and information, sex machines dismantled. If we could spend the corrections budget on education, eventually we will decrease the prison population drastically.

Historically, the roots of the Arab Israeli conflict go back to the days of Abram (before he became Abraham–Genesis 17) of Ur. The two biographers of Abraham, Zakaria-ye- Massuyeh, and Honein Ibn Ishagh ably trace the origin of the Arab-Israeli conflict to Abraham and his two sons, Ishmael and Isaac. The two brothers were fighting as most children do. Ishmael gathered his friends in one camp which became the origin of Arabs, and Isaac doing the same, naming his camp and entourage/followers the Israelis. Two brothers and their progenies, blood related cousins, have been killing one another for more than three thousand years…I guess one might say that Abraham was a faithful and superb prophet, fathering Judaism, Christianity and Islam, but did not know how to be a daddy to his own sons.

Personal Memories

 Speaking of children fighting, I remember as a small boy being the youngest in the family. I used to argue and fight all the time with my sister next in age to me. We used to go to my father with our stories as to how we were victimized, expecting father to intervene on our individual behalf. My father would sit patiently and dispassionately listen to us carefully one at a time. My sister and I would anxiously await a judgment and a disposition. My father would hold both of us in his arms and say something like “I see you two have a disagreement, and I have faith in both your abilities to resolve the disagreement by understanding and talking and not fighting…” He would kiss us and let us go. My father was an esthete. He was a poet and a calligrapher. He flooded our home with books, and books and books… We had music, poetry, and flowers…Next to God, love and family, education was most revered by our father.

What to Do?

What do we need to do to correct what Abraham failed to do? How do we bring peace and reconciliation to Jews and Muslims? All major religions and their Holy Books including Bhagavad Gita of Hindus, Avesta of Zoroastrians, Torah of Moses, Quran of Islam and Bible of Christians recommend forgiveness and conciliation. As one exposed to all these Holy writings, I am most impressed by Christian love and the Pauline theology of hope, possibilities, forgiveness, and redemption. It is the unique attribute of Christian teaching to transform one’s enemy through the act of love and turning the other cheek. What a magnanimous feat of humanity and Godliness. I am for establishing dialogue, learning the enemy’s language, pressing flesh and showing acts of love and mercy.

Happy Father’s Day to all.

The Meymandi touring Exhibition Gallery, North Carolina Museum of Art, is named for my late father, Farajollah Meymandi.

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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 Memory

Monday Musings for Monday June 5, 2017
Volume VII.  No. 23/335

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The Science Series: Memory

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

Part I The nature of Memory

The print and broadcast media have made the diagnosis of post traumatic disorder (PTSD) ubiquitous. 15 years of war in Afghanistan, wars in Iraq and Syria have produced veterans who indeed suffer form PTSD and brain trauma. We will devote the next three “MM”s to the understanding of memory and recent advances in understanding and treatment of PTSD.

The Faithful readers of this space recall our review of the book “Searching for memory” by Daniel Schacter, a University of North Carolina at Chapel Hill (UNC) alumnus and professor of psychology at Harvard.  In that book with an outline of different types of memory Schacter devoted a broad section to persistent memory which is the hallmark of post-traumatic stress disorder. Recurring unpleasant memories. In this piece, after describing and discussing the phenomenology and architectonics of memory and its types, I will focus on post-traumatic stress disorder,

Schacter’s research explores the relation between conscious and unconscious forms of memory, the nature of memory distortions, how individuals use memory to imagine possible future events, enhancement of online learning, as well as the effects of aging on memory. In general, there are four large categories of memory which are always included in psychiatric evaluation and standard mental status examination. They are:

1)    Episodic memory: dealing with the patient’s ability to recount biographic data such as dates, places of significant events of life, marriage, birth of children, service in the Armed Forces, travels and jobs

2)    Somatic memory: which has to do with the functions of various parts of the brain, and the reaction of those brain structures to the cascade of neuronal hormones sweeping over them. Somatic memory is often affected by anxiety and depression

3)    Procedural memory: how well the patient can repeat a series of numbers or objects forward and backward immediately or after a given time lapse. Also, how well the patient may recall a seven part story.

4)    Verbal fluency memory: such as testing the a patient’s ability to generate words starting with a given letter such as “O”. The number of words generated in a given time, let’s say one minute and the quality of the words generated reveal much about the patient’s memory and general fund of knowledge and vocabulary. For example, if a patient is asked to generate in one minute words starting with the letter ”o”  and he goes like a machine giving words in alphabetic order, “octave, octennial, octet, octillion, octillionth, October, octodecimo, octogenarian, octomerous, octoary, octoploid, octopod, octopus, octoroon, etc…” you know that he excels in verbal fluency memory and is of superior intellect.

Schacter characterizes memory in a different way.  He calls these the seven sins of memory The Seven Sins of Memory: How the Mind Forgets .

  • 1)  Transience–the decreasing accessibility of memory. Schacter cited as a somewhat facetious example former President Bill Clinton’s “convenient lapses of memory” during the Monica Lewinsky investigation. Clinton claimed in the hearings that he sometimes couldn’t remember what had happened the previous week.
  • 2)  Absent-mindedness–lapses of attention and forgetting to do things. Examples, said Schacter, are forgetting where you put your keys or glasses. He noted a particularly famous instance in which cellist Yo-Yo Ma forgot to retrieve his $2.5 million cello from the trunk of a New York City cab.
  • 3)  Blocking–temporary inaccessibility of stored information, such as tip-of-the-tongue syndrome. Schacter recounted the embarrassment of John Prescott, British deputy prime minister, when a reporter asked him how the government was paying for the expensive Millennium Dome. Prescott struggled to find the word “lottery,” trying “raffles” instead.
  • 4)  Suggestibility–incorporation of misinformation into memory due to leading questions, deception and other causes.
  • 5)  Bias— For example, research indicates that people currently displeased with a romantic relationship tend to have a disproportionately negative take on past states of the relationship.
  • 6)  Persistence–unwanted recollections that people can’t forget, such as the unrelenting, intrusive memories of post-traumatic stress disorder. They become a tragic prisoner of memory,” and eventually committed suicide.
  • 7)  Misattribution–attribution of memories to incorrect sources or believing that you have seen or heard something you haven’t.

Next week, Part II, we will discuss post-traumatic stress disorder which has to do with sustained unwanted, obsessive intrusive memory.

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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 Memorial Day

“Monday Musings” for Monday May 29, 2017
Volume V. No. 22/334

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Memorial Day, Pericles, Abraham Lincoln, Gettysburg Address

 

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

Today is Memorial Day. Some reflections:

In so many great books and in so many great bodies of literature, we are told that “to die for one’s own country is the noblest deed.” The conceptual architectonics of this notion goes back to 5th century BC Athens and to mid-nineteen century AD America. The architects are two superb statesmen, Pericles of Athens and Abraham Lincoln of America separated by almost 2500 years. The occasion was the funeral oration by Pericles for the war dead in Athens 404 BC, and the funeral oration by Abraham Lincoln at Gettysburg in 1865 AD for the America’s civil war dead.B oth speeches proclaim that democracy is worth sacrificing lives and spending the nation’s financial and material resources. In their speeches, Pericles and Lincoln forcefully and eloquently submit that “to die for the cause of democracy and national unity is the noblest act.”

Pericles and Lincoln, these two incomparable souls had qualities that set them apart as statesmen. They were not merely politicians. They both had bedrock principles and solid foundation of beliefs that did not change with public polls and political expedience. They both had a moral compass and had a sense of absolute right and wrong. They each had a vision for their nation as a model for the world and humankind, and they had the ability to build consensus. Pericles and Lincoln both led their respective nations, Greece and America, into civil wars. Pericles led his nation to war between Sparta and Athens (431 to 404 BC), and Lincoln led America to our Civil War (1861 to 1865). The Athenians and Spartans spoke the same language and worshipped the same gods. So did the Confederate soldiers and their brethren to the north. They spoke English (or according to H. L. Menken they all spoke ‘American’) and worshipped the same God. As an aside: you will enjoy reading H.L. Menken’s “American Language” which gives a deep analysis contrasting British English with American English.

The Origin of Memorial Day

The journey starts with Pericles and his funeral oration of 404 BC. Later Publius Vergilius Maro (70 BC to 19 BC to ), usually called Virgil or Vergil in English, the celebrated Roman poet in his famous epic poem in Latin, Aeneid, translated the words of Pericles from Greek to Latin. Lincoln, an intellectual and scholar, had read Aeneid as much as he had read the Bible. Aeneid is a poem about war. It spells out the conduct and the protocol of man at war. Virgil came to the conclusion that men who gave their lives to their country should be memorialized. Virgil popularized Pericles’ of views some 400 years earlier, laying down the roots of what we today know as Memorial Day.

Lincoln used Virgil’s concept of memorializing the dead soldiers. He also emulated Pericles who with unparalleled eloquence and clarity concluded that “to die for one’s nation is the noblest deed”. Almost 2500 years after Pericles, Abraham Lincoln, on November 19, 1863 in his funeral oration in 272 words Gettysburg Address told the nation why the war, where he was going with the war, and what the outcome of the war would be. He clearly articulated why 620,000 soldiers have given their lives. He told the nation that the ultimate goal was to ensure the unity of the nation and guarantee freedom for all Americans.

The Gettysburg Address, Lincoln’s marvelous use of words loaded with religious and Biblical symbolisms such as “fourscore, dedicate, consecrate, hallow, and sacred ground” invoked the spiritual dimensions of his persuasive message. And Lincoln did not have a team of speech writers and spin artist pollsters on his staff… In contrast, it is unclear to us why the ill-defined Iraq and Afghanistan wars now going on 14 years, at a cost of thousands of lives, and the expenditure of hundreds of billions dollars, continue. America is still waiting for an explanation of why we are there. Would not it be nice if we had a living Lincoln who could use 272 words to give us this reason?

Memorial Day as we know it today, originally called Decoration Day, is a day of remembrance for those who have died in service of the United States of America. Memorial Day was born out of the Civil War and a desire to honor our dead. It was officially proclaimed on May 5, 1868 by General John Logan, national commander of the Grand Army of the Republic, in his General Order No. 11. “The 30th of May, 1868, is designated for the purpose of strewing with flowers, or otherwise decorating the graves of comrades who died in defense of their country during the late rebellion, and whose bodies now lie in almost every city, village and hamlet churchyard in the land,” he proclaimed. Memorial Day is now observed in almost every state on the last Monday in May with Congressional passage of the National Holiday Act of 1971. This helped ensure a three day weekend for this Federal holiday, though several southern states have an additional separate day for honoring the Confederate war dead.

Salute to the veterans for the noble act of sacrificing for America and condolences to their families of the deceased.

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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 Wagner, and Opera

“Monday Musings” for Monday May 22, 2017
Volume V, No. 21/332

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Bayreuth Margravial Opera Stage

Happy Birthday to Richard Wagner: A Few Thoughts about Opera

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

Today is Richard Wagner’s 204th birthday (May 22, 1813- February 13, 1883). We celebrate his natal anniversary with joy and some added reflections: Wagner was a German musician, opera composer, and a disciple of the German philosopher Arthur Schopenhauer, (Feb 22, 1788- September 12, 1860) with whom he split over the issue of “toleration”. Wagner was truly a genius. But he hated the Jews and the Italians, all of whom he called barbarians. He also hated the word opera because it is an Italian word and he thought Italians are of a lower race. Instead, he called his work “Music Drama“. Wagner was a contemporary of Verdi (October 10, 1813-Jan 27, 1901), the world famous and renowned Italian Opera Composer. Toward the end of his life, Wagner had a change of heart about Italians and had some good things to say about Verdi. But he remained a staunch anti-Semite.

Richard Wagner, the ruthless, racist and megalomaniacal genius not only composed his own opera but wrote the libretto (pleural, libretti), designed the stage, and conducted the work. His compositions are not just opera but an all encompassing Gesamtkunstwerk, like the Super Bowl halftime show! In addition to writing the libretto, composing the music, and designing his sets, he was a brilliant prose writer. I recommend getting a hold of some 12 volumes of his original work and read them for the sheer power of their syntax and thematic composition.

He also architecturally created the Bayreuth Opera House where his work was produced and staged.  After 204 years, almost all of his operas including the Flying Dutchman, Ride of Valkyries, Tannhauser, and Die Meistersinger Von Numberg are a steady diet of most opera houses and symphonies throughout the world. From time to time, North Carolina Symphony plays Wagner.  The colossal  program of Wagner and Russian music which featured in the first half, Prelude to Act I, Lohengrinn and the second half the memorable performance of virtuoso violinist, Itzhach Perlman playing Violin Concerto in D Major, Opus 35, by Peter Ilyich Tchaikovsky remain vivid in memories.  As an aside, the world renown violinist, Joshua Bell, played Jean Sibelius’ Concerto in D minor for Violin and Orchestra, Opus 27, with North Carolina Symphony to a standing room only crowd in Raleigh’s Meymandi Concert Hall. And there will be other special programs of Wagner’s music in the future.  Raleigh has an extraordinarily rich cultural life.

Wagner’s writings and Teutonic operas tell us that he had a deep knowledge of history. His operas, especially Tristan and Isolde, and the “Ring Cycle” consisting of four operas, 18 hours, are full of Zoroastrian parables, Buddhist reference to “nothingness” before becoming “something” and the writings of Rumi, Shams Tabrizi, and Baba Taher Oryan. He loved Aryan Persians as much as he hated the Jews. He spoke of the Jews as inferior creatures preoccupied with usury, money changing, and nothing else. He made fun of Jewish cantorial music and ridiculed the religious tradition of the Jewish synagogue.

Delving into his personal life, one discovers that he was an illegitimate child of a Jew, Ludwig Geyer. He was born in the Jewish quarter of Leipzig, the ninth child of Carl Friedrich Wagner who died six months after Richard’s birth, following which Wagner’s mother began living with the actor and playwright Ludwig Geyer with whom she had a longstanding relationship. Ludwig was a friend of Richard’s late father. Richard almost certainly suspected that Geyer was his natural father. He and Ludwig whom he publicly called “Dad” shared a love of theater, opera and language. Around age 14, however, Richard changed his name from Richard Geyer back to Richard Wagner.

In his early life, Wagner was heavily influenced by Shakespeare and Goethe. He was determined to set the writings of these two illustrious authors into music. In 1826, at age 13, he started to take music lessons. By 1827, the family had moved back to Leipzig. Wagner’s first lessons in harmony were taken in 1828-1831. In January 1828 he first heard Beethoven’s 7th Symphony and then, in March, Beethoven’s 9th Symphony performed in the Gewandhaus. Beethoven became his inspiration, and Wagner wrote a piano transcription of the 9th Symphony. Regarding his obscure genealogy, He often kiddingly said “May be Beethoven is my dad!”… Wagner was also greatly impressed by a performance of Mozart’s Requiem. From this period we have Wagner’s early piano sonatas and his first attempts at orchestral overtures. In 1829 he saw the dramatic soprano Wilhelmine Schröder-Devrient on stage, and she became his ideal of the fusion of drama and music in opera. In his autobiography, Wagner wrote, “If I look back on my life as a whole, I can find no event that produced and left so profound an impression upon me.” He had an unsuccessful marriage to his second wife, Cosima, and had disastrous relationships with other women including Minna Wagner.

In Wagner lies an enigma. He was a truly brilliant artist with gifts in music composition, writing, poetry, and deep knowledge of history who was pathologically intolerant of others, especially Jews. Yet he was the son of a Jew and had Jewish DNA. His profound anti-Semitic rant has given to millions of words of psychobabble attempting to explain that his hatred of Jews was deeply rooted in self-hatred. As a person, he had no shred of decency and no touch of sublime humanity. He broke up with his idol and mentor, philosopher Schopenhauer, because of Wagner’s extreme hatred of Jews. Schopenhauer could not take Wagner’s extreme intolerance of the Jews. Personally, I take and enjoy Wagner’s rich and lasting contributions to the arts and literature, and merely ignore the rest of him.

On the local scene in Raleigh, the transfer of Dix property to the city of Raleigh was accomplished on May 5, 2015,   I am looking forward to the day we will have an opera house built in Dix Park, NC’s answer to the NY’s Central Park. With such a venue, we can not only do the more lavish and demanding Wagner operas, but stage some modern operas the list of which is approaching 90. I have noticed and admired the Met’s willingness to add some of the modern operas such as Cyrano de Bergerac with Placido Domingo as Cyrano, Sondra Radvanovsky (Roxanne), and librettist Henry Cain. I have yet to see any opera in America by Michael Tippett, Hans Verner Henze and Olivier Messiaen (I saw his Saint Francois D’Assie in Paris several years ago), and other composers.

Meantime, Happy 204th Birthday to Richard Wagner!

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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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