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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Monday Musings for November 5, 2018
Volume VIII, No. 45/409

Ballot in voting machine

Moral Imperative of Casting Our Vote

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

Tomorrow, November 6, 2018, is election day. The occasion gives me the opportunity to reiterate what is good about America and what is right with our lives and why we should take the matter of voting seriously. We should get up in the morning and purposefully and diligently go to our district polls and cast our votes. It is not only a civic obligation and personal responsibility. Voting is a moral responsibility. Here are some reflections:

This election cycle has been most unusual. It is midterm election with no one on top of the ticket.  Billions of dollars are spent nationally to tear down opponents and avoid addressing issues, policies and priorities. Elections are taking the flavor of mini civil wars. Nonetheless, I submit that America is the best thing that ever happened in this world and to this world. While I do not have Lincoln’s eloquence at Gettysburg, I do take inspiration from his every word to make the point that to preserve the integrity of our nation and continuity of Republic we MUST vote. Not four score and seven years ago, but about ten thousand years ago, the age of Neolithic man, God set out to send humans on the road to perfection. He sent the ancient Persian prophet, Zaratustra (Zoroaster), as early as 500 BC, to bring us the concept of good and evil which in modern day philosophy is known as epistemological dualism. The Sumerians brought us literacy and language. Lydians of Asia Minor (Turkey) gave us writing, Egyptians taught us social order and government; the Persians, participatory democracy; the Greeks city-state and citizen representation; the Babylonians gave us devotion and discipline; and Jesus came bringing us civility, hope and love. 1215 years later, the Anglo-Saxons brought us the Magna Carta. And in 1756 we were given Mozart, through whom music flowed like water running through the fountains of Tivoli.

But it was not until 1776 that God commissioned, in a divine and mysterious manner, a group of faithful thinkers to lay the cornerstone of a new experiment that in a short span of time has become the envy of the world. The experiment is the Republic they created. It is our United States of America. I am convinced that God had a definite hand guiding the framers of our constitution, the US Constitution, in creating this profoundly decent and just document. The American Constitution, as a literary piece, combines Augustinian grace, Franciscan tenacity, Christian hope and possibility, Talmudic order and Zoroastrian aspiration for good deed and perfection. It is a talismanic masterpiece with magical powers. We have seen Sultans, kings, Shahs and potentates come and go. But governing by the rule of law, the unique legacy of the American Constitution and the nobility of Bill of Rights are here to stay.

We should all be proud to be Americans. As individual citizens all of us occupy the lofty position as guarantors of this sacred legacy, the legacy that in America, laws and not men rule. We, citizens, are the law makers, and we are the ultimate governors of our country and our destiny. As one American who enjoys the inalienable freedom and liberties bestowed upon me, I thank God for America, and for the sacrifice and guardianship of our sacred United States Constitution by our founding fathers. America is unique in that nowhere on earth the sanctity and supremacy of the rule of law are so cherished and enshrined in the very fabric of the nation’s psyche and primordial DNA.

Yes, from time to time, America may go down financially, and we may experience high national debt and low employment, but we bounce back out of the doldrums triumphantly. How we as citizens may contribute to the health and durability of America is to vote. Our responsibility as Americans is to partake of the liberty, to be patriotic, and to cast our vote. Exercising the right to vote is more than a serious responsibility. It is more than a civic obligation. It is a moral imperative. We owe it to ourselves, to our families and to our nation, to protect and conserve our Republic by going to the polls and voting. Tomorrow is the day. Let’s show our gratitude for America by voting.

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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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Report on Dix Park

Monday Musings for Monday October 29, 2018
Volume VIII. No 44/ 408

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Progress Report on Dix Park

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

(Editor’s Note: the planning and construction of the 303 acres Dix Park, Raleigh, similar to the NY Central Park designed by Frederic Law Olmsted some 150 years ago is in full swing,  Recently, the Subcommittee on Communications of Dix Legacy Committee under the leadership of its Chair, the learned Ran Coble compiled a position paper.  It is the vision and recommendations of Dix Legacy Committee to the designers of the Park.  Below is the edited cover letter that accompanied the position paper.

Preamble

The history and legacy of Dorothea Lynde Dix (1802-1887) are complex.  To do justice to this saint-like, passionate humanitarian of the 19th century America, Dorothea Dix’s biography deserves a 24 volume work comparable to the 24 volume, 12,000 page biography of Moses compiled by Eusebius of Pamphili ( 263 AD).  Reading Dorthea’s writings as a Sunday school teacher and a teacher in public and private schools, it is obvious that she was a disciple of, and adherent to, Pauline theology of faith, hope and love..  To honor the legacy of this Holy lady who taught the poor, and fought for the rights of the “insane” is a formidable task.  Nonetheless, in their wisdom, the visionaries of Dix Park Conservancy Board established the Dix Legacy Committee (DLC) as a principle standing committee of the Board to ensure the continuity of her work.  DLC has been functioning since Jan 2015 and has been meeting regularly to develop and define the functions of the committee.  We also hold longer meetings and retreats when it becomes necessary.  For example on September 22 in a long meeting with input and assistance from Sean Malone, CEO and President of the Park and Kate Pearce, Raleigh City planner and Liaison to the Board, developed the following as DLC ‘s Legacy:
“Legacy of compassion…, of inclusion, …of bringing together and uniting…, of connectedness with nature…, of mental and physical health and wellness…, of discovery and learning…, of respite from a troubled world and mind…, of fostering dignity…”

DLC has been blessed with the talents and dedication of a large group of consultants and observers who have given, and continue to give, generously of their time and talents.  To better define the function of the committee, three major subcommittees have emerged.  They are Subcommittee of recruitment and retention chaired by Anne S. Franklin.  This group is charged with insuring the gender and racial diversity of DLC.  Subcommittee on Flora and Fauna, chaired by Thomas Earnhardt, and Subcommittee on Communications, chaired by Ran Coble.

The attached compendium, is a recent product of the Communications Subcommittee chaired by Mr. Ran Coble which will be submitted to the Conservancy Board and thence to the Park Planners.  The best way to introduce Mr. Coble, I resort to the work of the Dutch theologian/philosopher Erasmus (1466- 1536) who in a long and convoluted thesis defines Miracle as follows: “When you combine intelligence (brain) with industry (hard work) you get a miracle.  I guess Erasmus had folks like RanCoble in mind when he penned that definition…

Ran and his subcommittee have provided us with a comprehensive expose of issues that would be important to the person of Dorothea Lynde Dix, were she alive today.  We want to emphasize that the DLC will continue to work on the issues of brain dysfunction and the need to accommodate psychiatric patients.  With contemporary research, we know that all conditions labeled as mental illness and addiction are basic anatomical and hormonal disorders of the brain.  DLC recommends to do away with the use of the term mental illness since it is heavily tainted with stigma causing social alienation and marginalization,

In the last five years in brain research, the field has entered the exciting age of connectomics.  We have had genomics, proteomics, and now we have entered connectomics which is the field of study of connectomes, and production of comprehensive maps of connections within an organism‘s nervous system typically of the brain.  The human brain has 100 billion neurons (brain cells) interconnected by 100 trillion connections.  These maps are being developed and studied with enormous speed. Harvard biologist Jeff Lichtman has devised a contraption, connecting a giant electron microscope to Magnetic Resonant Imaging (MRI) and functional MRI (fMRI) taking pictures of the connections of the neurons in the brain. DLC continues to work on all fronts, social, economics, health and wellbeing of our citizens.  We welcome your reflections and critics.

Submitted with Respect,

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

Distinguished Life Fellow, American Psychiatric Association
Adjunct Professor of Psychiatry, UNC School of Medicine at Chapel Hill

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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 Gun Violence…

Monday Musings for Monday October 22, 2018
Volume VIII, No. 43 /407

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Gun Violence Control, Where is the Wisdom?

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

The former President Obama called the massacre of 20 innocent children and six adults on Dec 27, 2013, in Sandy Hook Elementary school in Newton, Connecticut, the worse day of his presidency.  History tells us that every president since GW has had a/the worse day.  For George W Bush it was September 11, 2011, for FDR it was Pearl Harbor, December 7, 1941.  All our 44 presidents have had the worse day in their presidencies.     It would be a meritorious project for some PhD candidate in history to compile a volume on every US Presidents’ worst day in the office.

We thought and hoped  that the December 27 occurrence was a turning point in the debate over guns in America.  But it was not. Last month’s deadly shooting at Marjory Stoneman Douglas High School in Parkland, Florida, was just the latest example of gun-related violence targeted at students, often by individuals not much older than themselves.  The statistics are staggering:  The first four Months of 2018 (real-time data, May 1st): -4,685 gun deaths -8,301 gun injuries -196 children shot/killed -819 teenagers shot/killed.  The numbers are logarithmically increasing and the dynamics of these violent acts are becoming more complex.

A brief review of  the history of gun violence, especially since the 1960s, might be helpful. We remember the University of Texas clock tower in Austin Texas, then in the 70s Kent State University Massacre, in the 80s. Cleveland School mass killing and the 90s several schools, including Columbine High School, mass shooting at Virginia Tech, not counting mass murders in other facilities including Sikh Temple, army bases and others, the numbers are staggering. But none was as gruesome as the Sandy Hook massacre.  Everyone seems to agree that these tragedies must end.

After the December 27, 2013 shooting, the then Vice President Joe Biden chaired a task force to examine the issue by holding extensive public hearings in which expert testimony was given by representative of American Psychiatric Association (APA), American Medical Association (AMA), American Bar Association (ABA), and forensic authorities were collected. A report was compiled but no action took place. The matter became politicized, National Rifle Association (NRA), Democrats, Republicans, Second Amendment to the Constitution all began spinning in the media. Gun control advocates brought in an extensive agenda, namely tougher penalties for ill gun sales, increased school safety programs, expanded background check for gun buyers and mandate to keep guns out of the hands of criminals and folks with history of mental illness.  Republicans and NRA saw this as unnecessary interference by government.  So a compromise was generated by Senators Joe Manchin, a Democrat from West Virginia and Patrick Toomey a Republican from Pennsylvania, focusing attention on background check. It failed.

Issues like gun violence control, abortion, and cloning carry within their constitutional DNA a huge dose of controversy. My focus in this essay is a dispassionate and analytic examination by separating the hype and hysteria from reality and data.It  is hoped that cool heads and wisdom will prevail.

In the debate of gun violence mental illness has gotten a bad rap. The alleged connection between mental illness and mass violence is not supported by objective data and science:  “substantial research shows that the vast majority of people with serious mental illness never act violently, and the vast majority of violent crimes -96 % by the best available data-is not perpetrated by persons with mental disorder” said Paul Appelbaum, Past President of APA, Professor of Psychiatry, Medicine and Law at Columbia College of Physicians and Surgeons. What we need to do is to face and design program of mental health care instead of warehousing the mentally ill in jails and prisons.

The APA position which I am advocating is to appoint a presidential commission to develop a vision for a system of mental health care, creating a mechanism for facilitating responses to key mental health issues such as designating a White House point person, improving early identification of youth with mental health problems and developing sensible, nondiscriminatory approaches to ensuring that dangerous individual cannot gain access to guns.  In his report and testimony Dr Appelbaum stated that people with mental illness who are engaged in regular treatment are considerably less likely to commit violent acts than those who need but do not receive appropriate mental health treatment.

Another expert testimony at the Vice President Task Force was Dr. Thomas Insel, the then Director of National Institute of Mental Health stated that “Suicide, not homicide, is the most urgent public health problem associated with gun violence. About 90% of suicides involved individuals with mental illness. Dr. Insel reported that “the popular association of homicidal violence and mental illness is tenuous at best..” Despite common public perceptions, there is little connection between gun violence and mental illness.  Only 6 percent of violent crimes are committed by someone with a diagnosed mental illness, as opposed to 96 percent suicides that are associated with mental illness.

What to Do?

For more than 55 years, I have been involved in various capacities with the North Carolina mental health system. At no time the services to and for our patients have been as chaotic, sparse, and erratic as they are today. Fifty years ago, in North Carolina, we had a system in place that was truly superb. At Dorothea Dix Hospital, where I received my psychiatric training, in the late 50’s and early 60’s, patients had predictable, excellent, and academically cutting edge treatment available to them with ready access. No patients had to wait for days and in some instances for weeks in emergency departments of general hospital waiting for a bed. And no patients were put in jail and prisons because of lack of mental health treatment and shortage of psychiatric beds.  We have certainly devolved and regressed.  Taking care of patient with mental illness–and really it is brain disease—is a moral responsibility about which Thomas Jefferson and our country’s other founding fathers expounded.

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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 a Few Things..

“Monday Musings” for Monday October 15, 2018
Volume VIII.  No. 42/406

 

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Reflections and Observations

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

Three things I do not understand:

1)  CEOs of big businesses like Merrill Lynch who send their companies to near bankruptcy and exit with a quarter billion dollar retirement package.

2)  Coaches who compile a less that a mediocre record, yet get contract extension and a whopping raise in their salaries sending their annual compensation into millions while our teachers barely make ends meet.

3)  Student athletes who can barely read and write. They work like slaves to generate a product with sales in the billions of dollars yet they get punished for accepting any gift from fans. This is a repetition of 17th adn18th century slavery, and the epitome of hypocrisy and unfairness. The entire system is unethical. It should be illegal and ought to be banned. One reasonable solution is to pay the student athlete a salary and pay teachers to tutor them and bring up academically, while they play their sport.

World Chess Championship in Raleigh

Negotiations are underway to bring back chess masters from all over the world to Raleigh for a match.  The last time they convened in Raleigh was in 2014.

I was privileged to be in Reykjavick in 1972 and see the late Bobby Fisher playing chess with his Russian opponent Boris Spassky, about whom I have written in the past. What impressed me about the young Bobby, besides his bad behavior and total paranoia and mistrust for everyone, was his total mastery of the game, and his brilliance. His kind of brilliance was unfortunately blinding and not illuminating. It was more damaging than benefiting.

To me, Bobby Fischer was a good reminder of Richard Wagner (1813-1883), the most brilliant opera composer, writer and thinker of the 19th century. Wagner’s biological father was a Jew. Like Wagner, Fischer was also born to Jewish parents, yet like Wagner, in his life time, he piled an incredible amount of derogation and insult on Jews.  Like Wagner, Fischer was an unrepentant and zealous anti-Semite.

There are plenty of reasons to bury the memories of Bobby Fischer and let him fade into dustbin of oblivion. But his brilliance in chess may be selectively used as a role model for teaching focus, determination and devotion to learning to our young people. He provides a good example of how to train the brains of our children and grandchildren.  Let us celebrate him, and his contributions to the honored and honorable game of chess.

David Edwards/Le Laboratoire

David Edwards, a professor of Biomechanics at Massachusetts Institute of Technology (MIT) has started a gallery at the Louvre Museum in Paris that truly combines science and art, dealing with how a primitive, nondescript stem cell is transformed into a neuron. David is so good at what he does, and I am so impressed by his brilliant mind and abundant practical imagination, that I think any one going to Paris ought to plan to go see this exhibit. He is so much in touch with how science and humanities overlap that we might invite him to become a Meymandi Fellow at the National Humanities Center in RTP.

Post Traumatic Stress Disorder (PTSD) and Domestic Violence

October is Domestic Violence Awareness Month. The ravages to two wars US has been involved for the past dozen of years is directly related to ever higher incidence of PTSD. More human lives (both male and female) are lost to domestic violence. 2011 recorded the highest number since we have been keeping records. The victims, especially children, are severely scarred and emotionally abused. Domestic violence is of epidemic proportion in certain segment of our society. Iraq war has worsened the rot on families of military returnees who experience post- traumatic stress disorder.

Fortunately, we have Interact of Wake County, a worthy organization that is taking the matter of domestic violence seriously. Interact is providing safety, shelter and emotional support for the victims and their families. Interact is shining light on the murky and unpleasant landscape of this unwelcome epidemic. Interact deserves the support of everyone.

 Repulsive Public Events

It is unconscionable for print and electronic media to devote so much space and time to absolutely repulsive stories dealing with people consuming huge amounts of food (hot dogs and doughnuts) for a cause or a prize. We have seen these races where people gorge 12 doughnuts or 2400 calories to run four miles which burns about 400 calories, to raise money for a worthy cause. The goal of raising funds for a worthy cause is holy, but the method is most repulsive. With the epidemic of obesity causing diabetes, hypertension, and cardiovascular disease, I believe your story to encourage gluttony, profligacy and self-indulgence was most unwise. I believe people ought to be encouraged to fast, lower caloric intake, and lose weight, while they run and engage in fund raising.

 Beethoven, The Mysterious Metaphysical Force of Deity

In 1824, Ludwig Van Beethoven was deaf. He was ill, temperamental, grouchy and uncooperative. He was 53 years old and ready to die.  Yet he composed the majestic Ninth Symphony. I have heard the Ninth in many venues in Europe, Australia, America and even Africa, to audiences of tens of thousands. NC Symphony’s performance under the baton of Maestro Grant Llewellyn belongs right up there with the National Anthem of Europe conducted by the late Leonard Bernstein and the NY Philharmonic…Bravo!

An Opera House for Raleigh

Gaetano Donizetti was one of the three bell canto opera composers (the others were Giacomo Rossini and Vincenzo Bellini) who made brutal demands on the vocal cords of his lady singers. We need to bring more of their operas to Raleigh. Also, the idea of Raleigh having its own opera House is most intriguing.

Raleigh is inching closer to becoming a late 16th century Florence where the arts, music, poetry and dance flourish; where brisk intellectual conversation and children’s laughter fill the air of its vast parks; where fountains flow with life and energy and where academia and business meet their maximum potentials. Raleigh is the essence of the NC State’s Motto, “Esse Quam Videri”, to be rather than to seem. Perhaps we can fit the new opera house in soon to be born Dix Park.

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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 More Opera…

Monday Musings for Monday October 8, 2018
Volume VIII. No. 41/405

Verdi-photo-Brogi

Giuseppe Verdi

Maestro Giuseppe Verdi’s Otello

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

Last week we celebrated the birth of the Western Opera Orpheo et Eurydice on October 6. Today we wish to celebrate the birth of the greatest opera composer of the 19th century, Maestro Giuseppe Verdi who was  born on October 10, 1813.  We wish all opera lovers an elevated and felicitous day.  Here is a brief review of one of most artistically and psychologically challenging composition, Verdi’s Otello.  The opera opened on Feb 5, 1887 at Teatro Alla Scala, Milan, Italy. By the way, Shakespeare’s play is Othello, but Verdi’s opera is Otello. The opening of Otello was spectacular and hyped up. Arturo Toscanini (March 25, 1867 – January 16, 1957, lived to be almost 90 years old and died on Mozart’s birthday) held the first chair cello in Maestro Verdi’s orchestra at the premiere of Otello. The opera was received with a tumultuous public endorsement. Verdi was not only a beloved composer and the quintessence of the 19th century Italian opera, but he was hailed as a hero capable of bringing various semi-independent political hegemonies under one government and one king. The political pundits promulgated Verdi as an acronym for Viva Emanuel Rei (Reign) D’Italia (Long live Victor Emanuel King of Italy). Yes, the war-torn Italy was united because of the work of a composer, the beloved Maestro Verdi. At the conclusion of the opera, near midnight of February 5, 1887, there were thousands of people in the streets shouting Viva Verdi. Toscanini, the young gifted cellist, was very excited about the triumphant premiere of Otello. He wrote “I went home after midnight. I was very excited. I knelt at my mother’s bedside, and woke her up with a scream ‘Mama, Otello was a success.’ Maestro Verdi is a miracle maker. Viva Maestro Verdi, Viva Verdi…”

That evening Verdi could not sleep, because throngs of people gathered outside of his window chanting Viva Verdi. Otello, just like Nabucco, debuted in 1842, was an unbelievable triumph. We will devote several essays to Italian Operas in the months to come.

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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 Birth of Opera

“Monday Musings” for Monday October 1, 2018
Volume VIII, No. 40/404

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Palais Garnier, Paris

A Few Words About the Opera

and How it Relates to Buddhism and Sufism

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

Happy 418th Birthday to Western Opera.

 In the past few weeks we have had too many topics including Dix Park, Psychoanalysis and Neuroscience, Rash Hashanah and Yom Kippur crowding the calendar.  This week we will be celebrating the 418th  birthday of the Western Opera on Friday October 6.

History of Western Opera

Opera is an Italian word. It means work. In the late 16th Century, a group of Florentine scholars decided to get together every week and study the music and writings of the ancient Greek. They called themselves the Florentine Camarata. It was very much like our modern day book clubs, except that these people were very serious about their work. The culmination of these studies and discussions was Jacobo Peri’s composition of Orpheo which was performed at 8:00 PM, October 6, 1600, at Pitti Palace in Florence. Of course, in 1607, Claudio Monteverdi gave us his version of Orpheo. It marks the beginning of Opera. We have enjoyed 418 years of opera as result of the intense work of this group.

There are five powerful instruments used for introspection and research on self. One can learn more about one’s self through psychoanalysis, which is usually very expensive and time consuming. The other tools are studying history, theater and poetry. The last but certainly not the least is through understanding and studying opera. Opera, a combination of words and music, offers us the most comprehensive and potent introspectoscope. Opera gives the participant an opportunity to become aware of one’s unconscious in dynamic gradation. Do we, as viewers, possess at least some of the evil and sexual identity confusion that eclipses Iago and Othello (in opera Otello)? Are we endowed with passion that made Don Jose kill Carmen? Are we capable of transcendence that come with the Zoroastrian parables in Wagner’s Ring Cycle? In order to get to know ourselves better, I believe opera should be an integral part every citizen’s cultural and intellectual diet. It is much less expensive that psychoanalysis, and while being intellectually stimulating, it is more enjoyable and entertaining.

Types of Opera

Italian opera dominated Europe throughout the 16th and early 17th centuries. Around 1670s, French opera with its founder and inventor, Jean Baptist Lully (1632-1687) emerged. Lully was an Italian orphan who immigrated to Paris at age 14. He rose to become the court composer for the Sun King, Louis 14th, who reigned for 73 years. Lully gave us the French Overture, and its dotted rhythm brings on grandeur, pomposity and majesty meant for Louis 14th. Other French composers followed: Jean-Philip Rameau, Jean Jacques Rousseau, Christoph Willibald Von Gluck, Giacomo Myerbeer, Bizet etc. There are German, Russian, Chinese, and now many third world countries operas. Also, there are lyric opera, grand opera, opera buffa and opera seria, just to name a few.

Carmen

Carmen is an opera comic in four acts. It was written by Georges Bizet. He was a genius. He died penniless at age 38, exactly three months after Carmen was first staged. Had he lived three more years, he would have reaped immense wealth because of Carmen’s success all over Europe. Perhaps Bizet and Van Gogh were soul brothers. They lived in poverty, yet after death, their work’s value increased immensely. Bizet knew music and composition. His musical compositions at age 17 easily compare to the music of Mendelssohn and Mozart. His one act opera in 1857, Le Docteur Miracle, shows his mastery of operatic idiom at an early age. In Act II of Carmen, the accelerating gypsy dance is an orchestral tour de force in which dissonance and sliding harmonies paint the scene of Lilla Pastia’s underworld tavern. Bizet knew human nature. He was as keen as Shakespeare when it came to assessing human nature. The famed German philosopher, Fredrick Nietzsche in an essay on Carmen wrote that he saw the opera 21 times. “Every time I see Carmen, I sit still for five hours, I become more patient which is the first step of true holiness…”

Carmen is a story about love, not of higher order, but as futility, cynical, cruel and at best deadly hatred of two sexes. Love translated in the horror proclaimed in Don Jose’s last cry “yes, I have killed her…I have killed my adored…” Carmen, the epitome of carnal desire, temptation and primal raw sexuality, is the eve and the serpent rolled in one. In act III she sees her mortality in the cards that she and her gypsy friends were reading. She gave into her fate and led a reckless life. Don Jose, a decent and simple soldier when he first met Carmen, turns into a love crazed killer. He is Adam. He is Kane. He would not have been transformed into a killer if the violence and killing were not in him to start. There is a bit of Adam, though deeply hidden, in all of us. Don Jose is Adam. Jose’s unrestrained male sexuality and machismo ultimately caused his destruction.

Perhaps, unlike Nietzsche who claimed to become a better philosopher every time he sat through a performance of Carmen, we can see this very deeply moving and instructive work as a beginning.

Opera, Sufism and Buddhism

To read the 19th century German philosopher, Arthur Schopenhauer (1788-1860), whose writings are very much imbued in Sufism and Buddhism: “To be, one must first not be…” might help us to understand Richard Wagner (1813-1883), the genius anti-Semitic German musician, composer of opera (he hated the word opera because it is an Italian word and he hated Italians!, and called his work “Music Drama”), who was a disciple of Schopenhauer. His operas, especially Tristan and Isolde, and Der Ring des Nibelungen, or Ring Cycle, consisting of four operas, 18 hours, are full of Zoroastrian parables and Buddhist reference to “nothingness” before becoming “something.” This ruthless, racist and megalomaniacal genius not only composed his own operas, but wrote the libretto and conducted the work. His compositions are not just opera but an all-encompassing Gesamtkunstwerk, like a Super Bowl halftime show!

The writings of Rumi, Shams Tabrizi and Baba Taher Oryan, all Persian Sufi Poets, assert the Buddhist notion of the issue of “being”, the western concept of which is called ontology. Western opera takes us beyond “doing” and introduces us to “being”, a singularly Buddhist and Sufi concept.

In my mind, opera continues to be the most complete art form. It has the greatest capacity for communication and impact per second of any other art form including my most favorite art form, classical music. What I wonder is when, and where, in NC we will see 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, this season. I yet to see any opera by Michael Tippett, Hans Verner Henze and Olivier Messiaen (I saw his Saint Francois D’Assie in Paris several months ago), and other composers. Perhaps NC Opera will meet the challenge.

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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 My Brother

“Monday Musings” for Monday September 24, 2018
Volume VIII.  No. 39/403

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Scholar and His Books by Gerbrand van den Eeckhout.

Encomium for my brother, Dr. Mohammad Javad Meymandi (born September 21, 1924)

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

Recently, I had the pleasure (and honor) of giving a physical examination to my 94 years old brother while he was visiting us in Raleigh. He lives in Malibu, California. His visit gave us the opportunity to celebrate the Tar Heel version of his distinguished 94th natal anniversary. My brother is a remarkable man. He is mentally and physically active. He does not walk. He leaps like a graceful gazelle. He prances. He climbs stairs two or three at a time. He can recite poetry in many languages, and argue persuasively in many languages. With passion and purpose, he spreads joy and love to everyone around him. His speech is well-articulated, melismatic, clear and ethereal in content, coloratura; and syntax. He is an American-educated scholar and former university administrator. He is an emeritus professor and chancellor. Yet he continues to learn and to study by reading omnivorously and researching constantly. He is a prolific writer. His textbooks in agriculture and plant ecology, and principles of translation continue to be taught at the University of Tehran.

While examining him, in front of me, I saw the most wondrous and complex machine consisting of the brain, a network of 200 billion cells (neurons and glia) and 30 trillion synaptic connections. There diverse and complex neurons that surprise observers at every turn. I found that along with his 2.5 lbs. brain, with all those neurons and synaptic connections, my brother has almost perfect system review with vital signs more similar to a teenager rather than a 94 years old person. And all this wrapped in a beautiful soul and infinitely delicate and sensitive sense of awareness.

A bit of history of neurobiology:

James Watson and Francis Crick discovered Deoxyribonucleic Acid, DNA in 1953.They won the Nobel Prize for Medicine or Physiology in 1962. Soon the genomics project and sequencing of genes and DNA was completed. The discovery of proteomics ensued, and now with the work of brilliant neuroscientists with more advanced instrumentation, we have connectomics. The work of Harvard’s Jeff Lichtman illustrates the dimensions of human connetomes and advances in the science of connectomics. We now know that the so-called mental illness is nothing more than brain dysfunction. Something goes wrong with connections of the complex structures of this mysterious organ called brain. It is called connectopathies. It explains autism, bipolar disorder, schizophrenia and most major psychiatric illnesses and problems. In addition, brain structure is not simple like kidney, liver or lung, making it vulnerable to misconnection(s). The diversity and complexity of brain cells are mind boggling.

But the brother I know has been not only my brother but my teacher, my role model, and my mentor since my birth. When I was a little boy, he used to come home from high school and teach me all he had learned that day. His teachings made me excel in College Saint Louis, a Jesuit School, in Tehran with all instruction in French. Also, he has been a rich source for offering spiritual guidance and direction, a true role model. Now with all the other seven siblings gone he and I are the only two left which makes him the patriarch of the family. For his birthday, the family, the extended family, and friends, compiled a book titled “The Star of the Pantheon of the Patriarchs, Dr. Mohammad Javad Meymandi” which was dedicated to him on his birthday on September 21. I am writing this very personal note at the request of many who have met him on his visits to Raleigh. They wish for others to get to know my brother I wrote this in his honor. It should be read in dactylic hexameter like reading Homer…

Encomium: 94th birthday of my brother, Professor M. J.  Meymandi of Malibu

When I think of my brother, Mohammad Javad Meymandi, I think of Benjamin Franklin, the wise and thoughtful patriot, the oldest of the framers of the Constitution,

whose towering intellect was subdued by his humility;
whose wisdom guided the American literary world;
whose brilliance was to illuminate and not to blind;
whose sense of humanity and humor made him loved by family, friends, colleagues and students,
whose sense of balance and vision brought him charm and appeal;
whose commitment to principles, to the truth, and to the love for/of humanity, made him as immutable as mountain Sinai;
whose beneficence and generosity of possession, generosity of time and generosity of
soul made him an oak with tens of thousands of branches giving shade and shelter to
one and all. His very name, Javad, means generosity.

When I think of my brother Javad, I think of Abraham of Ur to whom was given the mission “Go, teach my people faith…”
The mission for Javad Meymandi was “Go, teach my people history, critical thinking, self-reliance, and devotion to the principles of altruism and patriotism.”

When I think of Javad Meymandi, I think of Saint Jerome and Saint Augustine of Hippo who came, who gave, who served unselfishly, unreservedly and openly…
And whose devotion to truth, justice and love of humanity transcended all other considerations.

And finally, when I think of my brother, Javad, I think of a warm and accepting friend.

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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 a Few Things…

“Monday Musings” for Monday September 17, 2018
Volume VIII. No. 38/402

maimonides

Moses Maimonides

 YOM KIPPUR AND MOSES MAIMONIDES OF CORDOBA

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

Rosh Hashanah, the Jewish New Year, 5779, began on Sundown Sunday  September 9, leading to Yom Kippur which begins at Sundown September 18, 2018. These ten days of reflection, introspection and atonement are the holiest days of the Jewish calendar. Yom Kippur (Yom means day and Kippur means great–the great day) which is focused solely on prayer, fasting and redemption bears much mystery,.

One of my favorite Jewish Theologians, Martin Buber, whose thinking and writings were influenced by Sigmund Freud and Fredrick Nietzsche describes these ten Holy Days as a drama that unfolds. Rabbi (Lord) Jonathan Sacks, the former Chief Rabbi of UK and Commonwealth, in a seminal essay wrote “These days constitute a courtroom drama like no other.  The judge is God himself, and we are on trial for our lives.  The drama begins with Rosh Hashanah with the sounding of the shofar, the ram’s horn, accounting that the court is in session.  The book of life is written on Rosh Hashanah; and on Yom Kippur, when the atmosphere reaches a peak of intensity atonement and prayer, the book is sealed…”  In Christianity there is Lent and in Islam there’s Ramadan and Eid-e-Fetr which parallel the intensity and concentration of prayer and the  fascinating drama of the personal relationship between God and humans.

As promised in the last week’s “MM” to honor the Holy Day of Yom Kippur, we present a review of colleagues Fred Rosner and Samuel Kottek biography of Moses Maimonides of Cordoba.

Moses Maimonides of  Cordoba

REVIEW OF BOOKS
by Assad Meymandi, MD, PhD, DLFAPA

Moses Maimonides
Edited by Fred Rosner, MD and Samuel S. Kottek, MD
229 pages of text, 41 pages of reference notes and 10 pages of index
Jason Aronson, INC., Publisher

There is a sweet anecdote at the beginning of Sherwin Nuland’s biography of Moses Maimonides which has to do with Jewish mothers insisting their sons to become doctors, the “My Son, the Doctor” paradigm.  It goes something like this: “Imprisoned in a tower in Madrid, disabled by syphilis and further weakened by abscess in his scalp, The French King Francis asked of his captor, the Holy Roman Emperor Charles V, to send the finest Jewish physician to attempt a cure.” Frances discovered that the doctor sent to him was not Jewish but a baptized Christian. Irate, Francis dismissed the doctor and insisted to be treated by a genuine Jew. That physician may have been Moses Maimonides, brought all the way from Cordoba.

Not only was Moses Maimonides of Cordoba was a good Jewish doctor, he was a Rabbi, a philosopher and a prolific writer.  During his life time he wrote 5.3 million words, most of which have been preserved. He wrote on all aspects of medicine, infectious disease, nutrition, spirituality and internal medicine. But he also made inroad into the world of psychiatry.

You would think that cognitive behavioral therapy (CBT), an effective methods of treating w aide range of psychiatric problems, including obsessive compulsive disorder (OCD), anxiety disorder, depression, borderline personality disorder and many other neuroses including phobia and panic disorder, is thought to be one of the contributions of the twentieth century medicine, until you read about the life and work of the polymath, “super-genius” physician, theologian, philosopher and astronomer, Rabbi Moses Maimonides of Cordoba  (MM of C) .

The Rabbi, a major author of Helakhic authorities, the collective corpus of Jewish religious, rabbinical and later Talmudic laws wrote about CBT way back in 1170. Fred Rosner, a respected hematologist and medical ethicist, a professor of medicine at Mount Saini School of Medicine in NY, and his colleague Samuel Kotteck, professor of the history of medicine at the Hebrew University-Hadassah Medical School, Jerusalem, have collected papers and articles by no fewer than 20 scholars offering this  remarkable edited volume. It is a slender   and compact 229 pages chock full of historical jewels. In essence it is a biography of Dr. Maimonides, along with a description of his writings and work.

Fred Rosner’s erudite discussion in this  well researched  and meticulously referenced book shows the reader that Moses Maimonides, in his famous trilogy, The Commentary on Mishnah (means ‘repetition’), is the major source of rabbinic Judaism, the Mishneh Torah, and the Guide for the Perplexed traces much of what we know today about effective nutrition, methods of practicing CBT and biofeedback, guided imagery and self-awareness, a discipline he learned from the  work of the Persian physician, Abu Ali Sina, Ibn Sina  or Avicenna  (980-1130) and Saint Augustine of Hippo  (345-420).

In a chapter that asymptotically approaches brilliance and virtuosity, Gad Fruenden that explains how Maimonides, a citizen of the medieval age of superstition and primitive thinking, opposed astrology radically. He was quick to give credit for his enlightened thinking to Omar Khayyam, the Persian poet and astronomer, born 1085, died 1123, only eight years before the birth of Maimonides. So for all practical purposes, Avicenna, Khayyam and Maimonides were contemporaries. Although Omar Khayyam is known for his poetry and The Rubayats, he was a scientist and an avid astronomer to whose work Galileo Galilei (1564-1642) has made numerous references. Like Aristotle, Maimonides insisted on scientific objective and not speculative findings. In his book, the Guide collection of his personal letters referring to practice of medicine he wrote: “Medicine is not knitting and weaving and the labor of the hands, but it must be inspired with soul and be filled with understanding…”

Reading Moses Maimonides of Cordoba make us fall in love with our holy profession all over again, and take refuge from the oppression and intrusions of the government and bureaucrats.

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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 and the 2016 winner of NC Award in Fine Arts.

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A Few Events…

“Monday Musings” for Monday September 10, 2018
Volume V!!I. No. 37/401

rosh

Rosh Hashanah, Jewish Year 5779

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

This is a very busy week for calendars of faiths. Besides Rosh Hashanah,  the beginning of Jewish New Year, Yom Kippur, the most solemn Holy Day which this year takes place on September 18; Tishrei and Sukkot the most joyous day in the Jewish calendar are all crowded in the span of 10 days. Also, there is the Constitution Day on September 17 which most purists, like my household, consider and celebrate as a Holy day in itself. In addition, our beloved North Carolina Symphony starts its 83nd season on September 20 featuring virtuoso violinist Joshua Bell. Here ae some reflection on each occasion.

Constitution Day

The US Constitution is 231 years old.  We wish it a Happy birthday, its 231th.  On September 17, 1787, the delegates to the Constitutional Convention met for the last time to sign the document they had created. We encourage all Americans to observe this important day in our nation’s history by attending local events in your area. Celebrate Constitution Day through activities, learning, parades and demonstrations of our Love for the United State of America and the Blessings of Freedom Our Founding Fathers secured for us. If you forgot to celebrate the Constitution Day yesterday, it is not too late.  You and your family can do it today.

Rosh Hashanah, Jewish year 5779

Sundown, day after tomorrow, September 20, 2017 will mark the beginning of Rosh Hashanah. The etymology of the word Rosh Hashanah is RAAS (HEAD OR BEGINNING) AL (OF) SENNEH (YEAR or DATE), THUS ROSH HASHANAH, the beginning of calendar.  The Jewish year is 5779 (1st ofTishrei, a joyous occasion for all Jews). Some reflections:

Moses was born 1590 BC, and reportedly lived 120 years until 1470 BC. Scholarship about the birth of Moses, 3608 years ago and Rosh Hashanah, the start of the Jewish calendar 5779 years ago is very interesting. The relationship between the two dates has gone through many twists and turns. The struggles very much remind me of the struggle of C-major and C-minor in Beethoven’s Fifth Symphony, battling back and forth for attention and primacy. The final note is the celebratory C-major coming through triumphantly. The currently perceived resolution of these two competing dates is simply that it was approximately 6,000 years ago when the world’s oldest religions simultaneously began to emerge. Abram of Ur, renamed Abraham by the Lord (Genesis 17), had much to do with this remarkable emergence. We could say that this year marks 5779th year of the dawning of the human awareness of God…and the dawn of monotheism. It sends a chill down one’s spine to get in touch with human connectedness and human history. It is regrettable to neglect the fact that all of us Jews, Christians and Moslems are children of Abraham and as such should love one another like brothers and sisters.

 

Occasions like Rosh Hashanah, Yom Kippur, Islam’s Eid-Al Fetr, celebrating completion of Ramadan, the Muslim month of fasting, worship, and purgation of the soul (was observed on June 14, 2018), Easter Sunday and Purim, the Jewish Holiday that marks liberation of the Jews by Cyrus the Great (Book of Esther), collectively elevate our awareness that we are children of God and regardless of labels that separate us, we are inextricably inter-connected.  We wish everyone not only a joyful 5779 but a fruitful and consequential life. The other holy occasion is Yom Kippur which will begin at sundown on September 18, 2018.

Next week’s “MM” will be devoted to Yom Kippur and a book review on Moses Maimonides of Cordoba, the Rabbi, the formidable physician/clinician, the awe-inspiring medical researcher and discoverer, the superb medical ethicist, and the remarkable writer. Shana tova.

 Music: Mankind’s Savior

Seeing Mozart’s masterpiece, Idomeneo, in any venue, any city, and at anytime is a good reminder that Mozart was an ordinary man with all the flaws and scars of alcoholism, syphilis (from Pamena of Magic Flute), kidney failure and periodic bankruptcy, with an extraordinary and truly God-like mind to produce and write music of such complexity, architectural soundness of structure, yet immense sublimity and transcendence, that is beyond any mortal’s comprehension. The gift of Mozart is available to all lovers of music.  The memorable production of Idomeneo by the Metropolitan Opera is super special.  The unusual assembly of the international cast involved countries of Australia, England, Canada, South Africa, India, New Zeeland, and France. Our own Maestro James Levine, veteran Met Opera Music Director (now, emeritus), and now conductor of the Boston Symphony, born and raised in Cincinnati, Ohio,  who conducted the feast, was America’s contribution. The virtuous performance of the star-studded cast and Levine’s skillful directing once again proved that music is the universal language of peace, understanding and love.

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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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