On Valentine’s Day

“Monday Musings” for Monday February 12, 2018
Volume VIII. No. 7/371
St_Valentine

An Essay on Valentine’s Day

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

HAPPY VALENTINE’S DAY!

(This year’s Valentine’s Day is day after tomorrow, Wednesday February 14. Some reflections on history and biochemistry of Valentine’s Day):

History and Origin:

The word Valentine has to do with human sacrifice. Self-sacrifice and martyrdom are not new. They go back to the Iron age when Virgil in his Book IV, dramatically depicted the departure of Aeneas for the Trojan war leading to Dido’s plunging a knife into her breast and sacrificing herself for the love of Aeneas. And we know that during the reign of Roman Emperor Diocletian (244-311 AD) Christians were caught and fed to the lions. Were those professed Christians who risked their lives and became dinner for the Emperor’s hungry lions on a suicide mission as are today’s fanatic suicide bombers of Islam? A good question to reflect upon…the martyr sacrificed self. The fanatic bomber(s) sacrifices self and kills innocent others. That is murder. Fortunately, things got better for Christians after Emperor Constantine (272-337 AD) converted to Christianity in 313 AD. The same persecuted Christians under Diocletian were now pampered and given cushiony jobs under Constantine. What a difference a mere 75 years make!

History tells us that there were three Saint Valentines and the one we westerners strongly identify is the Saint Valentine of Rome who was a priest martyred in 269 AD by the orders of Diocletian. Some 200 years later Pope Gelasius I (he was the Pope when Saint Augustine ’345-430 AD’ became the Bishop of Hippo) decided to recognize Saint Valentine’s love and devotion for Christianity and established by papal order the Saint Valentine’s Day. It was not until Chaucer days in the fourteenth century England when the feast of February 14 first became associated with romantic love, a pure Anglo invention.

For this was on seynt Valentynysday Whan euery bryd cometh there to ches his mate.”

Chaucer Parlement of Foules, circa 1381.

Our Saint Valentine comes from mid-15th century, “sweetheart chosen on St. Valentine’s Day,” from L.L. Valentinus, the name of an early Italian saint (from L. Valentia ”strength, capacity;”). Choosing a sweetheart on this day originated 14th century as a custom in English and French court circles- meaning “letter or card sent to a sweetheart”. The romantic association of the day is said to be from it being around the time when birds choose their mates.

For the past seven centuries the invention has served us well. Imagine the number of weddings that have been facilitated and children conceived by Saint Valentine. Incidentally, the etymology of Valentine is from Latin valentines means valence, and the word value takes its roots from the same origin.

Biochemistry:

Many people think that falling in love mimics a state of psychosis- a confirmation of this notion comes from Shakespeare’s insistence of the “fine frenzy” of the poet- the madman and being in love are indistinguishable insanities. We all have done the crazy “falling in love” things that there are to do-up all night, romantic breakfasts at dawn, impulsive trips to exotic isles, heartfelt torrents of vows, and suddenly becoming a poet fluid with sentiments and expressive powers… There are a whole host of brain chemical and neurotransmitters such as dopamine, catecholamine, indolamines, endorphins etc., involved in libidinal activities.

Recently however, we have begun to associate the phenomenon of falling in love with a chemical that churns in our body causing us to do crazy things. The molecule is called Phenylethylamine (PEA), a first cousin of amphetamine, which the body produces in its adrenal glands. PEA causes excitement just as amphetamines do. However, it is not as disruptive as amphetamine. Leading scientists and neuro-endocrinologists insist that biochemistry and psychiatry have a definite place in explaining the phenomenon of romance and falling in love. Why should this be left exclusively to poets and Harlequin romance writers. Scientists, too, have a lot to say about it.

There are people who are in constant need of excitement and romance. These are probably the people who have affairs outside of marriage, or those who have multiple marriages while chasing their need for constant stimulation and excitement. These individuals engage in many love affairs. It is suggested that high PEA victims may be suffering from a bipolar affective disorder (manic depressive) form of illness. In order to reach their highs, they must be in love and constantly enjoy the infusion of PEA in their body and brain. Examples of famous PEA levels are folks like Elizabeth Taylor and Marilyn Monroe, and Zsa Zsa Gabor. Some years ago, British psychiatrists coined the appropriate diagnosis of hysteroid dysphoria to explain the phenomenology of high serum PEA. It was never accepted by the American Psychiatric Association and as to what it leads people to do. A male reader, an emeritus university professor wrote and suggested that we should include the male genre. After all, we have had our share of sustained elevated PEA in males, folks such as Don Juan, Machiavelli, Bill Clinton…

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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 was the 2011 inductee to Raleigh Hall of Fame, and 2016 recipient of the NC Award, Fine Arts.
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On St. Paul and CETP

“Monday Musings”, February 5, 2018
Volume VIII, No. 6/370
dore-conversionofsaul

Conversion of Saul to Saint Paul…and the Discovery of CETP.

By: Assad Meymandi, MD, PhD, DLFAPA*

The Feast of the Conversion of Saul to Saint Paul the Apostle:

Many biblical scholars and historians of impeccable credentials including Eusebius of Pamphili, Saint Jerome, Saint Augustine of Hippo, Saint Ambrose who converted Saint Augustine of Hippo form pagan pursuits and Manichean beliefs to Christianity in 386 CE, and baptized him on Easter morning 387 CE, and Pope Gregory, have written and attested that the conversion of Saul to Paul took place on January 25. Among more modern historians, I recommend a comprehensive and magnificent book published in 1747 by Oxford Press written by the most formidable historian of early Christian era, Lloyd George Lyttleton (1708-1773). The book uses earlier references to lay down the cornerstone of this historic event, namely conversion of Saul to Paul on this date. Saul was a Pharisee with a precise/dry life style, demanding, draconian, exact and unforgiving. Every “t” had to be crossed and every “i” had to be dotted. He lived a life of exactitude with no love and no joy. Paul on the other hand brought the message of hope, faith, love, charity and forgiveness. The two people, Saul and Paul, were extremely opposite in orientation and life style. In many Christian churches including the Roman Catholic, Eastern Orthodox, Oriental Orthodox, Anglican and Lutheran churches, January 25, is celebrated recounting the conversion. The feast is at the conclusion of the “Week of Prayer for Christian Unity and International Christian Ecumenism” which began in 1908. The feast is an octave (an eight-day observance, not a musical octave!) spanning from January 18 (observed in Anglican and Lutheran tradition as the Confession of Peter), to January 25.

Here is the collect for the occasion.

“O God, who taught the whole worldthrough the preaching of the blessed Apostle Paul,draw us, we pray, nearer to youthrough the example of him whose conversion we celebrate today,and so make us witnesses to your truth in the world.”

A New Discovery in Health Care. A Plug for Prevention:

Like any other human endeavor, in medicine, we have hype, hyperbole, hysteria and high drama. Charlatans from every corner claim to use their powder on food to make you burn calories and lose weight. Full page ads for miracle treatment of back pain in both skinny and fat people. It should be known to all obese people who suffer from back pain that taking off one pound of body fat takes five pound off the aching back. Incidentally, in my view, doctors advertising in news media, both print and electronic, violate Oslerian ethical mandate of medicine. It is very distasteful. It is more than distasteful. It is really disgraceful. Medicine is not a commodity. Medicine is not a business. Medicine is a calling. Medicine is a priesthood, and we, as doctors, are privileged to be handpicked servants to help our patients (not clients, not heath consumers) for which we should be grateful.

However, there are some medical discoveries reported in peer reviewed journals that are époque making and worthy of note. The recent discovery of Cholesteryl Ester Transfer Protein (CETP) or Evacetrapib is one. A bit of explanation is in order. In America, cardiovascular diseases are the biggest killers followed by cancer. For over a half of century scientists have implicated excess circulating cholesterol, especially low density cholesterol or “bad” cholesterol is responsible for occlusion of coronary arteries, leading to heart attack. We have produced a class of drugs call Statins that lower the bad cholesterol and increase the good. However, Statins have undesirable side effects. The side effects include muscle and joint pain and muscle damage. In some cases Statins have been known to cause lysis or eating away of muscles called rhabdomyolysis. Other side effects of Statins are liver damage, kidney failure and fatigue/depression. Liver damage caused by Statins occurs by increasing production of digestive enzymes. Other serious side effects may be low libido and pancreatitis. I see quite a few patients with neurological side effects, such as memory loss, depression and sometimes more serious neurologic conditions.

More On Cholesteryl Ester Transfer Protein (CETP):

A recent paper published in the medical literature describes a new chemical that assists cholesterol lowering drugs or Statins to become more effective and biologically efficient. the name of the agent is Cholesteryl Ester Transfer Protein (CETP) Inhibitor. It is potentially capable of replacing use of Statins altogether doing away with Statins’ side effects. But the best life style is prevention, proper diet; exercise and discipline of what one puts in one’s mouth are the ultimate answer to good health. Medicine does have its genuine miracles. In America, a pill taking culture, we have been brain washed that for every ill there is a pill. A pill to sleep, a pill to stay awake, a pill to focus and concentrate, a pill to cure erectile dysfunction, a pill to cure irregularity, a pill to regulate too much regularity. A pill to cure depressed mood, a pill to tone down elevated mood. Aram Khachaturian or Leonard Bernstein could have done well to compose a piece of music like Saber Dance or Candid to express our ominous pill taking culture. I submit that we should pay more attention to prevention. With 80% Americans ranging from fat to very obese and morbidly obese, no wonder we have so many cardiovascular deaths, diabetes, musculoskeletal, that is back and joint problems. I believe we must invest in prevention and have a major national program of awareness to seriously address health issues most caused by fatness. One of the things that I think is most discouraging is to see so many doctors and nurses (health care providers) who are obese. This is truly an ugly and unacceptable site. Instead of putting something in our mouths, we must learn to take something away from our mouths..

Surely, here we are celebrating the discovery a chemical that will potentially help millions. But the main message is to celebrate prevention. We have had luminous achievements in this field. Salk vaccine against polio is a good example. 2011 was the first year no polio was reported in India with a population of one billion. Malaria is on its way to extinction, same as some 25 other infectious diseases including the big killer small pox. To take responsibility for one’s health is not only a civic, but a moral responsibility. Tobacco, alcohol and obesity kill without discrimination.

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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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OnVerdi…and Football

Monday Musings for Monday January 29, 2018
Volume VIII. No. 5/369

Maestro Giuseppe Verdi’s Otello and Super Bowl LII

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

(Editor’s Note: Super Bowl has become an unofficial National Holiday. The following first appeared in The Fayetteville Observer, Sunday January 31, 1988, and since reprinted every year in various publications. The style is that of Andy Griffith’s. But first, a word about Verdi’s’ Otello:)

I: Verdi’s Otello

Verdi-photo-Brogi

Giuseppe Verdi

This year’s super bowl falls on February 4, one day before Verdi’s Opera, Otello, opened at Teatro Alla Scala, Milan, Italy, February 5, 1887. By the way, Shakespeare’s play is Othello, but Verdi’s opera is Otello. The opening of Otello was just as spectacular and hyped up as is the Super Bowl sporting event. 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.

II: American Football Loses Something in Translation

image004

A while back, my sports-minded, slim, trim, 67-year-old sister, from Iran was visiting us in America. In her younger days in Iran, she had taught physical education and music. So, her interest in American sports was genuine. One day she asked me to explain American football to her. I tried. We sat down on a Monday night to Cowboys/Bears game on television.

“The ball, why is the ball egg-shaped and not round? She asked.”
“I don’t know,” I said.

Then came the kickoff, the convergence of defense and offense, I could not quickly find an equivalent for “first and ten” in Farsi (the Iranian language) as I translated play by-play. So I set out to say “You see, Khanum Baji-respected form of addressing an elder sister–, the offense, that is the team that has the ball, has four chances to gain ten yards…” by the time I had gotten this far, a Bear defense had intercepted Danny White’s pass with what the color commentator was colorfully and hyperthyroidically screaming on top of his lungs as “a spectacular, fantastic and unbelievable catch’n runback.” Golly, I was getting behind my translating. The interceptor was tackled.

“Why these fellows beating on the guy who intercepted the ball?” she asked “Oh, they are just congratulating him!” I said. “I can’t believe it, look; they are hitting him on the head and pushing him around as hard as they can…” “Khanum Baji, please take my word for it. This is just a friendly celebration of their victory. There are somethings that you just have to take on faith…” I exhorted. She was not satisfied. I could tell from her subtle frown. By now, an injured Bear was being worked on, Frank Gifford guessed that he “must have had the wind knocked out of him,” as I translated faithfully. “What do you mean the wind knocked out of him?” She asked in disbelief, “The guy is half dead. He is not moving. He has been lying on the field for five minutes. I really don’t want to watch this violence…” “Okay, I said.”

We started to move when the TV cameras panned Mike Ditka on the sideline. He was spitting all over the place and maniacally pacing the sideline. “Why does that guy spit so much?” she asked pointing at Ditka. “I don’t know,” I replied. The next play was a Bear touchdown, We were ready to change channels, but my sister, hearing the thunderous applause asked me to explain to her what had happened. I did. “Why are these half-naked women doing this lewd dance after the ball carrier spiked the ball?” she asked. What are those fluffy frilly things they are twirling?” she asked. “Pom Poms” I said. “They add to the excitement.” I added. I explained the function of the cheerleaders: Cheerleading is a highly competitive field. Cheerleaders are a national resource honored by Playboy, Penthouse, Presidents, Senators and Congressmen.” She interrupted me: “There they go again, beating the guy who carried the ball and scored,” she observed, “They are celebrating again,” I said. “Will they arrest or penalize those who knocked out the other guy?” she asked. “No, Khanum Baji, they are heroes, they get their pictures in the paper.” I said. People love violence. My sister’s frown got a mite deeper. “Tell me, is this a state supported game?” she asked. “No, Sis, It is private enterprise at work.” I explained. “You see, the players go on strike if they don’t get their way. An average player makes around $250,000 for six months work. Why, one fellow, Steve Young, whose contract called for $47 million,” I continued, my sister’s frown had definitely deepened, She seemed concerned and curious. “What is the salary of high school or college teachers here?” she asked. “In the range of $19,000 to $30,000 a year” I said. She was visibly upset.

“What is going on now?” she asked looking at Ditka with an expression of disdain and disbelief. “I don’t know, “I replied. “You sure don’t know much, do you?” She said. I grinned, and we flipped to the concert in PBS-something that both she and I could understand and enjoy.

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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 Mozart

“Monday Musings” for January 22, 2018
Volume VIII. No. 4/368

mozart_comic

Natal Anniversary of Mozart: The Mystery of Mozart’s Genius

By: Assad Meymandi, MD, PhD, DLFAPA*

The past couple of months have been so full of events and topics of importance that we neglected to devote time to the God of classical music, Mozart. Thursday January 27, is Mozart’s birthday. He was born in 1756 and died on December 5, 1791. We celebrate the gift of his birth and observe his death in today’s “MM”.

Johann Chrysostom Wolfgang Amadeus Mozart, one of the most enigmatic individuals of the 18th century. He was in poor health throughout his short life. His medical history shows that he had smallpox, tonsillitis, bronchitis, pneumonia, typhoid fever, rheumatism, gum disease, and possible cirrhosis of the liver and hepatitis all caused by excessive use of alcohol and possible sexual indiscretions. Toward the end of his life, he had poor hygiene, most likely because of poverty, and had to move to a smaller apartment with limited accommodations and facilities.

Mozart was enigmatic because of ineptness, inelegant personal conduct, and his lack of social grace. Yet in his operas, he demonstrates deep understanding of human nature. He takes us through a most complex circuitous labyrinth of psychological wonders that is humanly impossible. As I listen to his operas over and over, I keep asking myself how did he know so much? For example, his opera King of Crete, Idomeneo, set in 1200 BC, is an incredible psychological study of human possibilities, frailties, feelings and complex psychodynamics of behavior. Medical literature do refer to Mozart’s scatologia/lalia and coprophilia as symptoms of Tourette Syndrome, a neurologic disorder the victims of which experience uncontrollable urge to make foul noises and use curse words. Modern medicine has pinpointed the biochemical etiology of the disease, namely excess dopamine concentration in the basal ganglia of the brain. This condition is neuroendocrinologically the opposite of Parkinson’s disease where there is a paucity of Dopamine in the basal ganglia.

Dispensing with superlatives and avoiding the use of adjectival palates of hero-worshiping, nonetheless, an observer is made to confess that Mozart was undoubtedly a genius. Leonardo Da Vinci, Michael Angelo, Shakespeare, Goethe, Ferdowsi, Avicenna, Ibn Rushd (Averroes), there are only a handful of them…Classical music, especially Mozart’s music, like classical books, such as Virgil’s Aeneid, Homer’s Iliad and Odyssey, Plato’s Republic, Dante’s Oeuvre, have a theme, are written in noble language and are lasting across generations. All of Mozart’s 626 pieces are abundantly endowed with these basic qualities. They have a theme, they are written in noble and elegant musical notes and are transgenerational.

In his short life of 35 years, Mozart composed a known body of work, 626 pieces, of lasting elegance and complex musical intricacies, some of which are miraculous. Let’s take the summer 1788. How could anyone compose symphonies and operas in a hot summer, combating illness and mourning the death of his mother? in six short weeks, Mozart composed four master pieces of unequal elegance and sublimity. And, yet in the depth of despair and depression, he composed the glorious Jupiter Symphony in C Major K 551. It is beyond mortals. It takes more than six weeks to sit down eight hours a day to just copy the music of the fabulous compositions. Yes, in the hot summer of 1778 when Mozart’s was mourning the death of his mother, and processing his father’s lament and accusation that Mozart killed his mother, because of his ill behavior of leaving the nest and abandoning family,. Reading Maynard Solomon’s biography of Mozart with focus on summer of 1778 leads one to believe in Mozart as a miracle…

There are literally billions of words written about Mozart, his life and music. In addition to Solomon’s book, I have found another respected musicologist and dramaturge, Joseph T. Kerman, Emeritus Professor of Music at the University of California, Berkeley, born April 13, 1924; died March 17, 2014, one month short of 90, whose credible analysis of Mozart’s music is most enlightening. Kerman, too, has much to say about Mozart’s summer of 1788 and his final composition, Mozart’s Requiem K 626. Is a delight to read.

Readers of this space recall an essay on special children of God, we listed Mozart as follows: “Not four score and seven years before Lincoln’s Gettysburg address, but about ten thousand years ago, the age of Neolithic man, God set out to send man 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. The 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.” Yes, in my view, Mozart, a flawed human was basically a divine prophet. With unparalleled beauty and sublimity, he was ordained to fulfill what Bach started with Clavier Book I and Book II. We also recall in the essay in this space on Thomas Jefferson and his fondness for music, how he arranged to meet Mozart. Jefferson had planned to ask Mozart to compose a piece in memory of Jefferson’s late beloved wife, Martha Wayles Skelton Jefferson, very much like Bach’s commissioned pieces by the Goldberg family The Goldberg Variations. However, Jefferson was turned off by Mozart because of his “ineptness and lack of grace… The gentleman is socially uncouth and frivolous…” Jefferson said. Yet, Jefferson loved Mozart’s “heavenly music” and traveled long distances to listen to professional performances of Mozart’s music. References to the relationship between Jefferson and Mozart are at best recondite.

Yes, Mozart belongs to the circle of Gods in the distant cosmos of tomorrows…We are thankful for having Mozart, and today, with acute awareness of the gift of Mozart, we mourn his death, but enjoy celebrating his music.

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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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Brain and Behavior Part II On Epigenetics…and Faith

“Monday Musings” for Monday January 15, 2018
Volume VIII. No. 2/366
DNA

Epigenetics, Depression Gene, Book of Genesis and Pauline Theology of Faith, Hope, Love and Redemption

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

Faithful readers of this space recall the article on epigenetics that defies Darwinian Theory of Evolution. Darwin asserted that it takes millennia to evolve changes in an organism. The studies of the families in northern Sweden, sparsely populated Norbotten, just six people per square mile, reveal that it takes only a couple of generations to effect evolution. The ancient biblical story in Genesis chapters 41 through 47, which describes the Egyptian Pharaoh’s dream of “seven years of plenty and seven years of famine,” prove to be relevant to the science of epigenetics and the rapid two-generation-evolution-cycle instead of two millennia. Epigenetics, a 21st century science, is the study of changes in gene activities that does not involve alteration to the genetic code but is passed down to successive generations. Many scientists including British colleague, neurologist/polymath, Raymond Tallis, a former Meymandi Fellow, National Humanities Center, call this phenomenon as “Darwinits.” Here is a summary of research described previously.

In the 19th century, a province in northern Sweden called Norrbotten literally experienced seven years of famine followed by good harvest and abundance of food. The feast and famine period that occurred in this sparsely populated province (only six people per square mile) has offered astonishing epidemiologic and scientific data that have given birth to the science of epigenetics. The years 1800, 1812, 1821, 1836, and 1856 (the year of potato famine in Ireland) were years of total crop failure and famine for the people of Norrbotten. But in 1801, 1822, 1828, 1844, and 1863, there was excellent harvest and an abundance of food. Scientists of the renowned Karolinska Institute, Stockholm, Sweden, have undertaken the painstaking work of evaluating this history of famine and feast to see how it affected the lives of the children born then.

They have found that “life conditions could affect your health not only when you were a fetus, but also well into adulthood,” concluding that parents’ experiences early in their own lives change the traits they pass on to their offspring. The result of the study shows that the years the children were well fed, their own subsequent offspring grew up to be healthier and physically bigger. Epigenetics makes it possible to enhance the activities of the good genes and silence and discourage the activities of the bad genes. The task is not very difficult. To chemically flip the “good” switch on, one must introduce a methyl group (CH3) to the side chain of DNA—a very simple procedure; or vice versa, to flip it off, introduce a demethylate compound to suppress the activities of the bad genes. The exciting science of epigenetics is very much like a switch on the outside of the genetic circuits and genome that influences the behaviors of a gene. The very prefix epi, which means to lie outside of the root structure, helps explains that, while not an integral part of an organism’s genetic code, epigenetics can influence the gene’s activities from the outside. Flipping the switch enhances (turns a gene on) or inhibits (turns a gene off) DNA activity.

Now we are learning that genetic configuration and longevity of a cell is very much related to telomeres. In 2009, Elizabeth Blackburn, Jack Szostak, and Carol Greider, won the Nobel Prize in Physiology or Medicine for their elucidation of the structure and maintenance of telomeres (the tips of chromosomes). These investigators discovered that telomeres are DNA sequences with a structure that protects chromosomes from erosion and that a specific enzyme, telomerase, is involved in their repair after mitosis. In daily psychiatric practice one wonders why the incidence of suicide is so high in so many families irrespective of socioeconomic and religious orientation. Here is an examination of depression.

Is there a depression gene?

Suicide of Ali Reza Pahlavi, 44 year old son of the late Shah of Iran (Jan. 4, 2011) which followed by the suicide of his sister, Leila Pahlavi in 2001, has stirred many questions regarding the genetic aspect of depression. We have known depression as a distinct clinical illness since the days of Hippocrates (460 BC-370 BC) and Galen (129 BC-217 BC). It was called melancholia with the fascinating etymology of melon, black; cholia, colon, or black bowel. The ancient clinicians thought the origin of depression was in the intestines.

It was not until the Persian physician-polymath, Abu Ali Sina (Avicenna 980-1037 AD) and Abū I-Walīd Muḥammad bin Aḥmad bin Rušhd (Averroes 1126 – December 10, 1198), and contemporary colleague, the Jewish physician, Rabbi, theologian and philosopher, Moses Maimonides of Cordoba (Rambam 1135-1204) who stirred up academic kerfuffle and forwarded the basic thesis that depression had to do with the brain and not the gut.

Rambam in 1150, not yet 25, a physician to the Muslim Caliph, described depression, obsessive compulsive disorder (Vasvas), and designed methods of treatment that we today continue to use, namely cognitive behavioral treatment (CBT). Of course, they used many herbs and botanical products. Their pharmacopeia is replete with plants, herbs and roots. Edinburgh University in Scotland, around 350 years ago, created the famous Edinburgh Botanic Garden with nearly 400 acres of plants with the single purpose of copying Avicenna’s pharmacopeia. Avicenna’s medical textbook Canon of Medicine was taught in all European medical schools well into the nineteenth century.

Sir William Osler’s writings have many references to these giants of medicine. Three learned colleagues interested in history of medicine, Mohammad M. Sajadi, MD; Davood Mansouri, MD; and Mohamad-Reza M. Sajadi, MD, of Baltimore, Maryland, have written a comprehensive article in Ann Intern Med. 2009;150:640-643. Visit www.annals.org for further details about the genius of Avicenna as a clinician, teacher, author and polymath. Avicenna’s brilliance continues to shine and give guidance to the teachers of medicine even a millennium after his death. Fast forward to present the clock of medical science and technology.

We now know that DNA provides powerful clues to understanding disease. Data from the National Institute of Mental Health strongly suggest a particular gene may increase the risk of depression. The scientists have found that people with one form of a protein that transports serotonin, one of the many mood-related neurotransmitters, are especially prone to depression when faced with traumatic events, such as alienation, loss of power, country and princely positions. The displacement is especially consequential for members of disposed royalties. In exile, these privileged children often forget their native tongue and do not learn the language of their adopted country which exacerbates the sense of alienation and social isolation. The version of the particular depression gene prevents the neurons (brain cells) from re-absorbing serotonin, which leads to feelings of sadness and negative mood and may make it harder for them to recover emotionally from a crisis. Depletion of the good juices of the brain such as dopamine, indoleamine, serotonin and catecholamine, epinephrine and nor epinephrine leads to depression.

Untreated depression often leads to poor quality of life, addiction to, abuse of, substance and other forms of self-destructive behavior including suicide. Just as there are families predisposed to paucity of brain dopamine and familial suicide, I know of many families genetically predisposed to an abundance of brain dopamine, especially in the Locus Coeruleus and the Limbic system, particularly hippocampus, the seat of memory in the brain. This is the biochemical and neuroendocrinological equivalence of Pauline theology of hope, love, faith and redemption. Fortunate folks with well-endowed dopamine circuitry face adversities and vicissitudes of life with optimism and possibilities.

Science has accumulated enough knowledge about the mechanisms of cognition, mentation and perception and their molecular underpinnings at the synaptic junctions that we can make bold advancement in the area of understanding the nature of depression gene. We reviewed the book by the learned science journalist Sharon Begly, Train Your Mind, Change Your Brain, in which she cited her work with Dalai Lama and the interest His Holiness, has exhibited in neuroplasticity. One of the strongest findings in neuroplasticity, the science of how the brain changes its structure and function in response to input, is that “it is almost magical to observe the ability to physically alter the brain and enlarge functional circuits…” We may have depression genes. But we also have a plastic brain, and chromosomes that have flexible telomere length, even making us live longer. We now are learning the molecular biochemistry and endocrinology of joy, a constant running brook of dopamine, producing Straussian symphonic poem of life.

Let it be known that joy is not the same as happiness. Happiness is the uncorking of a bottle of wine and celebrating an evanescent moment. Joy, on the other hand, is steady, permanent, and life giving. Like a running brook, it is constant and it refreshes. Joy changes the morphology and molecular structure by our brain. And these changes may be brought about by a simple change in our attitude and approach to life. Scientists have shown that by just showing purpose and determination, and by merely uttering positive words and intentions, the level of brain dopamine is raised. Think joy. Read Saint Paul’s writings and replenish your brain’s dopamine.

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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 the Brain and Behavior

“Monday Musings” for Monday January 8, 2018
Volume VIII, No. 2/366

brainps

Brain and Behavior

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

“As humans we can identify galaxies light years away, we can study particles smaller than the atom, but we still haven’t unlocked the mystery of the three pounds of matter that sits between our ears,” said the 44th US President Obama in one of his last White House press conferences. Obama followed up by announcing that he will seek $100 million for brain research in the budget he is presenting to the Congress. He came through with his promise. The research proposal includes approximately $40 million for research at the National Institutes of Health, $50 million at the Defense Advanced Research Projects Agency and $20 million for the National Science Foundation. We have precedence. Scholarship and literature about the brain expanded rapidly, thanks to a federally funded $2 billion-per-year research effort organized by Congress in 1990 dubbed “The Decade of the Brain.” Mind/brain” exploration has also been driven by advances in basic knowledge and by new imaging and biochemical technology. This knowledge and technology allow scientists to watch the brain as it orchestrates the functions of life. Here are a few considerations:

Brain is not just as an organ of mentation, perception, cognition, and memory, but is a marvelous, even mysterious, complex structure. This structure is responsible for our rich repertoire of feelings, such as anger, jealousy, hatred, love, fear, hostility, sadness, compassion, generosity, kindness, guilt, pleasure, altruism, peace and joy. Traditionally, science has been more concerned with understanding mechanisms than with appreciating personal meanings. However, to understand the brain in totality, we must pay attention to both. As a consequence of this attention, we have learned that the brain is also responsible for our complex spiritual and cosmological pursuits. When an outfielder leaps up to snag a fly ball, we admire the ballet-like performance and ponder it. The moment the ball is hit, the outfielder’s brain begins to receive visual inputs. The eye tracks the ball; the brain computes its trajectory. Within milliseconds, millions of instructions are flashed to hundreds of muscles, telling each the exact degree of tension or relaxation required to move the body to the spot where the ball will descend. A flood of signals feeds back to the brain indicating whether each muscle is responding correctly. Finally, in a flurry of rapid-fire calculations that would outstrip the most powerful computer, the brain orders muscles to propel the body upward and extend the arm. Gloved hand and baseball arrive at exactly the same point at the same time. On the other hand, take the case of Rajang Srinivasen Mahadevan, a native of Mangalore, India, who manages to remember the first 31,811 digits of the number pi. This feat is achieved through the function of hippocampus and amygdala (please see my review of the book by psychiatrist and Nobel Laureate Eric Kandel which appeared in this space two years ago), two anatomically small portions of the limbic system and nucleus ceruleus.

What part of the brain is responsible for the sudden and overwhelming feelings of warmth and spirituality that sweep one’s soul when listening to a favorite composer? Does the brain contain the soul? What goes wrong with the dopamine and acetylcholine neurotransmitting systems in the brain of an Alzheimer’s patient with no memory, feelings, or personality, producing the unwelcome transformation of a person into a human object? What happens to the brain’s indoleamine and serotonin system in clinically depressed patients whose pain of living is so great that death becomes welcome? What about the ascetic dervish who fasts for 40 days and finds ecstasy in solitude and meditation? And what goes on in the brain of the violinist Medori (she last performed in Meymandi Concert Hall of Raleigh on January 16 and 17, 2009), who at age six was able to play classical music without looking at the notes?

These are but a few examples of the myriad secrets of this three-pound organ we call the “brain.” The spin-off of the “Decade of the Brain” is a better understanding of its role in healing, spirituality, and wellness. For example, meditation has been shown to enhance healing. It is hoped that our knowledge of the brain will continue to expand and cure for Brain diseases, such as schizophrenia, Alzheimer’s, autism, and other neurologic diseases will be achieved.

The neurophysiology of meditation has been worked out since in studies from London’s Maudsley Hospital, Sweden’s Karolinska Institute, New York’s Columbia Hospital, and the National Institute of Mental Health. Those studies have demonstrated that meditating for 20 minutes, morning and night, decreases oxygen consumption and the heart rate below the heart rate found in sleep. It also increases the blood flow to muscles and organs, decreasing the level of lactic acid and low-density lipoproteins.

The brain—containing 100 billion neurons, 900 billion glial cells, 100 trillion branches, and 1,000 trillion receptors—reacts to stimuli in a series of electrical bursts, spanning a complex map of connections. To keep this fascinating machine functioning and intact, it must be constantly stimulated and exercised. Whether it is calculating an algorithm or memorizing Lorenzo De Ponte’s libretto for Mozart operas, the poetry of Wordsworth, or the prose of Ibn Khaldoun, the brain must keep working to stay alert and fresh.

As physicians, we are blessed with the gifts of intellect and compassion. Our patients are getting grayer. We must encourage them to continue to exercise their brains, and, as their role models, we physicians should continue to be avid “memorizers” ourselves.

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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 Longest Night…

“Monday Musings” for Monday January 1, 2018
Volume VIII, No. 1/365
12222014

The Night of Yalda, more from

Mowlana Rumi (Rumi-nation)

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

There is a syzygy in the holy month of December. The stars are aligned to bring us four events carefully choreographed to produce a cosmic feast. The first event, of course, is Christmas on December 25. The other three events are Winter Solstice, December 21, the longest night of the year, Shab-e-Yalda (see below) and the shortest day of the year. The third event, to some of us equally important, is the birth of Ludwig Van (not Von) Beethoven on December 16 (Please see ‘MM’ December 18, 2027, No 51/3630,and Hanukkah which began at sundown, December 12, 2017. Although not a religious holiday like Yom Kippur, Hanukkah is about rededication to the will of Yahweh. Reading religious holy books including Zoroaster’s Avesta; Hindu’s sacred and magnificent book, Bhagavad Gita; Moses’ Torah, Christians’ Bible, especially Paul’s letters in the New Testament; and Islam’s Qur’an, one becomes acutely aware of commonality of the message of these books: love, duty, responsibility, redemption, promise and possibilities for all humans, for all children of God. Wish you a joyful 2018, an opportune time for self-discovery.

SHAB-E YALDA

December 21 is the longest night of the year. In Mede and Persian history and Zoroastrian tradition, it is a holy night, “Night of Birth”, the birth of Mithra, the God of illumination and salvation. The birth of Ahura Mazda. Persian poets have written extensively about the night of Yalda (Shab-e-Yalda). Here is a stanza from Baba Taher Oryan (950-1019), the mystical Persian poet who roamed the mountains of Hamadan naked:

“Shab-e-Yalda is the longest night of the year,

To have more time to read and learn…
To have more time to worship….
To have more time to reflect…
To have more time to connect with the beloved and
To have more time to nurture one’s soul…”

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

May you have a fruitful and joyous Yalda night

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More Rumi

Low in the earth
I lived in realms of ore and stone;
And then I smiled in many flowers;
Them roving with the wild and wandering hours,
O’er earth and air and ocean’s zone,
In a new birth,
I dived and flew,
And crept and ran,
And all the secret of my essence drew
Within a form that brought them all to view-
And lo, a Man!
And then my goal.
Beyond the clouds, beyond the sky,
In realms where none may change or die-
In angel form; and then away
Beyond the bounds of night and day,
And Life and Death, unseen or seen,
Where all that is hath ever been,
As One and Whole.

(Rumi: Thadani’s Translation)

 

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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 Christmas

“Monday Musings” for Monday December 25, 2017
Volume VII, No. 51/364
GustavoDoreJesusesbajadodelaCruz
Gustave Doré

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

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

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

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

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

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

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

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

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He 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 Beethoven’s Birthday

“Monday Musings” for Monday December 18, 2017
Volume VII, No. 51/363

Liszt_at_the_Piano

Lizst at the Piano, by Josef Danhauser

Holy Week: Beethoven and Al Ghazali’s Birthdays

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

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

Maestro Llewellyn conducted Beethoven ninth on three occasions here in Raleigh which prompted me to write him this note:

Dear Friend, Maestro Llewellyn:

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

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

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

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

Love, Joy and Blessings

AM

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

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

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

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

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

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

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

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

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

 

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On Dix and Mental Health

Monday Musings for Monday December 11, 2017
Volume VII. No. 50/362

dix

Saint Dorothea Lynde Dix

By Assad Meymandi, MD, PhD, DLFAPA*

(Editor’s Note: The city of Raleigh has signed a memorandum of understanding (MOU) with the governing board of Dix Conservancy Park. The project, developing Dix Park, is in full throttle. It is exciting to envision Raleigh to be the home of destination park for the entire state of North Carolina while maintaining the basic commitment to the wellbeing of fellow citizens with brain disease (formerly called mental illness). We celebrate the occasion by dedicating today’s ‘MM’ to the apotheosis of Humanitarianism, Dorothea Lynde Dix, and invite people to visit the Park.

This is not an essay. It is not a column. It is not a “Monday Musings”, it is not a eulogy or encomium. It is a love letter, a love letter to a lady whom I have never met. Yet she has become a central part of my life and career. The lady is Dorothea Lynde Dix, born almost a century and a half before me. I first came across her name “Dix” on a plaque in a hospital ward. It was in the late 50’s. I was a medical student at The George Washington University School of Medicine in Washington DC. Medical students rotated through Saint Elizabeth Psychiatric Hospital for clinical clerkship in psychiatry. I was assigned to “Dix” Ward which was an acute care admission ward for adults. Little did I know that I would end up in a place called Dorothea Dix Hospital in Raleigh, NC for my psychiatric residency training. Little did I know that someday I would be living on the grounds of DDH when my three sons were born. Little did I know that someday I will be contributing to turning the beautiful 303 acres of land in the middle of downtown Raleigh into a destination park, Dix Park, that would benefit not only Raleigh but the entire State of North Carolina. It is obvious that North Carolina will benefit from Dix Park as NY has benefited from the Central Park.

A brief Bio:

Dorothea Lynde Dix was born on April 4, 1802 in Hampton, Maine. Her father was a fanatic religious man, almost draconian in discipline, which made the sickly Dorothea’s childhood unpleasant. At age 12, little Dorothea left home to live with her grandmother in Boston, and then she went to an aunt in Worcester, Massachusetts. From a very early age, Dorothea was interested in helping people. Afflicted with tuberculosis, she was physically weak. But she over compensated her physical weakness with moral strength, devotion to duty and compassion for the poor and the marginalized.

Dorothea travelled to Europe to get help from British doctors to recover from her deadly affliction. In those days tuberculosis was like Ebola virus or AIDS today. It killed a lot of people. In the course of her travels, on a cold morning in March 1841, she was introduced to the female section of the East Cambridge jail which was full of mentally ill patients. The half-naked inmates, some chained, some in restraints with no beddings or cover, were shivering. The treatment was brutal. The place was extremely dirty with human feces and urine strewn about. The jailer/superintendent told the visibly shaken Dorothea that “the insane do not feel heat or cold.” Dorothea Dix was moved by the sight. She obtained permission to go back and began teaching the inmates Sunday school. Most of the inmates responded to her attention and kindness. She began a campaign of changing the name from inmate to patients. Her success in changing the names was only marginal.

Career:

Dorothea Dix began teaching school at age 14. In 1819, she returned to Boston and founded the Dix Mansion, a school for girls, along with a charity school that poor girls could attend for free. She began writing textbooks. Her most famous book, Conversations on Common Things, published in 1824 is a delight to read. Dorothea was a determined, hardworking and focused person with enormous compassion for the ill, especially for the mentally ill. Tuberculosis had made her weak and often despondent. But she reacted with more vigor and determination to fulfill a mission which she carved for herself, namely improving treatment and living conditions of the mentally ill. In 1848, Dix came to North Carolina to find the condition of care of the mentally ill “despicable”. Through a chance encounter while staying in Raleigh, she met James C. Dobbins of Cumberland County and his wife Louisa. Through her friendship with Louisa, Dorothea persuaded James Dobbins to introduce a bill to create a hospital for the insane, later called Dorothea Dix Hospital. It was her tenacity, discipline, devotion, along with the generosity and thoughtful consideration of NC General Assembly that the land was purchased and the hospital built. Dorothea was a genius in connecting people, identifying and marshalling politicians of influence and persuading them to contribute to her cause. Right in the middle of the Civil War, she lobbied President Lincoln to her cause, creating Saint Elizabeth Hospital in Anacostia, Washington, DC (1855).

Dorothea knew of Lincoln’s psychiatric history and his proclivity to mood disorder and depression. She also knew of Mrs. Lincoln’s emotional and mental difficulties. Cleverly and adroitly, Dorothea used that knowledge and information to persuade President Lincoln to build Saint Elizabeth Hospital. This was in the middle of the Civil War when resources were sparse. Nevertheless, she made the President aware of the need for humane treatment of the “insane”. What a miraculous accomplishment. With these efforts, she single-handedly turned the former jails and snake pits that contained the mentally ill into the clean wards of a hospital setting, with good nutrition, comfortable living conditions, protecting the patients form extremes of cold and heat. In the late 1950s and early 60’s, Dorothea Dix Hospital in Raleigh was a national model for cutting edge research and treatment of the mentally ill.

The original tract of land designated for the hospital project was 425 acres. Throughout the years, 122 acres have been given to NC State University, the Farmer’s Market and building of roads leading to those facilities, leaving 303 acres. On May 5, 2015, the city of Raleigh purchased the 303 acres of land from State of North Carolina for 52 million dollars with the expressed purpose of tuning the tract into a destination park. It took 11 years from the conceptual phase of the project (April 2004) to signing of the document (May 5, 2015) to accomplish the feat. Because of the persuasive energy of Dorothea, the wisdom of 1850s North Carolina General Assembly, and the hard work of a group of contemporary Raleigh leaders, we will have a destination park named for Dorothea Dix. It might be helpful to recognize the collective wisdom of the NC General Assembly which in the past has given us the “Horn tooting” Bill in 1932, birthing the distinguished NC Symphony and another bill to create the NC Museum of Art in 1929. We are grateful.

Future :

While we rejoice the recent transaction between the Governor and the city of Raleigh to create a 303 acres Dix Park, a destination park, we must not forget the patients who suffer from brain disease and chemical imbalance of the brain (I really believe we know enough neurobiology and brain science related to avoid the stigma laden term of mental illness and use brain disorder instead). Our fellow citizens who suffer from brain disease deserve continued care and compassion. We should support National Association of Mentally Ill (NAMI). It is my hope to change it to the National Association of Brain Disorders (NABD).

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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. He Received Raleigh Medal of Art in 2001, inducted into 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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