On Parkinson’s Disease

Monday Musings” for Monday July 16, 2018
Volume VIII. No. 29/393

Science Series
No. 87

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          James Parkinson

Parkinson’s Disease

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

(Editor’s Note:  The response to the last week’s column on Alzheimer’s disease was unprecedented. We thought it appropriate to offer a follow up on another debilitating brain disease, namely Parkinson’s disease. This conludes our six part sries on Brain and Behavior,  First a brief history:

Parkinson’s disease (PD) was originally diagnosed by James Parkinson, a British neurologist in 1817. We do have evidence that as early as 12 century BC, Egyptians knew about the disease and wrote on papyrus about a king drooling with age. Also the Bible contains a number of references to tremor. An Ayurveda medical treatise from the 10th century B.C. describes a disease that evolves with tremor, lack of movement, drooling and other symptoms of PD. Moreover, this disease was treated with remedies derived from the mucuna family, which is rich in L-DOPA. Galen wrote about a disease that almost certainly was PD, describing tremors that occur only at rest, involving postural changes and paralysis.

In 1817 James Parkinson published his essay reporting 6 cases of paralysis agitans, An Essay on the Shaking Palsy, that described the characteristic resting tremor, abnormal posture and gait, paralysis and diminished muscle strength, and the way that the disease progresses over time. He also acknowledged the contributions of many of the previously mentioned authors to the understanding of PD. Although the article was later considered the seminal work on the disease, it received little attention over the forty years that followed. Nevertheless, early neurologists who made further additions to the knowledge of the disease include Trousseau, Gowers, Kinnier, Wilson and Erb.

Of all these early diagnosticians the most important was Jean-Martin Charcot whose studies between 1868 and 1881 were a landmark in the understanding of the disease. Among other advances he made the distinction between rigidity, weakness and bradykinesia. It was Charcot who championed the renaming of the disease in honor of James Parkinson. In America, there are more than four million patients afflicted with this dreaded and deliberating disease.

James Parkinson (1755-1826) was a polymath. He had vast academic interest in all branches of science, including, geology, environment, medicine specializing in neurology and diagnostics  He held several doctoral degrees. He held strong views of social issues as an activist, and argued with the then British Prime Minister, William Pitt, in support of universal suffrage. His 1817 seminal paper on the topic of paralysis agitans continues to be used to describe Parkinson’s Disease, the clinical features of which are intention tremor, and others listed below.

Diagnosing Parkinson’s s disease is through observation.  It really does not require a million dollar workup to make the diagnosis.  Here are some of the signs and symptoms:

Tremor or shaking, usually begins in a limb, often your hand or fingers. You may notice a back-and-forth rubbing of your thumb and forefinger, known as a pill-rolling tremor. One characteristic of Parkinson’s disease is a tremor of your hand when it is relaxed (at rest).

Slowed movement (bradykinesia). Over time, Parkinson’s disease may reduce your ability to move and slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk, or you may find it difficult to get out of a chair. Also, you may drag your feet as you try to walk, making it difficult to move.

Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can limit your range of motion and cause you pain. Exercise both aerobic and anaerobic is important to fight rigidity.

Impaired posture and balance. Your posture may become stooped, or you may have balance problems as a result of Parkinson’s disease.

Loss of automatic movements. In Parkinson’s disease, you may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.

Speech changes. You may have speech problems as a result of Parkinson’s disease. You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections.

Writing changes. It may become hard to write, and your writing may appear small (micrographia)

 Brain Lesions

The research neuroscientists who work on the brain talk a lot about neurological diseases such as Alzheimer’s Disease (A-D) and Parkinson’s Disease (PD) as the proteins in the brain become misfolded. This misfolding phenomenon occurs with tau protein and “goo”/amyloid junk-like stuff by misfolding the amyloid cluster into larger plaques. The plaques kill the brain cells. In (PD) the protein called alpha-synuclein clumps in similar fashion. Other protiens called prions clump in conditions like mad cow disease which is a form of animal PD.

Basic Facts of Brain Structure and Function

Way back (and down) approaching the spinal column sits the brain stem. It is an important part of the brain that produces neurohormonals and chemicals that are responsible for sleep. Much research is concentrated on brain stem to find a safe sleeping aid for billions of people who have sleep disorder. Another part of the brain which is responsible for being awake and alert is the thalamus. A third important structure that plays a majorrole in PD are the basal ganglia (plural for ganglion). In PD, the structure of the basal ganglia is attacked and erosion takes place. Again, the destruction is by misfolding of alpha-synuclein protein.

Treatment is basically by use of anticholinergic drugs, L-dopa or L-dopa like chemicals and dopamine agonist (re-enforcers). Physical exercise is very important in the management of PD. More recently electrical stimulation of the brain has gained ground. If you do have PD, please devote yourself to exercising.  Neurology literature recommends boxing–yes boxing–the abhorred pugilistic sport, as a very helpful treatment for Parkinson’s Disease. And if you do not have PD devote yourself to exercising, anyway.

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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 Brain

“Monday Musings” for Monday July 9, 2018
Volume VIII, No. 28/392
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On the Brain and Behavior, Part V

Editor’s Note: This is part V of a six part series on Brain and Behavior. In Part I, the general topography and physiology of the brain was discussed. In Part II, the topic of Epigenetics was explored. In Part III, the emergence of ‘Age of Mind’, the marriage between psychoanalysis and neurosciences was examined. Part IV, we offered an example of such marriage in the form of a book review to enhance our understanding of what lies in the future of the union of psychoanalysis and neuroscience. Today, Part V and next Monday, Part VI, we conclude the series by offering clinical examples of two dreaded brain diseases, namely Alzheimer’s and Parkinson’s Disease.

Alzheimer’s Disease, The Latest

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

News from the recent meeting of The World Association of Alzheimer’s Disease. Alzheimer’s Disease is a heartbreaker. Some reflections, but first a bit of history:

Brief History:

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

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

Clinical course:

Alzheimer’s disease is brutal. It robs the afflicted of experiencing joy, communication, and connection with life. The patient turns into a zombie. Most important loss is loss of dignity and nobility of the soul preceded by urinary and fecal incontinence. We now have 5.7 Americans suffering from this disease (worldwide over 100 million). It is more prevalent in women because of female hormonal and body chemistry. There may be accompanying mood disorder such as depression; or behavior disorder such a s violence; and thought disorder such as paranoia and delusions.

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

Diagnosis and treatment:

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

Chemical Treatment:

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

The latest News in treatment of Alzheimer’s Disease

Last week the scientific journals form England, Sweden and USA reported the synthesis of a drug, manufactured by Biogen and Eisai pharmaceuticals, code-named BAN2401, which has demonstrated its effect in slowing the progression of the disease. However, not to spread false hope, we are quoting Lon S. Schneider, a sober and non-hysteric Alzheimer’s researcher at the University of Southern California’s Keck School of Medicine, “not to read too much into Eisai an Biogen product…” BAN20401 has not shown clinical benefits in subjects at 12 months of treatment/ We will provide our readers with periodic updates

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

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

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

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

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On Thomas Jefferson

“Monday Musings” for Monday July 2, 2018
Volume VIII. No. 27/391
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Happy July 4th! Natal Anniversary of America and Mortal Anniversary of John Adams Thomas Jefferson -What Kind of Music Uncle T.J. Liked?

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

We are interrupting our six part series on brain and Behavior to salute our beloved America’s birthday. We will resume the series next week

Happy 242th birthday to our beloved nation. We thought it is fitting to honor the US flagby flying it in today’s “Monday Musings”. On July 4, 1826, on the 50th golden anniversary of signing of the Declaration of Independence, John Adams died. Historians put his death at around 9:00 AM. Adams and Thomas Jefferson, political arch enemies for decades, had reconciled and become good friends and pen pals in the last two decades of their lives. They exchanged more than 300 letters before that fateful day, July 4 1826. According to reliable history, Adams’ last words were “Thomas Jefferson still survives…” not knowing that Thomas Jefferson too had died that morning at age of 83.

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

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

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

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

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

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, 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 Brain

Monday Musings” for Monday June 25, 2018
Volume VII, No. 26/390

Eric_Kandel_01

Brain and Behavior

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

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

Part IV
IN SEARCH OF MEMORY

THE EMERGENCE OF A NEW SCIENCE OF MIND

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

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

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

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

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

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

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

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

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

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

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

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

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

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On Brain Series

“Monday Musings” for Monday June 18, 2018
Volume VIII. No. 2
5/389

DNA

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

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

Part 2

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, 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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“Monday Musings” for Monday June 11, 2018
Volume VIII. No. 24/388

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

 Father’s Day

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

We interrupt our series on Neuroscience “Brain and Behavior” to observe Father’s Day which is coming on Sunday, June 17, 2018. We will resume the neuroscience series next week.  Now a few reflections on Father’s Day

:Brief History

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

Father vs. Dad

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

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

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

Personal Memories

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

What to Do?

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

Happy Father’s Day to all.

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

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

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On the Brain and Behavior

“Monday Musings” for Monday June 4, 2018
Volume VIII, No. 23/387

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Brain and Behavior

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

Brain and Behavior, Part one

“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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“Monday Musings” for Monday May 28, 2018
Volume VIII. No. 22/386

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Memorial Day, Pericles, Abraham Lincoln, Gettysburg Address

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

Today is Memorial Day. Some reflections:

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

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

The Origin of Memorial Day

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

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

The Gettysburg Address, Lincoln’s marvelous use of words loaded with religious and Biblical symbolisms such as “fourscore, dedicate, consecrate, hallow, and sacred ground” invoked the spiritual dimensions of his persuasive message. And Lincoln did not have a team of speech writers and spin artist pollsters on his staff… In contrast, it is unclear to us why the ill-defined Iraq and Afghanistan wars now going on 15 years, at a cost of thousands of lives, and the expenditure of hundreds of billions dollars, continue. America is still waiting for an explanation of why we are there. Would not it be nice if we had a living Lincoln who could use 272 words to give us this reason?

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

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

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

 

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On Wagner’s Birthday

 “Monday Musings” for Monday May 21, 2018
Volume VIII, No. 21/385

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                                                                 Bayreuth Margravial Opera Stage

Happy Birthday to Richard Wagner: A Few Thoughts about Opera

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

Tomorrow is Richard Wagner’s 205th birthday (May 22, 1813- February 13, 1883). We celebrate his natal anniversary with joy and some added reflections: Wagner was a German musician, opera composer, and a disciple of the German philosopher Arthur Schopenhauer, (Feb 22, 1788- September 12, 1860) with whom he split over the issue of “toleration”. Wagner was truly a genius. But he hated the Jews and the Italians, all of whom he called barbarians. He also hated the word opera because it is an Italian word and he thought Italians are of a lower race. Instead, he called his work “Music Drama“. Wagner was a contemporary of Verdi (October 10, 1813-Jan 27, 1901), the world famous and renowned Italian Opera Composer. Toward the end of his life, Wagner had a change of heart about Italians and had some good things to say about Verdi. But he remained a staunch anti-Semite.

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

He also architecturally created the Bayreuth Opera House where his work was produced and staged.  After 201 years, almost all of his operas including Flying Dutchman, Ride of Valkyries, Tannhauser, and Die Meistersinger Von Numbergare a steady diet of most opera houses and symphonies throughout the world. several years ago, the North Carolina Symphony played in the first half of the program, Prelude to Act I, Lohengrin. The second half featured the memorable performance of virtuoso violinist, Itzhach Perlman playing Violin Concerto in D Major, Opus 35, by Peter Ilyich Tchaikovsky. As an aside, on May 12, 2015, the world renown violinist, Joshua Bell, played Jean Sibelius’ Concerto in D minor for Violin and Orchestra, Opus 27, with North Carolina Symphony to a standing room only crowd in Raleigh’s Meymandi Concert Hall. And there will be a special program of classical music with Conductor Grant Llewelyn featuring Joshua Bell this coming fall. Raleigh has an extraordinarily rich cultural life.

Back to Wagner:

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

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

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

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

On the local scene in Raleigh, the transfer of Dix property to the city of Raleigh was accomplished on May 5, 2015.  A group of citizens is working very hard to create a world class destination park on the 303 acres of land in the heart of downtown Raleigh for all to enjoy.  Personally, I am looking forward to the day we will have an opera house built on Dix Park, NC’s Central Park. With such a venue, we can not only do the more lavish and demanding Wagner operas, but stage some modern operas the list of which is approaching 90. I have noticed and admired the Met’s willingness to add some of the modern operas such as Cyrano de Bergerac with Placido Domingo as Cyrano, Sondra Radvanovsky (Roxanne), and librettist Henry Cain. I have yet to see any opera in America by Michael Tippett, Hans Verner Henze and Olivier Messiaen (I saw his Saint Francois D’Assie in Paris several years ago), and other composers.

Meantime, Happy 205th Birthday to Richard Wagner!

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

 

 

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On Gun Violence

Monday Musings for Monday May 14, 2018
Volume III, No. 20/384

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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 nearly 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.

There is a glimmer of hope.  UNC system President, Dean of UNC School of Medicine at Chapel Hill, Dr. William Roper, and WakeMed administration have agreed to provide a psychiatric unit of 40+ psychiatric beds for Wake County.  With the projected population growth in our area, to do an adequate job, we need a facility with 500 psychiatric beds.

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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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