Category Archives: The Writer

The writer is a Distinguished Life Fellow, American Psychiatric Association, Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill. He is the Founding Editor and Editor in chief, Wake County Physician Magazine (1995-2012).

On the Mind…

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

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Sigmund Freud                                       Carl Jung

Thinking About Thinking, Episteme, Chrestomathy,

Twenty First Century: The Age of Mind, PART II

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

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

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

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

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

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

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

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

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

What To Do?  What is Next?

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

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

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

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

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NC Symphony at the Meymandi Concert Hall

A Few Thoughts on Messiah and Maestro Handel

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

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

Messiah is special in many ways:

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

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

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

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

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

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

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

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

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

 

 

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

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Sir Laurence Olivier’s Hamlet

SHAKESPEARE’S HAMLET

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

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

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

Why Hamlet?

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

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

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

The Psychoanalytic Implication of Hamlet

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

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

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

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

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

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

 

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On Thanksgiving

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

 

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THANKSGIVING 2018

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

To My Dear Family, Friends, Colleagues and Readers:

Thanks for being

Thanks for becoming

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

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

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

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

Thanks for science and the universe

Thanks for Socrates’ elenchus

Thanks for Aristotle’s entelechy

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

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

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

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

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

Thanks for family and connectedness

Thanks for the World

Thanks for eternity

Thanks for transcendence

Thanks for America

Thanks for life, and oh, yes

Thanks for timely death

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

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

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On the Mind

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

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        Marcel Proust                                 Sigmund Freud

mauro mancia

        Mauro Mancia

The Science of Mind,  21st Century Perspective

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Moral Imperative of Casting Our Vote

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

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

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

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

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

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

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

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Report on Dix Park

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

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Progress Report on Dix Park

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

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

Preamble

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

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

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

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

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

Submitted with Respect,

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

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

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

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On Gun Violence…

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

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Gun Violence Control, Where is the Wisdom?

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

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

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

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

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

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

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

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

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

What to Do?

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

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

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On a Few Things..

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

 

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Reflections and Observations

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

Three things I do not understand:

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

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

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

World Chess Championship in Raleigh

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

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

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

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

David Edwards/Le Laboratoire

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

Post Traumatic Stress Disorder (PTSD) and Domestic Violence

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

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

 Repulsive Public Events

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

 Beethoven, The Mysterious Metaphysical Force of Deity

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

An Opera House for Raleigh

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

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

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

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On More Opera…

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

Verdi-photo-Brogi

Giuseppe Verdi

Maestro Giuseppe Verdi’s Otello

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

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

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

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

 

 

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