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 Opera

“Monday Musings” for Monday October 2, 2017
Volume VII, No. 40/351

palais-garnier-paris-opera-house_1

Palais Garnier, Paris

Happy 417th Birthday to Western Opera.

A Few Words About the Opera

and How it Relates to Buddhism and Sufism

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

 In the past few weeks we have had too many topics including Dix Park, Psychoanalysis and Neuroscience, Rash Hashanah and Yom Kippur crowding the calendar.  This week we will be celebrating the 417th  birthday of the Western Opera on Friday October 6.

History of Western Opera

Opera is an Italian word. It means work. In the late 16th Century, a group of Florentine scholars decided to get together every week and study the music and writings of the ancient Greek. They called themselves the Florentine Camarata. It was very much like our modern day book clubs, except that these people were very serious about their work. The culmination of these studies and discussions was Jacobo Peri’s composition of Orpheo which was performed at 8:00 PM, October 6, 1600, at Pitti Palace in Florence. Of course, in 1607, Claudio Monteverdi gave us his version of Orpheo. It marks the beginning of Opera. We have enjoyed 416 years of opera as result of the intense work of this group.

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

Types of Opera

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

Carmen

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

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

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

Opera, Sufism and Buddhism

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

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

In my mind, opera continues to be the most complete art form. It has the greatest capacity for communication and impact per second of any other art form including my most favorite art form, classical music. What I wonder is when, and where, in NC we will see some modern operas, the list of which is approaching 90. I have noticed and admired the Met’ s willingness to add some of the modern operas such as Cyrano de Bergerac with Placido Domingo as Cyrano, Sondra Radvanovsky (Roxanne), and librettist Henry Cain, this season. I yet to see any opera by Michael Tippett, Hans Verner Henze and Olivier Messiaen (I saw his Saint Francois D’Assie in Paris several months ago), and other composers. Perhaps NC Opera will meet the challenge.

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

“Monday Musings” for Monday September 25, 2017
Volume VII. No. 39/351

maimonides

Moses Maimonides

 YOM KIPPUR AND MOSES MAIMONIDES OF CORDOBA

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

Rosh Hashanah, the Jewish New Year, 5778, began on Sundown Wednesday  September 20, leading to Yom Kippur which begins at Sundown September 29, 20117. These ten days of reflection, introspection and atonement are the holiest days of the Jewish calendar. Yom Kippur (Yom means day and Kippur means great–the great day) which is focused solely on prayer, fasting and redemption bears much mystery,.

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

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

Moses Maimonides of  Cordoba

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

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

There is a sweet anecdote at the beginning of Sherwin Nuland’s biography of Moses Maimonides which has to do with Jewish mothers insisting their sons to become doctors, the “My Son, the Doctor” paradigm.

It goes something like this: “Imprisoned in a tower in Madrid, disabled by syphilis and further weakened by abscess in his scalp, The French King Francis asked of his captor, the Holy Roman Emperor Charles V, to send the finest Jewish physician to attempt a cure.” Frances discovered that the doctor sent to him was not Jewish but a baptized Christian. Irate, Francis dismissed the doctor and insisted to be treated by a genuine Jew. That physician may have been Moses Maimonides, brought all the way from Cordoba.

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

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

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

Fred Rosner’s erudite discussion in this  well researched  and meticulously referenced book shows the reader that Moses Maimonides, in his famous trilogy, The Commentary on Mishnah (means ‘repetition’), is the major source of rabbinic Judaism, the Mishneh Torah, and the Guide for the Perplexed traces much of what we know today about effective nutrition, methods of practicing CBT and biofeedback, guided imagery and self-awareness, a discipline he learned from the  work of the Persian physician, Abu Ali Sina, Ibn Sina  or Avicenna  (980-1130) and Saint Augustine of Hippo  (345-420)  (see page 7).

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

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

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, 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 Rosh Hashanah, Yom Kippur, Tishrei and Music

Monday Musings” for Monday September 18, 2017
Volume VI. No. 40/300

rosh

Rosh Hashanah, Jewish Year 5778

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

 

This is a very busy week for calendars of faiths.  Besides Rosh Hashanah,  the beginning of Jewish New Year, Yom Kippur, the most solemn Holy Day which this year takes place on September 29; Tishrei and Sukkot the most joyous day in the Jewish calendar are all crowded in the span of 10 days. Also, there is the Constitution Day on September 17 which most purists, like my household, consider and celebrate as a Holy day in itself. In addition, our beloved North Carolina Symphony starts its 82nd season this week,. Here ae some reflection on each occasion.

Constitution Day

The US Constitution is 230 years old.  We wish it a Happy birthday, its 230th.  On September 17, 1787, the delegates to the Constitutional Convention met for the last time to sign the document they had created. We encourage all Americans to observe this important day in our nation’s history by attending local events in your area. Celebrate Constitution Day through activities, learning, parades and demonstrations of our Love for the United State of America and the Blessings of Freedom Our Founding Fathers secured for us. If you forgot to celebrate the Constitution Day yesterday, it is not too late.  You and your family can do it today,

Rosh Hashanah, Jewish year 5778

Sundown, day after tomorrow, September 20, 2017 will mark the beginning of Rosh Hashanah. The etymology of the word Rosh Hashanah is RAAS (HEAD OR BEGINNING) AL (OF) SENNEH (YEAR or DATE), THUS ROSH HASHANAH, the beginning of calendar.  The Jewish year is 5778 (1st of Tishrei, a joyous occasion for all Jews). Some reflections:

Moses was born 1590 BC, and reportedly lived 120 years until 1470 BC. Scholarship about the birth of Moses, 3607 years ago and Rosh Hashanah, the start of the Jewish calendar 5778 years ago is very interesting. The relationship between the two dates has gone through many twists and turns. The struggles very much remind me of the struggle of C-major and C-minor in Beethoven’s Fifth Symphony, battling back and forth for attention and primacy. The final note is the celebratory C-major coming through triumphantly. The currently perceived resolution of these two competing dates is simply that it was approximately 6,000 years ago when the world’s oldest religions simultaneously began to emerge. Abram of Ur renamed Abraham by the Lord (Genesis 17) had much to do with this remarkable emergence. We could say that this year marks 5778th year of the dawning of the human awareness of God…and the dawn of monotheism. It sends a chill down one’s spine to get in touch with human connectedness and human history. It is regrettable to neglect the fact that all of us Jews, Christians and Moslems are children of Abraham and as such should love one another like brothers and sisters.

Occasions like Rosh Hashanah, Yom Kippur, Islam’s Eid-Al Fetr, celebrating completion of Ramadan, the Muslim month of fasting, worship, and purgation of the soul (was observed on June 25, 2017), Easter Sunday and Purim, the Jewish Holiday that marks liberation of the Jews by Cyrus the Great (Book of Esther), collectively elevate our awareness that we are children of God and regardless of labels that separate us, we are inextricably inter-connected.  We wish everyone not only a joyful 5778 but a fruitful and consequential life. The other holy occasion is Yom Kippur which will begin at sundown onSeptember 29, 2017.

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

 Music: Mankind’s Savior

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

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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 Forgiveness

 

“Monday Musings” for Monday September 11, 2017
Volume VII.  No. 37/349

saadi

Saadi

ON FORGIVENESS

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

Today, September 11, 2017, coincides with the 16th anniversary of the brutal attacks on America.  The attacks were a series of four coordinated areal insurgence by the Islamic terrorist group al-Qaeda on the United States on the morning of Tuesday September 11, 2001. The attacks killed 2,997 people, injured over 6,000 others, and caused at least $10 billion in infrastructure and property damage.  It was a brutal attack on our beloved nation,  The attacks destroyed people and properties but they did not destroy the soul of America.  The National September 11 Museum and Monument are there as eloquent testimony of America’s resolve.  A few reflections on forgiveness:

About a year ago, a 77 year old man came to see me about gradual onset of a devastating depression. Harry (not his real name), always a positive, energetic and productive person, had lost his will to live. He told me that he was experiencing a gnawing sensation at the pit of his stomach. He could not sleep, had lost his appetite causing him to lose a considerable amount of weight. His wife confided in me that she was afraid that “Harry would end it all.” She had carefully removed all firearms from home. This, in itself, caused further escalation of Harry’s anger and irritation. We evaluated Harry and ran appropriate laboratory tests to rule out myriad of physical causes for his depression, including endocrinopathies such as hyperparathyroidism often caused by a parathyroid adenoma, a benign cancer of the parathyroid gland, and others. By the way, this was the cause of the  late US Senator from North Carolina, John East’s depression and suicide, a perfectly curable form of depression by surgery).

In the course psychotherapy, exploring his past and family history, we came across a demon. He casually mentioned that he has not seen eye to eye with one of his sons. As a matter of fact, he became angry that we were spending so much time on that unimportant lost relationship. In the course of therapy, the issue of forgiveness was bought up and explored. Harry took the matter seriously. He had 40 years worth of anger for his estranged son. Finally, as our work progressed, he chose to approach his son. The miraculous process of forgiveness rapidly assisted his total recovery. He became well and was terminated, and his medications were gradually discontinued. In the Christmas card I received from him and his wife, they were thankful to discover the powerful effect of forgiveness. Harry is back enjoying life, being positive, energetic and productive. This process prompted me to write the following essay on “Forgiveness.”

Some Thoughts and Reflections on Forgiveness:

In the ten thousand year annals of Neolithic man, the issue of forgiveness vs. revenge occupies considerable space.  Since Sumerians’ earliest recorded history, the contributions of three stars in the intellectual constellation guide us with their luminosity and brilliance. They are St. Augustin of Hippo, born in 354, the author of City of God and Confessions; Moses Maimonides of Cordoba, born in 1137, author of Talmudic Laws; and Ibn Khaldoun, who penned the definitive Islamic Cannons in 1363 (born 1332, died 1405).  Throughout their work, all three have spoken of grace, stoicism, altruism and forgiveness in the most compelling and persuasive manner. Some believe that the Lord’s Prayer, especially the passage: “Forgive us for our trespasses as we forgive those who trespass against us”, a staple of Christianity, and the only actual piece of literature ever authored by Jesus of Nazareth, is a hand me down from Zoroaster, the 500 BC Persian prophet and author of Avesta, and Abraham. It has been vastly copied by other major religions of the world, namely Judaism, Christianity and Islam. The celestial books of Torah, the Bible and the Holy Quran, each have hundreds of references to the issue of forgiveness and peace. A celebrated Persian poet and Sufi, Sheikh Mosleh-e-Din Saadi Shirazi, born 1210-1290, in his book, Gulestan-e-Saadi, refers to this subject with the most tender words:   “Forgiveness heals, comforts, transforms, preserves, remembers, promises, buries the dead and raises them once again.  Forgiveness refuses to be quiescent until all possibilities have been exhausted.”

Psychologically, forgiveness is altruistic and selfless. Forgiveness does not mix with self-centeredness and narcissism. It takes discipline and selfness to be able to forgive. God created us with the gift of forgiveness, compromise and peace. With recent stunning advances in biochemistry and neuroendocrinology, we have come to know that forgiveness plays a major role in preserving the function and the architecture of our brain, our hearts and our souls. Brain research, in the last half of the twentieth century, clearly demonstrates that feelings of enmity, adversity and anxiety produce undesirable and harmful hormones, specifically beta carbolines and the bad kind of catecholamines that increase blood pressure and heart rate; decreases immune response, and lowers the number of precious T-cells that fight infections. On the other hand, data driven seminal articles in peer reviewed medical magazines such as Archives of Internal Medicine, Lancet and New England Journal of Medicine demonstrate that forgiveness, peace and a sense of spirituality decrease blood pressure, sharpens body’s immune response and lengthens life span.

One of the most overworked words in English lexicon is the word “communication”. It has almost lost its meaning and effectiveness. The tools necessary for achieving the nirvana of forgiveness are understanding and empathy, both of which are achieved through communication, talking, sharing feelings and ideas. Forgiveness is not achieved through virtual reality. Two people must see each other, talk to each other, and possibly touch each other before forgiveness takes place. One must have not only a sense of sympathy for the other person’s pain and discomfort, but empathy, to feel the pain that the other person is experiencing. There are many alienated children, parents, and in laws who fall prey to this circuitous labyrinth of hatred, intolerance and “I will not say a word to that person as long as I live” diatribe. To hate, to resent, and to avoid wastes enormous emotional energy aimlessly directed at draining, depleting and destroying.

The evil acts of September 11, 2001 have posed an unprecedented ethical challenge. How do we, as a decent and civilized nation, respond?  These events have clearly demonstrated that the answer to world ills does not come solely through advanced technology and inflated stock market values. America is the most decent and generous nation on earth. The supremacy of the rule of law, and not of kings, Shahs and Ayatollahs, guaranteeing every American the dignity of individual human right, is unprecedented.

However, In the 1950s, with lingering cold war and the age of Sputnik, America accelerated programs of science, math, and technology. While these advances are essential, we are just beginning to learn that the ultimate answer to the world’s problems lies with better understanding of ourselves and those who hate us. In this terror driven world, we must resolve to learn more about ourselves through introspection, reflection and self- examination. As an act of thanksgiving, it might be a good idea to dedicate ourselves and a portion of our time to be more prayerful, more reflective, more knowledgeable, and more altruistic. Also, it is a good time to go see and call on those family members and friends whom we have long resented. Let’s replace the beta carbolines of our brain with endorphins and dopamines.

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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 Dreams and Mental Health

Monday Musings for Monday September 4, 2017
Volume VII.  No 36/348

on-the-couch

On Dreams, Psychoanalysis and Neuroscience

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

Interest in dreams goes back to Sumerian recordings some 8,000 years ago. There are abundant references to dreams in Torah, the Bible, the Holy Quran, and other celestial books, such as Avesta, the book of Zoroaster, written 500 BC. But it was not until early last century, when Freud published his work on understanding and interpreting dreams, that a firm connection between dream, memory, and “mental” history began to evolve.

Fast-forward the clock. Neuroscientific interest in dreams started in 1953 with the discovery of rapid eye movement (REM) sleep by Aserinsky and Klietman, taking psychophysiologic findings of dream into the realm 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, the enormous 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 Interleukin-1 (IL-1) in Sleep Regulation, Memory, and Brain Regulation.”

This brings me to a most interesting read: Psychoanalysis and Neuroscience, which was edited by Dr. Mancia. 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. This particular work by Mancia, Psychanalysis and Neuroscience [Springer, 436 pages, 2006] is organized into four parts that propose a link between neuroscientific knowledge and psychoanalytic theories of mind.

Overview

Part I—Memories and emotions. Part 1 of the book consists of eight chapters written by experts in their respective fields and examines one basic message: Memories stand out and last longer when they are accompanied and highlighted by emotional experience. The message conveys the importance of interconnection of memory with emotions. With scientific detail and elaboration, the authors demonstrate the proteins in the amygdala and hippocampus are responsible for retention of memories, which are parts of the limbic system that is, overall, responsible for housing emotions, denoting the common neuronic pathway for 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.”

Part II—The shared emotions. The second part of the book examines the sensorimotor side of “empathy pain,” the role of the anterior cingulate cortex in affective pain, and social cognition and response to embodied stimulation.

Part III—The dream. The third part of the book, which is perhaps the most exciting, deals with the dream in the dialogue between psychoanalysis and neuroscience. One chapter dissects the neurobiological and psychoendocrinological anatomy of dreams and memory formation. In recalling events of the past as practiced in psychoanalysis, the brain’s physiology and even anatomy and morphology stands to be changed. This part of the book reminded me of another significant book recently published, Train your Mind, Change your Brain, in which author Sharon Begley, a Wall Street Journal neuroscience reporter, showed how thinking can change the brain functionally and anatomically.

Part IV—The fetus and the newborn. Part IV discusses fetal behavior. While the word embryology is seldom used, the authors of these two chapters examine in detail the onset of human fetal behavior and the neurophysiologic impact and influence of nursing on the early organization of the infant mind.

Discussion

With the knowledge that the basic instrument in the discipline of psychoanalysis is recall of memories, dreams, and transference, the 21 contributors to this book make a good case as to why there should be a robust and constant conversation between psychoanalysts and neurophysiologists. It is time for these disciplines to learn about and from each other. The book’s contributors invite readers, in the most scholarly and convincing manner, to consider that psychoanalysis is a powerful reservoir of volumes of memories and should integrate resources with neurophysiology and enjoy the mutual fertile and rich products. It is the expressed purpose of the book to further elaborate and understand the relationship between memory, dreams, and neurobiological changes occurring during the experience and the course of psychoanalysis. This holy partnership is encouraged, and the book’s contributors, like priests, are willing to bring about this holy matrimony to the world of science.

The downside of the book is that it is a rather difficult read, likely owing to the fact that it is a translated work. I do not know how much education on psychoanalysis and neurophysiology the translator, Mrs. Judy Baggott, has had. To a linguist, such as myself, who is conversant with a variety of Eastern and Romance languages, the slip of the translator shows fairly frequently. Her skirt should be longer! However, this minor flaw should not dissuade anyone from tackling this enormously informative and scholarly work.

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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 Obesity

Monday Musings” for Monday August 28, 2017
Volume VII. No. 35/347

General practitioner measuring waist of obese patient

General practitioner measuring waist of obese patient

THINKING THINGS THROUGH

The Moral Dimensions of Obesity, A Form of Severe Self-Abuse

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

 (Editors’ Note: Today’s ‘MM’ is a letter to an imaginary man of cloth or religious leader, giving us an opportunity to explore a very important social, religious, and health issue, namely obesity).

Dearest friend, man of cloth:

I consider you a combination of pastor, theologian, scholar-teacher-artist with the intellectual gift of balance and reason. So, from time to time, when I am exercised about some issue (the latest was the unacknowledged repeated errors of translation in the 1611 King James Bible) I bring it to you.

As a practicing physician and teacher with added interests in the arts, Christology/Christendom and theology, I have been thinking especially in the past couple of years “How Christian love influences and relates to our health?”.

I know that Christian love clearly teaches us not to be abusive to one’s self, to one’s fellow humans, and not allow others to be abusive to us. Yet we have this ominous epidemic of obesity that is rapidly deteriorating into a pandemic. We abuse ourselves by eating too much and not exercising. The cost of medical care is approaching 20% of America’s gross domestic product (GDP) most of which is spent on preventable disease stemming from obesity.

We go through excuses blaming obesity on various “glandular,” “metabolic,” “ovarian cyst,” as causes. And as of late, the biggest fraud perpetrated by my own medical profession is “genetics” is blamed to make us fat. Of course, genetics does have a place in illness, but it does not excuse gluttony. And we, the doctors and the medical profession, are not sanguine either. We have coined a new disorder, “Metabolic Syndrome” that seems to provide fat people with more excuses for laziness and lack of discipline. Blaming genes is an additional way of making excuses. Admittedly, science shows that genetics plays a role in obesity. Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome. However, they are so rare that they do not register in epidemiologic radar screen. In some rare cases, multiple genes may increase one’s susceptibility to obesity but require outside factors; such as abundant food supply or little physical activity. Another emerging source of blame that I often hear in my practice is finger pointing a member or members of the family, sons, daughters, spouse, or parents. As the late comedian Flip Wilson used to say ”the devil made me do it…” There is no denying that people suffering from obesity need compassionate treatment, understanding, and love. But a serious national conversation should address the deadly epidemic of obesity. And perhaps it should be initiated in our religious institutions by our religious leaders. All said and done, the bottom line is very simple: taking in more calories than are expended accumulates fat. Keeping trim is a personal responsibility.

Traveling through Africa, Rwanda, Somalia, Ethiopia, Eretria, Ghana, Uganda and Sub-Saharan countries, one seldom sees a fat person except for the rulers and government officials, the members of the oligarchies. The new figures published by the US Health and Human Services are frightening. In the US, 80 million are pre-diabetic, with borderline elevated blood sugar and high basal metabolic rate (Basal Metabolic Rate—BMR–of 28 or above.) This figure is substantially more than previously estimated. Add this to the 51 million already diagnosed diabetics and you see that the population is floating in a sea of unused sugar. In the same report, HHS points to the alarming prediction of increase in future incidence of diabetes type II. The rate of increase is not linear, it is not logarithmic. It is exponential.

Type II diabetes has three causes 1) push button easy and sedentary life style. 2) abundance of food and 3) seductive ads on TV and other media. But the over-arching cause is lack of discipline.

The sad part of this life threatening, abominable and expensive illness that often leads to complications of hypertension, cardiovascular disease, blindness, kidney failure and early death, is that it is altogether preventable (except for Juvenile or type I diabetes, which constitutes a very small percentage of the cases.)

Diabetes is a behavioral disease. It may be prevented by controlling one’s weight and by daily rigorous exercise. Patients with type II diabetes are typically morbidly (twice normal weight) obese and have a scripted set of problems in common: bad back and musculoskeletal pain, irritability, slowness and depression, bad heart, high blood pressure and high incidence of addiction to either tobacco and/or alcohol. And they walk around with shopping bags full of medications given by their well-meaning physicians, a pill for each symptom.

Let me make one exception: Patients with psychiatric disorders including schizophrenia who are on psychotropic and antipsychotic medications, especially the third generation antipsychotics such as Risperdal and Zyprexa are vulnerable to pronounced side effect of obesity which they cannot control.  These unfortunate patients require more compassionate care, supervision and rigorous dietary consultation to prevent obesity and heart disease.

Now, my question: what are the church or organized religion’s responsibility, duty and obligation to eliminate this epidemic? And what are the Diocese, the State, the National Council of Churches and other religious organizations are doing to ensure that the clergy is not fat? Is it not un-Christian, unloving and blasphemous for the clergy, the role models for congregations and the moral and ethical leaders in our midst not to have the discipline of trimming down and staying slim? I am glad to report that organized medicine and the doctors have taken impressive strides in this area. You see very few fat physicians walking around!

I would really appreciate your reply.

Sincerely,
Assad 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 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 Music, and a Play

Monday Musings” for Monday August 21, 2017
Volume VII, No. 34/346

260px-Johann_Sebastian_Bach220px-AugustStrindberg

J.S. Bach, by Haussmann                       August Strindberg

Brief Reflection on Bach’s Music  and

Review of  “Miss Julie”, A Remarkable and Consequential Play

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

I.  Bach’s music: I have been asked frequently by friends, especially those friends in mourning for the loss of a loved one, why Bach’s music is so comforting. Here is a brief refection:

Dear Friends:

The evocative question exploring the magic–no, I should say the miracle of–Bach’s music, is joyful to contemplate.  I believe Back’s music is based on the fundamentals of conceptual and structural framework of fugue. In music, fugue is the well-defined contrapuntal compositional technique. A fugue subject is delicately balanced with musical agons that struggle to rhythmically produce not agony but friendship and love. The very formidable skill of producing harmony and love from agons, as Bach has achieved in his hundreds of compositions from, is a miracle.

To understand the mystical appeal of Johann Sabastian Bach’s fugue, one must consider and review the etymology and onomastics of the word fugue. The English term fugue originated in the 16th century is derived from the French word fugue, or the Italian, fuga. This in turn comes from Latin. Also fuga, which is itself related to both fugere (“to flee”) and fugare (“to chase”). The adjectival form is fugal. Variants include fughetta (literally, “a small fugue”) and fugato (a passage in fugal style within another work that is not a fugue).

So, the keyword is flee, and fleeing. Fleeing from what and to what? With his powerful spiritual mission, JSB composed his music suggesting that we flee from the mundane and to, the holy house of transcendence. As a matter of fact, in psychiatry and neurology we have ambulatory states of altered consciousness that is diagnostically called fugue. But medical fugue is a world apart from musical fugue. Yes, I magically flee from the mundane and enter the epistemic threshold of transcendence every time I listen to the music of Maestro JSB.  Thank you dear friends for sending me the pieces by Bach, especially his Matthauspassion, composed in 1727, forgotten but discovered by Mendelsohn in 1829.  We owe Mendelssohn much for this noble deed. My humble prayers are with all the mourners.

Love Joy and blessings,
AM

II.   Review of Miss Julie (Editor’s note: A Raleigh theater performed Miss Julie a dozen years ago.  We are told that it is returning to the stage. It is a remarkable play.  Here are the program notes I wrote for the playbill).

To appreciate and understand this sober and pedagogically significant play, Miss Julie, one must realize that it was written in 1888, in the then very conservative northern European country of Sweden. The country was imbued by the late 19th century Victorian mentality, morality, and social restrictions which permeated the entire of Europe. This was the age where tablecloths had to be long enough to cover the legs of the tables, lest sexuality and eroticism were inferred. It was also, the dawn of existentialism. Soren Kierkegaard, a Danish theologian, philosopher (1813-1855) had already laid the foundation of dealing with “here and now” of which human sexuality was an essential part. Then came Fredrick Nietzsche (1844-1900), who reinforced the notion of confronting the erotic issue head on. In Nietzsche’s biography there is a very passage relating his attending the opera Carmen 23 times, and proclaiming that every time he saw the opera he became a more informed person, a better philosopher and a more consumer of erotic mystic. Existential thinking and vigorous writings continued by Martin Heidegger (1889-1976), and later ushered into the 20th century by Albert Camu (1913-1960) and Jean-Paul Sartre (1905-1980). The roots of this play go even farther in history. It goes back to the “Axial Age”, roughly 200 to 900 BC when diverse philosophical thoughts such as Hinduism, Buddhism, Confucianism and Taoism formed the nucleus of humanities and theater as we know it today.

Miss Julie was a revolutionary play when it opened in 1888. It is in a way like Ricard Strauss’ Salome bringing out all the ugly but realistic side of erotic sex, class, murder and death and laying it on the table. Miss Julie remains one of the foremost naturalistic dramas of all time. It was a groundbreaking work that heralded a new era in modern theater, as Strindberg advocated a lack of intermissions, the use of real props and natural light. It culminated with all the elements of the era’s existentialism, eighteenth century theatre, and opera verismo, along with heightened revealing honesty and iconoclastic class barriers. Today, over 120 years later, the play still has major relevance and emotional impact. Critics believe that it is an amazing play that “still terrifies with its insoluble equation of sex, class and death.” The play offers a synopsis of human psychosexual development, examines the pedagogic succession of human affect, behavior and mental content of the landscape of unconscious.Some historians and dramaturges believe the play carries a good bit of the playwright’s own life and biography.

Born in Stockholm, August Strindberg (January 22, 1849- May 14, 1912) was born to a woman who was twelve years younger than his father. She is identified as a “servant woman” in the title of his autobiographical novel, Tjänstekvinnans Son (The Son of a Servant). The humble background heavily identifies him with Jean in the play.  This speculation is reinforced by the fact that his aunt Lisette was married to the English-born inventor and industrialist Samuel Owen. The entire family was socially ambitious. They wanted to break out of the social class restraint and enter higher rungs of the society. For example, August’s brother, Johan Ludvig Strindberg became a successful, wealthy businessman. It has been seen as the model for the main protagonist Arvid Falk’s wealthy and socially ambitious uncle in August Strindberg’s novel Röda Rummet (The Red Room). August became a very successful writer, wealthy by the late 19th century standards. Many argue that his autobiography should be taken with a grain of salt, because it is perhaps more a reflection of his ambitions of where and what he wanted to be, or what he wished for his readers and viewers  perceived him to be. And he had the talent and verbal skill as a writer and orator to succeed. He was a diluted Swedish version of our Samuel Clements. Many refer to him as the Mozart of the letter. He wrote over one hundred books, plays, essays, scholarly dissertations and poems. I remember seeing his portrait in Stockholm’s subway, and his statue by Carl Eldh, which graces one of the major squares of the city. He died from cancer, age 63, in Stockholm.

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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 Puccini

Monday Musings, August 14, 2027
Volume VII,  No. 33/

La Scalla

La Scala

Opera Season is Coming: Some Random Thoughts

Giacomo Puccini:  A Personal Glimpse

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

This is not a scholarly dramaturgical and psychoanalytical critique of the Western opera.  But I thought it would be fun to offer some random thoughts on several popular operas primarily those created by Puccini.  No, I am not an authority on Puccini and his compositions.  Many scholars and psychobiographers of Puccini,  including the renowned music critique Joseph T Kerman, while enjoying Puccini’s music, refer to it as cheap, vulgar and anti-intellectual.

Personal observation:

I love Puccini’s operas and his music. I grew up with vivid stories and memorabilia of giants, like Puccini, Rimsky-Korsakov, Rachmaninov, and Aram Khachaturian, etc., who had visited my hometown of Kerman.  We had hand-cranked phonographs playing the music of these giants which filled the halls and our living quarters with their music.  I remember, as a child, almost every night my mother read the stories of A Thousand and One Nights to me as Korsakov’s Scheherazade played in the background.  Often, my mother, a high palate amateur signer, herself, would belt out and sing along.  Growing up in a rich environ where music, words, languages and prayers were prominent, was most gratifying.  My mother, whom we all called Jambeebee, the “reigning lady of the world”, died in 1994 at the age of 101.

Brief biography of Puccini and Onomastics of Turandot:

Giacomo, ok, Giacomo Antonio Dominico Michele Secondo Maria, was born in Lucca, Italy, on Dec 22, 1858 to a well to do family.  He completed his studies at Milan Conservatory, 1880 to 1883.  He composed 12 operas.  His first, Le Willis in 1884, was a flop (so were Verdi’s firsr few operas including Oberto, conte di San Bonifacio and Un giorno di regno).  Puccini’s last, 12th opera was Turandot, a most brilliant work that to some surpasses the magic of Verdi’s Aida, by the way,

Onomastics of the word Turandot

Turan means China. Dot, short for dokht means daughter.  So Turandot means daughter of China or a Chinese young lady,  Puccini and his able librettist, Alfano, while researching material for Turandot, went to Persia after WWI, the purported birth place of the Unknown Prince Calaf, the hero in the opera.  Legends have Calaf born in and raised in Kerman, Persia, my hometown.  Finally, with collaboration of his faithful librettist, Pianist Franco Alfano, he started to produce the opera. Unfortunately, he died in 1924, leaving Turandot unfinished.  But the power of friendship and fidelity prevailed.  Alfano, completed the opera.  it was staged in 1926.

A brief history of Puccini’s 12 operas:

Tosca was Puccini’s seventh opera sandwiched between his other two enormously successful operas, La Boheme and Madama Butterfly. Tosca is in three acts. Puccini started composing it in 1895 and completed it by 1897. It is a story of love, despair, resolution, unselfishness, hope and redemption. Tosca has been in the repertoire of opera houses around the world, and continues to be a “work horse.”  I know that Palais Garnier, the Paris Opera House has performed it more than 300 times in its 305 years of existence. Sicily’s. The Palermo Opera House, Teatro Massimo is the best place to view Puccini and Rossini operas.  La Scala Di Seta, had Tosca in the repertory scheduled tis coming fall.

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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 State of US Healthcare

“Monday Musings” for Monday August 7, 2017
Volume VII, No. 32/344

 240px-Duke_Chapel_4_16_05

Duke Chapel

America’s Health Care System is a Mess

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

There is one constant thread that runs in all of the Socratic dialogues and that is: Socrates always asked his interlocutors “what do you do? What are you selling? How are you making a living?  And above all, how are you measuring your success?”  I think the master’s method of 2300 years ago, is applicable to today’s American medicine.  We really do not know the value of our treatments to our patients.  We do not know how to measure health gain.  All this result in less focus on improving health and more on minimizing cost.

Medicaid expenses are bankrupting the county governments, especially small rural counties throughout NC and the nation.  Medicaid cost is eating into education and public health budgets.  Medicare rules conceived by what appears to be chaotic minds of a group of bureaucrats known as health policy makers, running around with no direction, are crippling to the practicing physicians who are taking care of patients. The focus is to contain and minimize cost.  No attention to improving health.  We are an illness-oriented system.  We need to become or be transformed to a health-oriented system.

In a book generated by Washington DC’s American Enterprise Institute, “The Diagnosis and Treatment of Medicare”, authors Andrew J Rettenmaier and Thomas R. Saving describe the ills of Medicare and seek solution to the problem.  In fairly intelligible and clear language, much of this 179 page book’s 14 chapters is spent on outlining the two basic problems with the Medicare system:

1)  Medicare simply can not afford to provide coverage for elderly health coverage, especially with the baby boomers approaching retirement age.

2)    There are no limits on payment of claims submitted to Medicare by health providers and clinicians.  The system lacks rigorous accountability and transparency.

3)    The system lacks means-testing.  A Mr. Rockefeller, if 65 and over, may not pay for his care out of his pocket.  He is obliged to go through the system and file papers for his treatment.  Means-testing is a very useful instrument to lighten the burden on Medicare.

At the end, the book does not offer any serious and systematic solution to the Medicare system that is universally known and agreed upon.  America’s health care system is like a patient in an Intensive Care Unit (ICU).

I submit that the ultimate solution is to focus on health and the turn the medical care system to a huge public health/prevention machine.  Prevention should be paramount in medical curriculum, medical practice and medical clinics.  Like Socrates, we need to constantly ask ourselves what is it that we do, how can the efficacy of what we do be measured, and how can we avoid the slippery slopes of medical profession becoming a commodity, business or industry?

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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 Parkinson’s

“Monday Musings” for Monday July 31, 2017
Volume VII. No. 31/343

Science Series
No. 87

j_parkinson

James Parkinson

Parkinson’s Disease

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

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. 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) the 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 excercising. And if you do not have DP 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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