On the Legacy of Dietrich Bonhoeffer

Monday Musings for Monday April 9, 2018
Volume VIII. No.15/379


Dietrich Bonhoeffer – His Legacy of Noble Writing, Justice and Moderation

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

We could not let April to pass without remembering the phenomenal life of theologian Detrick Bonhoeffer:

Seventy three years ago, April 9, 1945, on a gray morning during Easter week, Dietrich Bonhoeffer was hanged. He was 30. Germany was on the verge of total defeat. But Hitler’s killing machine was still operating. Bonhoeffer was charged as a traitor to Hitler and to the Nazi regime. We are dedicating today’s “Monday Musings” to honor the memory of this outstanding scholar, theologian, Lutheran pastor and writer. Bonhoeffer was the son of a well to do and prominent German neurologist, professor of neurology and psychiatry at the University of Berlin and the director of the psychiatric clinic at Charité Hospital in Berlin, Dr. Karl Bonhoeffer. Dietrich, with his twin sister, were the fifth and sixth of eight children. His mother, Paula von Hase, was a daughter of Klara von Hase, a Countess by marriage who had been a pupil of Clara Schumann and Franz Liszt Paula was a college graduate and home-schooled the children. The family was full of classical musicians and music advocates. He was in America in 1930, and later pastored miners and common people in Barcelona as a pastor and not academic theologian. He was interested in ecumenism. He concentrated on removing and neutralizing Hitler and his despotic regime.

Dietrich was an exceptional pianist, and his parents thought he might pursue a music career. He was also athletic and played championship tennis and chess. He was expected to follow his father into neurology and psychiatry, but he surprised and dismayed his parents when he decided by age of fourteen to become a theologian and later a pastor. When his older brother told him not to waste his life in such a “poor, feeble, boring, petty, bourgeois institution as the Church”, 14-year-old Dietrich replied: “If what you say is true, I shall reform it!” What we learn from his later life, he was a martyr, too. Just like Socrates who had a chance to escape the prison where he was awaiting death sentence on charges of corrupting the youth of Athens, Dietrich, too, had a chance to accept the help of the World Council of Churches and flee to US. But he did not. He waited his trial, spending two years in jail before his execution. During his time in jail, he wrote a series of articles and treatises about human rights and humanities that approach Socratic dialogues in their eloquence and Plato’s Republic in the beauty of poetry and linguistic supremacy. From prison, he also wrote love letters to his twin sister. The collection of these letters and the ones written to other members of his family and friends provide superb reading to understand the potential strength of conscience and man’s devotion to the truth. And the truth to him was that the Nazi Regime was despotic in need of elimination. He was a participant in the German resistance movement against Nazism and a founding member of the Confessing Church. His involvement in plans by members of the Abwehr (the German Military Intelligence Office) to assassinate Adolf Hitler resulted in his arrest in April 1943 and his subsequent execution by hanging in April 1945, 23 days before the Nazis’ surrender. However, recent research now challenges the assumption that he was directly involved in the assassination attempt. His view of Christianity’s role in the secular world is well-known. He did not advocate theocracy, but strongly suggested that humanity ought to be governed by laws that are fair, righteous and moral. As a matter of fact, the last thing he did before approaching the gallows, he was reading from his pocket edition of Plutarch, and was quoting from Bible. Faithful readers of this space recall that we reviewed Plutarch book “Moralia”. Dietrich Bonhoeffer was reading passages from that book before his execution.

Bonhoeffer has written 25 books all worth reading and re-reading. From the collection, I find myself going back to two volumes, Act and Being. Like any classic literature, Bonhoeffer’s writings have a theme, are written with elevated and noble language, and change the lives of the readers. His pen continues to speak to us today. There are a number of credit worthy biographies of Bonhoeffer in circulation, the latest of which is by Eric Metaxas. Eric’s writings are insightful.


*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, Life Member, American Medical Association; Life Member, Southern Medical Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is the recipient of the NC Award, Fine Arts.

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On “Giants”

“Monday Musings” for Monday April 2, 2018
Volume VIII, No. 14/378


Five Formidable Geniuses

By Assad Meymandi, MD, PhD, DLFAPA*

(Editor’s Note: Stephen Hawking was an English theoretical physicist, cosmologist, author, and Director of Research at the Centre for Theoretical Cosmology within the University of Cambridge. He was afflicted with amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), a fatal neurodegenerative disease. He died a few weeks ago on March 14 2018 at age 76. To honor his memory, we are re-running below. Unlike Sir Isaac Newton, Sir Stephen Hawking was a kind, humerous, humble and compassionate gentleman. His loss creates a permanent vacuum in the august temple of human intellectual possibility.}

Book Review

On the Shoulders of Giants
By Stephen Hawking
1266 pages
Running Press Book Publishers
Philadelphia, Pennsylvania

Dramatis personae of this huge volume, 1266 pages of dense texts, physics, mathematics, geometry, functions and calculus, along with warm humane and human stories are five characters. They are Nicolaus Copernicus, (1473-1543), Galileo Galilei (1564-1642), Johannes Kepler (1571-1630), Sir Isaac Newton (1642-1727), and Albert Einstein (1879-1955). I presume the title of the book is from a letter Sir Isaac Newton wrote on February 5, 1676 to his bitter enemy Robert Hooke, which contained the sentence “if I have seen farther, it is by standing on the shoulders of giants.” Of course Robert Hooke, the greatest experimental scientist of the 17th century is relegated to the dustbin of oblivion and burned out of sight by the brilliance of Sir Isaac Newton. This is perhaps the reason one seldom hears the name Robert Hooke. Some biographers and historians have interpreted Newton’s letter to Robert Hooke as a thinly veiled insult to Hooke, his crooked posture (we do not have a picture of Hooke, but have hundreds of Newton’s), and short stature which made him but a giant…

One of the exciting aspects of this book is that the writings by these five giants on whose shoulders the author, Stephen Hawking proposes subsequent physical scientists have stood, are translation of the original copy. No attempt has been made to modernize the authors’ own distinct usage and spelling or punctuation. As a former United Nations translator, I personally appreciate the discipline of keeping the text pure and uncontaminated by interpretation. The book has an introduction penned by Stephen Hawking, a renowned theoretical physicist. Like Sir Isaac Newton before him, he is a Lucasian Professor of Mathematics at Cambridge. Faithful readers may recall our review of his 1988 book A Brief History of Time which remained on the New York Times bestseller list for a record breaking 237 weeks. His other more recent bestseller book is The Universe in a Nutshell. He enjoys the reputation of being the most brilliant theoretical physicist since Einstein. But this book is not only about dry and inflexible raw science, the pages are imbued with human history, personal relations, and warmth which reflect the author’s personal humanity. The life story of each of the five heroes is full of accounts of their growth, adolescence, falling in love, marrying and settling down to raising a family. For example, here is the story of Einstein, the closest man to our time (he died in 1955); in 1903, Einstein married his Serbian sweetheart, Mileva Maric, and the couple moved into a one bedroom flat in Bern. Two years later, she bore him a son, Hans Albert. That was the happiest period of Einstein’s life. Neighbors later recalled seeing the young father absent-mindedly pushing a baby carriage down the city streets. From time to time, Einstein would reach into the carriage and remove a pad of paper on which to jot down notes to himself. The notepad in the baby’s carriage contained some of the formulae and equations that led to the theory of relativity.

And about the giant farthest from us in time, Nicolaus Copernicus (1473-1543): After receiving the degree of Doctor of Canon Law, Copernicus practiced medicine at the Episcopal Court of Heidelberg. He returned to Poland in 1503 and moved into his uncle’s bishopric palace in Lidzbark Warminsk where he spent the rest of his life in priestly service. However, the man who was a scholar in mathematics, medicine and theology was only beginning the work for which he would become best known, the theory of motions of heavenly objects, asserting that the earth moves and the sun remains at rest. He wrote that the center of the earth was NOT the center of the universe. The first 400 pages of the book are devoted to Copernicus- his genius for building bridges between theology, medicine, physics, astronomy and Aristotle who lived about 700 years before him is legendary. There is a most intriguing chapter filled with formulae and tables demonstrating the latitudes of Venus and Mercury, additions and subtractions of Saturn and Saturn’s movement of Parallax over the course of a year.

Returning to Newton- 445 pages are devoted to the life and work of Sir Isaac Newton and his seminal work, Mathematical Principles of Natural Philosophy(Philosophiae Naturalis Principia Mathematica) generally known as Principia. Newton is considered the father of infinitesimal calculus, mechanics and planetary motion, and the theory of light and color. But he secured his position in history by formulating gravitational force and defining the laws of motion and attraction. One very interesting thing about Newton’s use of the word Math after he returned to Cambridge- Newton studied the philosophy of Aristotle. He was fluent in Greek. In Greek the word Math means knowledge, and not just numbers and calculation. Newton was a polymath, a man of much knowledge, and that is how he used the word math in his dissertations. One of the significant events of Newton’s life was the 1665 bubonic plague which made Cambridge University close. He called the year away from Cambridge the “annum mirabilis” (the miraculous year) during which he worked out the laws of motion and gravity. In those years, Cambridge was the convening spot for the likes of Newton, Hooke, the architect of St. Paul’s Cathedral, Sir Christopher Wren, Edmond Halley and others. Newton was the editor-in-chief of the Cambridge publications, and would not allow publication of any of his rival Robert Hooke’s works. This shows the intense enmity Newton held for his intellectual and academic rivals.

Galileo Galilei occupies 235 pages of this colossal volume. Galileo was the son of Vincenzo Galilei, a virtuoso violinist and accomplished composer. As an aside for the opera lovers (not a part of this book) Vincenzo was a member of the Florentine Camerata, a group of writers, musicians and scholars who poured over the ancient Greek operas for a period of 17 years. They gave birth to what we know today as the Western Opera. The first opera, Orpheus et Eurydice, composed by Josepi Peri was performed at Peti Palace in Florence, 8:00 PM, October 6, 1600.

Galileo was teaching Copernican theory of the earth in motion. He got into hot water with the church and his work Two Chief World System was brought before inquisition tribunal in 1616 with an edict forbidding him from teaching Copernicus.

Finally the book on Kepler occupies 96 pages. Kepler was a German astronomer who was famed for his dedication to absolute precision. He was obsessed with measurement and what in today’s parlance we call metrics. His obsession made him calculate his own gestational period to the minute, i. e., 224 days, 9 hours, 53 minutes. He had been born prematurely. So ladies with preemies don’t fret, you may have given birth to a Kepler or to a Mother Teresa- she, too, was born prematurely. Kepler was a deeply religious man. His relationship with the writings and teachings of Martin Luther who lived and wrote only about fifty years earlier, is most interesting. It makes for fun and exciting readings. In Kepler’s time there was very little difference between astrology and astronomy. Kepler had predicted a severe winter, as well as a Turkish incursion, and when both predictions came true, he was triumphantly hailed as a prophet. Another historical aside (not a part of this book): the first person who wrote eloquently to disparage astrology and establish astronomy as a science was the famed Persian poet, Omar Khayyam (1048-1131), some 500 years before Kepler.

The book is huge. The reading and understanding of the work and character of these giants expand the warehouse of mental space. It is most enjoyable and fun. Finishing 1266 pages feels like having finished climbing Mount McKinley and living to write about it.


*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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“Monday Musings” for Monday March 26, 2018
Volume VIII. No. 13/377


A Special Book for Easter

By Assad Meymandi, MD, PhD, DLFAPA*

Christianity, The First 3000 Years
By Diarmaid MacCulloch
1184 pages

Happy Easter and joyous reading!


Faithful readers recall the review of Paul Johnson’s Book History of Christianity, 600 pages long, which we presented previously. In that book, the author has favoured Reformation, Martin Luther, and Protestantism. We now have another colossal work, Diarmaid MacCulloch’s 1184 pages, Christianity, The First 3,000 Years, in which one detects strong anti-Catholic bias. However, undeniably, the book is a landmark in its field, astonishing in its range, compulsively readable, full of insight and points of interest for the general reader. It is not the over-illustrated coffee-table type book you might expect. The book is scholarly, dense, yet written in a readable and engaging style, but not as well written as Plato’s Republic or Edward Gibbon’s Rise and Fall of the Roman Empire. The impressive volume provides an excellent overview of Christianity. It is most appropriate reading for Easter.

The book begins with Judaism and Greek philosophy, giving the background to the remarkable historical phenomenology of Christendom. It is prodigious, thrilling, and gives the reader a master class of a history without leaving one’s chair. MacCulloch is to be congratulated for his accessible handling of so much complex and difficult material. This is a book generous in detail and sound in judgment. It fills the gaps that heretofore existed in history of religion.

The content

The book consists of seven parts. The first part is about “A Millennium of Beginnings” (1000 BCE-100CE). In this part the history of the Greek beginnings, Rome and the coming of the Roman Empire are discussed.

In the second part Israel (100-1000 CE) is examined. The second part, “One Church, One Faith, One Lord?”, examines the lives of Jesus, Paul, Gospel of John, the Book of Revelation, and the Jewish Revolt and the End of Jerusalem, and finally the Imperial Church, Constantine and Papacy.

In part three, “Vanishing Futures: East and South (451-1500)”, a close examination of Asia and Africa, church fathers such as Saint Augustine of Hippo, emergence of Islam in 620 CE, the Church of China, Mongols and Islam in Africa are scrutinized.

Part four, “The Unpredictable Rise of Rome” (300-1300), the making of Latin Christianity, Latin Christendom and “The church of All People” are painstakingly dissected.

Part five, “The Imperial Faith” (451-1800), the emergence of the new Rome, Orthodoxy and the Russian Church are examined.

Part six “Western Christianity Dismembered” (1300-1800), Martin Luther, Reformation, Papal monarchy, Wittenberg and Luther’s 95 questions/theses, and other reformers are discussed.

Part seven, “God in the Dock”, (1492-present), the author examines the Age of Enlightenment, Judaism, Skepticism, and Deism, crowning the section with a more precise dissection and deeper understanding of the roots of religion in America’s deep south. It also gives the reader an understanding of evangelical fervor and culture wars. The book has 67 illustrations, maps and paintings. The text is 1014 pages, the alphabetically arranged notes are 89 pages, and 49 pages of index, plus introduction, totaling 1185 pages

The title of the book, Christianity, the First Three Thousand Years, is fascinating if not intellectually challenging. We know that Christianity is only 2000 years old. Where does the author get 3000 years of Christianity? At first glance, the reader knows not whether the author is going to address 1000 BC to today or from the beginning of Christianity until one thousand years from now. Well, in this review I will attempt to answer that very question. The title refers to the former, one thousand years before Christ until today. The author skillfully documents that there was Christianity before Christ. There was a Socrates whom many historians and theologians including Soren Kierkegaard call Saint Socrates. As a matter of fact, Soren wrote his PhD thesis “On the Concept of Irony with Continual Reference to Socrates”. Soren was a Socrates “groupie”! We know that Socrates is exalted because of his reverential devotion to teaching enlightenment to his young students for which he was accused, tried and executed. MacCulloch’s “alternative” religious history, favoring the Catholic Church, holds that Christianity really began 3000 years ago. He asserts that before Christ there was a Jewish God, Yahweh, and a Greek God. There were prophets such as the Persian prophet Zarathustra and there were other prophets of the Old Testament Bible such as Isaiah, Ezekiel, Jeremiah, etc., all of whom he calls precursors to Christianity which came on the scene 2000 years ago.

MacCulloch devotes considerable space to examine how Christianity has spread throughout the globe. He follows this spread, starting with the origins of the Hebrew Bible, tracing the three main religions of Judaism, Christianity and Islam, filling in often neglected accounts, including conversions and confrontations in Africa and Asia. He also explains the Crusades. Further, Mr. MacCulloch looks at the roots of the faith that galvanized America, charting the rise of the evangelical movement from its origins in Germany and England to the southern plains of America. In his book, MacCulloch explains that Christianity, one of the world’s great religions, has had an incalculable impact on human history. In a systematic manner, the author devotes several chapters to the main ideas and personalities of Christian history. As cited above, other chapters are given to the organization and spirituality of the church, and how Christianity has changed politics, sex, and human society. The author’s range of discussion spans from Palestine in the first century to India in the third; from Damascus to China in the seventh century; and from San Francisco to Korea in the twentieth.

Global History of Christianity

In my view this huge volume is the first truly global history of Christianity. This formidable compendium is the most comprehensive and up to date single volume work in English that presents the development of Christian history differently from any of its predecessors. The author shows how, after a semblance of unity in its earliest centuries, the Christian church divided during the next 1400 years into three increasingly distanced parts, of which the western Church was by no means always the most important. He observes that at the end of the first eight centuries of Christian history, Baghdad might have seemed a more likely capital for worldwide Christianity than Rome. He concludes that all in all, Christianity is a landmark in the history of the faith that continues to shape the world.

It is comforting to have MacCulloch’s complementary history of the Christian Church. MacDiarmid MacCulloch is a better writer than Paul Johnson, and his book is a lively and entertaining effort. On the downside, unfortunately, there is a strong anti-Catholic bias throughout his work which is even more disturbing than Johnson’s pro-Catholic stance. In fact, there are several passages in the book that almost give you the impression that MacCulloch must have been writing them with a permanent sneer on his face. In summary, if you are English and Protestant and believe that the best thing that happened to England was the Reformation, then you will probably love this book. If not, the author’s multiple biases and prejudices will probably grate on you. I consider the book a triumphantly executed achievement.

Strengths and weaknesses of this very impressive and comprehensive text are many. I have read Edward Gibbon’s “The Rise and Fall of the Roman Empire” starting in my native tongue of Farsi then in French and finally in English, many times. Gibbon’s English syntax is delicious reminding the reader of lyrical poetic writings of Plato in Republic. Well, I found the use of language in this book to be dry and matter of fact. The syntactic enjoyment is lacking! On the other hand I learned more about the rise and fall of the Roman Empire by reading this book, than reading Gibbon’s work. Another weak or prejudicial point is that I found references are lacking or outright non-existent. The scholarly world knows that the father of Skepticism is Al-Ghazali, (1058-1111), the Persian poet, theologian and philosopher. Yet in Part seven of the book, discussion of Skepticism, there is no mention of either Al-Ghazali or Al-Farabi (870-950).

Finally, to the members of my family and close friends who received this review in advance, I wrote “If you want a delicious book, a feast of a book, a sumptuous and exciting intellectual and spiritual banquet for you and for your family, this book is it!—especially if you read it along with Paul Johnson’s book either back to back or simultaneously—“ Another attraction the book has for me is that it is about the Bible, a book which I truly enjoy and admire. In a recent interview for a national magazine, the interviewer’s last question was

“If you were forced to live on a deserted island and were allowed to bring one book, one selection of music, and one piece of artwork, what would they be?”


That book has not been written. It would be a book containing the genomic display of all the biblical (Old and New Testaments) characters including Christ. If it is not written by the time I am assigned to a deserted island, I will take pen and paper to write it myself. Nobel Laureate, Craig Venter, whose book I have reviewed in this space, has given us a taste of that venture. Since I have not written that book and it is not yet available, I guess I will settle for the Bible, an amazingly comprehensive and complex book. For example, there are 114 references to King Cyrus of Persia alone in the Bible (see Isaiah 45 where Cyrus the Great is called Messiah).


Beethoven’s Ninth Symphony, a piece of transcendent theology, musical genius, bringing the message of hope, promise, possibility and redemption to all humans. I have already devoted space to dissecting this truly miraculous opus magnum.


Pietà, by Michelangelo.


*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 Nowruz

“Monday Musings” for Monday March 19, 2018
Volume VIII, No. 12/376

Nowruz, Persian (Iranian) New Year

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


Two days hence, Wednesday March 21, marks the Iranian New Year, Nowruz. Yes, March 21, the first day of spring, vernal equinox, is also the first day of the Persian New Year. Today, Iranians celebrate year 5779. My sources in Tehran tell me that most of the 70 plus million Iranians who were mostly pleased with the nuclear accord signed by Iran and US to lift the sanctions, two years ago, giving the Iranians the best New Year’s present they could get, are now fearful of what the present administration might do. Iranians feel that the nuclear accord was a good new year present (in Farsi, Eidee). However, no matter what, the Iranians are not going to let anything spoil the festivities. The Persian people are used to political vicissitudes and domestic extremes. After all, the Persian civilization (the Medes) was there before Moses (1590 BC-1470 BC, lived to be 120 years) wrote the Pentateuch, the first five books of the Old Testament (scholarship notwithstanding)……

The Persians were there before the Code of Hammurabi, the Babylonian law code, was written in 1772 BC.

Persia, the Persian Empire and Zoroaster gave humanity monotheism, and issued the first declaration of human rights. Persia was there before the Old and the New Testaments….

Avesta, the Zoroastrian Bible, was there before the Synoptic Gospels, the Gospel of John and the Book of Revelation…. Monotheism was exhorted in Gatha and the Book of Gushtasb by Zarathustra before Moses wrote about Yahweh….

The Zoroastrian code of conduct: “Good thought, Good word, and Good deed” was there long before the Ten Commandments…

Cyrus the Great of Persia liberated the Jews 500 years BC (Babylonian Captivity). There are dozens of references made to him and to the Persian Empire in the Bible. In Isaiah 45 Cyrus is named Messiah. Additional references may be found in Chronicles, Ezra, Daniels, Hezekiah, Maccabees 1, Maccabees 2, Maccabees 3, Maccabees 4, Maccabees 5, Esdras, Sirach, and Esther.

The world’s first charter of human rights, Cyrus Cylinder, housed in the British Museum, completed its American tour three years ago. It was exhibited in Arthur M Sackler Gallery (the late Dr. Sackler was a psychiatrist) and J Paul Getty Museum, Los Angles, before returning back to the British Museum. The writing is elegant cuneiform (Mikhi) script (image below).

America has a special historical link with Persia. When the founding fathers were contemplating the architectonics of the US Constitution and the relationship between the central/federal government and the 13 colonies, John Adams and Benjamin Franklin referred to the Persian Empire, and copied the form of Persian government, a Republic, where individual states are sovereign and autonomous. Also, Benjamin Franklin copied the ancient Persian postal service and adopted the Persian mail system (Peyk).

Persia’s contribution to music has been vast and innumerable. Let me illustrate one. No matter where in the world a symphony is playing when the concertmaster enters the symphony hall to tune the orchestra before the maestro takes over, it is the oboe, a pure Persian instrument that gives the first note to guide the concertmaster to tune the orchestra. It is universal and with no exception. It is the Persian instrument, the oboe, that set the tune for the entire orchestra.

In more modern history, the late President Truman often in his speeches referred to Cyrus the Great and the Persian Empire’s achievements.

The Persian New Year, vernal equinox, when the day and night are equal and exactly 12 hours long, representing nature’s exquisite justice, was celebrated 5779 years ago, in the month of Edar yek (1) which followed the month of Shavat, as the Persian New Year or Norooz. Therefore, on March 21, vernal equinox, we celebrate Nowruz, the first day of the Persian calendar 5779.

We are Persians; we are inheritors of such dazzling history and civilization….

And with humility and gratitude, we share this joyous occasion with all humanity. Happy Nowruz (New Day, New Year) to all.


The Cyrus Cylinder
*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 Changing Psychoanalysis

“Monday Musings” for Monday March 12, 2018
Volume VIII, No. 11/376


Thinking About Thinking, Episteme, Chrestomathy:

Twenty First Century, The Age of Mind

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 suggested 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 responses to stress as adults. Thus, differences in an infant’s interactions with its 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 Freud, one is Eric Kendal whose most recent book, “The Science of the Mind”, we reviewed two years ago in these pages. Dr. Kendal 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 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 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 offer persuasive argument for 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 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 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 are likely to contribute to a deeper understanding of a number of key issues in psychoanalysis. An issue that is often raised is that a neurobiological approach to psychoanalytic issues would reduce psychoanalytic concepts to neurobiological ones. Congruence between psychoanalysis and biology, 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 sufficient basis for a science of mind. Psychoanalysis research is depleted from opportunities to add more knowledge: Kurt Eissler and Hartvig Dahl. Yale psychiatrist, the late Marshall Edelson in his book “Hypothesis and Evidence” says we must bring psychoanalysis and biology together.

If psychoanalysis is to rest on its past accomplishments, it must remain, as Jonathan Lear and others have argued, a philosophy of mind, and the psychoanalytic literature-from Freud to Hartmann to Erickson to Winnicott-must be read as a modern philosophical or poetic text alongside Plato, Shakespeare, Kant, Schopenhauer, Nietzsche, and Proust. 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 is falling behind .biology might reinvigorate 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, for psychic determinism, for the role of unconscious mental processes in psychopathology, and for the therapeutic effect of psychoanalysis. Now, biology will not immediately 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 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.

Harry Harlowe was an American psychologist best known for his maternal-separation and social isolation experiments on rhesus monkeys, which 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 humanistic psychologist Abraham Maslow worked for a time with him. This work echoed some of the ideas expressed by Sigmund Freud in “On Narcissism”

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 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.

Increases in plasma ACTH and glucocorticoid responses in childhood lead to stress in adults. Thus, differences in an infant’s interactions with its 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.- Sigmund Freud, “Beyond the Pleasure Principle”

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 Conscious procedural or episodic memory to unconscious declarative memory (classic conditioning)

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 (with the help of 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.

We need to make a significant fraction of psychoanalysts technically competent in cognitive neuroscience 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.

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 structure dedication in both basic science and its application to clinical medicine. To promote a quality education, the Flexner Commission commended 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.


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

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“Monday Musings” for Monday March 5, 2018
Volume VIII, No. 10/374

magna carta

The Architects of the Magna Carta 

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

ON THE HUMANITIES, PART II, Matilda Maude of England

Magna Carta, Latin for “Great Charter.” The next time you are in London, go by the British Library, near Euston Station, climb the stairs. On the left you enter a pavilion full of old books, ancient manuscripts, including a Guttenberg Bible, etc. On the right, you will find a good size room set aside to display the magnificent British document, the Magna Carta, signed by King John of Lackland dated December 28, 1215. The document was actually written in Runnymede on June 15, 1215.

The room exhibiting Magna Carta is wired with the latest technology to give the viewers all they want to know about Magna Carta. But I have found the display, describing King Lackland’s Magna Carta, much lacking (pun intended), especially in the intellectual and political history of the precious document. What is presented in the British Library is very useful, but short on depth and epistemic understanding of events leading to the birth of the document. Here are some reflections and a brief critical analysis:

Faithful readers of this space recall the essay on Queen Matilda Maude of England (February 7, 1102- to September 10, 1167), who laid the cornerstone of Anglo-Saxon freedom and the governance of the rule of Law. Matilda was like our 20th century Susan B. Anthony (February 15, 1820 to March 13, 1906), who championed women suffrage by laying the work for the 19th amendment which was signed in 1919 by President Wilson. What a feat, 99 years of freedom and voting right for the American women. Going back to Matilda Maude and her important work to sow the seeds of Magna Carta in Britain’s mental space: Matilda and her younger brother were the only two legitimate children of King Henry I who had altogether sired 23 children. She reigned for a brief period of time and was never crowned, thus not listed in the British monarchic line of succession. Instead, her male cousin Stephens of Blois was the monarch 1135-1154 and is listed in the history books. Omitting the work and contribution of Matilda Maude form history of Magna Carta is a major historic and intellectual oversight.

Another significant omission is the impact of assassination of Thomas Beckett, the Archbishop of Canterbury, on December 29, 1170. As one notices, he was assassinated one day short of 45 years before the signing of Magna Carta. Archbishop Becket was assassinated by four knights from the court of King of England Henry II. They were dispatched to “rid England from a bothersome and intruding priest”. With the brutal killing of Beckett, the public became sensitized to the atrocities of Henry II, his wife Eleanor of Aquitaine, and their three sons (very much like Libya’s Gaddafi and his sons) and a ground swell of revolt against kingship began to slowly brew over the next 45 years. Indeed the excesses of Kings of England over a century brought on the emergence of Magna Carta, the principle message of which was to severely restrict the powers of the throne.

King John Lackland who signed Magna Carta was not a benevolent and humanitarian king like King Cyrus the Great of Persia and Hammurabi of Babylon and other famous altruists of yore. The 12 years old battle of Bouvines definitely restored French power under King Phillip II Augustus bringing the Angevin-Flanders conflict to an end. But the battle of Bouvines in 1214, enfeebled King John considerably. By 1214, King John was a worn out fellow bereft of energy and friends. The British Lords and aristocracy viewed him as a usurper of land with hedonistic tendencies similar to those Henry III. They detected King John’s weakness and vulnerability by moving rapidly and writing a document consisting of 61 clauses, they named it Magna Carta. It restricted the liberties of the king and moved England toward a constitutional monarchy. Magna Carta is essentially an unimpressive document mostly dealing with laws of commerce and cannons of trade. It does not hold a candle to US Constitution, our Bill of Rights, and the Declaration of Independence But some of its clauses are brilliant examples of human rights advocacy. Consider Article 39. It states “No freeman shall be arrested or imprisoned or deprived of his freehold or outlawed or banished or in any way ruined, nor will we take or order action against him, except by the lawful judgment of his equals and according to the law of the land.” Doesn’t it sound like something written by John Locke or Thomas Jefferson? In America, we are blessed to have the intellectual depth, wisdom, and knowledge of 2500 years history by a group of devoted patriots, America’s founding fathers who gave us our Republic. They skillfully wove concepts from Declaration of Human Rights by Persia’s King Cyrus the Great, dubbed Messiah in the Bible (Isaiah 41), Code of Hammurabi, and the renaissance philosophers, especially Pico Della Mirandola’s “Oration on the Dignity of Man” in the tapestry of our beloved nation.

Personally, I love America. Unlike many of my misguided colleagues who are ashamed of America, I am proud of America. I love the cacophony and gridlock in US Congress with 8% approval rating. I love the liberty and freedom to disagree, argue, and have robust and serious conversation without fear of being arrested and jailed. I love America’s devotion and commitment to supremacy of the rule of law and not those of a ruler, a Shah, an Ayatollah or a some two-bit dictator-President-for-Life. And I am happy to pay my taxes to ensure the survival of our freedom, but not happy to see my taxes wasted, and moneys misspent on programs that encourage delinquent and antisocial behavior. Behavior like irresponsibly fathering many children by many women, and not being a daddy to them. Behavior like setting one’s highest ambition in life to get on public welfare. Behavior like coming to America, living here for many years, enjoying the fruits of the liberty, freedom and equality America offers, yet not learning the English language, and not assuming any civic pride and patriotic responsibility….


*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 Humanity

“Monday Musings” for Monday February 26, 2018
Volume VIII. No. 9/373

Omnipotence or Ominous Impotence Of Humans and Humanity

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

Looking over the annals of human history, it is undeniable that we have made progress in industry, mechanization, discoveries, and advancement in health, technology and finance. After all, we put men on the moon with their safe return to earth nearly half a century ago. But one wonders if we have made any progress in civility, humanity and assertion of the necessity of love and charity in human relation. One wonders if we have succeeded in overcoming greed, if we have learned to stop manipulating, exploiting and using our fellow humans for our selfish gain.

1770 BC, a fellow by the name of Hammurabi, in Khuzestan, a part of Susa, Persian Empire, wrote a set of 282 rules or laws, each of which dealing with the rights of individual and the ultimate respect for one another. Over 50 of the 282 codes deal with equality of humans and specifically with the dignity and rights of women.

Cyrus the Great, the Persian Emperor, to whom the Bible has more than 100 references, over 2500 years ago, rule his kingdom with dignity and beneficence. One of the Biblical references, for example, Isaiah 45, calls Cyrus the Great, King of Persia, the Messiah. Cyrus emancipated the Jews and established equal rights for men and women. In managing his vast empire, to be in touch with his emissary/rulers in distant parts of the kingdom, developed a formal service charged with sending and receiving communiqués to and from his lieutenants, thus the birth of the postal service which he called “Peyk”. The cabinet of Cyrus the Great consisted of twelve viziers (ministers or secretaries) several of whom were women. The first person in charge of the Royal mail service was a woman. Her name was Mithra (which in Zoroastrian parlance means, dignity). The father of the United States Postal Service (USPS), the polymath Benjamin Franklin, referred to Mithra in both official language, as well as amorous terms. After all, the gentleman was a lady’s man! No wonder he had special regards for Mithra…In 2010, in the same county, Persia, they are stoning women for as insignificant offense of showing their hair, or ankles or holding hands with a male in public. Is this progress in civility, humanity and human dignity?

Fast forward the clock of history. Count Giovanni Pico della Mirandola (24 February 1463 – 17 November 1494), the Italian Renaissance philosopher, at the age of 23, in 1483, in his equivalent to today’s PhD thesis proposed to defend 900 theses on religion, philosophy, natural philosophy and magic against all comers. The result was the famous Oration on the Dignity of Man. It has been called the “Manifesto of the Renaissance”, and a key text of Renaissance humanism. In this essay, Pico invokes the writings and thoughts of all ancient wise men, going back to Moses, Zoroaster, Zerubbabel, Pythagoras, Aristotle, Platonic philosophers and neo-platonic philosophers such as Plotinus to conclude: “At last, the Supreme Maker spoke: we have made you a creature neither of heaven nor of earth, neither mortal nor immortal, in order that you may, as the free and proud shaper of your own being, fashion yourself in the form you may prefer. It will be in your power to descend to the lower, brutish forms of life; you will be able, through your own decision, to rise again to the superior orders whose life is divine.”

So, where are we? Why we are not rising to the superior orders in advancing the cause of humanity, human dignity and enhance connectedness in human family?

Saadi Shirazi, the eloquent Persian poet (born 1210, died 1290) has a poem, the rough translation is Bani Adam, the progenies of Adam. That is to say, we humans are organs of one body…An organ separated from body cannot function…So, we humans without one another cannot function…” He goes on to say, “If one organ of the body is ill and aches, the rest of the body experiences pain and become restless…” I do not know of any more eloquent and descriptive simile that illustrates human being’s connectedness and brotherhood. Yet we have constant war, constant destruction and constant killing. In America we have a population of 300 million, or about 4.5 to 5% of the world’s roughly six billion, yet we consumed over 25% of the world reservoir of energy. We have over 2.5 million people in prison, more than any other developed nation. Reliable sources report that up to 80% of our prison and jail population have a diagnosable psychiatric illness and should be treated in rather than imprisoned. Certainly what International Affairs Committee is doing and has done since its inception in 1995 is helpful to bring these matters to the forefront of consciousness, and bring people together. Congratulations the NADE’s Board of Director and to host Jeffrey Price.

The title I have chosen for my talk today “Omnipotence or Ominous Impotence” draws on these historical facts. The life of Neolithic man on this earth is short, about ten thousand years. Looking back 8000 years ago with the emergence of Sumerians and invention of writing in Lydia, the world has witnessed rise and fall of many dynasties, empires and powerful nations. There was Mesopotamian kingdom, Accadians, Egyptians, and the mighty Roman Empire, Pax Romana, which was destroyed by Rome’s pre-occupation with the affairs of the Middle East. There was the Persian Empire now in shambles, and in modern day, the empires emerging in the developed world, British Empire and now America… Pax Americana…They have all experienced omnipotence, yet the ignominious ending has been nothing but impotence, destruction and reduction to a vague memory forgotten in the dustbin of human history. In England, there was Lady Matilda Maud (1102-1167) who first wrote a manifesto of human and women rights. Her activities led to emergence and development of King John’s Magna Carta in 1215. In America, Susan B Anthony (1820-1906) fashioned her activities after Lady Maud. In 1920, the 19th amendment to the Constitution signed by President Woodrow Wilson gave women right to vote.

With the historical decline and retrogression/regression of human values and the humanities, I am offering some thoughts and suggestions. The history of humanity has offered us some brilliant role models who forcefully invite us to espouse the kind of altruism that promises the salvation of humanity

I want to invoke the names of three brilliant stars in the intellectual firmament whose teachings have influenced human behavior the most. The first is Saint Augustine of Hippo, born 345, died 430 AD. He was born a pagan, converted to Christianity at age 32, in 386, was baptized Easter Sunday April 4, 387. He wrote 49 volumes in theology, philosophy and other topics related to humanities, a total of 25 million words. Saint Augustine’s autobiography, 13 books of Confessions bravely talks about his stealing from his parents, fathering a son out of wedlock, stealing pears form neighbor’s yard, lying to his mother and finally sneaking off to Carthage, thence to Rome where he became a Manichean and finally met his intellectual superior in the person of St. Ambrose in Milan. St. Ambrose, one of four Latin Doctors (beside Augustine, Saint Jerome, and Pope Gregory) was instrumental in setting Augustine’s course to conversion and ultimately to priesthood and Sainthood.

Saint Augustine’s writing is replete with man’s dalliance with false omnipotence. He wrote extensively about narcissism, self-indulgence and greed. As a matter of fact, he called a newborn baby not a bundle of joy and innocence, but a bundle of sin, because the baby is wrapped up in self and survival and removed from consideration of others. This is what in psychoanalytic jargon is called “primary infantile autism” or “primary infantile narcissism”. As the child grows and the central nervous system matures, reality testing skills and learning to have consideration for and, deference to, others are developed. The opportunity to grow and become more altruistic, more giving, and less selfish and self centered is the gift of life. Saint Augustine was a proponent of the concept of grace and salvation. He espoused Pauline theology of grace which briefly is described as “an unearned and undeserved free gift”. He wrote more than a million words on grace.

The second brightest star of the intellectual firmament we are exploring is Moses Maimonides of Cordoba, born 1135, died 1204, a Jewish physician, colleague, theologian, philosopher, clinician and practitioner. He too wrote about 20 million words in his life time. He also was concerned about the issue of grace and salvation. Moses, in spite of being the Caliph’s personal physician in Cordoba, was pressed by anti-Semitic forces to flee to Egypt. There is a small statue of Moses (Rambam) in Cordoba. Emily and I take a single long stem rose and place it at his statue every time we are in Cordoba. We do the same when we visit the tomb of Claudio Monteverdi, father of Western Opera (Orpheo et Euridice 1607) in Iglesia de Santa María Gloriosa dei Frari, Venice, Veneto Region, Italy

The third brightest star of the intellectual constellation is Ibn Khaldoun, born 1336, died 1420, an Arab/Muslim theologian, economist, philosopher, music lover and advocate and writer. He too wrote about 20 millions words in his lifetime. Ibn Khaldoun was the father of trickledown economics which was adopted by the late President Reagan in 1981. He appointed Columbia Professor Robert Mundel, as Chair of the White House Economic Council. Emily and I had lunch with him at his villa near Florence in 1993. And our conversation was around Ibn Khaldoun whose books and writings surrounded Robert’s study. He won the Nobel Prize for Economics in 1999, after fathering the birth of Euro as a unit of currency for Europe. He is now busy developing a unit of currency for the Middle East. Incidentally, Ibn Khaldoun’s advocacy of music was ingenious. A word of history of the world of music in Islam is in order: Mohammad, the founder of Islam was born 580 AD. At age 40, 620 AD, he started Islam and two years later, the Islamic Holy Book, Quoran, was completed. In early Islam, music and paintings were prohibited by Islamic cannon and Fatwa. Ibn Khaldoun, a lover of music noted that it is permissible to sing the passages from Quoran as the Muezzins sing their invitation to prayer from minarets five times a day. He suggested to the ruling grand Ayatollah of the day to organize a competition and invite the best readers of various Islamic nations to come to a place and compete, picking the best singers of the Quoran passages. It is called Talavat Quran Majeed. It started in 1365 and continues to this day. It is like the Olympics of signing. He later introduced percussion (tablah) and strings to enhance the majesty of Quoranic passages. The Talavat competition has gone on uninterruptedly since 1365. The only other continuous musical event regardless of war, depression and uncertainties is Handle’s Messiah, since 1742. The first performance was attended by George I. He was so moved by the Alleluia chorus that he stood up, handing down the custom of standing ovation to this day.

These three writers’ advice against hubris, omnipotence, appearance and glitz, repeatedly warn us not to mistake ominous impotence for power and omnipotence. The distilled message of almost 60 million words written by these three sages is—and I am offering it as a take home treat– “The road to grace, salvation is to know what is good inside of you, that is intellect love, compassion, altruism, empathy, access to the rich array of so many other feelings; and knowing what is good outside of you, family, connectedness, friendship, music, nature, flowers, dance, and poetry; And to be thankful for them by giving something back and making a difference in the lives of others.”The issue of awareness is very important. It takes discipline to be aware. The heightened form of awareness in Sufi is called “Zekr”, that is to be constantly of aware of all good things inside and outside. Mowlana Rumi said “Blessed those who are in Zekr, they are in constant prayer…” What do we do with all this doom and gloom and pessimism? I think there is hope. There is possibility, there is redemption.

I believe that ultimately for those who believe in God that God wants us humans, His children or Her children, to succeed and progress. From time to time, one is chosen to become a role model. He sent Buddha to teach us patience, wisdom and awareness. He sent Zoroaster to give us the concept of good and evil, epistemological dualism. He sent Moses to exemplify discipline, devotion and yes, the gift of doubt. He sent Jesus of Nazareth to demonstrate the power of love. He sent Mohammad to offer us Islam total submission to the will of God. He sent Mozart to illustrate the power of music. This every day common man with multiple organ system failure, including kidneys and liver ravaged by alcohol, mourning the death of his mother and his little daughter, in the summer 1886 wrote Symphony in G minor, topping the trio with Jupiter Symphony in C major. No mere human can do this. Finally he sent America, our Founding Fathers, Thomas Jefferson, George Washington, James Madison, Benjamin Franklin and others to give us a system of government, a republic, that cherishes the supremacy of rule of law, and not the whims of kings, shahs and Ayatollahs. America is a decent and generous nation. America is there in case of natural disaster, in Tahiti, in Pakistan, in Nepal and Myanmar. America is a land that allows its citizens to reach their maximum potential. I am very optimistic about the future of the world because the world has America.


*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, Life Member, American Medical Association; Life Member, Southern Medical Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is the 2016 recipient of the NC Awards, Fine Arts.

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On Dorothea Dix

“Monday Musings” for Monday February 19, 2018
Volume VIII, No. 8/372

Dorothea Lynde Dix

(Editor’s Note: The author of this paper is a brainy and hardworking teenager, Olivia Ng, the daughter of colleague Peter Ng, and granddaughter of another colleague the distinguished Raleigh surgeon, Fred N. Olivia is completing her frosh year at Davidson College, The paper about Dorothea Dix has brought much deserved honor to Olivia. In addition to the text, there are dozens of notes (33 to be exact), references and footnotes. Frankly, when reading her paper, I had the feeling that I was reading a scientific paper in Nature and Science magazines. The text is presented with such incandescent intensity and persuasive power that makes reading a sheer intellectual and humanistic feat. Olivia has a brilliant future. I am glad to share her paper with our readers)

Olivia Ng Senior Division Historical Paper 2,475 Words

If I am cold, they are cold; if I am weary, they are distressed; if I am alone, they are abandoned.

Dorothea Dix, 1843

Dorothea Dix, born in 1802, was one of the world’s most renowned female activists,educators, and reformers. She was a woman ahead of her time who encountered pressing issues, and despite the odds against her, overcame personal, social, and political obstacles to resolve them. Dix had a profound influence on the mental health field through her courage to explore, encounter, and exchange information through teaching others, spurring the beginning of the revolution of improvements in the mental health field and changing perceptions of the mentally ill.

Dix grew up in an unstable household in Hampden, Maine, where she formed a strong sense of compassion for others by caring for her younger brothers. When she was twelve, after learning to read and write from her alcoholic father, Dix moved to live with her wealthy grandmother, where she demonstrated her compassion and love of teaching by founding a girl’s school when she was fourteen. In 1824, Dix published a popular book of facts, called Conversations on Common Things, which provided basic knowledge to people of different social classes, which helped build her reputation as an educator.

Though Dix enjoyed her work, it was often interrupted with chronic sickness and depression, and she was sent to Europe in 1836 for her health.4 While there, her health improved, and she became acquainted with several influential figures involved in reform, including prison reformer Elizabeth Fry, founder of the York Retreat for the mentally ill, Samuel Tuke, and politician William Rathbone. Exposure to such influential figures helped give Dix a foundation for her ideas and reform work when she returned to America shortly after her grandmother’s death in 1837. Having no financial support from her family, Dix’s grandmother’s death left her an inheritance that allowed her to become more involved in charity and reform work which became extremely important in 1841, when Dix found her calling. That year, Dix was teaching Sunday school at the East Cambridge Jail in Massachusetts, and was shocked by the living conditions. She went to court, secured heat for the prisoners, and began her lifelong journey of visiting various mental asylums and prisons throughout the United States (U.S.) and the world, documenting the brutal conditions she found in each one with exacting detail. Throughout her travels, she presented her findings to various audiences, fighting for the rights of the mentally ill.

Dix created a conversation around mental health that led to the expansion of the field, improvements in conditions for the mentally ill, and furthered social acceptance and understanding of mentally ill people, all issues of significance in society today. Until Dorothea Dix began to explore mental asylum conditions in the 1800s, understanding of the mentally ill was limited, and few were concerned nor cared to understand their plight. The mentally ill were viewed as useless, having no feelings or senses, and as a burden on society. The state felt it had no option other than to put them into asylums, which at that point, was seen as radical, progressive, and liberal. Dix’s decision to investigate the asylums and improve them was seen as outrageous. Few cared about improving asylums, including the private and public financial backers of institutions in progressive states with asylums, whose support was necessary for change. For such reasons, Dix was often opposed by governments and the upper classes because she was viewed as challenging the state’s authority and ideals, posing threats to social order. Dix’s radical ideas also resulted in her being seen as a feminist and as supporting the unpopular women’s suffrage movement, though she did not participate in the suffragette movement. Despite opposition, Dix sought to improve the horrid conditions that she consistently observed that others saw as sufficient, including lack of heat in freezing temperatures, the housing of men and women, and criminals and mentally ill together, frequent rape, the chaining of people to beds, starvation, bad sanitation, and poorly-built buildings.

Dix’s understanding and compassion for the mentally ill was rooted in her childhood when she lived with her mother, who struggled with depression and was rumored to be mentally challenged. Dix struggled with depression as well, but her understanding of the struggles of the mentally ill became clearer when, in 1841, while in Massachusetts, she took action after witnessing the appalling conditions. From then on, Dix was determined to advocate for thementally ill. Throughout her travels in the state, Dix found similar inhumane conditions and presented them to the state government in her Memorial to the Legislature of Massachusetts in1843.13  Through vivid descriptions of unthinkable conditions, Dix petitioned for the expansion of a state insane asylum in Worcester, Massachusetts, which she believed offered curative treatments rather than abuse, for the mentally ill. Other insane asylums she described, however, varied in administration and care, from families keeping insane people in their barns and stables in the freezing cold, to the insane being confined in rooms, denied exercise, being chained to beds, and once in a while, given an opportunity to walk the grounds of facilities in iron collars and leashes. In other cases, they were “treated,” in a tranquilizer chair, invented by Benjamin Rush (see Appendix I). Other forms of cruel treatments for disobedient people, or those who tried to act for themselves, were beatings. A newspaper article published in Oil City, Pennsylvania on March 26, 1880, told the story of John Carroll, a man who, while under a brain fever, was sent to an insane asylum in Pittsburgh, only to return to tell this story:

“When I walked out,” says Carroll, “he knocked me down, and, with three others, kicked and beat me until I was senseless. When I came to my senses I was lying in a cell. I had on a strait-jacket, and was lying on a bare, damp floor. There was no furniture in the room.”

Such was typical of what Dix found as she visited mental asylums around the country; yet the most disturbing thing that Dix encountered was that almost all prisoners were denied a source of heat, most often in the dead of winter in the Northeast, and left blanket-less and alone in tiny stone-walled cells.

When visiting an almshouse in Berkeley, New York, Dix asked a superintendent if an insane person had fire for warmth, and he indignantly replied, “Fire! Fire, indeed! What does a crazy man need of fire? Red-hot iron wants fire as much as he!” Yet, when Dix spoke to the insane, they often spoke of the cold. Another misconception that caregivers had of the insane was that they were incapable of polite interaction. Dix found this to be extremely inaccurate when one “crazy man,” as described by the caretaker, a physician educated at Cambridge, sent her letters of appreciation for books she had given him. An excerpt from one reads, “You express confidence that I have self-control and self-respect. I have, and, were I free and in good circumstances, could command as much as any man.” This letter helps reflect the common stereotype that although many insane were considered to be incapable, helpless people, in many cases that Dix encountered, the insane were capable of self-control and polite interactions.

Through meeting and treating those thought to be insane like normal people, Dix was able to more accurately depict the struggles and needs of the mentally ill and more successfully campaign to meet their needs. Once Dix understood what measures needed to be taken, she continued her work in mental reform, spreading her campaign and influence. Dix traveled around the country, bringing mental health reform into the public and government’s focus. She traveled through Rhode IslandNew Jersey, starting her first hospital for the mentally ill, the Trenton State Hospital, Tennessee, Kentucky, Ohio, Maryland, Pennsylvania, Alabama, Georgia, South Carolina, North Carolina, Mississippi, Texas, Louisiana, and Illinois (see Appendix II for a sketch of the Trenton State Hospital).

In 1848, Dix traveled to Washington, D.C., where she met with Vice President Millard Fillmore. Her evidence, compassion, and conviction led him to give her a grant in 1852 and to draft a land grant bill for mental hospitals. Dix used the $100,000 federal grant to establish Washington, D.C.’s St. Elizabeth’s Hospital. However, the bill, though passed by the Senate, failed to pass in the House of Representatives. Though it remained a topic of discussion, it was later vetoed by President Franklin Pierce in May, 1854 due to budget cuts.24 However, Dix’s ability to create any sort of legislation was a major accomplishment and raised public and federal awareness on her cause for mental health reform.

Dix did not stop campaigning, and she took her influence across the Atlantic to Europe. Starting in 1853, Dix campaigned in Canada, Scotland, Italy, Greece, Turkey, France, Australia, Austria-Hungary, Germany, Russia, Holland, Belgium, Denmark, and Scandinavia. Her widespread campaigning exposed the major problems in the world’s mental health institutions. She was especially successful in Turkey and Greece. Dix even addressed Pope Pius IX in Rome, Italy, and upon further inspection of Dix’s findings, he promised to take action. Dix’s campaign around the world brought the issue of mental health reform to the public’s eye, and made known the problems within mental health institutions and what needed to be done to reform them.

Throughout her campaigns, Dix informed others through speeches to both public and private audiences, demanding improvements of living conditions and treatment of the mentally ill. She emphasized the fact that the insane can feel temperature and emotion and, therefore, needed heat in the winter, and faced horrible stresses from being locked up in rooms for years on end. Additionally, in place of treating the mentally ill by simply locking them away in dark, dank rooms, she addressed the need for medical and emotional treatment. One treatment she found to be extremely successful from personal experience during her tours of facilities was based on the ideology behind “talk-therapy.” First used by Dr. John Galt, a superintendent of the Eastern State Insane Asylum in Virginia, talk-therapy was a method of treatment that involved housing patients with the occasional use of calming medicines, rather than restraints such as chains, and talking to patients about their problems as if they were sane. By explaining the ideology behind talk-therapy, as well as telling stories from her own experiences from visiting them, Dix combined her obvious sense of human compassion and details of horrific conditions of asylums, to stir the hearts and minds with whom she exchanged ideas. Dix’s emotional and humane appeals helped her spread awareness of the importance of mental healthcare around the world, spurring the mental health reform movement, slowly swaying and convincing governments and the public of its importance, founding hospitals, and improving conditions for the mentally ill around the world. Though extremely successful in her mental reform movement, Dix was often not considered to be the activist type. She was extremely quiet, shy, and suffered from severe glossophobia, the fear of public speaking, and agoraphobia, the fear of being in areas where escape is difficult. Not only that, but Dix had no basis for helping the mentally ill besides her sense of compassion; she did not have a medical background, nor did she work in a mental asylum. Yet, she dedicated nearly her entire life to exploring the conditions of the mentally ill and advocating for them. Throughout her life, Dix’s reform movement not only aided the mentally ill, but also helped her grow as a person. By the end of her campaigning, she was no longer quiet and glossophobic, but a sophisticated, well-spoken advocate for the mentally ill.

Yet, unlike many reformers, Dix refused personal credit for her work and was uncomfortable with receiving such recognition. In fact, she refused to allow a new hospital in Raleigh, North Carolina, to be named after herself, and only permitted the hill it was built upon to be named Dix Hill for her father. Given this, it is only a reflection of her lasting impact on the mental health reform of the 19th, 20th, and 21st centuries that many hospitals renamed themselves for Dix after her death.

Dorothea Dix explored new, humane standards for the treatment of the mentally ill, improved and created institutions for their care, and exposed the pressing issues inside asylums that were hidden from public view, while going against the societal expectations of women and the accepted standards of mental health. Through her exchange of ideas, Dix raised awareness of the mentally ill throughout the U.S. and in over ten other countries around the world. Her standards for treatment of the mentally ill have been implemented throughout the world and have significantly improved the lives of millions for over 150 years.

Dix not only helped the mentally ill but also other disadvantaged people by the founding of schools for the feeble-minded, a school for the blind, and several nurse-training facilities. Dix also proved that women can make a difference. She left the “home sphere” far behind, traveling around the country and the world, speaking with people of influence including the Pope. She broke others’ expectations of herself as a woman: the expectation that women and men remain in separate spheres, where women stayed in the home and men worked and involved themselves in public matters. Dix stepped outside of the home sphere, doing what she believed needed to be done for a cause that few saw as important, or relevant at all. She went where few dared to go, for the benefit of others whom had no impact on her life. She encountered pressing issues of mental health, where no one believed there were problems, and worked for almost her entire life to fix them. She improved mental health care and treatment, and she opened the doors for an entire field, which, because of her, is considered a key component of overall health today. She gave the insane a voice, and unlike others, believed they could be helped. She launched a mental health care revolution that has left a mark on mental health institutions for over 150 years following her death. Dix was a woman ahead of her time who fearlessly explored the unknown, encountered major issues, spent her entire life resolving them through advocacy for change, exchanging little-known information with the world, and improving leaving mental health for her time and future generations.


*The editor is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life Fellow, American Psychiatric Association; Life Member, American Medical Association; Life Member, Southern Medical Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He was the 2011 inductee to Raleigh Hall of Fame, and 2016 recipient of the NC Award, Fine Arts.

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On Valentine’s Day

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

An Essay on Valentine’s Day

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


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

History and Origin:

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

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

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

Chaucer Parlement of Foules, circa 1381.

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

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


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

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

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


*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life Fellow, American Psychiatric Association; Life Member, American Medical Association; Life Member, Southern Medical Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He was the 2011 inductee to Raleigh Hall of Fame, and 2016 recipient of the NC Award, Fine Arts.

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On St. Paul and CETP

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

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

By: Assad Meymandi, MD, PhD, DLFAPA*

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

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

Here is the collect for the occasion.

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

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

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

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

More On Cholesteryl Ester Transfer Protein (CETP):

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

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


*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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