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On a Few Reflections and Observations

“Monday Musings” for Monday October 27, 2014

Volume IV, No. 43/143

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Potpourri of Reflections and Observations

By Assad Meymandi, MD, PhD, DLFAPA*

The Birth of Existentialism

I am delighted to know that many of our readers are pleased with our occasional philosophical discourse. After all, philosophy means literally “love of wisdom.”  Wisdom is not information, it is not knowledge; yet it is both of those, and more. Also, it is gratifying to receive readers’ mail who ask for more discussion of people who have made a difference in this world, like Soren Kierkegaard, born 1813, died 1855, a brilliant sarcastic, humorous and incredibly prolific thinker theologian/philosopher. He, along with Martin Heidegger (1889-1976—I once went to Berlin to meet and talk with him), Jean Paul Sartre (1905-1950) and Albert Camus (1913-1960) are the four horses of Existentialism, all of whom give credit to St Augustine of Hippo for their start and cutting their teeth in understanding the basic premises and principles of existentialism. Soren used to write books pseudonymously, and then critique them harshly, calling the writer of the books, meaning himself, a no good “oeuf”…

A writer asked about Manicheans. This reader was stimulated by my review of James O’Donnell’s book on the life of Saint Augustine. Yes, Saint Augustine of Hippo for 14 years of his life, between ages of 18 (372) and 32 (386, the year he converted to Christianity) was a Manichean. Augustine was baptized by Bishop Ambrose of Milan on Easter morning 387.

Mani was a Persian. He was born and raised near today’s Basra which was a part of the Persian Empire. The religion is heavily based on Zoroastrianism and Zoroaster’s (Zaratustra) dualistic approach to heaven and earth, good and evil, body and soul… He is purported to have gone to China and converted Turan, Shah of China, (Puccinin’s Turandot which is really Turan-dokht, the daughter of Turan) and is based on this Emperor’s daughter.  Manicheans were sophisticated and learned. They often ridiculed Christians and their ”faith.” Manichians were highly educated, most master-rhetors, engaged in the art of persuasion, like today’s Law professors. They believed in dualism, rationalism and materialism. Augustine’s corpus of work contains19 volumes refuting Manicheans, Donatists, Palagirists and Arians. It makes for stimulating reading and ultimately giving reader a roadmap to true wisdom.

AM

Greed/Financial Dysfunction

The market has rebounded from five years ago. S&P is back to new highs. The stock market is volatile but not in a doldrums. Several years ago, when depression and unemployment engulfed our nation, I wrote that I needed help to understand a few things about our financial system. Here is what I wrote: “While stocks have lost about 50% of their value in one year, and many 401 K for the middle class American workers have been wiped out, we see the salaries and compensations of the CEOs who have caused this chaos have gone up. Let me quote some of these salaries from published statistics, US Department of Labor: Lloyd Blankfein, Chair and CEO, Goldman Sachs Group, Inc. received $68.0 million dollars in compensation, and when the company failed the federal government pumped in $10 billion dollars to rescue it.  Similarly, James Dimon, Chair and CEO, J. P. Morgan Chase & Co., $30.4 million in compensation and $25 billion government bailout; Kenneth Lewis, Chair, CEO, Bank of America Corp., $16.4 million, $25 billion; John Mack, Chair & CEO, Morgan Stanley, $16 million, $10 billion; Vikram Pandit, CEO Citigroup, Inc, $5.7, with $25 billion bailout;  William McGuire, Chair and CEO, UnitedHealth $40.7 million; and another Merrill Lynch high flyer, Peter Kraus, head of strategy, $25 million, just to name a few.”

What I still don’t understand and would like for someone to explain to me is how could these people run their companies to the ground, cause millions of their shareholders to have their retirements wiped out and yet be rewarded and the government, without shame, bailed them out?  Please help. Today, five years later I do not believe any of these individual have been reprimanded.

AM

Editor, Psychiatric News:

The August 16 presidential column, Psychiatric News, interested me immensely. In her column, Dr Stotland made a point that the meeting of the Royal College of Psychiatry in London was modest, “using the meeting facilities of the inexpensive venue of the Imperial College has enabled the College to experiment with a meeting without pharmaceutical support…” She stated that “The meeting briefcases carried only the seal of the college…”

For decades, I have criticized the unholy and ethically unacceptable marriage of organized medicine and drug manufacturers. The unwelcome and greed-laden alliance of healthcare and pharmaceutical industries is an abomination. In recent months, we have learned that the scientists, writing papers in leading medical journals, have been sponsored by the drug makers. The Vioxx/Merck mess is a good example. Ghost authorship and ghostwriting occur even in our most trusted peer reviewed journals.

The late President Eisenhower, once in the late 1950s warned against the military-industrial complex. Now, the nation must be warned against the medical-pharmaceutical complex. It is ominous. Organized medicine and APA must find a way to fund their needs through Foundation moneys and not through revenues of advertisements by drug companies.  Also, physicians ought to buy their own lunches, their own pens and their own scratch pads. And they should not get their “medical education” from drug representatives but from rigorous engagement in continued medical education. We must cleanse the holy temple of medicine from these corrupt practices. Maybe Dr. Stotland will start us off on this much needed pilgrimage.

Sincerely,

Assad Meymandi, MD, PhD, DLFAPA

The Gift of Pistachio and a Pinch of Sufism

This is a personal note.  I know that it should be handwritten. But legibility becomes a problem.  I am writing to tell you how touched I was to receive your thoughtful card with your inserted personal note bearing syntactical elegance and rabbinical wisdom (Rabbi from Aramaic and later Hebrew roots means ‘My teacher’.) Also thank you for the gift of pistachios, every individual kernel depicting the Hafez poem” Pesteh Khandan.” Pistachios were known to Sumerians. There are records in cuneiform (spike or Mikhi) alphabet what scholars have interpreted to be pistachio associated with green color. Sanskrit word PESTEH is the etymology of our word pistachio. During Achamenid Dynasty, in Persia, Shiraz became the center for growing groves of pistachio trees. And in the pre-Islamic world, they used to ferment and make a wine from pistachio. There was and continues to be to this day, one species of pistachio that actually opens in the pod/shell on the tree before they are picked.  They are called “laughing or smiling pistachios.” The Shiraz poets such as Mosleh-Din Saadi (1210-1290) and Khajeh Shams-Din-Hafez (1337-1406) have romanced this species of pistachio as the smiling or laughing (KHANDAN) fruit. As one can see, a cracked pistachio looks like a smiling face.

Saadi and Hafez were Sufis. Sufi philosophy has given birth to the discourse and science of “ontology.”  For the last 1200 years, it has evolved the beatific message “to be in the world but not of the world.”  Sufism invites, encourages, and teaches the art and skill of “being” as a contradistinction of “doing.”  We need to set aside time for introspection and reflection…All one’s “doings” should be in the ultimate service of “being” and “becoming”….

Rumi, one of the most eloquent and influential Masters of Sufi in relation to ontology said: “Blessed are those who are in a state of constant worship….for the very act of worship is the essence is self-awareness and self-knowledge…”.  I must assert that Rumi is very much exploited by literary charlatans and marketers who pose as Rumi authorities, yet do not know a word of Farsi language!)

May your faces like Hafez’ Pesteh be Khandan, smiling and happy forever.

AM

Etymology of the Word “Religion”

Saint Thomas Aquinas (1225-1274) and John Calvin (1509-1564), two disparate theologians of the 13th and 16th centuries, along with Persian physician Abu Ali Sina Avicenna (980-1037), the famed medical diagnostician and clinician of the eleventh century have written independent treatises on the “religion.”  Here is a summary of their work on the topic:

The etymology of the word “religion”, re-ligion”; re: again, ligating: binding, connecting (surgeons ligate veins and tie up arteries); thus, re-connecting, re-binding, re-attaching…what to what is the question.  Perhaps to the beatific vision of eternity and transcendence of love…

AM

A Euro for Asia

The wire services just unloaded a very heartwarming and personal story: Robert Mundel, Reagan’s Chairman of Economic advisors, father of trickle down Reageanonomics (Ibn Khaldoun ‘1332-1406’ was the real father, Robert Mundel was a promulgator!), but he was the true father of the “Euro”, the 1999 Nobel Laureate in Economics, is now back in the news. He wants to foster or father the equivalent currency of Euro for Asia. The name has not been conceived. The Sultan of Abu Dhabi, owner of the multi-trillion dollar “Sovereign Fund” which has been rescuing American Banks and Financial institutions (including Bank of America, UBS, CitiBank, and Washington Mutual) is behind the effort.

A personal note: We had the privilege of having lunch with Dr. Mundel in his Palladian villa in Italy on Friday June 25, 1992. It was a memorable occasion.

AM
Randy Pausch’s name was being considered by some members of the National Humanities Center Nominating Committee for membership to the Board before we earned that he was dying. I was fortunate to be in the audience when he gave his “Last lecture” at Carnegie Mellon. It was a fascinating experience. He was a picture of health. He did summersaults and push-ups during his lecture, and at the conclusion of his speech, carried his wife off the stage. It is very sad that he died, yet, it is glorious the way he lived and the legacy he left for us. I am reviewing his book which will appear in a future issue of WCP.

AM

The Dope on Cannabis

In response to a reader’s question about cannabis and alcohol:

The scholarship on cannabis and data driven research on this controversial drug show that cannabis may and does affect not only the higher cortical structures but also the subcortical parts of the brain, what is known as the Limbic system, causing not only bipolar disorder (radical mood swings and irrational and impulsive behaviour), but actual psychosis. Alcohol has the same adverse effects on the brain through different pathways. So, I really condemn both. I am absolutely against legalizing cannabis. I would be happy to give you reference to these studies. A drunken parent should not hypocritically admonish a pothead child. It does not work. This is one of the astonishing teachings of Saint Augustine of Hippo, the ultimate role model to humankind. Although he was addicted to sex, after his conversion to Christianity and soon after becoming a Bishop, he had enough discipline to stop sex altogether. The same, I condemn tobacco and its ill effects on the body in general. However, I guess the reason tobacco is not banned is that it does NOT cause bipolar disorder and psychosis.

The ultimate answer to these problems is education which starts in utero. Mamas must adopt Augustinian discipline to love themselves and their fetus(es), stop tobacco, alcohol and over-eating while they are pregnant, and continue to be role models to their children. Greed spoils capitalism and private enterprise. Making money out of harming others by selling, cannabis, tobacco, alcohol,  and other harmful substances is immoral.

AM

Hypocrisy and Greed of University Leaders

I am opposed to lowering drinking age in college as many, including 100 college and university leaders, promote. While prohibition is often counterproductive, I believe the answer to binging, abuse and unreasonable use of alcohol is education. The answer also lies in curtailing greed and hunger for money. The University leaders ought to cut out advertising of beer from all TV sports. It is sheer greed to have alcohol products sponsoring sports events, and it is sheer hypocrisy for the university leaders to tolerate this practice because it produces revenue for their institutions. Ban alcohol ads from all television sports.

AM

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

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On Two Seminal Events

“Monday Musings” for Monday September 15, 2014

Volume IV. No 37/137

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Constitution Day and the  Birth of Samuel Johnson, Father of the English Dictionary

By: Assad Meymandi, MD, PhD, DLFAPA*

This week portends occurrence of two seminal, historic and consequential events worthy of observing and celebrating:

First, The US Constitution and Constitution Day:

On Sept. 17, 1787, exactly 227 years ago, the Founding Fathers of our beloved Republic signed the sacred document we know and cherish as the U.S. Constitution, giving birth to our great nation. No, America is not great because of its prosperity. It is not great because of the proverbial American Dream of a brick home with a two-car garage. It is not great because it gives us security, opportunity and order. It is not great because of its advanced technology and its number of Nobel Laureates in science, medicine, literature and humanities.  America is great because it is a nation of laws and because of its absolute commitment to uphold and maintain the supremacy of the rule of law. Today, Constitution Day, it is fitting to take a psychological scalpel, analyze and dissect what goes into America’s reverential devotion to upholding the rule of law. These two cases, one national, one local, dramatically and eloquently give us the reasons.

Psychiatrist Nidal Hasan went on a rampage on Nov. 5, 2009, killing 13 and wounding 32 of his fellow soldiers at his Texas military base. Speaking on his own behalf in court, he said, “The evidence will clearly show that I am the shooter.” Hasan is paralyzed below the chest and requires special medical attention at Brooke Army Medical Center. He is incontinent and in need of round-the-clock nursing care and rehabilitation. Also, there is a special security team assigned to protect his life day and night. He was tried in a specially fortified court room. Sources familiar with his care report that Hasan’s security detail rivals that of the president. The cost is in the millions.

Yes, the majesty of the supremacy of the rule of law in our beloved land of America is dramatically demonstrated by how we are treating an admitted killer. The American Dream is not vacation homes, technology and prosperity. It is our laws, our sacred Constitution and the sacrifice of the Founding Fathers that are the muscles, bones and spirit of the American Dream. The supremacy of the rule of law and not the whims of a dictator, a king, a shah or an ayatollah is the foundation of the majesty of American democracy.

On the local scene, a few years ago, with astonishment and awe, I sat and watched the court proceedings of former Gov. Michael Easley on television. I ws astonished, because a former chief executive officer of a sovereign state was being sentenced, and in awe, because of the unshakable and uncompromising supremacy of the rule of law in America.

America, from time to time, may go down financially we may experience high national debt and low employment, but we bounce back out of the doldrums. Nowhere on earth the sanctity and supremacy of the rule of law are so cherished and enshrined in our nation’s psyche. Our responsibility as Americans is to partake of the liberty, be a patriotic citizen and vote. Also,  In my view, the catechism of being an American should consist of a good knowledge, if not verbatim memorization, of four documents. They are The Declaration of Independence, US Constitution, The Bill of Rights, The Federalist Papers and George Washington’s Farewell Address. I believe every American child by 9thor 10th grade ought to memorize the 7200 words of The Declaration of Independence, The Bill of Rights, The Federalist Papers, and GW’s 6091-word Farewell Address to gain an appreciation for the responsibility of being and American. These four documents are the civic catechism of our beloved nation. We should be thankful for them. Long live America.

The second event is The birth of Dr. Samuel Johnson: 

This is a special week for the lovers of the lexicographers, especially the lovers of  the English language, because Samuel Johnson, the author and compiler of the first English dictionary was born on September 18, 1709. He spent his life compiling and collecting words while studying at Oxford for a doctorate degree. The book was finally published on April 7, 1755. In comparison, the Académie Française had forty scholars spending forty years to complete its dictionary, which prompted Johnson to claim, “This is the proportion. Let me see; forty times forty is sixteen hundred.  As three to sixteen hundred, so is the proportion of an Englishman to a Frenchman“.

Academie Francaise was literally created by Cardinal Richelieu in 1635, a full one hundred and twenty years before Johnson’s English Dictionary. So, Samuel Johnson had a lot of catching up to do.

 Permit me to relay a personal connection: The day Dr. Johnson announced the completion and publication of his dictionary was on Thursday April 7, 1755, at 11:00 AM. I arrived in United States, New York’s Idlewild Airport, on Thursday April 7, 1955, at 11:00 AM, exactly 200 years after the birth of the first English dictionary. While learning the English language and preparing to enter college pre-medical studies in September 1955, I learned about Dr. Johnson, and through the auspices of the Library of Congress, managed to find a copy of his original dictionary containing fifty thousand words, which I memorized.  In addition, I was memorizing the 285 thousand words of the 1955 edition of Oxford Dictionary. By the way, the first edition of the Oxford Dictionary was published 150 years after Johnson’s original dictionary. The love affair between me, Dr. Samuel Johnson, and the English language, over the years has only deepened.

We take our language for granted. But look, the English language is so fresh and young. It did not exist 2000 years ago.  Every English word we use was coined by someone, there was a need for its invention, and there is always an exciting story behind the circumstances of the creation. In depth learning of English words and language makes you a personal friend out of every word, so conceivable you can make 285,000 friends. No language on earth gives you free access to its ancestral roots—etymology—and no language is as flexible, changing and accommodating as the English lexicon.   Not only one may memorize and learn the meaning and use of each English word, but also learn about the etymology and origin of each word. I recommend this project as a stimulating pursuit- learn about the need and the occasion for creation of each English word, the person responsible for coining of the words, and the changes the words have undergone since their coinage. I my early days in America, I truly fell in love with the Samuel Johnson’s English language, and continue to cherish that precious love affair.

Back to this week’s hero. Dr. Johnson was a complex sort of fellow. He was posthumously diagnosed as a possible Tourette Syndrome victim (remember our Monday Musings about beloved Mozart who had the same presumed diagnosis). This is a condition whose victims engage in scatolalia, coprophilia, and uncontrollable motions-tics-with socially unacceptable manners that approach vulgarity. In the case of Samuel Johnson, these grotesque habits and gestures were aggrandized by his giant-like appearance, over six feet tall and a huge girth. Children often either ridiculed him or were afraid of him. Dr. Johnson studied and later on taught at Pembroke College, Oxford. He was a brilliant man, a brilliant writer, and a brilliant poet and historian. He had a rich scholastic and literary heritage, coming from a lineage of physicians and scholars. Stories abound that the Oxford aficionados, perhaps because of jealousy, delayed conferring the doctorate degree upon him. In return, in a true passive aggressive way, he delayed completion of his dictionary by several years…

Another very interesting story about Dr. Johnson is that he had a cadre of helpers who submitted material for the compilation of his dictionary. Among them, there was a surgeon, afflicted with paranoid schizophrenia who in a bout of delusion and paranoia had killed an innocent victim. He was put away for life in a mental hospital. This brilliant surgeon contributed as many as 5000 entries to Dr. Johnson’s Dictionary. The book “The Professor and the Madman” by Simon Winchester gives you a delicious read. Wonder where are the Samuel Johnsons of today!

Johnson visited the surgeon  in his mental hospital ward often.

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

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A Compendium of Letters

“Monday Musings”  for Monday July 15, 2013

Volume III, No. 26/129

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(Editor’s Note: Today’s column is a compendium of letters to the editor of various publications)

Profligacy of our Postal Service

By Assad Meymandi, MD, PhD, DLFAPA*

Recent articles in the press re: USPS evoke some thoughts and suggestions. Postal service started by Cyrus the Great, the King of Persia (600- 530 BC), around 570 BC. He needed to have postal couriers to bring him news from the four corners of his vast empire on a regular and daily basis. His first person for the job, his Postmaster General, was a woman, a Postmistress by the name Mithra. She was Vizier of the Postal Services. Benjamin Franklin, a genius, a polymath, a polyglot, and fluent in history of civilization, in his writings made frequent references to Mithra. This little known fact also reflects the human right and equality women enjoyed in pre-Islamic Achaemenid Persia. Cyrus had two other female viziers also.

Thanks to our founding fathers, and especially to Benjamin Franklin, for more than 200 years, Americans have relied on the US Postal Service to deliver the mail through storms of all kind. But changing technology, a global recession, and rising debt now threaten the national mail service. Mail volume is expected to drop by 14% this year, and the USPS estimates that it will lose seven billion dollars. There is no question that by any measure the USPS’s financial condition is dire.

Among solutions contemplated is by USPS officials are closing of up to 700 branches and delivering mail five days a week or at least to stop Saturday mail delivery. USPS has tried to balance the budget by raising rates, trimming its work force through attrition and buyouts, automating mail sorting, realigning routes, and freezing executive salaries. Here are some thoughts about alternative solutions: Like Germany, Britain and Japan USPS ought to open its services to competition from private companies. In a recent report in Financial Time, professors of the London School of Economics suggest “profit motive would bring a drive for efficiency…”

As I travel around the world and observe national habits, I have not seen any country that offers so much in amenities to the postal carriers as we do in America. Our postal carriers seem to all have jeeps to carry them around. I suggest that USPS, like Germany, Britain and Japan mothball the millions of combustion engine jeeps they buy, fuel and maintain, spending billions of dollars on that one item and encourage the delivery to be carried on foot. Another benefit of such change in policy is trimming down the unwanted fat the jeeps carry around. Trimmer, and healthier postal workers save on the health bill. Obesity that causes diabetes, cardiovascular disease, hypertension and musculoskeletal problems, like chronic backache, could be prevented and truly billions and billions dollars in healthcare savings realized through switching from machine delivery to foot delivery. American profligacy is not only driving us to bankruptcy, it is literally killing us.

Assad Meymandi, MD, PhD, DLFAPA


 One Serpent or Two Serpents Caduceus

Letter to the Editor, News and & Observer

The wrong caduceus was used in the op-ed page article “Dying Well, Knowing the Cost”, N&O, June 13, 21013. Caduceus, a staff with two serpents is related to Mercury and all its functions and attributes including commerce. Caduceus with a staff and one serpent is medical symbol that goes to Asclepius. In 1902 through an error made by a culturally illiterate VA doctor in NY, the commercial caduceus was adopted as a medical symbol and never corrected. However in 1952, American Medical Association (AMA) took action to correct the symbol. AMA has taken further initiative of correcting the symbol in all its formal medical printings and communications.

A M

“Iran, 3000 Years of Stoning Women”

Letter to the Editor, The News and Observer, Raleigh, NC

I am writing to strongly object to the content of the political cartoon on the editorial page of N&O, Monday June 10, 2013. Among many evils going on in the world your cartoonist lists “ 3000 years of stoning women in Iran”.  A bit of history might be helpful.

It is the Persian Empire and not Iran that is over 3000 years old.  As a matter of fact, Persia and some of its cities go back 8000 years. Cyrus the Great and other kings of Persia are invoked in the 66 books of the Bible on innumerable occasions. Isaiah 45 is almost singularly devoted to the beneficence of King of Persia where he is named Messiah. Cyrus emancipated the Jews and established equal rights for men and women. In managing his vast empire, to be in touch with his emissaries, rulers in distant parts of the kingdom, Cyrus 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, being the amorous type and a lady’s man, has referred to Mithra in his writings. In addition, we had Toorandokht and Poorandokht (both women) ruling the Persian Empire during the Sassanian (Sassanid) dynasty, 224-651 AD. Also, we are reminded repeatedly in the Old Testament that wisdom is a woman (Proverb 1-9), and in Greek the word for wisdom is Sophia. May be one of these days we will have a female US President to bring some wisdom and love to our dialectically torn nation. I have a granddaughter who will make a good candidate…

Cyrus Cylinder, the iconic representation of declaration of human rights, is now on tour in US.  Yes, under the Mullahs and the present day regime, the level of human dignity and civility has deteriorated.  But the regime is only 30 years and not 3000 year old.

AM

Letter to the Editor, The News & Observer, Raleigh, NC

 

Dear Sir:

Mental Health

Kudos to John Drescher for his insightful column N&O, June 1, 2013, “On Mental Health, Job isn’t Done”. The only correction I offer is that some studies reveal that over one third of NC inmates have a diagnosable mental illness (brain disease), not 15 to 20 percent as stated in the article.

For over 50 years, I have been involved in various capacities with the North Carolina mental health system. At no time the services to and for our patients have been as chaotic, sparse, and erratic as they are today. Fifty years ago, in North Carolina, we had a system in place that was truly superb. At Dorothea Dix Hospital, where I received my psychiatric training, in the late 50’s and early 60’s, patients had predictable, excellent,

and academically cutting edge treatment available to them with ready access. No patients had to wait for days and in some instances for weeks in emergency departments of general hospital waiting for a bed.  And no patients were put in jail and prisons because of lack of mental health treatment and shortage of psychiatric beds. We have certainly devolved and regressed. Taking care of patients with mental illness–and really it is brain disease—is a moral responsibility about which Thomas Jefferson and our country’s other founding fathers have expounded.

There is a glimmer of hope.  UNC system President Tom Ross, his chief of staff, Kevin Fitzgerald, Dean of UNC School of Medicine at Chapel Hill, Dr. William Roper, and WakeMed administrator William Atkinson have agreed to provide a psychiatric unit of 40+ psychiatric beds for Wake County.  With the projected population growth in our area, to do an adequate job, we need a facility with 500 psychiatric beds.  We can do better, and must do better.

AM

Editor, WSJ: I am submitting the essay below for op-ed page, or the letter in response to Mr. Gary Fields’ excellent article in today’s WSJ. Thank you

AM

Gary Fields’ comprehensive article, WSJ, June 8-9, 2013, on the dilemma of the families where there is severe mental illness is indeed of Pulitzer quality. Mr. Fields took a psychological and historical scalpel and ably dissected the huge problem of mental health care in America. However, here are some reflections:

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

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

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

What to Do? 

For nearly 50 years, I have been involved in various capacities with the North Carolina mental health system. At no time the services to and for our patients have been as chaotic, sparse, and erratic as they are today. Fifty years ago, in North Carolina, we had a system in place that was truly superb. In the late 50’s and early 60’s, patients had predictable, excellent, and academically cutting edge treatment available to them with ready access. Taking care of patient with mental illness, which is really brain disease, is a moral responsibility about which Thomas Jefferson and our country’s other founding fathers expounded. America has a moral obligation to provide care for the mentally ill.

Assad Meymandi, MD, PhD, DLFAPA

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

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On the Strength of the American Medical System

Monday Musings for Monday July 8, 2013

Volume III. No. 25/128

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In Defense of Medicine

By: Assad Meymandi, MD, PhD, DLFAPA*

The press has been full of stories bashing American medicine. Pharmaceuticals have been maligned and accused of greed. In my writings I have personally devoted enough space to extensively critique the doings and shenanigans of the pharma industry including the malignant and greed imbued practice of ‘direct to consumer’ television and newspaper advertising. The pharma’s greatest sin is greed and the bottom line.  We have criticized the trend of pharmaceutical industry spending more on advertising and public reactions than they spend on research and development. The public relation comes in the form of free lunches and junkets for medical practitioners and researchers. We have objectively and constructively warned against the unholy medical-pharmaceutical complex and its unwelcome product of pushing pills and inventing new diseases to use the pills. Adult Attention Deficit Disorder, Fibromyalgia and Chronic Fatigue Syndrome are but a few examples of such unscientific atrocities. These are accomplished through ‘direct to consumer’s’ television and media advertising. However, this essay is dedicated to defense of medicine in general, and American Medicine, the best in the world, in particular.

With Flexner report of 1908, America purged itself of the substandard medical schools which up to that point were engaged in witch hunt, snake oil, and superstition.  Flexner report rooted American Medicine in solid scientific firmament.  In the 1950s when I decided to study medicine, I looked around the world including most of the European medical schools and found the American medical education to be best. I chose America.

We do have our problems. The cost of medical care is out of sight.  We spend 17% of GDP on health care, yet our health care access is below many European countries. Health issues are a source of anxiety to most citizens. In a recent issue of JAMA, it is reported that of 500,469 cases of percutaneous coronary intervention (PCI), 10.9% of the operations have been inappropriate. This type of waste is unacceptable. Unfortunately, greed continues to be an unwelcome part of practice of medicine. It ought not to be.

What is good about American Medicine?

In the last 10 years, between 2001 and 2010 America has logged ten great triumphs in advancing public health.

  •  We have doubled the lifespan of Americans at an unprecedented rate. The average life span of an American baby born today is 82 years.
  •  Vaccine Preventable Diseases:  There has been a substantial increase in utilization of rotavirus, quadrivalant meningococcal conjugate, and human papillomavirus vaccines, tetanus and diphtheria
  •  Prevention and control of infectious diseases such as HIV/AIDS.
  •  Tobacco Control
  •  Vast advancement in maternal and infant health
  •  Motor Vehicle safety. And finally,
  •  Cardiovascular disease prevention and increased awareness of the epidemic of obesity, which is the focus of this discourse.

In the late 50’s, when I was in medical school, even as students, we could feel the competition between, large medical centers for cardiac surgery. My alma mater, The George Washington Medical school being located in the nation’s capital, was the favored child receiving huge grants to advance cardiovascular surgery. Dr. Brian Blades (pun not intended), Chair of Surgery at GW, was in fierce completion with Johns Hopkins Chair of Surgery, Alfred Blalock to the North, and that of Baylor University Michael DeBakey of Texas to the south. DeBakey developed the left ventricular assist device (LVAD) now perfected and worn by thousands of patients including Dick Cheney, the former US Vice President (who had a heart transplant). LVAD is not an artificial heart. The patient must have a heart and the heart must be still working. But the pump helps delay congestive heart failure by relieving strain on a muscle too weak to function by itself. The average human heart beats 100,000 a day, 205 billion times over a lifetime. The rotor in a typical LVAD spins about 8,000 times a minute assisting the worn out of cardiac muscle. The world is in awe of America’s advance in cardiovascular surgery. The first heart transplant, by Dr. Christian Barnard in 1967, is a common-place operation performed in all university hospitals and even community hospitals throughout US. The past fifty years we have seen new treatments like coronary artery bypass graft, introduced in 1960, perfected. Discovery of new class of drugs like statins to lower cholesterol, emerging in 1980s, ACE inhibitors to lower blood pressure in the early 90’s, and beta blockers to reduce stress hormones in the early 80’s, have been major contributions of American system of research.

Since mid-century, the heart disease death rate has fallen by 1.7% annually, though progress seems to have slowed in recent years because of epidemic of obesity. Smoking cessation in America has been phenomenal.

In the 1990’s, dubbed the decade of the brain, the National Mental Health Institute invested over two billion dollars in research grants to gain better understanding of the brain.  We now know, and the faithful readers of this space recall our several articles devoted to the suggestion to change mental illness to brain disease and dysfunction.  Brain research using advanced imaging technique, such as positron emission tomography (PET) scan, magnetic resonance imaging (MRI) and functional magnetic resonant imaging (fMRI), as well as biomedical markers, and the discovery of new neurotransmitters has enabled us to gain better understanding in diagnosis and treatment of brain disease.

In 1981, when the first patient with Auto-Immune Deficiency Syndrome (AIDS) was diagnosed, it was America and American medicine that isolated the virus and discovered the cocktail of antiviral drugs that makes the lethal illness into a chronic illness. My esteemed (and hard charging) beloved colleague, Myron Cohen of University of North Carolina (UNC) School of Medicine promises a cure for AIDS before long. American medicine has made impressible gains in stem cell research growing brand new organs in the laboratory. A good example of this effort is Dr. Anthony Atala’s work in the area of engineering human organs. He has produced a liver after successfully bio-engineering urethras, kidneys, and bladders. Atala’s quest is “How can we increase the number of tissues we bring to patients and how can we make more patients benefit from these technologies?” We have every reason, with humility, to appreciate America’s unparalleled gains in medicine.

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

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On Jefferson, Adams, Music, and Independence Day

“Monday Musings” for Monday July 1, 2013

Volume III. No. 24/127

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Monday Musings
By Assad Meymandi, MD, PhD, DLFAPA*

Happy July 4th! Natal Anniversary of America and Mortal Anniversary of John Adams Thomas Jefferson -What Kind of Music Uncle T.J. Liked?

Happy 237th birthday to our beloved nation. We thought it is fitting to honor the US flag by flying it in today’s Monday Musings. On July 4, 1826, on the 50th golden anniversary of signing of the Declaration of Independence, John Adams died. Historians put his death at around 9:00 AM.  Adams and Thomas Jefferson, political arch enemies for decades, had reconciled and become good friends and pen pals in the last two decades of their lives. They exchanged more than 300 letters before that fateful day, July 4 1826. According to reliable history, Adams’ last words were “Thomas Jefferson still survives…” not knowing that Thomas Jefferson too had died that morning at age of 83.

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

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

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

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

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

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

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On the Brain and Behaviour, Part IV

Monday Musings for Monday June 24, 2013

Volume III, No. 23/126

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NIH Neuroscience Center Building, Rockville, MD

(Editor’s Note: This is part IV of a four part series on Brain and Behaviour. In Part I, June 3, 2013, the general topography and physiology of the brain was discussed. In Part II, Monday June 10, the topic of Epigentics was explored. In Part III, June 17, the emergence of ‘Age of Mind’, marriage of psychoanalysis and neurosciences was examined. Today, Part IV, we conclude the series by offering an example of such marriage in the form of a book review to enhance our understanding of what lies in the future of the union of psychoanalysis and neuroscience.)

 Brain and Behaviour, Part IV

PSYCHOANALYSIS AND NEUROSCIENCE

By Assad Meymandi, MD, PhD, DLFAPA*

PSYCHOANALYSIS AND NEUROSCIENCE

Edited by Mauro Mancia. 436 pages. $199.00

Springer.  New York, NY

The faithful readers of this space recall that we begun reviewing books about mind, memory, neuroscience and the brain many years ago. The first book reviewed in this series was the book by Harvard clinical and research psychologist, Daniel L. Schecter, Searching for Memory, the Brain, the Mind and the Past. The last book reviewed in this series was the Nobel Laureate psychiatrist Eric Kandel’s book, “The Emergence of a New Science of Mind,” published in the October 2011.

We now offer the review of a fascinating book, “Psychoanalysis and Neuroscience,” edited by the enormously sage of the Italian Academia, neurobiologist and psychoanalyst Mauro Mancia. First a word about the author/editor:

Mauro Mancia is Professor Emeritus of Neurophysiology, University of Milan, Italy and Training Analyst of the Italian Psychoanalytical Society. His interest is in the link between neuroscientific knowledge and psychoanalytic theories of mind and he has written extensively on the subjects of narcissism, dreams, sleep, memory and the unconscious.

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

Fast forward the clock. Neuroscientific interest in dream started in 1953 with the discovery of Rapid Eye Movement (REM) sleep by Aserinsky and Klietman, taking psychophysiologic findings of dream into the realm of biology. There are many exciting discoveries in the area of psychoendocrinology of dream and memory coming out of many sources and laboratories both in US and abroad. Here is the title of one of the recent articles: “The Role of the Inter-relation Between Serotonin (5-HT), Muramyl Dipeptide and Interleukin-1 (IL-1) in Sleep regulation, Memory and Brain regulation,” by the editor of this book and his colleagues, published in American Journal of Physiology. 

The book is organized in four parts.

Part I:

Memories and Emotions: consists of eight chapters written by experts in their respective fields.This segment examines one basic message: memories stand out and last longer when they are accompanied and highlighted by emotional experience. The message of this section of the book is the importance of interconnection of memory with emotions. With scientific detail and elaboration, the authors demonstrate the proteins in amygdala and hippocampus responsible for retention of memories are parts of the limbic system that overall is responsible for housing emotions denoting the common neuronic pathway for memory and emotions. In 1940s, while mapping specific components of the limbic system, Paul D McLean invoked the romantic notion that the limbic system is “the anatomy of emotions.”

Part II:

The second part of the book consists of three chapters. It examines the sensorimotor side of “empathy pain,” the role of the anterior cingulate cortex in affective pain, and social cognition and response to embodied stimulation.

Part III:

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

Part IV:

The two chapters of this part discuss fetal behavior. While the word embryology is seldom used, the authors of these two chapters examine in detail the onset of human fetal behaviour, and neurophysiologic impact and influence of nursing on the early organization of the infant mind.

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

The downside of the book: It is a rather difficult read, I guess because it is a translated work. I do not know how much psychoanalysis and neurophysiology the translator, Mrs. Judy Baggott, has had. To a linguist, conversant with a variety of Eastern and Romance languages, the slip of the translator shows fairly frequently. Her skirt should be longer!  However, this minor flaw should not dissuaded anyone form tackling this enormously informative and scholarly work.

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

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On the Brain and Behaviour, Part III

Monday Musings for Monday June 17, 2013

Volume III, No. 22/125

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Brain  and  Behaviour,  Part   3

Thinking  About  Thinking,  Episteme,  Chrestomathy

Twenty  First  Century , The  Age  of  Mind

By Assad Meymandi, MD, PhD, DLFAPA*

Editor’s Note: This is part III of a four part series on Brain and Behaviour. Part I, June 3, 2013, the general topography and physiology of the brain was discussed,  Monday June 10, the topic of Epigentics was explored.  Today we examine the relationship between psychoanalysis and biology.  Next week we will review some of the books about the subject to enhance our understanding of what lies in the future of neuroscience.

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

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

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

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

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

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

The American psychologist best known for his maternal-separation and social isolation experiments on rhesus monkeys, Abraham Maslow, 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. As an aside, the etymology of the word companionship comes from Latin for bread—PAIN—nutrition.  Another psychologist, Hans Selye, had pointed out as early as 1936 that humans and experimental animals respond to stressful experiences by activating their hypothalamic-pituitary-adrenal (HPA) axis. The end product of the HPA system is the release of glucocorticoid hormones by the adrenal gland.

The prefrontal 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.

What To Do?  What is Next?

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

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

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

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On Epigenetics and the Epigenome

Monday Musings for Monday June 10, 2013

Volume III, No. 21/124

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Epigenetics and the Bible—Brain and Behaviour Part II

By Assad Meymandi, MD, PhD, DLFAPA*

This is a follow up—Part II–on last week’s “MM” devoted to Brain and Behaviour. Today we discuss the related important topic of epigenetics.

It seems a bit odd to start a discussion of cutting edge, up to the minute, science of epigenetic with an ancient Biblical story: Genesis chapters 41 through 47 talks about the Egyptian Pharaoh’s dream of “seven years of plenty and seven years of famine…”   Well, here is the relevance of the Old Testament to this cutting edge 21st century science:

Actually, there is a place in northern Sweden called Norrbotten sparsely populated, six people per square mile that has offered astonishing epidemiologic and scientific data which have given birth to the science of epigenetics. In 19th century Norrbotten there were literally seven years of famine followed by good harvest and abundance of food.  For instance, 1800, 1812, 1821, 1836, and 1856 (the year of potato famine in Ireland) were years of total crop failure and famine for the people of Norrbotten. But in 1801, 1822, 1828, 1844, and 1863, there was excellent harvest and abundance of food.  Scientists of renowned Karolinska Institute have taken the painstaking work of tracing the effect of this famine and feast to see how it affected the lives of the children.  With these studies, they have established “life conditions could affect your health not only when you were a fetus but well into adulthood”, concluding that “Parents’ experiences early in their own lives change the traits they passed to their offspring.” The result of the study is that the years parents were well fed; their children grew up to be healthier and physically bigger offspring.

In 1967, when the writer was director of Cumberland county Mental Health Center, applying for a grant for the Head Start program, I used a study by Karolinska Institute which was published in the Acta Physiologica Scandinavica, and Lancet, demonstrating that fetus and fetal central nervous system (CNS) exposed to excess secretion of maternal catecholamines and its metabolites, especially metanephrines, vinyl mandellic acid, and 3-methoxy 5-hydroxy methyl glycol (MHPG) produces babies that are more irritable, scrawny, cranky, susceptible to Attention Deficit Hyperactive Disorder (ADHD), and prone to anxiety, phobia and social maladjustment. The project titled “Intrauterine Head Start” was funded and our findings were published. So, the knowledge of environmental influence on fetus is not new. What is new is the epidemiologic studies from Norrbotten in defiance of Darwin’s assertion in his seminal work “On the Origin of Species”, 154 years old coming November 2013 (I will have another ‘MM’ in November marking the anniversary of this seminal work), that evolution takes place over millions of years. The Norrbotten studies suggest that evolution and environmental influence affect genes in one or two generations. It does not take millions of years. This is heretical. Suddenly, we have evidence that Darwin was wrong! It takes only 25 to 75 years, one to three generations, and not millennia for evolution of genes to take place.

 What is epigenetics?

The exciting science of epigenetics as the name implies is “the study of changes in gene activity that does not involve alteration to the genetic code but gets passed down to successive generations…” It is very much like a switch on the outside of the genetic circuits and genome that influences the behaviors of a gene. The very word epi means above explains that this activity while not an integral part of an organism’s genetic code, from outside or above influences the gene’s activities.  In essence it is like a switch that may turn on or off the activity of a gene.

In Utero Cell Differentiation

A cell in the kidney and the cell in the brain, a neuron, have the exact same DNA. The nascent cell can differentiate only when crucial epigenetic processes turn on or turn off the right gene in utero. This is why studies of identical twins show why one sibling develops asthma or bipolar disorder, even schizophrenia while the other is perfectly normal. The studies from Norrbotten clearly show that because of epigenetic switch you can pass down epigenetic changes in a single generation.

There are several epigenetic drugs on the market. 5-Aza-cytidine (produced by Celgene Corporation is an example of an epigenetic drug that prolongs the life of patients afflicted by severe myelodysplastic syndromes, MDs). By turning a switch that is outside of the genome sitting on DNA, one enhances (turns the gene on) or inhibits (turns the gene off) of DNA’s activities. Cutting edge science is after discovering how to enhance the activities of the good genes and how to silence and discourage the activities of the bad genes. The task is not very difficult.  To chemically turn on the good switch is to introduce a methyl group (CH3) to the side chain of DNA, a very simple procedure. Or vice- versa, remove demethylate (take the methyl, CH3 group off) the compound and suppress the activities of the bad genes. In recent years FDA has approved three other epigenetic drugs that are thought to stimulate tumor suppressing genes. It is hoped that we will find drugs that turn off expression of genes of many diseases including cancer, Alzheimer’s, autism, and schizophrenia, even alcoholism.

In the case of Alzheimer’s disease, where blobs of starch like gunk or amyloids are deposited in the brain interfering with transmission of messages in nerve cells (neurons) causing dementia, by using the instrument and knowledge of epigenomics, it is conceivable to find the switch (the epigenome) that turns off the dumping of amyloid in the neural synaptic clefts. Currently, the National Institute of Health is investing heavily in better understanding and codifying epigenomics. The Human Genome project completed in March 2000 found that the human genome contains approximately 25,000 genes. Private enterprise, and Craig Venter, who won the Nobel Prize in Medicine or Physiology in 2005 bested government bureaucracy and completed the project ahead of the government by two years. We had Venter’s book reviewed in this space a few years ago. Now we need a massive project to identify the epigenome and compile the human epigenomic book. The number of epigenomes far exceeds 25,000 and the cost of completing the project will cost hundreds of billions of dollars. Besides, it will cause a bad case of Darwinitis. We will keep you posted as the science of epigenomics further develops.

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

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On the Brain and Behavior

“Monday Musings” for Monday June 3, 2013

Volume III, No. 20/123

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Brain and Behavior

By Assad Meymandi, MD, PhD, DLFAPA*

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

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

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

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

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

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

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

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

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On Graduations

Monday Musings for Monday May 13, 2013

Volume III, No.18/121

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(Editor’s Note:  Richard Wagner was promised for today.  But I was asked by President Norval Kneten to give the commencement address to the 111th graduating class of Barton College, Wilson, NC on May 12, 2013.  It is dedicated to all college graduates across the globe. Richard Wagner will appear next Monday, May 20, 2013.)

Commencement Address

By Assad Meymandi, MD, PhD, DLFAPA*

Mr. Chairman, members of the Board of trustees, Mr. President, honored guests, fellow students, Ladies and Gentlemen:

Happy Mother’s Day! Today should be proclaimed a holy day…

So, you graduated from college. Congratulations! You have been through a lot of graduations. You graduated from pre-kindergarten. You graduated from kindergarten, then from elementary school, middle school, high school, and now from college. But I submit that you have graduated more times than you know. You and I were born as helpless babies who could not survive without the nurturing, care and love of our parents, especially our mothers. When a newborn is hungry (for the science majors, that is driven by low blood sugar, below 70 mg percent) the baby screams. “Mama is coming,” and she brings the bottle or the breast. This goes on day and night until something miraculous–and I choose the word miraculous advisedly—it miraculously happens around age week to week and week and half.  Let me explain this miracle: when the baby gets hungry and screams and while mother is saying “Mama is coming,” the baby equates the voice of the mother to anticipated gratification and stops screaming momentarily. But if Mama falls asleep, of course the baby resumes screaming. At the ripe old age of 10 days, the anloge or the infrastructure of ego functions are laid.  Yes, we all graduated from this stage of extreme narcissism and self- centeredness at the age of 10 days. It is a miracle.

Then, you graduated from infancy, learning to sit, to stand, to crawl, to walk, to run, and to separate and individuate, running away from mama only to return and hide behind her skirt. Games like peak-a-boo reinforce this phase. Then you graduated from childhood. You later graduated from latency phase of growth and development, age seven to twelve, and entered adolescence. You went through adolescence and negotiated the vicissitudes of teen years and graduated into adulthood. And now with the support and continuous love and sacrifice of your parents you are graduating from college as well- balanced, educated, mature person.

The purpose of life is to turn that narcissistic bundle, the newborn baby, into the altruistic and loving adults you all are.  Let’s briefly examine the attributes of an altruistic and loving adult. This person for the most part of waking hour is aware that he or she is a child of God. Not the child of a mayor, the child of a governor, the child of a king, the child of a President, a Shah, an Emperor, or an Ayatollah, we are children of God.  Do you know of a loftier position in all creation?  Being aware of this gift given to us at birth is the essence of Pauline theology of Grace and Christian love.

This person for the most part of waking hours has good feelings, happy feelings, and as result has good thoughts and does good things. Doing good things is vastly different from being a do-gooder. Doing a good deed is altruistic. Being a do-gooder may be narcissistic and self- serving.

This person is a joyful person. The etymology of the word joy is the Sanskrit word (and Farsi) JOOYE, meaning a running brook. Let me explain: a camel driver crossing the desert in 100 degrees in the shade for several days reaches an oasis with trees, grass and a running brook of clear cold water. He waters his camels, then takes a fistful of this cold and refreshing water and drinks it and splashes some on his face. The feelings at that moment generated by JOOYE, the running brook, is where JOY comes from.  Joy, like a running brook, is constant. It is refreshing. It is life giving…  this person is not just happy, but JOYFUL. Happiness is temporary, evanescent, and artificial, while joy is constant, refreshing and life giving… be joyful.

This person makes a pledge, a resolve to be a growing person. What is growth? To me, growth consists of three parts: to know more today than I did yesterday, to do fewer bad things today than I did yesterday, and to love more today than I did yesterday. Knowing more every day is a demanding and disciplined task. At my age, just had my birthday yesterday, well north of 70, every night I go to bed, I take an inventory of what I know. I mean sheer knowledge. If I have NOT learned more today than I did yesterday, I get out of the bed and go read my medical, science and humanities journals. You and I must be aware of the responsibility of enriching our cognitive reservoir. Yes, we must know more today than we did yesterday. The sheer act of learning and internalizing knowledge is pure joy. We all do bad things. Good people do bad things.  We must take an inventory that we did fewer bad things today than yesterday. This is what Saint Paul theology calls power of redemption. And to be a growing person, we must be more loving today than we were yesterday.

Now, what is love? We love our Aunt Molly, Cousin Bert; we love apple pie and the beach, and BBQ. Love is one of the most confusing words in English lexicon. English language, young, accessible and dynamic as it is, is very short on affective words, feeling words, words that describe feelings. There are 400 Arabic words whose equivalent in English is one word “love”.  It is frustrating to use the same four letter word for the rich reservoir of feelings we experience in our lives. So let me resort to the Greek.

There are three words for love: Eros, the love involving sex, reproduction and carnal fusing, Philia, the love we have for our relatives, brothers, cousins, and extended family. But the love I want to focus upon is the third Greek word, Agape, which is the love God has for all of us, and we must learn to have it for all humanity. Let’s focus on Agape, the kind of love that God has for us. It has three parts: a loving person is not abusive to one’s self, a loving person does not use and abuse alcohol, does not smoke, does not use drugs, and does not get fat. The epidemic of obesity in America causes diabetes, cardiovascular disease, back pain, bringing a health care bill approaching 20% of our Gross Domestic Product (GDP). Obesity is a very serious form of self- abuse which is not loving. Obesity is a moral issue. Second leg of agape is not to be abusive to one’s fellow man, regardless of what you do for a living. As a physician, don’t abuse your patients by making them wait for you. For garbage collectors, don’t strew the stuff all over the street, be neat, do not abuse others- including the US government by cheating on taxes. And lastly, the third leg, do not let anyone else abuse you. Learn to say “NO” and mean it. Do not let friends talk you into doing abusive things. Love, like a tripod, has to have all three legs to stand up.

Now, I want to introduce you to three role models who have shown us how to be loving and lovable. These three brilliant stars of the intellectual constellation are Saint Augustine of Hippo (354-430). Saint Augustine was a pagan. He was a brilliant student throughout his entire life, but as he grew up he did a lot of bad things, like stealing from his parents to buy toys and literally purchase acceptance and friendship of his peers, that is to say, to be popular. He used to steal apples from his neighbor’s yard, not because he was hungry, but because it was fun to do. He lied to his mother repeatedly. As he grew up, he sired an illegitimate son by a concubine. He converted into Christianity at age 31 and after a couple of years became a Bishop of the city of Hippo. All this is recorded in his 13 book “Confessions. The first nine books are autobiographical and the last four exegetical, an analysis of the book of Genesis, the first book of the Old Testament. Augustine wrote more than five million words.

The second role model is the Jewish physician, Rabbi, philosopher and theologian, Moses Maimonides of Cordoba, Rambam, (1135-1204).  He, too, wrote more than five million words. And the third person is the Arab economist, theologian and music advocate, Ibn Khaldoun (1332-1406). Surprisingly, he, too, wrote more than five million words. Islam prohibited music and the arts for fear of inviting and spreading lust into society.  Ibn Khaldoun was very much interested in bringing music back to Islam. He knew as an exception singing the passages of the Holy Quran (Bible of the Muslims) called Talavat is acceptable. So he petitioned the ruling Caliph to start a competition singing the text of Quran, just like our Oscars. The competition began in 1352 when he was 20 and continues to this day. All Muslim nations send delegations of singers to these annual competitions. This has played in war, in peace, in famine and in plenty, since 1352. As an aside, another piece of music that has continuously played since its opening night, Christmas Eve 1741, is Handel’s Messiah. On the opening night King George II was in the audience. When the chorale sang the Alleluia Chorus, the king was so moved that he stood up giving an ovation. This is why to this day we, too, stand up when Alleluia Chorus is sung. Like Talavat, Messiah has played continuously in war and peace, in famine and plenty since its debut in 1741. So, let’s see what these gifted people, the residents of the Pantheon of superior intellect, spirituality and faith tell us. These three people wrote more than 16 million words in their life time. I do not pretend that I have read every word of what they have written, but I have read a good bit of their writings. To give you a summary in the form of a gift that I hope you take home with you, repeat it in your mind, and if you would, like a favorite song, hum it until it becomes a part of you.

Here is what they said.  Here is what these three most accomplished and brilliant children of God said: the pathway to salvation and grace is “to know what is good inside of you, namely brain, this wondrous two and half pounds mass of billions of neurons, that is nerve cells, and trillions of synapses where these neurons chemically inter-connect,  love, compassion, loyalty, faith, intellect and self-awareness; and what is good outside of you, namely friends, connectedness, family, flowers, dance, poetry, music and beauty of nature, and to be thankful for them ‘by giving something back.’  This is the beginning of altruism, philanthropy LOVE OF MANKIND, and joy.  Remember, it all started when you were only 10 days old…

Let me repeat and pass onto you the gift these three people have given to us so that their gift may become an integral part of our mentation, cognition, perception and lives: To know what is good inside of you, namely brain and intellect, love, compassion, loyalty, faith, intellect and self-awareness; and what is good outside of you, namely friends, connectedness, family, flowers, dance, poetry, music and beauty of nature, and be thankful for them by giving something back…”

Yes, you and I are privileged to be children of not a mayor, not a king, not a governor, not a President, not a Shah or Ayatollah…You and I are children of God- all seven billion of us occupy that lofty status.

Yes, we have many good things inside of us, many good things outside of us. And we will be constantly aware of them and be thankful for them by giving something back…

And now I close by recalling a passage from one of the most beloved poets of the 20th century, Khaleel Gibran: “Empty and dark shall I raise my lantern, and the Guardian of the night shall fill it with oil, and He shall light it also…”  May your lanterns be always full, and may they be lighted also.

God Bless America.

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