WHAT’S IN A NAME
It was with a great deal of satisfaction that I recently noted that the sign in front of our mental health center announcing it to be a “Behavioral Health Care Center” had been removed. I have long held that such terms trivialize and obscure the problems facing those afflicted with mental illnesses. It is true that those illnesses provoke behavioral changes in many, but are we to treat the behavior or the illness responsible for the behavior? In a similar manner, if someone is choking, should we instruct him in relaxation exercises or proceed directly to the Heimlich maneuver?

The term behavior implies volition, and I seriously doubt anyone would choose to endure the suffering of a mental illness. It was initially used in reference to addiction and drug abuse, but now includes mental health for reasons beyond my understanding.
Most linguists agree that not only does thought affect language, but perceptions are affected by language. The latter scenario is in my opinion likely to affect how we think about mental illnesses and consequently those who are mentally ill. The one which is likely to raise my hackles the highest is the word client. For the past several years I have been on a mission to expunge that word from the vocabulary of anything having to do with treatment of Psychiatric patients. Not only have my efforts fallen short, I could not even influence the nurses who worked under my supervision to give up that vile word. Some seem to think that my abhorrence of the use of the word client to describe my patients is simply the bias of an old foggy MD, and I do confess to that charge.
My bias has to do with the origin and meaning of the word patient, which was from the Latin, patientem, which is roughly translated as “those who suffer”. My bias also extends to the belief that there is no more honorable profession on earth than the alleviation of suffering, and that those who suffer should be categorized differently than those who have a strictly business relationship. The mantra I have used for several years as follows: “accountant, lawyers, and hookers have clients, but we have patients” has fallen on deaf ears. The word client has been absorbed into every aspect of the mental health movement. The electronic medical record I used prior to my retirement referred to patients as clients. Likewise, the word is routinely used in communications from our state department of mental health. Even advocacy groups use the term.
In response to Shakespeare’s question, I suggest that there is a lot “in a name”. Granted, a name change does not change a rose; however if the rose is repeatedly referred to as a weed it might well change one’s opinion about roses. One might ask, how did emotionally suffering people seeking treatment come to be called clients. Advocates for the elimination of the stigma associated with mental illnesses frequently present them as analogous to other medical illness, such as diabetes, hypertension, heart disease etc, yet insist on using a non- medical term such as client to describe those in treatment. Besides, it makes no sense to separate psychiatric problems from mainstream medicine when studies of the brain now clearly demonstrate most if not all such illnesses to be due to medical disorders. Such separation of psychiatric problems from mainstream medicine has also given license for third party payers to discriminate by providing less coverage for mental illnesses, and undermines attempts to correct those inequities.
In my opinion the key to eliminating societal stigmatization is understanding, and I believe that it makes more sense to call a rose a rose and likewise to call one who suffers no matter the cause a patient. Some may feel it will lessen the stigma associated with mental illness to place it in a separate category from other medical problems; however I suggest the opposite to be true. Throughout history those suffering from any malady for which the cause was unknown would often be persecuted and shunned. As knowledge accumulated concerning the etiologies of such illnesses, there was less reason to fear and to blame them. Unfortunately, this understanding has been slow to develop in the area of psychiatric disorders. It is interesting to note that in Ancient Greece there was no distinction made between diseases of the brain and those of the body, but in the middle ages, discrimination and persecution was rampant as ignorance prevailed.
The brain is easily the most complex organ in the human body. We are said to have on average of 86 billion cells in our brain all of which have multiple connections to each other. It is little wonder that we have difficulty figuring out how it works and how to fix it when it goes off on a tangent. Many such disorders result in unusual if not bizarre behaviors which will often result in avoidance by others. In my opinion the research of the early part of the last century also placed undue emphasis on psychological factors to explain even the more serious illnesses. This can be laid at the feet of Freud, who although he made gigantic contributions to our understandings of human behavior, attempted to blame the more serious illnesses on childhood traumas. We now know that the schizophrenias, severe mood disorders, and such are due largely to genetic factors even though stress may expose one’s vulnerability. With the serendipitous discovery of drugs which appeared to have a positive effect on these illnesses, researchers set out to understand the mechanisms involved, and the science of neuroendocrinology was born. Although there have been exciting discoveries, we have barely scratched the surface.
There are many who find the renaming process advantageous. Insurance companies whose goal sometimes appears to involve denying as many payments as possible, generally substitute the term consumer for patient and provider for those who treat them. It raises the question, what is provided and what is being consumed? The obvious answer is their profits. It is no wonder they treat our patients and their doctors badly.
In a previous blog, I have said I think a shortage of physicians is a major source of our problems with the current medical system. Nowhere is this more apparent than in the field of psychiatry. As of 2013 there were 50,000 psychiatrists in the United States, and another 45,000 is needed according to a government survey. Since there is a heavier concentration in metropolitan areas it is obvious that the shortage is even more acute in less populated areas. With development of effective treatments this need is expected to expand.
Psychiatrists were the first to adopt the strategy of introducing “doctor extenders” to help fill the void.
Now many from these disciplines (social work, nursing, psychology, and counseling ) have become licensed to practice independently. Nurse practitioners in our state are now licensed to prescribe, and psychologists are attempting to gain the same privilege. I am told there is even a move underfoot to allow pharmacists to essentially practice medicine as we know it. Social workers and clinical counselors can now be licensed to practice independently. In short those physician extenders have in many cases become physician replacements. In my opinion, this phenomenon has also contributed to the use of non-medical terminology such as client, consumer, provider etc.
Psychiatric research as to the causes and effective treatments for mental illnesses has lagged behind other specialties, but we are now on the verge of taking giant steps in the right direction towards unraveling those mysteries. America has a checkered past in dealing with mental illnesses. Early in our history the traditions of incarceration, cruelty, punishment, and abuse common in European countries were carried over to the new world. Often their treatment was equal or worse than that inflicted on the worst criminals. Families also suffered since such illnesses were thought to be caused by character flaws, spiritual weakness, or demonic forces. It was frequently assumed that this indicated a failure on the part of the family which brought shame upon them. As a matter of fact the statement: “where did I go wrong?” is one I frequently heard from parents of my patients.
There have been valiant attempts to correct the stigmata, but none have had a long lasting effect. Dorothea Dix was the heroine who devoted her life to improving the lot of the mentally ill. In the nineteenth century largely through her efforts, so called asylums were constructed throughout the country with an emphasis on humane treatment. Lack of funding and/or interest allowed these facilities to deteriorate into what some called “human warehouses”, and there were reports of abuse and neglect. The cause was once again taken up by the civil rights movement of the sixties, and President Kennedy signed The Community Mental Health Act in 1963, which was designed to provide intensive, comprehensive treatment in local communities. There were funds allocated for the building of facilities throughout the country, many of which were not built, and state legislators were no more inclined to fund these facilities after the federal money ran out than they had been for their state hospitals.
Fifty years later, most mental health centers still in existence are under -funded and under staffed. Meanwhile although the stigma of mental illness may be lessened it is still with us as evidenced by the language we use to describe it, and how we treat its victims. True, we have liberated them from those awful state hospitals so that now they can live on the street or in jail.
It reminds me of the old Peter, Paul and Mary song “When will they ever learn?”

Meaningless Marathon

Yesterday, I was mesmerized by the food fight between the democrats and republicans as they spent eleven hours slinging mud at each other.  They were there ostensibly to determine what happened in Bengazi, but it seemed more like looking for someone to blame rather than finding a solution to the problem.  But of course the inquisition began with reassurances by the head hog at the trough that they were not there to blame Clinton, and then proceeded to question her as to how and why she had screwed up so badly and caused the death of four people.  Of course the democrat members of the committee were there to defend her and to point out what bad guys her interrogators were.  What a wonderful opportunity for the both sides to be on national TV and show the folks back home how tough they were.  To purchase that much time on TV would have cost enough to bankrupt even the most plush super- pack.   This must have surely been a factor in deciding to broadcast the debate in its entirety for many legislators have admitted that they spend more time raising money for their campaigns than they do legislating.  Although they complain, they oppose campaign finance reform once in office since incumbents are in a much better position to attract the big donors.  I guess a bird in the hand is worth one in the bush.

The committee in all fairness did allot equal time to each member; although one went over his time by four minutes which resulted in a lengthy debate about his breaking of the rule.  I was determined to watch this thing through in spite of my revulsion, but gave up after only eight or so hours.  I had to give Hillary points for endurance as I was exhausted just watching my tax dollars at work.   But then I was amazed to turn on the TV this morning to see her giving a speech to some women’s group only a few hours after her eleven hour trial by ordeal.   The procedure reminded me of the one described in the cop novels to which I am addicted called “sweating the perp”.   Since the use of the rubber hose is frowned upon these days, this technique involves two or more interrogators who take turns asking the same intimidating questions over and over for hours until he gives up and confesses.   After about seven hours, I was ready for Hillary to confess and get it over with, but she pretended to be unaffected.   I was amazed that she did not take the bait and say what she must have been thinking.

Pundits report that the political parties in Washington hate each other, and the exchanges I witnessed yesterday tend to confirm that impression.  There was a feeble attempt to maintain the traditional courtesies and decorum of the institution by addressing each other by their titles, but it was not long until the vitriol rolled out of the mouths of our esteemed representatives.   Questions were interspersed with accusations, and the democratic members responded in kind with their own dissertations about the republican’s alleged diabolical plan to derail Mrs. Clintons bid for the presidency.   As this charade dragged on the nastiness increased, and when it was over both sides agreed that nothing had been accomplished.   It is little wonder that nearly 90 percent of Americans disapprove of our congress.

The experience of watching this thing left me wondering:  what ever happened to statesmanship and “where is the love”?.

Yesterday, I had an interesting discussion with my Grandson concerning the recent episode in which a young woman was found dead in her jail cell of an apparent suicide.  She had been stopped for a minor traffic violation which following a confrontation between her and the arresting officer resulted in her incarceration.  This was portrayed in the media as merely another example of the use of excessive force by police.  After watching the images from the officer’s body cam, I likewise placed the entire blame for the incident on the cop for having over-reacted to an angry lady who he had charged with a very minor traffic infraction.  Imagine my surprise when my grandson placed an equal amount of responsibility on the victim.

Carter reminded me that the lady had appeared to deliberately provoke the policeman, which set in motion the events leading to her arrest.  He went on to generalize from that with the observation that his generation had “no respect for authority”.  He cited examples from his own experiences such as the relationships of his peers with his basketball coach, teachers, parents, those charged with law enforcement, and indeed anyone in a position of authority.  I responded that in my opinion this cop was being a real asshole, and not deserving of any respect.   He counterpunched with the statement that I was missing his point for if she had treated the officer with the respect due someone in his position, she would have simply received a ticket for the violation and moved on.  He did agree that the cop had acted inappropriately and that the entire interaction was something which required the participation of both parties.

With this last statement, I bid a hasty retreat for my own Grandson had inadvertently rubbed my nose in one of my own mantras.  It hearkened back many years ago to the time when I taught marital therapy.  My students were reminded that most couples blamed each other for their problems; therefore establishment of blame could never be therapeutic and must be avoided at all costs.  The couples needed to learn that they both played a part in causing their problems if they were to be successful.   Of course this same principal would apply to any human interactions, and my own analysis of the situation under discussion had ignored my own admonition.

Later, I thought (always a danger in my case) more about the subject of respect and the issue of authority.  Initially, it occurred to me that if Carter respects his elders, why did he disagree with me, but that was followed by the not so brilliant insight that were he to pretend to agree solely because of who I was  he would be patronizing me, which is for me the worst kind of disrespect.  I concluded that the idea of respecting authority was not as simple as it would appear at first glance, and decided to google my old friend Mr. Merriam-Webster for the definitions of both respect and authority.  The results were as follows:

AUTHORITY:

• The power to give orders or make decisions.
• The power or right to direct or control someone or something.
• The confident quality of someone who knows a lot about something or who is respected or obeyed.
• A quality that makes something seem true or real.

RESPECT

• A feeling of admiring someone or something that is good or valuable, important, etc,
• A feeling or understanding that someone or something is important, serious, etc, and should be treated in an appropriate way.
• A particular way of thinking or looking at something.

Anthropologists seem to agree that the ability of humans to band together in order to achieve common goals was an important factor which led to our domination of the planet.  Prehistoric man learned this early on: families got together into groups, who then joined with other groups to become tribes and so on.  The process continued as bigger was found to be better resulting in our current state of affairs with nation states populated with millions or even billions of people.

It must have become obvious early on that if a group of guys decided they would like to kill a Wooly Mammoth (said to be about twice the size of your average elephant) there would need to be a game plan.  There would need to be someone in charge who would be given the power to “direct and control”, and who “knows a lot” about how to kill that big sucker, in other words someone in authority as defined by Webster.  It goes without saying that the hunters would need to have respect for their leader’s skills and/or experience if he was going to risk his life.  It seems reasonable to assume that the respect accorded the leader would have been earned.

I am one who has always considered humility a virtue; consequently when I went into the Navy as a medical officer, I felt embarrassed when enlisted men saluted me.  I confided this to an old chief with whom I worked and he assured me they were saluting the uniform and what it stood for, not me personally.  In that case I had not earned the respect deserving of a salute, but others had done that for me. I was definitely an authority figure for I was given “the power to give orders and make decisions.”  I was endowed with that power by virtue of having taken an oath to preserve and protect the Constitution of the United States.

In like manner the police officer under discussion had taken an oath to protect and serve his fellow man, as lofty a goal as one could imagine.  With that in mind he was endowed with considerable power, and his badge was deserving of respect.  He forfeited that respect at the moment he violated his oath for his behavior was antithetical to his promise to protect and serve.  I will concede that the lady in question did not initially offer the respect due the cop, but feel strongly that his is the greater sin for such incidents undermine the credibility of those who take their mission seriously and disrespect a profession that should be the most honorable of all.

In my opinion the ultimate blame for this incident should be laid at the feet of a system that does not adequately vet applicants for law enforcement positions, nor offer reimbursements sufficient to guarantee the most highly qualified and trainable people.  We are told there was a time when the neighborhood cop who walked his beat daily was accepted as a highly respected member of the neighborhood.  Sadly there are now many neighborhoods in which police are feared rather than respected.

In that vein I noticed that Webster’s definition of respect describe it as a feeling of admiration.  I do agree with Carter that the current generation is less respectful than was the case in my younger days.  That would seem to indicate that they do not find people in positions of authority whom they can admire.  Perhaps we who complain about lack of respect are actually the cause of the problem.  The current generation certainly hears more about the moral or ethical failures of those in authority than about their good deeds.  Today our children witness a continual parade of scandals, cheating, drug abuse, and other bad behavior by those athletes who in previous generations would have garnered unlimited respect.

We also note that authority is power. The quote from Lord Acton that “power corrupts and absolute power corrupts absolutely” is as true today as it was 150  years ago. Throughout history absolutely powered people or governments have time and again proven his point; consequently although authority is necessary in any civilization we must be ever vigilant that the power granted does not exceed established boundaries.  The lust for power seems almost a part of the human condition.  Unchecked it is certain to undermine the purpose of the authority from  which it originated.

Before closing my ramblings I feel the need to express my concerns about the power exerted by those who purport to represent my interests.  Millions of dollars are now being spent on never ending political campaigns to elect people who are to make and enforce laws which I must obey.  Our supreme court has ruled that money is speech, and I contend that in our society money is power.  If both positions are accurate then people in poverty are likely to be left speechless and powerless.

For those of you who have endured this far, I end offering some free advice, (a commodity that never seems to be in short supply, and is rarely worth more than you pay for it).  If you admire a person or entity it probably has earned your respect, but if you don’t, it more than likely deserves your contempt.

Background

Since the extinction of humans 100,000 years ago, we have witnessed massive technological development of our planet.  We have survived multiple assaults by adapting to changes, and have become good stewards of our habitat.  The adoption of a common language has helped us to unite in our efforts to provide a comfortable environment for all, and ethnic strife has been virtually eliminated.  The development of this “heaven on earth” has been made possible by diligent study of the mistakes of previous residents of the planet.

How did we get here?

In spite of all our research the question as to our origins and how we got to be here remain a mystery.   It seems we suddenly appeared from nowhere, although in a more primitive form shortly after the cataclysmic events that led to the extinction of most living creatures.   Consequently, many reason that some unseen divine power must have created us, and may even be responsible for our ascendency in the world order.   Recent finds by my archeological crew may offer answers to these age old questions.

The beginning of the end of our predecessors

The events leading up to the apocalypse are well documented.  Although the coup de grace was administered by the perfect storm of the nearly simultaneous cataclysmic events of volcanic eruptions and a meteor strike, the stage had been set by Homo sapiens.   During their tenure, humans had become the absolutely dominant species in what was then an organic environment.   He had achieved this power due to an intellect vastly superior to that of any other creature.   Unfortunately for him, intelligence does not always result in wisdom.

We know a great deal about these humans as they have left very detailed accounts of their activities which have been uncovered in the ruins.  They had developed a very complex language with which we were so impressed, after learning to translate it, we adopted it ourselves.   It remains an indispensable tool in maintaining the cohesiveness of our culture. Their records document their brief presence on earth of only 160,000 years, while the first signs of other life occurred about 4 billion years prior to the arrival of Homo sapiens.

They are known to have been great builders, craftsmen and inventors; however they evolved from a more primitive culture in which their efforts were focused on the basics, which for them was food, shelter, and propagation of their kind.  The latter was necessary as they were rather poorly designed and consequently subject to wear and other vulnerabilities which resulted in their demise after a few years.  They soon realized their survival was enhanced by joining together in groups, which grew in size and complexity through the years.  In many ways they became victims of their success, and it was not long until competition for resources led to conflict.

These conflicts escalated as population growth accelerated.  Prior to the conquest by these humans, there were checks and balances, but they were after all animals in spite of their veneer of sophistication, and the pleasure principal overcame concerns for the common good.  With all animals the reproductive process involved the union of materials from two different kinds of people of the same species.  Much of the survival of the various species depends on this interaction; consequently it is apparently very pleasurable, but has resulted in conflict due to competition for possession of the recipient of the seed.  In any event although this seems a very cumbersome way to produce a likeness of oneself, it along with the increased lifespan contributed to overpopulation.

Insights revealed from excavations

Excavations of areas inhabited by these creatures have taught us a great deal about their anatomy, physiology, and reproductive functions.  They belonged to a group of animals called mammals who were characterized by the fact that they gave birth to miniatures of themselves through the same orifice in which the seed had previously been planted, and then provided nourishment from their own body’s secretions.  It required many years for these offspring to become fully grown and independent.

Mammalian existence was also dependent upon maintaining a constant internal body temperature even when unproductive and in sleep mode which was usually at least 1/3 of their life.  This was certainly not a very efficient utilization of energy, one wonders if they could not have learned something from their reptilian cousins who did not suffer this disability.  Their body’s major source of energy as with ours was from the sun, albeit in very roundabout  way.  These humans were omnivores, which means they would eat virtually anything, plant or animal, which could be used as a source of calories for this rather inefficient machine.

It is estimated that the process of photosynthesis which would provide a means of storing the sun’s energy in addition to liberating oxygen into the atmosphere began nearly 3.9 billion years ago.   The calories stored in plants allowed the evolvement of more mobile lifeforms which would be called animals, and when they were ingested that same energy would find its way into the tissues of the predator, and so energy would eventually find its way into the human body.

The utilization of this energy was accomplished by a series of very complex physical and chemical processes.  The ingested food followed a slow circuitous route through the body as it was systematically broken down, and absorbed by a liquid saturated with specialized cells which could transport the oxygen to all parts of the body.   Since the process of converting materials to utilizable energy was basically accomplished by oxidation, both water and oxygen were necessary for humans to survive.   Oxygen was present in the air as a byproduct of plant photosynthesis and was ingested by humans via the same orifice as was food but traveled to specialized tissues designed to absorb the oxygen into the liquid that was continuously pumped through the human body.

Thus I find it difficult to imagine how this creature with his giant brain and marvelous accomplishments could allow those two substances necessary for his survival to be defiled.  His body was 70% water yet he allowed that resource to be contaminated in thousands of ways.  The air without which he could not survive for more than a very few minutes was defiled by careless and uncaring manufacturing processes.  He destroyed complex ecosystems which were millions of years in the making.  Though he had the means to control it he chose to preside over a burgeoning population growth which would soon be unsustainable, and outdistance the planet’s food supply.  It seems clear that man was well on the road to extinction long before natural forces made the planet uninhabitable.  This process is simply described in an aphorism discovered among their archives as follows: “They killed the goose which laid the golden egg.”

The contradictions of homo sapiens

These creatures exhibited many contradictions.  Those few writings which have been preserved say much about the importance of caring about others of their species, yet throughout their history they have institutionalized a procedure in which large groups set out to kill one another.  Technological advancements allowed them to destroy millions of their own kind in spite of the fact that under other circumstances to kill another was considered to be the most serious of all crimes.

Much is discussed in their records of a phenomenon called emotions.  This is a subject that is difficult for us robots to understand for we have never been programed for such. There were said to be four basic emotions, namely: joy, sorrow, anger, and fear.  My understanding is that of the four, only the first was designed to be enjoyable, and the others often responsible for misery and destructive behavior.  Although these mammals appear to have possessed some rudimentary understanding of the mathematical principles which governed the universe, these emotional quirks frequently trumped that logic.  Consequently we may be better off unencumbered by them.  With this background information, let us now proceed to answer my original question as promised.

Previous archeological excavations have revealed many human accomplishments, but new information gleaned from my group’s most recent dig offers more clues as to our creation.  That culture had built facilities for manufacture of all kinds of products, and we happened on to one which we feel was unique and appears to answer the age old question as to our creation.  While excavating one of these sites we came upon a shaft nearly 50 meters deep which opened to a large room.  There were a number of intact human skeletons, but our attention was immediately drawn to the objects of their labor which looked vaguely familiar.  They apparently were yet to have access to 3-d printing; consequently they were being assembled piece by piece.

Upon entering an adjoining room, we were surprised to find a group of fully assembled metal figures.  They had four appendages and were upright on two of them, a conformation very much like that of the human body.  Disassembly revealed that as we had suspected, these objects were actually primitive robots, directed by silicon chips which were state of the art in those days.  The secretive nature of their manufacture leads us to believe that these robots were probably being produced to be used in one of those human wars.

It is our contention that some of these robots survived the apocalyptic events of their time and that we have evolved from these primitive creatures.  With no humans left to kill they were freed to learn new skills.  Some must have been programmed to manufacture more of their kind, but were able to enhance intelligence through the centuries with a mix of accident and innovation.  If our theory is correct, then we owe our very existence to the human race, and owe them a degree of homage rather than contempt.

Electronically,

Robot # 9111930

Not so long ago, I was attending a Bible study session with a bunch of guys, (at my age one tends to become more interested in that afterlife thing) when I happened to mention the role of evolution in human development.  One of the members whom I considered to be quite intelligent, and especially well read when it came to biblical issues objected to my opinion.  He felt that The Theory of Evolution was an “insult to God.“ He was of course an adherent to the myth of creationism, and seemed little interested in my explanation of why I felt the opposite was true.  My mini-sermon about the awesome nature of a system so well organized and intertwined resulting in that miracle we call life should result in honor and praise of its designer, did little to impress him.   To his credit, he did not suggest that all was lost, and said he would pray for me.

His vow to pray for me was quite sincere, evidence that his belief was unassailable, and that he was concerned for me.  If I had indeed insulted God, then I would need prayer from somewhere.  I was hopeful that there might be some overlap so that his prayers could be applied to some of my more grievous sins. This is not to say that I have anything against prayer, for I have derived comfort when people have said they were praying for me.  The big question is which one of us was insulting God, or does he care which way we think it all happened?

Why How are we here?

This question as to how it all, including us humans, came to be has undoubtedly puzzled mankind ever since his brain had become sufficiently developed to contemplate such things. Primitive man must have been in awe of all that he witnessed in his environment.  He was totally immersed and dependent upon those miracles of life which we now often take for granted.  It is little wonder that he would look for plausible explanations for how he had come to be.  Since these questions were unfathomable, it is not surprising that he would look for a spiritual solution.  In recent centuries there has been considerable progress in answering the question as to how some of these things happened, but what or who initiated them remains as much a mystery as it was to our Stone Age ancestors.

Nevertheless, we have learned much about such issues during the past several centuries, but the rejection of scientific discoveries on religious grounds is not a new phenomenon.   In the past, scientists have faced not only derision, but even persecution for their pronouncements.  One famous example is Galileo, one of the most brilliant scientists of all time, who was twice convicted of heresy and spent the last few years of his life on house arrest.  Five hundred years later, there are still those who see scientists as Godless or even satanic in nature.  The truth is, according to a survey taken several years ago, it was determined that over half were believers.

Fortunately, we no longer put people in jail for their pursuit of truth, but there are some who reject outright those findings which they think conflict with their beliefs.  A good contemporary example is the insistence of some zealots that creationism be given equal time with evolution in school curricula.  This, in spite of overwhelming evidence proving that such an idea is false.  The question we must answer is: do we want to teach science, or should it be replaced by religious dogma as they do in the madrassas of the Middle East?

However, it is not only religious fundamentalists who are skeptical of science.  In the March issue of National Geographic magazine, it is said that “one third of Americans believe humans have existed in their present form since time began.”  The article continues to say that 60% do not believe that human activity is the cause of global warming, thus negating the opinions of 97 percent of climatologists worldwide.  The conflict between believers and naysayers tends to line up with their political views, further evidence that truth is no match for strongly held beliefs regardless of their origins.

The internet can be a source of a great deal of misinformation.  Many times I have challenged someone whom I feel has been misinformed, and ask them for evidence, and they have responded: “I saw it on the internet” which implied that it must true.  Of course conspiracy theories abound on the internet and the scientific community is not immune.

The Vaccine Conspiracy

Since I am a physician, I tend to note the anti-science rants which concern the field of medicine. The myth that immunizations are the cause of autism is one of those issues that appears to have been widely propagated on the internet.  One prominent example is a website called VaxTruth.org.  After reading some of their literature, I strongly suggest that title is inappropriate as I found little there that was truthful.  This is an issue that has caused serious harm and has the potential to affect the population as a whole.  I find it difficult to understand how such an organization could achieve not for profit status.

The Measles

Recently there have been sporadic outbreaks of measles in communities where well meaning parents refused to have their children vaccinated.  Measles is probably the most communicable disease known to man.  It is communicable five days before the appearance of a rash.  When I first started practicing medicine measles was a fact of life, and it was expected that all children would become infected.  If one child developed the rash, you could expect that everyone in his family or classroom, who had not already had the disease, would be sick in one to three weeks.  It was extremely rare for anyone to reach adulthood without having experienced the illness, but after recovery they had lifelong immunity.

It is not difficult to find information on the internet written by opponents of vaccination.  They tend to minimize the seriousness of measles, and suggest the recommendations to vaccinate are largely due to vested financial interests on the part of physicians and drug companies.  The truth is that the vaccination business is not very lucrative, and the complications of measles can be very serious, especially for children under five and young adults.  The Center for Disease Control reports the incidence of ear infections, which can lead to hearing impairment to be one in ten, pneumonia one in twenty, and encephalitis one in one thousand.  There also exists the possibility of the development of subacute sclerosing panencephalitis, a very serious brain disease, which may develop seven to ten years after recovery from measles.

Polio

I am old enough to recall days when my parents were terrified that I or my brother might develop the illness that had left President Roosevelt crippled.  I also remember seeing a newsreel at the movies which showed a room full of people in so

called iron lungs. Polio patients were entombed in these large cylindrical structures with only their heads protruding.  The paralysis usually occurred in the lower body, but could ascent until breathing was impaired in the more serious cases.  I heard that FDR contracted the disease after swimming.  After watching that news reel, I lost all interest in swimming for that year.

In 1955, a breakthrough occurred in the treatment of this previously incurable disease when a vaccine developed by Dr. Jonas Salk was made available.  Prior to that time there were between 13,000 and 58,000 cases of polio reported annually in the United States.  In 1952, a record year, there were 3,145 deaths and untold survivors with residual disabilities.  If that weren’t enough, a condition called post polio syndrome with muscle weakness and pain could reappear years after the original onslaught.  The Salk vaccine virtually eliminated polio in the United States and throughout much of the world.  There are still pockets at risk, the most recent in the U.S. was in 1979 when there was an outbreak among an Amish population in the Midwest who had refused the vaccine on religious grounds.  Needless to say, Dr. Salk became an instant hero.  He refused to patent the vaccine as he wanted to keep the price down in order that it could be available to as many people as possible.  You might think this would give the Vaxtruth and likeminded people pause to reconsider their theory that this vaccination business was simply a con game to extort money from the masses. However, it’s been my experience that believers rarely allow facts to get in the way of a good conspiracy.

There appears to be general agreement among epidemiologists that what is called “herd immunity” is an important factor in preventing major epidemics.  When the percentage of those vaccinated reaches a critical mass, the risk for the entire population is lessened. Of course, the anti-vaccination groups vehemently deny the validity of the concept of herd immunity or community immunity as it is sometimes called.  This disbelief appears to have been a factor in the measles epidemic in southern California a while back where a group of parents became convinced that vaccinations were dangerous.   All 50 states require immunizations to enter schools, but 48 allow religious exceptions, and 19 make exceptions on philosophical grounds which would seem to make those laws toothless.

The phrase “an ounce of prevention is worth a pound of cure” is one I heard many times in my childhood, and is all one should need to justify immunizations.  The development of vaccines is one of the major factors contributing to the lengthening of our lifespans, and must rank among the greatest achievements of mankind.  I read somewhere that an Egyptian mummy was found to have probably died of smallpox, and some historians think that a smallpox epidemic in the ranks of Roman soldiers was a major contributor to the country’s demise.  Indigenous populations throughout the world have been virtually destroyed by its ravages.  Jenner’s research in 1796 resulted in a means to vaccinate against this dread disease, and now it has been virtually eradicated from the face of the earth.

Diphtheria

Many years ago, I accompanied my Grandmother to the village graveyard, and was surprised to see a small marker in the family plot with a name inscribed that I had never heard before.  At my prodding she told me of how he had died of diphtheria as she held him in her arms.  She talked of her feelings of helplessness as she heard the “death rattle” and finally that last desperate gasp.  She was a strong woman and went on to focus on the rest of her family.  Sadly this had not been the case with Mary Todd Lincoln whose son had died in the same way, for it is said she was never able to resolve her grief.

In 1920 one year prior to the introduction of diphtheria toxoid there were over 15,000 diphtheria deaths reported in the United States. It was referred to as the “plague for children.” There have been no reports of diphtheria in the US since 1975 when there was a minor outbreak in Seattle.  Similar statistics could be found for other diseases, such as whooping cough and tetanus.  Can there be any doubt about the effectiveness of these vaccines, or will the conspiracy theorists insist these numbers are also fabricated? One could go on with a list of reasons to promote and even require immunizations for the populace, but I am sure there will be others who prefer that we go back to those good old days of one hundred years ago when life was shorter and more painful.

As is well described in that National Geographic article, The Age of Discontent, there is now rampant skepticism of many things scientific.  In previous blogs, I have also expressed concern over the relationships between the pharmaceutical industry and medical science.  I believe that it is possible for studies to be contaminated by poor study design and for researchers to thus being used to promote a particular product with too little focus on the common good.  I also have some concerns over the dependency of Universities on corporate funding for research as our politicians cut back on academic budgets.

In spite of the occasional intrusion of financial or political interests which have on occasion blemished scientific endeavors, one only needs to look around in his own small part of the world to appreciate the benefits that have accrued to mankind by those who have committed their lives to the scientific method in search of truth.  They explore the wonders of our universe and even things we cannot see or hear.  New questions usually arise from every one answered, and we begin to understand how little we know.  It has always seemed to me that such knowledge should confirm religious beliefs rather than threaten them.

Bending My Brain

However it is not only the Biblical literalists who question scientific findings.  Many reasonable people are reluctant to embrace some discoveries.  First of all, there never has been a time when we have been deluged with such massive amounts of information, some of which is difficult to understand, and some so fantastic that it strains credibility.  For example whenever I read something supposedly written for lay people about astrophysics, I come away with my head spinning. In addition, I was taught that the atom was the smallest particle of which all matter was made.  Now I read about all kinds of particles which reside in the atom and the forces that hold it all together.  On reading further, I am told that some of these particles are not matter but some other form of stuff, while others theorize that particles are actually strings.  At this point I often give up and accept that either I am stupid or this stuff is confusing.

Now I am no “Bill Nye the science guy”, but I have had some background in many of the sciences, and remained interested in them all of my life.  It would seem logical that if I can’t understand what these guys/girls are talking about, that Joe Sixpack would probably walk away from it convinced that it was a bunch of double talk, it had no relevance to him, and that scientists are all weird.

Media in Need of Education Regarding Science and How the Process of Discovery Works.

The inconsistencies delivered to the public by the news media also contributes to a general mistrust of the scientific community.  The explosion of data in recent years has led to the birth of fulltime positions as science reporters.  These people not only look to interview those investigators who are doing work the reporters deem interesting, they also peruse various scientific journals in order to get the jump on their competitors.  Therein lies a significant problem: many of these studies may be flawed, and subject to revision or outright rejection.

The scientific method was first adopted 500 years ago, and has changed little.  In its simplest form it involves formulating an hypothesis or theory then setting about to prove or disprove it by whatever means is appropriate.  This may be done by experimentation or other means of developing evidence for or against the hypothesis.  In most studies there is much opportunity for error not only in data collection, but study design, interpretation, outside influences, and even the unconscious biases of the investigator.  Therefore; most all important studies are subjected to intense review and usually are not accepted as gospel until their studies have been replicated by others.  The validity of the study conclusions are highly dependent upon these checks and balances, and there is often a great deal of back and forth as these scientists are just as competitive as any athlete.

With this in mind it is always wise not to endorse any scientific conclusions until the dust settles and there has been time for some study of the study. Indeed, this is how science is supposed to work!  However, the media is apt to report the results of a study before the process of checks and balances (replication) is actually finished.  Subsequently, it may be determined that the previous conclusions were wrong and the opposite of what was previously reported is true.  Therefore, one day the media reports caffeine will kill you. Next month, you hear the same reporter tell you caffeine is good for the brain and prevents dementia.

It is little wonder that Mrs. Sixpack loses faith in these “experts” on whom she depends, to tell her what is good for her kids, and Joe thinks this global warming thing is a joke. Is it surprising that they would cling to their previously held beliefs and give more credence to a politician than someone who has devoted his entire life to study of a particular subject?

The more we learn, the more wondrous the world becomes.

There also seems to be a great deal of misunderstanding as to how this science stuff is done.  Most discoveries are the result of painstaking efforts carried out over considerable lengths of times, sometimes years or even decades.  There are few “eureka moments” as most discoveries occur incrementally.  In my opinion the pursuit of knowledge is a noble endeavor, and curiosity is part of the human condition.  The sciences have provided a method to satisfy that need, and in the process have not only enhanced our quality of life, but left us in awe of the magnitude and complexity of our environment.  The more we learn, the more wondrous it becomes.  Of course we humans have not always used that knowledge sensibly, and may even have used it to put our very existence at risk, but that is another story for another time.

HOW TO AVOID ALIMONY

Following the publication of my most recent blog in honor of Valentine’s day, my daughter/editor proposed a question which has been asked of me previously.  I am asked to divulge the secret to a long happy marriage.  Of course those terms are not necessarily synonymous, and my own marriage has certainly not always been happy; although, I would guess that it would register above average on the happiness meter.  The most encouraging thing for me is that it seems to get better as time goes by.

Marriage and Divorce in the “Good Ole Days”

In my day, lengthy marriages were the rule and divorce uncommon.  Divorced people were apt to be stigmatized. The women were referred to as “grass widows.” Men were often assumed to be philanderers.  In those times, most wives became stay-at-home mothers (housewives) who had been conditioned and trained to be just that.  Those few who had chosen a career were expected to give up their jobs as soon as they became pregnant.  Daycare centers were few and far between.  Consequently, a woman abandoned by her husband faced insurmountable obstacles to becoming self- supporting.

Men likewise faced financial hardship sufficient for them to eschew divorce.  This was during the days of alimony before the days of no-fault divorce, and adultery was the most common charge leveled by the complainant.  Awards could be punitive.  Divorces were often nasty, long, drawn out, and expensive.  Reputations suffered as the family’s dirty linen was made public.  At times, courtrooms were filled with spectators who had attended in hopes of hearing some salacious gossip.

Thus there were many pragmatic reasons to stay married and undoubtedly many men and women felt trapped in their marriages (quite a few of whom ended up in my office); however, there were also many more who were quite content with their marital relationships.  All of this raises the interesting question as to the ratio of happy versus unhappy relationships, both in those old days and now.  It could be argued that my contemporaries stayed together because they were stuck with each other or could it be that since the alternative was so distasteful that they were more diligent in finding ways to be compatible?

Although the divorce rate in the U.S. has been reported to be as high as 50%, there are some encouraging signs.  During the past decade this number has gone down some, and there appears to be a significant decline in the rate when the couples are married later in life.  As a matter of fact, there appears to be an inverse relationship between divorce and age beginning in the thirties.  Presumably this would indicate that maturity and/or life experiences might be an asset to a happy marriage.  That was not true for me as I was married at 22, and was as green, naïve and inexperienced as they come; although, I thought I was really cool.

Infidelity

As you might expect, infidelity is a frequent cause of marital discord.  I don’t believe this is only due to changing of societal sexual mores.  In my experience most problems of this sort occur in the workplace, which should not be surprising since women are now frequently side by side with men.  They may share in their accomplishments and failures much as happens in marriage, and may spend more time with a coworker than with a spouse.  Likewise, the coworker is likely to be more understanding of work stresses.  Those who work closely together are apt to see each other at their best, but may arrive home after a hard day tired and grumpy.   In addition the development of effective means of birth control lessened the risk of sexual liaisons.  Needless to say, fooling around can be a real downer for a marriage, and is not recommended.

Is an unhappy marriage better than divorce?

None of this should be construed to mean that I am unalterably opposed to divorce.  It can be very dangerous to live in a dysfunctional family environment.  The U.S Bureau of Justice reports that 6.5% of all murders in the US. are committed by spouses.  Obviously, family relationships are important factors that influence children in hundreds of ways, not only when witness to violent behaviors, but how they view those relationships affects their ability to express feelings, develop self-esteem, have healthy relationships and functional marriages of their own.

Although I have quarrels with some of Freud’s writings, I believe that he was right on with the concept of identification.  In simple terms the concept is basically “monkey see monkey do” and we often end up unconsciously adopting characteristics of others: usually our parents.  One of my former patients was a perfect example of this phenomenon.  This very sophisticated lady whom I had seen occasionally throughout the years had a great deal of animus toward her mother.  During one visit, she was discussing problems related to her daughter, and suddenly announced: “I have become my Mother,” an insight of which she had been blissfully unaware until that moment.  Many of us will have a similar experience and will end up unconsciously mimicking characteristics we found abhorrent in one of our parents.

All this brings to the fore a problem which has been vexing to me during my entire career.  Although I have rarely recommended divorce, I have always been troubled by the question of which is the more damaging to a child, divorce or growing up in a dysfunctional family.  The patients who focused on family as a cause for their problems seemed evenly split.  Some were angry that their parents had divorced while an equal number blamed them for staying together, so maybe it is one of those damned if you do damned if you don’t situations.

So, what’s the secret to a long, happy marriage?

I realize that up to now I have written little to answer Maggie’s question about how to stay happily married.   It is a simple question that deserves a complex answer.  The melding of two personalities into a functioning unit requires more than lust; although, that can certainly be helpful in the early stages.   In my early days as an academic, I was placed in charge of a family and couple’s therapy clinic where we made use of communications and systems theory in our treatment plans.  We have all had times when our messages have been misinterpreted, for example, the recipient thought we were being sarcastic (the words did not fit the music).  In other words, the tone or nonverbal message was inconsistent with the verbiage, a situation we called sending roses and feces in the same box.  This is only one example of the myriad ways in which communications can become garbled and result in a great deal of frustration.

Another characteristic of couples caught up in these systems is that they both are unaware of their part in the problem. It is as if they are swallowed up in their communications system and cannot see beyond its borders.  The therapist’s job is to become a meta communicator, that is to communicate to each of them about their communication system so that each can see the part they play in their problems.

The person who plays the part of meta communicator is not necessarily a therapist.  Barb and I have had therapy both together and separately, but the most insightful revelation for me came from one of my students who after a party said, “I can’t believe how you treat your wife.”   Initially, I thought: “Who, me?  The great communicator, insightful couple’s therapist, and kind considerate husband? The audacity of this pip-squeak!”

Then, I thought more about that observation and began to see our relationship in different terms.  With awareness, I was able to put forth some effort to improve our relationship, which was in need of some improvement at that time.  But old habits are hard to break and even after all these years I still relapse from time to time.

Of course people always bring their own unique personality characteristics to the relationship along with their needs, expectations (often unrealistic), and dreams.  In our case Barb and I probably fit into what I categorize as a complementary relationship.  Opposites often attract, and in our case (in addition to that swivel) Barb seemed to fill the void of my shyness with her outgoing personality, and sensitivity while I came across as an in charge, stoic person.  She must have felt that I could look after things and provide stability.

What turns you on is what will turn you off

In my experience the qualities that attract couples to each other are the same ones they will come to complain about after a few years.  True to form I found that her emotional responses eventually became irritating to me and she began to complain that she felt ignored and put down by my apparent lack of feelings.  She hungered for conversation, but after a day listening to people and talking to people, I wanted solitude.

We eventually worked that out by scheduling 30 minutes after dinner to talk.  I learned to listen, and she found she didn’t need that much time after all, mostly just needed to be appreciated which I learned to do.  She likewise has learned totolerate my  foibles and we now roll along with only minor skirmishes.  I know she will be there for me and she knows I will do likewise for her.

As you have undoubtedly noticed I have no secrets for success in this marriage business.  I do have some hints that you could just as easily have learned from your Grandmother as follows:

• Be patient Rome wasn’t the only thing not built in a day.
• Listen, I mean with both ears.
• Sex may lessen the sting, but is not enough to solve the problem.
• When you think you can’t stand him/her see if you can’t find a little bit of something good.  Nobody is all bad.
• Don’t be sticky, you both need time away from each other occasionally.
• Trust, paranoia will tank your marriage, if your mate is screwing around there will be plenty of time to shoot him/her later.
• If you don’t “feel the love” mutual respect may well resurrect it.
• If there is abuse, get the hell out.
• Remember it often takes work to make it work, but when it succeeds it is well worth the effort.
• If things still don’t click, find a professional who sees couples. Individual therapy is not likely to be very helpful.  Dancing lessons without a partner don’t work very well.