Nostalgia

Nostalgia is an interesting word.  It comes from the Greek roots, nostos meaning a return home, and algos meaning pain, suffering.  Originally, it was used to describe severe homesickness.  Over time, it has evolved to mean a bittersweet yearning, usually associated with fond and idealized memories of the past.

It’s almost June, almost the beginning of summer vacation.  It’s a time when I recall memories of summers past, years spent at summer camp, and I am filled with nostalgia. From age thirteen through age twenty-three, my summers were spent at the J Bar CC Ranch Camp, just outside of Elbert, Colorado.  I began as a camper.  My final year was as the camp’s assistant director.  In between are most of my memories of adolescence.

Ironically, the first week of my first year at camp I suffered from nostalgia, in the original sense of the word.  At night, I buried my head under my pillow homesick, ashamed and afraid of being teased.  That phase of nostalgia quickly passed.  For most of the nine years that followed, I looked forward to being at camp from the beginning of June through the end of August. It was a safe place to be and to grow.  Now, my nostalgia is that bittersweet yearning, the lovely memories of a time long past, the experiences that were my transition from child to young adult.

I think of camp and I am flooded by a collage of words and phrases, words triggering my memories and emotions, each calling to mind a story. Horseback riding, swimming, archery. Hikes up Pike's Peak. Camp outs. Campfires, music sung, guitars played.  Star-filled skies. My first ‘girlfriend’. My first dance.  The mess hall, the rec hall, the corral. Capture-the-Flag.  Hailstorms, often followed by rainbows.  Meadows filled with wildflowers.  The sound of pine trees in the wind.  The smell of pine trees in the rain.  The final campfire of summer. Old friends.

Not loving my first year of medical school, I did my second year of medical school over two years, while working half-time as assistant director of the camp.  I was trying to decide whether-or-not to continue my medical training or to make camping my career.  As assistant director, I became involved with boards and budgets, hirings and firings.  Camp was no longer camp.  It was a job.  I returned unambivalently and fulltime to medical school, never regretting my choice. No doubt, though, my years of camp counseling influenced my eventual decision to become a child psychiatrist.

I have a strong yearning to return to camp, just once more, to walk the land that I remember so well.  To this day I can clearly visualize the terrain, every hill and every valley.  Once, many years ago, I visited camp with my wife.  Prior to that visit, I told her what a beautiful place it was.  My wife saw it and was not nearly as impressed.  Yet, she found my comment reassuring.  I told her, “That which is beautiful is not necessarily loved, but that which is loved is necessarily beautiful.”

The Name of the Rose

“Perhaps the mission of those who love mankind is to make people laugh at the truth, to make truth laugh, because the only truth lies in learning to free ourselves from insane passion for the truth.”  So says the protagonist Brother William to his young pupil Adso as they survey the monastery and its great library burned and in ruins.

I recently reread The Name of the Rose by Umberto Eco.  Published in 1980 this historical novel and murder mystery is a difficult read, but worth the effort.  The story takes place in the early 14^th century within the walls of an Italian Benedictine monastery.  It was a turbulent time in the history of Christianity.  There was contested leadership within the church and a direct challenge to established church authority with the rise of monastic orders.

The protagonist, Brother William, is a Franciscan monk called upon to investigate a series of murders that occur within the walls of the monastery.  William, once an inquisitor, no longer relies upon the inquisition’s harsh methods. Instead, his tools of investigation are logic and philosophic inquiry.  William is mentor to a young Benedictine novice, Adso, in whose voice the story is narrated.

Woven into the story's multiple mysterious murders are a series of theological debates, told as they would have taken place in the 14^th century.  Religious ‘truths’ were passionately argued. One man’s truth was another’s heresy.  To be on the wrong side of an issue could mean death.  To be on the right side, especially if martyred, could mean sainthood.

One debated ‘truth’ concerned monastic vows of poverty.  For those taking such a vow, this was their measure of faith and piety.  Not so according to established church leadership, believing that ascetic vows posed a threat to church wealth, power and authority.

Within the monastery was a great library.  There was debate about the purpose and usefulness of the library. Some saw the library as a great repository of knowledge.  Others argued that God’s words, as revealed in the Bible, stood alone.  Books were extraneous, the product of man’s arrogance, man’s sinful pride in cleverness and knowledge.

Laughter itself was cause for dispute, one side seeing laughter as a joyous acknowledgement of God’s goodness, the other side arguing that laughter was derisive and frivolous, making light of man’s sinful state, working in service of the devil.

In the novel, religious ‘truths’ were argued with fatal results  The murders and motives solved, William warns his young pupil, “Fear prophets, Adso, and those prepared to die for the truth, for as a rule they make many others die with them, often before them, at times instead of them.”

Umberto Eco, writing with imagination, scholarship and eloquence crafted a story that reminds us of the dangers and cruelty of dogma, that "insane passion for the truth.”  And he reminds us of the necessary corrective power of laughter and humor.

In another time and another place philosopher Isaiah Berlin warned, “It is a terrible and dangerous arrogance to believe that you alone are right . . .”   I couldn’t have said it better.  Umberto Eco did.

Medicine and Philosophy

“It is a lame creature who calleth himself a physician and he be void of philosophy and know her not.”  (Paracelsus, 1493—1541) 

My formal background in Philosophy consisted of one undergraduate Intro to Philosophy course, which was the most numbingly boring class I ever took.  I was assigned two papers for that class, one on Hobbes and one on Kant. The only all-nighters I ever pulled in college, were writing those awful papers.  I agonized over those papers, knowing as I wrote them that they made no sense. I recently reread them. They still make no sense.  Yet, I got an A in the class which only confirmed for me, at the time, that Philosophy was a lot of bull.  Philosophy was off my radar for many years thereafter.

It was during my psychiatry residency, I realized there was a gap in my education, a gap that my background in science and in psychology could not fill.  I wanted to better understand my patients.  I wanted to know the degree to which my patients had no choice but to do as they did. Was their behavior determined?  Where there is no choice, there can be no blame. Or, did they have choice, free will?  Where there is choice, there is accountability.  And I wanted to be consistent.

I wanted to know more about the mind and the brain.  How does thinking arise from matter?  I wanted to know more about human nature.  Are we inherently good or evil or neither?  I wanted to understand how we know what we know.  What can we know for certain?  What makes for a good and meaningful life?  An ethical life?  After all, as Socrates admonished, “the unexamined life is not worth living.”  My interest in philosophy was rekindled.

This winter I will be back in the classroom, teaching a new course, Medicine and Philosophy, to a group of senior medical students.  For most of them, it will be their introduction to philosophy. I will look back on the experience of my introductory course and try not make the same mistakes. My task ahead is to make philosophy as meaningful, interesting and exciting to a group of skeptical medical students, as it is now for me.

The introductory class I’m planning will not be a historical survey of philosophy nor will it be taught didactically.   My class will be constructed on two premises. First, everyone is a philosopher.  Second, philosophy is not passive, it is an activity.  In class, we will do philosophy.

Everyone is a philosopher.  Some just need help putting their beliefs, their values and their opinions into words. The first task in class will be for each student to begin to articulate their philosophies. Once that has begun, we will proceed with the work of philosophy.  I will provide some basic tools, tools that date back 2500 years to the time of Socrates and Plato, and they will be asked to critically examine, refine and sharpen their thoughts.

The over-arching goal of this course Medicine and Philosophy is for students to develop and expand their critical and creative reasoning, and along the way, learn to apply the critical and creative thinking of philosophy to sound medical practice.  I want no student physician in my class to ever be accused of being a lame creature, void of philosophy.

Philosophy comes from the Greek roots phylos meaning to love and Sophia meaning wisdom. I will teach a class about wisdom and hope they love it as much as I.

That’s lesson plan one.  Only fifteen more to go.

An Educational Challenge

Several years ago, I taught a course on parent guidance to a group of child psychiatry Fellows.  This was a bright group of students, all of whom were in their 4^th or 5^th year of post-doctoral training. 

I assigned them a task.  I asked them to pretend to write an advice column for a parent magazine, a 400- to 500-word column, sharing their views and opinions in response to parent inquiry.  For their first column, I asked them to respond to a parent seeking advice about spanking. 

A week later, I collected their columns.  I read them and, for the most part, thought they were dull and mediocre.  My wife read them and thought there was something not quite right about them.  After doing some investigation, she discovered that 7 out of 8 papers were written almost word-for-word from articles found on-line. 

Initially I was angry and disappointed.  I let the students know that if they had been on faculty, they would have been fired for plagiarism.  If they had been in a graded course, they would have failed. 

The students thought I was being unfair.  After all, if I had asked them to write a column about the side-effects of Paxil, wouldn’t they have Googled side-effects of Paxil in order to get the information?  I tried to explain that they were comparing apples and oranges. I didn’t ask for a recitation of facts about spanking. I asked them to articulate an opinion, their opinion. 

As I talked more with the students, I began to understand why they struggled with my task.  I was reminded that they worked in a high-pressured academic environment in which time was short and demands excessive.  Some admitted to going on-line as a short-cut, a time saver. I was reminded that much of their science and medical education, preceding my class, was done on computer while trying to learn massive amounts of information. It was their reflexive response to seek out the right answers on-line.  I was reminded that these students functioned in an environment where they were under constant supervisory scrutiny. They were afraid to be wrong. To be creative and original was to risk being wrong. 

As a teacher, that class was an awakening.  I became aware of a potentially serious educational pitfall. For many years, my student’s education had not encouraged the formulation and expression of opinion.  They had neither the experience nor the confidence to put their own thoughts into words and think that it could be okay. 

I have shared my cautionary story with teachers of all grades and levels, reminding them that, in this age of information, we must conscientiously teach critical and creative thinking.  Every student deserves time to think, to play with ideas, to develop opinions.  No right or wrong.  Computers off.  No Googling allowed.