After Life?

“There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.”  (from Shakespeare’s Hamlet)

Both of my grandfathers died when I was sixteen.  A few months after each had died, I dreamt that they had returned to say goodbye.  These dreams were different from other dreams.  They were vivid, lifelike, as if I was really in the presence of my grandfathers.  Each dream was accompanied by my tears and by a deep sense of loss and love.  Each grandfather came to say goodbye only once and never again returned.

My mother died on February 16^th, 2010.  Her final days began with agitation and ended with the calming numbness of morphine.  I wished from her a last moment of awareness, a lucid and quotable last thought, perhaps to tell me that she had glimpsed the other side of life and that there was no need to fear.  But she did not do so.

I have few warm memories of my mother.  She was an often depressed and always anxious person.  She kept an immaculately clean home.  She was not demonstrative with affection.  I don’t remember hugs or kisses.  In my household, food, order and cleanliness were the substitutes for love.  My mother died of complications from dementia.  In her last months, she would stand at the window of her apartment, count the cars in the parking lot and repeatedly wonder out loud where so many cars came from.

A brief digression while I set the stage.  Approximately 8 months after my mother’s death, while driving at night with my wife, I had an odd and momentary vision of a deer’s face in the leaves of a passing tree.  I thought to myself that this might be what a hallucination is like, or maybe it was a sign of my old age, with declining mentation and advancing imagination.  It lasted for only a second and I really didn’t make too much of it.  If anything, I was a bit amused by the spectral vision.  A few moments later my wife grabs my arm yelling, “There’s a deer!”  I got a momentary glimpse of a large buck looking in my direction, standing broadside across my lane of the road.  This was no hallucination.  I hit the brakes and swerved, missing the buck by a few feet and a few fractions of a second.  Had my wife not been looking forward at the road, I doubt I would have seen the buck in time to avoid a serious collision.  My wife and I arrived home safely, both of us a bit shaken by a disaster barely averted.

That night I went to bed and had a dream.  My mother came to see me.  We were sitting side by side riding in a car.  No one else in the car knew she was there.  But she was visible to me.  She was beautiful and serene in appearance, not withered, gray and demented as my mother came to be in her last years.  I asked her to tell me what it was like on the other side, the side beyond life.  She did not speak to me, but she held me, comforted me, and softly kissed me as I never remember her having done in life.  And in my sleep, I wept as I had not done for many years.  I awoke that morning remaining sad, grieving for my mother believing, as was true for my grandfathers, that this too was to be a onetime dream, one time to say goodbye.

I am a psychiatrist, trained in science, trained to interpret dreams rationally.  Freud’s great discovery was that dreams are a glimpse into our unconscious, an expression of our unfulfilled wishes.  The rational part of me tells me to accept this as the explanation and interpretation of my dreams.  But there is a part of my soul that wonders, “what if?” These dreams of my grandfathers and of my mother were so real, so vivid, and so different from all my other dreams.  What if these ‘dreams’ were not just the yearnings of my psyche, but visits from those who loved me, trying to offer their comfort and their goodbyes?  What if my mother was trying to answer my questions about the other side, telling me she had found a peace and love in death that she had not known in life?

My rational self says that this is not so.

But how do I know for sure?

Maybe, just maybe . . .

Reason tells me “not so.”

My soul cries, “what if?”

The Electronic Medical Record

“The development of the child’s soul is connected indissolubly with his craving for the Thou . . .”  (Martin Buber, 1878--1965)

As a Child and Adolescent Psychiatrist, I witnessed the corrosive power of electronic media on children’s behavior, education and socialization.  Of all I witnessed, perhaps the most disturbing was the negative impact on the interactions between children and parents. Children and parents spoke less to each other, played less with each other, and looked less at each other.

Every day, I reminded parents of the importance of being parents; unplugging, monitoring the electronics, setting limits and having rules.  I encouraged children and parents to read together, play games together, have conversations together, be present, engaged and undistracted together.

Yet, at a time when I was informing families about the importance of turning off screens and making eye-contact, I was under pressure to turn away from my patients and towards a computer screen.  I was expected to embrace technology that promised to enhance and revolutionize medical care. Medicine had entered into the age of the electronic medical record, the extraordinarily labor-intensive and time-consuming electronic medical record.

An article in the Journal of the American Medical Association had this to say about the skills required of the future physician.  “In addition and most importantly, the physician will have virtuoso data entry and retrieval skills, with an ability to talk, think, listen, and type at the same time rivaling that of court reporters, simultaneous interpreters, and journalists on deadline.”  (JAMA, June 12, 2014 – Vol 309, No. 22, pg 2385)

I, a physician of the past and present, who happens to be significantly challenged in data entry and retrieval skill, was at first offended, next bewildered and then outraged.  Is this true?   Will this be the next generation of doctors? What about ‘bedside manner’, compassion, integrity, and problem solving, virtues I always thought defined the desired skillset of the physician?

I know when I was a medical student, my teachers worried about my generation of doctors. My teachers lamented that my generation was becoming enamored with laboratory tests and radiologic studies.  They feared we were losing the skills of taking a good history and a doing a thorough physical exam.  My teachers feared that laboratory tests would replace the physician’s skilled and observant eyes, ears and hands.  To a large extent, they were right.

Now, having been teacher to a new generation of doctors, I fear that as technology is embraced and becomes the norm, the young physicians will sacrifice yet another powerful tool for diagnosis and healing . . . the power of relationship.

Societally, relationship seems to matter less.  Where once I-Thou mattered, it is an increasingly I-it world.  I-Thou and I-it are concepts of dialogue and relationship from theologian and philosopher Martin Buber.  I-it is the nature of most interactions.  I-it interactions can be pleasant and friendly, but I-it interactions are impersonal, the exchange with one another often being a means to an end.  I-Thou occurs only when one is fully present in the company of the other, listening, engaged, undistracted.  It involves not only eye contact, but I-contact, full presence.

I have recently retired.  A new generation of doctors will determine how medicine will be practiced.  Will they practice I-it or I-Thou? Will they integrate virtuoso data entry and retrieval skills and still remain present, able to respond with compassion and humanity?  What’s at stake is not only how they will practice, but the example they will set, how they will model for the patients, parents and children who will seek their guidance.

A Point of Light

“Twinkle, twinkle little star, how I wonder what you are.”

When I was a child, I had a telescope.  I learned the names of the stars and the constellations.  I tried to fathom the vast distances that separated one star from another and them from me.  I looked up in wonder.

My favorite constellation was Orion, visible in the winter sky with its two bright stars Betelgeuse and Rigel, and its belt made of three aligned stars.  The brightest, yet most distant of these three stars is the middle star Alnilam, Alnilam meaning ‘string of pearls’ in Arabic.  Scientists have studied Alnilam and estimate that it is four-million years old.  It is a ‘bright supergiant’.  Its distance from earth is approximately 1350 light-years.  When I look at Alnilam, I look at history.  The point of light I see and call Alnilam started on its journey at a time when the world’s total population was just over 200-million people, when Constantinople was the world’s largest city, when Mohammad had just died and when Islam was in its early ascendancy.

I ponder the mystery of light.  How does a point of light, a photon starting from a distant star, penetrate the emptiness of space and reach my eye?  How does that point of light trigger the chain of reactions that occur within my retina and my brain that causes me to perceive that light?  How does my perception become conscious awareness of that light that began its journey over a thousand years ago?

Scientists ponder the mystery of light.  I learned in Physics about the paradox of light.  It is both a wave and a particle.  It is both, and it is neither.  In other words, our language and our knowledge are not enough to penetrate the mystery and complexity of light.  Einstein’s great insight was that light always travels at a constant speed, and that there is no such thing as real time and real space.  Light is absolute in an otherwise relative universe.

I am no Einstein.  For me, these are difficult and mystifying concepts.  I understand that there is a complex and mysterious “out there” that I perceive with limited understanding.  I really know very little about this complex universe.  But I look at the sky, at a billion points of light, and find solace in the mystery.  The stars remain beyond human explanation, beyond human reach, and beyond human folly.

Mystics ponder the mystery of light.  I am no mystic, but I’ve read the Kabbalistic story of creation, about the Light of creation and the primordial Vessel that was created to contain the Light, and how, when the Vessel could no longer contain the Light, the Vessel shattered.  I am unable to understand the mystery of a single point of light.  Yet I, like the primordial Vessel, must receive the constant influx of almost infinite points of light.  The light is contained in the images and memories of my mind.  And, miraculously, I don’t shatter.

If I taught Science or if I taught Sunday School, I would want my students to ponder the mystery of light, to reflect on the journey of a point of light from its moment of creation to the moment of awareness.  I would want them to look up at the stars in wonder.  I still do. 

 

Addendum:  Years ago, I told my wife that should I die first, and should there be an afterlife, I will signal her by becoming a star in the sky.  I told her to be on the lookout for a fourth star in Orion’s belt.  Since the universe is expanding and Orion is getting older, he could probably use the extra size.

Horse and Rider

I used to be a good horseback rider.  In fact, one summer I was Head Wrangler at a camp in Colorado.  My nickname was ‘Boots’.  I managed a stable of thirty horses and gave riding lessons to all the campers. However, when that summer ended my riding days were pretty much over.  My boyhood dreams of becoming a cowboy had faded and instead I became a medical student.  A few years later, I discovered that from my riding I remained saddled with some important lessons about life.

I was a young Psychiatry Resident, seeing a patient who kept telling me about his “unbridled rage.”  He told me that he had to keep a “tight rein” on his anger, or he would lose control.  I began talking to my patient about how people live their lives like a horse and rider.  They can go through life always riding with a tight rein and a heavy hand, never loosening their grip, never allowing the animal to run.  Or they can ride with a loose and floppy rein, letting the animal run uncontrolled.  Or they can know and respect the animal, riding with a gentle but firm hand on the reins, always in control, but working together, rider and horse as one unit.

Unfortunately, my patient didn’t run with my impromptu metaphor.  I had tried to ‘stirrup’ some thoughts but fell short in my effort.  He continued with his litany of ‘whoas’.  Fortunately, over the years my delivery and timing improved and I continued to share with other patients my metaphorical musings.

In the metaphor, the animal represents our nature, our drives, our needs and our desires.  As do we, horses come with a variety of temperaments and predispositions.  Some horses are restless and high-spirited.  Some are placid.  Some learn easily.  Some are hard to teach.  Some are gentle.  Some are quick to temper.  Some are born to race. Some are born to pull the plow.  Some are thoroughbreds and some are nags.

Ultimately, it is the rider who is responsible for the quality of the ride. The rider must learn to ride with proper technique and with good balance.  The rider must look out for the well-being of the horse.  The rider must recognize the terrain and know where to lead.  The rider must evaluate when to proceed with caution, and when it is safe to gallop.

I’d love to take credit for this metaphor of horse and rider, but Freud beat me to it by about 100 years. And if you substitute ‘charioteer’ for ‘rider’, Plato beat us both to it by 2000 years.  I may not have been the first one to think up this metaphor, but I'll bet Freud and Plato were never Head Wranglers.  And original or not, I have found it to be a personally and professionally useful metaphor.

So, what’s the ‘mane’ point of my ‘tail’?  Perhaps this.  When possible, when the terrain allows, lead life not with a heavy hand but with a firm and gentle rein.  Trust and surrender some to needs and wants, never out of control, but respectful that the horse on occasion would like to run.

Shakespeare and Me

“Last scene of all, 

That ends this strange eventful history,

Is second childishness and mere oblivion,

Sans teeth, sans eyes, sans taste, sans everything.”

(from the comedy As You Like It)

I just bought a book, Shakespeare and Me, a collection of essays by writers, actors and directors on what The Bard means to them.  It inspired me to write this brief essay about Shakespeare through my ages.

I am awed by Shakespeare.  His craftsmanship with language is unparalleled. He turns words into magic. He turns iambic pentameter into soaring oratory and dialogue.  The quality of his plots varies greatly.  But the quality of his character development is unmatched.  Before there was 'psychology', Shakespeare led us into the minds of his characters with clarity, subtlety and depth. No author, poet or playwright has ever done that better.

My first encounter with Shakespeare was at age 7 or 8. My parents took me to a production of Macbeth.  Before going, they had me read a child friendly synopsis of the play.  Even so, I don’t know how much I actually understood, but I thought the three witches were pretty cool with their, “double double toil and trouble.”  At the end of the play the good guys win and the bad guy is dead.  As far as I knew, it was a happy ending.

My very first course in college was “Shakespeare on Film,” taught by the internationally known scholar Samuel Schoenbaum.  Among the movies I remember from that class was a 1935 Busby Berkeley version of A Midsummer Night’s Dream with Mickey Rooney playing Puck, as well as a 1957 Japanese samurai retelling of Macbeth called Throne of Blood.

Throughout college, I continued to take electives in Shakespeare.  I still have the paper I wrote about The Tempest and my interpretation of its dark comedic irony.  Miranda was naïve and sadly misguided when she proclaimed, “O wonder!  How many goodly creatures are there here!  How beauteous mankind is!  O brave new world that has such people in’t!”  I was learning to read Shakespeare between the lines, with an ear tuned to the ironic.

When I studied Neurology in London, I saw Shakespeare performed at The Globe in Stratford-upon-Avon.  When I did my residency in Ann Arbor, I saw outstanding productions of Shakespeare at the annual festival in Stratford, Ontario. Since then, wherever I lived, I sought out any and all local Shakespeare productions.

On our second date, I took Sue to a production of Romeo and Juliet.  It turned out to be a punk interpretation, performed on skates.  It was hardly Shakespeare, but it was a good conversation starter.  For our honeymoon, I took Sue to the Shakespeare Festival back in Stratford, Ontario.  Good Shakespeare.  Good honeymoon.

When my youngest daughter was studying Hamlet in High School, I read out loud to her each night, explaining and interpreting as we went along.  Hamlet is my favorite of the plays, a play I have read on countless occasions, seen on stage many times, each time discovering new meaning and nuance.  I was proud of us both when my daughter told me that she got the only A in her class on the Hamlet test.

How are things with 'Shakespeare and Me' at this age?  Shakespeare wearies me.  As I get older, Shakespeare’s writings get darker.  There is no optimism in his plays, even in his comedies.  There are few characters that ascend, and many that fall.  There are few that are wise, and many that are fools.  Some characters have their great moments, but most have their deep and tragic flaws. There are no sustained victories and no heroes.  Would any of the essayists in my new book disagree?

I read less Shakespeare now. Maybe my age being what it is, maybe the state of the world being what it is, I have less resilience for Shakespeare’s darkness and pessimism.  Like the 8-year-old boy I once was I want to believe that there can still be happy endings.

The Road Taken

 “In all important transactions of life we have to take a leap in the dark. . .”  (William James, 1842-1920)

Throughout my years of practice, Robert Frost’s poem, “THE ROAD NOT TAKEN”, hung in my office, a gift from my wife.  Reportedly, it was not one of Frost’s favorite poems, but it is one of mine.  I first read Frost’s poem in High School.  It was the 60’s, the decade of nonconformity, and I was a 16-year-old adolescent.  I felt that the poem emphasized taking the road LESS TRAVELED BY and THAT HAS MADE ALL THE DIFFERENCE.  It was about not following the crowd. It was about daring to be different, venturing where few had gone before.

At age 40, I wrote the following, with a different, midlife interpretation of the poem.  “Now middle-aged, married and well into my career, I read THE ROAD NOT TAKEN no longer as a teenager, but aware of other words with a different emphasis.  The poem is about A YELLOW WOOD with LEAVES NO STEP HAD TRODDEN.  So, I read this as a poem about beginning the early autumn of life.  And when I read the poem closely, I notice that the two roads are not so different AND BOTH THAT MORNING EQUALLY LAY.  The poem is about having to choose.  And if the poem had been written “I chose the one more traveled” the meaning remains unchanged.  To choose one road means surrendering the possibilities of the other. Time marches on.  But a choice has to be made.  Go left or go right or go nowhere.  KNOWING HOW WAY LEADS ON TO WAY I understand that I may never return in my lifetime to THE ROAD NOT TAKEN.  Every choice is a loss.  Every choice means giving up the possibility of a journey along the other path.”

Now 65, and beginning my journey as a new retiree, I once more return to Frost’s poem with yet another perspective and interpretation.  Loss is not in the choosing.  Loss is in the failure to choose, the failure to embark upon a journey unknown.  Life is filled with uncertainty and where the road may lead is often unclear.  It is difficult to choose without knowing that the road is safe and arrival at the desired destination a guarantee. Without reassurance it is easy to get stuck.  However, coming to the fork-in-the-road and fearing to choose, it is easy to lose the opportunity for new experiences and new understanding.  Now, having chosen a new road, I accept the unknown and the possibility of disappointment or even failure.  Where this new road will take me is unclear and yet to be revealed.  I start my journey with hope and by choosing to embark on a road unknown, I gain the possibility of new insight and great discovery. 

I come to where TWO ROADS DIVERGE, I choose, and that makes ALL THE DIFFERENCE.

Electronics and Education

“There seems to be a direct conflict between the advocates of (technology) in early years education, on the one hand, and the warnings arising from studies in paediatric medicine and biology, on the other.”  --Aric Sigman, health advisor to the European Parliament’s Quality of Childhood Group on the Impact of Screen Media on Children.

The over-use and misuse of electronics is today the single greatest threat to children’s physical, cognitive, social, emotional, behavioral and spiritual development!  (Note the bold type and exclamation mark.  After more than 35-years of practice in Child Psychiatry, I try not to mince words.)

Statistics from 2011 estimated that the average school-age child spent 8-hours of each day in front of a screen.  This statistic is already obsolete.  Since 2011, there has been an explosion of iPhone technology and availability.  Also, since that time, there has been wide-spread distribution and use of computers in the classrooms.

The research is there.  Anything you do for more than 8-hours-a-day changes the brain’s wiring and physiology, especially if you have a young and growing brain.  Anything you do for more than 8-hours-a-day takes away from something else you could or should be doing, like exercising, playing outdoors, reading a book, or sleeping. 

On Wednesday July 18^th, 2018, all the major national newscasts carried the story that researchers at USC, in a study of 2500 youths, found that the excessive use of electronics can lead to symptoms of ADHD.  Since that story I have listened, but not heard any significant outcry from parents or educators.  Despite the evidence and warnings to the contrary, schools continue handing out computers to students as early as Kindergarten.  I know that in this day-and-age, in order to be competitive in the work force, kids have to come out of school with good technologic and computer skills.  I get it.  But Kindergartners?

I have tried to ask school administrators some basic questions.  I just want to know, from their perspective, what is the ‘right’ age to introduce electronics into the curriculum, based upon what?  What is the evidence that electronics enhance learning?  What is the contrary evidence?  What is the industry sponsored ‘evidence’?  What does the independent research show?  I have received no answers, just silence.

Given the lack of response, pretending now I am the school administrator, I have come up with my own guidelines.  Computers should be introduced into the classroom only after the following skills are demonstrated:

·         Reading skills that include the ability to read and comprehend early chapter books

·         Writing skills that include the ability to formulate and write a linear thought in a paragraph, using at least three sentences

·         Mastery of basic arithmetic including adding, subtracting, multiplication and division

For most students these skills should be obtained by or during the 4^th grade.  Please, for God’s sake, no computers in Kindergarten! 

What should parents do?  Speak out.  Use the power of the PTO’s to express parental concern. Ask administrators the important questions. Insist upon thoughtful answers. Make ‘electronics’ an issue to be addressed by school board candidates.  Advocate for well-rounded education, by advocating for quality programs in music, art, theater, sports, etc.  Take a stand.  It will make a difference.