SANITY v. INSANITY

I had a strange dream…

The phantasmagoria of the passing green fields riddled with picket fences and cows grazing the fields pass by at blinding speed. As I hurtled on the autobahn it was hardly the illusion of what sanity is made of. On and on the whoosh of the beautiful fancy passed me by at speeds that seemed unreal that all images stood still momentarily and then with the blink of an eye were gone. And as surely as the speeds tested the Mach number a sudden stop on a country mile brought images of the cows wearing bells clanking their way across the road as the traffic came to a dead stop. The calm within the storm.

The fields stretched far into the distance and there before me was a spectacular image of a beautiful rendering of a castle perched high atop a mountain with sweeping vistas of tall trees. 

Was it an illusion? painter’s imagination? Or was it a work of art? Or was it reality?

The castle stood quietly in its cloaked splendor a midst the floating mist of moisture laden clouds, which kissed it gently and with each stroke uncovered more of its majesty. This was the Schloss Neuschwanstein. The beautiful architectural rendering of what has been considered the imagination of a deranged mind. King Ludwig II of the House of Wittelsbach was declared insane for spending the family fortunes in building castles and bringing it to ruin. The “Mad King of Bavaria” was declared insane and deposed. Three days later on 13 June 1886 his body was found in a shallow lake near Munich along with the body of his psychiatrist.

The beautiful castle still stands in all its grandeur. It rises majestically as its turrets prick the clouds trying to shed the truth about its creator. Was King Ludwig II crazy? If he was why is this endearing legacy in the form of such architectural splendor a draw of fancy of every child and adult in the land and across the globe. Some call it architectural fallacy. Some just shake their heads in incredulity, while others shake their heads in awe. But my dream ends there and as I awaken from this strange corpus of mystified wonder, fresh questions arise.

What is mentally insane? Is it the argument about squandering wealth? Was the “Mad King of Bavaria” mad because he loved the architectural challenge of creating such masterpiece as the Schloss Neuschwanstein? Was the dwindling fortunes of a family, the force that invoked the insanity declaration? Was his drowning a suicide or as some now claim it was a murder because of memory-recalled anecdotal evidence that seems to suggest of such a travesty? Whatever caused his demise, it leaves lingering doubts of what was the intent. If you were to venture into the castle’s interior you would find the trappings of a voracious reader fully ensconced in a perfectly royal “reading throne” next to the royal bed overlooking the Bavarian countryside. 

The tapestries adorning the walls and the rich texture of thought that seems to inhabit every piece of the furniture in the finished rooms suggest great concert between idea and perfection. The Swan room another fancy of the deposed King suggests his predilection to the beauty of the swans. He loved the image of a swan and everything in the room speaks of it. Was this idiocy, madness or a mind in love with the beauty in nature? If one looks critically at today, some girls are fascinated with princesses, and dress in their make believe land of holding court or some boys swing a 42 inch wooden stick and envision themselves in the trappings of a Yankee stadium galloping across the diamond after hitting the home run to the applause of thousands. Yes we all have dreams, but wherein lies this insanity that doomed the King?

Today the proliferating morass of psychiatric diagnoses fills a 991 page Diagnostics and Statistical Manual of Mental Disorders DSM-V book. The most common childhood diagnoses of ADHD and ADD now seem to afflict a large and significant number of adolescents in the U.S. and through the developed countries. Anytime a child is hard for the “busy parent” he or she is rendered as a “case” and stuffed with pills to keep him or her from invading the “calm and quiet” of the parents or teachers who have grown to have a depleting content of patience. In fact the increasing diagnosis is a boon for the mental health and the pharmaceutical industry. A pill and all is quiet for the parent or the teacher to indulge in their fancy. Is that a parental insanity escalated to levels of self-absorption that their mechanics of finding solitude be based on prescribed medication? So where is the true sense of sanity? Is there one? Is the person who fiddles in his pocket to make sure that his car keys are still there, the makings of an obsessive compulsive disorder, therefore a psychiatric conundrum? Is the perfect crease on a pair of pants an obsession in need of a pill? Is the parent’s desire for a successful child a fancy worth putting the weight of adulthood on him or her thus depriving that child of his or her “childhood-ness” an insane proposition invoked by the parent? Where does one or for that matter “who” who can draw the line between the thoughts of a wild imagination and the carefully controlled and constructed mindset of sanctified order?

Mental health issues stemming from “neuro-chemical imbalance” are widely appropriated to  a certain population because of their non-conformist behaviors but do these rise to the level of the challenges such as the shock, the stress, the horror of a war in the form of PTSD that need an understanding ear, a steady emotion and potential short term use of medication. When the flights of fancy of an imaginative soul are deemed insanity to prevent cost overruns, or invasion of “quiet time” then something is truly insane.

Do you brush your teeth every morning and before going to bed every night? Is that a ritual of good habit or a compulsion? Do you watch with intense disdain when someone sneezes into their cupped hands rather than in the crook of their elbow? Do you wear gloves to touch all doors, railings, banisters in public places or yearn for a tap with running water to wash your hands afterwards, or look for the ever-present bottle of Purell nearby to ward off the microscopic evils that might rob you of your health? Do you shake hands with people? You see where I am going with this? I once came across a famous female doctor who walked with her hands behind her back. She looked like a duck at times with the arch in her back as her rear end trailed behind. What were the metrics of her “saneness?”  

So we come back to my dream once again. Was the “Mad King of Bavaria” really mad or just indulgent of his fancies of perfection and beauty? Was the drive to depose him the arch purpose of the family or the kingdom to preserve the wealth and power of the family and the kingdom? These are difficult questions, but even more difficult is the premise of a wanton approach to label for selfish desires.

Each one of us comes replete with our own baggage of experiences, some experiences are tortured and others are comforting. It is the composite of this collective that makes us who we are. Where in these realms, is the demarcation line between what is and what is not sane? True the ones that have truly lost all temporal sense of existence need help to function. But here again where is that temporal boundary? When the frontal lobe and its cognitive sense of right and wrong, good and evil, yes and no has departed and the parietal lobe of the brain links action to a constant stream of a circular thought devoid of the temporal constraints then one is compelled to visit the malady with all the tools of rational thought and action to correct the imbalance. But what is sane? This question poses many others in our minds. How we answer these and other such questions might then become the defining path for a society. The pathos and ethos contained within the crucible of humanity might just be the elixir of existence and not the vectors between the sane and insane. For instance some would consider the price of this painting at $117 million, insanity. Would you?

We help others not to add to the ritual and decrees of making more use for the help we have created, but for the true sense of lifting another’s life. We do not add to the plethora of psychiatric diagnoses just to pigeonhole another fellow human into a life-long servitude to drug-promoted-mind-control. We live to better each other’s lives and in that we must rest our laurels. 

HOPELESS APPROXIMATIONS

Needless to say that time is the ultimate warrior against life. It is. We, humans live as if the end will be the big giant supernova and that remains a few billion years away. That it would be a big whoosh of collapsing dust into a black hole spreading our dust into the universe through its glorious accretion disk jets. Alas, the vision is sorely in need of revision. The four score years haunt the vessel that inherits the wide eyed immortality thoughts. No, it is a simple and tested hypothesis, observed over millennia and validated in its entirety. Life ends whether in a flash or with a whimper, it ends.

Humans are adept at visualizing grand obscure corridors of endless hallucinatory thoughts, of this or that. You know, like the ones we all have. Buy a lottery ticket and become an instant millionaire, live in palatial homes and travel with the jet setters, eating caviar and drinking aged wine to perfection, whatever that means. Yet we still inhabit the same shell with all its confines and a mind filled with the baggage of experiences. The collected images of the past, embellished through the lens of time, with fancy and incredulity foster and remake the person we are, for better or worse. No wealth or grandeur can escape the shackles of a buried past. We live therefore within ourselves, as us. And no hope will shake the limits of our destiny.

This one fine day, an elderly man with an eye towards perfection and a nose for a tale, held my interest. He was confined to his physical limits from arthritic joints, a stiffness that was pervasive in each movement. Yet he was as real in thought as you or I. He sat quietly without so much as the sound of his breath adding to the noise pollution around. My restlessness in my erect vertical stance leaning against the wall must have breached his sense of comfort at some level.

“Tough day?” he asked.

“Yes a little.” I replied.

“That is life.” He said quietly.

I looked up and smiled at his frail frame affixed in the shiny wheelchair. There was concern on his forehead and in his eyes that were weighted by years of wisdom could perceive through the cataracts of time and infirmity when hurt echoes within another’s silent flesh.

“What is it?” he said and after a pause added, “May I ask?”

“My patient is not doing well.” I replied.

“We are all humans, with limited abilities. Nature has her own sets of rules that defy anything we can think of or consider. We do our best and then let the Grace of God take over. We live and we die, and there hangs a tale. Nothing that is will be, everything will perish with the mind. We just do our best!” Never have words with such simplicity or clarity eased a burden as those did that afternoon. Something ticked. Comprehension! I still remember the echo of those words, expressed with the same lilting inflection as he had said them, so many years ago. Wisdom indeed is the paradise for the open mind of an experienced age.

We look for perfections where hopeless approximations are the rule. We look for science where art would better approximate and vice versa. We are forever looking for “something” other than what we have. Clearly something is wrong or right? That pot of gold at the end of the rainbow is what Leprechauns are made of and 1 in 170 million chance of winning the big bonanza is out of reach for the remaining, yet hope springs eternal to find, to discover, to invent, to redeem, to prosper, to live.

Even with our best intellectually crafted approximations in face of what Nature has in store, we still manage to change the world incrementally in small quantum hops as a different place for all. For better or worse, that is what humans do. We are destined to the limits of our virtues, vices and deeds. We are an interesting species. After all we are the “quintessence of dust” approximating the angels on one hand and the devil on the other. We are constantly bouncing off the firewall of Perfection.

"After all we are all humans doomed to live a life of Hopeless Approximations."

EMRs - MEANINGFUL USE ?

What did meaningful use mean? Wrestling with this concept as an inducement to get paid for a spent cause is hardly the realm of a wonderful idea. And then to wrap it up in the cloak of universal utilitarianism of benefits is another blow to the human intelligence, as if there was any left in this drone milked society of ours today.

They haven’t yet proved it, that the use of EMRs has any beneficial effect on a patient’s health. But what they have proven without prejudice or bias that the imposition of this multi-billion dollar enterprise borne of an inquisitive mind to gather a fully populated big database of who does what to whom at what cost, was a boon to technology, to the middle-service-providing-people through pocket-lined contracts and a bane to the patient and the doctors, for whom it was the next coming since “pet rock.”.

Why the harsh sentiments? Why indeed?

If all you see in the pupil of your physician’s eye is the pixilated glare and flicker when you ask a question, a need has been met. But whose need, you might ask?

Yet salvaging from this experiment the emerging theme of observational science become evident too. EMRs have filled some classic gaps in the field of “this therefore that” philosophical construct through data mining. But then one would ask, is that not a good thing? Surely that question sends pings of synaptic pleasures through every epidemiologist’s veins in the form of an endorphin glow. But does a win for the individual, the patient that sits patiently on the opposing side of the flickering screen?

Thus far and this from variously sponsored studies from the pros and cons tilting windmill landscapes of contingent data, the answer remains elusive, for the propagandists  to outright, no for the pragmatists!

But lest we forget that there is a larger purpose in the linkage between the patient’s personal data and the unified correlates of big data, and the minions that spend countless hours mining it, one heap of digits at a time, we might miss that hot breath of the fire breathing dragon. And Lo, just as we question, here comes a fleeting wave of “Eureka” heralding the new dawn of discovery. Ah we have arrived at the threshold of a new paradigm. The net to bag the big fish has been cast. The rewards is well nigh at hand. “This might be a paradigm that will change the very essence of humanity,” they claim. We will know what drives what. We will know what genes are the presentiments of a given somatic discontinuity. We will know! We will know! We know! We know!

This new door into the cross-linked informational landscape between phenotype and genotype is the brainchild of big institutions, by cross-referencing a “Phenotype-wide Assay” with the “Genotype-wide Assays” and finding the needles that rule the haystack of diseases, we will, they claim harness the power. Well that is good you would think, right? And in many ways it might be. We might for instance know the multi-tasking genes that commit adultery in the soma and create a conundrum of metabolic disorders, of cancers, of heartaches and depressed human thoughts and even what makes us laugh at a bad joke or cry at a good one. All laudable concepts, all worth the congratulatory accolades! But, and this might be a mini-but, what about the gene drivers and the soma (Lamarckian) drivers within the individual. The interacting forces of these two cross-referenced Morlocks and Eloia might have differing opinions to that viewpoint. No? Might we not be surging in our minds towards a paradigm flawed in reality but gorgeous in concept?

Let us presuppose that a typical phenotype is associated with a specific genotype, that would be great, now modify the genotype and the scourge visited upon the phenotype would vanish. Voila! QED. But not so fast, lest we forget that there are incoming volleys that serve different masters within the cell and thus are automated upon invariant schedules and rise up to demands from different sources, via a supply chain of differing mechanistic pathways and cross-talks, the only rational thought we might be able o entertain is yeah, there is a “probability” that this might be associated with that, since it seems to occur in 60 or 70 or 80% of the populace.

Oh but there goes that probability thing again. This probability thing that garners almost a 100% of medical literature comes face to face with the “Ioannidis’ nightmare,” which shows more than 50% of the studies cannot be replicated due to the false gods of bias.  After all the trust lies at the feet of the curator of that big data... But I digress. Oh hey, why not! Educating the mind is a reasonable rational rewarding thing to do. Sometime as someone clever said, I would rather be an octopus and slap eight people at the same time to jog their thinking in one fell swoop, rather than a shark going after chum.

So have we resolved this matter? For now, maybe not but we might have started thinking about unintentional pathways and byways and alleyways that might pose a burden to those that do not represent the rich majority of specified shared genotype-to-phenotype-magical-shoots-and-ladders-type-approach. Just so you feel inclined to shoot the messenger here, read this one about changing landscape of the statins.

Come on give in a little and explore this concept…