The Spirit Catches You and You Fall Down

Posted on by
7

I have finally finished reading this book. It took me over a year to, at last, experience this long-awaited epic.

Let me begin by sharing the following set of questions and responses with you, which is taken from a chapter within The Spirit Catches You and You Fall Down entitled “The Eight Questions”. These set of questions, developed by Arthur Kleinman, are designed to elicit the the perspective of patients in experiencing their illness. Below is the author’s interpretation of the family’s answers in response to the illness of their daughter:

  1. What do you call the problem?
    Qaug dab peg. That means the spirit catches you and you fall down.
  2. What do you think has caused the problem?
    Soul loss.
  3. Why do you think it started when it did?
    Lia’s sister Yer slammed the door and Lia’s soul was frightened out of her body.
  4. What do you think the sickness does? How does it work?
    It makes Lia shake and fall down. It works because a spirit called a dab is catching her.
  5. How severe is the sickness? Will it have a short or long course?
    Why are you asking us these questions? If you are a good doctor, you should know the answers yourself.
  6. What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment?
    You should give Lia medicine to take for a week but no longer. After she is well, she should stop taking the medicine. You should not treat her by taking her blood or the fluid from her backbone. Lia should also be treated at home with our Hmong medicines and by sacrificing pigs and chickens. We hope Lia will be healthy, but we are not sure we want her to top shaking forever because it makes her noble in our culture, and when she grows up she might become a shaman.
  7. What are the chief problems the sickness has caused?
    It has made us sad to see Lia hurt, and it has made us angry at Yer.
  8. What do you fear most about the sickness?
    That Lia’s soul will never return.

To be honest, initially, I felt quite ethnocentric while reading the first few chapters of the book. It’s one thing to theoretically understand cultural relativism, but it’s another to witness, as if a fly on the wall, the tragic process and consequences of the accumulation of cultural differences. I was initially agitated by and somewhat angry at the fact that certain traditional Hmong people perceive the western medical system as the cause of illness and harm. Anne Fadiman, however, did an excellent job as the author in integrating the tragic facts of the story with detailed historical lessons, which provided me with a better understanding of the Hmong people. My frustration ought to have been directed, instead, towards the lack of awareness in cultural issues which ultimately resulted in the occurrence of medical errors, decreased quality of care, and poor adherence, all of which would have been preventable had a greater appreciation for cultural differences been the norm.

Now, I’m glad to say that I recognise the importance of utilising a shaman in the clinical setting as much as the prescription of anti-depressant medication. Only by reaching out to people of different cultures in a relevant and appropriate context can we then begin to make progress. The intricacies of this delicate art can often be revealed through cultural brokers — not merely interpreters — who master not only the language, but also the way of life.

On a related note, I recently spoke with an individual who has spent his life working with an NGO in improving the lives of people in developing countries. He told me how the United Nations had once built numerous wells in Cambodia in an attempt to enable safe access to clean drinking water. The wells, however, were not used by the local people because they did not understand the purpose of drinking clean water. The idea of parasites and water-borne diseases was a foreign concept. The wells were easily built; the ideas, not so.

Thinking Critically About fMRI

Posted on by
2

I’m feeling nostalgic about the better days. Why don’t we briefly chat about functional Magnetic Resonance Imaging (fMRI). I was exposed to a fascinating discussion on a number of potential issues with fMRI during one of Steven Barnes‘ lectures in late 2009. As we approach 2011, I wonder to what extent these concerns have been addressed by the scientific community.

In a nutshell, fMRI measures the level of brain activity through assessing changes in blood flow and O2 consumption. Haemoglobin, which carries oxygen in red blood cells, exists in different states, including deoxyhaemoglobin, which is paramagnetic, and oxyhaemoglobin, which is diamagnetic (see Iron’s oxidation state in oxyhemoglobin). Essentially, increases in neural activity lead to increased blood flow and O2 consumption, which alters the magnetic properties of the haemoglobin complex. An active region of the brain receives more oxygenated than deoxygenated blood, which decreases the magnetic susceptibility of the region. This change in blood flow can be measured by the Blood Oxygen Level Dependent (BOLD) contrast effect, which reaches its peak amplitude after six seconds, of which a two-second window is usually used for analysis.

fMRI employs a number of methods through which the final results are produced. Paired-image subtraction and averaging techniques are used within subjects, during which any neural activity as a result of experimental manipulation (e.g., visual stimuli, activities of working memory, etc.) is subtracted from a baseline measurement of activity and then averaged over multiple trials. The mean difference image is often used to calculate an area of activity between subjects.

Problems with fMRI?

We need to be aware of the following:

  1. fMRI is highly theory-driven. Subtractions are based on current theories and may change in validity over time.
  2. There is an incredible amount of individual variability which are potentially removed through averaging.
  3. What does it mean to average spatially? In a room with multiple book stacks, can we find the average location of books?
  4. The averaging shows that certain regions have greater activation than inactivation. Deactivation (e.g., lesion of septal area), however, is neglected and may be of importance in behaviour.
  5. fMRI assumes that every brain region has the same amount and intensity of blood flow. This is not the case, as demonstrated through cerebral angiography.
  6. The BOLD response may be influenced by anxiety, which occurs to certain individuals inside MRI machines.

I have a very limited understanding of fMRI — feel free to correct any of the above and share your thoughts. How much have the above points been addressed, if at all? I’d love to hear what you think.

(The image used in this post was selected after a cursory search through Google Images. Did you notice the abnormalities of the scan? If not, have a closer look. It only occurred to me after I had nearly finished writing this post that there appears to be a large tumour in the posterior region of the left hemisphere. I’m not sure about the significance of the hollow area in the adjacent picture.)

The Dream of a Ridiculous Man: A Cynic’s Intergalactic Journey of Metamorphosis

Posted on by
Reply

Eastwood Zhao
The University of British Columbia
November 2010

“The Dream of a Ridiculous Man,” written by Fyodor Dostoevsky in 1877, is an insightful story in which the cynical narrator takes flight in a dreamland and travels on a fantastic journey, through which he ultimately discovers the source of human misery and vows to embrace life with a rekindled spirit. The idea of the omnipotent heart is a prominent theme and is introduced early in the story as the protagonist begins his adventure of self-discovery. Because the heart is a powerful symbol of one’s numerous qualities, including conscience, character, soul, emotions, and spiritual love, the narrator’s shooting of his own heart symbolises its silencing, which enables the resurrection of the character from a state of cynicism to one of hope. Only with a silenced heart is the Ridiculous Man then empowered to expel the predisposed perspective through which he sees the world, to witness the peaceful state of being with which he falls in love, and to be disgusted by his own infectious “germ of corruption, iniquity and deceit” (217). Ultimately, the Ridiculous Man rises from the ashes to passionately love life and the world in which he lives. The path of self-discovery on which the Ridiculous Man travels through his dream demonstrates a fundamental character transformation, in whom apathy is converted into passion, suffering into love, and cynicism into passionate conviction.

The overall manner in which the narrator behaves and reasons is characteristic of a modern cynic.  He is a self-proclaimed “Ridiculous Man” whom lengthy years of education and life experiences have moulded into an apathetic and suicidal individual (201). He is convinced that “nothing matter[s]” and that there “has been nothing” since his initial presence on the Earth (202). As seen in the Ridiculous Man, as opposed to achieving meaningful social change, the modern cynic expresses “apathy and resignation” (Kanter, Mirvis, and Stivers) while feeling an implicit sense of “alienation and hopelessness” (Goldfarb and Stivers). Combined with his sense of apathetic absence, the narrator has a strong desire to terminate his own life with a “splendid revolver,” which he purchases despite his “poor” economic condition (203). Earlier research defines Cynicism as an attitude distinguished by a “dislike for and distrust of others” (Cook and Medley). Contemporary work equates cynicism with  “disillusionment resulting from the failure of… contemporary society to meet the high expectations presented by modern-day life” (Kanter and Mirvis).

Upon seeing a “tiny star” twinkling in the abyss of the night sky, the narrator decides on the precise moment at which to kill himself, but is interrupted by a helpless, crying little girl who seeks assistance (204). Understanding her request, the Ridiculous Man does not offer help but, instead, stamps his feet and shouts at her (204).  Unlike the ancient Greek school of philosophical Cynicism, whose followers “scoffed at the relentless pursuit of power, wealth, and materialism by their fellow beings,” cynics in modern times do not see the benefit in adhering strictly to ethics and morality (Andersson). Soon, the narrator is disturbed by the manner in which he had treated the little girl and is unable to follow through with his plan of suicide as he is troubled by an internal turmoil. He claims that “the world would really be nothing for anyone” after he is gone, highlighting the extent of his egotistical mentality (206). Concurrently, however, he is angered by the apparent incongruence of feeling “pity” and “poignant” for the little girl while being apathetic. The concept of cynicism has been described as “a personality trait, an emotion, a belief, or an attitude” (Andersson). Perhaps it is in the heart, not the mind, where cynicism lies.

The dichotomy between the heart and the mind is of symbolic significance and used numerous times by Dostoevsky to create meaning. The first instance to which one is exposed the idea of the heart-mind separation is demonstrated through the Ridiculous Man’s belief that dreams are “directed by desire, not reason, by the heart and not the mind” (207). The elucidation of the narrator enforces the concept which establishes the heart as the the centre of origin of dreams. From both historical and literary perspectives, the heart can be described as an organ which possesses specific functions and control a multitude of human characteristics. According to Dr. Sherwin B. Nuland in The Mysteries Within, the heart is considered by the ancient Egyptians to be the organ of utmost importance in the human body, not only during life by also after death. Furthermore, numerous civilisations of the past attributed the conscience and character of an individual to the heart:

It seems always to have been understood – originally as fact, even if now only as  metaphor – that moral, spiritual, emotional, and even sexual behavior and thoughts are attributable to the heart. (Nuland)

As dreams emerge from the heart, which is the site of qualities such as conscience, character, and emotions, and because one may argue that it is within the heart in which cynicism lies, then according to logic, the particular dream which the Ridiculous Man experiences should be a constant, monotonous reflection his present, cynical state of being. Considering, however, that in his dream, the Ridiculous Man shoots himself in the heart, not the head, a deeper level of analysis is required in order to determine the effect of the silencing of his heart:

Suddenly I dreamed that I picked up my revolver and, still keeping my chair, pressed it to my heart – my heart and not my head… With the revolver pressed to  my heart I waited a moment or two… I quickly pulled the trigger (208).

The narrator possesses a wounded and silenced heart. Being “wounded” and “bleeding” (215), his heart emits a “physical pain” as the narrator realises the presence of  the lodged “shot, the bullet” (209). Subsequently, the Ridiculous Man falls silent as “[d]eep silence reign[s] for almost a full minute,” which liberalises his soul with the awareness that “all would be different now” (209). Since ancient times, the heart has been acknowledged to be the origin of one’s soul:

Who shall ascend in the hill of the Lord? or who shall stand in his holy place? He that hath clean hands, and a pure heart; who hath not lifted up his soul unto vanity, nor sworn deceitfully (The Holy Bible, New International Version, Psalm. 24-3).

The above passage from The Holy Bible suggests that those with pure hearts carry untarnished souls, which facilitates their passage into heaven. Furthermore, dating back nearly three thousand years, Homer describes the death of Sarpedon after Patroclus plunges “a spear into his solid heart”:

From the wide wound gushes out a stream of blood,
And the soul issued in the purple flood (Nuland).

Aristotle, too, believes in the soul’s dependence on the heart:

But it was not enough for Aristotle that the heart should be merely the ruler of the body – he went further. In his system… the soul could not possibly be an entity completely independent of the body – it must arise from the heart, which he also considered to be the origin of the emotions … (Nuland).

The references above establish the relationship between the heart and the soul. Because of the silencing of his heart, not only are the pre-existing qualities of the narrator silenced, but also his soul. At once, the narrator is freed from the influence of his strangling conscience, character, and emotions, unbound from his suffocating cynicism, and liberated from his tarnished soul. Indeed, during his flight through “dark and unfamiliar space,” the narrator’s “silent companion” represents his silenced heart, enabling his view of the world in an unobstructed fashion (210). During his escape to a world “infinitely far away,” as if a Phoenix emerging from the ashes, the narrator’s heart is “resurrected” as his soul rings with “sweet and stirring ecstasy” and as he senses life once again (210).

The Ridiculous Man’s transformational journey of intergalactic proportions has a literary parallel. A Christmas Carol was written by Charles Dickens in 1843, in which Ebenezer Scrooge, the cynical and embittered main character, experiences a number of dream-like visits from the Ghosts of Christmas and ultimately metamorphosise into a loving, benevolent character. Written 34 years prior to the story which we currently examine, the predominant theme of character transformation through the symbolic use of dreams is prominent in both stories. Perhaps one might wonder whether the former has had an influence on the latter, as suggested by Miller in Dostoevsky’s Unfinished Journey. The internal transformation of the Ridiculous Man, however, differs, to an extent, from that of Scrooge as the former witnesses a pure, loving, and innocent Earth which comes to be infected and diseased by his own “germ of corruption, iniquity and deceit” (217).

Three important moments of contrast highlight the metamorphosis of the Ridiculous Man. At the start of voyage, the silent companion promises that the Ridiculous Man “shall see everything” (211). Indeed, as he flies closer to the new Earth, he wonders if the new planet “hold[s] suffering,” since on the old Earth he can “only love truly by suffering and only through suffering” (211). He claims that without suffering, he is able to “love in no other way and know no other love” (211). Upon witnessing, however, the corruption which he brings to the new Earth, the shadows of suffering on the people’s faces, and their claim that “suffering [is] beauty, for in suffering alone [lies] thought,” the narrator holds his “arms out to them in despair, accusing, cursing, and despising” himself (218) for he has come to view his previous, cynical self with disdain.

After initially encountering people of the new Earth and observing the loving ways in which they live, the Ridiculous Man asks himself in bewilderment how they “never insulted… never roused… to feelings of jealousy or envy” (213). Following the people’s contamination by him, as if he were a “malignant trichina, an atom of the plague afflicting whole kingdoms,” the narrator watches in horror as jealousy, cruelty, and violence is conceived (216). This contrast further highlights the internal conflicts between the narrator’s present and former selves, an individual who was previously bewildered by the absence of insults and jealousy.

Following the people’s corruption, the Ridiculous Man is told that he, himself, once used to believe, that “[k]nowledge is superior to feeling, consciousness of life is superior to life” (217). The Ridiculous Man, formerly a cynical individual, once also subscribed to such a point of view. This is evident through his initial characterisation, through which he possesses great knowledge but fails to feel the world, is intellectually aware fails to live his life. Towards the conclusion of the story, the narrator witnesses the destruction and suffering which he brings to the world and vows to “preach tirelessly” (220) about the “living image” of his dream which has “taken hold of [his] soul for ever” (219) by urging us all to “love others as one loves oneself” and fight against the notion that “[c]onsciousness of life is superior to life, knowledge of the laws of happiness is superior to happiness” (220), demonstrating his complete transformation from a cynic to one who is full of hope and love for humankind.

The narrator emerges up from his dream as an individual with a renewed heart. He has risen from the ashes of cynicism to embrace life with out-stretched arms. His great love for humankind emerges from his healed heart, which is of symbolic significance for spiritual love:

But in a symbolic sense, the heart continued to maintain a kind of hegemony – especially in affairs of the heart. By this, I mean to imply not only romantic love but love for humankind as well. Perhaps of most significance, I refer to spiritual love. In the Christian tradition, the heart is both the province and provenance of divine love, and like all matters of faith, such a belief is independent of the need for biologic substantiation. The concept is metaphysical and not subject to the rules of scientific evidence. It is the heart of Christ – to some the Sacred Heart – and not his brain that is the centrality of divine love.

Indeed, the narrator has had a transformational change of heart: in a world with much “corruption, iniquity and deceit” (217), he has courageously given up apathy for hope,  cynicism for idealism, and egotism for selfless, philanthropic love. Perhaps we ought to learn from and continuously improve ourselves like the Ridiculous Man.

Works Cited

Andersson, Lynne M. “Employee cynicism: An examination using a contract violation framework.”  Human Relations 49.11(1996):1395-1418.
Cook, W. W., & Medley, D. M. “Proposed hostility and pharisaic-virtue scales for the MMPI.” Journal of Applied Psychology, 1954, 38, 414-418.
Goldfarb, J. The cynical society. Chicago: The University of Chicago Press, 1991.
Kanter, D. L., & Mirvis, P. H. The cynical Americans. San Francisco: Jossey-Bass, 1989.
Nuland, Sherwin. The Mysteries Within. Simon & Schuster, 2001. Print.
Stivers, R. The culture of cynicism: American morality in decline. Cambridge, MA: Blackwell Publishers, 1994.

Insights or Abilities: Kindness and Curiousity

Posted on by
Reply

More thoughts from Dr. Jill Bolte Taylor’s book, My Stroke of Insight:

This experience of losing my left brain has opened my mind to look more positively at people who have experienced various forms of brain trauma. I often wonder, in the absence of language or the ability to communicate with others in a normal way, what insights or abilities has the person gained? I don’t feel sorry for people who are different from me or perceived as not normal anymore. I realize that pity is not an appropriate response. Instead of feeling repelled by someone who is different, I am drawn towards them with kindness and curiosity. I am fascinated by their uniqueness and compelled to establish a meaningful connection, even if it is merely direct eye contact, a kind smile, or appropriate touch.

Wounded – not stupid – animal

Posted on by
Reply

Neuroanatomist Dr. Jill Bolte Taylor describes her cerebral haemorrhage from a ruptured Arteriovenous Malformation in My Stroke of Insight:

I wanted to communicate: Yelling louder does not help me understand you any better! Don’t be afraid of me. Come closer to me. Bring me your gentle spirit. Speak more slowly. Enunciate more clearly. Again! Please, try again! S-l-o-w down. Be kind to me. Be a safe place for me. See that I am a wounded animal, not a stupid animal. I am vulnerable and confused. Whatever my age, whatever my credentials, reach for me. Respect me. I am in here. Come find me.

A Special Moment

Posted on by
3

This summer, I have been volunteering in various capacities, but one in particular deserves a special mention.

Gathered at this government-subsidised housing complex are children of all ages, ranging from kindergarten to seventh grade. Most of the children are of African descent, many of whom are refugees from war zones. No, I’m not with Médecins Sans Frontières. No, I’m not in a developing country. I am somewhere in the Greater Vancouver Regional District, at an African children’s summer camp.

This camp is no CEDAR or GEERing UP. Situated within a low-income, disadvantaged area and inside the confines of a two-room apartment, which has been modified to suit the needs of the programme, up to 20 children laugh, cry, and play together with the support of two paid staff members.

A large bookshelf sits near the doorway with a wide collection of reading materials tightly placed together. Sitting at the very top of the shelf is a heavy book, one which catches my eye and brings back the nostalgia of high school. I recall using this a-thousand-some page textbook for Biology 11. Waking it from hibernation, I bring the book to two of my friends, who are beginning and nearly finishing their elementary school careers, respectively.

“Let me show you something cool. Do you want to learn about the brain?” I ask.

We flip to the chapter on the nervous system and I begin to tell them, in very simplified terms, about different parts and functions of the brain. They are intrigued by the drawings of neurons and the nervous system and would point at every single figure, followed by asking what it is. I tell them that the human brain is the most amazing, and my favourite, organ, that the back of the brain (occipital lobe) allows us to see, that the right side of the brain controls the left side of the body.

“There, now that you have learned all this knowledge, you are truly a scientist!” I tell them. Indeed, moments later, I overhear these budding scientists lecturing their friends on the brain.