I got drafted right out of college, to serve during the Korean War, as previously noted. I was eager to serve my country, but could not agree to go off to some foreign country to kill some other human. When the draft board accepted my protest and allowed me to serve my county in some other way, I was able to secure, through the American Friends Service Committee, an appointment to the Iowa State Psychiatric Institute at Independence, Iowa. Once fully exposed to the medical field, I was fascinated by its potential. What a wonderful way to serve people, I thought, if you possess the knowledge to cure their illnesses. Once there, they put me through training to serve as a psychiatric nurse’s aide, and then put me to work. What followed were, for me, a series of remarkable revelations.
I learned how to give shots, keep track of medicines, give haircuts, shave off diabetic ulcers on feet, and spent a lot of time just visiting with patients, letting them tell their stories. I heard long tales of lost loves, betrayed trusts, economic hardships, and unjust treatment. A picture gradually formed in my naïve mind that these people were just like the rest of us. They had the same problems and strange beliefs that almost every slice of humanity exhibits. It seemed to me that most everyone there would survive well on their own, if they simply had a chance. It seemed to me that these were people who deserved their own right to pursue life, liberty, and happiness. Yes, there were a few patients with bizarre behavior, who would not survive outside without someone else able to take care of them. Granted, some of them would wind up homeless, if they were turned out. Yet the great majority, I felt, did not really need to be there. I accepted that incarcerated status of these patients because I knew myself to be completely ignorant about medicine and psychiatry at that point in my life. When escorting patients, I attended some of the staff conference sessions determining if a certain patient could be discharged or not. The reasons given for keeping them incarcerated did not make sense to me. I did believe that the staff was really trying to do the right thing for these patients, but were greatly misled. It gradually seemed fairly clear, at least to me, that this was not a hospital for the treatment of mental illness as much as it was a wastebasket for all those individuals who did not fit in easily with the norms of their society.
Shortly after my employment by the State of Iowa, and initial exposure to the world of psychiatry in the 1950’s, there was an additional shocking event which led me to further question the wisdom of psychiatric therapy in the late fifties: electrotherapy day. These chosen patients would come in, with street clothes on. Some were inpatients and some were outpatients. They were not changed into gowns. They did not get any kind of examination or labs beforehand. They did not, to my memory, have this procedure explained to them or sign any agreement. They were summarily asked to lie down on a table, and without any sedation, any anesthesiologist nearby, or EKG monitoring, had paddles placed on either side of their heads, and then got the shock. They would all convulse, jerk all over, wet themselves as they emptied their bladders, and briefly, once the convulsions stopped, just lay there, not even breathing. Then there would be one deep breath, after what seemed like a long time, and small motions would appear again in their limbs. They would slowly come to, in a dazed state. After a few hours of gradually regaining their senses, they were allowed to go back home, often with wet spots still on their clothing, and told when to come back next month for another, what seemed to me, primitive treatment. How, I wondered, is this helping anyone in any way? How could anyone be right in the head after being repeatedly nearly electrocuted multiple times? How this could be appropriate treatment for anyone was quite beyond me.
N The late fifties were a time of dramatic changes in the culture of the United States. The country prospered under Eisenhower. We had survived World War II, and were now engaged in a robust recovery. Every home was getting a TV. There was a rush of new manufacturing, new homes, an interstate highway system, and a feeling that the sky was the limit for the prospects of our country. It was an exciting time to be alive. There were also tremendous advances in medicine. The first pacemakers were being implanted. Cardiopulmonary bypass was being developed, soon to lead to an immense field of complicated surgery and treatments for heart disease that never existed before. Antibiotics were, for the first time, widely used; more new ones were rapidly being developed. This allowed us to treat easily infectious disease which had previously caused widespread death and morbidity. That capability dramatically changed the way we were able to treat patients. I remember, as a child, being confined to one room of our home for a week because I had Scarlet Fever. All of a sudden, we were just giving penicillin for such illnesses, and isolation became a rare event. Whole hospitals and isolation units were rapidly disappearing because they were no longer needed for quarantines and isolation. New surgical procedures and new ways of treating disease appeared almost daily. We were excitedly rushing into this entire new world of treating disease. We were saving lives and prolonging life at a rate which had never been seen before in the human experience.
Yet, there were some terrible mistakes being made in this burgeoning rush to treat human disease in new and dramatic fashion. I lived through one of those new procedures first hand, saw the surgery being done, and saw the wreckage it left behind. That experience taught me to critically question the value of any new procedure until there is solid data to support its value. There was, in the late fifties, a neurosurgeon who stated that he could cure mental illness by doing prefrontal lobotomies on selected patients. This was an exciting concept, that you could cure the mentally ill with a simple surgical procedure. That neurosurgeon, Dr. Walter Freeman, in an effort to promote the value of his procedure, was traveling throughout the Midwest, from hospital to hospital, carrying his instruments with him in his car, and setting up one day surgery in those hospitals that wished to participate. There was a tremendous amount of interest in this new treatment, and the Mental Health Institute of Iowa at Independence, Iowa, elected to be one of those participants. There was excited talk about getting our patients treated in this way, and getting them suddenly cured.
The hospital selected seven patients to be treated with this exciting new procedure. I was assigned to take care of them postoperatively, after their surgery. After I had checked the first patient, and found her to be unconscious, but stable, I took a few steps to the door of the next room, to see one of these remarkable new cures being performed. The door was open. There was no attempt to provide antiseptic operating room isolation. I do not recall seeing any antiseptic being used on the patients face, although there probably was. I do not remember any attempt to tape over or guard the patient’s eyes. One of the members of our own psychiatric staff placed electrodes on each side of the patient’s head, and then shocked him. That patient convulsed. Then that surgeon placed an ice pick sized sword above the patient’s eye, under the eyebrow, and pounded it up into the patient’s head. Then he swayed that mini-sword side to side and pulled it out. He did this on both sides, and then stepped back, ready for the next patient. They rolled through in rapid sequence, and were done, as I remember, with all of the patients, in less than one hour. I soon had multiple patients in my recovery room, moaning, stirring, and gradually reaching up to hold their heads. They were all getting big black eyes. All of them had trouble responding to any command or question. All of them were dazed and fumbling, later staring, then were falling back asleep. And none of them were ever the same again.
I cringe all over again to relive that moment. Some of these patients I had gotten to know well, and had especially liked a few of them. None of them were worth a nickel afterwards. They could not plan, could not think, could not tell a joke, could not understand a joke, and seemed quite lost. I never saw any one of them laugh again. The prefrontal cortex is what makes us human. It is what allows us to see into the future. It is what allows us to plan, and overcome instincts to respond and plan ahead in a responsible way. It is what separates us from other animals. It is what allows us to think about the universe, and think in grand ways. It is what makes the unique personality that is what each of us becomes. That was all taken away from them by a man who wanted to achieve fame and fortune by being an innovator. When it became clear that his procedure was not helping people, but destroying patient’s lives, he kept plugging along, trying to enlist more hospitals to subject patients to his innovative surgery. The intense interest in this new surgical approach to mental illness, however, soon faded into remorse, as it should have. All of this disaster is well-documented in a PBS special, The Lobotomist, which was aired in 2012, in our local PBS stations.
I have, since that experience, and having those events seared into my mind, never done any procedure on any patient, unless I was convinced in my bones and my soul, and as supported by scientific evidence, that it was going to do them some good.
There was more after that. Before I left the employ of the State of Iowa, I was asked to become part of a team that was going to treat patients in a new and innovative way, in order to cure their mental illness. It had quite recently become the rage in the psychiatric world. We were going to give them insulin shock therapy. This was supposed to bring these patients out of their prison of abnormal thoughts, and free them to a world which would allow them to comply better with their society. Since electroshock therapy wasn’t helping patients as much as it should, was the thinking, there must be some other way to shock them out of their dysfunctional state into a more acceptable state of behavior. Certain patients were selected to be given this new therapy, and a special ward was opened to give this treatment, using the most skilled nurses that worked at that institution. Most of the patients selected in that first group were, as I recall, labeled as sexual deviants of various descriptions.
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Most mornings were quite benign, to begin with. These patients, each with their assigned bed, were not given any breakfast, but were instead given an overdose in insulin. They were initially unaffected, and were allowed to walk around on that floor. We had a record player on, playing Frank Sinatra or other somewhat unobtrusive music. London Town, New, York, New York, and Fly Me To the Moon have been etched in my memory since. After a while, they would start to get sleepy, and would be led back to their beds. Sometimes we had to separate two of our younger patients from having sex in a side hall closet, but most mornings were quiet, and there was an interval of slumber for all the patients. Then the fireworks would begin. One by one, they would all start convulsing. We had been instructed to not bring them out of their insulin coma until they either convulsed or their vital signs were failing. At that moment of convulsion, however, there was a rapid rush to the bedside, a frantic attempt to pass a nasogastric tube, then bolus a weak syrup under pressure. There was near panic when we could not immediately get a nasogastric tube down. While patients were convulsing, we were trying to hit those moving targets well enough to start an intravenous drip, then immediately give them fifty percent glucose. Patients would within minutes stop convulsing, and then would fairly rapidly become awake again. We did not lose any of them, although I thought each day that maybe someone would die. They all gained weight, because of their heavy doses of sugar. None of them got any better, in the sense that none of them became what those who were keeping them under incarceration considered to be “normal” for their society. This treatment, begun with such great fervor and promise, did not help at all. No one does it any more.
In my subsequent prolonged training and prolonged surgical career, I have at each step marveled at this organism our blind watchmaker creator has crafted. I know that none of the human body was created by design. I know that once life began, there was natural selection, and that whatever variety of whatever organism existed, that best fit into the environment where it existed, was the variety that had the most chance of survival. I completely believe that only, in this most natural way, has the human organism become what it is. It has constantly evolved, becoming more and more specialized and more complex, more intelligent, more understanding, more searching, simply because it was driven to survive. Nevertheless, the complexity and vast interaction of the various organs of the human body is stunning. There are myriads of different cells, myriads of parts of those cells, myriads of enzymes and hormones that drive the function of those different cells, remarkably variable architecture of those cells into complex organs, and a universe of organ interactions which reach astronomical perplexity. We do not yet know a fraction of the interaction of those chemical interactions which allow us to function, survive, touch , taste, see, feel, hear, plan, think, learn, love, question, and gaze into the future. Then there is that most magnificent organ of chance of all: a glob of grey cells, weighing few pounds, that is protected by a bony vault at the top of our bodies. It consumes twenty five percent of all the energy that we use, and allows us to reach out to the entire universe.
This internal space/world is what is most important to our survival, at this stage in our existence. I think that we need to concentrate most on understanding life, and developing respect for all other life, before we commit suicide for ourselves and all other creatures on this planet. This should be our first priority, before we reach out to the stars. I think we have gotten our priorities mixed.
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I believe in the exploration of space. I think that is exactly what we are drawn to do, as the human species. It would be a shame for us not to stretch our minds even further, to question everything, to use the knowledge we have accumulated in this world. It would be a shame for us to not use this explosion of knowledge to reach out to the stars. Of course, we are all overcome with the desire to know if there is any other life out there, and if there is other life, what in the universe is it like? This is a magnificent quest. It would be a mistake to not look into and beyond the stars, to find, if we can, what else is out there. It would be misguided to not try to understand our beginnings, how life was formed, figure out, if we can, where life is headed, and ask what the universe is headed for way past our time of life. This is the stuff which gives purpose to all our lives, challenges our imaginations, leads us to understand more and more of everything that exists. This search is absolutely fascinating. It has also led to technologic advances which benefit all of us today.
As in all things in the human experience, however, we need to keep our priorities straight. Every virtue becomes a vice when carried to excess. The excess that I see at the current time is to believe that there is some other planet or world out there that we can easily colonize and on which we can survive, after we have either destroyed or polluted our planet to the point that it is no longer livable. I think that is a most unrealistic stretch, under our current state of knowledge. The earth is a very unique part of the universe. It is a planet of the right size, of the right composition, at the right distance, from a sun of the right size and intensity, to have a chance of sustained life. Because we have a magnetic shield, we have been protected from having our atmosphere and our water blown away by that radiation from the sun. We have instead, been nurtured by that fantastic flow of energy coming from a constant nuclear bomb, ninety three million miles away.
Although we may be able to discover many other planet earths in the solar system, and a multitude of moons which reveal circumstances which might be supportive of life, it appears virtually impossible that we will be able to travel to any of them in a living form. I have to marvel at all the attempts to better understand the planet Mars, and whether there is enough water there to sustain life. That is truly a wonderful quest. To think that it will be possible to colonize Mars with human beings, however, is an irrational reach. Mars does not have a magnetic shield. Whatever we may wish to put there, should any life survive the journey, will be bombarded by radiation. The sun will soon sweep it clean again, through deadly electromagnetic energy. The theory has been that we can place a shielded terracolony on Mars that will sustain life, yet we have not as yet been able to develop a totally isolated terracolony on earth that is sustainable, long term. That time of evolving life on planet Mars, if it ever was present, has come and gone. We will not even be able to get to Mars without exposure to lethal solar radiation, and the probability of many drastic gene mutations. There may be many moons on which the chance of life exists. There is the possibility that we could seed one or more of them with amino acids or other substrates of life for some form of life to begin. One thing is sure though. Whatever life it is won’t be us. In the first place, we will not be able to get there in a survival state. In the second place, if life does evolve on these other moons, it certainly will not be us. It will follow its own rules of survival. We seem to totally forget how much we live in a uniquely protective cocoon on the planet Earth.
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Whenever I have opened a chest, during my career, I have marveled at the complexity of the lung, which is our first barrier against inhaled pollutants, dust, smoke, fumes, chemicals, infections, and noxious substances such as asbestos. It is involved in a complex reflex process with its neighboring heart to regulate heart and lung pressure, minute to minute, constantly regulating rates of contractions and breathing. It is our first barrier against a multitude of infectious assaults on our body. It is the organ with which we recruit, from our environment, the oxygen we need to burn all foodstuffs in our bodies, in order to create the energy all our organs need to function. It is the organ which exchanges out the carbon dioxide our bodies discard after our metabolic processes. It gives and gives, and keeps on giving, even though we punish it severely. It has four times the amount of it that we need in order to survive. We do not start getting short of breath, or become unable to do normal body function, unless there is only twenty five percent of it or less remaining to function. We take our lungs for granted, thinking they will always be there, as we puff incessantly on our cigarettes, and expose these lungs to various noxious particles and agents. We then act surprised, when after decades of abuse, these same lungs state their inability to support us any longer as they would love to do. We wind up breathless, on oxygen, using multiple inhalers, struggling to breathe on bad nights, wheezing, coughing, gasping, sitting bolt upright in bed, trying to stay alive. No matter how many times I looked directly at some other person’s lung, I was always awed by this magnificent organ, of all that it did for us, of how many generations of various life organs it took to produce it, all by natural selection, and of how terribly we treat our lungs, in such a cavalier manner. For some obscure reason, we keep looking outside us for miracles, when we already contain innumerable miracles inside us.
We have this immense universe of complexity within us, which we understand as yet, in only primitive ways, in spite of our explosion of research, investigation, and communication. We have this intensely unique environment on which we survive, our planet, but do not protect it, and talk about escaping it. We seem to ignore the necessity of exploring and sustaining our internal universe to its fullest. We have eroding infrastructures. We have a health care system which caters to those who have wealth, but squeezes out those with little wealth. We are killing other humans, excusing that self-destructive violence in the guise of religious mythology. We are polluting our only home, the only one we will probably ever have, with malignant rapidity. It appears that we think we can pollute our home, Earth, and our personal homes, our bodies, with impunity, then escape to some far off perfect home in the skies. I don’t think so.
It is an immense pleasure to explore the universe. We absolutely need to do that. It is also an immense mistake to think that we can ignore our own planet and body homes. Ethics, as is here stated, contains an intense and soul felt respect for all life, all of which is tied together on this planet. To look beyond, without taking care of our homes first, our planet, and our own bodies, is to me, not ethical. Ethics, as here defined, demands that we concentrate on taking care of ourselves first, and all of our other neighbors in life, before we concentrate on our reach for the stars. Life on earth is our first priority, before we attempt to establish life elsewhere.