Psychiatrists and the Nobel Prize

 

The verdict came in a week ago and the Nobel Prize in Physiology or Medicine was awarded to Karl Diesseroth, MD, PhD, Peter Hegemann, PhD and Georg Nagel, PhD.  The award for the discovery and implementation of optogenetics in neuroscience.  This technique is a revolutionary one for neuroscience and this award was expected for some time for these researchers.  Since the Prize was publicized there has been an explosion of images, videos, and social media posts featuring Diesseroth, his colleagues, and family members.  In this age of social media, there are an army of influencers using the story to get views.  For my part, I will just say congratulations.  The story I want to tell here is more about psychiatrists and the Nobel Prize.

Many years ago, when I worked at an acute care hospital, I was the department member who presented unusual grand rounds.  I gave one on the mathematicians Paul Erdös and Kurt Gödel reviewing their accomplishments, creativity, and eccentricities.  I followed it up with a grand rounds on the first psychiatrist to receive a Nobel Prize in 1927 – Julius Wagner-Jauregg.  He discovered the treatment of dementia paralytica (late-stage neurosyphilis) with malaria carrying mosquitos.  It is important to recall that this form of neurosyphilis made up 10-20% of all asylum care at the time, this was a pre-antibiotic era and at the time late-stage neurosyphilis (or General Paresis of the Insane/GPI) was a uniformly fatal illness. An estimated 30% of this population recovered with malaria inoculation and concomitant treatment of the malaria with quinine.

The downside to the treatment and subsequent controversy was the fact that 10-15% of patients died as a result of the malaria. This therapy disappeared entirely with the advent of the antibiotic era in the 1940s.  Wagner-Jauregg is described as a psychiatrist, but the training in those days was not standardized. After medical school he trained with a histopathologist, then in a psychiatric clinic for 4 years, and eventually headed a psychiatric clinic at the University of Graz in Austria.  His academic focus there was on goiter, cretinism, and iodine.  He produced 80 publications during his academic career and succeeded two highly regarded psychiatrists in clinics. 

His career was not without controversy.  First, he was a Nazi sympathizer.  His application to that party was denied because his first wife was Jewish.  Second, he promoted eugenics.  Third, he administered electric shocks to soldiers for “malingering” and several of them died leading to a formal inquest.  Fourth, some did not find the malaria therapy of neurosyphilis that impressive probably because the cure was also fatal to a significant number of patients. Like any infectious disease, outcomes depend on host factors and neurosyphilis lead to significant physiological compromise and deconditioning.  Fifth, he was also credited with calling for the iodination of salt to prevent goiter based on his thyroid studies, but subsequent work determined there was no direct connection to that policy being adopted in Austria as it occurred decades after his research and at least 2 other research groups were credited.  He had a problematic personality and believed that the usual rules did not apply to him. Although I find century old personality critiques stretching credibility – I agree with several authors that his accomplishments were overshadowed by the controversies.  The best proof of overshadowing is that most people are not aware of his name or accomplishments – even though he won the Nobel and Freud did not, Freud is more widely known and studied to this day.    

Wagner-Jauregg and Freud were contemporaries.  Freud was 1 year older and at times they influenced each other’s career. Wagner-Jauregg was called upon to write a critique of Freud’s work for an academic appointment and Freud provided expert testimony in a hearing where Wagner-Jauregg was accused of killing shell shocked soldiers with some type of electrotherapy.    From 1925-1938, Freud was nominated 12 times for the Nobel Prize in Physiology or Medicine and once for the Nobel Prize in Literature in 1936 but never won the award. In his biography, Peter Gay writes that Freud thought about the award constantly, hoped to get it, and was disappointed when he did not.

Depending on the author, both Freud and Wagner-Jauregg are written about as neurologists or psychiatrists and Freud is occasionally called a psychologist.  This is because of a lack of uniformity in training and credentialling in the 19^th and early 20^th century.  When you read about many of these prominent figures you will find that they head neurology and psychiatry clinics interchangeably and in many cases were also neuropathologists, neuroanatomists, and histologists.  A good example if the photo at the top of this post.  It is a photo of Alois Alzheimer (back row 6^th from the left) with his colleagues in neurology clinic (title Nervenklinik 1910-1911).  The strict translation is “psychiatric clinic or mental hospital”.  At the time this was in the Munich Psychiatric Clinic headed by Emil Kraepelin.

If we think of criteria to apply to determine if a researcher is a psychiatrist or not dating back to that time, I suggest the following:

1) Physicians who made major contributions to neuropsychiatry prior to the formal establishment of the fields of psychiatry and neurology.   Charcot, Wernicke, Alzheimer, Kraepelin, and Freud practiced across both domains.

2) neuropathologists or neurologists who were also psychiatrists or had a major interest in psychiatry; note that Freud was a Privadozent in neuropathology and Adolph Meyer came to the US to work as a neuropathologist.   António Egas Moniz is typically cited as a neurologist who practiced psychiatry.

3) physicians trained in both neurology and psychiatry.  There were really 2 waves of neuropsychiatry.  In the US practically all psychiatrist before 1935 practiced both and it was revived for military psychiatry in WWII. After graduating from medical school in 1901 von Economo spent a year working in an internal medicine clinic and over the next four years worked at various clinics in Europe with Marie, Kraepelin, Alzheimer, and Oppenheim learning psychiatry, neurology, and hypnosis. He returned to the University of Vienna in 1906 and was appointed Professor of Neurology and Psychiatry in 1921.

4) physicians board certified in psychiatry by the ABPN – modern standard – can occur even if the psychiatrist does not practice or see patients.

5)  physicians who headed psychiatric clinics or hospitals – many prominent examples like Franz Nissl who did research with Alzheimer and Kraepelin and is known for histopathological discovery but he eventually replaced Kraepelin as Professor of Psychiatry and Director of the Psychiatric Clinic at the University of Heidelberg.

6) attending physician in psychiatry.

7) physicians trained by self-identified psychiatrists.

With those expanded criteria – we can look at additional Nobel Laureates in the table below:

 

Laureate(s) (year)	Recognized for	Criterion invoked	Basis / caveat
Camillo Golgi & Santiago Ramón y Cajal (1906)	Microscopic structure of the nervous system	1	Pre-specialization neuropsychiatry; foundational to both fields, but neither was a clinical psychiatrist
Julius Wagner-Jauregg (1927)	Malaria therapy for general paresis of the insane	1, 2, 6	Career psychiatrist; the paradigmatic psychiatric laureate
Otto Loewi & Henry Dale (1936)	Chemical neurotransmission	1, 5	Trained in the Central-European neuropsychiatric/physiology milieu; psychiatric mentorship claim is indirect
António Egas Moniz (1949)	Prefrontal leukotomy for psychiatric illness	2	Neurologist whose award was for a psychiatric treatment
John Eccles (1963)	Synaptic physiology	1	Fundamental brain science; no psychiatric certification
Bernard Katz, Julius Axelrod, Ulf von Euler (1970)	Neurotransmitter storage/reuptake	1, 5	Axelrod's catecholamine work underpins biological psychiatry; lineage claim is thematic, not certified
Arvid Carlsson (2000)	Dopamine as a neurotransmitter	2, 5	Central to psychopharmacology/psychiatry; not a psychiatrist
Paul Greengard (2000)	Dopamine signal transduction	2	Molecular basis of psychiatric drug action
Eric Kandel (2000)	Molecular basis of memory	4	Psychiatry-trained; strongest ABPN-type example
Karl Deisseroth (2026)	Optogenetics	4, 6	Psychiatry-trained; ABPN board certified, attending physician inpatient and outpatient.

 

Looking at the table of Nobel laureates Only Wagner-Jauregg and Deisseroth practiced clinical psychiatry.  Kandel was trained and board certified as a psychiatrist but worked as a basic science researcher. I would count all three as psychiatrists. 

Of the remaining laureates the following completed medical degrees Camillo Golgi (University of Pavia 1865), Santiago Ramón y Cajal (University of Zaragoza 1873), Otto Loewi (University of Strassburg -1896), Henry Dale (Cambridge University 1909), António Egas (University of Coimbra 1899), and Ulf von Euler – (Karolinska Institute 1930). 

Two of the laureates were trained as PhD scientists Julius Axelrod (George Washington University - 1955 and Paul Greengard (Johns Hopkins University -1953).  The remaining three laureates were trained as physicians and scientists - John Eccles (MB, BS, MD -University of Melbourne) (Oxford - DPhil 1929, Bernard Katz (MD University of Leipzig – 1934) (PhD University College London – 1938), Arvid Carlsson – (MD, PhD University of Lund – 1951).  The interesting observation in this case is that most of the Nobel awards were to scientists with medical training or combined MD/PhD training.  There is some selection bias since the category is Medicine or Physiology.  

Even though neuroscience is considered a relatively new discipline it has historically had a close relationship to psychiatry for over 100 years.  Psychiatry has developed out of the close relationship with neurology and neuroscience and that seems to be lost by many modern-day critics.  That seems to be semantics more than anything else.  Just because you could not get a BS in Neuroscience in Cajal’s era did not mean neuroscience did not exist.   

In addition to Freud there were several additional neuropsychiatrists or possibly psychiatry adjacent researchers who were nominated but never received the Noble.  Ugo Cerletti (1877–1963) — an Italian neuropsychiatrist had correspondence with the Nobel committee and actively wanted the prize, but controversy about the method as well as conflict with his student Lucio Bini who subsequently patented his own machine may have been a factor in him not getting it.  Others include Joseph Babinski, Vladimir Bekhterev, Henry Head, Eduard Hitzig, and Hans Berger.

One of the fascinating aspects in training and reading about psychiatry is the tremendous diversity in training that occurred.  I previously asked the question whether the field though standardization has become less intellectually stimulating than it was in the past.  I used von Economo’s career as an example.  With standardization you can no longer go through a lab, a neurology clinic, or a psychiatry clinic in 4-year blocks and come out studying and researching whatever you want.  It is rare these days to see an MD doing basic science research, but fairly common to see them doing clinical research.  The neuropsychiatrists of the early 20^th century are not the neuropsychiatrists of the early 21^st century.  Before the board certification rule in the US in 1934, all psychiatrists were considered neuropsychiatrists.  Today they come in three forms – double board certified in psychiatry and neurology, psychiatrists with a neuropsychiatry fellowship or neurologists with a behavioral neurology fellowship, or self-proclaimed.  None of the psychiatrists doing this work are very visible. Most of the patients they treat are not seen in routine outpatient practice. They are more likely to be seen in acute care settings and specialty clinics.

The reason why the Nobel is so important in psychiatry is not because of the scorecard.  Having people of that caliber in the field, especially when they take an active role in teaching, mentoring and research brings the field up to a higher level.  I think it worked that way in the early 20^th century when Warner-Jauregg made a landmark finding in biological psychiatry.  It worked that way when Kandel made similar discoveries in plasticity and memory in the 1970 (8).  I hope it works that way now with the award to Deisenroth.   I hope his work is being studied in psychiatry resident seminars across the country.  

Not that I expect it will stimulate any more MD, PhDs – but I hope it stimulates people to think about what a psychiatrist should know and how it improved our knowledge of the field.  I hope it encourages all of us to expand beyond the roles that have been defined for us by businesses, administrators, or people who otherwise attempt to intellectually restrict the field.

 

George Dawson, MD, DFAPA

 

References:

1:  Boyden ES, Zhang F, Bamberg E, Nagel G, Deisseroth K. Millisecond-timescale, genetically targeted optical control of neural activity. Nat Neurosci. 2005 Sep;8(9):1263-8. doi: 10.1038/nn1525. Epub 2005 Aug 14. PMID: 16116447.

2:  Deisseroth K. Optogenetics: 10 years of microbial opsins in neuroscience. Nat Neurosci. 2015 Sep;18(9):1213-25. doi: 10.1038/nn.4091. PMID: 26308982; PMCID: PMC4790845.

3:  Yizhar O, Fenno LE, Davidson TJ, Mogri M, Deisseroth K. Optogenetics in neural systems. Neuron. 2011 Jul 14;71(1):9-34. doi: 10.1016/j.neuron.2011.06.004. PMID: 21745635.

4:  Deisseroth K, Feng G, Majewska AK, Miesenböck G, Ting A, Schnitzer MJ. Next-generation optical technologies for illuminating genetically targeted brain circuits. J Neurosci. 2006 Oct 11;26(41):10380-6. doi: 10.1523/JNEUROSCI.3863-06.2006. PMID: 17035522; PMCID: PMC2820367.

5:  Deisseroth K. Optogenetics in Sight. N Engl J Med. 2026 Oct 8;395(14):1444-1446. doi: 10.1056/NEJMe2610388. PMID: 42842909.

5:  Chung K, Wallace J, Kim SY, Kalyanasundaram S, Andalman AS, Davidson TJ, Mirzabekov JJ, Zalocusky KA, Mattis J, Denisin AK, Pak S, Bernstein H, Ramakrishnan C, Grosenick L, Gradinaru V, Deisseroth K. Structural and molecular interrogation of intact biological systems. Nature. 2013 May 16;497(7449):332-7. doi: 10.1038/nature12107. Epub 2013 Apr 10. PMID: 23575631; PMCID: PMC4092167.

6:  Sohal VS, Zhang F, Yizhar O, Deisseroth K. Parvalbumin neurons and gamma rhythms enhance cortical circuit performance. Nature. 2009 Jun 4;459(7247):698-702. doi: 10.1038/nature07991. Epub 2009 Apr 26. PMID: 19396159; PMCID: PMC3969859. 

7:  Whitrow M. Freud and Wagner-Jauregg: a historiographical study. Psychiatric Bulletin. 1990 Jun;14(6):356-8.

8:  Danto EA. Trauma and the state with Sigmund Freud as witness. Int J Law Psychiatry. 2016 Sep-Oct;48:50-56. doi: 10.1016/j.ijlp.2016.06.004. Epub 2016 Jun 17. PMID: 27324417.

9:  Kandel ER. Psychotherapy and the single synapse. The impact of psychiatric thought on neurobiologic research. N Engl J Med. 1979 Nov 8;301(19):1028-37. doi: 10.1056/NEJM197911083011904. PMID: 40128.

10:  Gomes MDM. Franz Nissl (1860-1919), noted neuropsychiatrist and neuropathologist, staining the neuron, but not limiting it. Dement Neuropsychol. 2019 Jul-Sep;13(3):352-355. doi: 10.1590/1980-57642018dn13-030014. PMID: 31555410; PMCID: PMC6753910.

11:  Hansson N, Palmen L, Padrini G, Karenberg A. Babinski, Bektherev, Cerletti, Head, and Hitzig: European Neurologists Nominated for the Nobel Prize 1901-1950. Eur Neurol. 2020;83(5):542-549. doi: 10.1159/000509078. Epub 2020 Jul 30. PMID: 32731244.

Supplementary 1:  My suggested criteria for psychiatrist or not is not completely original but borrows heavily from criteria sent to me by Sheldon Benjamin, MD - a neuropsychiatrist and long time educator in that field.

Graphics Credit:  This is a well known photo reproduced in several texts.  The copyright has expired and it is in the public domain.  For full details as well as identification of other people in the photo - see the full Wikimedia post:  https://commons.wikimedia.org/wiki/File:Alzheimer_with_his_co-workers_Nervenklinik_Munich_1909-1910.JPG

Adventures In Vaccine Reactions – Revisited

 

Component	PNEUMOVAX 23 (Pneumococcal Vaccine Polyvalent, PPSV23)	Prevnar 20 (Pneumococcal 20-valent Conjugate Vaccine, PCV20)	References
Antigens (type)	Purified unconjugated capsular polysaccharides	Capsular saccharides individually conjugated to carrier protein (glycoconjugates)	1, 2, 4
Serotypes	23 serotypes: 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, 33F	20 serotypes: 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, 33F	1, 2
Antigen quantity per 0.5 mL	25 µg of each polysaccharide	~2.2 µg of each saccharide, except 4.4 µg of 6B	1, 2
Carrier protein	None (unconjugated)	CRM197 (non-toxic diphtheria toxin variant), ~51 µg	1, 2, 3
Adjuvant	None	Aluminum phosphate, 125 µg aluminum	1, 2, 3
Preservative	0.25% phenol	None	1, 2
Buffer/surfactant/salt (inactive)	Isotonic saline solution	Polysorbate 80 (100 µg), succinate buffer (295 µg), sodium chloride (4.4 mg)	1, 2, 3
Formulation	Clear, colorless solution; ready to use (no reconstitution)	Sterile suspension; ready to use	1, 2
Route	Intramuscular or subcutaneous	Intramuscular only	1, 3
Latex	Vial/syringe components not made with natural rubber latex	Not specified in retrieved label	2
1:  Prevnar 20.  FDA Package Insert.  2021:  https://www.fda.gov/vaccines-blood-biologics/vaccines/prevnar-20 2:  Pneumovax 23.  FDA Package Insert.  2021: https://www.fda.gov/files/vaccines%2C%20blood%20%26%20biologics/published/Package-Insert-PNEUMOVAX-23_0.pdf 3:  Kobayashi M, Pilishvili T, Farrar JL, Leidner AJ, Gierke R, Prasad N, Moro P, Campos-Outcalt D, Morgan RL, Long SS, Poehling KA, Cohen AL. Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep. 2023 Sep 8;72(3):1-39. doi: 10.15585/mmwr.rr7203a1. PMID: 37669242; PMCID: PMC10495181. 4:  Two New Pneumococcal Vaccines-Prevnar 20 and Vaxneuvance. JAMA. 2021 Dec 28;326(24):2521-2522. doi: 10.1001/jama.2021.22119. PMID: 34962532.

 

 I saw my primary care MD yesterday and got the Prevnar Pneumococcal vaccine.  They had offered it to me last October but given the reaction to a previous injection Pneumovax 23 – I decided to hold off an do more research.  Everything I could find suggested that this was a new vaccine and a severe local reaction was not a contraindication to further pneumococcal vaccines.  I have seen and treated people with both pneumococcal pneumonia and meningitis and wanted to decrease the chances of getting either condition. They both have significant mortality rates and the patient I treated for meningitis survived but was completely deaf as a complication of the infection.

I have had anaphylactic reactions to anti-rabies Duck embryo vaccine.  That was not a modern vaccine and have since had newer versions of anti-rabies vaccines without complications.  As a precaution, the nurse who administered the shot told me to hang around in the clinic for 15 or 20 minutes before leaving.  I also had a history of not getting the influenza vaccine for 20 years based on that duck embryo allergy designation.  After seeing several fatalities from influenza including one in a young very physically fit man – I saw an allergist who said: “If you can eat eggs - I would not worry.”  I have been getting the influenza vaccines every year since and have had no problems with it.   Great advice from that allergist/immunologist.

I am naturally interested in why one pneumococcal vaccination caused such a reaction and the other did not.  I constructed the table for comparison. In terms of design, both use capsular saccharides or polysaccharides – the main difference being Prevnar 20 conjugates (or attaches) them to a carrier protein CRM197. Polysaccharides alone lead to a T-cell independent response that produces antibodies but no memory B cells.  The conjugated polysaccharides in Prevnar 20 produce a T-cell dependent response with memory B. cells.  That mechanism is thought to be encapsulation by T-cells and intermittent presentation of the antigen to external B-cells.   

The other significant difference is in the total amount of antigen injected at the immunization site.  For Pneumovax that is 23 antigens x 25 mcg/antigen or 575 mcg total.  For Prevnar that is 19 antigens x 2.2 mcg/antigen + 4.4 mcg or 46.2 mcg total.  So there is a much larger deposit of antigenic material at the immunization site for Pneumovax.  That may also be the reason why Pneumovax does not require an adjuvant.

The remaining differences seem trivial and are not likely to explain the difference in localized vaccine reactions. If something changes in the next few days, I will correct this post but at this time it seems unlikely.  In this case there is a clear explanation for the difference in vaccine reactions in a patient with multiple allergies and a history of an anaphylactic reaction to some vaccines.

In this era of vaccine controversies, I thought it was important to make the point that a reaction from one vaccine does not mean you can’t take another one.  It is more confusing when they have the same indication and it is the next shot in a series.  This example also illustrates that a local reaction, even if it is fairly severe does not mean there will be a systemic reaction like anaphylaxis. Analyzing what happens if you have a reaction is necessary because vaccines are that important.  In my case, I have an excellent internal medicine specialist who knew this would not be a problem.  If there is any doubt – allergists and immunologists are available for second opinions.

 

George Dawson, MD, DFAPA     

Fall Color

My wife and I just returned from a 3-day trip to visit friends and take in the fall color.  The trip took us north to US Hwy 2 from Duluth, MN to Wakefield, MI and then south to Winchester, WI.  My home town is on that route and I have driven HWY 2 both ways to Minnesota and Michigan hundreds of times.  When you are an old man like me with a personality like mine – that means a lot of associations along the way.

The overriding themes seemed to be feeling grateful, being lucky and particle spirituality.  I have posted about my blue-collar origins in the past.  Much of that comes down to railroads, mines, relatives I never met, and the thousands of people I have interacted with.  The railroaders include a grandfather and a great-grandfather and three more recent railroad employees - my father, brother, and uncle.  My earliest introduction to Hwy 2 was driving with my family to Ironwood, MI 30 miles away to pick up my father. He would drive a freight train down to the Fox River Valley, sleep on a locker room bench overnight, and then return to Ironwood rather than our home town.  I never found out why he was never delivered to his starting point.  I was always focused on the image of that hard wooden bench he was sleeping on - especially as he got older and started to look more fatigued.

Railroad jobs were highly valued.  The pay was good if you could work, but there was a seniority system that strung a lot of people along.  It seemed like a prolonged residency program – all of the work and inconvenience and none of the rewards.  There was plenty of work in the local switch yards that my father could rarely get because of that system.  Instead, he worked 40 hours in 4 days and slept on a bench 2 nights per week.  Six decades later that still raises a lot of questions for me and there is nobody around for the answers. 

Apart from the work-related trips, we would drive over to the Upper Peninsula of Michigan (UP) to buy margarine.  Until 1967, Wisconsin had a law that banned adding yellow food coloring to margarine.  Without it - the sticks of margarine were an aesthetically unappealing white in color.  We drove over to Michigan to get the yellow stuff.  Wisconsin became the last state to repeal that law in 1967.           

Hwy 2 starts as an exit off US35N in Duluth. The freeway drops quickly down a long hill to that exit.  From that hill you can see the Richard I Bong Memorial Bridge.  It is an impressive piece of engineering and it seems to be aging well.  We lived there my first three years out of residency training as part of a National Health Service Scholarship arrangement.  I really liked that city even though the lake kept it cold.  When I lived in Duluth, I was a member of the Duluth Speedskating team.  Before we had ice we would do dry land training out to the middle of the Bong Bridge.  Rhythmic side to side motions from an extreme flexed position at the waist.  It was done at night in darkness, in the gales of November, uphill to the middle of the bridge – the highest point -  and back down again.  There were about a dozen of us following a coach who was my age at the time.  By the end of the month, we were on a 400m oval of ice that we flooded ourselves.  

In the summer, I would cycle to my office across the Bong.  That involved 5 miles on the Skyline Drive in Duluth until I could drop down a steep avenue to the bridge.  There were days when I imagined myself in a movie – cycling over Lake Superior to and from work.  It was that unreal.

I am reminded of my cycling escapades along this route. On my first attempt I thought it was going to be an easy romp down an old railroad right of way right 60 miles into my home town.  The trail was about 100 yards north of Hwy 2.  Railroads are built on a bed of gravel called ballast that is tightly packed to support the immense weight of trains.  The ballast is about 18-24” deep.  There are about 3,240 wooden ties per mile and each tie is about 9” x 9” x 96” or 4 cubic feet.  The rails rest on those ties.  That means when the rails and ties are removed about 6 inches of loose gravel covers the surface.  When I took an undersized mountain bike down that trail it was quite a mess.  It is impossible to move forward when your wheels are buried in gravel.  You can go about 6 feet and eventually collapse to one side or spin out and fall over.  I made it about 27 miles and got picked up in Maple by my wife.  My second attempt was on a road bike that involved cycling over the Bong on my usual route but taking Hwy 53 south from Superior to Pattison Park and then county roads east and north to Poplar, WI.  From there is was all Hwy 2 and battling heavy traffic for the next 47 miles into my home town. Looking back both of those cycling adventures were foolish.  That is affirmed by the loss of two of my friends.  Both were experienced cyclists.  Both killed while cycling. I will never put myself in high traffic areas again.

The most rewarding part of that trip was pulling into my grandmother's driveway and walking in to see her with my three young cousins.  My grandmother was always worried that I cycled too much.  I did not want to add to that by describing any of the close calls.  I made a joke instead and my youngest cousin laughed the loudest and the longest.  It was an infectious laugh that made the rest of us laugh. I think about that every time I see her - 30 years later.  

There was always plenty of sports related travel both ways on Hwy 2.  Football, baseball, basketball, track, canoeing, and kayaking.  We drove over two rivers that I had canoed and kayaked multiple times, including one where I was almost killed twice in one day.  The Montreal River was not very visible from the road.  I was guessing it is fairly tame this time of the year.  In the spring it moves 1800+ cubic feet per second down a steep gradient through a narrow canyon with steep rock walls.  In some stretches the gradient looks like you are going down a staircase.  If you go down in that water, there is no way out. The day I tried it with the friend I was driving to see and 4 novices in 3 aluminum canoes I was trapped against the bottom by a canoe full of water and then an aluminum canoe wrapped around a boulder holding me down. I was lucky to get loose – twice.  

I think about the games played not so much about the scores or seasons. I was quarter miler in high school and think about a qualifying heat I ran in Ironwood. I was trying to run a sub 50 second quarter mile and failed. I really knew nothing about running or training.  When I finally started learning about the biomechanics of running and realized I could train indefinitely – I beat that time at age 45 on the high school track in my hometown. 

I thought about football practice and weight lifting back in those days. How much more or less am I lifting now as an old man? In high school we used homemade weights fashioned out of concrete set in coffee cans at the ends of an iron bar.  I think they were estimated to weigh 60-80 pounds.  Our weight-lifting area was behind the spectator bleachers on the football field.  I still get a mental image of all of my teammates and the expressions on their faces going through practice.  I remember who went on to college and where they ended up.  I remembered who is no longer with us and the last time I talked to them.   I remember how hot it could get and how bad all of the equipment smelled.  At times I think about what I would have changed over 50 years ago on those fields.

And then it is on to other friends.  I drive past a courthouse and think of my friend who took care of it for decades. He never owned a car and would either walk or cycle to this building to makes sure it was running right – even on the bleakest winter night.  As we were driving up Birch Hill - headed east outside of Odanah I had thoughts about coming down that hill in the opposite direction in a 1963 Plymouth Valiant.  My friend Bob – had his father’s car and decided to see how far it could coast from the top.   It was a standard transmission.  He reasoned it would coast a long way.  It’s the kind of thing that teenage boys did before there was an Internet and Smartphones.  I tell my wife the story about a guy from my hometown who was coming down this hill one night on his new Norton Interceptor when he decided to put the kickstand down and crashed.  But the hill is most famous as a line of demarcation between the mild to moderate snowfalls of Wisconsin and the epic ones of the UP.

All the while music is playing in the background.  Rock music by the decade from a streaming service.  No more cassettes or CDs. Just tell the phone what you want.  In the past - we had to carry separate briefcases just for the media. I used to be able to sing along to the falsetto parts but no more.  I can strain to hit "Goin' Up the Country" on a good day but no more Steve Perry or old time Robert Plant. I start talking about vocal ranges of rock singers.  I know Grace Slick is a contralto.  I think Jim Morrison was an alto – but might be wrong.  Lately I have been playing his tracks over and over again. I have seen many videos of his band mates praising his lyrical ability. His song Soul Kitchen started playing spontaneously at home as we were leaving.  The music cuts out several times as we go off the grid reminding me that we are streaming and not listening to downloads.

I think about my relatives along the way – the ones with the greatest impact on my life. My life story is one of many tragedies and I start to think about life being tragic.  I have the recurrent thought – “You did not really plan anything – you were just lucky.”  As usual I can’t disprove it.  At no point in my early life along this highway did I say to myself: “You need a plan to (go to college, get a job, join the Peace Corps, avoid the draft. etc).”  My early life was a series of desperate last-minute decisions.  I had to do something.  In some cases, the decisions were failure based. In some cases like a high lottery number when I was 1A during the Vietnam War draft - luck was clearly a factor.  In some cases, I was just moving along to the next failure.  I think about those failures and what I was like at the time. I think about how everything seemed to fall in place after those desperate decisions.  My life seemed out of control until I was in my thirties. 

And whenever I think about that random walk through life, I always end up thinking about my undergraduate professors.  They were people who believed in me and they were not shy about saying it.   They were people who had clear life plans and philosophies and knew how to live life.  They were people very comfortable about living life outside of a blue-collar world. They were people who the friends we were visiting and I later agreed were the best people you could ever meet.  It is still a mystery to me how I thrived at a small, now defunct college by identifying with those professors and realizing I had a genuine knack for academics.  We did summer projects along Hwy 2.  The focus was water chemistry leading us to remote rivers and creeks – in some cases driving down logging roads.  As we drove down those roads we talked about the Watergate scandal.  We took hundreds of water samples and then ran all of the analyses ourselves back in the chem lab - in triplicate.  In biology classes we sampled the insects and plankton living in streams and rivers and did all of the taxonomy.  It opened up a whole new level of thinking in the place where I grew up.

At some point in the trip my mind wanders to composite particles and elementary particles.  A few years ago, I discovered that protons and neutrons lasted a trillion trillion years (10⁵⁰ to 10⁵² years).  Almost all of the protons were formed when the universe formed.  The protons in my body are 13.8 billion years old and they have plenty of life left in them.  If I am cremated 96% to 98% of my body is oxidized or vaporized as carbon dioxide, water, and nitrogen gas.  My protons are back out into the universe to live again - for billions of years.  If I am buried it takes slightly longer but the same process prevails in the end. That seems like a spiritual process to me, but I am trying to get opinions from experts.  From my own reading it seems consistent with what Spinoza called a single unified and infinite substance identical with God.  He saw individual humans as temporary perturbations in the infinite substance.  I am part way through 2 books on particle physics and the origins of the atoms in the human body from the cosmos.  During a recent phone call with one of my undergrad classmates, he thought my reading and connections to protons over 50 years after our last chemistry class together was quite humorous. 

As we drive through Ironwood, Hurley, and Bessemer – the last time I was here Hwy 2 was just 2 lanes wide.  Now it is 4 lanes wide with a lot of traffic.  Just to the north is Copper Peak – a ski flying hill.  It has been out of business for 20 years but it is being rebuilt with a large grant.  My wife and I watched a ski flying competition there back in the 1980s.  There were three guys from my hometown standing behind us that day. One of them was the funniest guy I ever knew. He was killed in a car accident a few years later.  One of the other guys was the nicest guy I ever knew.  He died in an industrial accident about 10 years later.  The third guy is still alive. He was responsible for my first dental crown when he elbowed me in the mouth playing basketball and broke tooth number 24 in half.  I get an image of all of us standing there, talking, and joking.

When we get to Wakefield, I think of the first time I was there as a kid to visit my aunt and uncle.  My uncle worked in a copper mine setting explosive charges.  As we drove around Sunday Lake to find their house, I remembered a spillway on the opposite side of the lake but did not look for it this time.  We still had 22 miles to go down S. County Hwy 519.   The fall color along that route was spectacular and I don’t know why.  The weather there is probably subject to what is happening on both Lake Superior and Lake Michigan.  At some point big lakes bring the baseline temperatures down, especially in low lying inland areas.       

When we finally arrive at our destination – we are greeted by a couple I have known since 1970.  We stayed in touch through the lean times, the industrious times of medical careers, and now in retirement.  We caught up on families, common interests, activities, and the medical infirmities of aging or as my friend put it “an organ recital”.  Among the four of us we have 4 knee replacements, 1 shoulder replacement, 1 hip replacement, 3 ablations for arrhythmias, a pacemaker placement, and various other necessary surgeries.   Nobody is upset about it.  The general attitude is do what is necessary to keep going.  There is some reminiscing but not a lot.  I want them to do as well as they want us to do.  The two days we spend there flies by and we are back on Hwy 2 headed home – hoping to see them a lot sooner next time.  On the road again I think of how important this relationship has been.

In the past few years, I have touched on semantics on this blog and the increasingly well-worn phrase: “The map is not the territory.”  My territory as I have outlined it involves extended connections to people at almost every fork in a 274-mile stretch of road.  There are so many of these connections they can be overwhelming, especially considering the emotional aspects.  With a few exceptions it is impossible to estimate the impact of all of these people on my life.  I am always happy to see them and I miss them when I don’t.  Some people reading this might be surprised.  I am considered to be a loner and asocial on the surface but I don’t think many people really are.  Especially if they have an active memory and can recall the details of what happened to them on Hwy 2 or anywhere else. 

They are just quieter…

 

George Dawson, MD, DFAPA

 

Supplementary 1:

I tried to capture some of my personal experience - the way I think most of the time as I went along this trip.  It has a lot of room for improvement - but at the same time it covers a lot of ground.  I debated constructing a diagram of all the people I would think about along this route and probably will at some point laying it over the route on the map.  I also wanted to provide details of how semantic memory automatically created meaning from these relationships but will defer that to another time. I could not include everything and that may seem paradoxical for a guy with few apparent relationships.  

Supplementary 2:

Some people might argue that my associations and experiences in locations has nothing to do with a map.  The experience of the geography is also different.  The best example I can think of is the Blueberry Store.  With my hundreds of trips on Hwy 2,  I could always count on seeing the Blueberry Store on the west side of Maple, WI on the south side of the road.  Over the decades of my life it went from being a weathered appearing general store to a run down appearing store to an abandoned store.  It was eventually demolished in 2019.  Even though I never went inside - it was a familiar landmark and every time I drive by - I remember what it looked like.  Every time I drive past that empty lot - I see mental images of the Blueberry Store.  Not ghosts - real mental images.  So the territory for me is people, relationships, and memories - none of which are on the map.

Supplementary 3: 

If you think you have had an important interaction with me in the past - you are probably right.  I intentionally used few names in this essay.  But whether you played football with me every night for years, asked me for help when I was a lab assistant, or was the last person to see me before I left for the Peace Corps I remember you.  And if you were in the Peace Corps with me - my head is still full of those images and conversations from 50 years ago and I wish I was talking with you right now. 

References:

1:  Wenliang Li ,The proton’s next secret. Science 393,663-664(2026). DOI:10.1126/science.aek0574

2:  Spinoza, Benedictus de. "Ethica, ordine geometrico demonstrata." In Opera Posthuma. [Amsterdam: Jan Rieuwertsz], 1677.  (Grapevine Kindle edition and translation – Benedictus de Spinoza.  Ethics. 2023.