A North American Cruise

Not going on a cruise was a always a high priority on my bucket list.  I am reporting that (for many reasons) I have failed in that pursuit.  My wife and I just got back from an 10 day excursion into Alaska by sea and out by land.  The first leg was a 6 day cruise from Vancouver, British Columbia to Juneau, Alaska and overland from there to Denali (Mt. McKinley) and back to Anchorage with a direct flight back to Minneapolis.  I started typing this as we left Ketchikan, Alaska headed for Icy Straight Point, Alaska. There is a mountain range silhouetted by the sunset outside my window.  The shore line seems to pass by at a rate much faster than the reported 16 knots, but that is not bad for a vessel weighing 93,000 tons.

Cruise ships these days are engineering marvels.  The one that I was on was 11 stories high.  It had a walking/running track on the top deck (200 meters/lap) with extensive spa and gym facilities.  The technical details of this ship are hard to find, but a little research showed that it was powered by 2 x 19 MW azimuth thrusters rather than propellers.  That explained the easy maneuverability of this nearly 1,000 ft long ship.  In front of the Hubbard Glacier, the captain was able to spin the boat in a circle for a couple of revolutions.  Sitting on the aft deck, the propulsion units have enough thrust to create prop wash that extends to the horizon.  A tour of these capabilities and the engineering involved would have been fascinating (for a few of us) but I understand the security constraints.

In the 5 months leading up to September each year about a million cruise ship passengers make this journey. As a psychiatrist who likes to keep track of cultural phenomena, this was one that I had missed.  The ship lines involved have created ports along the way with excursions to highlight the area resources and make the natural attractions readily available to a number of interests. A few examples include excursions into the world’s largest temperate rain forest capped off by a meal of fresh Alaskan crab. On that excursion today I learned some interesting facts. Ketchikan and the surrounding area on the island have a total population of about 10,000 people during tourist season, but when that is over the whole lower town built around the cruise industry shuts down and many people leave until next year. It rains almost 7 days a week in Ketchikan and the total annual rainfall is about 13 feet. One of the natives told me that people need to take Vitamin D and volunteered the typical dosing ranges of 2,000-5,000 IU per day. Some of the outliers were taking 10,000 IU. She said nothing about levels being drawn or cases of toxicity. The weather for this cruise was outstanding - generally sunny with temps in the 70s except for the period next to the glacier.   The town itself seemed to be organized like many small American towns.  The government buildings and fire department were most prominent.  I wondered what it might be like to be a psychiatrist in Ketchikan.  But I did not have too long to think about it, because in 4 hours we were back on the boat headed for Icy Straight Point.

In the meantime, I am nearly at the 50 day point of walking about 12,000 steps per day.  I decided to head up to the running track on the 11th floor of the ship and cover some ground.  This is the third day I am doing it.  There are a lot of people huddled in deck chairs in the bright sunlight. Even though the air temp is in the high 50s to low 60s, there is a stiff breeze blowing directly over the bow.  The only reasonable wear is heavy fleece or a windbreaker and a sweater.  I decided to sample my fellow passengers as I walked using an old survey method from wildlife biology.  From a demographic standpoint about 25% of the population was less than 40 years of age and half of that sample was less than 18.  At one point the cruise line had a special activity for the younger adults. Despite the age structure of the crowd, in the warmer climate pulling out of Vancouver, there was a steady loud beat of dance music on this deck, all compiled by a young disk jockey.  With this mix of ages there are always a number of clashes between the generations.  The energetic 10-15 year olds running randomly around the deck among the older folks.  A few grumbling old folks commenting negatively on the number of tattoos, especially on younger women.  Tall, thin, spectacled and silent post-adolescent girls are walking around in Converse high top basketball shoes.  Boys in that same age group are swaggering, swearing, and discussing Ivy League fashion.  The majority of the crowd was older and very well mannered.  There were a couple of groups celebrating anniversaries and weddings.  I had learned from another physician from a similar cruise that there were several people who required dialysis and there was a nephrologist on board to monitor that treatment.  The place was crawling with extraverts.  At times it was difficult to avoid conversations.  I saw a fellow introvert bundled up on a deck chair, facing away from the crowd and reading a book in the bright sunlight.  I could feel his pain.

Like most inescapable public gatherings the cruise creates quite a bit of tension within me.  At one point in my life I was a very active outdoorsman.  I was a tree hugger of the highest degree.  I was a white water kayaker and canoeist.  I nearly drowned three times in one day on the Montreal River in Upper Michigan and went back for more white water kayaking after that.  But at some point, all of that changed.  The landscapes seemed to be the same.  Hawaii was like Wisconsin with volcanoes. Colorado was like Wisconsin with mountains.  The terrain always looked better on television.  Alaska present thousands of miles of coastal mountains, some of which have the highest number of peaks greater than 10,000 feet of any mountain range in North America.  The glaciers were also unique, especially glaciers coming right out to the edge of the ocean, breaking off and creating waves, ice floes, and icebergs.  The ship navigated right into this area among the chunks of ice and spun around a few times before heading to Seward.

Polychrome Pass - Denali National Park

In everyday life I am still out there and very active, but the conditions have to be right and I have to be able to measure everything – miles, heart rate, cadence, speed, and all of the derivatives.  I avoid the hours from 10 AM to 3 PM or whenever my shadow on the ground is shorter than my actual height – a standard Dermatology tip on avoiding skin cancer.  I am no longer cycling in the rain.  The goals were more complicated.  I can no longer go out in the woods and plant trees with a grub hoe ignoring the biting flies and mosquitoes.  The parallel dimension was the demands of inpatient psychiatry.  There were decades of complicated problems, no solutions and confronting aggression and hostility at all levels on an almost daily basis.  I lived to go home, shut the door and enjoy the solitude.  Being stuck on a cruise ship where nearly everyone is an extrovert and trying to engage me in conversation is the antithesis of the last 25 years of my existence.  I am quite happy to be ignored but on a cruise ship it is common to encounter at least 10 crew members all of whom meet you very cheerily and begin with some variation: “Good morning sir. How are you today? Can I help you with anything?” I am sure that is standard cruise training is designed and implemented by extroverts.  Extroverts seem to dominate the customer relations fields and that’s why there is all of this unnecessary talk.  If I was consulting I might suggest an I (Introvert) Badge that translates to “You don’t have to ask me – if I have a problem I will ask you.” Or in the case of extreme Introverts “You don’t have to greet me – we are cool and I don’t think I am better than you.”

The entire cruise atmosphere was a study in contrasts for me.  On the one hand we were cruising through some of the most desolate places on the planet, ideal turf for introverts wanting solitude.  On the other we brought a party with us and even a party director who seemed bent on providing the maximum number of activities and entertainment per day.  That led me to think about people who might be stressed by the cruise.  Did anyone have anxiety or panic attacks?  I never made it down to talk with the ship's doctor about those problems, but it was easy to see how they might occur.  I also had the thought about people getting on the boat who were already depressed.  Would it lead to any adverse outcomes.  According to Wikipedia, there was at least one reported incident of a person who had gone missing on a cruise and who was seen jumping overboard when the security camera footage was reviewed.  I could find only one article on this phenomenon in Medline.  There is an associated literature that suggests that the mental health of seafarers in general, but primarily on merchant ships, may be poor as evidenced by suicides as a percentage of total deaths or deaths due to illness.  That author also suggests the numbers may be significantly higher if disappearances at sea are counted.  Suicide was also a topic during the tour.  Our tour guide said that Alaska had the highest suicide rate among the 50 states.  According to the CDC that is not strictly true but they do have the second highest rate at 23/100,000 or roughly double the age-adjusted suicide rate for the entire country.  They also have ready access to firearms.  Any Alaskan can carry a firearm concealed or unconcealed without a special permit.  One of our guides took a temporary break from the work to do a stint transporting mentally ill Alaskans to hospitals for treatment.  At this point, I can look back and see the opportunity to do a lot of good in Alaska if you are a psychiatrist who likes winter weather and are motivated to the point where you don't need a lot of collegial support.  But it is definitely a job for a younger person than I am.

Food is always a big point of discussion on cruises.  I can understand the advantages of not having to purchase or prepare it.  But the usual commentary is on how abundant it is and how good it is.  I am a very finicky eater and give it mixed reviews.  It was clearly abundant with large cafeteria style dining available all day long.  There were typically many entrees available followed by many deserts and pastries.  There was an ice cream bar and other specialty (pasta, eggs Benedict, pizza) stations on the side.  Food consumption there was unlimited and there were no additional charges.  You just walk into the cafeteria as many times a day as you like and you don’t have to pay anything for food.  In addition, there were two formal dining areas that needed reservations with more limited but high end entrees and appetizers.  Food consumption in those venues was limited to the standard restaurant style meal at no additional charge.  Finally there were four more restaurants that required additional payment for additional high end cuisine with consumption limited to that meal.  Beverage packages required the use of a pass card and prepayment of various beverage packages.  It should come as no surprise that cruises are risky for people trying to control their weight.  Before getting on this cruise a coworker told me that when her mother came back from a cruise she was almost “unrecognizable” due to weight gain.  Unless there is a conscious plan to limit consumption and exercise weight gain must be the rule on most cruises.

As far as the quality of the food, I give mixed reviews.  I am not much of a carnivore, but I do consider myself to be an expert in breakfast type foods, pizza, pasta, chicken, fish, and desserts.  If I compare the meals from the specialty sit down restaurants with restaurants within a 10 mile radius of my home it is clearly inferior.  That is not to say it was not good, just not excellent.  Almost everybody on a cruise raves about the food.  Their opinions may be biased by the overall cost of the cruise, the emphasis on food onboard (galley tours, discussions with the chef, wine tastings, etc), availability to well past the satiation point, and the ease of availability by no acquisition or preparation time by the onboard guest.  In addition, one of the few consistent television programs available onboard was Top Chef and it was on 24/7.  It has been trendy in the press to slam Americans for gluttony and obesity, but I won’t go there.  About 90% of the guests were Americans and Europeans from various ethnic origins, followed by Asians from various countries and then guests from Spanish speaking countries.   The cuisine was a mixture of American, Thai, Indian, and Japanese foods and it got good reviews from people originating from those countries.   I don’t think anyone was in an eating frenzy, just consistent consumption.  The majority of the food selections were very healthy and the main problem for consumers was portion control and limiting carbohydrates.

Alcohol consumption also seemed well controlled.  There were hierarchies in the beverage packages, most cost for the high end package containing alcoholic beverages.  There was a shopping area that sold expensive alcoholic beverages in large bottles with a duty free advantage, but I never saw anyone in that shop. Most of the drinking occurred in the deck and spa areas and with meals.  There was a meeting listed for anyone who was a friend to Bill W.  That may not be the rule on all cruises.  I listen to a morning talk show on the way to work and heard that the people on that show were aware of some "rock and roll" cruises that needed to make extra stops to pick up more alcoholic beverages.  This was a cruise that seemed to target families and multiple generations.

There is a curious tradition of formal dining that persists to this day.  I have been told that early cruises had assigned seating in the dining areas and at times that involved eating with the captain.  In those days everyone had to be dressed formally for it – for men that meant a sport coat and tie.  That tradition persists today but only on 2 days of the cruise.  It seems an unnecessary artifact to me.  The captain doesn’t eat with the guests.  I was told by one of the crew that they believe it encourages more socially appropriate behavior and a classier atmosphere.  My guess it that it probably has no more impact than the “no shirt, no shoes, no service” rules posted in various part of their literature. The extra attire takes up valuable room in the suitcase of nothing is really added.  My guess would be that all of this window dressing is the work of Extroverts (“Isn’t dressing up in formal attire fun?”).

After looking at a number of other comparisons like entertainment, electronic devices and Internet access, total cost of the cruise and associated excursions – I realized that an obsessive approach could be taken in the analysis. There are several web sites that take this approach.  The overriding question for me was what are the real differences between people who like cruises and people who don’t.  Whenever I give my opinion there is a general outcry that I am unreasonable and that my wife is a saint for putting up with me.  How could I not like a cruise?  And like most things it is a question of preferences.  My preference for eating carbohydrates dates back to an early age and I know the correlates and I think I know how all of that works at some level.  I also realize that those same mechanisms can produce preferences in billions of my fellow humans that are not my preferences and in this case it means that (at least on the surface) many more people seem to prefer cruises more than I do.



George Dawson, MD, DFAPA


Supplementary 1:  This post was originally completed aboard a cruise ship sailing for Glacier Bay, Alaska - just off the coast from Gustavus, Alaska about 48 miles west of Juneau.

That is me holding up the sign to Yukon (formerly known as the Yukon Territories) just north of Juneau and 600 miles south of the city of Dawson (formerly known as Dawson City).  My ancestors were given the name Dawson on Ellis Island, because their name was not pronounceable, so the founder of Dawson City is not a relative.

Supplementary 2:  Sometime after posting this, I discovered that the late David Foster Wallace had been interviewed by Terry Gross on her public radio program Fresh Air.  In that interview he talks about an article he wrote on going on a cruise and discusses that about 1/4 of the way down in the transcript.  He also wrote a piece called Shipping Out: On the (nearly lethal) comforts of a luxury cruise.  All of that writing can be found by search engines.  David Foster Wallace is an acclaimed writer and his writing about cruises is both accurate and entertaining.  It has an added dimension (especially in the Fresh Air transcript) of considering whether fun and enjoyment can be managed.