Thursday, August 22, 2019

The Last High School Reunion




I just went to my last high school reunion.  The reunion model in my hometown is apparently changing so that graduates from all years will meet every 5 years - rather than just meeting with your specific class cohort.  Reunions have a lot of stereotypes.  Hollywood produces a fairly consistent revenge of the nerds on the cliques that suppressed them theme.  Real life is hardly ever that  clearcut.  I have limited experience with reunions myself.  I went to one other reunion about 20 years ago.  I spent most of the time talking with two of my classmates who were farmers and looked forward to seeing them again.

My high school class was moderate in size by today's standards - 230 people.  Twenty per cent of my classmates have died.  As I looked at that list I was reminded of the first girl that I ever slow danced with in the 8th grade. I was reminded of the girl who had an outstanding sense of humor and who could always make me laugh.  She was always in a good mood and I was always happy to see her.  I was reminded of the guy I was always paired with in gym class for wrestling who was about four times stronger than me and and who could wrap me into a knot. I remembered the girl in my homeroom who was just in front of me in alphabetical order every day when they took attendance.  I remembered the guy who was killed in a fight in college and what a tragedy that was.  I have been thinking about him a lot over the past 48 years.

My association to personally knowing almost everyone on that list is a comment that one of my psychoanalyst supervisors made when I was in training.  He asked me what I thought about learning that someone I knew had died.  I was a very neurotic kid and had significant death anxiety from an early age and my response was: "It could have been me." He told me that I was wrong and gave me what I considered to be a more narcissistic response: "Better him than me!"  Over the decades since, I have tracked that response and most of the time my original response is the first one I think of. But that is complicated when you grow up and mature with a group of people. I know that I was not always at my best in terms of social interactions but I can also recall being bullied and punched and intimidated like most people in school. What happens when you learn of the death of one of your antagonists from middle school or high school?  It turns out to be more complex, but at this point in life it does not matter.  I feel badly about anyone who does not make it to retirement.  I am at the disadvantage of being trained as a psychiatrist - so I don't know what it is like for other people.  Physicians are trained to save lives and psychiatrists are trained further to know that only a relatively primitive person rejoices in the death of another.  But more significantly, even the bullies change over time often to the point that they are not recognizable from their high school behavior.

At the previous reunion that I attended, I walked past a guy who I knew and he knew me. He probably remembered me from high school and all of the associated baggage as well as I remembered him.  We walked past each other several times that night and made eye contact but never spoke. Several years later I was out cycling and decided to pull into the cemetery to see if I could locate my father's headstone.  He would have been dead about 37 years at that point.  I found it and noticed that just to the left was the headstone of a good friend from high school and college.  To the left of that was the guy from the reunion that I never talked to.  His gravestone sat in a field of gravestones with his family name.  I can recall my father talking about people with that family name. Our families were from the same part of town and they did the same kind of work and yet 30 years out of high school there was something lingering there that kept us from acknowledging our common roots. That kind of put things in perspective and I was determined not to let that happen again.

A critical issue is that we know a lot more about human development than we did 30 years ago. I know that as well as anybody both professionally as well as personally.  Looking back on my life in  late high school and early 20 years - I recall feeling like I was in a fog. I could not think very clearly and spent a lot of time daydreaming and fantasizing. I had limited social skills and compensated by avoiding social interactions. The blue collar culture that I was raised in taught me to be suspicious of authority figures - especially politicians and business and union leaders. Some time in my late 20s - I came out of the fog. I would never have guessed that my profession would eventually involve intense interpersonal interactions with people all day long.     

My personal experience starts with the fact that I am an introvert.  It might not come across in the writing on this blog, but conversation with me invariably includes a lot of long pauses unless you are filling in the dead air.  Nobody would consider me charismatic.  I am very comfortable being by myself for long periods of time without social contact.  I don't seek out social contact, and often don't signal people that I am in the area and ready to engage them in conversation. For the past 5-10 years there have been arguments raging about the introversion-extroversion dimension and the relative merits and faults of each.  My real world experience is this dimension really exists but it is more complicated than the stereotypes. For example, introverts are not avoidant and are comfortable in social situations.  They are just not conversationalists and are not engaging. In my case for example, I have no problem at all talking with people all day long about the intimate details of their life.  I have no problems giving hundreds of lectures to medical students, residents, and other physicians.  On the other hand, at a residency graduation celebration - one of my residents came up to me and asked me if I was trying to hide behind the drapes in the ballroom.

The good news is that the reunion went very well. Contrary to the stereotypes, everyone seemed grateful to be there.  Several people had medical and psychiatric close calls that they shared with me.  And I am using close calls the way Carl Sagan did in the Demon Haunted World - without emergency medical or surgical intervention they would not have made it.  Retirement was probably the next most common topic that I discussed with classmates.  The majority of people I talked with were retired, happy to be retired, and either inquisitive about why I am not retired or actively trying to talk me into retiring.  One of the considerations I did not mention to anyone is that I still have not worked as long as they did before they retired (about 35 years) but would be getting there in another couple of years.

The most interesting conversations occurred with people who I have known the longest even though I have not seen them in decades.  We talked about past times, what we had done in the past, and what we planned for the future. I was reminded of the fact that some of these folks knew where I lived as a kid, came over to that house, and did things like play chess and work on models. We did these activities in an odd part of my parents house at the top of a stairway.  Based on what my friends had accomplished, I was reminded that they were bright, creative, and inquisitive people.  They had accomplished a lot and successfully raised families.

On the topic of children and grandchildren - it was clear that the next generation had identified with their parents (my classmates) as evidenced by their vocational choices or choice of hobbies and pass times. Spending time with grandchildren was given as one of the reasons for happiness in retirement.

The physical environment of the reunion was carefully developed by the committee.  The food was buffet style and excellent. Decorations were tasteful and historically meaningful with hippie themes.  This reunion coincided with the 50th anniversary of Woodstock.  There was some barely audible surfer music playing at one point that faded out and no more music was heard.  At the 30th reunion, there was loud disco music at one point and only one couple disco dancing.  I think the committee realized that at 50 years - talking is more important than dancing.

I don't think I have anything profound to say about reunions. anything that I observed there I have seen in life many times before. As people get older,  they are more reasonable. There was some concern about political discussion going into it and an informal ban.  I violated that by talking with a friend who was a political activist until recently - but he said that after years of involvement that he was burned out - much less interested.  Apart from that discussion - politics and other provocative topics were not mentioned at all.  I thought about my prevailing model of a successful society. People just want to work and make it home safely to their families at night.  I saw nothing at my reunion to counter that idea, but it was clear that the retirees maintain a family focus in retirement and do what they can for the next two generations.

Was I successful in countering my introverted tendencies?  I think that I was to a large extent.  I talked to most people that I made eye contact with. I talked to some people more than I probably have to date on that night. I am sure that talking to people on a daily basis for over 30 years has changed me to some extent. My experience at the previous reunion led to a conscious change.  There were probably more opportunities, but at some point there was equilibrium in the room and small groups had formed where people were probably talking with those who they were most comfortable talking with.  I was not perfect by any means.  The room had a view of Lake Superior and a breakwall with a lighthouse on the western end. At one point when the conversation had bogged down - I looked out there and saw a speedboat cruising along the distant side of the breakwall. I watched the boat for a few minutes and projected myself out there and then snapped out of it and came back to reality.

My two farmer friends from the previous reunion never showed up and there were other people that I missed.  Once you have lived a whole life out of high school it seems that those important people go in an out of your life very quickly. A good friend of mine from my class was in town a few months earlier and got my email address from my brother.  When I heard he was looking for me - I tracked him down on LinkedIn and sent him a message.  He was not at the reunion and has not contacted me.

It was a good reunion. I liked being a part of this generation  and some of its subcultures. I was with most of these people in one capacity or another for at least 5 years and and 5 of us were together since kindergarten.  Personality change is gradual even with an early boost from developmental neurobiology.  For me a moderate amount of change has only taken about 50 years. 


George Dawson, MD, DFAPA


Supplementary:  My wife who is an extravert who can talk with anybody gave me high marks for interaction at the reunion.  That is as close to an objective review as I can get.






10 comments:

  1. I was also in a fog through most of my youth. It was likely a combination of bad diet (no one really knew what a good diet was back then), sleep deprivation, authority issues and raging hormones. I had problems with autoimmune issues and poor health. Naturally I gravitated toward punk rock even through med school. I probably would have been diagnosed with ADHD today and all of the treatments would have done more harm than good. In retrospect a lot of it was noise and my body breaking down that was just the result of bad lifestyle decisions. The so-called issues were just symbols in a psychoanalytic sense. I was introverted but now I am right in the middle of the spectrum according to the 5PF. A moderate amount of disagreeableness remains though it is more focused and more adaptive. Neuroticism is very low though I am sure it would have been high at 20. I was always conscientious. Openness is right in the middle. That helped me revamp diet/lifestyle and get rid of a lot of health issues, and I'm a lot stronger at 60 by every objective metric except speed. Sugar really is poison for some people like me. My CRP-HS dropped to .3 and insulin to 4 with almost complete elimination and so did most of the chronic health issues although I never had metabolic syndrome.

    I maintain that a formerly adaptive combination of agreeableness and conscientiousness for doctors is absolutely destroying the profession now as we are seen as easy marks for pols and admins. Welby gets steamrolled today.

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    1. I don't know if it is agreeableness and conscientiousness or misdirected "professionalism". The ability to keep calm and tolerate a lot of stress has always been valued in the field. The extends to not being argumentative even when an argument is necessary. I credit my psychoanalyst supervisors for encouraging me to argue more and more importunately that you don't have to take it personally.

      Identification with my father and grandfather produced a healthy skepticism of most standard authority figures even in the medical field but I was not vocal about it until I completed residency. At least as vocal as an introvert can get. Severe gaslighting that forced me out of last job only confirmed the truth in that blue collar philosophy.

      Sugar is moderately poison for me. 2/3 of my grandmothers had DM Type II and my genetic profile puts me at about a 10% risk all things being equal. I read an article about 10 years ago that uric acid levels should be included in cardiovascular risk assessment panels. That piqued my interest because I have had gout attacks since med school. I recently found a paper that shows the connection and the interesting fact that it seems to be linked to the fructose moiety in sucrose. I think sugar is poison for most people at the rates it is being consumed in this country. I am still trying to track down a reference that points out that the average American consumes more sugar in a day than our primitive ancestors consumed in years.

      Johnson RJ, Nakagawa T, Sanchez-Lozada LG, Shafiu M, Sundaram S, Le M,
      Ishimoto T, Sautin YY, Lanaspa MA. Sugar, uric acid, and the etiology of diabetes
      and obesity. Diabetes. 2013 Oct;62(10):3307-15. doi: 10.2337/db12-1814. Review.
      PubMed PMID: 24065788; PubMed Central PMCID: PMC3781481.

      https://diabetes.diabetesjournals.org/content/62/10/3307

      Delete
  2. I would consider "professionalism" a blend of conscientiousness and agreeableness. So it is 100% right in some situations and 50% right in others.

    Good science requires the practitioner to not suffer foolishness gladly. Good therapy and general patient care requires the practitioner to suffer it and hold the tongue unless the patient is ready. Many MDs and psychologists find it hard to switch gears and thus are regarded as easy marks in the boardroom.

    Mensch in the office, Sun Tzu in the boardroom is ideal, but that's a tall order. This is why case conferences in psych are terrible, as Meehl pointed out years ago in his famous article.

    I find it odd that CRP-HS and insulin levels aren't used more often in diabetic management. Robert Lustig, a pediatric endocrinologist at Stanford has excellent web resources on the subject of sugar as poison.

    It's remarkable that a dietary macro that isn't even necessary is 70-80 percent of the American diet. Of course, the food pyramid is a complete crock and there's a good reason to be disagreeable. Yes we need glucose at the cellular level but the body can always make that through gluconeogenesis.

    I found in clinical practice that disagreeableness is a liability in training, an enormous asset in private practice. The agreeableness that makes one an ideal intern will lead to signing terrible contracts and getting played for a fool later on.

    The 5FP is a great tool. The phenomenology and stats behind it is sound and I find it correlates very well with what I predict.

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  3. Fatty liver disease used to mean the patient was an alcoholic.

    No more.

    Thanks to fructose, which is metabolized by the same pathway, we are now seeing it in nonalcoholic young adults.

    All the talk about murder as a public health issue, type two diabetes kills someone every seven seconds.

    Stopping sugar subsidies is the easy no-brainer way to save lives.

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    1. I always thought that a good public health intervention would be to substitute glucose (dextrose) for sucrose and tried it at home. It is less sweet than sucrose and not crystalline so it is more difficult to use. But it would be like adding Vitamin D to milk or thiamine to flour except it would be a direct substitute and it would eliminate fructose.

      The other substitute sweeteners these days are sugar alcohols (malitol, xylitol). Some food claiming "no added sugars" have unspecified amounts of these compounds. I have not researched them yet.

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    2. I don't believe in bans as government intervention is largely responsible for this problem. Sugar and processed food should not be subsidized. I think any attempt to get rid of it will be met with the public fury that surrounded New Coke. In a free market processed food cannot logically be cheaper than local produce and meat. We use 12 cal of energy to produce 1 cal of food.

      I correct my correction. On a worldwide basis, DM2 kills someone every seven seconds.

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    3. Dr. Dawson - check with your favorite veterinarian on the toxicity of sugar alcohols in canines - it is surprisingly high!

      and the diarrhea of a small child who has scarfed a hand full of "Grandma's special sweets" is also truly impressive!

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    4. Here is a recent study in Beagles: https://www.ncbi.nlm.nih.gov/pubmed/28478098

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  4. Erythritol is an alcohol sugar that is zero calorie. It's in a lot of fat bombs and keto products.

    Stevia and monkfruit are natural and have zero calories. Stevia has an aftertaste, in my opinion, but monkfruit is good but hard to find. All of these beat aspartame which has a negative impact on gut biome.

    The thing is everything tastes sweet once you cut out sweets as tastebuds reregulate. Sometimes sugar substitutes are teasing the dragon, in my experience.

    The real key is getting back to fat as flavor, which used to be the case, as any Julia Child cookbook illustrates.

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