Monday, May 31, 2021

The Current Moral Crisis In The United States


It is fashionable these days to talk about moral crises that really aren’t moral crises. The level of rhetoric is at the point where disagreements can be spun as moral crises, while people are dying in the streets. The best examples I can think of are the long-standing epidemics of gun violence and racism. New examples are cropping up every day. There are current trends in violence against Asian Americans and Jews against the backdrop of long-standing trends. Discrimination and violence against black Americans is finally acknowledged as being widespread and is the basis of an activist civil movement and hopefully systematic reforms.

All of the statistics to back up my statements in the first paragraph are easily available and I am not going to post all those references here. Since I started writing this blog one of my concerns has been gun violence and how to stop it given the level of interference with common sense gun law reforms by one of the major parties and major lobbying concerns. I saw the attempt to counter that political interference as being futile and focused more on public health interventions and possible psychiatric intervention. The latest good review of that approach is available in a review by Knoll and Pies (3).  For many years I have advocated that homicidal ideation should be seen as a public health intervention point and that it should be part of the strong public health message. To this day nothing has happened. Public health organizations do have research-based suggestions such as locking up firearms and common-sense gun laws like banning large capacity magazines, banning assault rifles, and universal background checks, but the general lack of progress in that area is not reassuring. There has been some movement in allowing more research on gun violence, an area that was previously blocked by gun lobbyists.

What is the connection between gun violence, racism, and violence toward our fellow Americans?  I think there are all based on the same interpersonal dynamic. That dynamic is seeing another person as being significantly different from you, attributing negative characteristics to them, and using both of those premises for treating them different from you up to and including perpetrating violence toward them.  In psychiatric jargon, we use the term projection to capture this process or in the extreme projective identification. These are not psychiatric diagnoses, but defense mechanisms that are distributed across the population even though they may be more likely in people with specific psychiatric diagnoses.

In my readings over the years I have been looking for a likely origin or at least first sign of this kind of thought pattern. In other words, have people been thinking like this since the beginning of recorded time, or is this a new phenomenon?  In the course of that reading, I came across a book written by the anthropologist Lawrence Keeley called War Before Civilization. In this book, Keeley explores the idea of the noble savage from prehistoric times.  In other words, were pre-historic people inherently peaceful as some had suggested or were there early signs of violence and aggression. A review of the evidence suggests that the majority of human prehistoric civilizations engaged in frequent warfare and total warfare – in other words attacks not limited to combatants and decimating the opposition’s infrastructure and ability to make war.  Keeley reviews the motivations and consequences of primitive warfare in great detail including tactics (surprise attacks, slaughter of noncombatants, and general massacres) and specific practices like mutilating dead bodies. There is clear evidence the latter functioned in part to dehumanize and humiliate the enemy and send a message to the survivors. These dynamics were not limited to prehistoric man and have continued through modern times and modern warfare.

A recent report referencing Keeley’s book appeared on Scientific Reports (2) this week.  It was a reanalysis of a Nile Valley burial site of 61 people from about 13,400 years ago. It is thought to be some of the earliest evidence of Homo sapiens interpersonal violence.  In that analysis over 100 lesions were identified in the skeletal remains from what appeared to be projectile weapons.  Examining the mortality curve of the individuals in the cemetery showed that it was consistent with multiple burials rather than a single event.   The stone artifacts examined were consistent with spear or arrow heads. Some we designed to kill by lacerating and causing blood loss. Some were discovered embedded in bones, but others were discovered within the area where the body was discovered and that was viewed as being consistent with the ability to penetrate the body.  The authors conclude that the majority of people in the cemetery died of blunt or sharp force trauma and that there were multiple episodes of interpersonal violence.  Some of the combatants had been wounded multiple times prior to death.  They also concluded that these episodes were most likely the result of “skirmishes, raids or ambushes” likely related to territorial disputes that may have been affected by the weather. (p. 9).

What can be inferred from this long history of human violence and aggression? First, groups of humans have been perpetrating violence against one another since prehistoric times. Second, during these episodes total warfare was very common and the human cost of war is always high. The estimated percentages of deaths in ancient society were generally higher than in modern society for a number of reasons. That was not a deterrent to ancient humans.  Third, the psychological states during these episodes of violence show a potentially broad range of thinking leading to aggression.  Very limited incidents such as the theft of livestock or a rumor of a sexual affair between members of different tribes or villages may be all that was required to start a series of retaliations leading to all out war.  Once a violent conflict ensued – there were thought patterns and rituals in place to justify the killing, prevent bad outcomes for the killers, humiliate the dead, and embarrass their families.

The current moral crisis in America seems to have a direct link with prehistoric behaviors. It is enacted by aggressive behavior that is described as racism, antisemitism, and gun violence, but the dynamic is the same one described in ancient man.  In other words, once a person can be seen and characterized as an enemy (for whatever reason),  it is very easy to vilify them, attribute the worst possible motivations to them, and use that as a basis for rationalizing aggressive behavior. In the past weeks, I saw two elderly Asian American women attacked at a bus stop by a man wielding a knife. The attack as so violent that the large blade of the weapon broke off inside the body of one of these women. In a more recent event, a heavily armed long time employee shot 9 of his coworkers and then killed himself when he was surrounded by police.  In both cases, the “motivation” for the violent behavior is unknown.  There is a suggestion of mental illness, but the majority of people with diagnosed mental illnesses and even the same diagnoses are not violent or aggressive. The sheer volume of mass shootings in the United States suggests it is more of a cultural phenomenon here than anywhere else but that is confounded by the easy availability of firearms.  The main difference between modern and ancient times is that we have a societal structure that is designed to contain violence and aggression and prevent larger outbreaks.  It is clearly ineffective at this point in preventing violence.

I am suggesting a common thought process here that does not require any psychiatric diagnosis and one that can be intervened upon and self-monitored.  In order to perpetrate discrimination, hate crimes, and even homicidal violence toward others 3 conditions have to exist.  First, the potential victims of violence need to be seen as sufficiently different from the perpetrator so that he can attribute unrealistic negative attributes to them and rationalize his aggressive action.  Second, the attacker can see himself as sufficiently different from the potential victims that he feels threatened by them and can rationalize attacking them for that reason alone.  A common example is that the attacker feels victimized by his coworkers and feels the need to strike out at them.  And finally, the attacker must have a plan to either seriously injure or kill the victim(s). All of these thought patterns can be considered derivative of thoughts present in ancient man leading to the wide ranging aggression and warfare described in the references.

I think there is much to be said for intervention based on the observations in this post.  For the time I have written this blog, I have advocated for intervention based on homicidal or aggressive behavior. When I worked as an acute care psychiatrist – treating violence and aggression was easily half of my job.  If we can suggest that persons with suicidal ideation or self-injurious behavior contact a crisis intervention service or hotline – why don’t we have a similar suggestion for people with homicidal thinking?  And further what about general education about the primitive origins of these thought patterns.  Just the other day I posted the following:

“Ridiculing people who died of C-19 and were antivaxxers and anti-maskers is bad form - plain and simple.

Bring civility back and restart civilization.

It starts with recognizing the value of a single human life.”

There was much agreement with the post, but also several people who suggested that I was naïve for not being able to recognize enemies or that I was a “better person” for being able to overlook the behaviors of a group of people who were potentially dangerous to others.  My post was not about moral superiority or not recognizing enemies – it is all about the fact that disagreement should not lead to enmity and beyond that we are all members of the same tribe.  We all came from Africa. And seeing differences between us that do not exist is probably ancient thinking that obscures the fact that we are all a lot more similar than we are different.  As I explained to some of the critics of my post, they seemed to be focused on the exceptions rather than the rule.  They also seemed to be making arbitrary exceptions based on seeing more differences than similarities. 

We are currently at a crossroads in this country.  People are making money and generating political capital by emphasizing differences and exploiting the primitive thinking that I have outlined in this post.  Much of the aggression plays out at a symbolic level in social media, but the Insurrection at the Capitol building and the increasing levels of physical violence illustrates that it is far from always symbolic. Americans have traditionally left ethics and morality up to religious institutions where it may be presented at an abstract level.   

It is time to get back to the basic premise of why every person is unique and needs to be treated with respect by virtue of being a member of the human race. It seems like an obvious but untested approach to reducing interpersonal violence at all levels in a society that is not currently equipped to prevent it.


George Dawson, MD, DFAPA



1:  Lawrence H. Keeley. War Before Civilization. Oxford University Press, 1997.

2:  Crevecoeur I, Dias-Meirinho MH, Zazzo A, Antoine D, Bon F. New insights on interpersonal violence in the Late Pleistocene based on the Nile valley cemetery of Jebel Sahaba. Sci Rep. 2021 May 27;11(1):9991. doi: 10.1038/s41598-021-89386-y. PMID: 34045477 (Open Access).

3:  Knoll JD, Pies RW.  Moving Beyond "Motives" in Mass Shootings.  Psychiatric Times 36(1) Jan 13, 2019. Link

Permissions:  Graphic above is from reference 2 per the following Creative Commons license. 

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Saturday, May 29, 2021

News From Africa



Some readers of this blog may recall posts in the past about human origins from Africa. I first became aware of the migratory pathways of early humans and the archaeological and genetic evidence from participating in a National Geographic test. That test looked at haplotypes and how modern humans migrated from East Africa to essentially around the world. The test also estimated the percentage of Neanderthal heritage. Since that original sample I have been tested at 2 other laboratories. One of them confirmed the National Geographic analysis and the third test is pending. My original intent was to highlight the fact that all Homo sapiens are from East Africa, and that the distinctions we like to consider “race” mean a lot less than most people think. Genetically human beings from different races are much more similar than different.  If we all share common ancestors, similarities would seem to be intuitive, but the events that have occurred since my original post suggest otherwise.  Racial and tribal biases have been with her since prehistoric times and continue in modern societies.

Despite those biases, evidence continues to flow from Africa. In the may 6 Nature there was a research paper on the discovery of a 78,000-year-old gravesite in Panga Ya Saidi, Kenya that contained the body of a 3-year-old child. The body and gravesite had evidence of burial practices including intentional placement in an excavated grave, specific positioning of the body, and wrapping of the body in a perishable material.  The authors exhaustively review the evidence for those conclusions. They and the author doing the commentary on this article (2) also review the meaning of these rituals.

The editorial first and the commentary by Louise Humphrey (2) from the Center for Human Evolution Research. Dr. Humphrey sets the stage in the Middle capstone Age (320,002 30,000 years ago). The research question is the first evidence of modern human behavior during that era. Various human innovations were discovered during this timeframe in Africa. The earliest human fossils were also discovered in Africa during this timeframe. One of the key indicators of complex behavior is how the dead were prepared and handled. Anthropologists considered this to be a marker of increased symbolic capacity and thought. Dr. Humphrey reviews existing fossil records of mortuary treatments done by humans and provides a map in her paper (2) where the archaeological sites are mapped ranging from 50 to 780 thousand years ago. Given the time range the hominid species identified included Homo sapiens, Homo neanderthalis, and other species of the genus Homo.  The critical work of the scientist involved is to “reconstruct a series of human actions associated with the deposition of the body”. What does the planning suggest? What meaning can be inferred from the site? Time and effort involved in the ritual suggest that the treatment is more meaningful. In the literature reviewed that included a dedicated site, wrapping the body, and positioning the body. Her conclusion was that the paper suggested the burial in the main paper was “symbolically significant”.

The research article (1) is a detailed description of the excavation and analysis of gravesite of a 2.5 to 3.0-year-old child. The researchers named the child Mtoto – a Kiswahili word for small child.  Estimated age of the gravesite was about 78,000 years ago. There is a detailed drawing of the preserved skeleton that includes a large portion of the cranium, spine, ribs, right clavicle, left scapula, left humerus, and proximal femurs.  There were 5 teeth present and they were felt to be consistent with H. sapiens, although some other features were present suggesting that there may have been regionally distinct populations. The evidence for placement of the body in a specific location was reviewed. The skeletal remnants were minimally displaced. The body was in a flexed position. The body present position was consistent with wrapping. This was interpreted as “more elaborated involvement of the community in the funerary rite…”. The evidence for intentional burial included an excavated trench and settlement patterns consistent with burial.

The authors review the scant evidence for mortuary practices during this era. They conclude that H. sapiens was probably preserving corpses of the young members of their groups between 69 and 78 thousand years ago.  That is contrasted with burial practices in Eurasia by Neanderthals and other modern humans dating back 120,000 years.  Infant and child burials in the sites were described as “ubiquitous”. The authors see the lack of mortuary practices during the middle Stone Age in Africa in general as being inconsistent with “modern-like conceptions of the afterlife and/or treatment of the dead”. They do point out that the absence of the behavior is not the same as the lack of capacity.

This paper was important from a number of perspectives. Overall, it is apparent that archaeological/paleobiological evidence of burial practices during the Stone Age is limited. East Africa is commonly viewed as the cradle of civilization. In 2 of the DNA analyses I have had done on myself, all my ancestors retraced back to East Africa. The data about Neanderthals mortuary practices is interesting because in the past decade, archaeological evidence supports the idea that they were conceptually more sophisticated than they had previously been given credit for.  One of the questions I came away with from this paper is why so few burial sites or other evidence of mortuary practices exist in Africa.

The inferences about human cognition based on mortuary practices are interesting to consider even in modern times. Over the course of my lifetime, funerals have changed significantly. Embalming and displaying the body, was fairly typical in the families I have been affiliated with until the turn-of-the-century. That mortuary practice was primarily grief focused. There was a religious service that was often a divine explanation of what had occurred and what was to be expected. Over the years I grew to become very interested in what the clergy from different faiths would say during the funeral. Other people would frequently speak with varying degrees of effectiveness. A common meal or reception would frequently follow the religious service there is often a separate burial with the graveside religious service the next day.

In about the year 2000, things seem to change significantly. I remember attending a funeral and being shocked that the body had been replaced by a small box of ashes. Cremation suddenly became the rule rather than the exception. The funeral service was focused on being a celebration of the deceased’s life rather than strictly grief focused. There were often photographs and video displays relevant to the deceased person’s life. The eulogies were also more lighthearted. Jokes or humorous vignettes about the deceased were more common. I don’t know what lead to these changes and have not been able to find a good analysis of why it occurred. The archeological elements of ritual, respect for the dead, the existential balance of the meaningfulness of their life in contrast to death, and the promise of a spiritual afterlife is all there. With cremation there is an added element of remembering the deceased as they were in real life and that theme is more consistent with a celebration of their life.  All of these elements are fairly implicit and embedded in ritual. An obituary is written and proofed several times. In the Internet era, it is posted on several sites and is eventually routed to sites when ancestry analysis occurs.  I have seen direct evidence that Internet obituaries exist in cyberspace much longer than they could be viewed in a newspaper. There is no doubt that multiple people have carefully planned the event.

The most important aspect of the death of an individual is their impact on the conscious states of others.  That is often simplified as a “memory” but it is more complex than that. For decades the grief process was considered to be a closed process. The person grieving goes through a number of cognitive-emotional stages and at some point they reach a stage where there baseline emotions return and they are left with memories of the individual. In the common vernacular that was described as closure.  In reality, the process is typically more open ended and the relationship with the deceased lives on. Any one of us who has lived long enough can recall at will or by association what those relationships and that person was like, why they are missed, and how they are still affecting us.  The increasing lifespan of modern humans leaves us all with a lot more time for those thoughts.

An additional consideration is the pattern of mortality and how it differs from the Stone Age to modern times. The average age of a person in the Stone age is estimated to be in the 25-35 range but that is skewed by considerable (45%) infant mortality. Did that have an impact on mortuary practices and the grief process?  Some experts suggest that more care was taken in attending to deceased infants and children implying that our ancestors had a selective thought process about those deaths. Given the time and scant evidence we may never know what our ancestors were thinking with a high degree of certainty. We do know that in the Middle Stone Age – our ancestors engaged in rituals that reflected their thoughts on death in general and that specific person.


George Dawson, MD, DFAPA




1:  Martinón-Torres M, d'Errico F, Santos E, Álvaro Gallo A, Amano N, Archer W, Armitage SJ, Arsuaga JL, Bermúdez de Castro JM, Blinkhorn J, Crowther A, Douka K, Dubernet S, Faulkner P, Fernández-Colón P, Kourampas N, González García J, Larreina D, Le Bourdonnec FX, MacLeod G, Martín-Francés L, Massilani D, Mercader J, Miller JM, Ndiema E, Notario B, Pitarch Martí A, Prendergast ME, Queffelec A, Rigaud S, Roberts P, Shoaee MJ, Shipton C, Simpson I, Boivin N, Petraglia MD. Earliest known human burial in Africa. Nature. 2021 May;593(7857):95-100. doi: 10.1038/s41586-021-03457-8. Epub 2021 May 5. PMID: 33953416.

2:  Humphrey L.  Burial of a child during the Middle Stone Age in Africa.  Nature. 2021 May; 593(7857): 39-40.

3:  Ponce de León MS, Bienvenu T, Marom A, Engel S, Tafforeau P, Alatorre Warren JL, Lordkipanidze D, Kurniawan I, Murti DB, Suriyanto RA, Koesbardiati T, Zollikofer CPE. The primitive brain of early Homo. Science. 2021 Apr 9;372(6538):165-171. doi: 10.1126/science.aaz0032. PMID: 33833119.

4:  Beaudet A. The enigmatic origins of the human brain. Science. 2021 Apr 9;372(6538):124-125. doi: 10.1126/science.abi4661. PMID: 33833107.

5:  Olden K, White SL. Health-related disparities: influence of environmental factors. Med Clin North Am. 2005 Jul;89(4):721-38. doi: 10.1016/j.mcna.2005.02.001. PMID: 15925646.

6:  Brotherton P, Haak W, Templeton J, Brandt G, Soubrier J, Jane Adler C, Richards SM, Der Sarkissian C, Ganslmeier R, Friederich S, Dresely V, van Oven M, Kenyon R, Van der Hoek MB, Korlach J, Luong K, Ho SYW, Quintana-Murci L, Behar DM, Meller H, Alt KW, Cooper A; Genographic Consortium. Neolithic mitochondrial haplogroup H genomes and the genetic origins of Europeans. Nat Commun. 2013;4:1764. doi: 10.1038/ncomms2656. PMID: 23612305; PMCID: PMC3978205.

7:  Fu Q, Rudan P, Pääbo S, Krause J. Complete mitochondrial genomes reveal neolithic expansion into Europe. PLoS One. 2012;7(3):e32473. doi: 10.1371/journal.pone.0032473. Epub 2012 Mar 13. PMID: 22427842; PMCID: PMC3302788.



Additional references above are for a more expansive essay on paleobiology, genetics and the importance recognizing a common ancestry.