Rick Sings - poetry by Phill Taggart

“Well I woke up this morning and I had myself a beer.” Roadhouse Blues (1970) Jim Morrison Lyrics The Doors Composition

Many years ago, I was asking a patient about his morning routine and he replied with the Roadhouse Blues lyric and started laughing. At the time he was taking medications that I prescribed but also seeing a naturopath who was giving him a complex solution of minerals that was supposed to treat his mental illness. His family was more concerned about him than he was concerned about himself.  Severe mental illness leaves a person focused on irrelevant pieces of information out in the environment for amusement/entertainment/meaning while ignoring the basics – like self-care and not standing out too far in public.  Clinicians refer to some of that as inappropriate social behavior, but it is a complex multi-layered problem. The same process can result in a great deal of difficulty staying focused on the necessary day-to-day routine. In that mix, there are boundary problems that can contaminate the most altruistic impulses and affect personal safety.  Phil Taggart does a great job of painting that picture in his book of poetry Rick Sings.

In a brief introduction we meet his brother Rick.  Rick has a severe mental illness that clearly affects his ability to function. I am writing that after reading the entire book and all the poetic descriptions. We find out that Rick has a lot of problems in living, managing his self-care and medications.  There are times when he is not eating well, where he is in an agitated state, where his hygiene is affected, and where he puts his housing security at risk by taking in women who have lost housing or were the victims of violence. His brother is a force to help keep him on track and check in with him.  Those encounters are the basis for this book.

The first images we get are family chaos – the product of mental illness, alcoholism, aggression and violence, and the death of a young sibling.  Rick’s modern-day world is tied in with that early history. Here are two stanzas from the poem Morning Coffee

 

The rest of this poem has stark images of people who come into your life and leave with you liking or not linking them or yourself along the way.  At some point it is hard to know if the memory is that sad or current sadness clouds the memory.

I recently read an essay on how art can be rhetorical in the persuasive sense. This poetry consists of observations and emotions that the imagery elicits. There is no hint of bias – only the empathy elicited by images and situations.  I had not thought of this before but Taggart’s poetry is the perfect medium to communicate the major problems facing people with severe mental illnesses and anyone trying to help them. You can’t help being pulled in when he advises his brother to stay away from the police for his own protection or when he has to let a security guard know that “he’s with me” to avoid awkward social situations.

There is a stream of consciousness flow to the poetry with associations across the lifetimes of Taggart and his brother. I liked this feature because it is the way a lot of people (including myself) think. Focus on the present and in some downtime – think about an event that happened in 1975. When your brother is in the picture – think about common events. Several of those themes run through this book of poetry and it is masterfully done.   No associated explanations – just a description of an event with a universal emotion.

I liked this book of poetry.  In keeping with my book reviews, I like the idea of conditional recommendations.  In this case – liking poetry will help.  It will even be better if poetry stimulates your mental imagery and emotions. I call the writing style of this poetry free verse like E.E. Cummings.  The phrases are also arranged differently on the page to emphasize different thoughts and actions.  If you like that style, you will like this book even more. Beyond liking poetry, this book will potentially help you understand the problem of severe mental illness and its effects on people and their families. Even though there are efforts out there to decrease stigma and attributing stigma to a lack of understanding of the problem – stigma has always been a problematic concept for me. If more people experienced what Phil Taggart puts into his poems there would be a greater understanding. He is a strong voice in this area.  Read this book if you are interested in a deeper understanding the problem.

 

George Dawson, MD, DFAPA

 

Reference:

Phil Taggart.  Rick Sings.  Santa Barbara, California. Brandenberg Press 2014: 67pp.  https://philtaggartpoet.com/

 

 

Riding The "L" Train

My wife and I went to the Edward Hopper exhibit at the Walker Arts Museum last Saturday.  Hopper is one of my favorite artists because I consider him to be the artist of chronic insomniacs.  I am a chronic insomniac.  By that I mean, many of his most favorite paintings depicted scenes that were seen either directly through a window at night or the perspective of seeing a room illuminated by two or three lighting sources at night.  Reading the informational displays next to the art, I learned that may have been from riding the "L" train in New York City late at night and peering into offices where people were still working.  Some of his paintings are very natural night time occurrences like his famous painting of a diner at night called Nighthawks.  In some of his paintings displayed in this exhibit there were annotated drawings with clear attention to the light and sources of light in his paintings.  In Office At Night for example is a notation about light coming in (at night) from the window, from an overhead office light, and from a lighted adjacent room.

Nighthawks has always interested me just in terms of its form and attention to lighting details.  It interests me even more after reading Kandel's book on art and what the viewer brings to the viewing situation.  I suppose there are a lot of people just seeing a diner at night.  But if you are an insomniac, night is an entirely different proposition for you.  Many insomniacs dread the night because they equate it with no sleep.  But many of us see it as the most exciting part of the day.  It is like a different world where your perceptions are much clearer.  I have actually cataloged some of my nighttime experiences, and they remain as vivid today as they did decades ago.  For example, I remember one night, I was wide awake at 10 PM and decided I was probably not going to sleep that night.  What better time than to go to the chemistry lab where I was working at the time and continue some experiments I was working on?  It was about -5 degrees and a three mile walk.  About two inches of snow had fallen and it crunched and squeaked every time I took a step.  I was past an old decrepit sandstone block hotel at the half way point and more snow started to come down.  Across the street was a large white marble bank building flashing the time and temperature.  There were at least four lighting sources, the flashing time and temperature, the street lights, light coming out of the shops and rooms in the hotel, and light reflecting up off the fresh snow.   I walked for three miles in these unusual lighting circumstances hearing and feeling that crunching and squeaking under my boots the entire way.  It was thoroughly invigorating.  I reached the lab, did a few experiments.  As the sun came up, I found a couch in the building and fell asleep.  That may not sound like much to someone who is used to sleeping at night, but it is what I bring to viewing a Hopper painting of a diner at night.  I find myself very excited about it, when it probably does not have that effect on others.  I could easily walk into that diner at night and talk with my fellow insomniacs.  We would all be in a fairly good mood.

All of this also reminded me of Kandel's recent book  The Age of Insight and his focus on beholder's experience.  The main idea is that viewer experience is critical to the completion of the work of art.  This idea originated with Alois Reigl, an art historian who developed a formal method for analyzing works of art.  The corollary is that each new generation of artists has the implicit task of educating the public about new ways to view art.  Some of Kandel's focus was on Viennese modernist painters - Klimt, Kokoschba, and Schiele and their role in educating the public about unconscious instinctual urges through their paintings during the time that psychoanalysis was being developed.  The theory of the viewer's experience also looked at the issues of inner and external coherence.  In the case of inner coherence, the painting has a clear narrative that does not require the viewer to complete the story.  In the case of less clear narratives the viewer may respond to the physical or emotional space of the painting, social equality with the people in the painting, and emotional and empathic equality with the people in the painting.  According to Kandel: "The ambiguity in the image elicits both a conscious and an unconscious process of recognition in the viewer, who responds emotionally and empathically to the image in terms of his own life experiences and struggles."  This is a critical but rarely recognized aspect of art.  I have been out of college for some time at this point, but recall no classes that were either specifically art classes or liberal arts courses on the interpretation of art that discussed the response of the viewer as necessary to complete the art, even though that idea had been out there for over 50 years.

These considerations also highlight the artistic aspects of other media - like photography.  There are many common criticisms of photography as art.  Many consider the creative process to be too truncated: "It's just a picture after all anybody can do it."  Some consider it to be a predictable way to elicit an emotional response, such as the Humane Society and Save the Children commercials that are broadcast on late night television.  But photography is a lot more than that.  As an example, I posted this sequence of pictures of 4 sisters over a span of 37 years years to my Facebook feed.  I found these pictures especially in sequence to be emotionally stunning and I wanted to see what some of my friends who were photographers thought.  To my surprise, I got two responses: "wow" and "very cool" from friends who do not seem particularly interested in photography - at least based on what they post on Facebook.  In this case the only narrative is implicit and partial and that is sisters as they age.  The body language and facial expressions seem to change over time.  I think it would be very difficult for the average viewer to not respond emotionally, empathically and construct their own theory of the mind interpretation for what is going on.  Photography can clearly be as compelling as painting or other forms of visual art.

Being a neuroscientist, Kandel is a wealth of information on the neurobiology of the beholder's experience.  On the chapter focused on that issue, he talks about unconscious determinants of beauty and attractiveness.  He discusses activation of the reward system both at the level of the ventral tegmental area and orbitofrontal cortex (OFC) in response to attractive faces, especially smiling faces and beautiful images.  He points out that one experiment showed that beautiful pictures activate the OFC more than the motor cortex and with ugly pictures it is the opposite suggesting that seeing ugly or fearful faces sets up the brain to prepare for a fleeing response.

Kandel's approach to the discussion of the artist and the beholder and their necessary relationship to complete the art and now the underlying neuroscience makes a lot of sense to me.  The most compelling aspect of this story (apart from loving the art) is the idea that you can look at this problem from the perspective of neuroscience and not get carried away.  Kandel is as comfortable discussing the neuroscience as his is the qualitative and subjective aspects of the creation and perception of art.  One does not necessarily explain the other.  At some point in psychiatry subjective became a dirty word and the illusion was created that in the extreme our unique brains can be measured and characterized by a simple collection of symptoms.  Any student of consciousness knows that it is absurd to think that 7 billion unique people with unique brains can be broken down to a relatively few disorders or personalities or executive functions or IQs or however else we might want to approximate their neurobiology.  Art and the beholders experience is a great example of that.  I have a good idea of why I like Hopper's work.  My theory of the mind is that he was a fellow insomniac who did not mind being an insomniac.  I have other speculation about his work, especially the people he included that I will hold for now.  Another thing I have learned over the years is that people are not necessarily interested in one anothers interpretations of art.

My favorite art and the art that I collect is pure abstract art and I hope to develop a detailed post about that in the not too distant future.

George Dawson, MD

References:

Eric R. Kandel.  The Age of Insight: A Quest To Understand the Unconscious in Art, Mind, and Brain, From Vienna 1900 To The Present.  Random House, New York City, 2012.

Gustav Klimt Page -  This artist is prominent in Kandel's book and his works are on display at this web site.

Neuron Perspectives in Neuroscience

Eric Kandel's thought, research, and writing have been a major source of inspiration to me ever since I read his neuroscience text and his classic article Psychotherapy and the Single Synapse in the New England Journal of Medicine nearly 34 years ago.  I was very pleased to see that he wrote the lead article in Neuron's   25th Anniversary edition entitled "The New Science of the Mind and the Future of Knowledge."  I read the article in the same spirit that I read the original NEJM article, guidance from a world class neuroscientist who was also trained as a psychiatrist.  At that level the article is quite exciting because somewhere along the line Dr. Kandel has clearly been following concepts that are far removed from the synapse and does a good job of summarizing the major points and the current deficiencies.  He also comes back to the idea that psychotherapy is a biological treatment as he proposed in the original 1979 article.

One of the most interesting aspects of the article is that Kandel does not apologize for psychoanalysis.  He is also not excessively critical.  I read an article about his residency class at Harvard and psychoanalysis was certainly prominent at the time.  Although it is fashionable these days to throw Freud under the bus, he points out that Freud and subsequent analysts were right about a number of issues that neuroscience has caught up with including:

1.  Unconscious mental processes pervade conscious thought.
2.  The importance of unconscious thought in decision making and adaptability.

The probable link here is that Freud, psychoanalysis, and current neuroscience is focused on the mind rather than descriptive psychiatry.  At some point the majority of the field got sidetracked on the issue of identifying a small number of pathological conditions by objective criteria.  The mind was completely lost in that process and those few psychiatrists who were focused on it were engaged in generating theories.  He criticizes the field for a lack of empiricism but recognizes that has changed with clinical trials of psychodynamic psychotherapy and recent interest in testing psychoanalytical theories with the available neuroscience.  He also points out that Aaron Beck was a psychoanalyst when he developed cognitive behavior therapy focused on conscious thought processes and became a leading proponent for an evidence based therapy.

It was good to see a discussion of the hard problem of consciousness.  I was on the ASSC listserv for many years until it eventually lost a home and was shut down.  Many of the experts in consciousness studies posted on that thread but there was very little neuroscience involved but plenty of discussion of the neural correlates of consciousness.

Information flow through the brain has always been one of my interests.  The idea that information flows through biological systems at both chemical and electrical levels is a relatively recent concept.  At the clinical level behavioral neurologists like Mesulam and Damasio discussed it based on cortical organization and information flow primarily at cortical levels.  I taught a course for many years that talked about the basic information flow through primary sensory cortex, association cortex and then heteromodal cortices.  The model had good explanatory power for any number of syndromes that impacted on this organizational model.  For example, achromatopsia made sense as a lesion in pure sensory cortex and posterior aphasia made sense as a lesion of heteromodal cortex.

Using this model, overall information flow from the sensory to the motor or output side could be conceptualized, but there were plenty of open boxes in the flowchart along the way.  The theory of how consciousness is generated from neural substrates was still a problem.  Social behavior was another.  Despite decades of descriptive psychiatry, the diagnostic criteria for major psychiatric disorders still depended on symptoms.  In many cases aberrant social behavior was a big problem and often a more accurate reflection of why patients were disabled, unable to work and had limited social networks.  Even though there were scales to rate positive and negative symptoms in schizophrenia, aberrant social behavior cut across a number of major psychiatric disorders.  In my first job as a community psychiatrist, we rated social behavior of the people in our community support program and it was a better predictor of disability than diagnosis or ratings of positive symptoms.  The neuroscience of social behavior remained resistant to analysis beyond the work done on cortical lesions and obvious comparisons to those syndromes.  But people with schizophrenia had no obvious frontal lesions.

Dr. Kandel points out the developments in these areas ranging from de novo point mutations affecting circuitry in the frontal cortex to mirror neurons to the neuroendocrinology and genetics of social behavior.  The review of Thomas Insel's work with voles and the extension of that work by Bargmann in C. elegans highlights the importance of specific systems in social behavior and how these systems are preserved across species.

One of the most interesting areas outlined by Dr. Kandel was the issue of art and the neuroscience of its creation and perception.  I have just posted on abstract art and was able to locate a quote from Kandinsky:

"The abstract painter derives his "stimulus" not from some part or other of nature, but from nature as a whole, from its multiplicity of manifestations which accumulate within him and led to the work of art.  This synthetic basis seeks its most appropriate form of expression which is called "nonobjective".  Abstract form is broader, freer, and richer in content than objective [form]." (Kandinsky Complete Writings on Art - p 789)

Kandel develops a narrative based on Viennese art historians and the importance of the aesthetic response to art.  That response is an emotional one based on the life experience of the viewer and the neuroscience of that response can be studied.  He looks at the inverse optics problem, facial recognition, and comes up with a flow diagram of the processes involved in viewing visual art.  I did not realize it until I read this article but he has a new book on the subject and ordered a copy to review at a future date.

Some of the conclusory remarks about neuroscience and what it means to society are the most important.  It is easy to be cynical about any scientific endeavor and it is also very easy to be political.  Neuroscience has to endure (although to a much lesser degree) than what psychiatry endures.   There are people out there commenting on neuroscience who don't seem to know much about it.  In many cases they are not scientists.  Even in the case of scientists, it is often easy to forget that the public will probably not hear the most objective and the most scientific.  They will typically hear from the experts who unambiguously support one side of the scientific argument as opposed to the other.  Kandel is cautious in his suggested applications of neuroscience to society.  He does not view it as a panacea or an explanation for behavior necessarily.  An example:

"Attributing love simply to extra blood flow in a particular part of the brain trivializes both love and the brain.  But if we could understand the various aspects of love more fully by seeing how they are manifested in the brain and how they develop over time, then our scientific insights would enrich our understanding of both the brain and love."    

Hopefully you will have time to read this paper.  I have highlighted a few more based on my reading about neuroscience over the past 20 years or so.  I will end with a paragraph on technical expertise.

When I was interviewing for residency positions 30 years ago, one of my questions that drew the strongest emotional reaction was: "Does your program have a reading list for residents?"  That question on average elicited shock or at least irritation from the average residency director.  The only exception was Johns Hopkins.  They handed me a neatly bound list of several hundred references that they considered key references that every psychiatric trainee should read.  I should have taken it as a sign and applied there, but my trajectory in life has been more random and circuitous than studied.  If I was a current residency director, I would have a list with a neuroscience section and the following articles from this volume of Neuron would be on it.  People often recoil when I talk about the technical expertise needed to be a psychiatrist.  Technical seems like too harsh a word for most psychiatrists.  Most of the media debate after all is essentially rhetorically based political discussions  I would say that if you read these articles, you can consider them to be a starting point for what you might need to know about neuroscience and psychiatry in the 21st century.

George Dawson, MD, DFAPA

A reading list for psychiatrists of the future (all available free online at the above link):

Kandel, Eric (2013) The New Science of Mind and the Future of Knowledge.  Neuron 80: 546 – 560

                             

McCarroll Steven A, Hyman Steven E (2013) Progress in the Genetics of Polygenic Brain Disorders: Significant New Challenges for Neurobiology. Neuron 80:578-587.

Südhof Thomas C (2013) Neurotransmitter Release: The Last Millisecond in the Life of a Synaptic Vesicle. Neuron 80:675-690.

Huganir Richard L, Nicoll Roger A (2013) AMPARs and Synaptic Plasticity: The Last 25 Years. Neuron 80:704-717.

Dudai Y, Morris Richard GM (2013) Memorable Trends. Neuron 80:742-750.

Shadlen Michael N, Kiani R (2013) Decision Making as a Window on Cognition. Neuron 80:791-806

Buckner Randy L (2013) The Cerebellum and Cognitive Function: 25 Years of Insight from Anatomy and Neuroimaging. Neuron 80:807-815.

Abstract Art

When I was a kid in a small town we had the same art teacher for the first eight years.  There were five elementary schools and Mr. Cooper would travel to all five schools and try to teach us art.  I just recently learned that he also taught art in the same way in elementary schools in the surrounding small towns.  When I went to junior high school I was surprised to see him in the 7th and 8th grade teaching in an old art deco building on the high school campus (my high school was grades 7-12).

The format in his classes was generally the same.  He would spend the first 10-15 minutes talking about art - usually a specific artist or groups of artists, or a technique.  A couple of times a year he would bring in a large orthographic projector that would allow him to project pictures from art books onto a movie screen.   He would typically turn us loose for the last 45 minutes using a specific technique.  During that time he would walk around and make comments on what we were doing and make suggestions on how to improve our art.  Mr. Cooper was very serious and talked with us in a serious manner even though we were kids.  He was serious about art.

The most memorable sessions for me involved finger painting.  That day we would all get a blank piece of white paper.  Mr. Cooper would walk around and place a dollop of thinned wheat paste onto the paper and tell us to spread it around.  He would them come around and place red, blue, green, and yellow powdered paint on the corners of the paper - several tablespoons of each.  For a class of 20-30 kids it takes a while to set all of that up.  Before he could get back up in front of the class, 90% of the kids were already smearing the paint around and 98% of them had smeared it all together.  The standard mix resulted in a lavender clay colored product.  When that happens you are limited to geometry - whatever lines or shapes you could put into the surface.  The few people who keep their colors separate - had many options based on the primary color options and combinations of those colors.  I have never thought about it before but this is a science intersection of sorts - more degrees of freedom or combinations from the basic step of not mixing all of your paint together.

I was one of the people who never mixed the colors together.  I liked the boundaries between bright colors and the areas of pure bright colors.  I liked the non geometric shapes stretched across the paper through numerous color zones.  There was something very satisfying about creating a painting from this simple technique.  At the same time, we were presented with art work by the masters.  We saw plenty of meticulous realistic art from the masters of several eras.  Even then it seemed like many had an abstract quality.  I can remember liking Edward Hopper's work at first sight.  This Andrew Wyeth image had the same effect.  Over the past 40 years, I have studied art where I could find it but I always gravitate to the abstract.  If I have a choice it is typically color field artists like Hans Hoffman, but any abstract artist will do.  I used to tell myself that I would start painting again in my spare time, but practicing medicine these days is not conducive to spare time or doing anything creative during it.  My wife and I do have time to appreciate local abstract artists and purchase some of our favorite pieces like the work of Steve Capiz below (click to enlarge):

    
The artist in this case has been painting abstracts for 50 years and he is still going strong.  He is currently painting very large canvasses on the order of 6-10 feet high and wide.  The last time I was in his gallery there were probably 40 - 50 paintings on sale and I honed in on exactly two of them including the one above.  If you walk into my house you will find the above 36" x 36" painting to the right of the entrance and as you look across the room to the left there is a 48" x 48" abstract above a fireplace in your line of sight.  If you look down the stairwell there is a large print - Morris Louis #2703.  There are four other paintings by Steve Capiz throughout the house.

The reaction to abstract art is always interesting.  When I post some of the art on my Facebook page, friends often comment on what the painting looks like.  It seems like a projective test.  My wife takes the interior design approach.  The colors of the painting need to "pull together" the colors in the room.  Our painter wears a T-shirt that says: "Don't buy art to match the furniture."  He encourages my wife to listen to me when it comes to abstract art.  But I am really not aware of why I love abstract art and why I can discriminate enough to select 2/50 paintings from my favorite artist.  Did it have something to do with my fingerpainting experience?  Or is my brain set up to fingerpaint in a certain way and be attracted to abstract art?  My life experience has certainly been broadened by art.  I have no idea how it has affected my thinking.  Some of those details are known for musical performance.  Learning to play the cello and clarinet has probably led to some enduring changes in my brain plasticity.

Experiments aside - I am glad I met Mr. Cooper when I was a kid.  It has been my experience that you never know enough at the time to optimize your experience with good teachers.  That is as true for art as it was for neuroanatomy.

George Dawson, MD, DFAPA