Joseph N. Abraham, MD
I don’t much care for medicine, but it pays the bills and I am told I do it adequately enough. There is a large hypocrisy in my attitude, of course; I, like all people, am very grateful for doctors when I need them. But I find the ailments in people’s bodies to be much less interesting than the ailments in their lives.
So I’m interested in how to be a physician of the human condition. I have come to believe that the sources of human suffering, particularly in the modern world, are more a product of disordered thought — of logical disease, if you will — than of anatomical or physiological disease.
My 30 years in the emergency room give me an unusual view of logical disease. First, as in traditional medicine, behavioral medicine focuses on the big problems. I am interested in the smaller ones. With that, psychology and psychiatry don’t really see everyone, not even in public clinics. There is a vast, invisible segment of humanity who only emerge into the larger world when they are sick enough to visit the ER, and who quickly disappear once they are treated.
Second, the emergency room is the place where most short-term commitment papers are issued. Some of those commitments address traditional disorders, such as schizophrenia or manic-depressive conditions. But others are for people who are just depressed or otherwise confused; people who are suffering from disordered internal dialogues, from logical disease.
Third, the ER gets quiet sometimes but the doctor is required to remain there. So it’s the one place where a wide variety of people interact in egalitarian ways. Doctors may be some of the best-educated and best-paid people in the community, but hospitals also employ high school drop-outs who, despite holding full-time jobs may still require public assistance. In between those two extremes are many varieties of education, experience, and insight. Sooner or later, people talk about their lives, and the conversations occasionally touch on the taboos of religion and politics. The results are not always predictable. If you listen, you can find janitors who will tell you surprising things. And sometimes highly skilled, otherwise compassionate professionals say things that are just offensive. Other than social services, law enforcement, and occasionally journalism, there are few situations where the highly educated interact regularly and intimately with adults at all socioeconomic levels.
Finally, the ER creates a certain neurotic outlook in the doctor. The ER doc typically has one chance to decide if something serious is going on, and missing some diagnoses can be disastrous. So the ER physician often becomes very sensitive to anything that looks out of place. Typically that’s a mismatch between the doctor’s knowledge base and the patient’s symptoms, but sometimes it’s a mismatch between the patient’s story and other clues. If you watch people carefully in the ER, and you have sufficiently neurotic antennae, sometimes you realize that a patient isn’t telling the real story. A lot of that is simple dishonesty, things like drug-seeking or avoiding personal responsibility. But occasionally there’s something really big going on in a patient’s life, something they don’t talk about, maybe something they can’t think about.
I have also been a researcher in biology for over 20 years, specifically in the field of organic behavior.1)The accepted term is ‘Behavioral Ecology’, but after years of thinking about that phrase I’m not exactly sure what the heck it means. So I prefer ‘Organic Behavior,’ because it turns out that all living things make decisions, and therefore exhibit behavior. A weed may not have a brain, or at least not a brain as we understand it, but it makes constant decisions: how much to invest in roots, how much in stems and leaves, when to flower, which way to grow, and how to manage its resources in a wide variety of situations. My area of research suggests ways that our biological makeup creates logical problems, even more logical disease, for us. There are many who would prefer to believe, even insist, that we are purely intellectual creatures, independently directed by learned thoughts and completely uninfluenced by genetics and biology. We will talk about that, but I simply ask the skeptic to suppress a sneeze, a cough, or many other urgent bodily functions. Those might seem fatuous. But I also ask the skeptic to suppress anger.
Anger is a biological response to threat. We have all been shocked by our decisions and behaviors when we are angry. That we are shocked strongly suggests that our behaviors contradict our logical processes, or at least our conscious logical processes. The sources of our actions should either be nature or nurture, and angry behavior apparently isn’t learned, isn’t logical, behavior. The only remaining option would appear to be nature.
In addition to my biological research, I have also struggled for the past 25 years to make some changes in education. Politicians and bureaucrats have their own logical diseases, and I have come to suspect they are only peculiar exaggerations of everyday dysfunctions. Those exaggerations can provide helpful insights, because the outrageous caricatures we see in these two groups can help us recognize the same logical diseases in our own lives: smaller dysfunctions, but hardly tamer.
Politicians and bureaucrats may suffer from logical disease, but so do scientists, philosophers, and all academics and authorities. That was the surprise for me. We consider scientists among the smartest humanity offers, but as we wander through this blog, we will see that even our brightest minds are riddled with contradiction and hypocrisy. I have actually become so disappointed in my colleagues that I have started to think of myself as a natural philosopher rather than a scientist.
Surprisingly, philosophy was my starting point. My beginnings in philosophy, and particularly epistemology2)‘Epistemology’ is the study of what we know and how we know it. began when I was a callow seven years old, before I even knew what philosophy was. I may tell that story eventually. But the rest of it, the medicine, the biology, and the civic activism, really started with with my philosophical beginnings.
Philosophy, epistemology, and logical disease. That’s what I want to discuss.
I was born in Evanston, Illinois, making me the only Yankee on either side of my family (at least considering my European and Middle Eastern ancestors; I also have some native American blood, perhaps some from up north although that probably wouldn’t qualify them as Yankees). I grew up in Sulphur, Louisiana where my father was the Episcopal priest (‘Father Abraham’ no less).
After a stint in the Navy I attended the University of Louisiana and was graduated in zoology with minors in French, art, and chemistry. I received my MD from Tulane in 1986, and did an internship in Bangor, Maine where I discovered I don’t really like medicine.
In 1989 I founded what is believed to be the first comprehensive endowment for public education, but it largely collapsed in 2011 from the recession.
I worked on a doctorate in biology at a southern university I will not name. I produced two dissertations, both of which were published in peer-reviewed journals, but I was denied my PhD. My theses in those two papers were rather obvious, or so it seemed to me. My biological colleagues, however, have uniformly rejected my ideas, which has given even more to think about (including, occasionally, my own sanity). The experience has informed some of my ideas about logical disease.
I live among the Cajuns & Creoles of south Louisiana, and their culture has also greatly influenced my thinking.
At the tender age of 53 I was married for the first time, and we have a couple of young kids. That’s been a blast, the best thing that has ever happened to me; I don’t have the energy that I had when I was younger, but I have a lot more patience and greater faith in people, particularly children, to figure out things for themselves. I constantly learn a lot about myself and everyone by watching my kids, and worrying over them. That will also become key to my writings here.
Footnotes [ + ]
|1.||↑||The accepted term is ‘Behavioral Ecology’, but after years of thinking about that phrase I’m not exactly sure what the heck it means. So I prefer ‘Organic Behavior,’ because it turns out that all living things make decisions, and therefore exhibit behavior. A weed may not have a brain, or at least not a brain as we understand it, but it makes constant decisions: how much to invest in roots, how much in stems and leaves, when to flower, which way to grow, and how to manage its resources in a wide variety of situations.|
|2.||↑||‘Epistemology’ is the study of what we know and how we know it.|