Joseph N. Abraham, MD
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I never cared much for medicine. But it paid the bills and I was told I did it adequately enough. There is a large hypocrisy in that attitude, of course; like everyone else I am very grateful for doctors when I need them. But I found the ailments in people’s bodies to be much less interesting than the ailments in their lives.
So I was more 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 gives me an unusual view of logical disease. That may sound like the sort of problems that psychology and psychiatry address, but not quite. First, just as in traditional medicine, behavioral medicine focuses on the big diseases and the big problems. I am interested in the smaller dysfunctions; or perhaps, the smaller dysfunctions that can create such large problems in our lives. 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 too sick to avoid the ER, but 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 the big mental health problems such as schizophrenia or manic-depressive conditions. But others are for people who are just depressed, fearful, abusing alcohol or drugs, or otherwise confused. These people often suffer from disordered internal dialogues, from logical disease.
Third, the ER is frequently quiet, but the doctor is required to remain there. So it’s the one place where a wide variety of people interact in egalitarian ways, with the patients, and with each other. Doctors may be some of the best-educated and best-paid people in the local community, but hospitals employ all socio-economic levels, including high school dropouts. In between the extremes of the MD and the dropout are a wide variety of people who are divergent in their education, experience, and insight. When it gets quiet, people eventually begin talking about their lives. Sometimes the conversations even touch on the taboos of religion and politics, and the results are not always predictable. If you listen, you will find janitors who will offer surprising insights; and you will hear highly skilled, otherwise compassionate professionals say things that are just narrow-minded and even offensive.
So outside of maybe social services and law enforcement, the E.R. is one of the few places where one regularly and intimately talks to people at all levels.
Finally, the ER creates a certain paranoid outlook in the physician. The ER doc typically has just one chance to decide if something serious is going on, and missing some diagnoses can be disastrous. So the emergency 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 if 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 won’t talk about, maybe even something they won’t think about. I’ll hear a patient say something odd, and follow it up with a simple question. On more than one occasion, the response was a bomb-shell.
I have also been a researcher in biology for over 25 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 words literally mean. 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 in which our biological makeup can create even more logical disease for us. There are many people who would prefer to believe, even insist, that we are purely intellectual creatures, independently directed by learned thoughts and dispassionate analysis, and that we are completely uninfluenced by genetics and biology. We will talk about that misconception in some of the posts here, but I simply ask the skeptic to suppress a sneeze, a cough, or many other urgent bodily functions.
Those examples might seem fatuous, but I would also ask the skeptic to suppress anger.
Anger is a biological response to threat. After we calm down, we have all been shocked by our decisions and behaviors when we are angry. That we are shocked strongly suggests that those behaviors were not logical choices, or at least our conscious logical choices. The sources of our actions should either be nature or nurture, and angry behavior apparently isn’t nurture, it isn’t logical. So the only remaining option would appear to be nature.
In addition to my biological research, I also struggled for the past 30 years to make some changes in education. Politicians and bureaucrats have their own logical diseases, and for both of them, Louisiana has few equals. I have come to suspect that the failures of Louisiana government are only peculiar exaggerations of everyday dysfunctions in the rest of us. Those governmental exaggerations provide helpful insights, however, because the outrageous caricatures we see there can help us recognize the same, but smaller logical diseases in our own lives.
And although those daily dysfunctions may be smaller, they are hardly tamer.
Politicians and bureaucrats certainly suffer from logical disease, but I have come to realize that so do physicians, scientists, humanists, and all manner of academics and authorities. That was quite the surprise for me. We consider the doctors of law, medicine, and philosophy to be among the best that humanity offers, but as we wander through this blog, we will see that even humanity’s brightest minds are riddled with contradiction and hypocrisy. I have actually become so disappointed in my colleagues in science and medicine that I have started to think of myself as a ‘natural philosopher’, rather than a scientist. At her best, the philosopher does not subscribe to any particular world view, but is very much a perspectivalist: in considering the human condition, she will shift from paradigm to paradigm, aware that no one of them has cornered truth.
Surprisingly, philosophy was my starting point. My beginnings in philosophy, and particularly epistemology began when I was a callow seven years old, even before I 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 questions.
Philosophy, epistemology, and logical disease. Those fascinate me.
I was born in Evanston, Illinois, making me the only Yankee on either side of my family (or at least considering my European and Middle Eastern ancestors; I also have some native American blood, and perhaps some of those ancestors came from up north, although that probably wouldn’t qualify them as Yankees). I grew up in Sulphur, Louisiana2)The city of Sulphur does not stink. We have been the butt of jokes for years, but the sulfur mines, once the most productive in the world, were exhausted decades ago. Before many of the current environmental laws and regulations were enacted, however, the refineries between Lake Charles and Sulphur were quite malodorous, and Sulphur got the blame. 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 just how much I don’t like medicine.
In 1989 I founded what is believed to be the first comprehensive endowment for public education, but it largely collapsed in the 2011 recession.
I worked on a doctorate in biology at a southern university that I will not name. I produced two dissertations, both of which were published in peer-reviewed journals,3)J.N. Abraham, 1998. “La Saboteuse: An Ecological Theory of Sexual Dimorphism in Animals.” Acta Biotheoretica 46:23-35. 4)J.N. Abraham, 2005. “Insect Choice and Floral Size Dimorphism: Sexual Selection or Natural Selection?” Journal of Insect Behavior 18(6):743-756. but I was denied my PhD. My theses in both papers were rather obvious, or so it seemed to me at the time. My biological colleagues, however, have uniformly rejected those ideas, which has given even more to think about (including, occasionally, my own sanity). Those experiences also heavily informed my ideas about logical disease.
For most of my life, I lived among the Cajuns & Creoles of south Louisiana, and the informality and tolerance of their culture has also greatly influenced my thinking. I recently retired and moved to Europe. The reasons for that are numerous, but the most ironic is that I cannot afford quality medical insurance in the U.S. Here in Europe I can buy a year’s worth of qulaity insurance for what a month’s worth would cost me in the U.S.
At the tender age of 53 I was married for the first time, and we have a couple of 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 words literally mean. 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.||↑||The city of Sulphur does not stink. We have been the butt of jokes for years, but the sulfur mines, once the most productive in the world, were exhausted decades ago. Before many of the current environmental laws and regulations were enacted, however, the refineries between Lake Charles and Sulphur were quite malodorous, and Sulphur got the blame.|
|3.||↑||J.N. Abraham, 1998. “La Saboteuse: An Ecological Theory of Sexual Dimorphism in Animals.” Acta Biotheoretica 46:23-35.|
|4.||↑||J.N. Abraham, 2005. “Insect Choice and Floral Size Dimorphism: Sexual Selection or Natural Selection?” Journal of Insect Behavior 18(6):743-756.|