Your Brain is Trying to Kill You

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[I am open to correction in any point of the post below].

….all diseases may, in some sense, be called affections of the nervous system, because in almost every disease the nerves are more or less hurt; and in consequence of this, various sensations, motions and changes, are produced in the body.

–Robert Whytt (1714-1766), Scottish Physician

 

One of my obsessions as a child (and as an adult) is probably related to my having Autism Spectrum Disorder, Level 1 (in my case, what used to be called “Asperger’s Syndrome). I have always been fascinated by the heart and death and why a particular medical condition caused the heart to stop beating, especially if the condition was not itself a heart disease. I’d wonder about how a gunshot that missed the heart could sometimes cause rapid (or in the case of certain head wounds, nearly immediate) cardiac arrest. I would see Daddy shoot a rabbit, and it would run for ten or twenty yards, then collapse, dead. Why did its heart beat strongly enough to support its running, then suddenly stop. Or, in another scenario, why can a human being hold her breath over three minutes (and for free divers, close to ten minutes), yet someone who slips underwater or chokes on a piece of meat suffers cardiac arrest, in some cases, in a minute or two. Recently I heard of a case of a twenty-eight year old man who choked on food, and when rescue arrived two minutes later, his heart had already stopped. He was revived and had no neurological effects—but what caused his heart to stop so quickly.

Now I am not a medical doctor; the furthest I got in the medical field was as an EMT-Basic who was not even certified to give IVs or advanced cardiac life support. However, I can read, and over the years I learned that people shot often bleed out and that people who drown in fresh water can suffer cardiac arrest within a couple of minutes from electrolyte imbalances, but what about the choking victim. In the case of the gunshot victim, why does the loss of 30-50% of blood volume arrest the heart? Surely that is enough blood to stretch the sarcomeres enough for systole to continue.

I used to blame the heart—it was strong, yes, but also very fragile—too fragile, and stops too easily or too quickly for doctors to halt the underlying cause of the arrest in time to avoid brain damage or death. It turns out that often the real culprit is not the heart, but the brain.

The brain responds to bodily trauma in a way that is often destructive to the body. True, there is the diving reflex that diverts blood flow to the heart and brain that allows some drowning victims to survive. However, the rapid release of neurotransmitters in trauma or asphyxia or even in a myocardial infarction (heart attack) can result in stoppage of the heart. In effect, the sympathetic nervous system which speeds up the body, with its neurotransmitters, conflicts with the parasympathetic nervous system, which slows the bodily functions, and this conflict can lead to cardiac instability and a fatal arrhythmia. While the electrical instability of the heart itself can cause a fatal ventricular arrhythmia during an MI, often the big straw that breaks the small camel’s back is a massive release of stress hormones that is “ordered” by the brain. In the case of severe bleeding, such as occurs in gunshot wounds, a nervous system mechanism causes the heart to slow down (“brady down”) and stop after 30-50% of blood volume is lost. Some head injuries, such as bullet wounds that affect key areas of the brain associated with the brain stem, cause, according to a military medic with whom I talked, almost immediate Torsades de Pointes (a chaotic heart rhythm) which progresses to ventricular fibrillation and death. The military uses pharmacological blockers to cut off sympathetic and parasympathetic signals to the heart, and sometimes that buys extra time to treat the patient. A recent animal study published by the National Academy of Sciences found that it is the release of neurotransmitters with conflicting effects on the body that leads to cardiac arrest, and when such parasympathetic and sympathetic signals are blocked, it buys several minutes in which the heart continues to beat until oxygen is totally exhausted. Yet this time could allow doctors to reverse the asphyxia without going through the (far more often than not) unsuccessful CPR and advanced cardiac life support in the face of cardiac arrest. Some scientists are not suggesting that in cases of asphyxia cardiac arrest, animal studies be done to determine whether pharmacological blocking agents to stop both parasympathetic and sympathetic signals from reaching the heart during asphyxia crises will keep the heart beating longer. Apparently there is a pattern to the course of dying in such cases, and knowing the pattern can help the timing of intervention. If blocking agents work in animals, this may be an option for human treatment.

Thus I should stop blaming the heart for early cardiac arrest in these conditions, at least in most cases, and blame the brain instead. A person with the strongest heart in the world could go into cardiac arrest quickly from asphyxia or blood loss if her nervous system effects cause the arrest.

As a philosopher of religion, this raises some issues for intelligent design arguments, at least those in the British natural theology tradition. Animal bodies are filled with examples of poor design; Francis Collins, who is a devout Christian, mentions some of them in his attack on intelligent design arguments (one of the design flaws is that instead of a totally separate, two-tube system for food and air, we have a system in which a flap closes the airway while we eat so that air goes into the trachea rather than the esophagus. Collins points out that any human engineer would have enough sense to avoid such a flawed design. The fact that our brains “try” to kill us during severe disease, trauma, or asphyxia does not suggest intelligent design—it suggests that some of the so-called protective mechanisms of the brain can make cardiac arrest occur more rapidly, resulting in less time for doctors to focus on underlying causes and resulting in the deaths of many people who would not otherwise die. Give me a good cosmological contingency argument any day over an intelligent design argument. Now I am not calling God incompetent; I believe it is possible that evolution became flawed due to an angelic fall (as we see in J. R. R. Tolkien’s mythical account, in which Melkor (or Morgoth) and his allies damaged nature itself in their rebellion against Eru (God).

I suppose the satisfaction of curiosity is a good feeling, but I am also frustrated with the slow progress of medicine in this area in which very few studies have been done. I am glad some scientists are working in this seminal area of science and medicine and hope that their efforts result in lives saved from an early death.

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David Wainwright Evans, MD, FRCP: Rest in Peace

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David Wainwright Evans was a good man, a good scholar, and a good friend. His vita would be impressive by any standard: service in the Royal Air Force in World War II, both as a bomber pilot and a fighter pilot, Fellow of the Royal Society of Physicians, Consulting Cardiologist, Papworth Hospital, UK, and Fellow Commoner, Cambridge University, UK. I first met Dr. Evans via e-mail in 1996. I was planning to edit a book of scholarly articles in opposition to brain death criteria for declaring a person dead. Dr. Evans immediately agreed to contribute to the volume, and he wrote a fine chapter, “The Demise of ‘Brain Death’ in Britain.” He worked with a number of scholars and physicians on article on brain death and on ethical issues that arise if brain death is not death. This has obvious implications for the ethics of organ donation. Dr. Evans believed, as I do, that removal of unpaired vital organs from the “brain dead” individual is the taking of innocent human life and is therefore morally wrong. Dr. Evans remained true to his values even when pressured to change, and he retired early from cardiology in order to express openly his beliefs. That takes a great deal of moral courage, and I admire Dr. Evans for that. He was also an opponent of war, having seen its destructiveness as an RAF pilot. Dr. Evans was a fine Christian gentleman, a member of the Church of England who was faithful in his duty to God.

I had the privilege of seeing Dr. Evans twice in person while visiting England, first to attend a conference, and next on vacation (or “holiday” as the British call it). He and his wife, Rosemary, were gracious hosts and both visits were pleasant for me and (in the second visit) for my wife as well. Dr. Evans and I exchanged hundreds, perhaps thousands, of e-mails, in an excellent personal and professional friendship. The suddenness of his passing was a shock, but he was well into his eighties and died peacefully in his sleep. He is in the hands of God now, and I hope to see him again one day in a far better world than this one. Rest eternal grant unto him, O Lord, and may light perpetual shine upon him. May his soul, and the souls of all the faithfully departed in Christ, rest in peace. A-men.

Jahi McMath, Brain Death, and the Lies of the Medical Establishment

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After post-tonsillectomy bleeding, Jahi McMath suffered a cardiac arrest that damaged her brain. She was declared brain dead. The hospital wants to remove her ventilator, but the family is opposed. While there have been extensions granted by judges, the hospital, the medical establishment, the State of California, and the bioethics establishment have ganged up to force Ms. McMath’s ventilator to be removed. The hospital refuses to do a needed tracheotomy since “we can’t operate on a dead person” (this in spite of the fact that the hospital would support removing the organs of a person declared “brain dead” even though that is surgery as well). The hospital refuses to authorize transport, and under California law, the coroner “has to release the body.” This is an example of declaring a person dead by fiat and is a logical consequence of the acceptance of “brain death” criteria beginning in 1968.

Henry K. Beecher was the chairman of the Harvard committee on brain death. In an article in the 1968 JAMA, he argued that brain death should be considered death in part because organs could then be harvested from the patient while they are still perfused with oxygenated blood. In later articles he was more explicit in saying that death was redefined in the interests of organ transplantation. The 1981 Uniform Determination of Death Act (UDDA) or a compatible law has been passed in all fifty states. The law says death can either be declared after cardiopulmonary arrest or when the “whole brain” is dead. The President’s Commission report claimed that once the brain is dead, the body’s organic unity is gone.

Brain death criteria are not well-supported by evidence. Cicero Coimbra, a neurologist in Brazil, has noted that one of the tests to determine brain death, the apnea test, which involves removing the ventilator from a patient suspected of being brain dead for three minutes to check for spontaneous respiration. Dr. Coimbra points out that this test can itself cause brain death in patients who are not initially brain dead. He also argues that there is hope for some of these patients–hypothermia and other treatments to preserve brain cells may have good results. There have been cases in which a person was about to have organs removed for transplantation–and the person fully recovered. It is possible that removing a ventilator from Ms. McMath might take the life of a person who might not otherwise die from her head injury.

The entire brain is not dead in most cases of brain death–studies have found EEG activity in the majority of so-called “brain-dead” patients tested. For organs to be removed, body temperature has to be close to normal, and body temperature is mediated by the hypothalamus, which is part of the brain (along with the pituitary gland, part of the endocrine system). Supporters of brain death claim that these parts of the brain do not count–one wonders what else they would say would not count if further evidence of continuing brain activity is found.

As the recent President’s Council report points out, brain dead people are organic unities. Their blood circulates, and oxygen/carbon dioxide exchange continue. While the ventilator provides oxygenated air, machine dependence is not equivalent to death. Some conscious people are ventilator-dependent, and no sane person would consider them dead. The President’s Council identified death with loss of respiratory function combined with permanent loss of consciousness. Why, then, does ventilation count for life and not the heartbeat? Also, given that our knowledge is limited concerning the generation of consciousness in the brain, claims of permanent unconsciousness are arrogant at best.

I respect Arthur Caplan as a significant scholar in bioethics. What I cannot respect is his ignoring opponents of brain death in his public statements as if there is no current debate on the topic in academia. It reveals a lack of respect for opponents of brain death criteria, some of whom are physicians (Dr. Coimbra and Dr. Alan Shewmon as well as the late Richard Nilges practice or practiced neurology). Professor Caplan is surely aware that just because a law says death occurs at a certain point does not imply that the law is correct. Many bad laws have been passed–the UDDA may be another example of bad law.

Current bioethicists tend to think that patient autonomy is fine when the patient (or the patient’s family in the case of an incompetent patient) refuses care. But if a patient or patient’s family wants continued care, then there are appeals to “futility,” as if “futility” is not a value-laden term. “Death” is also a value-laden term and can be used for utilitarian ends such as justifying organ harvesting from heart-beating donors or to save money by removing a ventilator from a little girl. The hypocrisy of many doctors, hospital administrators, and “bioethicists” is sickening. The trashing of the value of Ms. McMath’s life is ethically monstrous. Given the history of movements such as the eugenics movement and experiments such as the Tuskegee Syphilis Experiment, I wonder what motivations are really in the minds of some of those most eager to remove Ms. McMath’s ventilator. Utilitarianism now trumps the value of human life, and medicine is corrupted to the point that I wonder whether some doctors are really practicing medicine any more.

If it were determined that Ms. McMath could not recover, the family’s wishes should be honored, even if the care Ms. McMath receives is “extraordinary care.” The family would also have the moral right to ask that the ventilator be turned off — but autonomy goes both ways and not only in the direction that cynical “bioethicists” desire.

The 2013 Annual International Conference of the Society for Psychical Research: Part I

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The 2013 annual conference of the Society for Psychical Research took place at Swanea University in Swansea, Wales, UK from September 6-8. This was one of the most interesting conference I have attended, since my primary interest in psychical research is the survival issue, and many of the papers dealt with survival. I was able to attend most sessions; I wanted to see the ruins of Oystermouth Castle when I was there, so I missed some sessions to walk to Mumbles. It was a grand site, well worth seeing.

 Alan Murdie did a fine job as Chairman of the Program Committee and MC. He is a worthy successor to Bernard Carr, who has done a splendid job the past thirty years in the same role. The first paper, by John Poynton, was entitled “Different Vibrations or Different Spaces? A Basic Question in Psi Research.” As I listened to this fascinating paper, my mind wandered back to Sunday School class when I was in high school. The teacher, Ken Schott, said that Heaven “could be in this very room, but in a different dimension,” and since then I have been intrigued with that idea. Professor Poynton surveyed possible locations of OBE survival, dividing the options into:

 (1) single field theories, in which there is one single physical space (this he called “the common view” and

 (2) many field theories, in which physical and OBE bodies occupy two different spaces of some kind (which he stated is the more common view in scientific settings).

 Problems with single field theories include:

 (1)   How can the OBE body displace matter—“Kant’s Problem.”

(2)   OBE space does not seem to be wholly isomorphic with physical space.

(3)   OBE experiences are of a different quality than experiences in physical space.

(4)   The theories are illogical—they seem to posit an outdated medieval world which Heaven and Hell are literally above the physical world.

 In many field theories, different spaces may be viewed simultaneously—this can easily reduce to the single field idea. There are two many field alternatives to single field theories:

(1)   Unnested—different spatial fields/worlds.

(2)   Nexted—different superimposed spatial fields with a different hyperspace with faster vibrations.

 Stevenson and Whiteman seem to assume non-nested spaces.

The nested view is held by the spiritualists—it holds there is an objectively real spirit world in the same space as we exist, but the matter vibrates more rapidly.

There may be a hierarchy of spaces, such as physical space, the space of paranormal experiences, and the space of mystical experiences.

Theorists suggest two ways layers may be organized:

(1)   Like layers through a cake (Carr, Smythes)

(2)   Like a Russian doll (Findley)

Prof. Poynton raised the important issue of whether human beings are capable of experiencing a four-dimensional world. Kant denied that we could [for Kant, space—as well as time—are forms of sensibility that structure our sense experience and are necessary and universal forms in the mind that we impose on the world. Kant believe the form of sensibility that is space to be three dimensional by necessity]. Prof. Poynton mentioned a fascinating account of an NDE by the Roman historian Plutarch in which the NDEr could see in four directions at once.

Prof. Poynton also raises the interesting Aristotelian point of how much do we know what fundamental processes (potentiality and actualization of potential)  that underlie the manifestation for an observer of any spatial world and the object experienced? How much do (and can) we know about the constitution of non-physical objects.

 Michael Whiteman uses words like “light” or “noetic” space. [Here I would point out that a medieval thinker overlooked in many discussions of psi is Robert Grosseteste (1168-1253), who believed that all was made of light and that light is the medium between matter and spirit]. Jean-Pierre Jourdan prefers to posit a “fifth dimension.”  Bernard Carr prefers the term “hyperphysics.” His position is that the extra dimensions are time-like—different levels of the “specious present” but in the same space.

Professor Poynton’s paper was one of the most interesting at the conference. It was, by nature, highly speculative, but the speculations on multiple spaces (or times) seem reasonable and hopefully can generate further research that can aid in our understanding of OBEs, NDEs, and a possible “afterlife world.”

Goth Culture

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Fille-goth

Fille-goth (Photo credit: Wikipedia)

Black garb. Victorian dresses. Hanging out at graveyards. A love of the macabre. Enjoyment of music in minor key. All these characteristics are, at least on the surface level, signs that someone is a “Goth.” Goth culture represents one of the fascinating aspects of the contemporary world0–the number of subcultures distinguished by dress, lifestyles, and special interests. This is in part a search for identity, but it also reflects the natural human desire to have friends with common interests (as Aristotle recognized over two thousand years ago).

Goth culture dates back at least thirty years. Musical groups such as Bauhaus performed songs that had to do with the gothic tradition in literature–they focused, for example, on Edgar Allen Poe‘s work or on Mary Shelly’s Frankenstein novel.  Young people interested in gothic horror and fascinated by graveyards and death flocked together. They began to wear black and many Goths wore makeup to exaggerate a pale appearance.

Goths do not share any particular world view–some are anti-Christian, some are Buddhists, some are traditional Christian or Jewish. I once chatted with a Muslim Goth. Gothic culture is a way for people who are “different” in their particular interests to find a sense of belonging. Being “different” myself, I can understand that desire. Some of my students think I am a Goth who does not dress like one–I love horror stories, horror music, horror movies, hanging out at graveyards, and being out in the dark “hunting” for ghosts. My office at school is filled with animal skulls–goats (one painted red), a cat, and a monkey. I have a “Grim Reaper” clock and several small manufactured human skulls. The picture of the Mona Lisa hanging on my bulletin board shifts into a skeleton as someone passes by it. I also have a framed copy of a Victorian death photo in which a dead boy, propped up, has his arm around his sister. Now all of this may be a sure sign of my immaturity (I wholeheartedly agree). Most local Goths, though, are very anti-Christian so joining their group is not really an option for me, an orthodox Anglican Catholic.

Emo is said to have replaced Goth, but I do not believe that is the case. There are fewer Goth clubs, but the breadth of Gothic culture as compared to Emo should keep Goth alive for many years. Goth culture, ironically, is often more life-affirming than the angst (usually the teen angst) of Emo. For that reason, Goth culture is not dead or dying–it is alive and well and needs no funeral. Plus, women with jet black hair and wearing black are….aesthetically pleasing.

There is a great deal of ignorance about Goth culture. Some Fundamentalist Christians identify it with Satanism. That is sheer ignorance and does not reflect the past–it is the kind of stupidity that led the West Memphis Three to spend years of their lives in prison despite their innocence of the murder of three cub scouts. Some people fear difference and find it to be evil. That is sad, but it is human nature. Hopefully the Fundamentalists will grow out of their ignorance and realize that Goths are people like them who enjoy each other’s company and are trying to get by in life the best they can. Hopefully this short essay provides a more balanced position on gothic culture.

On “Guilty Pleasures”

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Estonian heavy metal group Remote Silence perf...

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I enjoy listening to classical music and jazz, especially bebop. I also enjoy listening to heavy metal music, something that I count among my “guilty pleasures.” I cannot explain the attraction, although the groups I like the most (Anthrax, Zao) tend to write more intellectual lyrics than are found in other heavy metal bands. Another guilty pleasure may relate to this interest–I love horror fiction and horror movies. Black Sabbath became successful when they tried to reach horror fans with their music, and other groups followed. From Rob Zombie to black and death metal, horror themes are found in heavy metal music. Now some people would say I should be ashamed of this guilty pleasure, and perhaps they have a point. Richard Weaver, the author of the fine book Ideas Have Consequences, thought jazz to be decadent, and he would have rolled over in his grave if he had lived long enough to have heard heavy metal music.

As for horror fiction, I prefer books of higher literary quality–not only the classic works such as Frankenstein and Dracula, but also works of fine contemporary horror writers such as Ramsey Campbell and, yes, Stephen King. Dean Koontz is not as strong, though his writing has improved over the years. I love his Frankenstein series. Now and then I don’t mind reading a trashy horror novel–or seeing a trashy horror movie. With a red face I admit I like both the movies Reanimator and Bride of Reanimator. H. P. Lovecraft would have fainted if he saw how his work was adapted, but there is a campiness to these movies that eases the shock of their graphic imagery.

Another guilty pleasure is that I collect animal skulls–so far I have several dog, cat, and deer skulls, a cow skull, a horse skull, a goose skull, and perhaps more if my old brain could remember them. I do not know the source of that interest entirely–as a child I was afraid of skulls and skeletons when they appeared in horror movies or shows. I remember watching, in the late 1960s as a child, an episode of the horror soap opera Dark Shadows. Someone was sitting down and glanced up to look at a bookcase. Several skulls floated in the air. I screamed, got in trouble, and eventually was…. punished….. for insisting on continuing to watch the show. While an interest in skulls could be explained by my fear-fascination with death, such a pleasure becomes less guilty due to my fascination with form in nature. So many patterns repeat in nature, not only in different living organisms, but inanimate ones, too. That’s the excuse I give myself to feel better about this interest.

Last but not least is ghost investigations. I have no idea whether or not ghosts exist.  I do believe (and have experienced) things that are difficult to explain via conventional science. But I enjoy being in the dark, feeling like a child in the woods listening to ghost stories. It is not that I do not take this activity seriously, but I find it to be lots of fun despite the work involved.

Everyone probably has at least one guilty pleasure, something he enjoys that seems incongruent which his known character and interests. Someone who likes fine wines may have a cheap white Zinfandel now and then. A person who enjoys fine dining may enjoy the occasional splurge as a cheap, greasy fast food restaurant. I’m not convinced that these guilty pleasures are worth feeling guilty about. They reveal human beings to be interesting and complex creatures who can tie together disparate, even contradictory, interests together in their minds. If quirks and guilty pleasures do not harm a person and make this short life a little more interesting, then more power to them.

Newspapers and Stillborns

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Memorial Service

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Before I read Robert Kastenbaum’s textbook on death and dying, I was not aware that some U. S. newspapers refuse to print the obituaries of stillborn infants. I had to read the statement twice to believe it was there–to be fair to Kastembaum, he does not like that fact any more than I. Although my fraternal twin brother, Jeffrey, was not stillborn, he died two hours after birth of severe bilateral pulmonary hemorrhage. The tendency in society is to downplay the import of such losses and downplay the parents’ grief. “The child really didn’t get a chance to live.” Granted, the child’s life was short, but what follows from that? Is a mother or father’s love somehow missing because a baby was stillborn or died shortly after birth? What gives a newspaper a moral right to deny the existence of such infants to the point of refusing to print their obituaries? I wonder if a society that allows abortion through the ninth month of pregnancy (provided, during that last trimester, that a woman has a doctor certify that the fetus is a threat to her physical and/or “mental” health) can properly value stillbirths or infants dying shortly after birth. Those newspapers that forbid such obituaries are reflecting the values of moral liberals in the wider society, liberals who do not admit the intrinsic value of human life from conception onward. Such an attitude is reflected in bioethicist Peter Singer’s statement that “An adult chimpanzee is of more moral worth than a newborn human infant.” He would go as far as to deny personhood to a newborn until the baby is a week old, and even then Singer does not believe that true moral personhood is present until the child is several years old. American society may not be quite that radical, but when children are considered to be burdens rather than gifts, a stillborn infant can be relegated to secondary status–or perhaps to tertiary status, lower on the scale of value than nonhuman animals.

Recent research on grief suggests that parents, especially mothers, mourn deeply over stillbirths and over infants who die shortly after birth. The least a newspaper can do is to acknowledge their loss by printing their child’s obituary. To do otherwise is to exhibit a fundamental lack of respect for the dignity of the stillborn infant or of the infant who dies shortly after birth. To do otherwise says that the severe grief felt by parents over the infant’s death is misguided. I suggest that it is not the parents who are misguided; it is newspaper editors who refuse to respect the dignity of all human persons, born, stillborn, or unborn.

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