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.

The Cult of Celebrity

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Just Whitney

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I am sorry that Whitney Houston, a beautiful woman with a beautiful voice, died, apparently another victim of the “fame factory” of the music business. Neither money nor fame provide fulfillment in life. If a person chooses to be sad over her death, there is nothing wrong with that. I remember feeling quite down after Elvis Presley died on August 16, 1977 (my Grandpa on my dad’s side of the family died the next day, so those dates are both etched on my mind). No one can deny that professional singers such as Elvis Presley and Whitney Houston have done good in providing a source of joy, the gift of music in its many styles, to their fans. However, there has been a lack of balance among Americans. One would think that a major world leader had died given the amount of coverage of Ms. Houston’s death. Of course that is not her fault, and she probably would have been embarrassed. Americans (and the Europeans) are unbalanced in their fascination and obsession with celebrities in the entertainment industry, whether such entertainment be music, movies, or athletic teams. Such as obsession implies, in my judgment, a shallow society that trades the most important things for the less important. When Mother Theresa and Princess Diana died within a few days of one another, people went wild with grief over Princess Di‘s death. It was as if she had no faults. Yet little was said about Mother Theresa’s death, and she did not receive the posthumous adulation that Princess Di received. Yet although Princess Di did a great deal of charity work and had been speaking in favor of abandoning mines in warfare, I would guess that Mother Theresa did much more good. And while Whitney Houston thrilled the country with her stirring performance of the Star Spangled Banner during the First Gulf War (which was a bad war anyway, in my opinion), physicians and scientists who help to save lives and restore people to their formal level of functioning receive little thanks. The near-worship of celebrities borders on idolatry, and anything said even remotely negative about a favored celebrity can land a person in a fistfight.

In a nation where community is dying and people grow more geographically from their families, the celebrity can become a substitute for family members or friends. Someone will keep up with a celebrity in the same way in the past that people would keep up with their family members through community gossip. One gains a “companion” without the risk of intimacy. When a celebrity dies, especially at a young age and unexpectedly, the news media focuses on that event to the point that it, in effect, canonizes the celebrity. Perhaps in a world stripped of saints and ritual, the cult of celebrity functions as a substitute for religion. If so, it will disappoint, for celebrities, in the end, are human beings, with weaknesses and faults like every other human being, from the wealthiest celebrity to the poorest people on the planet. Celebrity worship is the religion of the immature and shallow, of people who have little more to do than read the gossip magazines every week. It is good the enjoy the fruits of talented people in athletics, in acting, and in music. What is not good is an unhealthy obsession with people one barely knows rather than focusing on one’s own family and friends. It becomes an easy way to “care” without really caring, to “love” without the hard work that goes into real human love. It is an escape, and a pathetic one. Hopefully people into such unworthy worship will take a look at their lives and look to the true sources of meaning in life, faith, family, friends, and others whom we love, both emotionally and practically.

Newspapers and Stillborns

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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.

Dr. Richard Nilges: A Tireless Advocate of Truth

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Dr. Richard Nilges, neurologist and long-time critic of brain death criteria for human death, died last month after a long, productive life. I never met him in person, but via e-mail and telephone–the first time was in 1996. I was interested in editing a book of essays opposing brain death criteria. Never having edited a book before, I asked both Dr. Paul Byrne, a neonatologist and the dean of opponents of brain death criteria, and Dr. Nilges to help, and both graciously agreed. Dr. Nilges wrote a chapter for the book, which was published in 2000 as Beyond Brain Death: The Case Against Brain-Based Criteria for Human Death (Kluwer [now distributed by Springer-Verlag]). Dr. Nilges’ chapter, “Organ Transplantation, Brain Death, and the Slippery Slope: A Neurosurgeon’s Perspective,” was the most passionate chapter in the book, reflecting a lifetime of difficult battles against the medical establishment. He retired early after serving as an Attending Staff Member in Neurosurgery at Swedish Covenant Hospital, Chicago. His conscience would no longer allow him to declare patients dead using brain=based criteria. For many years after his retirement, Dr. Nilges, writing with Paul Byrne and others (such as Dr. David W. Evans and David Hill in the U.K.), spoke out against brain death criteria when medical and scholarly opponents of brain-based criteria for death were scarce (the late Professor Hans Jonas of the New School for Social Research was an exception). During the 1970s and 1980s, Dr. Nilges’ position was considered to be a fringe position by the medical and medical ethics establishments. But the work of Dr. Nilges and other pioneering opponents of brain death criteria eventually bore fruit. Professor Stuart Youngner began to hack at the medical arguments in favor of brain death criteria, bringing out arguments concerning continuing brain function in patients declared “bran dead” which Byrne and Nilges had noted years before. The real breakthrough came with Dr. Alan Shewmon, a pediatric neurologist at the UCLA School of Medicine, came out in opposition to brain death criteria. Eventually an entire network of physicians, philosophers, sociologists, and other scholars came to oppose brain death criteria; many questioned the morality of the current system of organ transplantation. If brain death is not death, then removing vital organs from the “brain dead” patient involves killing the patient. Not all opponents of brain death criteria oppose organ transplantation–Dr. Truog does not–but even Dr. Truog believes that people contemplating signing a donor card and families considering donation ought to be told that organ transplantation from a beating heart “brain-dead” donor kills the donor.

Now articles opposing brain death criteria have been published in major medical and bioethics journals. Some younger scholars are writing against brain death criteria, such as Professor Scott Henderson in his Death and Donation (Wipf and Stock, 2011). Thus there is a third generation of scholars willing to oppose the medical establisment’s continued support of brain death criteria. This would not have been possible without the pioneering and courageous work of the first generation opponents, including Dr. Richard Nilges. His legacy and influence will live on in the patients he helped over the years and in the scholars he inspired to have the courage to question what they may have previously taken for granted.

Dr. Nilges was a devout Roman Catholic whose faith was central to his life. Requiescat in pace.

Suboptimal Design, Evolution, and Anger at God

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C. S. Lewis once said that modern man places “God in the dock.” That is, moderns, instead of humbly submitting to God as the “clay to the potter,” they put God on trial and call Him to account for the evil and suffering in the world. Although Job, the Church Fathers, Augustine, and the other Medievals dealt with the problem of evil and suffering, it was modernity that developed full-fledged theodicies, broad-based explanations of why God created a world in which He permits evil and suffering.

A woman was driving down I-95 near where I live and was in an accident. She was rescued from her burning car. Only a few weeks later she choked to death on a piece of bologna in her home while her small children were asleep. This is one of those stories almost too painful to hear (like the scene in Saving Private Ryan when the soldier holds up his helmet that had been shot through and said something to the effect, “Hey look here! How lucky can that be” before a bullet hits him square between the eyes and kills him).

I have struggled with religious doubt all my life. I have also struggled with anger at God for the suffering of the world, especially (though not exclusively) the suffering of children. When I thought about the woman choking to death I thought of the suboptimal engineering of evolution. We walk upright and have developed the ability to talk, but that makes it anatomically more likely that we will choke to death. A human engineer would be fired for putting the food pipe and the windpipe where food can easily go down the wrong way. The epiglottis does not have a fail safe. I confess that my feelings were fury at God that He would use such as sorry a..ed process such as evolution to produce a suboptimal product that even a human engineer could design more efficiently. Other instances of suboptimal design can be mentioned: our mouth being too small for all our teeth, or our backs suffering pain because originally backs were meant for walking on all fours. There are young people who die suddenly and unexpectedly of a “primary electrical event” in the heart, some defect so small that our autopsy techniques and microscopic studies cannot yet identify it.

I do not know that there is an answer to the mystery of inefficient design this side of heaven. Some people might explain it in terms of a primeval Fall, but it is difficult to place that story in an evolutionary framework (although C. S. Lewis has tried). Given the sometimes violent behavior of our close relatives, the chimpanzees, toward one another, it seems that humans were always “fallen.” If that is the case, isn’t human suffering, pain, and death a part of the suffering, pain, and death that occurs in “nature, red in tooth and claw,” to use Lord Tennyson‘s words?

The Eastern Orthodox Church has the approach that makes the most sense to me–that the ultimate answer to evil and suffering is eschatological, beyond this life. Ivan Karamazov could not live with that answer in the novel The Brothers Karamazov, but like Ivan’s brother Alyosha,  I do not see that there is a choice if one wants to hold onto sanity. If God is evil or does not exist, then the world is absurd. I, at least, cannot live my life believing that. So my anger fades and I trust that God understands and will forgive this “miserable sinner.”

Fundamentalists and Afterdeath Communication

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Comfort in Grief

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I listened to a fine talk tonight at the Rhine Research Center in Durham, North Carolina by Louis LaGrand on extraordinary experiences of those grieving a loved one. Many of these individuals have an experience of the loved one communicating with them, ranging from an intuition of the deceased person’s presence to a full-body apparition carrying on a conversation with the surviving loved one. Many people who have such experiences, which as LaGrand noted, are really “ordinary” rather than “extraordinary” (millions of people have them) are given a cold shoulder by fundamentalists from two camps: the religious and the secular.

Secular fundamentalists who accept materialism as their religion would reject such experiences as subjective hallucinations. No matter what veridical evidence the grieving person offered, the secular fundamentalist would automatically reject it. These secular fundamentalists are often college and university professors who should be open minded, but who would not hesitate to ostracize or even threaten the job of an academic who dares to take these experiences as possibly objective or real. If secular fundamentalists are wrong about exceptional experiences being hallucinatory only, then their entire world view would be undermined. Their religious faith in secularism would be destroyed. And since many secularists are still in adolescent rebellion against an overly rigid religious upbringing, they will insist that any evidence contrary to their own views is invalid, the facts be damned.

The same is true of religious fundamentalists. Protestant fundamentalists, for example, will say, “The Bible says the dead don’t contact us and we shouldn’t contact them. If anything does contact us, it’s probably a demon rather than a loved one.” Of course they ignore Samuel’s vision of Saul rising up from Sheol, but they claim that was a one-time exception due to the permission of God.

The ignorance of Christian fundamentalists lies primarily in their claiming to know more than they really do. How do they know what state human souls are in between death and resurrection? How do they know whether the Biblical injunctions against mediumship and communication with the dead applied to such practices in pagan religious circles? How do they know that God would not give permission to a deceased individual, in certain cases, to communicate with a living person who needs comfort? I have always been impressed by the intellectual pretense and arrogance of fundamentalism, both Christian and secular. Both ignore the possibility that deceased loved ones may indeed be contacting their grieving friends and relatives. Both ignore a potential way through exceptional experiences to comfort the grieving in their loss.

Death and Annihilation

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When I was a child, I broke Piaget’s rules of child development–I had a developed concept of death by age five–that of complete annihilation. Having a twin brother who died two hours after he was born complicated matters for me since I learned about death at a young age. When my dog, Fuzzy, was killed by a car, I learned first hand that death meant the loved being would not return. And then, while watching the Easter episode of “Davy and Goliath,” when Davy’s grandmother dies the day after she looks perfectly healthy when he’s playing in the attic with her and they’re playing catch in her front yard, devastated me. I could not see through death’s darkness to discover the light of resurrection.

Later I was taught the Christian hope of the resurrection of the body. Intellectually I believe it is true. But emotionally, at two a.m., lying on my left side, hearing my heart pound through the mattress, I wonder if my religion is totally false, whether God does not exist, and whether death really means annihilation, the blanking out of consciousness.

The ancient Epicureans believed in annihilation and the famous Epicurean poet, Lucretius, wrote, “Death is nothing to us,” since if a person is annihilated, he can no longer suffer–so what’s there to fear about death? When I have taught philosophy classes, I find that most students agree with Lucretius.

Few students agree with Miguel de Unamuno, the great Spanish writer, who in his book, The Tragic Sense of Life, considered the prospect of annihilation at death worse than images of suffering in Hell. Nor do they understand Milton’s Paradise Lost, when the demons are damned to hell–they say something to the effect, “Yeah, it’s bad that we’re in Hell, but at least we have our consciousness, our self-awareness.”

Most atheists claim that the prospect of annihilation is either a matter of indifference or of comfort. David Hume horrified Samuel Johnson by his lack of fear of annihilation. Bertrand Russell once said, “When I die, I shall rot,” and had no more problem with the prospect of annihilation that someone would with a minor inconvenience. Is my attitude due to a strange personality, or is there more to the fear of annihilation than meets the eye.

Rene Descartes famously said Cogito, ergo sum: “I think, therefore I am.” Although I do not agree with him that the human essence is consciousness (embodiment is an essential part of human personhood), there is something to be said for his focus on self-consciousness. Consciousness is a gift we take for granted. How wonderful it is to be aware of the beautiful world around us, to be aware of loved ones, to be aware of our bodies and our own thoughts! Can we realize what a wonderful gift that is? Losing one’s awareness totally and irretrievably, blanking out into nonbeing, is not frightening because of any pain I would feel, but because I would feel, think, and sense nothing at all–for all practical purposes, there would be no more me. That is why the promise of resurrection is so precious–it is a promise to restore us to the fullness of life, which includes our self-awareness–and more. But if death is the end, as St. Paul put it in I Corinthians 15, “Let us eat and drink, for tomorrow we die.” That is why I have always thought Hell was a gift of God’s mercy–He gives the unrepentant as much reality as they can have without annihilating them. I have no sympathy for the view of Edward Fudge and others who believe that Hell is total annihilation, for that would be an act of a cruel deity. The concept that I could be annihilated at death if the nonbelievers in an afterlife are correct frightens me, like it did Unamuno, almost infinitely more than the prospect of consciousness in Hell. We, like all creatures, have a natural desire to continue in being (philosophers as diverse as Aquinas and Spinoza recognized that fact). Death in the sense of total annihilation goes against that natural desire. This is why Ambrose Bierce’s short story, “An Occurrence at Owl Creek Bridge” is one of the most frightening stories I have ever read–I won’t give away the ending–it’s worth reading. I pray for deeper faith, to go beyond, “Lord I believe, pardon my unbelief” to a faith that lives beyond doubt. May we all have such faith.

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