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Of Loose Wires, Green Goblins, and Other Matters.

When I was a lad, I would regularly gather with a few chums in my uncle's garden shed to share puffs of a purloined cigarette and listen to the popular BBC show "Much Binding in the Marsh" on an old floor model radio, well past its prime, which had a tendency to wheeze, buzz, and distort the signal. When such an interruption occurred, we dealt with the inconvenience by slapping the machine hard--if necessary several times--until order was restored.

We had differing accounts of why the cure was (generally) effective. On the basis of what I had learned by observing my family, I claimed that all machines had wires in them, that sometimes these got loose, and that a good blow often put them back into place. The lad who lived next door opined that the radio had a green goblin inside, who occasionally dozed off and needed to be woken up in order to keep the radio working properly. And the twins from across the street produced various answers, usually involving long accounts of dust particles and various environmental influences--they were much more interested in the artistic ingenuity of their explanations than in their plausibility and, being Irish, they could really go on (and on) about them in an amusingly imaginative way. We had no interest in checking the inside of the machine or arguing about the truth of our differing accounts; we were quite happy to accept them all. What mattered was that the radio worked and we could hear the show.

For centuries a good deal of scientific thinking in western civilizations was not unlike our pre-teen shed conversations--an alliance of practical loose-wire thinking, irrational or tautological green-goblin theories, and increasingly complicated explanations. For well over a thousand years this mixture satisfied most people that they had what they needed to know in order to function in a purposeful natural world created for their contemplation, enjoyment, and use.

The arrival of the new science in the seventeenth century, however, created a new demand--power over nature for the "relief of man's estate"--and possessed a fairly clear sense of how to satisfy it. The first step was to discard one's faith in the old notions and insist that from now on all explanations had to be reasonable and material and, if possible, mathematical. The second was to stress the importance of experiments under proper conditions. Loose-wire thinking had to be tested (and confirmed or rejected on the basis of replicable empirical results), green-goblin thinking eradicated, and overly complicated speculation trimmed with Occam's Razor.

The publication of Isaac Newton's Principia (1687) was a triumphant and reassuring vindication of the new science, but, of course, the old thinking did not disappear. The work of Robert Boyle illustrates that well enough. One of the most prominent proselytizers of the cause and a pioneer in the development and promotion of the new scientific method, Boyle was also an alchemist striving to change metals into gold, an ardent supporter of causes to promote the Christian faith and, in his medical practice, a champion of traditional folk treatments. His book, Medical Experiments: or, A Collection of Choice and Safe Remedies, For the most part Simple, and easily prepar'd: Very Useful in Families, contains over five hundred medical recipes, including one for Paracelsus's Zebethum Occidentale (powdered human dung) to be blown into the eyes to relieve strain and a "homely, but experienced Medicine for a sore Throat"--a linctus of Album Graecum (or "white Dogs-turd") to be swallowed slowly. The book was extremely popular, going through several editions, even after Boyle's death in 1691.

For the general populace, the obvious place where received wisdom, superstition, and the new science most frequently collided was medicine. Patients with pains and illnesses always needed relief and reliable guidance, especially since many of the options were at best dubious and at worst lethal. Here, the new empirical science achieved a triumph rivalling Newton's work in physics, one which has long been celebrated as the finest contribution ever made by a single individual to "the relief of man's estate": Edward Jenner's work in the 1790s to eradicate smallpox.

Jenner is often credited with the discovery of immunology. But, in fact, immunization against smallpox had been known and practised for centuries long before him and had been introduced into western Europe early in the 18th century. The procedure (called variolation, after the Latin word for the disease) was effective but risky, since it involved rubbing smallpox pustules or scabs from smallpox victims into a scratch on the patient's arm and hoping that the procedure would not bring with it a full-blown attack of the disease. Since some patients did succumb to smallpox as a result of the immunization, variolation was a fiercely contested practice: Was the immunity worth the risk?

Jenner sought an alternative to variolation in the growing but still not widely known country practice of infecting people with cowpox, a mild disease endemic among milkmaids, which seemed to bring with it an immunity to smallpox. Jenner was not the first to notice the connection, but he determined to test it by inoculating subjects with cowpox, waiting for some time, and then injecting them with smallpox, and in a series of textbook experiments he demonstrated that cowpox was indeed an effective and safe immunizing agent against smallpox. He published his findings in 1798. In subsequent decades the procedure he laid out became widely implemented throughout Europe, and Jenner has been world famous ever since.

For all its revolutionary successes, however, the new science also created a new problem: the growing influence of increasingly powerful scientific societies and professional associations, whose members were eager, among other things, to defend and augment their reputations, social influence, and income, if necessary at the expense of any threat they perceived to their acknowledged expertise. Jenner's work, for example, was met in some quarters with abuse, hostility, and accusations of fraud, fostered, in large part, by physicians who had a stake in the commercial aspects of variolation and wished to defend their turf. Such professional self-interest was at the time particularly significant also in the treatment of scurvy, another terrible illness, which killed more sailors than storms and warfare combined. The cure for scurvy (citrus fruits) was known and written about as early as 1593, and accounts of its efficacy were common in the 18th century, especially in Spain. A very small and incomplete clinical trial strongly suggesting the efficacy of lemons and oranges as cures for scurvy was conducted onboard ship by James Lund, a navy doctor, in 1747. The medical establishment in England, however, had its own ideas and stubbornly refused to listen, let alone to explore or approve alternatives. Their opposition had a pernicious influence, particularly on the Royal Navy, until the 1790s, when the Lords of the Admiralty, with a war on their hands and desperately in need of sailors, pre-emptively disregarded expert scientific advice and ordered lemon juice to be issued as a daily ration to the crews on its ships. The instant disappearance of scurvy as a serious shipboard illness confirmed the Tightness of their decision and has served ever since as a warning: scientific experts have agendas, and these do not always include unswerving allegiance to the appropriate procedures or the loftiest goals of the scientific enterprise.

Not that we need that example, of course, given that we have more than enough from our own times. For the pursuit of genuine science nowadays requires one to remain vigilant not only about the self-interest of professional associations but also about politically motivated government largesse and the "scientific" pronouncements of large companies peddling improvements in any number of areas. In search of knowledge, fame, and fortune, scientists have, of course, had many astonishing successes (transplant surgery, transistors, genome sequences, antibiotics, and the Green Revolution, to cite only a few that immediately come to mind). Our faith in these successes and the humanitarian and economic benefits they confer has led us to transform our education system in our public universities, to increase government funding for science exponentially, and to look to science to deal with our most important problems. However, we have also witnessed, especially in medicine, any number of loose-wire procedures posing as science turn into (often richly rewarded) disasters or extraordinarily expensive diversions.

The nadir in the history of modem science might well be the 1949 Nobel Prize for Physiology or Medicine awarded to Antonio Egas Moniz for his pioneering work in developing lobotomy, a procedure whose main attraction, it seems, was making patients, the majority of whom were female, more manageable. And then there's the War on Cancer, launched by Richard Nixon in 1971. This continuing national campaign encouraged, among other things, a lot of rather dubious loose-wire projects and, after more than forty-five years and the expenditure of countless billions of dollars, for all the significant improvements in knowledge, diagnosis, and treatment of some cancers, has resulted in a disappointingly small change in overall mortality rates for the disease. Its single greatest achievement so far (an important victory) has been to convince a lot of people to stop smoking. Maybe science sometimes has to go on long detours like this to discover the short way home, but the enormous cost has always had a distinctly political whiff. Meanwhile, on other fronts we have the pharmaceutical industry, sloppy or complicit regulators, and careless physicians to thank for our very own opiate wars and various alliances between large corporations, governments, and the universities, vowing (not very reassuringly) to keep scientific research dynamic and disinterested, always mindful of the public good.

One area where our understanding of nature has been, in the past century, a veritable wild west show, with good science, bad science, quasi-science, folk traditions, and fads riding the range as rival gangs constantly sniping and snipping at each other, has been the treatment of psychiatric disorders. We have witnessed the astonishing rise and subsequent fall of psychoanalysis (a protean green goblin if ever there was one), a bewildering menu of alternative mental wellness therapies, an extraordinary rise in the popularity of legal psychotropic drugs of questionable efficacy, and a flourishing market for traditional folk remedies, not to mention various illicit possibilities. So far the new science, now legally empowered to rule on the efficacy of many different options, has, in spite of a considerable effort, been unable to chart a reliable course through the therapeutic battle royal, let alone to come up with an agreed-upon understanding or cure for even the most common mental illnesses. In the past century and a half, no area of modern science has had so many hyperbolically heralded and lavishly funded "breakthroughs" followed a few years later by rueful admissions of failure.

I unwittingly became personally acquainted with these range wars in the late 1980s when I had myself checked into the psychiatric ward at our city hospital at the insistence of my wife, a Registered Nurse with professional clinical experience of psychiatric medicine, who recognized an acute state of suicidal depression when she saw one. In my first consultation with the resident psychiatrist, a Scottish doctor whose incisive intelligence was soon evident, she asked me if I would like a behavioural or a chemical explanation for my condition. After a moment's pause, I observed that she was asking me to choose between sin and Fate. "Aye," she said. "I am." I told her that, as a devout Homerophile, I believed in Fate, not sin, so that I would much prefer the chemical option. "Good," she replied. "I agree."

I later learned that my residence in that hospital ward occurred at the height of a revolution in which the biological treatment of mental disorders--launched originally by Thorazine (1954), Miltown (1955), and Valium (1963) and recently popularized by Nancy Andreasen's best-selling The Broken Brain (1985)--was in the ascendant and psychoanalytic therapy in rapid decline and that my doctor was a faithful acolyte of the new orthodoxy. The therapists in the hospital were displeased when I failed to show up for their sessions, but they could not override the physician. So I took the pills diligently, paced anxiously around the ward listening to Neil Diamond (the consensus choice of residents for music in the common area), and after several weeks was discharged. When the illness struck again (and again), I immediately resorted to what had worked before--antidepressants and sleeping pills. As I have aged, the duration of an "episode" has grown longer and the time between bouts has shortened considerably (my Scottish psychiatrist had warned me that this would happen, if I was successful in resisting the impulse to kill myself), and, in spite of many exhortations from friends and relatives and social workers to try various therapies or "natural" alternative medicines, I stuck with the familiar therapeutic cocktail.

I also did considerable internet research and realized that, in spite of all the dreary months I have spent in the past thirty years dealing with this miserable illness, I have been in some respects relatively lucky, because successful treatment seems to require a judicious balance of certain pills and dosages and routine consultation, a combination unique to a particular individual, something that one can only discover for oneself through trial and error. By visiting online chat rooms, I soon learned that many people suffer very badly in their (sometimes futile) search for the right combination, with stories of side effects and withdrawal symptoms so alarming that one is almost persuaded to abandon antidepressants altogether. I have been fortunate (so far) to avoid that contingency and have managed to trudge grimly through each attack to its eventual conclusion months later.

Of course, as a number of people have observed, many of the most pressing scientific questions about psychotropic medicine are moot because of the well-known and little understood placebo effect: the most useful treatments may well be those that help to make patients believe that they are on the road to recovery (whatever the specific details may be). I know that my own treatment requires a firm routine of particular pills and dosages and regular consultations, to satisfy my obsessive conviction that if I punctiliously follow every instruction to the letter every day, I am on the correct path (even though the light at the end of the tunnel is very dim and I am aware that there is little scientific evidence that the medications 1 take are all that effective). So I rely on my family doctor, who is very sympathetic and level headed: she carefully reviews the options and the routine and then wisely hands the responsibility to me: "This isn't your first rodeo," she tells me. "You know what to do. See me next week."

Ian Johnston is an emeritus professor at Vancouver Island University. He has translated a number of works of classical literature, including Homer, Aeschylus, Sophocles, Ovid, and Lucretius. These translations are freely available (as are many of his other writings) on his web page johns ton ia. https://records.viu.ca/~johnstoi/
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Author:Johnston, Ian
Publication:Humanist Perspectives
Date:Dec 22, 2019
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