Medical Examiner Quotes

Screw up my life?" He stared at me for a second and then said, deadpan, "I'm a five-foot-three, thirty-seven-year-old, single, Jewish medical examiner who needs to pick up his lederhosen from the dry cleaners so that he can play in a one-man polka band at Oktoberfest tomorrow." He pushed up his glasses with his forefinger, folded his arms, and said, "Do your worst.

After the trial, I watched as another female pathologist collected maggots from a spinal column found in the desert. There was a decomposed head, too, and before leaving work she planned to simmer it and study the exposed cranium for contusions. I was asked to pass this information along to the chief medical examiner, and, looking back, I perhaps should have chosen my words more carefully. 'Fire up the kettle,' I told him. 'Ol'-fashioned skull boil at five p.m.

THE MAXIMS OF MEDICINE Before you examine the body of a patient, Be patient to learn his story. For once you learn his story, You will also come to know His body. Before you diagnose any sickness, Make sure there is no sickness in the mind or heart. For the emotions in a man’s moon or sun, Can point to the sickness in Any one of his other parts. Before you treat a man with a condition, Know that not all cures can heal all people. For the chemistry that works on one patient, May not work for the next, Because even medicine has its own Conditions. Before asserting a prognosis on any patient, Always be objective and never subjective. For telling a man that he will win the treasure of life, But then later discovering that he will lose, Will harm him more than by telling him That he may lose, But then he wins. THE MAXIMS OF MEDICINE by Suzy Kassem

Staying alive, as it turns out, is mostly common sense.

The spirit is one of the most neglected parts of man by doctors and scientists around the world. Yet, it is as vital to our health as the heart and mind. It's time for science to examine the many facets of the soul. The condition of our soul is usually the source of many sicknesses.

There are no emergency autopsies,” another resident pointed out to me. “Your patients never complain. They don’t page you during dinner. And they’ll still be dead tomorrow.

SELFISH”: The medical examiner can’t bring herself to admit that sometimes, she’s the one who wants to be cut open, to have someone tell her all of her own secrets.

If you examine your motive for doing anything, you'll soon discover that your reason is that you believe it will make you happy.

When you hear hoofbeats, think of horses--not zebras.' In other words, most things are exactly what they seem, and the simplest answer is usually the right one.

The chairman of the state board of medical examiners was a retired physician who thought that President Teddy Roosevelt was the only other man in the world besides himself who had not been made from a banana.

Mine is a gruesome job, but for a scientist with a love for the mechanics of the human body, a great one.

Nothing but the natural ignorance of the public, countenanced by the inoculated erroneousness of the ordinary general medical practitioners, makes such a barbarism as vaccination possible.......Recent developments have shown that an inoculation made in the usual general practitioner's light-hearted way, without previous highly skilled examination of the state of the patient's blood, is just as likely to be a simple manslaughter as a cure or preventive. But vaccination is nothing short of attempted murder. A skilled bacteriologist would just as soon think of cutting his child's arm and rubbing the contents of the dustpan into the wound, as vaccinating it in the same.

One of the first things we teach medical students is to listen to the patient by taking a careful medical history. Ninety percent of the time, you can arrive at an uncannily accurate diagnosis by paying close attention, using physical examination and sophisticated lab test to confirm your hunch (and to increase the bill to the insurance company).

To confront death every day, to see it yourself, you have to love the living.

That’s what I want you to tell me. See, I deal with…well, most days, bizarre paranormal crap. You are Queen Weird. I need the queen on this before I have to start hiring a new staff of medical examiners who don’t freak out when the dead move off their tables. You know where I can find some of these unusual people? I know you hang out with them. (Tate) Thanks, Tate. I always look forward to these ego-bolstering pep talks of ours. (Simone)

Were these boys in their right minds? Here were two boys with good intellect, one eighteen and one nineteen. They had all the prospects that life could hold out for any of the young; one a graduate of Chicago and another of Ann Arbor; one who had passed his examination for the Harvard Law School and was about to take a trip in Europe,--another who had passed at Ann Arbor, the youngest in his class, with three thousand dollars in the bank. Boys who never knew what it was to want a dollar; boys who could reach any position that was to boys of that kind to reach; boys of distinguished and honorable families, families of wealth and position, with all the world before them. And they gave it all up for nothing, for nothing! They took a little companion of one of them, on a crowded street, and killed him, for nothing, and sacrificed everything that could be of value in human life upon the crazy scheme of a couple of immature lads. Now, your Honor, you have been a boy; I have been a boy. And we have known other boys. The best way to understand somebody else is to put yourself in his place. Is it within the realm of your imagination that a boy who was right, with all the prospects of life before him, who could choose what he wanted, without the slightest reason in the world would lure a young companion to his death, and take his place in the shadow of the gallows? ...No one who has the process of reasoning could doubt that a boy who would do that is not right. How insane they are I care not, whether medically or legally. They did not reason; they could not reason; they committed the most foolish, most unprovoked, most purposeless, most causeless act that any two boys ever committed, and they put themselves where the rope is dangling above their heads.... Why did they kill little Bobby Franks? Not for money, not for spite; not for hate. They killed him as they might kill a spider or a fly, for the experience. They killed him because they were made that way. Because somewhere in the infinite processes that go to the making up of the boy or the man something slipped, and those unfortunate lads sit here hated, despised, outcasts, with the community shouting for their blood. . . . I know, Your Honor, that every atom of life in all this universe is bound up together. I know that a pebble cannot be thrown into the ocean without disturbing every drop of water in the sea. I know that every life is inextricably mixed and woven with every other life. I know that every influence, conscious and unconscious, acts and reacts on every living organism, and that no one can fix the blame. I know that all life is a series of infinite chances, which sometimes result one way and sometimes another. I have not the infinite wisdom that can fathom it, neither has any other human brain

Oh, yes—that thing about house cats is true. Your faithful golden retriever might sit next to your dead body for days, starving, but the tabby won’t. Your pet cat will eat you right away, with no qualms at all. Like any opportunistic scavenger, it will start with your eyeballs and lips.

Don't deny reality for the sake of objectivity.

The second insurance company approved the policy after Hale took Roan to the Pawhuska doctor again for the required medical examination. The doctor recalled asking Hale, “Bill, what are you going to do, kill this Indian?” Hale, laughing, said, “Hell, yes.

During my two years training as a medical examiner in New York City, I was quick to learn that there is no such thing as a 'minor' surgery.

few days after Vryke’s death, a lawyer arrived at the San Francisco medical examiner’s office in the Hall of Justice. She was

She says she is aware of the irony of being a medical examiner who smokes, but that for all the blackened lungs she's seen, it is more disturbing to open the chest cavity of a veteran and find it is pristine.

She says she is aware of the irony of being a medical examiner who smokes, but that for all the blackened lungs she’s seen, it is more disturbing to open the chest cavity of a veteran and find that it is pristine.

When my parents passed on, and we read their wills, we discovered something we didn’t at all expect, especially from our devoutly Catholic mother: they had both left instructions that their bodies be donated to science. We were bewildered and we were pissed. They wanted their cadavers to be used by medical students, they wanted their flesh to be cut into and their cancerous organs examined. We were breathless. They wanted no elaborate funerals, no expense incurred for such stuff – they hated wasting money or time on ceremony, on appearances. When they died there was little left – the house, the cars. And their bodies, and they gave those away. To offer them to strangers was disgusting, wrong, embarrassing. And selfish to us, their children, who would have to live with the thought of their cold weight sinking on silver tables, surrounded by students chewing gum and making jokes about the location of freckles. But then again: Nothing can be preserved. It’s all on the way out, from the second it appears, and whatever you have always has one eye on the exit, and so screw it. As hideous and uncouth as it is, we have to give it all away, our bodies, our secrets, our money, everything we know: All must be given away, given away every day, because to be human means: 1. To be good 2. To save nothing

Everyone thinks “murder” when you say you work as a medical examiner, but homicides are rare. “Natural” is the most common manner of death and represents about a third of the cases that come to a medical examiner’s office.

Now I found myself at a windy crime scene in the middle of Manhattan rush hour, gore on the sidewalk, blue lights and yellow tape, a crowd of gawkers, grim cops, and coworkers who kept using the word “clusterfuck.” I was hooked.

To begin with, this case should never have come to trial. The state has not produced one iota of medical evidence that the crime Tom Robinson is charged with ever took place... It has relied instead upon the testimony of two witnesses, whose evidence has not only been called into serious question on cross-examination, but has been flatly contradicted by the defendant. Now, there is circumstantial evidence to indicate that Mayella Ewel was beaten - savagely, by someone who led exclusively with his left. And Tom Robinson now sits before you having taken the oath with the only good hand he possesses... his RIGHT. I have nothing but pity in my heart for the chief witness for the State. She is the victim of cruel poverty and ignorance. But my pity does not extend so far as to her putting a man's life at stake, which she has done in an effort to get rid of her own guilt. Now I say "guilt," gentlemen, because it was guilt that motivated her. She's committed no crime - she has merely broken a rigid and time-honored code of our society, a code so severe that whoever breaks it is hounded from our midst as unfit to live with. She must destroy the evidence of her offense. But what was the evidence of her offense? Tom Robinson, a human being. She must put Tom Robinson away from her. Tom Robinson was to her a daily reminder of what she did. Now, what did she do? She tempted a *****. She was white, and she tempted a *****. She did something that, in our society, is unspeakable. She kissed a black man. Not an old uncle, but a strong, young ***** man. No code mattered to her before she broke it, but it came crashing down on her afterwards. The witnesses for the State, with the exception of the sheriff of Maycomb County have presented themselves to you gentlemen, to this court in the cynical confidence that their testimony would not be doubted, confident that you gentlemen would go along with them on the assumption... the evil assumption that all Negroes lie, all Negroes are basically immoral beings, all ***** men are not to be trusted around our women. An assumption that one associates with minds of their caliber, and which is, in itself, gentlemen, a lie, which I do not need to point out to you. And so, a quiet, humble, respectable *****, who has had the unmitigated TEMERITY to feel sorry for a white woman, has had to put his word against TWO white people's! The defendant is not guilty - but somebody in this courtroom is. Now, gentlemen, in this country, our courts are the great levelers. In our courts, all men are created equal. I'm no idealist to believe firmly in the integrity of our courts and of our jury system - that's no ideal to me. That is a living, working reality! Now I am confident that you gentlemen will review, without passion, the evidence that you have heard, come to a decision and restore this man to his family. In the name of GOD, do your duty. In the name of God, believe... Tom Robinson

Screw up my life?” He stared at me for a second and then said, deadpan, “I’m a five-foot-three, thirty-seven-year-old, single, Jewish medical examiner who needs to pick up his lederhosen from the dry cleaners so that he can play in a one-man polka band at Oktoberfest tomorrow.” He pushed up his glasses with his forefinger, folded his arms, and said, “Do your worst.

I enjoyed the intellectual rigor and scientific challenge of death investigation. Everyone there, from new students to the most senior doctors, seemed happy, eager to learn, and professionally challenged. None of the medical examiners had cots in their offices. “There are no emergency autopsies,” another resident pointed out to me. “Your patients never complain. They don’t page you during dinner. And they’ll still be dead tomorrow.

Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice. When a great ship steams across the ocean, even tiny ripples can accumulate over time, precipitating a dramatic shift in course. There are many Tertius Lydgates, male and female, inhabiting the lecture halls, laboratories, and clinics of today’s medical schools. Like latter-day Lydgates, many of them eventually find themselves expressing amazement and disgust at how far they have veered from their primary purpose.

Speechlessness, however, affirmed in the diagnosis, is carefully based on the facts of the examination, as we see by rendering the statements concerned, just as they stand in examination and diagnosis: "If thou examinest a man having a wound in the temple, ...; if thou ask of him concerning his malady and he speak not to thee; ...; thou shouldst say concerning him, 'One having a wound in his temple, ... (and) he is speechless'.

Remember: This can only end badly.” That’s what my husband says anytime I start a story. He’s right. So.

During the last shift, an X-ray had revealed a woman’s severed hand, complete with wedding ring, entirely embedded inside the chest wall of a man’s intact torso.

All the medical examiners in the state of Florida are forensic pathologists with medical degrees.

Dave said, “Devane was there while the Medical Examiner,

The body arrived soon enough: an unclaimed corpse from a nearby medical examiner. The guinea pigs? A cinch. Undergraduates will do anything for extra credit.

(I)f you try to treat the medical problem you *think* you see without fully exploring the differential diagnosis -- call(ed) "speculation on a foundation of assumption" -- you can kill your patient.

If possible, you also want to determine the cause of death (technically, only medical examiners can determine cause of death; we anthropologists call things like stab wounds and gunshots “manner of death”). But

And yet often when I was out in the park or the woods, say, with my own little girls, I'd seen something and think to myself, That's just like the such-and-such scene, where we found the eight-year-old. As fearful as I was for their safety, seeing the things I saw, I also found it difficult to get emotionally involved in the minor, but important, scrapes and hurts of childhood. When I would come home and Pam would tell me that one of the girl had fallen off her bike and needed stitches, I'd flash to the autopsy of some child her age and think of all the stitches it had taken the medical examiner to close her wounds for burial.

The girl who climbed up the water tower. We would have counted her an accident until the medical examiner found breaks and fractures from her hips to her heels. "You fall head first," he said. "Feet first's a jump.

After seeing the medical examiner pull into the Doyles’ drive, Margo nearly passed out. She had never felt such fear before in her life. It was as if someone had reached right down her throat and snatched her breath away.

Opening Yulia Koroleva's uterus was the most heartbreaking thing I'd ever done. When I saw that perfect fetus, when I took it in my hands, my vision clouded over with tears and my professional reserve fell away...[he] had fully formed organs each in its correct location, without any abnormalities. The foot length told me he had been nineteen weeks old, exactly halfway through gestation. I returned him to his mother's body, to be buried with her.

Josie often had to go for medical examinations," I said. "They took samples of her blood and other things. Josie never liked those examinations. They hurt her. Do you think there could be a way of making those examinations nice for her?

You’re part of the forensics club,” the medical examiner said doubtfully. I shifted my weight from foot to foot. “Detective Shepard is our adviser,” I said. It was true. Sort of. You could look at this semester as the weirdest independent study anyone had ever had.

As I followed Elsie back along the riverbank, I brushed my fingertips against the silky catkins on the willow trees and wished Daddy had failed the medical examination too. I stopped now and then to collect interesting-looking pebbles that clacked together satisfyingly in my pockets, and to pick the pretty wildflowers: stitchwort and ragwort, silverweed and harebell, lady's purse and cinquefoil. Elsie told me their names. As we walked, I repeated them over and over so I wouldn't forget them, storing them away like precious gems to admire again later, in private.

Next to her was the chief medical examiner sporting trendy black-framed glasses. The Therian oozed elegance and confidence as he held out his hand. He was also pretty hot. “Nice to meet you, Dr. Colbourn.” The way the doctor eyed Dex said he wouldn’t mind giving Dex a personal examination.

Classifying depression as an illness serves the psychiatric community and pharmaceutical corporations well; it also soothes the frightened, guilty, indifferent, busy, sadistic, and unschooled. To understand depression as a call for life-changes is not profitable. Stagnation is not a medical term. The 17.5 million Americans diagnosed as suffering a major depression in 1997 were mostly damned. (Psychobiological examinations confuse cause and symptom.) Deficient serotonergic functioning, ventral prefrontal cerebral cortex, dis-inhibition of impulsive-aggressive behavior, blah blah blah: the medical lexicon boils emotion from human being. Go take a drug, the doctor says. Pain is a biochemical phenomenon. Erase all memory.

The Case of the Radium Girls was a mystery to challenge even the greatest of medical detectives. Martland took his new responsibilities seriously. As he himself said, “One of the main functions of a medical examiner is to prevent wastage of human life in industry.”6 The cynical would say, however, that this proclamation had absolutely nothing to do with why he took an interest in the radium cases at that moment. The cynical would say there was only one reason a high-profile specialist finally took up the cause. On June 7, 1925, the first male employee of the United States Radium Corporation died.

Progress is not one of those floating comparatives, so beloved of our friends in advertising, we need a context, a perspective. What are we better than? Who are we better than? Examine this statement: Most people are better off. Financially? socially? educationally? medically? spiritually? I dare not ask if you are happy? Are you happy?

Defective is an adjective that has long been deemed too freighted for liberal discourse, but the medical terms that have supplanted it—illness, syndrome, condition—can be almost equally pejorative in their discreet way. We often use illness to disparage a way of being, and identity to validate that same way of being. This is a false dichotomy. In physics, the Copenhagen interpretation defines energy/matter as behaving sometimes like a wave and sometimes like a particle, which suggests that it is both, and posits that it is our human limitation to be unable to see both at the same time. The Nobel Prize–winning physicist Paul Dirac identified how light appears to be a particle if we ask a particle-like question, and a wave if we ask a wavelike question. A similar duality obtains in this matter of self. Many conditions are both illness and identity, but we can see one only when we obscure the other. Identity politics refutes the idea of illness, while medicine shortchanges identity. Both are diminished by this narrowness. Physicists gain certain insights from understanding energy as a wave, and other insights from understanding it as a particle, and use quantum mechanics to reconcile the information they have gleaned. Similarly, we have to examine illness and identity, understand that observation will usually happen in one domain or the other, and come up with a syncretic mechanics. We need a vocabulary in which the two concepts are not opposites, but compatible aspects of a condition. The problem is to change how we assess the value of individuals and of lives, to reach for a more ecumenical take on healthy. Ludwig Wittgenstein said, ―All I know is what I have words for.‖ The absence of words is the absence of intimacy; these experiences are starved for language.

Guns leave distinct types of wounds at different ranges. A contact wound, with the gun touching or pressed into the skin, can sear a round scorch mark called a muzzle stamp.

The outer layer of epidermis slid off in my hand like the rind of a rotten fruit.

There is not such thing as "minor" surgery. Minor surgery is surgery someone else has.

Maybe nobody cares about you when you are alive, but lots of people take an interest once you are dead.

Let conversation cease. Let laughter flee. This is the place where Death delights to help the living.

We can't leave the snow all bloody," I told the underside of his chin,shadowed with stubble. "It will scare the tourists." "The new snow will cover it up." He looked down at me."Shhh." Something in his Shhh tugged at my heart. He kept watchiing me,not examining m ear for medical emergencies but looking into my eyes,for a few more steps. I couldn't read his look.He was kind of blurry,for one thing,and I was kind of dizzy. I thought he looked..concerned. Sympathetic. Determined to rescue me from danger. I wished that was what he felt. But it couldn't have been.I was misreading him.

St. Peter went home well satisfied. He did not mention to Dr. Dudley the real reason for his asking for a medical examination. One doesn't mention such things. The feeling that he was near the conclusion of his life was an instinctive conviction, such as we have when we waken in the dark and know at once that it is near morning; or when we are walking across the country and suddenly know that we are near the sea.

Psychologisation describes the emphasis on psychological factors where there is little or no evidence to justify it (1). It's a process where relevant findings are ignored or downplayed in favour of data from incomplete examinations, flawed research or anecdotal reports. In a clinical context, differential diagnoses may be dismissed prematurely while psychological explanations are readily accepted. Psychologisation does not refer to situations where there is sound evidence that psychological factors play a significant role, or where all the arguments are discussed and the psychological explanations are deemed the most persuasive.

For the first time, Soviet scientists admitted that 17.5 million people, including 2.5 million children under seven, had lived in the most seriously contaminated areas of Ukraine, Belarus, and Russia at the time of the disaster. Of these, 696,000 had been examined by Soviet medical authorities by the end of 1986. Yet the official tally of deaths ascribed to the disaster to date remained the same as that announced the previous year: 31.

Moreover, autogynephiles often eroticise aspects of womanhood that most women dislike, such as menstruation, undergoing intimate medical examinations, experiencing sexism or wearing uncomfortable clothes. 'Forced feminisation' - someone making a man cross-dress or undergo sex-reassignment surgery - is a staple of transgender erotica. Quite a few of Lawrence's informants say they would find it shameful to be a woman, and that this turns them on.

A year after the event, the Office of Chief Medical Examiner had issued 2,733 death certificates for the victims of the World Trade Center bombings—1,344 by judicial decree and 1,389 based on identified remains. The count of Members of the Service confirmed dead was 343 firefighters, 23 NYPD officers, and 48 others, most of these Port Authority police. The dead left more than 3,000 orphans. It was the largest mass murder in United States history.

And there is one thing that I really, really like to have company for. Watching TV. I'm not particularly needy in relationships, I actually demand a fair amount of space. But I really like to be in bed with another human being and watch TV. That's as intimate and reassuring and tender as it gets for me. I find dating exhausting and uninteresting, and I really would like to skip over the hours of conversation that you need just to get up to speed on each other's lives, and the stories I've told a million times. I just want to get to the watching TV in bed. If you're on a date with me, you can be certain that this is what I'm evaluating you for—how good is it going to be, cuddling with you in bed and watching Damages I'm also looking to see if you have clean teeth. For me, anything less than very clean teeth is fucking disgusting. Here's what I would like to do: I would like to get into bed with a DVD of Damages and have a line of men cue up at my door. I would station a dental hygienist at the front of the line who would examine the men's teeth. Upon passing inspection, she(I've never met a male hygienist, and neither have you) would send them back to my bedroom, one at time, in intervals of ten minutes, during which I would cuddle with the man and watch Damages. Leaving nothing to chance, using some sort of medical telemetry, I would have a clinician take basic readings of my heart rate and brain waves, and create a comparison chart to illustrate which candidate was the most soothing presence for me. After reviewing all the data from what will now be known in diagnostic manuals throughout the world as the Silverman-Damages-Nuzzle-Test, I will make my selection.

I was so engrossed by the idea that it took me a moment to register that the drivers behind were laying on their horns and I had a green. I hit the gas, rummaged one-handed through the files Cumali had given me, found a note to the medical examiner with her mobile number attached to it, and pulled out my cell phone. I was halfway through dialing when I realized that a woman with a six-year-old child might not appreciate being woken, and, anyway, what was she going to do that late at night?

Despite the odium and widespread condemnation of Donald J. Trump, 45th President of the United States of America, he passed with all the fanfare of a fart in a mesh sack. Medical examiners said it was a thrombotic stroke, likely exacerbated by obesity and high blood pressure. Some said cocaine and opioids had been found in his system, but these reports were never confirmed. Trump was dead, and now it was time to start glossing over his dismal legacy and perpetuating his vision, posthumously, for Making America Great Again...

I recently asked more than seventy eminent researchers if they would have done I their work differently if they had thought Darwin's theory was wrong. The responses were all the same: no. I also examined the outstanding biodiscoveries of the past century: the discovery of the double helix; the characterization of the ribosome: the mapping of genomes; research on medications and drug reactions: improvements in food production and sanitation; the development of new surgeries; and others. I even queried biologists working in areas where one would expect the Darwinian paradigm to have most benefited research, such as the emergence of resistance to antibiotics and pesticides. Here, as elsewhere, I found that Darwin's theory had provided no discernible guidance, but was brought in, after the breakthroughs, as an interesting narrative gloss.

In this book, I examine the history and legacy of the preference for slimness and aversion to fatness, with attention to their racial, gender, class, and medical contours. This book enters a decades-long conversation about the preference for slenderness and the phobia about fatness in the United States.

Oh, yes—that thing about house cats is true. Your faithful golden retriever might sit next to your dead body for days, starving, but the tabby won’t. Your pet cat will eat you right away, with no qualms at all. Like any opportunistic scavenger, it will start with your eyeballs and lips. I’ve seen the result.

Romanians, however, paid a terrible price for Ceauşescu’s privileged status. In 1966, to increase the population—a traditional ‘Romanianist’ obsession—he prohibited abortion for women under forty with fewer than four children (in 1986 the age barrier was raised to forty-five). In 1984 the minimum marriage age for women was reduced to fifteen. Compulsory monthly medical examinations for all women of childbearing age were introduced to prevent abortions, which were permitted, if at all, only in the presence of a Party representative. Doctors in districts with a declining birth rate had their salaries cut. The population did not increase, but the death rate from abortions far exceeded that of any other European country: as the only available form of birth control, illegal abortions were widely performed, often under the most appalling and dangerous conditions. Over the ensuing twenty-three years the 1966 law resulted in the death of at least ten thousand women. The real infant mortality rate was so high that after 1985 births were not officially recorded until a child had survived to its fourth week—the apotheosis of Communist control of knowledge. By the time Ceauşescu was overthrown the death rate of new-born babies was twenty-five per thousand and there were upward of 100,000 institutionalized children. The

LUCAS HUNG ON, and Bob said to Rae, “If this works, I’m probably going to have to kiss Lucas’s ass. You might not want to be here for that.” “No time for it anyway,” Lucas said. “If this works, we need to get down to Quantico and check this stuff out.” Rae: “Why? We’ll just have him email it to us.” Lucas rubbed his face, and sighed. “Shit. You know, deep in my heart, I don’t understand that we don’t always have to go places to get things anymore,” Lucas said. “I was about to drive an hour over to the Medical Examiner’s Office to look at Ritter’s belt. The investigator sent me the iPhone photos in seven minutes. Kind of scizzes me out, the way it comes out of the sky now.

I had a wonderful rejuvenating half-hour massage before going backt to work. "You"re under a lot of stress because your chakras are way out of whack," the pleasant young masseuse informed me. That, and I'm working a graveyard shift sifting through fetid human remains under Frankenstein conditions, I thought privately. That, and the chakras.

Things changed after that between me and Mark. I stopped being mortified that people might mistake me for one of his acolytes. I was his Boswell, don’t you know. I interviewed him about his childhood—his father was a psychiarist in Beverly Hills. I cataloged the contents of his van. I followed him around at work, sitting in while he examined patients. He had been a bit of a prodigy when we were in college. After his father developed a tumor, Mark, who was pre-med, started studying cancer with an intensity that convinced many of his friends that his goal was to find a cure in time to save his father. As it turned out, his father didn’t have cancer. But Mark kept on with his cancer studies. His interest was not in fact in oncology—in finding a cure—but in cancer education and prevention. By the time he entered medical school, he had created, with another student, a series of college courses on cancer and coauthored The Biology of Cancer Sourcebook, the text for a course that was eventually offered to tens of thousands of students. He cowrote a second book, Understanding Cancer, that became a bestselling university text, and he continued to lecture throughout the United States on cancer research, education, and prevention. “The funny thing is, I’m not really interested in cancer,” Mark told me. “I’m interested in people’s response to it. A lot of cancer patients and suvivors report that they never really lived till they got cancer, that it forced them to face things, to experience life more intensely. What you see in family practice is that families just can’t afford to be superficial with each other anymore once someone has cancer. Corny as it sounds, what I’m really interested in is the human spirit—in how people react to stress and adversity. I’m fascinated by the way people fight back, by how they keep fighting their way to the surface.” Mark clawed at the air with his arms. What he was miming was the struggle to reach the surface through the turbulence of a large wave.

In 1995, China passed the National Maternal and Infant Health Law, forbidding couples who had “genetic diseases of a serious nature” to procreate. The conditions listed include mental retardation, mental illness, and seizures. These couples were required to undergo a mandatory premarital medical exam. It was hugely controversial, reviving international criticism that China practices eugenics. Actually, the wording of the national law was considered mild. Some provinces had more explicit regulations. In 1988, Gansu Province passed local regulations prohibiting “reproduction of the dull-witted, idiots, or blockheads.” Gansu abolished that law in 2002. Similarly, the National Maternal and Infant Health Law was defanged when requirements for the premarital medical examination were quietly dropped in 2003.

Actually, very few topics of scientific research can be studied with controlled experiments. There are many fields that everyone accepts as science, even though laboratory experiments are difficult if not impossible—fields like astronomy, evolutionary biology, geology, and paleontology. The prestigious British Medical Journal published a tongue-in-cheek article claiming to examine whether parachutes help prevent deaths in people who jump out of airplanes. The authors had eliminated anecdotal evidence from consideration, including in their review only randomized controlled trials. Of course, they couldn’t find a single experiment in which people were randomly assigned to jump out of an airplane either with or without a parachute. They concluded: “The perception that parachutes are a successful intervention is based largely on anecdotal evidence.

Dr. Knef was a medical man through and through. When Mollie Maggia’s jawbone had so shockingly broken against his fingers, he had been fascinated by it—so he had kept it, this oddly moth-eaten, misshapen piece of bone. Every now and again, after her death, he had examined it, turning it over in his hands, but he was none the wiser; anyway, she had died of syphilis, whatever the strangeness of her bones. He’d therefore popped the fragment into his desk drawer, where he kept his x-ray negatives, and eventually it slipped his mind. And then, one day, his duties had required him to dig through that crowded desk drawer for the x-ray films. He had scrambled through the bits and pieces he kept in there, searching for them. To his astonishment, when he finally pulled them out, the films were no longer ebony black. Instead, they were “fogged,”31 as though something had been emanating onto them.

[...] we have in our treatise a series of fifty-seven examinations, almost exclusively of injuries of the human body forming a group of observations furnishing us with the earliest known nucleus of fact regarding the anatomy, physiology and pathology of the human body. Crude and elementary as they are, the method by which they were collected was scientific, and these observations, together with the diagnoses and the explanatory commentary in the ancient glosses, form the oldest body of science now extant.

Every diagnostic challenge in medicine can be imagined as a probability game. This is how you play the game: you assign a probability that a patient’s symptoms can be explained by some pathological dysfunction—heart failure, say, or rheumatoid arthritis—and then you summon evidence to increase or decrease the probability. Every scrap of evidence—a patient’s medical history, a doctor’s instincts, findings from a physical examination, past experiences, rumors, hunches, behaviors, gossip—raises or lowers the probability.

If the cultural standing of excrement doesn't convince them, I say that the material itself is as rich as oil and probably more useful. It contains nitrogen and phosphates that can make plants grow and also suck the life from water because its nutrients absorb available oxygen. It can be both food and poison. It can contaminate and cultivate. Millions of people cook with gas made by fermenting it. I tell them that I don't like to call it "waste," when it can be turned into bricks, when it can make roads or jewelry, and when in a dried powdered form known as poudrette it was sniffed like snuff by the grandest ladies of the eighteenth-century French court. Medical men of not too long ago thought stool examination a vital diagnostic tool (London's Wellcome Library holds a 150-year0old engraving of a doctor examining a bedpan and a sarcastic maid asking him if he'd like a fork). They were also fond of prescribing it: excrement could be eaten, drunk, or liberally applied to the skin. Martin Luther was convinced: he reportedly ate a spoonful of his own excrement daily and wrote that he couldn't understand the generosity of a God who freely gave such important and useful remedies.

point. We work on the principle that behavior reflects personality and generally divide the profiling process into seven steps: 1. Evaluation of the criminal act itself. 2. Comprehensive evaluation of the specifics of the crime scene or scenes. 3. Comprehensive analysis of the victim or victims. 4. Evaluation of preliminary police reports. 5. Evaluation of the medical examiner’s autopsy protocol. 6. Development of a profile with critical offender characteristics. 7. Investigative suggestions predicated on construction of the profile. As the final step indicates, offering a profile of an offender is often only the beginning of the service we offer. The next level is to consult with local investigators and suggest proactive strategies they might use to force the UNSUB’s hand— to get him to make a move. In cases of this nature we try to stand off at a distance and detach ourselves, but we still may be thrust right into the middle of the investigation. This may involve meeting with the family of a murdered child, coaching family members how to handle taunting phone calls from the killer describing how the child died, even trying to use a sibling as bait in an effort to lure the killer to a particular place.

Mercedes took Richard to the hospital. He was examined perfunctorily and Mercedes was told he was an epileptic and was experiencing grand mal seizures. There was nothing to worry about—he’d “grow out of it.” He was not given any medication, nor was Mercedes asked to bring him back. At home, Ruth began noticing that her baby brother was having long staring spells in which he would just sit still and look at something—a wall, a table, the floor—for five, ten, fifteen minutes without speaking or moving. He was having petite mal seizures, but no one realized it then, and Richard wasn’t diagnosed or treated. Richard had one to two dozen of these petite mal attacks every month until he entered his early teens, when they, as well as the less frequent grand mal seizures, lessened and eventually stopped altogether. According to Dr. Ronald Geshwind, a certain number of people who suffer from temporal lobe epilepsy have altered sexuality and hyper-religious feelings, are hypergraphic (have a compulsion to write), and are excessively aggressive. Van Gogh, Julius Caesar, Napoleon, Dostoevsky, and Lewis Carroll all suffered from temporal lobe epilepsy. Years later, after all the trouble, Richard would be diagnosed as having temporal lobe epilepsy.

We know from history that much of what doctors do at any particular time is ineffective or even dangerous when viewed in retrospect. Years ago a famous professor warned his graduating medical students that half of what he'd taught them was wrong, but the trouble was he didn't know which half...the principle still applies: we don't know which of the well-intentioned therapies of the present will end up looking like the leeches and bloodletting of ancient time or like the thalidomide, Dalkon shields, and tonsillectomies of a more recent era gone by. Accordingly, the pronouncements of doctors should be viewed with healthy skepticism.

cause of cavities, even more damaging than sugar consumption, bad diet, or poor hygiene. (This belief had been echoed by other dentists for a hundred years, and was endorsed by Catlin too.) Burhenne also found that mouthbreathing was both a cause of and a contributor to snoring and sleep apnea. He recommended his patients tape their mouths shut at night. “The health benefits of nose breathing are undeniable,” he told me. One of the many benefits is that the sinuses release a huge boost of nitric oxide, a molecule that plays an essential role in increasing circulation and delivering oxygen into cells. Immune function, weight, circulation, mood, and sexual function can all be heavily influenced by the amount of nitric oxide in the body. (The popular erectile dysfunction drug sildenafil, known by the commercial name Viagra, works by releasing nitric oxide into the bloodstream, which opens the capillaries in the genitals and elsewhere.) Nasal breathing alone can boost nitric oxide sixfold, which is one of the reasons we can absorb about 18 percent more oxygen than by just breathing through the mouth. Mouth taping, Burhenne said, helped a five-year-old patient of his overcome ADHD, a condition directly attributed to breathing difficulties during sleep. It helped Burhenne and his wife cure their own snoring and breathing problems. Hundreds of other patients reported similar benefits. The whole thing seemed a little sketchy until Ann Kearney, a doctor of speech-language pathology at the Stanford Voice and Swallowing Center, told me the same. Kearney helped rehabilitate patients who had swallowing and breathing disorders. She swore by mouth taping. Kearney herself had spent years as a mouthbreather due to chronic congestion. She visited an ear, nose, and throat specialist and discovered that her nasal cavities were blocked with tissue. The specialist advised that the only way to open her nose was through surgery or medications. She tried mouth taping instead. “The first night, I lasted five minutes before I ripped it off,” she told me. On the second night, she was able to tolerate the tape for ten minutes. A couple of days later, she slept through the night. Within six weeks, her nose opened up. “It’s a classic example of use it or lose it,” Kearney said. To prove her claim, she examined the noses of 50 patients who had undergone laryngectomies, a procedure in which a breathing hole is cut into the throat. Within two months to two years, every patient was suffering from complete nasal obstruction. Like other parts of the body, the nasal cavity responds to whatever inputs it receives. When the nose is denied regular use, it will atrophy. This is what happened to Kearney and many of her patients, and to so much of the general population. Snoring and sleep apnea often follow.

Sauckel told me a very curious fact. All the girls whom we bring back from the Eastern territories are medically examined ; and 25 per cent of them are found to be virgins. That couldn't happen in Upper Bavaria! Contrary to popular belief, it is wrong to suppose that virginity is a particularly desirable quality; one cannot help suspecting that those who have been spared have nothing particular to offer ! And what is popularly said on the subject of Christian virgins I hesitate to repeat. When in the marriage ceremony the priest mentions virginity and the holy bond of matrimony, one always sees some of the lads grin and nudge each other; quite a number of them probably know this "Christian virgin" inside out!

There is an ongoing debate in the forensic medical community about the influence of brain injuries and abnormalities on the commission of violent crime. A number of killers, subjected to imaging studies or as a result of postmortem examination, have been found to have brain lesions of various sorts. Those in the deterministic camp, who believe that much aberrant behavior is influenced by distinct physiological causes, point to these lesions as proof that this is why the criminal acted the way he did. Those in the “free will” camp suggest that these lesions may be more symptom than cause—that is, they are the result of injuries produced by the impulsive, risk-taking behavior that these guys display as children.

of the remains you receive will be affected by this change.” Hirsch also revealed that our legal team had assembled a plan to issue death certificates for victims of the attacks based on two affidavits—one from the family and one from the employer of the missing person. “There will certainly be some victims who will never be positively identified, even by DNA,” he said. In those cases, the legal requirement for a death certificate would have to be met through sworn testimony of the people who last saw or heard from the vanished persons. “We will link the cases electronically once, and if, DNA or some other method identifies a missing person who has been issued a death certificate by judicial decree.” Dr. Hirsch finished his presentation that

Some people say he engineered his own arrest to gain an insight into modern methods of policing for a thriller he had planned. But you know what happens to artistic rats in prison: they have their rectums stretched, and not by overindulgence in Michelin-star food; they have their columns examined, and not by internet humorists or a qualified medical practitioner. I’m sure Rat knew this, too. Although he likes to accumulate a wide general knowledge, he would rather have a narrow rectum. A colon comes in handy here, before examples: two dots on top of one other, like the cowboys who copulate on Brokeback Mountain, on a slope so far away you need binoculars to see them properly. In prison there are too many insights and examples. Rat would never risk it.

Somewhere the help don’t quit as soon as the boss walks out the door. I’m gonna need a dozen clean pens.” The lambing barn had four rows of pens against the long walls and back-to-back in the middle. At any one time the pens could hold eighty ewes and their lambs. When things went well, a ewe came into the barn on Monday and left on Thursday, and after her apartment was renovated the shepherd could install a newcomer. When a ewe had trouble – mastitis, milk fever, pneumonia, blue bag – the pens filled with sick sheep and the sheep housing stock shrank. Penny spent a couple hours examining the ewes in the barn, medicating those that needed it, turning others with their lambs out into the sunshine. She slipped bands on lambs’ tails, checked new mothers for milk supply, milked out ewes for their colostrum, ear notched bad mothers so they could be culled.

Another common practice, the reps told us, was to take fancy meals to the entire doctor’s office (one of the perks of being a nurse or receptionist, I suppose). One doctor’s office even required alternating days of steak and lobster for lunch if the reps wanted access to the doctors. Even more shocking, we found out that physicians sometimes called the reps into the examination room (as an “expert”) to directly inform patients about the way certain drugs work. Hearing stories from the reps who sold medical devices was even more disturbing. We learned that it’s common practice for device reps to peddle their medical devices in the operating room in real time and while a surgery is under way. Janet and I were surprised at how well the pharmaceutical reps understood classic psychological persuasion strategies and how they employed them in a sophisticated and intuitive manner.

For doctors to determine that someone lacks capacity, or courts to find someone legally incompetent, is an extremely serious act and should be undertaken with hesitation and caution. A person who is suicidal is already in doubt about his or her value in the world, already feels powerless to transform or transcend life’s burdens. To declare this person incompetent is to confirm these feelings, to officially endorse the individual’s hopeless state. A finding of lack of capacity or incompetence completely erases the individual as a legally and medically respected decision-maker. It is exactly the opposite policy from what we should pursue: engaging a suicidal person in an earnest and respectful conversation about why he or she wants to die. Expanding the definition of incompetence as a utilitarian means of preventing suicide or controlling the actions of a suicidal person is dangerous and unnecessary social policy.

Gentlemen,' he was saying, 'I shall be brief, but I would like to use my remaining time with you to remind you that this case is not a difficult one, it requires no minute sifting of complicated facts, but it does require you to be sure beyond a reasonable doubt as to the guilt of the defendant. To begin with, this case should never have come to trial. This case is as simple as black and white. 'The state has not produced one iota of medical evidence to the effect that the crime Tom Robinson is charged with ever took place. It has relied instead upon the testimony of two witnesses whose evidence has not only been called into serious question on cross-examination, but has been flatly contradicted by the defendant. The defendant is not guilty, but somebody in this court-room is. 'I have nothing but pity in my heart for the chief witness for the state, but my pity does not extend so far as to her putting a man’s life at stake, which she has done in an effort to get rid of her own guilt.

Dr. Kary Mullis, who won the Nobel Prize in Chemistry for inventing PCR, stated publicly numerous times that his invention should never be used for the diagnosis of infectious diseases. In July of 1997, during an event called Corporate Greed and AIDS in Santa Monica CA, Dr. Mullis explained on video, “With PCR you can find almost anything in anybody. It starts making you believe in the sort of Buddhist notion that everything is contained in everything else, right? I mean, because if you can model amplify one single molecule up to something that you can really measure, which PCR can do, then there’s just very few molecules that you don’t have at least one single one of them in your body. Okay? So that could be thought of as a misuse of it, just to claim that it’s meaningful.” Mikki explained, “The major issue with PCR is that it’s easily manipulated. It functions through a cyclical process whereby each revolution amplifies magnification. On a molecular level, most of us already have trace amounts of genetic fragments similar to coronavirus within us. By simply over-cycling the process, a negative result can be flipped to a positive. Governing bodies such as the CDC and the WHO can control the number of cases by simply advising the medical industry to increase or decrease the cycle threshold (CT).” In August of 2020, the New York Times reported that “a CT beyond 34 revolutions very rarely detect live virus, but most often, dead nucleotides that are not even contagious. In compliance with guidance from the CDC and the WHO, many top US labs have been conducting tests at cycle thresholds of 40 or more. NYT examined data from Massachusetts, New York, and Nevada and determined that up to 90 percent of the individuals who tested positive carried barely any virus.”17 90 percent! In May of 2021, CDC changed the PCR cycle threshold from 40 to 28 or lower for those who have been vaccinated. This one adjustment of the numbers allowed the vaccine pushers to praise the vaccines as a big success.

Yet skill in the most sophisticated applications of laboratory technology and in the use of the latest therapeutic modality alone does not make a good physician. When a patient poses challenging clinical problems, an effective physician must be able to identify the crucial elements in a complex history and physical examination; order the appropriate laboratory, imaging, and diagnostic tests; and extract the key results from densely populated computer screens to determine whether to treat or to “watch.” As the number of tests increases, so does the likelihood that some incidental finding, completely unrelated to the clinical problem at hand, will be uncovered. Deciding whether a clinical clue is worth pursuing or should be dismissed as a “red herring” and weighing whether a proposed test, preventive measure, or treatment entails a greater risk than the disease itself are essential judgments that a skilled clinician must make many times each day. This combination of medical knowledge, intuition, experience, and judgment defines the art of medicine, which is as necessary to the practice of medicine as is a sound scientific base.

One of my colleagues in Duke, Ralph Keeney, noted that America's top killer isn't cancer or heart disease, nor is it smoking or obesity. It's our inability to make smart choices and overcome our own self-destructive behaviours. Ralph estimates that about half of us will make a lifestyle decision that will ultimately lead us to an early grave. And as if this were not bad enough, it seems that the rate at which we make these deadly decisions is increasing at an alarming pace. I suspect that over the next few decades, real improvements in life expectancy and quality are less likely to be driven by medical technology than by improved decision making. Since focusing on long-term benefits is not our natural tendency, we need to more carefully examine the cases in which we repeatedly fail, and try to come up with some remedies for these situations. For an overweight movie loved, the key might be to enjoy watching a film while walking on the treadmill. The trick is to find the right behavioural antidote for each problem. By pairing something that we love with something that we dislike but that is good for us, we might be able to harness desire with outcome - and thus overcome some of the problems with self-control we face every day.

Although these digital tools can improve the diagnostic process and offer clinicians a variety of state-of-the-art treatment options, most are based on a reductionist approach to health and disease. This paradigm takes a divide-and-conquer approach to medicine, "rooted in the assumption that complex problems are solvable by dividing them into smaller, simpler, and thus more tractable units." Although this methodology has led to important insights and practical implications in healthcare, it does have its limitations. Reductionist thinking has led researchers and clinicians to search for one or two primary causes of each disease and design therapies that address those causes.... The limitation of this type of reasoning becomes obvious when one examines the impact of each of these diseases. There are many individuals who are exposed to HIV who do not develop the infection, many patients have blood glucose levels outside the normal range who never develop signs and symptoms of diabetes, and many patients with low thyroxine levels do not develop clinical hypothyroidism. These "anomalies" imply that there are cofactors involved in all these conditions, which when combined with the primary cause or causes bring about the clinical onset. Detecting these contributing factors requires the reductionist approach to be complemented by a systems biology approach, which assumes there are many interacting causes to each disease.

The Covid-19 pandemic has made it clear that by several measures, the health status of Black Americans is on par with that of people living in far poorer nations, and that at every stage of life Black Americans have poorer health outcomes than white Americans and even, in most cases, than other ethnic groups. Racial health disparities show up at the beginning of life and cut lives short at the end. Black babies are more than twice as likely as white babies to die at birth or in the first year of life—a racial gap that adds up to thousands of lost lives every year.13 African American adults of all ages have elevated rates of conditions such as diabetes and hypertension that among white people are found more commonly at older ages. In the first half of 2020, owing to the pandemic, the Black-white gap in life expectancy increased to six years, from four in 2019.14 This inequality when it comes to the health of Black people’s bodies is rooted in false ideas about racial differences, developed and spread during slavery, and long challenged by Black medical practitioners and scholars, that still inform the way medical treatment is administered in America.15 To understand the racial divide in the health of our nation that was stripped bare by Covid-19, we must examine the roots of these myths. — In the 1787 manual A Treatise on Tropical Diseases; and on the Climate of the West-Indies, a British doctor, Benjamin Moseley, claimed that Black people could bear surgical operations much more easily than white people, noting that “what would be the cause of insupportable pain to a white man, a Negro would almost disregard.

The psychological impact of trauma in both the military and civilian arenas has been documented for well over 100 years [1], but the validity of the traumatic neuroses and their key symptoms have been continuously questioned. This is particularly true for posttraumatic amnesia and therapeutically recovered traumatic memories. Freud’s [2] abandonment of his seduction theory was followed by decades of denial of sexual trauma in the psychoanalytic and broader sociocultural realms [3]. Concomitant negation of posttraumatic symptomatology was noted in regard to the war neuroses, emanating equally from military, medical and social spheres [4]. Thus, Karon and Widener [5] drew attention to professional abandonment of the literature on posttraumatic amnesia in World War II combatants. They considered this to be due to a collective forgetting, comparable to the repression of soldiers, but instead occurring on account of social prejudices. He further noted that the validity of memories was never challenged at the time since there was ample corroborating evidence. Recent research confirms the findings of earlier investigators such as Janet [6], validating posttraumatic amnesia of both civilian and military origin. Van der Hart and Nijenhuis [7] cited clinical studies reporting total amnesia for combat trauma, experiences in Nazi concentration camps, torture and robbery. There is also increasing evidence for the existence of amnesia for child sexual abuse. Thus, Scheflen and Brown [8] concluded from their analysis of 25 empirical studies that such amnesia is a robust finding. Since then, new studies, for example those of Elliott [9], have appeared supporting their conclusion. This paper examines posttraumatic amnesia in World War I (WWI) combatants. The findings are offered as an historical cross-validation of posttraumatic amnesia in all populations, including those subjected to childhood sexual abuse.

It may seem paradoxical to claim that stress, a physiological mechanism vital to life, is a cause of illness. To resolve this apparent contradiction, we must differentiate between acute stress and chronic stress. Acute stress is the immediate, short-term body response to threat. Chronic stress is activation of the stress mechanisms over long periods of time when a person is exposed to stressors that cannot be escaped either because she does not recognize them or because she has no control over them. Discharges of nervous system, hormonal output and immune changes constitute the flight-or-fight reactions that help us survive immediate danger. These biological responses are adaptive in the emergencies for which nature designed them. But the same stress responses, triggered chronically and without resolution, produce harm and even permanent damage. Chronically high cortisol levels destroy tissue. Chronically elevated adrenalin levels raise the blood pressure and damage the heart. There is extensive documentation of the inhibiting effect of chronic stress on the immune system. In one study, the activity of immune cells called natural killer (NK) cells were compared in two groups: spousal caregivers of people with Alzheimer’s disease, and age- and health-matched controls. NK cells are front-line troops in the fight against infections and against cancer, having the capacity to attack invading micro-organisms and to destroy cells with malignant mutations. The NK cell functioning of the caregivers was significantly suppressed, even in those whose spouses had died as long as three years previously. The caregivers who reported lower levels of social support also showed the greatest depression in immune activity — just as the loneliest medical students had the most impaired immune systems under the stress of examinations. Another study of caregivers assessed the efficacy of immunization against influenza. In this study 80 per cent among the non-stressed control group developed immunity against the virus, but only 20 per cent of the Alzheimer caregivers were able to do so. The stress of unremitting caregiving inhibited the immune system and left people susceptible to influenza. Research has also shown stress-related delays in tissue repair. The wounds of Alzheimer caregivers took an average of nine days longer to heal than those of controls. Higher levels of stress cause higher cortisol output via the HPA axis, and cortisol inhibits the activity of the inflammatory cells involved in wound healing. Dental students had a wound deliberately inflicted on their hard palates while they were facing immunology exams and again during vacation. In all of them the wound healed more quickly in the summer. Under stress, their white blood cells produced less of a substance essential to healing. The oft-observed relationship between stress, impaired immunity and illness has given rise to the concept of “diseases of adaptation,” a phrase of Hans Selye’s. The flight-or-fight response, it is argued, was indispensable in an era when early human beings had to confront a natural world of predators and other dangers. In civilized society, however, the flight-fight reaction is triggered in situations where it is neither necessary nor helpful, since we no longer face the same mortal threats to existence. The body’s physiological stress mechanisms are often triggered inappropriately, leading to disease. There is another way to look at it. The flight-or-fight alarm reaction exists today for the same purpose evolution originally assigned to it: to enable us to survive. What has happened is that we have lost touch with the gut feelings designed to be our warning system. The body mounts a stress response, but the mind is unaware of the threat. We keep ourselves in physiologically stressful situations, with only a dim awareness of distress or no awareness at all.

All addictions — whether to drugs or to nondrug behaviours — share the same brain circuits and brain chemicals. On the biochemical level the purpose of all addictions is to create an altered physiological state in the brain. This can be achieved in many ways, drug taking being the most direct. So an addiction is never purely “psychological” all addictions have a biological dimension. And here a word about dimensions. As we delve into the scientific research, we need to avoid the trap of believing that addiction can be reduced to the actions of brain chemicals or nerve circuits or any other kind of neurobiological, psychological or sociological data. A multilevel exploration is necessary because it’s impossible to understand addiction fully from any one perspective, no matter how accurate. Addiction is a complex condition, a complex interaction between human beings and their environment. We need to view it simultaneously from many different angles — or, at least, while examining it from one angle, we need to keep the others in mind. Addiction has biological, chemical, neurological, psychological, medical, emotional, social, political, economic and spiritual underpinnings — and perhaps others I haven’t thought about. To get anywhere near a complete picture we must keep shaking the kaleidoscope to see what other patterns emerge. Because the addiction process is too multifaceted to be understood within any limited framework, my definition of addiction made no mention of “disease.” Viewing addiction as an illness, either acquired or inherited, narrows it down to a medical issue. It does have some of the features of illness, and these are most pronounced in hardcore drug addicts like the ones I work with in the Downtown Eastside. But not for a moment do I wish to promote the belief that the disease model by itself explains addiction or even that it’s the key to understanding what addiction is all about. Addiction is “all about” many things. Note, too, that neither the textbook definitions of drug addiction nor the broader view we’re taking here includes the concepts of physical dependence or tolerance as criteria for addiction. Tolerance is an instance of “give an inch, take a mile.” That is, the addict needs to use more and more of the same substance or engage in more and more of the same behaviour, to get the same rewarding effects. Although tolerance is a common effect of many addictions, a person does not need to have developed a tolerance to be addicted.

The biology of potential illness arises early in life. The brain’s stress-response mechanisms are programmed by experiences beginning in infancy, and so are the implicit, unconscious memories that govern our attitudes and behaviours toward ourselves, others and the world. Cancer, multiple sclerosis, rheumatoid arthritis and the other conditions we examined are not abrupt new developments in adult life, but culminations of lifelong processes. The human interactions and biological imprinting that shaped these processes took place in periods of our life for which we may have no conscious recall. Emotionally unsatisfying child-parent interaction is a theme running through the one hundred or so detailed interviews I conducted for this book. These patients suffer from a broadly disparate range of illnesses, but the common threads in their stories are early loss or early relationships that were profoundly unfulfilling emotionally. Early childhood emotional deprivation in the histories of adults with serious illness is also verified by an impressive number of investigations reported in the medical and psychological literature. In an Italian study, women with genital cancers were reported to have felt less close to their parents than healthy controls. They were also less demonstrative emotionally. A large European study compared 357 cancer patients with 330 controls. The women with cancer were much less likely than controls to recall their childhood homes with positive feelings. As many as 40 per cent of cancer patients had suffered the death of a parent before the age of seventeen—a ratio of parental loss two and a half times as great as had been suffered by the controls. The thirty-year follow-up of Johns Hopkins medical students was previously quoted. Those graduates whose initial interviews in medical school had revealed lower than normal childhood closeness with their parents were particularly at risk. By midlife they were more likely to commit suicide or develop mental illness, or to suffer from high blood pressure, coronary heart disease or cancer. In a similar study, Harvard undergraduates were interviewed about their perception of parental caring. Thirty-five years later these subjects’ health status was reviewed. By midlife only a quarter of the students who had reported highly positive perceptions of parental caring were sick. By comparison, almost 90 per cent of those who regarded their parental emotional nurturing negatively were ill. “Simple and straightforward ratings of feelings of being loved are significantly related to health status,” the researchers concluded.

In the future that globalists and feminists have imagined, for most of us there will only be more clerkdom and masturbation. There will only be more apologizing, more submission, more asking for permission to be men. There will only be more examinations, more certifications, mandatory prerequisites, screening processes, background checks, personality tests, and politicized diagnoses. There will only be more medication. There will be more presenting the secretary with a cup of your own warm urine. There will be mandatory morning stretches and video safety presentations and sign-off sheets for your file. There will be more helmets and goggles and harnesses and bright orange vests with reflective tape. There can only be more counseling and sensitivity training. There will be more administrative hoops to jump through to start your own business and keep it running. There will be more mandatory insurance policies. There will definitely be more taxes. There will probably be more Byzantine sexual harassment laws and corporate policies and more ways for women and protected identity groups to accuse you of misconduct. There will be more micro-managed living, pettier regulations, heavier fines, and harsher penalties. There will be more ways to run afoul of the law and more ways for society to maintain its pleasant illusions by sweeping you under the rug. In 2009 there were almost five times more men either on parole or serving prison terms in the United States than were actively serving in all of the armed forces.[64] If you’re a good boy and you follow the rules, if you learn how to speak passively and inoffensively, if you can convince some other poor sleepwalking sap that you are possessed with an almost unhealthy desire to provide outstanding customer service or increase operational efficiency through the improvement of internal processes and effective organizational communication, if you can say stupid shit like that without laughing, if your record checks out and your pee smells right—you can get yourself a J-O-B. Maybe you can be the guy who administers the test or authorizes the insurance policy. Maybe you can be the guy who helps make some soulless global corporation a little more money. Maybe you can get a pat on the head for coming up with the bright idea to put a bunch of other guys out of work and outsource their boring jobs to guys in some other place who are willing to work longer hours for less money. Whatever you do, no matter what people say, no matter how many team-building activities you attend or how many birthday cards you get from someone’s secretary, you will know that you are a completely replaceable unit of labor in the big scheme of things.

PATTERNS OF THE “SHY” What else is common among people who identify themselves as “shy?” Below are the results of a survey that was administered to 150 of my program’s participants. The results of this informal survey reveal certain facts and attitudes common among the socially anxious. Let me point out that these are the subjective answers of the clients themselves—not the professional opinions of the therapists. The average length of time in the program for all who responded was eight months. The average age was twenty-eight. (Some of the answers are based on a scale of 1 to 5, 1 being the lowest.) -Most clients considered shyness to be a serious problem at some point in their lives. Almost everyone rated the seriousness of their problem at level 5, which makes sense, considering that all who responded were seeking help for their problem. -60 percent of the respondents said that “shyness” first became enough of a problem that it held them back from things they wanted during adolescence; 35 percent reported the problem began in childhood; and 5 percent said not until adulthood. This answer reveals when clients were first aware of social anxiety as an inhibiting force. -The respondents perceived the average degree of “sociability” of their parents was a 2.7, which translates to “fair”; 60 percent of the respondents reported that no other member of the family had a problem with “shyness”; and 40 percent said there was at least one other family member who had a problem with “shyness.” -50 percent were aware of rejection by their peers during childhood. -66 percent had physical symptoms of discomfort during social interaction that they believed were related to social anxiety. -55 percent reported that they had experienced panic attacks. -85 percent do not use any medication for anxiety; 15 percent do. -90 percent said they avoid opportunities to meet new people; 75 percent acknowledged that they often stay home because of social fears, rather than going out. -80 percent identified feelings of depression that they connected to social fears. -70 percent said they had difficulty with social skills. -75 percent felt that before they started the program it was impossible to control their social fears; 80 percent said they now believed it was possible to control their fears. -50 percent said they believed they might have a learning disability. -70 percent felt that they were “too dependent on their parents”; 75 percent felt their parents were overprotective; 50 percent reported that they would not have sought professional help if not for their parents’ urging. -10 percent of respondents were the only child in their families; 40 percent had one sibling; 30 percent had two siblings; 10 percent had three; and 10 percent had four or more. Experts can play many games with statistics. Of importance here are the general attitudes and patterns of a population of socially anxious individuals who were in a therapy program designed to combat their problem. Of primary significance is the high percentage of people who first thought that “shyness” was uncontrollable, but then later changed their minds, once they realized that anxiety is a habit that can be broken—without medication. Also significant is that 50 percent of the participants recognized that their parents were the catalyst for their seeking help. Consider these statistics and think about where you fit into them. Do you identify with this profile? Look back on it in the coming months and examine the ways in which your sociability changes. Give yourself credit for successful breakthroughs, and keep in mind that you are not alone!