That way madness lies

To portray something -to make it believable- there has to be at least some understanding by the audience of what is being portrayed. Much in the sense, I suppose, that was suggested in the 1974 paper in The Philosophical Review by the American philosopher Thomas Nagel, asking what it would be like to be a bat. Not so much how it would feel to have the added sense of sonar, or be able to fly in the dark, but more about the consciousness of itself. As Wikipedia explains Nagel’s thinking: ‘an organism has conscious mental states, “if and only if there is something that it is like to be that organism—something it is like for the organism to be itself.”

This is a roundabout way of wondering whether an audience could ever know if an actor is representing something realistically if they cannot imagine what it would be like to be that thing.

Mental illness seems as if it is sufficiently prevalent that most of us would be expected to understand whether or not the author, or the actor, has captured its essence accurately, and yet, for those of us who have not experienced the wide panoply of its manifestations -the majority of us, I suspect- we might be easily mislead. The more gripping or sensational portrayals of illness, might well come to stereotype the lot. To stigmatize the condition.

I was scrolling through the BBC Culture section when I happened upon an article that discusses some of these same issues:

‘… the film industry has generally shown a shaky vision of mental health … It’s not that cinema evades ‘taboo’ themes here; it’s more that it tends to swing wildly from sentimentality to sensationalism.’ To attract an audience -i.e. to make a profit- ‘creative drama is drawn to the complexity and fragility of the mind – but mainstream entertainment still demands a snappy fix. And the definition of ‘insanity’ is inherently problematic.’

I am reminded of the French philosopher Michel Foucault’s book Madness and Civilization -subtitled A History of Insanity in the Age of Reason. He felt that the concept of madness was evolving over time: in the Renaissance, (as a thoughtful summary in Wikipedia puts it) the mad were portrayed in art ‘as possessing a kind of wisdom – a knowledge of the limits of our world – and portrayed in literature as revealing the distinction between what men are and what they pretend to be … but the Renaissance also marked the beginning of an objective description of reason and unreason (as though seen from above) compared with the more intimate medieval descriptions from within society.’

Later, however, ‘in the mid-seventeenth century, the rational response to the mad, who until then had been consigned to society’s margins, was to separate them completely from society by confining them, along with prostitutes, vagrants, blasphemers and the like, in newly created institutions all over Europe.’ (The Great Confinement).

‘For Foucault the modern experience began at the end of the eighteenth century with the creation of places devoted solely to the confinement of the mad under the supervision of medical doctors, and these new institutions were the product of a blending of two motives: the new goal of curing the mad away from their family who could not afford the necessary care at home, and the old purpose of confining undesirables for the protection of society. These distinct purposes were lost sight of, and the institution soon came to be seen as the only place where therapeutic treatment can be administered.’

But, back to the BBC Culture depiction of the role of cinema, ‘our mainstream perceptions of ‘madness’ are still fixated with movie scenes – much more emphatically, in fact, than the novels or memoirs on which they might be based. A classic film like One Flew Over the Cuckoo’s Nest (1975) seals the impression of a soul-destroying psychiatric asylum, where livewire convict RP McMurphy (Jack Nicholson) feigns insanity to escape prison labour – yet is ultimately crushed by the system. The dramatic depiction of patient treatment, particularly its brutal electroconvulsive therapy sequences, had far-reaching impact. In 2011, The Telegraph went so far as to say that the film was responsible for “irreparably tarnishing the image of ECT…’

Unfortunately, unlike many art forms, movies usually require a conclusion, a wrapping up of the story, and a realistic depiction of mental illness may not fit into that convenient format. There may be no black or white: not all characterizations can end either pleasantly or sadly -some are palimpsests, to be sure, but many can reach no definitive conclusions that would satisfy the average moviegoer. Hence the temptation to exaggerate, or at least frighten audiences into an odd manifestation of satisfaction.

The temptation, in other words, to see mental illness as alien, separate -like a creature we could not possibly understand because it is so different. As different, perhaps, as Nagel’s bat. But is it? Or was Foucault really on to something in his analysis of the way ‘madness’ seemed to be viewed in Renaissance literature and art -a view which accepted that at least some of the vagaries, some of the stigmata of mental illness, were merely variations of mental states that any of us could exhibit at times? And indeed, that occasionally intimated unique views on a world from which we might learn some important lessons -a world, though, that we might now discard, or shun as too bizarre. Too frightening. Too… real.

On the other hand, there is a danger of romanticizing the past, of airbrushing its naïveté into soft and reassuring colours; of assuming it was what it was because it had not yet been exposed to the unforgiving exigencies of current knowledge. A time when imagination and reality were sometimes allowed to merge. Encouraged to conflate.

It’s difficult to be certain where present day arts can be placed on this spectrum of understanding mental illness -not the least because it is difficult to know where it should be placed. But, suffice it to say, the more fully the illness is portrayed in all its complexity, the more we might be able to see it as a small, but important part of the tapestry of existence -a fragment of the struggle that marks all our days. And, as for any vicissitude, where there is suffering, we must provide succour and relief, and where there is dissimilarity, offer understanding and acceptance. Tolerance. The soul, says the poet Kahlil Gibran, walks upon all paths. The soul walks not upon a line, neither does it grow like a reed. The soul unfolds itself like a lotus of countless petals.



Give Sorrow Words

It is fairly intuitive to suspect that parental mental health has an effect on both infant and childhood development. Indeed there is a widespread attempt to address the issue with the use of evaluative tests such as the Edinburgh Postnatal Depression Scale to identify or even anticipate and take action to ameliorate the problem.

It was designed, of course, to deal with the disastrous effects a mother’s depression, especially a postpartum one, might have on the health of the newborn -everything from bonding, to breast milk production, to the safety of the baby itself, could be jeopardized with an untreated depression. But, aside from the obvious issues of domestic violence, the father’s mental state is seldom accorded the same vigilance -after all, he is not the one who has undergone profound physiological and hormonal alterations as the pregnancy progresses, he is not the one who has experienced the rigours of delivery, and he is certainly not the one whose hormone levels change so drastically once again in the postpartum period.

And yet, merely to assign the paternal side of the parental equation to a largely supportive role is perhaps to assume there are few mental consequences of the changes that this newly acquired responsibility entails. It is the woman who is under the watchful eye of the accoucheur, and not the partner -even if he attends most of the prenatal visits. And postpartum period is likely even more of a black-hole for partner surveillance.

But the man, too, can undergo psychological changes after the birth, as an article in the Guardian newspaper reports:

Although not adequately investigated, previous studies suggested that only  between 4-10% of men developed recognizable post-partum depressive-like symptoms, whereas a Swedish study found that ‘28% of men had symptoms that scored above mild levels of depression. Overall, 4% had moderate depression. Fewer than one in five fathers who were depressed sought help, even though a third of those had thought about harming themselves.’ The discrepancy is likely because, unless it is serious, or obvious, the men are less frequently assessed in relation to their spouses pregnancy.

But the answer might not be as easy as asking the father-to-be to fill in the Edinburgh Depression Scale like his partner. ‘The lead author of the Swedish paper, Elisa Psouni, from the department of psychology at Lund University, says the Edinburgh Postnatal Depression Scale (EPDS) used for both women and men is not so accurate in picking up depression in fathers. Her research showed higher levels of depression in dads because it added in a score more reflective of “male” symptoms of depression such as agitation, anger, irritability, working longer hours and drinking too much.

‘Depression in fathers may be rising not just because researchers are looking for it, but because more new dads are struggling. Psouni believes fathers increasingly face the same dilemmas that mothers do – including trying to combine parenthood with working. Fathers who got depressed often had external pressures, such as job issues, and if their partner was depressed, their own risk of depression doubled. Lack of sleep, having twins and conflict in the relationship can all contribute.

‘A depressed dad will play and smile less with his child. Children are deeply affected by paternal postnatal depression with studies showing poorer measures of wellbeing and more behavioural problems at the age of seven.’

I suppose we are all children of our eras, though, aren’t we. We usually see the world through societal eyes. Indeed, I wrote an essay in my weekly series about this back in 2013:

I was focussed, as were most obstetricians, on the mother of course, but even then I wondered about the effects of pregnancy on the dads.


Julie was sitting in the waiting room fussing with her new baby cradled ever so carefully in her arms. I recognized the older woman seated beside her -I’d met her mother several times before the delivery, and as a watchful guardian in the corner during the delivery- but I’d never seen Julie without her husband, Andrew. He’d come to every prenatal visit, and had hovered over her like a tent during her entire labour -at least those times when I was present, anyway.

They were a team, and as inseparable as a shirt from its tie -too inseparable, I sometimes thought. Each decision she had to make throughout the pregnancy -everything from prenatal supplements, types of analgesia in labour, to when to cut the umbilical cord after birth- was made after lengthy consultation between the two of them. She never seemed to be given the option of deciding for herself and yet she seemed to welcome his input. She basked in his concern; she waded in his eyes.

That day, I remember she insisted her mother stay in the waiting room with the baby while she had her routine post-partum check; it seemed a little unusual.

“You’re looking a bit tired, Julie,” I said, when I had finished my post-partum examination.

She nodded pleasantly, but she looked preoccupied. I assumed it was the usual new-mother state, though, and I was happy that her mother had agreed to stay with them for a while.

“Where’s Andrew,” I asked, more to change the subject than out of curiosity.

Her eyes suddenly surfaced from her lap and flew to my face. “Andrew?” she replied, a little too quickly, I thought. “Oh, he’s… at home…”

But there was hesitation in her answer -as if I was being invited to question her some more. “At home…?” I asked, gently. I could see some tears beginning to well up in her eyes. “Is he okay…?”

She sighed and fixed me with a melancholy shrug. “He’s been stressed a lot at work, I guess -he’s taken some time off…”

I leaned forward a bit on my desk to show her I was listening and her face collapsed.

“Soon after we got home with the baby, he began sitting around pretending to read, but he never turned the page. He didn’t want to go for walks with us, and he only played with his food… He started to argue…” She closed her eyes for a moment before resuming. “And even the baby didn’t seem to interest him anymore…” She stared out the window behind my desk, obviously uncertain how to proceed. I offered her some tissue from the box I keep on the desk and she wiped her cheeks. “He said he was afraid of hurting her…” she blurted out, uncoaxed.

Suddenly, she stared at me. “Can you imagine -he was afraid of hurting his own daughter..!”

I must have looked concerned, because she quickly sat back in her chair and almost smiled. “Yes,” she said, as if trying to reassure me. “I realized he was depressed -I’m a nurse, remember- so both of us went to his doctor a week or so ago. He was referred immediately to a specialist who put him on medications as well as enrolled him in some counselling sessions.” Just getting it off her chest seemed therapeutic, and the shadows of a tiny smile began to surface on her lips.

But nonetheless, she looked uncertain, and also perhaps a little bemused. “I didn’t think men could get post-partum depression, doctor.”

I smiled and relaxed in my chair while I riffled through my head for an explanation. “A new baby changes things for both of you, don’t you think? Only, he just doesn’t have the same hormones, Julie…” I added, not certain what more I could say about it.

She actually chuckled at the thought. “Damn! I was hoping you’d tell me he could do some of the nighttime breast feeding…”



Death, Thou shalt Die

Just when you think that Age has afforded you a full panoply of experience, another one comes along that you are forced to fit into the bookcase. It may be sufficiently unique as to require an entirely new shelf, but more likely, it will be something so obvious that you’re embarrassed you hadn’t thought of it before, and can squeeze it in beside another thing you’ve already read.

The internet does stuff like that -to me anyway. Permutations and combinations of issues I had always believed were immutably fixed in time and space unravel at warp speed making me question the wisdom of any assumptions it was thought safe to trust when I was growing up.

Like Death, for example. It used to be that after someone died, all that remained were memories, and perhaps a few of their possessions. ‘Dead and gone’ was a relatively intuitive reality in those days; ‘Dead and present’ was an oxymoron. Now, most of us have digital feet that continue to walk the screen no matter our corporeal substance. And, apart from the nuisance algorithms that track me from app to app, I had not given those footfalls much thought -until, that is, I came across an article in the Conversation on digital grieving by Jo Bell, Senior Lecturer, Faculty of Health Sciences, University of Hull:

She writes that ‘These days the dead are now forever present online and digital encounters with someone who has passed away are becoming a common experience. […] Each one of us has a digital footprint – the accumulation of our online activity that chronicles a life lived online through blogs, pictures, games, web sites, networks, shared stories and experiences. When a person dies, their “virtual selves” remain out there for people to see and interact with. These virtual selves exist in the same online spaces that many people use every day.’

When I first thought about this -the idea of inadvertently coming across someone, or something from whoever had died- I worried about the effect, and how I would react. But, as the author reports, ‘Yet for some, these spaces have become a valuable tool – especially so for the bereaved. An emerging body of research is now looking at the ways the internet, including social media and memorial websites, are enabling new ways of grieving – that transcend traditional notions of “letting go” and “moving on”.’

I was, of course, aware of the concept and probable value of memorials, but I have to confess that I hadn’t thought of them in terms of lasting online tributes. To be sure, I was weaned in another epoch when, apart from an obituary notice in the local paper, or flowers on a tombstone, there were precious few options to show that you remembered someone. But, of course, people today use the modalities they are used to.

Suicide is a devastating act, not only for the victim, but especially for those who are left behind. It makes sense that the friends would need to process the act as best they could. ‘For many mourners, the most important motivating factor seems to be the need to stay connected to the deceased and to “keep them alive”. And keeping a Facebook page going by actively maintaining the “in life” profile of the deceased, or creating a new “in memorial” profile, allows users to send private or public messages to the deceased and to publicly express their grief. […] The use of social media in this way goes some way towards answering the question of where to put one’s feelings – such as love, grief, guilt – after a death. And many people turn to the same sites to promote awareness raising and fund raising for various charities in memory of their loved ones.’

‘Unlike sentimental objects, social media pages and online spaces allow people to explore grief with others from the comfort of their own home. Talking to people online can also help to free up some of the inhibitions that are otherwise felt when talking about loss – it enables forms of uncensored self-expression that are not comparable with face-to-face conversations.’ Indeed, as they evolve, perhaps ‘online memorial sites and social networking spaces help the bereaved to see how events in the past can continue to have value and meaning in the present and the future.’

I was sitting in a dark corner of my usual Starbucks a few weeks ago thinking more of shadows than of death, when a couple of middle aged women sat down at the next table. Normally, I wouldn’t have paid them much heed, but one of them, a rather buxom lady was wearing a loose white turtle neck sweater that kept snagging one of her hoop earrings. Still waiting for my sausage-and-egg breakfast sandwich to cool, I have to admit I was searching for a divertissement, and her ear seemed as good as any.

‘I visited Krissy again today, Helen,” she said matter-of-factly to her similarly attired and equally Rubenesque friend.

Helen looked up from her still steaming espresso macchiato “That’s nice, dear. Anything new?”

Her friend shrugged and cuddled her cinnamon dolce latte in two serviettes folded to dissipate the heat, I suppose. “Well, a few others must have visited her earlier, because I saw some collars, and a milk bone…”

Helen nodded, but she sat back a little in her chair and left the macchiato to cool in front of her. I could see her staring at her friend, even in the dim light. “Julie, it’s been, what, two months since…”

“Seventy-eight days,” Julie interrupted her with an intensity that made me wonder if her latte had just burned through the napkins.

Helen nodded sympathetically and reached over the table to stroke Julie’s free hand. “I know dear… but…”

“But Krissy loves the attention, don’t you think?” Julie sighed at the thought.

“Loved, Julie. Loved…” Helen corrected her gently, and I could see her begin to stroke her friend’s wrist.

Julie’s face suddenly winced as her earring grappled with her sweater once again.

Helen seemed to think it was more than a simple entanglement. “There comes a time when you have to let her pass, dear,” she said, and squeezed Julie’s hand before letting it go.

“You mean take it down, don’t you…?” There was a look of desperation in Julie’s eyes, although in the shadows it was difficult to be sure. “But people are still leaving bones…” She was almost pleading now.

Helen smiled and reached across the table again, but Julie was already standing up.

“I… I need some air, Helen,” she said stiffly and began to walk away.

Helen shook her head slowly, gulped down her macchiato, and rose to follow her out of the door.

My breakfast sandwich seemed pleasantly warm in the sudden silence, so I took an experimental bite and sat back in my chair to enjoy it. For some things, I realized as I chewed contentedly, memory is enough. I felt no need to Facebook the disappearing sausage and egg…





The Mom and Pop Team

From time to time, I think we all need reassurance that we matter. That our seat at the game has not been taken by someone else. Could not be taken… Maybe that’s why we’re given names -so there’s no mistake. And if we’re not there all the time, it’s only because we sometimes have other duties to perform.

In many species, the male role in procreation can seem like that, I suppose: a postal service that’s only charged with delivering letters, not reading them, not dealing with the contents. At least that’s how it looks from across the street. On closer inspection, though, it would seem that the delivered mail is far more complex than it first appeared. It’s almost as if whoever reads the letter not only sees the blueprint, and the construction manual, but much like reading a newspaper, also learns of other important things which, at first glance seemed unrelated, but in the end, profoundly affect the building.

These processes would obviously be difficult to study in humans, so often we have to model them in other species and extrapolate the results to our own kind. Two articles in the Smithsonian magazine outline some of this information.

There are at least two time frames when the male influence on the resulting offspring was unsuspected: before conception -in fact, even before meeting his potential mate- and during growth and development of the fetus, and even its neonatal care. The how is interesting, but equally so is the why, I think.

First, let’s consider the production of sperm in isolation from its immediate need.

Sperm are produced in the testes, and then travel to a storage area via the epididymis -a long, wriggly 6 meter long tube in the human. It’s in the epididymis that the sperm mature and become motile. ‘As sperm traverse the male reproductive system, they jettison and acquire non-genetic cargo that fundamentally alters sperm before ejaculation. These modifications not only communicate the father’s current state of wellbeing, but can also have drastic consequences on the viability of future offspring.’ Sperm contain genes, of course, but simply having the instructions doesn’t mean they will be carried out. Genes can be turned on, off, or down, by other mechanisms –epigenetics. ‘One of the most powerful members of the epigenetic toolkit is a class of molecules called small RNAs. Small RNAs can conceal genetic information from the cellular machinery that carries out their instructions, effectively ghosting genes out of existence.’ The father’s previous diet, stress levels, and so forth can all have an effect on these small RNAs, and the small RNAs are in turn shed or reacquired as the sperm continue their journeys along the epididymis.

And then, as I mentioned, there is an effect on the developing embryo whether or not the male is actively involved with the female during her gestation or in the subsequent rearing of their offspring.  Although the data is from mice, it turns out that ‘The paternal genes a fetus carries can impact the maternal brain during pregnancy, priming her to allocate more or less of her time to tending to her kids.’

‘A child that procures as many nutrients as possible from mom can secure a father’s lineage at no cost to him—but a mother still needs to prioritize her own wellbeing during pregnancy and early childcare.

‘This sexual conflict is well exemplified by a gene called Igf2, which drives the rapid growth of fetal cells. Like most of our genetic material, Igf2 is inherited in pairs—one copy from mom and one copy from dad. But in contrast to other genes, only the version from dad gets put to work. The Igf2 from mom, on the other hand, is stifled through a chemical modification that acts like a muffler on an engine. Mom’s Igf2 DNA undergoes no changes—but the gene’s instructions can no longer be heard over the din of the cellular milieu. […] If an error occurs that also switches on the mother’s copy of Igf2, the baby quickly balloons in size. This could be good news for dad—a big baby is more likely to survive—but mom can get in serious trouble if she has to carry and birth an unmanageably large fetus.

‘To guard against this possibility, females have developed their own failsafe: another gene called Igf2r. The “r” stands for “receptor”: the product of this gene can sop up free-floating IGF-2 proteins before they exert their growth-promoting effects. Unsurprisingly, dad’s copy of Igf2r stays quiet. Such is the phenomenon of genomic imprinting—a form of non-genetic inheritance in which both copies of a gene exist, but only one parent’s version is left intact. Over 150 imprinted genes have been confirmed in mice, about half of which have conserved counterparts in humans.’

Suffice it to say that there are several other paternal genes that code for growth or neonatal behaviours that can affect the mother’s response and subsequent care of her offspring -a kind of effect that evolution has decided would be in the best interests of all concerned.

For example, ‘expression of an imprinted gene called Phlda2 in a fetus hinders the growth of hormone-secreting placental cells. These hormones recruit nutrients to support early development. Unsurprisingly, the offspring’s paternal copy of Phlda2 is kept under wraps. But mothers want their copy to remain switched on. […] Other researchers had noted that these hormones weren’t just working in the placenta, however. Throughout pregnancy, they were actually spreading throughout the mother’s body and accumulating in her brain—leading John [professor of biology at Cardiff University] to suspect that they could also be encouraging a mother to care for her young. […] The team’s work lends credence to the idea that fathers don’t dictate the health of children through genetic inheritance alone. In cases like these, they can even utilize the fetus as a chemical envoy in this battle between male and female, swaying a mother’s priorities towards more attentive childcare.’

During many of the years when I was in active practice of obstetrics, I often felt I needed to be an apologist for the father who did not have to suffer the many exigencies of pregnancy, not to mention the difficulties of labour and delivery. Clearly, after fertilization, his role in the process seemed merely supportive, and often peripheral.

Were I to start my career over again, though, perhaps I could put in a louder word for the importance of our male side -although I’m not at all sure mom would be listening as intently at the end.

Society is no comfort to one not sociable

The curse of modern society may be our need to discover patterns. Our need to explain everything could be an honest atavism, but the reasons we find may be way off the mark. Post hoc, ergo propter hoc, is a common fallback position that is often useful when the gun is not smoking -or when there’s no gun.

I suppose societies have always faced threats, though. And whether from without or within, they have always looked for remediable causes; the death of a society means the termination of shared customs at the very least, and shared loyalties just as probably -the sense of an us pitted against an implacable them who do not understand us.

Just as frightening, however, is an adversary who does not share our basic humanity. In an interesting article written by Nabeelah Jaffer, who is a former associate editor at Aeon,  she discusses ‘the inner dialogue’ which the philosopher Hannah Arendt writes about in The Origins of Totalitarianism. ‘We speak in two voices.’ Jaffer says of Arendt’s ideas. ‘It is this internal dialogue that allows us to achieve independent and creative thought – to weigh strong competing imperatives against each other.  You engage in it every time you grapple with a moral dilemma. Every clash of interests, every instance of human difference evokes it. True thought, for Arendt, involved the ability to put ourselves in someone else’s shoes. True loneliness, therefore, was the opposite. It involved the abrupt halting of this internal dialogue: ‘the loss of one’s own self’ – or rather, the loss of trust in oneself as the partner of one’s thoughts. True loneliness means being cut off from a sense of human commonality and therefore conscience.’

‘Loneliness is the common ground of terror’, as Arendt says. ‘It was loneliness, Arendt argued, that helped Eichmann and countless others … to give themselves over to totalitarian ideologies and charismatic strongmen. These totalitarian ideologies are designed to appeal to those who struggle with the internal moral dialogue that Arendt valued as the highest form of thought … Totalitarian ideas offer a ‘total explanation’ – a single idea is sufficient to explain everything. Independent thought is rendered irrelevant.’ So is the inner dialogue.

This got me wondering about what I see when I wander the streets of my city, and what I read and hear as people attempt to explain seemingly senseless crimes -especially violent ones- and attribute motive, usually in retrospect, to so-called ‘loners’. Not to loneliness, you understand, but to loners, an ostensibly different, more malignant, and ‘I should have guessed’ variety of human who does things of which you and I could barely conceive. But, I don’t know that the average person understands the difference between ‘loneliness’ and ‘loner’ -or even thinks it might be important.

As sometimes happens, I emptied the change in my pocket into a hat lying on the sidewalk in front of a young man. He was sitting quietly, eyes closed, in torn jeans and a dirty grey sweatshirt on a busy corner with his dog. The roughly printed sign by the hat merely said ‘We Are Hungry! Will You Help?’

He must have sensed someone stopping in front of him because he opened his eyes and smiled as I put the change in his hat. I was about to walk away when it occurred to me to ask about the ‘We’ in the sign. I don’t know why it mattered, to tell the truth; I suppose I was just trying to be friendly.

“Where’s the ‘We’?” I asked, trying not to sound too nosey.

His smile grew as he pointed to the sleeping dog at his side. I think I blushed at the naïveté of my question, but he didn’t seem at all surprised. “When the sign just said ‘I’m Hungry’ most people only walked by and pretended they didn’t see either me or Jason. I was only another runaway kid trying to get money for drugs, or something…” He shrugged resignedly, as if this was just life on the streets. “But they had no idea what it’s like -and even worse, they didn’t care.”

He reached over and patted the dog -a black lab, I think- and received a couple of tail wags for his effort. “I thought maybe letting them know I had a dog to feed might help…”

He wasn’t a menacing-looking boy -his auburn hair looked clean and combed, and although his face was definitely in need of a little soap, his expression was friendly and, well, innocent.

“And did changing the sign help?”

He seemed to think about it for a while, then nodded, and his eyes sought mine for a moment. “Well, you stopped to talk to me…”

That caught me by surprise. “Doesn’t anybody usually talk to you?” I felt foolish saying it, but the words tumbled out before I had time to think about them.

The expression on his face answered for him: ‘Are you kidding?’ it said. But I could tell he felt he should explain it to me. “I’m a beggar on the street -an eyesore for most people- so I spend my days in silence, just trying not to look frustrated. Trying not to annoy…”

He studied my face for a minute, obviously wondering whether or not it was worthwhile discussing it any further. Whether I would listen. “But I have Jason,” -he patted the dog again- “And he has me, so neither of us is lonely.”

For a moment, I felt I had entered his world. “And what about at night? Do you stay with friends, or…”

He shook his head and chuckled. “It’s just Jason and me. I’ve really never needed much more.”

I could tell by his face that he felt I was discouraging others from contributing to his hat, so I smiled and wished him good luck. But as I turned to walk away he looked up at me again, his eyes fluttered around me like little sparrows looking for a branch, and wondering if they should perch. “Loners are humans, too,” he said, and his face lit up with the joy of an inner dialogue he simply could not disguise. “Thanks for taking the time to talk with me, mister,” he added, just before he closed his eyes again to wait in daylong silence. But I was left with the impression that our words, as much as my money, were important in his world. And I couldn’t help wondering what those who never stopped to talk would think of him.

For that matter, I wonder what Arendt would have thought.

Thy wish was father to that thought

I’ve been waiting for something like this -expecting it, in fact, although not holding my breath: an exploration of the neurochemistry of fatherhood. I mean, it seemed obvious to me -a man, a father, and also an emeritus obstetrician- obvious that there are changes in many, if not most fathers with the birth of their child. And obvious that there must be some advantages to this.

Somewhere around 10% of mammals provide regular paternal care to their young, and this apparently leads to larger litter sizes, with shorter lactation and hence more frequent breeding opportunities. The issue is arousing increasing interest, as reported in an article in the Smithsonian Magazine -albeit with a lot of emphasis on the process in bat-eared foxes and clownfish, for some reason.

As for the foxes, ‘These furry fathers play a role in nearly every aspect of child-rearing: grooming cubs’ silky fur, engaging them in play and teaching them to stalk terrestrial insects with their bat-wing-shaped ears… And this commitment pays off: The amount of time bat-eared fox fathers spend monitoring their young is an even bigger predictor of pup survival than maternal investment or food availability.’

‘What drives fathering behavior in the first place? It turns out that, even without pregnancy and childbirth to prime them, the brains of new mammalian fathers undergo many of the same changes as their female mates’. Some of this may be triggered by being exposed to maternal behaviors and hormones even before the arrival of offspring. In other cases, the birth of an infant can stimulate the brains of new fathers via touch, smell or sight… These changes include increases in a few hormones that have massive effects on the brain: oxytocin, estrogen, prolactin and vasopressin… [T]he male body will actually repurpose some of its existing resources to achieve these attentive effects. Testosterone, which occurs in abundance in most male bodies, can be converted to estrogen through the actions of an enzyme called aromatase. During their mates’ pregnancies and in the months after birth, the testosterone levels of new fathers—including humans—will actually plummet as estrogen builds up in its stead, encouraging fathers to nurture their young… Mammalian fathers who pack on “sympathy” pounds, collecting extra fat in their bellies and breasts, may actually be pumping out prolactin themselves.’

And, turning to fish, ‘It’s true that most fish don’t parent their young, which are typically liberated into the vast wilderness at the egg stage, but of the 20 percent of species that do, less than a third exhibit female-only care. A whopping 50 percent of parenting fish are raised by single dads—including the clownfish of Finding Nemo fame… After a female clownfish lays a clutch of eggs, her partner takes over the majority of the workload… [T]he male clownfish spends most of his day meticulously fanning and nipping at the eggs to keep them clean. Meanwhile, the larger, more aggressive mom circles their anemone home, defending against potential invaders and predators.’

Of course, it has been hundreds of millions of years since there was a common ancestor of both fish and mammals, ‘But much of that original brain chemistry is still pretty much intact, according to Rhodes [a biologist and clownfish expert], and the brain-behavior connections in clownfish likely have enormous bearing on our own evolution.’

Interestingly, ‘Nearly 60 percent of mammals who choose long-term mates have shown evidence of males caring for young.’ And, ‘In several mammals, male investment increases offspring litter size, survival and sociability. Fatherhood may not be ubiquitous, but it appears to have evolved independently in many different lineages, lending credence to its importance in the diverse communities it pervades.’

This all takes me back to something I remember from my days as an obstetrician -probably because it seemed unusual, even for the time.

I’d been on call for several of my colleagues and was asked to attend the delivery of a young mother who had just recently been admitted to the ward. It was deep into the early hours before dawn, and I had been awakened from a brief and fitful sleep after another accouchement just down the hall. The lights in this delivery room were thankfully low, however -the mother, and her mother were obviously trying to set the mood, and an honest attempt was being made to keep things peaceful. Only a single narrow light was focussed on her perineum, and all else was dark.

At first, I thought that only the nurse, the patient, and her mother were present, but when my eyes adjusted to the gloom I could see a young man almost huddled in a dark corner on the opposite side of the room to the bed. Except for the nervous movement of his face when I entered, he could have been a duffel bag thrown on a chair. Only he and the nurse seemed to want him to sit beside his partner, but other two seemed oblivious. The nurse introduced everybody -including Brian, the father-to-be in the corner- but both the Linda, the young woman in labour, and her mother were far too preoccupied to notice, I think.

I’m not certain whether words had been spoken before I arrived, but only his eyes were allowed at her side -and except for my entrance, they never left his wife. Not once. ‘This is woman’s work’, the shadows seemed to whisper; even I felt a little out of place.

I wondered whether or not this had been an accidental pregnancy -a welcome, but unintended consequence of a meeting of strangers. And yet, he looked far from uninvolved -not at all like someone who was attending the delivery out of a sense of duty. I could see eager anticipation in those eyes. Wonder. Love.

Maybe I was reading too much from a distance; maybe I was projecting my own passion for my job, my own awe at the miracle of birth, but those eyes convinced me otherwise, and I just had to speak up.

“Would it be okay if Brian sat a little closer?” I asked.

His eyes suddenly blinked hopefully, and he leaned further forward.

“He said he was too afraid of blood,” Linda explained, “But sure… If he wants to come closer,” she added, a little doubtfully.

Suddenly, before I could say anything more, he was there at the bedside, clasping her hand like he would protect her from whatever ensued. And her mother backed off politely, her cheeks now wrinkled by a huge smile.

Another delivery called me from the room once their healthy, screaming baby had been born, but I did see them both later in the morning before I went off call.

Neither of them noticed me at first. The mother had gone home, and both Brian and Linda were lying on the bed staring at the now sleeping bundle between them.

I think it was Linda who saw me first, and tugged at Brian’s sleeve for him to look up from the baby.

“Thank you doctor,” Linda said, with a soft, tired smile on her face. “It was easier than I thought…” But her face belied her words.

She reached over the baby and tenderly stroked Brian’s arm for a moment. “But you know what helped the most?” She glanced lovingly at her partner, then blinked in my direction. “It was Brian…”

I could see her sigh, as her lips brushed the baby lightly. “Fathers are so important, you know.”

It was my turn to sigh, and I smiled and left the room. Yes, fathers are important…!

Good wine needs no bush

I try not to become embroiled in oenophilic arguments -as a person who long ago switched to Rivaners or Rieslings with their reduced alcohol contents, I usually just smile and nod if the issue arises of whether the grape or the soil is the principle determinant of flavour. Both make sense, I guess, but my money would be on the grape -after all it is the thing being fermented, not the dirt that its roots scrabble around in; it is the grapes that provide the carbohydrate, the fibre, and the aromatic hydrocarbons when they are crushed.

Still, the vines take up water from the soil which contains important nutrients as well.

Fortunately, I came across an article in the BBC Future series by Alex Maltman that tackled this very controversy: He is perhaps not a completely unbiased source, though, having written a book Vineyards, Rocks and Soils in which, as the introductory bio explains ‘[he] points out many of the geological errors, misconceptions and misunderstandings rife in wine literature and descriptions.’

Nevertheless, ‘The idea that a vineyard’s ground is important for wine took hold in the Middle Ages when, legend has it, Burgundian monks tasted the soils to find which would give the best tasting wine.’ Unsurprisingly, the idea didn’t really catch on until relatively recently, however, and even now, the weight of evidence still favours the grape. And, ‘[…] most vineyards are routinely gouged, fertilised and irrigated. With this amount of artificial manipulation, is this new preoccupation with the natural geology justified… The fact is that the claims largely are based on anecdote: the scientific justification is slender.

‘That’s not to say the ground isn’t relevant. It governs how roots obtain water, in a pattern that is pivotal to how grapes swell and ripen. We know of 14 elements that are essential for the vine to grow, and almost all of them originate in the ground. Some may make it through to the finished wine, in minuscule amounts that can’t be tasted, though in some cases they can influence how we perceive flavours.’

Also, ‘there recently has been excitement in scientific circles about the possible importance of microbiology in the vineyard because new technologies have revealed distinct fungal and bacterial communities at different sites. [Even though] It’s not clear what effect this has on wine taste.’

I suspect that the final word has not yet been written on the subject of what determines the characteristics of a wine.

Written, or spoken. Jacob doesn’t know one wine from another, I’m sure of it, and yet he has a variety of opinions, depending on his mood or -more likely- the amount of wine he has consumed. A wine’s qualities have always been known to be contextual, of course -the character of some wines seems to be contingent on the food, and in others on the company they keep, the milieu they inhabit.

Jacob has never committed to any particular favourites. Like the books he leaves open and scattered about his house as if he’d just put them down when the doorbell rang, he prefers to keep his options open in the event he’s losing an argument. But he is usually more relaxed with me -like Socrates, I know that I don’t know, so I can only ask questions.

I saw Jacob on a ferry to Vancouver Island the other day. I almost didn’t recognize him in his Tilley hat, light canvas jacket and khaki Bermuda shorts -or whatever you call those pants that end just past the knees and are garnished with long white socks. He was sitting by himself at the window, immersed, not in the scenery, but in sleep or, to be charitable, inward reflection -I couldn’t tell which. At any rate, there was a page open to a picture of a bottle of red wine on his lap, so he obviously meant well. The hour and a half trip wears heavily on the ferry, even with an exciting book.

I decided to sit beside him.

“Saw you coming,” he said and opened one eye as soon as he felt the cushion deform beside him.

He sighed and blinked a couple of times in the sunlight. “I was thinking,” he said, and glanced out the window at the whitecaps that seemed to be racing for the boat under the clear blue skies. “I’ve never been to any of the wineries over there,” he added, nodding in the direction of the hazy specs of land in the distance. “So I decided to have a look at their terroir.

He thought the word would impress me, I suppose. It did -especially his unsuccessful attempt at giving it a French accent. “What’s a terroir, Jacob?” I asked, but mainly to be polite.

He rolled his eyes, as if he thought everybody knew what it was. Then he mounted a condescending little shrug and sighed again. “A terroir is the environment in which a wine is grown -so it includes, soil, topography, climate, farming practices…” He glanced at me to see if I recognized it now, but when the look on my face betrayed not the slightest hint of recollection -or interest, for that matter- he shrugged again, but this time more disdainfully. “Think of a terroir” -I could almost see the italics- “as contributing to a wine’s characteristics as much as the grape.” He allowed a faint smile to besmirch his face, and lowered his head as if he wanted to peer over the top of his glasses like a professor giving a lecture. Unfortunately for him, he didn’t wear glasses, so it looked rather silly, I thought. “The district and the soil, matter almost as much as the grape, you see…”

“I see,” I said, although I didn’t really.

He sat back in the seat, still smiling. “I want to tour the area to check a few things…” He paused for a moment to allow me to ask about it, but when I didn’t, he repeated his sigh and rolled his eyes condescendingly. “I want to ask the various owners if their soils have been tested…” He narrowed his eyes suspiciously and glanced at me. “In other words, do they actually contain any slaty para-gneiss and amphibolite, or maybe mica in them?” he added smugly, sure that I would wonder, too, and allowed his smile to linger.

But I remembered the fustian description of an Austrian Riesling wine I’d read in that BBC article. The words he used were just too familiar -too similar to be coincidental- and I allowed my own smile to linger as well…