Let Virtue be as Wax

We are all products of our era, and often unbeknownced to us, our language is to blame. Words become signposts that reassure us that we know where we are headed. Where we came from. And yet they can be as lost as us –especially in the domain of sexuality. Even the word ‘sex’ itself –a seemingly self-defining concept- can be misleading. It’s origin, commonly attributed to the Latin verb secare –to divide, or cut- presumably to explain the physical difference between men and women, does not necessarily entrain the psychological divisions. Or behaviour.

To paraphrase Socrates at his trial, the unexamined word is not worth using. That ‘sex’ and ‘sexuality’ were so inconsonant I had not suspected. Sex, quite obviously, is a physical assignation; sexuality on the other hand, is the more psychologically -the more erotically- imbued preference. Indeed, the concept of heterosexuality did not exist as such in the past. Nor did homosexuality as an article by Brandon Ambrosino in the BBC News pointed out: http://www.bbc.com/future/story/20170315-the-invention-of-heterosexuality?ocid=ww.social.link.email  ‘One hundred years ago, people had a very different idea of what it means to be heterosexual.’ In fact, ‘The 1901 Dorland’s Medical Dictionary defined heterosexuality as an “abnormal or perverted appetite toward the opposite sex.” More than two decades later, in 1923, Merriam Webster’s dictionary similarly defined it as “morbid sexual passion for one of the opposite sex.” It wasn’t until 1934 that heterosexuality was graced with the meaning we’re familiar with today: “manifestation of sexual passion for one of the opposite sex; normal sexuality.”’ It would seem that ‘all of our sexualities are “just there”; that we don’t need an explanation for homosexuality just as we don’t need one for heterosexuality.’

‘“Sex has no history,” writes queer theorist David Halperin at the University of Michigan, because it’s “grounded in the functioning of the body.” Sexuality, on the other hand, precisely because it’s a “cultural production,” does have a history. In other words, while sex is something that appears hardwired into most species, the naming and categorizing of those acts, and those who practice those acts, is a historical phenomenon.’ Or, to put it another way, ‘[…]there have always been sexual instincts throughout the animal world (sex). But at a specific point on in time, humans attached meaning to these instincts (sexuality). When humans talk about heterosexuality, we’re talking about the second thing.’

And as well, ‘[…] sexual desire was situated within a larger context of procreative utility, an idea that was in keeping with the dominant sexual theories of the West. In the Western world, long before sex acts were separated into the categories hetero/homo, there was a different ruling binary: procreative or non-procreative.’ So sexuality is the desire and although the act may be categorized as procreative (different-genital intercourse), or non-procreative (it doesn’t matter), with erotic desire -in the past at least- the intention was not further categorized. It was the act that was noticed. The act that was labelled. ‘Something […] happened with heterosexuals, who, at the end of the 19th Century, went from merely being there to being known. “Prior to 1868, there were no heterosexuals,” writes Blank [the author of Straight: The Surprisingly Short History of Heterosexuality]Neither were there homosexuals. It hadn’t yet occurred to humans that they might be “differentiated from one another by the kinds of love or sexual desire they experienced.” Sexual behaviours, of course, were identified and catalogued, and often times, forbidden. But the emphasis was always on the act, not the agent.’

And yet nowadays, we seem to require labels –as if the words were themselves expositors and not mere descriptors. ‘Debates about sexual orientation have tended to focus on a badly defined concept of “nature.” Because different sex intercourse generally results in the propagation of the species, we award it a special moral status. But “nature” doesn’t reveal to us our moral obligations – we are responsible for determining those, even when we aren’t aware we’re doing so.’

The difficulty of negotiating this landscape had occurred to me long before I read the article, however. A few years ago I walked over to a downtown bus stop, tired after having a rather long day at work. I’d left the office early, and I thought I was the only one there until I noticed two teenaged girls sitting on the little bench in the bus shelter in passionate embrace. I didn’t want to embarrass them, but I did feel the need of sitting down. Unfortunately they had both put their backpacks onto what little remained of the seat on either side, so I thought I’d wait until they’d finished, as it were. I kept glancing at them, but their fervour seemed unending and I eventually resigned myself to standing.

Suddenly a head disentangled itself from the osculatory machinations and stared at me accusingly.

“Got a problem, mister?” it asked, while a hand deftly extricated a piece of overly-chewed gum from its mouth.

I blushed, but did manage a conciliatory smile hoping to defuse the tension. “Sorry,” I said, when I could find the words, “I didn’t mean to disturb you, but I was hoping I could sit down…”

The other head opened its eyes at the sound of my voice and managed an embarrassed smile while convincing its hands to leave her friend and move the pack from the seat. “We didn’t mean… We didn’t know anybody was standing there…”

The first head dropped its eyes to the pavement in obeisance. “Yeah, I didn’t mean to be rude…” She picked her eyes up again and sent them softly to my face before she looked at her friend. “It’s just that, like, some people get… You know, like, upset when they see us kissing.”

“Yeah, as if we were, like, tards, or something,” the second girl said as they both moved over on the bench to make room for me.

The word  tards seemed to offend the first girl. “She just means that, like, some people go strange when they see us being so… involved, I guess.” She looked at her friend and whispered something I couldn’t hear. “Like we’re pervs, or whatever,” she continued, after elbowing her gently.

“Yeah, the other day, one old guy walking by even, like, spat on the sidewalk when he saw us cuddling.”

“Yeah, as if he never cuddled with his partner…” the first girl giggled.

“He probably never had a partner, Joni!”

Joni shook her head. “Maybe not, but I don’t think he was, like, jealous or anything, do you?”

Her friend smiled. “He was just looking for a label, sweetheart. Some are easier to find, I guess.”

Indeed.

 

 

 

 

 

 

 

 

 

 

 

 

Sometimes the Twain Should Meet

That we are, each of us, different is a given; that societies and the cultures they produce are different, is also self-evident. But that any one individual picked at random should be representative of that difference is another matter. We humans tend to be bicameral when and if it suits us. For example: my Asian friend is clever and devious, so most Asians are probably clever and devious (inductive reasoning); but at other times: everybody knows the French are rude, so perhaps I should not hire that French person (deductive reasoning).

How much credence can we put in either type of reasoning when it comes to judging world views of different cultures? There was an interesting article in BBC News about this a while ago: http://www.bbc.com/future/story/20170118-how-east-and-west-think-in-profoundly-different-ways  And as you can imagine, the issue is complex: ‘From the broad differences between East and West, to subtle variation between U.S. states, it is becoming increasingly clear that history, geography and culture can change how we all think, in subtle and surprising ways – right down to our visual perception. Our thinking may even have been shaped by the kinds of crops our ancestors used to farm, and a single river may mark the boundaries between two different cognitive styles.’

‘[…] our “social orientation” appears to spill over into more fundamental aspects of reasoning. People in more collectivist societies tend to be more ‘holistic’ in the way they think about problems, focusing more on the relationships and the context of the situation at hand, while people in individualistic societies tend to focus on separate elements, and to consider situations as fixed and unchanging.’

For example: ‘An eye-tracking study by Richard Nisbett at the University of Michigan found that participants from East Asia tend to spend more time looking around the background of an image – working out the context – whereas people in America tended to spend more time concentrating on the main focus of the picture.’ So, ‘[…] this narrow or diverse focus directly determines what we remember of a scene at a later date.’ But because things like these seem to be so widely dispersed in a population, is it a genetic difference, or merely a learned, culturally favoured response? ‘Alex Mesoudi at the University of Exeter recently profiled the thinking styles of British Bangladeshi families in East London. He found that within one generation, the children of immigrants had started to adopt some elements of the more individualistic outlook, and less holistic cognitive styles. Media use, in particular, tended to be the biggest predictor of the shift. “It tended to be more important than schooling in explaining that shift.”’

The article goes on to suggest several theories as to why the so-called East-West differences arose in the first place -everything from epidemics, to types of crops grown by different populations, but the problem still remains: the differences lie on a spectrum –‘broad trends across vast numbers of people’. And yet even so, especially in small interpersonal discussions –dare I say ‘arguments’?- we are very likely to use whatever generalization makes our point.

But, for many of us, that tends to preclude any semblance of critical analysis. It’s far easier to succumb to the prevailing opinion without questioning the reasons for its presence, let alone its validity. And it’s not just the so-called East/West divide –the potential seems to arise whenever any culture examines another. Perhaps an example that stands out clearly in contemporary life, is that of the hijab –the headscarf. Sometimes the objections are couched in religiosecular terms of course, but they often boil down to simple perspective –Weltanschauung.

Aaisha, a Muslim friend of mine recently decided to wear the hijab, and although there were no prohibitive policies or objections from her bosses at work, she encountered resistance from a source she had not anticipated –her co-workers.

Some of it was just petty –“Why would you want to cover your hair?” one woman said to her, adding “It’s so beautiful” no doubt to take the sting out of her rudeness. But the woman had never complimented her hair before, so it rang hollow to Aaisha.

And then she told me about another, a man who had just joined the company a few months before and who seemed quite uncomfortable with hijab and glared at her whenever he passed her desk. Finally, she decided to talk to him about it.

“You keep staring at me, Jeffrey,” she said, smiling confidently as she walked up to his desk. “I get the impression you’re unhappy about something.”

He acted surprised at first, and then his scowl returned and he pointed at her head. “You didn’t used to wear that scarf, Aaisha,” he said, trying to keep his tone friendly.

Her smile broadened and she pointed to his tie. “I don’t remember you wearing that tie before, either, Jeffrey.”

He blinked uncomprehendingly. “It’s just a tie. I wear different ties all the time…”

She didn’t skip a beat. “It’s just a hijab,” she said, obviously proud of the word and pointing to her head.. “And you may have noticed, I also wear different ones all the time…”

His eyes narrowed and his forehead wrinkled. “A tie is different, Aaisha…”

She waited for him to continue, but he seemed to think his answer was complete –and for him, it probably was. Finally, she decided to ask the obvious question. “Oh…?  And how is it different?”

He actually rolled his eyes at the stupidity of the question. “It’s what men are expected to wear to work.”

The smile never left her face and she pointed to another man at the next desk. “John never wears a tie…”

Jeffrey shrugged. “We’re different, that’s all… And anyway, I’m my own person.”

Aaisha stood there, for a moment, and then blinked. “And so am I, I guess…”

Jeffrey seemed surprised at her answer, then shook his head. “Nobody makes me wear the tie…”

At this point, Aaisha laughed. “And nobody makes me wear a hijab, Jeffrey.”

He didn’t seem to know how to react. “But… Well, how about your husband?”

She shook her head, still smiling. “I’m not married… And my father and brothers are still back in England -just in case you want to involve them,” she added with a laugh.

Jeffrey began to sense he was losing the argument. “It’s a family tradition -and also a society thing- Aaisha. My father always wore a tie to work –and his father before him…” But his voice was less confident.

Aisha sighed. “Should I tell you about my mother, and her sisters? They all wore the hijab back in London –and not because they were forced to, they’d be quick to tell you. They just felt more a part of the community wearing hijab, so it, too, was a society-thing as you called it…”

He blinked, but slowly. “Your society, Aaisha, not ours!”

The smile returned, and she nodded her head towards John again. “And what about John? Does he belong to another society, as well? We’re all immigrants, Jeff; we’re all other if you go back a generation or two. And thank god we don’t all have to dress the same,” she said, touching the sleeve of his fraying shirt with her hand and winking coyly at him.

And for the first time, he smiled at her.

Crybabying

I remember (sort of) my days in Elementary School, when one of the most devastating insults a little boy could receive was to be labelled a crybaby. I’m not sure why, really. Maybe it meant you didn’t fit in with the prevailing umwelt –with what you were supposed to be as a little boy- or maybe it was just a talisman raised to guard against the fear that despite its undesirability, it might be hiding in us all –even the accuser. Children are inherently superstitious, don’t you think?

It never occurred to me to wonder about the expression at the time, nor even later when I had children of my own. Babies cry, often too much, and perhaps more to the point, often at inconvenient times: during the nights. But I never suspected that it was sufficiently upsetting that it would transmute into folklore as a children’s curse. In fact, as childhood made way for my adult clothes, I didn’t think much about it at all -let alone as an imprecation- until I happened upon an article in the CBC News: http://www.cbc.ca/news/health/babies-crying-health-study-warwick-university-1.4052932 ‘Researchers at the University of Warwick conducted a meta-analysis of studies involving about 8,700 infants in countries including Canada, Germany, Denmark, Japan, Italy and the U.K.’ and guess what? ‘[…]babies in Canada, Britain, Italy and the Netherlands cry more than babies in other countries.’ And not only that, ‘On average, Canadian babies cried 30 minutes more than babies from other countries.’ Great! There goes our long held patriotic claim to be the ‘polite nation’ -the one usually definable by what we are not: (not American, not greedy, not pushy, not… Well, you get the point). ‘Canadian babies had some of the highest levels (peaking at three to four weeks at 34.1 per cent of infants), followed by the U.K. (peaking at one to two weeks at 28 per cent) and Italy (peaking at eight to nine weeks at 20.9 per cent).’ ‘Germany, Japan and Denmark had the least amount of crying and fussing babies.’ Damn.

Mind you, if you actually look at the article reported by the CBC:  http://www.jpeds.com/article/S0022-3476(17)30218-4/fulltext – s0070, ‘Overall, fuss/cry durations were high across the first 6 weeks of life, then reduced significantly over the following 6 weeks. All studies found a “universal” reduction in fuss/cry duration between 6 and 12 weeks of age.’ The reasons for the differences were not at all clear: ‘[…] we can only speculate on the reasons why there are country differences, in particular between Denmark and the rest of Europe and North America. These could range from economic conditions, such as less social inequality, to caretaking patterns such as responsiveness, carrying behavior and management in Denmark that have been shown to differ from the United Kingdom. However, there may also be population genetic differences, and the infants both inherit their parents’ genes and are reared by them (gene-environment correlation). […]Feeding type was a further moderator of fuss/cry duration. Bottle or mixed feeding was associated with reduced duration of fussing and crying or colic from 3-4 weeks of age onward. Switch in feeding type is one frequently adopted method by parents dealing with a crying baby and has been found to reduce crying regardless of what formula change is instituted, suggesting a placebo effect.’

Unfortunately, ‘[…]this is a review of studies in North America and parts of Europe with only 1 study from Japan. No studies from threshold or developing countries were available, but these would be needed to provide adequate feedback to parents on other continents. Feeding type information was also not available for some studies.’

And what about ‘colic’ the catch-all word for persistent crying? ‘The most widely used definition for colic is the “Rule of Three’s”: an infant is considered to have colic if the infant fusses or cries for >3 hours, >3 days per week, for >3 weeks.’ Unfortunately it is, apparently, often a diagnosis of despair with no readily identifiable cause. Indeed, ‘The rapid developmental change in fuss/cry duration has implications for treatment and interpretation of treatment studies. Colic is the extreme of normal fuss/cry behavior, self-limiting, and, thus, the vast majority will spontaneously remit. Adequate management of fussing and crying in the first 3 months rather than treatment may be required. However, if excessive fuss/cry persists beyond the first 3 months, there is increasing evidence that this may indicate regulatory problems with adverse consequences for future development and may require treatment.’

But, bringing it back to Canada, my terre natale, ‘Psychology professor Dieter Wolke, lead author of the study, says Canadian parents need not worry. […] He pointed out that babies in Canada peaked around the three-four week mark but fell into a more normal range around week six.’ …Damned by faint praise again…

And what about Germany, Japan and Denmark? Especially Denmark –why does it always seem to win everything? ‘”In Denmark, it seems to be they’re more relaxed about it,” Wolke said. “They might have a little bit more support because of maternity and paternity laws … the father in the first few weeks can stay at home, too.” It’s worth noting that Denmark regularly falls at or near the top of the “best countries to live in” lists. Wolke speculates that this may foster a population that feels good about itself, and those emotions can transfer to the baby.’

Uhmm, excuse me! ‘”Babies are already very different in how much they cry in the first weeks of life,” the researchers said. “There are large but normal variations”’. So let’s not dump on les petits Canadiens, eh? It’s a squeaky wheel that gets the grease, after all. Right? …I mean that’s right isn’t it…?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Methought I heard a voice cry Sleep No More.

 

I have always had a healthy respect for fire. I suppose this is not unusual, although nowadays fire is not a regular component of our daily lives, so its presence awakens something that alternates between fascination and fear. Something atavistic. Fire –especially unexpected fire- can produce panic; smoke –also if unexpected, or inexplicable- can have the same effect. Both are worthy of our attention, both should command our respect, our search for the source.

That’s why smoke detectors are so valuable. The two commonest detection systems would seem to be either ionization and/or photoelectric –the former, ionization, grew from an attempt in the late 1930ies to detect poison gas, but the advance of the technology did not make it widely available –or affordable- until the 1970ies. The optical variety matured around the same time.

The purpose of both smoke and heat detectors, as we all know, is to alert us to the presence of the potential danger by activating some form of alarm –something that either by sheer volume or unpleasant pitch will demand action. It should arouse us if we are asleep, or get us out of our chairs if we are not. It should be audible over whatever other sounds are present in the environment, and sufficiently different from them to concern us. Usually, smoke alarms have a frequency of around 3000-3200 Hz and need to reach 85 decibels at 3 metres.

Anybody who has ever heard their smoke alarm sounding when the toast burns in the kitchen can attest to the discomfort this incites. It is piercing and –at least for the hearing population- impossible to ignore. Enough to wake the dead, as my mother used to say -but apparently not the child: http://www.bbc.com/news/health-38918056  As the BBC article reports, ‘Researchers at Dundee say there are several theories they were exploring as to why standard smoke alarms may not wake children.’ One, however, has led to an interesting innovation. ‘Rodney Mountain, from the University’s School of Medicine, said: “Children’s hearing ability, brain function, sleep patterns and stage of brain development is very different to adults. We are programmed to respond to human voices warning of danger, such as a mother’s voice shouting to warn a child. Children are not born pre-programmed for our modern world of danger warning sounds from digital beeps and sirens -they have to learn, recognise and interpret these sounds.”’

So, the researchers wondered whether the sound of a woman’s voice –a mother surrogate, essentially- might trigger a child’s arousal more effectively. ‘Research by Dundee University and Derbyshire Fire and Rescue found that of 34 children tested, 27 repeatedly slept through smoke detector alarms. They have developed an alarm with a lower pitch and a woman’s voice, which issues a warning: “Wake up, the house is on fire.”’ And, instead of the terrifyingly strident, ear-piercing pitch, ‘the prototype has a lower pitch of 520Hz, to which young children are more likely to respond.’

Of course, this approach is still in its experimental phase and ‘The researchers said it was important the study did not undermine the need for every home to be fitted with smoke alarms, as these will wake adults and had a proven record in saving lives.’

Several weeks after reading this article, I happened to be over for dinner at the house of an old friend. We were sitting in the living room enjoying a glass of wine before eating when the smoke alarm suddenly activated. Apparently some grease on the stove had started to smoke.

“Well, the alarm did its job, didn’t it?” she said, laughing and filling up my glass again when she returned. “It’s amazing how annoying they are. You can’t ignore the alarm –you just can’t!”

I chuckled and told her about the BBC article I’d read about the alarm failing to rouse children.

The smile never left her face even when she had another a sip of her wine, but I could tell she was still thinking about what I’d said. “You know, that reminds me of something that happened when my son Jeremy was still around two years old…” She closed her eyes for a moment, savouring the memory. “We were over at my father’s cabin at the lake. Jeremy loved it there…” Her smile grew even larger and transformed her face. “It was so different from the city where we lived. Everything was new to him –the birds, the trees, the lake with Grampa’s little wooden rowing boat… He was usually so tired, it was no trouble getting him to go to bed at night. He slept in a little crib in my room, and rarely stirred even when I eventually came in to go to bed at night.

“Anyway one morning dad and I were sitting in the kitchen enjoying a cup of coffee while Jeremy was still asleep. He’d just installed a new smoke alarm because he used the fireplace a lot at night and I told him I was worried about the dangers of fire in a wooden cabin. I suppose he’d put it too close to the counter, or something, because when our toast began to burn, suddenly the alarm went off. The noise was so loud and high pitched it was painful and I had to cover my ears. I remember my heart started pounding and I actually felt faint.

“’The man at the store told me it’d wake me from a coma,’ dad said once he’d turned it off. ‘I’m surprised Jeremy isn’t crying.’

“Or out here,” I said. “Your crib is so low to the ground, I took the side off it so he could get out if he wanted.

“I went in to check on him right away; I’d left the bedroom door partially open when I’d gone into the kitchen, but he was still lying motionless in the crib like he does when he’s really asleep. I even remember standing at the door and watching him for a while –he was so adorable when he was sleeping…” She sighed and had another sip of her wine.

“I could see the gentle rising of his chest as he slept, so I knew he was okay. Dad started calling me from the kitchen to tell me my burnt toast was getting cold, and I can recall speaking Jeremy’s name in a normal tone of voice, telling him to wake up. Suddenly his eyes flickered then opened and a big warm smile filled his face…”

Martha turned her head to look at me, her eyes little sparrows flitting from cheek to nose and hovering over my face trying to decide where to land. “Do you think that’s what they were describing in the article?”

I smiled and added a tiny shrug. “A mother’s voice is so important, isn’t it?” I said, but realized as soon as the words emerged that it wasn’t a particularly profound observation.

She nodded her head and laughed. “Curious how my voice could wake him as a child but not as a teenager.”

“Who starves the ears she feeds and makes them hungry, the more she gives them speech…”

“Pardon me?” she said, giggling with the wine.

I enlarged the shrug. “Just a fragment of Shakespeare,” I said. “It means that noise isn’t as valuable as words… I’ve always wanted to use that quote.” I glanced at my own wine and smiled.

 

 

 

Let No One Put Asunder

At my age, I suppose I should have learned to expect the unexpected, to revel in the entrepreneurism of a new and alien generation, and to wonder at its ability to see opportunity in the predicaments of others. But then again, why not? Isn’t that what lawyers are all about? And doctors…? Where would we be without predicaments?

Alright, I accept that the approach may seem cheeky, or even downright calculating, but I have to say I sometimes admire the attempt –a Swedish hotel chain is ‘offering a refund to couples who get divorced within a year of staying at one of its places.’ http://www.bbc.com/news/blogs-news-from-elsewhere-39382059 The idea being, apparently, ‘to encourage spouses to spend time together and work on their relationship’. And so, ‘It’s offering a “relationship guarantee” on mini-breaks at its hotels, so if things subsequently don’t work out and the marriage ends within a year, then the chain says it will reimburse the cost of a two-night stay’.

Of course, they’re not fools; nobody wants to be taken to the cleaners -they’re out to make a profit and, perhaps naively, figure that those who decide to vacation together for a while might not be that close to the brink. And, naturally, ‘There is some fine print: couples must be already married, stay in the same room and reference the relationship guarantee when booking. If they subsequently divorce and want to claim a refund, they have to submit court documents as evidence’.

I don’t know… At first glance, it might seem that they’re either very naïve, or really convinced they have an effective therapy -I mean, the divorce to marriage ratio in Sweden (2010, at least) was 47%. On second glance, however, the marriage rate in Sweden according to Eurostat Demographic Statistics –OECD Family Database (2014)- was only around 6 per 1000. So who, exactly, is sufficiently wide-eyed not to notice they may be on to something? I’m reminded of most private insurance agencies who offer great deals as long as you are low risk and have no major ongoing disabilities.

But it speaks to something larger, I think: the institute of marriage itself. Marriage is something which is incredibly difficult to define. In its simplest form, it is an officially sanctioned union between two people that affords legitimacy to any offspring and entails certain rights and responsibilities -and these vary from one society to another. In Western cultures it has been the religious –or secular (usually governmental)- authorities that are required to sanction and guarantee those issues. But in other societies, families, traditions, and deeply held beliefs often prescribe the boundaries, duties, and also the rights of each person in the relationship. Hence the cross-cultural misunderstandings and misgivings. We tend to ascribe the most legitimacy to that of the society in which we were raised.

Guilt, is not imposed, by and large, it is acquired -usually at a very early age- by deviating from the expectations of those we love and trust: our family, and immediate friends, bonds that link intimately with cultural and, often, religious beliefs. Sexual mores and intimacy are no exception -in fact, they are often the incentives offered by matrimony.

But marriage is becoming more popular recently, even in Sweden, with the ongoing influx of migrants from other cultures who were raised with different familial and religious obligations to which they feel they must adhere -obligations which may not be as easily dissolved, or as readily ignored as in the host country. After all, ‘Marriage is a matter of more worth than to be dealt in by attorneyship’ according to Shakespeare.

So is the hotel chain actually reading those trends, too? And are there other conditions –loopholes- that are not immediately apparent in their advertisements? Fine print? Exceptions? I don’t know, but I certainly wish them well. It’s a gamble on their part, to be sure… But I think I’d put my money in real estate, frankly.

Perhaps I’m just being far too cynical, though. Far too… divorced –there, I said it- but I’m willing to bet that they haven’t read the famous definition of how realistic are the expectations of marriage by none other than George Bernard Shaw in his preface to ‘Getting Married,’ 1908: ‘[W]hen two people are under the influence of the most violent, most insane, most delusive, and most transient of passions, they are required to swear that they will remain in that excited, abnormal, and exhausting condition until death do them part’.

Pick your side on divorce and marriage, but they do seem to follow each other around and around like a tail the dog. I have to say, part of me is tempted to quote Samuel Johnston’s sarcasm (out of context) on the hotel chain’s promise -that it’s ‘The triumph of hope over experience’. And yet, when I stop to think of it, why not credit them with the courage of their conviction? Why not Alexander Pope’s ‘Hope springs eternal in the human breast’…?  After all, that’s what they’re trying to accomplish in those couples who stay with them… And that’s what we all hope for, isn’t it?

 

 

Cycling in a Dish

Where do they get this stuff? Menses in a dish –or, to be more academically abstruse, ‘A microfluidic culture model of the human reproductive tract and 28-day menstrual cycle’?

It has a pedantic ring to it, even though it doesn’t exactly roll off the tongue, but I have to ask a simple, quasi-lay interrogative: why? Critical Thinking 101 –at least as they used to teach it- would demand to know why it is important that we make this model. If the answer is vague, or even unnecessarily complicated,  then one begins to suspect academic foppery.

The model is unique –I’ll give them that –let me refer to a succinct description of the model from a BBC News article: http://www.bbc.com/news/health-39421396 ‘The 3D model is made up of a series of cubes that each represent the different parts of the female reproductive system.

‘Each cube contains collections of living cells from the respective bits of this system – fallopian tubes, uterus, cervix and vagina (all human cells), and the ovaries (taken from mice).

‘The cubes are connected together with small tubes, which allow special fluid to flow through the entire system, much like blood.

‘This also means the “mini organs” can communicate with each other using hormones, mimicking what happens in a woman’s body during a “typical” 28-day human menstrual cycle.

‘Tests suggested that the tissues in the system responded to the cyclical ebb and flow of hormones, in a similar way to those of the female body.’

At first, I have to admit, I was skeptical of the need for the model –and yes, I was inclined to see it as foppery. But when I actually read the paper (http://www.nature.com/articles/ncomms14584) I was impressed. Why not just obtain the same cells from, say, hysterectomy specimens, grow them, and subject them to whatever hormones or chemicals you pick to study? It quickly became evident that there are two types of scientists: clinical, and laboratory –as a practicing doctor, I’m afraid I fall squarely into the clinical end, and never the twain shall meet… The reason became all too clear as I continued to read.

First of all, as they explain in the introduction, ‘Preclinical studies often begin with individual cells, separated from cellular and physical contacts that are important for biological function. These dispersed cells must be propagated through weekly reduction divisions and maintained on flat plastic; however, these cells are missing the cell physicochemical microenvironment, three-dimensional (3D) tissue-specific architecture, and blood flow perfusion found in natural tissues.’ In other words, they take a long time to grow and aren’t subject to the same environment they would have in the body (i.e. in vivo).

Secondly, what is used to perfuse them may not have the same effect as the blood circulation they would receive in vivo: ‘typical media composition is based on basal nutrients, bovine serum and a few specialized factors that are placed in a static setting with random mixing. As a consequence, cell–cell and tissue-level cytokine and endocrine signals are not integrated into signalling pathways.’

So not only can delicate organs be assessed as if they were still in the body (like the rhythmic beating of the hair cells that line the Fallopian tubes –cilia), but the effects of different pharmaceuticals could be safely tested in the model before expensive clinical trials were undertaken. ‘Despite large investments in research funding, only ∼8% of drugs for which Investigational New Drug applications have been filed will be approved by the FDA.’

I have to say that I am intrigued, and not a little embarrassed that I was put off by the title of the article. Perhaps to expiate that guilt a little, I mentioned it to Ted, a –I hesitate to say ‘older’- colleague of mine that I met for lunch the other day.

We are both retired now so, apart from our similar past histories, talk heads more towards hobbies and bowels, than to scientific literature. I’m not even sure how it came up, except that his niece was trying –unsuccessfully, it seems- to conceive and his sister had phoned him for advice. She had mentioned several chemicals she’d discovered in an online search –both as potential therapies, as well as putative endocrine disruptors. She wanted to know what Ted thought.

“So what do you think?” he asked me as he carefully cut his hamburger in quarters so he could manage the entry problems. “You retired a couple of years after me…” he added, as if that meant that I was a couple of years smarter than him –or at least a bit more up to date.

“Ted, you know as well as I do that it’s dangerous to speculate on the effects of chemicals on human pregnancies. There are too many variables, too many potential effects that may not show up till birth, or even later…”

He nodded. “I remember DES for threatened first term miscarriages and the later damage to reproductive anatomy -not to mention the clear-cell cancers of the vagina that didn’t show up till years later…”

“Or thalidomide for morning sickness in pregnancies…” I added solemnly.

He nodded thoughtfully and after carefully picking out shreds of lettuce that were hiding under the bun, attempted to cram a freshly-cut piece of the hamburger into his waiting mouth, but it leaked somewhere south of his lips. “They can’t even design a portable hamburger,” he said, unsure whether to laugh or blush. He wiped his face, picked up the meat, and then searched for more hidden pieces of lettuce and placed them on his plate.

When he noticed me watching his lettuce hunt, he shrugged. “I’ve always hated lettuce,” he explained. “So does my niece for that matter. Probably hereditary,” he mumbled and then licked his fingers, contritely. “I mean, look,” he said with a crooked smile on his face, “I solved this problem using in vitro techniques.” And he held up his now-clean fingers and licked his lips in embarrassed satisfaction. “There’s gotta be a way to test these drugs without endangering a pregnancy. Mice and rats are not humans and you can’t safely extrapolate the results to us.”

“Amen,” I said, shaking my head sadly. We’d had similar discussions over the years, so I suspect he was merely venting his frustrations again.

We sat in silence for a moment while he tried to improve his in vitro technique, as he insisted on calling it.

“You know, Ted,” I said after it looked as if his practice runs at the lettuce were failing, “I did read about an in vitro way being developed for safely testing things in women. It was in the journal Nature and entitled something like ‘Microfluidic culture model of the human reproductive tract’. I’m not sure they could adapt it to pregnancies, but maybe it might be helpful in seeing what effects drugs or other chemicals could have on reproductive cells in the events leading up to a pregnancy…” I tried to remember more. “And it seems to me they were even able to replicate a 28 day menstrual cycle…”

His eyebrows shot up, and then one stayed elevated, as if scotch-taped to his forehead. “Micro fluidic what…? My god, is your retirement that bad?”

I think I blushed –he made it sound as if I’d been caught downloading porn. “Uhmm, it’s called ‘body on a chip’, or something –or at least this part is…”

He suddenly turned his attention to the chips still languishing on his plate and smiled. “Thanks for the excuse,” he said. Obviously his wife or maybe Chrissie, his sister, had warned him not to order them, let alone eat them.

“Yeah, I gather that the idea, eventually, is to be able to take cells from somebody who needs a particular treatment and test those cells in the model with various chemicals to see what happens.” It seemed quite exciting to me.

“Mmmh,’ he said, polishing off the last of his fries, while the puzzled lettuceal remnants stared at him from the plate. “I don’t think I can tell Chrissie about it, though.”

I looked up from my napkin and cocked my head. “Why not, Ted? Wouldn’t she find it interesting?”

He rested his head on his hands and peered at me as if he were looking over a pair of bifocals like a professor with a sleepy student. “She’d be on Craigslist trying to buy one as soon as she got off the phone… In fact she’d probably try for a matching set –a male one as well as a female one,” he added when I stared at him.

I must have still looked puzzled, because he smiled and picked up a piece of lettuce. “Chrissie’s a dietician and she thinks her daughter has a terrible diet… and she certainly remembers mine,” he explained, shaking his head. “She’d be trying to feed this to the model to prove her point.” He sighed. “I’d never hear the end of it…”

I suddenly realized I’d not thought about it that deeply. He’s right, maybe the ‘body on a chip’ thing needs a bit more work before they advertise it on Facebook…

The Stealing Steps of Age

Elderspeak. We’ve all heard it: baby-talk for seniors, an almost unconscious reaction to those we deem cognitively impaired, or hopelessly out of date. It’s a kind of pretend-communication with those who seem unreceptive, or beyond the pale of verbal comprehension.

Although the term is aptly descriptive and eerily evocative of rows of beds with wrinkled heads whose staring eyes peek out from where their bodies are tucked, I have to admit I had not heard the word before seeing an article in the CBC News. It described a study published in The Gerontologist about the way a group of nuns cared for their elderly colleagues from their convent: http://www.cbc.ca/news/health/nuns-elderly-1.4039508

‘The sisters caring for cognitively impaired elderly nuns in a Midwestern convent spoke to their care recipients in a way that sounded strikingly different to linguistic anthropologist Anna Corwin. The nuns rarely used “elderspeak” — a loud, slow, simple, patronizing and common form of baby talk for seniors. Instead, Corwin reports, they told jokes, stories and blessed the sick nuns, all the while speaking to them like they were completely capable, even though their ability to communicate was significantly diminished.’

‘The nuns in the infirmary suffered from dementia, Alzheimer’s disease, aphasia, stroke and neurological deterioration, and all had limited or impaired communication abilities. Sometimes the caregiver nuns held the sick nuns’ hands, and sometimes they massaged their legs, Corwin said.’

It all sounds so… sensible. So empathetic. And yet, so often we are frustrated by our apparent inability to effectively communicate that elderspeak becomes a sort of default –almost as if those to whom we are speaking are not really listening, or, depending on their condition, are minimally aware of our presence. And this can be especially prevalent among overworked care providers in geriatric wards.

‘Kristine Williams, a professor at the University of Kansas School of Nursing in Kansas City, trains nursing home providers to use less elderspeak. Her studies found that communication training can reduce the number of diminutives, terms of endearments and collective pronouns senior caregivers use.’ But training to do what?

The nuns offer an interesting option. ‘The caregiver nuns had long-established deep relationships with their elder charges, Williams noted. “They are in almost a family-like relationship, as opposed to someone who’s a nursing assistant in a home,” she said.’ And what they offered, was not condescension or inadvertent humiliation. Not patronage or mere toleration. ‘”They see these older adults, even when they’re lying in bed moaning and can’t move, as not being reduced by these chronic conditions but still as whole individuals.”’

The study was an interesting one, and yet its findings should not surprise us. ‘Beauty doth varnish age, as if newborn, and gives the crutch the cradle’s infancy’ as Shakespeare said. In other words, finding beauty in old age can transform it and make it bearable –in this case both for the aged as well as the caregiver.

Now that I think about it, I suspect I learned that years ago when I was a beginning medical student and visiting my aunt Shirley who was hospitalized after a stroke. She was stored –that’s the only word to describe it- in an older part of an already-old hospital on a ward –a large room, really- lined on both walls with beds like a dormitory. And for the most part, as I described above, all one could see looking down the rows were heads peeking out from neatly tucked bedsheets, white hair splayed across the pillows or stuck to the scalp with sweat. Some had eyes that moved, but mostly it was a room of mouths –none speaking, all busy with just the chore of breathing.

Shirley was one of the exceptions, propped as she was by a series of pillows and a cloth bib whose tethers kept her from tipping over the bed railings and onto the floor. Her voice was slurred and indistinct, so I had trouble hearing what she had to say, but I could tell she was getting better because she was complaining about the woman in the bed next to hers.

“There’s nothing there,” she kept saying, her eyes pointed at the head beside her that was staring, unblinking, at the ceiling. “They’ve put me in an empty room, dear, and I don’t like it.”

My aunt had always been gregarious, some might even say nosy, so to be confined to a room where she couldn’t extract vital gossip and life histories, was a type of exile for her. A punishment.

“You seem to have improved each time I come here,” I said, trying to cheer her up. For my part, the ward depressed me. “They’re obviously treating you well,” I added, quickly running out of small talk.

Part of her mouth smiled, but most of her face seemed still asleep. Not at all happy.

“Your aunt is improving, sir,” a soft voice said from behind me.

I turned and saw a short, smiling, grey-haired nurse dressed in white trousers and a white shirt buttoned up to his neck. His eyes were twinkling, and he was gazing at my aunt as if he, too, was proud of what she’d accomplished. There weren’t very many male nurses then, so I was surprised. “I expect they’ll be transferring you to another ward, soon, Shirl,” he added locking her eyes in his and ignoring me for a moment. “So quit complaining, eh?” He chuckled when he saw her smile broaden and the rest of her face follow suit. He reached out and squeezed her toe through the sheet and wandered off to check on the next bed. Shirley giggled, obviously pleased.

I could hear the nurse talking to that unresponsive woman in the next bed, although he spoke quietly. First, he tilted his head to stare at the ceiling above her bed. Then, he smiled. “You know, Liz, I figure you must have much better eyes than me…” He liberated a skeletal arm whose flesh hung from it like curtains on a window and held it tenderly. “…Because no matter how often I look, I still can’t see whatever it is that you find so interesting up there.” He gently squeezed her hand. “We’re gonna have to discuss this over a beer someday, eh?”

Her face didn’t change, but her breathing seemed a little less laboured. A little slower. More even. “Anyway, is there anything you need me to help you with today?” he said as he ever so gently massaged her arm then flexed and relaxed her fingers. When he’d finished with that arm, he tucked it under the sheets again and repeated the exercise on the other. “I’m going to come back and move you into a different position in a few minutes, Liz, so don’t get too comfortable like that, eh?” He loosened the sheets around her and raised the railings around the bed again that guarded her from falling. “And I’m going to make sure that physiotherapist you like comes with me to massage your legs.” He winked at her flirtatiously and gave her leg a squeeze through the sheet.

“He might as well be talking to the pillow,” Shirley whispered, as he busied himself with the railing. “All she does is stare at the ceiling. She doesn’t seem to notice when I talk to her…”

“So wait for me, Liz. I don’t want to have to go looking all over the ward for you again,” he said, laughing, and wandered off to yet another bed.

“I do like Bill,” Shirley said when he was out of earshot. “He treats us all like family –like we matter.” She was silent for a moment and then, just when I was about to leave, she managed to snag me with her good hand. “But I don’t know how he stays so cheerful here. I think half of the patients don’t even know he’s talking to them.” And her eyes wandered over to the woman in the next bed again. “It must be terribly discouraging for him, don’t you think?”

I glanced at the woman, and for a moment, I thought I saw her eyes flicker as if they were searching for something. Someone. And then, a tear? But maybe it was just a trick of the light, because, as her face relaxed a tiny bit, they closed and she began to snore. Not loudly, not as if she couldn’t breathe –but quietly, comfortably, and slipped from the waking dream, into yet another more peaceful one further inside.