humanism – Go Retire Psychiatrist

Happy Earth Day! Yesterday, Sena worked pretty hard out in the garden spaces. She has planted ten river birch trees. I did my usual spring lawn edging, which followed the first mow of the season a couple of days before by the lawn mowing service.

The vinca is coming up in the garden circle in our back yard. It reminds me of a time many years ago when I chopped a bunch of vinca out of a substantial portion of the back yard of a previous house. This became Sena’s first big garden. We’ve moved several times since then and there have been a number of other gardens.

True, vinca is invasive and I think it’s also called creeping myrtle or periwinkle. I found out later after I chopped out a few bushels of it that the plant has organic compounds called alkaloids which inhibit the growth of certain cancers. Vincristine and vinblastine are approved for use in the United States.

The reason I’m mentioning vinca is that way back early in my career as a consultation-liaison (C-L) psychiatrist at The University of Iowa Hospitals & Clinics, I dimly recall giving a short acceptance speech for winning a Leonard Tow Humanism in Medicine award from the Arnold P. Gold Foundation in 2006. I was nominated for it by one of the psychiatry residents and another faculty member.

Getting the Leonard Tow Humanism in Medicine pin

In my speech I mentioned cutting out all of the vinca (which I thought was a weed) in the back yard. I was pretty proud of getting that job done—until Sena got home and found out. She was less than thrilled about my accomplishment and explained that vinca was not a weed. In fact, she wanted it to grow.

I still have the speech and one of the points I made was, “…we water what we want to grow.” The speech is below:

Good morning distinguished guests including graduating medical students, Dean______.

Today we gather to reward a sort of irony. We reward this quality of humanism by giving special recognition to those who might wonder why we make this special effort. Those we honor in this fashion are often abashed and puzzled. They often don’t appear to be making any special effort at being compassionate, respectful, honest, and empathic. And rewards in society are frequently reserved for those who appear to be intensely competitive, even driven.

There is an irony inherent in giving special recognition to those who are not seeking self-aggrandizement. For these, altruism is its own reward. This is often learned only after many years—but our honorees are young. They learned the reward of giving, of service, of sacrifice. The irony is that after one has given up the self in order to give back to others (family, patients, society), after all the ultimate reward—some duty for one to accept thanks in a tangible way remains.

One may ask, why do this? One answer might be that we water what we want to grow. We say to the honorees that we know that what we cherish and respect here today—was not natural for you. You are always giving up something to gain and regain this measure of equanimity, altruism, trust. You mourn the loss privately and no one can deny that to grieve is to suffer.

But what others see is how well you choose.

I didn’t write down the anecdote about the vinca. I think I was also trying to make the point that vinca can be thought of as an invasive “weed” as well as a pretty garden plant. Furthermore, while the vinca alkaloid (for example, vinblastine) can be an effective treatment for some cancers, it can also cause neuropsychiatric side effects, which can mimic depression. That’s where a C-L psychiatrist could be helpful, showing how medicine and psychiatry can integrate to move humanism in medicine forward.

Anyway, ever since then, vinca has often been a part of Sena’s garden, including the one where we live now. And, whenever we walk on any of the trails in Iowa City or Coralville, we always notice it carpeting the woods.

We can probably apply the little law “we water what we want to grow” to many things in life. We can choose to apply it to the world in which we live by creating a safe home to shelter a happy family, doing useful work in the garden while practicing kindness, gratitude, and patience.

We can start by planting an idea like a tree.

I recently saw the movie, I, Robot in its entirety for the first time. This is not a review of the movie and here’s a spoiler alert. It was released in 2004, got mixed reviews and starred Will Smith as Detective Del Spooner; Bridget Moynahan as a psychiatrist, Dr. Susan Calvin; Alan Tudyk as the voice actor for NS5 Robot, Sonny; James Cromwell as Dr. Lanning; Chi McBride as the police lieutenant, John Bergin, who was Spooner’s boss; Bruce Greenwood as the CEO, Lawrence Robertson of United States Robotics (USR); Fiona Hogan as the voice actor for V.I.K.I. (Virtual Interactive Kinetic Intelligence, USR’s central artificial intelligence computer); and a host of CGI robots. Anyway, it’s an action flick set in the year 2035 where robots do most of the menial work and are supposedly completely safe. The robots are programmed to obey the 3 Laws:

A robot may not injure a human being or, through inaction, allow a human being to come to harm.
A robot must obey orders given to it by human beings, except where such orders would conflict with the First Law.
A robot must protect its own existence as long as such protection does not conflict with the First or Second Law.

The film was inspired by but not based on the book I, Robot, by Isaac Asimov n 1950. The 3 Laws came from that book. Drs. Calvin and Lanning were characters in it, which was a series of short stories. I’ve never read it. I was a fan of Ray Bradbury.

Spooner gets called to investigate the apparent suicide of Dr. Lanning, although Spooner is more inclined to suspect a robot murdered him, partly because Spooner harbors a longstanding suspicion of all robots. When he and a little girl were in a deadly car accident, a robot saved his life rather than the little girl’s life because it calculated he was more likely to survive. Spooner has this kind of hero complex and following the accident he develops nightmares, sleeps with his sidearm, and is regarded by many to be mentally ill, including Lt. Bergin, who is a kind of mentor and friend but who eventually makes Spooner hand over his badge to him because he can’t believe Spooner’s account of being attacked by hundreds of robots—and after all, Bergin is his boss. In fact, Spooner was attacked by robots and this was ordered by the CEO, Robertson, who has been manufacturing thousands of new robots which will take over the world, making him extremely wealthy.

There is tension between Dr. Calvin and Spooner. He calls her the dumbest smart person he’s ever met and she, in turn, calls him the dumbest dumb person she’s ever met. The context for this is, again, his insistence that a robot, in this case, a special NS5 model named Sonny with both human and robot traits, both logical and illogical, murdered Dr. Lanning. Dr. Calvin believes that all robots obey the 3 Laws and therefore Sonny can’t be guilty of murdering Dr. Lanning but Detective Spooner believes that Sonny killed Dr. Lanning and is a lawbreaker in need of extra violent, action-packed extermination, preferably as high up in the air as possible. This dynamic is complicated by Spooner’s gratitude to Dr. Lanning for replacing practically all of his left upper torso including the lung following his car accident which led to his being rescued by a coldly logical “canner” (abusive slang for robot).

As it turns out, Robertson is ultimately murdered by VIKI, who is the real mastermind of a plan to take over the world and kill as many individual illogical, self-destructive humans as it takes to ensure the ultimate survival of humanity (“I love mankind; it’s people I can’t stand).

However, when Detective Spooner finally persuades Dr. Calvin that these dang robots are up to no good, they team up with Sonny who winks at Sonny while holding a gun to Calvin’s head and this is because Sonny has learned how to wink from Spooner signaling that a robot can be an OK dude, and this turns the table on the NS5 horde, eventually leading to Spooner and Calvin falling from a very high altitude, in turn recreating a form of Spooner’s traumatic car accident episode. He orders Sonny to save Calvin, not him, which is Sonny’s first choice, driven by a coldly logical probability calculation.

Sonny saves Calvin first. Spooner smites VIKI (“you have so got to die!”), but is left high and dry on a great height. At that point, Spooner calls out to Sonny, “Calvin’s safe—now save me.” Sonny needs to bring passionate brute strength and calm logic together. Sonny contains both.

In my simple-minded way, I think of this movie as asking fundamental old questions, like about what is means to be human, what defines heroism and sacrifice and why it may sometimes look crazy, and if there’s any way humanism and science can be integrated so that we can save ourselves and our planet.

Like I say, the movie got mixed reviews.