MRSA - Supergerm immune to Kryptonite

More years ago than I care to remember, I saw a stand-up comedian doing a (what I thought at the time) very funny rant on the old marketing slogan for bleaches and detergents, “Kills 99% of all known germs – dead!”

The first question he asked was the obvious one about whether there were any other ways to kill something other than dead. He then went on to speculate about the other one per cent which weren’t killed. “There they are, sitting in your toilet, on your kitchen surfaces, in your kitchen sink. They’re lapping up the detergent and loving it! They’re shouting out for more and getting bigger and stronger all the time until, one day, they come bursting out on you, big and mean and ugly – Supergerm!”

The problem is, it’s not a joke – it has become a sad fact.

In the normal course of events, Staphylococcus aureus is a fairly benign bacterium which is carried by at least 20% to 30% of everyone on earth on their skin or, most commonly, in their noses. It lives a rather boring and benign life in its host, generally not causing any damage. In particular circumstances, however, especially in the case of people with compromised immune systems, it will infest open wounds and prevent them from healing and it can also cause blood poisoning (sepsis), toxic shock and a particularly nasty form of pneumonia. In other words, though it is usually fairly peaceful, when it really gets going it can kill.

When Alexander Fleming accidentally discovered penicillin in 1928, he was actually investigating the properties of various staphylococcus bacteria – what he found out was that a secretion produced by a mould of the Penicillium family killed staphylococci. The first antibiotic was developed and millions of lives have been saved as a result. Unfortunately, in the past few decades, many antibiotics seem to have been losing their efficacy. For this we have only ourselves to blame.

Charles Darwin described evolution as “the survival of the fittest” and, seen from one point of view, the history of species on our planet is one of intense competition with each other, even warfare. (There is, of course, much more to evolution than this simplification, but it does contain a lot of truth.) As Tennyson put it, “Nature, red in tooth and claw.” Once humanity discovered that bacteria were behind many of the illnesses which kill so many millions of people every year, we declared war on them. To continue using the imagery of conflict, the development of penicillin – and antibiotics in general – provided us with a marvellously effective weapon to take the war to the enemy.

Any general worth his salt will tell you that there is really only one way to definitively win a war; you kill all the enemy soldiers or force their surrender. As long as units of the foe continue to survive and fight you, the war isn’t over. Worse, if those surviving enemy units develop tactics and weapons to counter you in the areas in which you are tactically and technologically superior, then you have a real problem. This is what has happened in the “war on germs.”

In the past few decades, there have been more and more incidences of bacteria developing which have become resistant to the most common antibiotics. To understand how this has happened, we have to look at the way antibiotics work and then just apply evolutionary logic – and penicillin is a very good example.

Penicillin destroys bacteria by damaging the cell walls of bacteria. Bacteria are one-celled organisms – basically just a mass of liquid held together by a more solid envelope, the cell wall. Penicillin attacks a particular building block of this wall so that when the bacteria wants to divide (which is the way bacteria reproduce) and thus stretches its envelope, making it thinner in the process, it rips and the creature, put simply, bursts.

But some bacteria are stronger than others, more thick-skinned, if you will – so it takes continued application of the antibiotic to kill them all. If the course of antibiotics isn’t given for long enough or in a sufficiently strong dosage, all that happens is that all the thinner-skinned bacteria are killed; those with thicker skins survive – and they’re the ones who reproduce. So the antibiotic treatment itself forces a kind of natural selection among the bacteria, until – if this process is repeated long and often enough – you get a strain of bacteria which isn’t much bothered by antibiotics. And this strain doesn’t even have to worry about competition from other relatives, since the nice humans have obligingly killed them off.

Over the course of decades, the irresponsible use of antibiotics has forced the evolutionary development of strains of bacteria which are immune to them. This has happened in four basic ways. Firstly, the overprescribing of antibiotics generally, frequently for illnesses which are not helped by them (antibiotics are useless for viral infections like the ‘flu and the common cold) or with which the normal immune systems of the patients could have easily dealt on their own.

Secondly, the frequent failure of patients to follow the instructions for taking the medicine (“after two days the symptoms cleared up and I didn’t like the side-effects so I didn’t take it any more”), leading to many situations where a residue of stronger bacteria survives the treatment.

Thirdly, insufficient attention to hygiene in hospitals. Bacteria love hospitals; they’re full of potential hosts with weakened immune systems, lots of opportunities to gain access to them through wounds etc. and lots of friendly doctors and nurses on which to hitch free rides from one patient to another. And, of course, lots of training for dealing with antibiotics. Hospitals can be tough for bacteria at first but once they’ve learned to deal with the antibiotics they’re germ heaven.

And fourthly, the unbelievable irresponsibility with which the agricultural business has used antibiotics. Animals, kept at closer quarters and in larger numbers together than nature ever intended, are routinely given low-level antibiotics from the cradle to the slaughterhouse, just to make sure they don’t get sick. As a result, minimal levels of antibiotics are passed into the human food-chain and even into our drinking water supplies. More training for the germs.

Staphylococcus aureus

So, let us now return to our friend, the Staphylococcus aureus. Over the course of time, many strains of this particular little beast have developed a first-class resistance to all sorts of antibiotics of the penicillin family and have been given the general name “Methicillin-resistant Staphylococcus aureus” (called after a particular penicillin derivative), more commonly (like J.R. Ewing) known by its initials, MRSA.

The number of people killed by MRSA every year is something very difficult to ascertain; one of the numerous cases of lies, damned lies and statistics in public health. A basic problem is that many of those at risk (children, chronically ill, elderly people, etc.) may be significantly weakened by an MRSA infection before finally dying of something else. One study suggests that around 19,000 people died of MRSA-related causes in the USA in 2005. A German TV report claimed that 160,000 people contracted an MRSA infection in German hospitals in 2008 and the German Society for Hospital Hygiene estimated that 40,000 people in Germany died in 2009 as a result of it.

Once someone has contracted an MRSA infection it is very difficult to get rid of it, particularly if they have a weakened immune system. Depending on the strain involved, certain special (very expensive) antibiotics may be effective, but frequently in the everyday clinical world, the precise strain is never analysed and no specific treatment is followed through. All too often, this is – as in so many things – a question of short-term costs. (That subsequent longer term costs of treating people with a chronic MRSA infection are usually much higher is something which the pencil-pushers running the various public and private health insurance corporations world-wide don't seem to want to think about.) Otherwise, the only thing to do is to isolate the patient, do everything possible to strengthen his/her immune system, try all kinds of alternative stuff which have been reported to sometimes work, like inhalations with lavender or tea-tree oil and … wait.

For the past ten years, I have worked a lot with people who are on respirators. They generally have tracheotomy tubes and these surgical holes cut in their windpipes are magnets for MRSA. Given their precarious state of health, they are regularly in and out of hospitals and many of them pick up a multi-resistant bug sooner or later. For them, the isolation is the worst – if you really want to deal with the infection and ensure that it doesn’t spread then you have to confine them to their rooms and make sure that everyone who visits them wears gloves, facemask and disposable surgical gown. For people punished enough by the vagaries of fate, this extra isolation can be very hard to bear.

What makes me so angry about it is that it could all have been avoided. Instead, we have taken the wonderful new weapon which was antibiotics and, in the past sixty or so years, proceeded to systematically blunt it.

MRSA is only the beginning. In recent years, there are increasing reports of strains of the bacteria responsible for tuberculosis and pneumonia (among others) emerging which are immune to the standard antibiotics used to treat them up to now. Supergerm is not alone, he’s called all his cousins and friends and they’re coming to the party too. The problem is that kryptonite doesn’t work on them any more.

 

Pictures retrieved from:

http://shanghaiist.com/attachments/Giacomelli/superbug.gif

http://static.howstuffworks.com/gif/superbug-1.jpg

Sweat, Baby, Sweat ... Visiting the Sauna

For quite a number of weeks now, I’ve been having back trouble. It’s a permanent possibility that people like me who work in the nursing area have to live with – despite all the tricks you’ve learned (and hopefully internalised) about lifting properly and using all the technical aids (like raising beds to working heights, etc.). In the heat of an emergency situation, or just as a result of slowly growing muscle tension after too long or too many shifts, sometimes something can just get pushed over the edge and you’re left with the painful result.

In my case, it seems to be a trapped nerve in my shoulder/upper back. After a couple of weeks of swallowing pain-killers and hoping that it would go away on its own, I finally surrendered to reality and paid a visit to the doctor. He diagnosed the trapped nerve – thus going a long way to silencing the pessimistic demon who’d been whispering dire predictions of disc damage to my overactive imagination – set an injection and prescribed rest.

There are worse things than a week’s sick leave in spring, especially when the reason for it isn’t a totally debilitating illness which confines you to bed and has you feeling continuously miserable. The week of rest helped considerably with the back pain, even if it hadn’t been long enough to get it to clear up completely. I therefore decided that I was fit enough to go working again. I further decided to spend the last day of my prescribed idleness doing something that I was certain would significantly aid my recuperation.

Remscheid, the town in which I live, is lucky to have a first-class public sauna. So on a sunny spring morning I made my way to the H₂0 Bathing and Sauna Paradise. H₂0 was built by the city in the wealthy days of the 80s, before the fall of the iron curtain brought the financial intensive care patient otherwise known as East Germany and globalisation hit old industrial towns like Remscheid, when Germany’s cities still had lots of money for such projects. Nowadays they don’t and the swimming complexes have to pay for themselves. Unusually for public run projects, the city made some good decisions here and expanded the swimming complex by adding a luxurious sauna area, which has an extremely good reputation and attracts visitors from far beyond the city boundaries. One on-line ranking list by insiders puts it in fourth place in Europe. At € 22 (around $ 30) for a day ticket it’s not exactly cheap but the investment is well worth while.

The sauna section of H₂0 has ten different saunas, each with its own particular character, ranging from a humid Turkish bath to a small half-buried wooden blockhouse with an open fire and a dry heat temperature of 110° C. Some of these are indoor, inside a complex which also includes resting rooms, comfortable seating around two open fires, a massage area, a whirlpool and a restaurant. The others are in the landscaped open area along with a number of pools (warm and cold), a secluded meadow area with sun loungers and a long, five-meter high wall of cut and shaped blackthorn twigs where water from deep natural reservoirs, rich in various mineral salts, continually splashes down to create an invigorating healthy mist.

The first thing a stranger to the sauna culture in Germany and Austria has to get used to is that nudity is mandatory inside the various saunas, and optional in most of the public area (though frowned on in the restaurant). This has good practical reasons, for the sauna is, above all, about serious sweating and this is best done naked on a towel. Germany has an old and respected nudist movement which may have something to do with the unexcited matter-of-factness with which nudity is viewed in the sauna setting.

There is nothing prurient and indeed very little that is erotic about such nudity. When the heat is making you gasp and the sweat is dripping in your eyes, the state of undress of your neighbour on the wooden bank next to you is the least of your concerns. Although, on reflection, I must qualify this statement. One reason why the nakedness of your neighbour is of so little concern to you is precisely because everyone is naked. There is an understated honest democracy about the whole situation. You realise very quickly that very few people have “perfect” bodies and one experiences an uplifting, liberating acceptance of one’s own less than godlike form in an environment where all are unselfconscious about the various parts of their anatomies which bulge, or sag, or are floppy or chubby.

Anyway, you don’t go to the sauna primarily to look at other people, you go there to sweat, more accurately, to sweat as part of a process which is conducive to deep relaxation. Good German saunas have developed a procedure where this is optimised – the ritual known as the Aufguss (an adequate English translation does not exist).

In private saunas, or those booked by a group of friends, the normal Finnish tradition is usually followed, whereby a wooden tub of water is placed near the hot stones on the oven and is poured with a ladle onto the stones to create steam. Because water is a much better conductor of heat than air, the sudden raising of the humidity in the sauna creates a subjective feeling of an intensification of heat, leading to an increase in sweating. The German tradition formalises and develops this practice.

At regular intervals the Aufguss is carried out. The guests gather in the designated sauna area and the Saunameister (or meisterin) takes the stage. He or she brings a bucket of water, generally mixed with an infusion of essential oils. The door is then closed and a measured amount of the scented water is ladled onto the hot stones. You feel the temperature rise sharply but that is only the beginning. The Saunameister then takes a large towel and begins to fan the air, taking the warmest back down from the ceiling where it has risen and driving it in your direction, sometimes as a sharp wind, sometimes as a gentle breeze. After a few minutes, the process is repeated.

The increasingly humid air in the sauna feels hotter and hotter. After the second round with the towel, a few honest souls admit to themselves that they have had enough and bolt for the door. The rest of us stay on, every pore in our body wide open and pumping sweat just as hard as they can. Perspiration is an automatic reaction by the body to try to cool itself; the evaporation of moisture leads to cooling in the normal course of events. This is not the normal course of events, for in the heavily hydrated hot air of the sauna no evaporation can take place. So the sweat pours down your body instead, purging you (at least minimally) of all sorts of waste products and poisons which have gathered in your skin in the vicinity of your pores.

And then the Saunameister ladles the rest of the water in his bucket onto the stones. Once more there’s the hiss of instantly boiling water. He takes his towel and begins to whip the superheated air in your direction. He’s really putting his back into it now and you don’t envy him; just sitting here is hard enough, the idea of having to work under these conditions doesn’t bear thinking about. From various corners of the room you hear involuntary gasps, but you know that it’s nearly over now. He wishes you pleasant sweating and there are murmurs of thanks, perhaps even some polite applause. Most of the guests follow him quickly out of the sauna.

Now comes the difficult – but in my opinion – essential part. After leaving the sauna, immerse yourself completely in a cold pool or take a quick cold shower (originally the Finns came out of the sauna and rolled naked in the snow!). You can feel all your pores slamming shut with the shock, your heart takes a leap and your blood pressure briefly bounces up as a result of the sudden constriction of your blood vessels in response to the cold. Half a minute or so is quite long enough and when you’ve towelled off you’ll find that you’re still basically warm from the sauna – even if you’re standing naked, outside, in winter.

As your heartbeat comes back down to a normal pace you find a marvellous sensation of complete physical relaxation setting in. Now is the time to put on a bathrobe and find somewhere comfortable to sit or lie down. In winter I often make my way to a comfortable armchair or lounger in front of one of the open fires; when the weather is warm (as it was on my last visit) I usually make my way to what they call “The Garden of Stillness” in H₂0, where no talking is allowed, and sit or lie in the sunshine.

One of the positive characteristics of our local sauna complex is a sense of peace and stillness. This is not the case everywhere and I have been to other complexes where there is an atmosphere of bonhomie more suited to a barbeque party. Some may enjoy it, but my own preference is expressed well in the Finnish saying, “saunassa ollaan kuin kirkossa,” – you should sit in the sauna as in a church. It is not a coincidence that the sweat lodge has deep religious significance in the Native American culture. The Finnish word löyly is, so the experts say, impossible to translate completely but it is generally used to describe the heat of the sauna room. It also, however, has other connotations denoting “spirit,” “soul” and “life.” For me there is something meditative about a day in the sauna, the deep physical relaxation freeing the mind to think of … nothing.

Usually, the last Aufguss I take part in is a traditional Finnish one, which H₂0 offers three times daily, the birch ceremony. In this, the sprinkling on the hot stones is done with bunches of leafy birch twigs which have been previously soaked in the water for a number of hours and the heated air is fanned with the twig bunches instead of with towels. For the third round, you can turn your back to the Saunameister or (if there is enough room) lie on your stomach and have your back lightly beaten with the twigs.

Pure, unadulterated physical luxury. We all need it every once in a while.

Pictures retrieved from:

http://static.rp-online.de/layout/showbilder/50250-H2o_panoramasauna.jpg

http://www.freizeitbad.de/uploads/tx_userbaeder/h2o_remscheid-main_01.jpg

Debates and Deliberations

“I beseech you, in the bowels of Christ, think it possible you may be mistaken.”

(Oliver Cromwell, 1650)

There is a large and very lively group among bloggers who practice what is often called “political blogging.” Those who live in the USA, where the phenomenon is particularly popular, divide themselves generally into two camps which define themselves as “Liberal” (some prefer the sobriquet “Progressive”) and “Conservative.” Many of them seem to spend a considerable amount of time reading each other’s posts, caustically commenting on them and then returning to their own blogs to write further posts which, they seem confident, will destroy the arguments made by their opponents.

John Myste, a blogger whom I have recently discovered, wrote an excellent post in which he describes the whole process very well and poses some very good questions about the point of the whole thing. As if to illustrate the argument he makes, the subsequent comments on his post seem to rapidly descend to a level of sniping over the conservative credentials of recent Republican presidents and presidential candidates in the USA. Business as usual in the trenches of ideological warfare.

The question John is asking is about what this sort of debate is supposed to achieve and his conclusion is not very much – at least if looked at from the point of view of winning over your opponent, persuading him/her to change his/her position and, ideally, accept yours. Which is, on the surface, what it would seem to be about. But, of course, this isn’t really what’s going on here at all.

John uses the analogy of the chess game, a test of analytical and intellectual strength between two opponents which results in a winner and loser. One could also use the analogy of a school or college debate where judges, following some kind of criteria, decide on a victor or victors. Even at this level, the acceptance of the verdict may become problematical since, with regard to many of the subjects debated, those judging may be open to the accusation of ideological bias. But there are no real judges in the virtual world-wide blogging web, no agreed way to determine winners and losers and so the discussions – if such they are to be called – can go on forever.

Such harmless on-line jousting is a reflection of the way we humans organise our civil society. Over the centuries, most civil units have accepted, in one form or another, a parliamentary model for deciding (or at least consulting) on the organisation of human affairs and this generally on a representative model. Despite the fact that many constitutions (particularly the older ones) make no mention of parties and factions, these seem to have emerged almost everywhere in some form or another.

Why our debates generally don’t come to agreed conclusions and why our representative assemblies seem to inevitably throw up party systems are, I believe, just two facets of the same very deep phenomenon which is, in fact, probably genetically hard-wired into us as humans; we are social animals and invariably organise ourselves into groups. On a level much deeper than the rational, we then identify with our group, give it our loyalty and automatically accord our group a default position of “rightness,” particularly when we come into contact with other groups. This frequently has little to do with a logically argued, superior rational basis for our position and is much more a reflection of our need to assume that our group is superior, better, righter than the other.

How deep our hard-wired need to regard our group as better than any other is can be seen if you look at the behaviour of two groups of monkeys meeting in a forest. From the first contact onwards there is great excitement and disquiet, shouting and screeching at each other, There is ongoing conflict between the two groups, raiding each other, mobbing of individuals or smaller groups caught outside the protective area of the larger group, attempts to kidnap females, or at least impregnate them. Only in the event of a greater common threat, like an approaching predator, do the two groups suspend their hostilities.

Among our primate cousins there are all sorts of good evolutionary reasons for this kind of behaviour. Even among our immediate pre-rational ancestors it made sense. But at the moment that development of thinking self-reflection occurred, a new factor was entered into the equation, throwing much of the evolutionary rationale into chaos. The device of the extra-terrestrial monolith, used in the first sequence (“The Dawn of Man”) of Stanley Kubrick’s and Arthur C. Clarke’s 2001: A Space Odyssey, may be speculative science fiction, but the insight that it was the superimposition of rational thinking on primate group behaviour which led to killing and war remains, in my view, basically valid.

Our capacity for rational thinking may have led us to develop our group identification and our instincts to aggressively preserve and enlarge the areas of interests (or supposed interests) of our particular group into ever more efficient ways to defeat, dominate and destroy other groups, but, thankfully, it hasn’t stopped there. We have discovered all sorts of ways to sublimate and control our group identification and aggression. Being a supporter or fan of a sports team is one, and attendance at a major sport event, like a football game can offer cathartic satisfaction for this deep instinct we have to simply identify with our group, right or wrong. Even in this area, it sometimes escapes the ritualised control of the rules and conventions accepted to briefly explode into mob violence, and this was the case as far back as Imperial Rome where the rival supporters of different teams of charioteers (signified by colours) frequently took to the streets to beat the shit out of each other.

But even on the more “serious” political level, we have also managed to formalise and ritualise these basic aspects of fundamental group identification and aggression. Churchill once said, “It is better to jaw-jaw, than to war-war,” and this observation is a good description about what all sorts of parliaments, assemblies and councils are about.

So, rather than fight, we meet to discuss our affairs. And in these meetings, people of similar interests group together and form factions and parties. Inevitably, it seems, such parties take on a life of their own, becoming firm groups themselves, with which people identify and which command their loyalty. Once again our instincts assert themselves. Loyalty to the party frequently becomes more important than the concrete issues which led to its formation in the first place. The policies proposed by other parties must, by definition, be wrong, for they are not the policies of our party and the issues become subordinated to a competition between parties for power. This tendency is then reinforced by another very deep instinct we have; an apparent need to follow particular individuals possessed of that charismatic characteristic known as leadership, who use these structures to achieve and exercise power.

Of course, reality is much more complex and there are, luckily, countervailing tendencies to negotiate, to make compromises, to form coalitions, etc. But still, we should not underestimate the power of our visceral, instinctive tendencies to identify with our group, beyond any considerations of reason and logic and what a powerful motivational force this is. Should anyone doubt this, I would suggest they simply look at what goes on at one of the two great party conferences in the USA following the nomination of a presidential candidate, or the faces and gestures of the party faithful in various party headquarters after the announcement of election results. What we basically see are expressions of pre-rational feelings like: We are the greatest! Our guy can destroy your guy! Yaaay, we won and you lost!

Harmless enough, most of the time. Yet I wonder whether the forms of government that have evolved over the past few hundred years or so, our representative parliamentary democracies, based on competitive adversarial party systems and the personal power struggles of individual leaders are adequate for the challenges facing our world, now and in the future. The growth and development of our group instincts led, ultimately to the formation of nation states, the units of power and administration we use to organise our communal living. Yet we live in a world of seven billion people whose lives are interconnected globally in all sorts of ways. We are all members of many groups and these groups are, increasingly, less limited locally than they ever were before. For most of us, the fundamental unit remains that, loosely seen, as the family – though this has far more expressions than the so-called classical nuclear family (mother/father/children), which (seen from a wider historical and cultural perspective) was never much more than a bourgeois 19^th and 20^th Century western myth anyway. But beyond the family there are all sorts of other groups; friends, religious groups, work connections, interest networks, etc. with which we identify, more or less closely and, in an increasingly mobile world and with the growth of all sorts of cyberspace connections, many of these are no longer limited by local and national boundaries.

Moreover, many of the organisations and power-wielding networks – particularly the big corporations which have more and more influence on all sorts of aspects of our lives – have long since left national boundaries (and, increasingly, effective controls) behind; all we need do is to look at the whole world of the “markets.”

In recent decades, more and more theorists have been looking at other ways in which we might potentially organise our societies. One of the interesting ideas to have been developed is that of Deliberative Democracy. Rather than being based on rule by elected representative assemblies (with all the aspects I have described here), it is described as “a form of democracy in which public deliberation is central to legitimate lawmaking. It adopts elements of both representative democracy and direct democracy and differs from traditional democratic theory in that deliberation, not voting, is the primary source of a law's legitimacy” (Wikipedia). It is an attempt to get beyond the idea of making decisions by simple majorities (usually by groups and parties which have vied to achieve a majority mandate) and instead have as many people as possible involved at all sorts of levels in consultation and decision-making processes. Its implementation and concrete workings are complex, but such is only a reflection of the very complex global societies in which we live.

It also offers us a possibility to move beyond a level of decision making based, fundamentally, on dividing society into groups and then deciding on the basis of which group, or coalition of groups is strongest (for a democratic majority is also, in the end, a measure of strength), in favour of involving the wisdom and expertise of as many people as possible in making decisions about issues which will affect them. Those interested in reading more can click the Wikipedia link and surf on from there.

It is, at the very least, a line of thinking worth … deliberating about.

Pictures retrieved from:

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https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfuE-jxIdrOb5yCM2zZwf-bdZPzBG0fDlVyv5OqXCtso7Ucy2vxSHjJxb0eOBDygcwPqao-fZFLnzKVDbvIQY5iFdfm7z2DoJ3vm425PV_P8BcoscqYKwRdVWPPtO09sSKq0XiNSUZKRc/s1600/2001-a-space-odyssey-ape.jpg

http://www.campaign.com/campaign_trail/2008/9/images/republican.convention.closing.jpg

Schizoaffective

It’s two thirty in the morning and Sigrid’s awake. There’ll be no more sleep tonight – too much adrenalin, excitement, fear and coffee.

She was always an early riser but things have become pretty skewed in the past couple of months. Now she’ll sleep, exhausted, around nine in the evening and then, a few hours later, wake up … and get up.

At the beginning she told herself – and others – that she enjoys it. Maybe she did at first. She was on sick leave anyway; some kind of strange thing involving trouble with her gut and a low erythrocyte count. She’d just collapsed one day, woken up to find herself lying in cold urine. Her doctor wasn’t sure about what was causing it; it might even be some kind of exotic parasite (she told us) and she had her own theory about where she might have picked that up. He’d put her on sick leave, iron tablets and antibiotics – if it didn’t clear up, then he’d start doing some tests.

She sits in the kitchen, a mug of fresh, strong, black coffee before her, smoking. The last time my daughter visited us, she left a copy of her school yearbook behind. Sigrid has spent many hours looking at it in the past few days and now she opens it once more. The house is silent, outside on the street, ten minutes can go by at this depth of the night before a car passes.

There is a connection I’m sure there’s a connection but nobody else can see it but it’s there. I needed long enough to see it myself but it’s all connected. The pictures you can see it in the faces that girl is telling us something but she can’t say it out loud because then THEY would find out and that could be the end of her …

She is SO brave and clever and thank God I can understand it. You can see it in her EYES she’s telling us that they are being held against their will and the hands of that dirty old man were touching her everywhere but he won’t do anything more because that would damage the goods instead he’s going to sell her to that circle of pimps but she knows because she’s seen what happens to the others that they just disappear but she’s found a way to send out a signal with that look in her eyes and I KNOW what she’s really saying …

We need potatoes, I could do fried potatoes with bacon and eggs tomorrow; I’ve got to use some of those eggs soon anyway or maybe I could bake …

Although if I’m going to bake then I should clean the oven first …

Restless, the nervous energy rocketing around inside her like a billiard ball hit hard by the cue and ricocheting again and again from the cushions, she starts to clean the oven. At three thirty she’s finished. She sits down at the kitchen table again. Another cup of coffee, another cigarette. She examines the pictures of the girls in the school yearbook again.

I am NOT mad, this is really happening, the others just can’t understand it. It’s all so CLEAR! He’s a doctor that’s the way he’s able to organise it all without anyone getting suspicious about it. But the evidence is here it’s all so clear because it’s in their names. This girl is called Collette and this one is Julie but it’s all a CODE Julie and Collette have changed their names so that they can send out a message without him realising that they’re doing it. How clever of them! How BRAVE! But now I’ve got to help them somehow because the message has reached ME and I’ve understood it …

Outside on the street, there’s a sound of a car stopping, briefly voices, the clunk of the door. The car drives on. The silence returns. She looks at the clock. A quarter to four.

Who was that? Probably just someone coming home late unless … Maybe they’re on to me no they couldn’t be I haven’t told anyone about the code the messages in the photos except Francis. No he wouldn’t be involved although he won’t take me seriously he can’t see it why can’t he see it? it’s so clear!

At least he seems to believe me about the rape. All those years ago and I forgot it completely but I remember now and I know what those poor girls are going through …

The car! Who got out? Did someone sneak in here are they watching me? There are so many of them and they’re so well organised and they could be hiding in the flat right now ogodogodogod ….Calm down, Sigrid! Check …

She gets up and turns on all the lights in the kitchen. Then she moves though the apartment, turning on all the lights in every room, standing in each room checking carefully, satisfying herself that nothing has been changed. She looks into the bedroom, watching my sleeping form for a few minutes, listening to my breathing. Going out, she leaves the door ajar. The front door is locked, she checks the chain. Feeling a little more secure, she goes back to the kitchen. Another cigarette, another cup of coffee. She sits down and examines the photos in the yearbook once more.

But I KNOW I’m right all those poor girls and I WILL do something for them all I have to do is persuade Francis and the boys as long as they don’t get to me first because we could all be in danger …

That’s where I found her when I got up in the morning. As I drank a cup of coffee she showed me the photos in the yearbook once more, once more explaining to me about the paedophile ring they were referring to, how the names and facial expressions of the girls there all had a meaning, how we needed to help them, how the father of my ex-wife (a retired doctor) was involved up to his neck in the whole thing.

I tried to explain to her that none of this was true, as I had frequently in the previous days, but gave up quickly. I wasn’t getting through to her. She had a rebuttal ready for everything I said, the explanations becoming ever more abstruse but, for her, none the less real for all that. I had to go to work. She accepted that. Would she be all right? Yes, she said. Would she think about making an appointment with a doctor? There was no need for her to see a doctor, she said, she was fine.

We’d had this conversation before as well.

On my way to work, I thought once more about my options. Sometimes knowing too much doesn’t help. As a health professional, I knew that someone suffering from mental imbalance can’t be forced to accept any kind of treatment unless they are an acute danger to themselves or others … and she hadn’t reached that stage – yet. If she accepted that she was delusional and needed help then medication would work pretty quickly, but her delusion is real for her so she can see no reason for treatment. I’d enlisted others to talk to her too, but they’d had as little success as I. She wouldn’t allow me to talk to her doctor, or allow him to talk to me. It would have to get worse before it would get better.

It did. About a week later she woke me in the middle of the night, a kitchen knife in her hand. She needed it for protection she said. She had to talk to me, explain the whole thing once more. I had to listen to her, she said. She waved the knife around and demanded that I get up. She was very distressed, sure that she was about to be attacked. By whom? The agitation and paranoia had become so great that her chains of reasoning had become completely incoherent, though they still seemed to make sense to her. I got up, knowing I had to be careful, hoping I could do something to calm her.

I couldn’t. I phoned for emergency medical help, she phoned the police, then a taxi and had left the apartment before the doctor or the cops turned up. Her sons and I tracked her down the following afternoon and we managed to get her to accompany us to the psychiatric clinic. 

Finally.

Sedation. Medication. And a slow return to what we call sanity. A realisation, at least, that something had gone wrong, that she had become lost in delusion. The woman I knew and loved was there again.

And they all lived happily ever after …

* * * * *

Unfortunately it didn’t last. This is a real-life story, no fairytale. After a couple of months, sure that she was back to normal and chafing under the side-effects of the medication, she stopped taking the pills. In retrospect, I sometimes wonder whether she hadn’t just been humouring us all the time – conforming until she felt she didn’t need to any more. Once again she drifted into her own version of reality, one incomprehensible to anyone else. Once more a growth in incoherence. But the theme had changed. Instead of imaginary paedophile rings, this time I was the enemy – one who was trying, for reasons known only to her, to have her locked away. There was another evening very like the one I’ve just described, though this time she became violent. Once more, committal.

Once more, sedation. But she had learned. You can be committed in Germany for four weeks on a judge’s order if the medical professionals attest that you are an acute danger to yourself and others. You can’t be forced to accept treatment. She didn’t; instead she “behaved” herself and was released.

And so, the relationship we had had for nine years ended. The woman I had loved, with whom I was sure I would grow old together, was gone, replaced by someone I didn’t know – someone who hated me and enjoyed showing me how much. Within three weeks I had found a new flat, renovated it, furnished it and had moved out, to the accompaniment of spiteful curses.

It’s three years ago now. We have no contact. From others I have heard that her life since has been difficult, but that she’s surviving somehow.

Me, I’m doing just fine. The reconstruction of my life happened quickly, thanks to the help of my daughters, family and many friends. Today, if I was offered my old life back, before Sigrid “lost” it, I think I would decline.

Life is sometimes very strange.

Pictures retrieved from:

http://www.psychologytoday.com/files/u81/Schizophrenia.jpg

http://trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/03/schizophrenic-joem.jpg

Handel’s Messiah

Two hundred and sixty nine years ago today, on April 13, 1742, the cultural event of the year took place in Mr. Neal’s new Music Hall in Fishamble Street in Dublin. The interest was so great that a newspaper announcement requested “as a Favour, that the Ladies … would be pleased to come without Hoops” and that “The Gentlemen are requested to come without their swords.” As a result, a hall which could normally seat 600 visitors was able to accommodate 700, and around 400 pounds sterling was raised to allow 142 inmates to be released from Dublin’s Debtor Prison. The event in question was described in Faulkner’s Dublin Journal in a review a few days later as “… the most finished piece of Musick … The Sublime, the Grand, and the Tender, adapted to the most elegant, majestick and moving Words, conspired to transport and charm the ravaged Heart and Ear.” It was, of course, the premiere performance of Messiah by George Frederic Handel.

Handel was born in Halle (Saale) in present day Saxony-Anhalt in 1685 and became one of the most admired and celebrated composers in his lifetime throughout the whole of Europe. As a young man he quickly made a name for himself as a talented opera composer in Hamburg and moved from there to Italy where he spent five years. Handel’s story is an excellent example of the cosmopolitan and tolerant nature of the European elite in the eighteenth century. Although he was a German protestant, the cardinals in Rome had no problem patronising and commissioning works from him, and he himself was apparently quite happy to compose sacred music for the clergy in Rome.

In 1710 he returned to Germany to take up the position of Kapellmeister to the German prince George, elector of Hanover. However, he quickly moved on to London to enjoy the patronage of Queen Anne and various members of the British aristocracy. There is an oft-repeated legend that Handel left his job in Hanover without leave of the Elector because the offers he had in London were better. He found himself, therefore, in a position of some embarrassment when the Elector George became King of England in 1714. Handel set down to write something of such beauty that it would win him the king’s forgiveness. At an evening entertainment on the Thames, the new regent was so enamoured by the music played that he asked for the composer and when Handel appeared the two were reconciled. The music in question was the Water Music. While it is a nice story, it doesn’t seem to have any basis in fact; when Handel went to England, it was clear that the Elector would succeed Queen Anne to the throne and the composer seems to have left with his blessing.

With a number of short interruptions, Handel spent the rest of his life in England, though he never learned the language perfectly and always spoke it with a thick German accent. Charles Burney, a young chorister who observed a number of rehearsals for Messiah in Chester in 1741 describes a scene where Handel lost his temper at a singer who claimed to be able to read music at sight but did not come up to the composer’s standards. “You shcauntrel! Tit not you dell me dat you could at soite?”

When they are inspired, great composers seem to be able to work at prodigious speed and Messiah, a full performance of which lasts nearly two and a half hours, was written in twenty four days. Although he composed great amounts of sacred music, Handel himself was not regarded as being personally particularly devout – he was, in that sense, very much an urbane, educated man of his time, part of a culture which regarded itself as civilized, enlightened and abhorring any kind of wild, naïve enthusiasm. Still, there is a story told that his assistant came into his room to find the master in tears. Asked if anything was wrong, the composer answered, “I thought I saw the face of God.” He had just finished composing the “Hallelujah” chorus.

The “Hallelujah” chorus. I knew I would have to come to it sooner or later. While it is undoubtedly majestic, it has become such an acoustic cliché (surpassed perhaps only by the opening bars of Beethoven’s 5^th) that it is often very difficult to take it seriously today. For those who only know the Messiah from Christmas sing-along events, where only the first part of the work is sung, the chorus is used as a conclusion, but in the full version of Messiah it occurs half way through the work. There is an old tradition, dating back to the first performance in London, that the audience rises to its feet for the “Hallelujah.” This is because King George II did so, though whether it was out of tribute to the composer, as an acknowledgement from an earthly king that he too must stand before the “King of Kings and Lord of Lords,” or simply because he wanted to stretch his legs is not known. Apparently nobody trusted themselves to ask him why.

One thing I think anyone who has ever been lucky enough to be part of a choral group singing Messiah will agree, the “Hallelujah” chorus is simply great fun to sing – you can really let it rip, all the stops pulled out, especially if you have an orchestra accompanying!

A Georgian street in Dublin, built around the time of the
Messiah premiere 

I have mentioned the prevailing cultural ethos of the 18^th Century already here, that urbane world of sophisticated, (frequently self-satisfied and superior), civilized rationality. This is reflected in the form and composition of the Messiah. Although its subject is nothing less than Jesus Christ himself, the amount of the oratorio devoted to the central events surrounding the suffering and death of the Messiah is relatively small; following an extensive first part, involving the prophesies of Jesus’ birth and the nativity story, the passion story is told in only nine arias and choruses and accompagnatos, lasting less than half an hour, before going on to the resurrection, the last judgement and the grandeur and majesty of the Saviour. This fits perfectly with the cultured gentility so strived for in Handel’s time – the nasty, the bloody and the brutal are given as little attention as possible before leaving the unpleasantness behind and moving on to triumphalist beauty. In that sense, many of the cultural themes of the eighteenth century can be seen as a reaction to the horrors of fanaticism and religious warfare which had gutted Europe from the Reformation to the end of the Thirty Years War and beyond. With the societal and ideological explosions initiated by the American and French Revolutions and the subsequent birth of Romanticism, this world of conservative, civilized rationality would be swept away.

Messiah is a wonderful example of what such a culture could achieve; genius expressed in ordered beauty. The music of Bach, Handel and Vivaldi is usually described as “Baroque,” though in my view it has little to do with what is known in, for example, art or architecture by the term. It can be ornate, with many flourishes, as the architecture is, but for me its basic characteristic is that of an ordered stateliness; a clear recognition that both reality and beauty are the working out of natural law – a musical expression of the vision of Newton rather than Bernini’s St. Theresa in Ecstasy.

Messiah is full of sublimely beautiful arias and choruses. The best known of them occur in the first part of the oratorio which is the part, as I mentioned earlier, most commonly performed. But the later parts of the work also contain many gems, including the beautiful “I know that my Redeemer liveth” and the marvellous “The Trumpet shall sound,” which, appropriately, involves a repeating trumpet solo part, magnificent in its understated sweetness.

Usually a couple of times a year, but at least once during Advent (as tradition demands J), I treat myself to a quiet evening at home and listen to the whole of Messiah. The recording I have was made in 1966 by the London Symphony Orchestra and Choir under the direction of Sir Colin Davis, which Wikipedia describes “as revelatory at the time of its issue for its departure from the large-scale Victorian-style performances that had been customary before then.” As such, it more accurately reflects the performances Handel himself would have conducted. Though, to be honest, when I bought it I was not aware that I was purchasing something regarded as a recording classic.

It was February 1999, and I had just been released from hospital after quite a long stay there following a pretty comprehensive nervous breakdown. It was a very dark period of my life, but that day I had a sense of some sort of new beginning. On a cold, rainy evening, I found my way into a large record shop in the town in which I then lived, driven by an instinct that I should buy something to mark that feeling of starting life once more. I came out with my two CD box set of Messiah. Though in retrospect I can now see that it would take almost two years more to really get my life back on the rails (when I finally stopped drinking for good), every time I take those CDs in my hands to put them in the player I still get a hint of the sense of lightness I felt on the evening I bought them and am once more thankful. For life. And for Handel.

There are, of course, numerous versions of all sorts of different parts of Messiah available on YouTube. I have chosen the aria and chorus, “O thou that tellest good tidings to Zion,” one of my personal favourites. I have a childhood memory of my mother, who is a trained classical mezzo-soprano (and who, at an age I won’t embarrass her here by mentioning, still has singing students coming to learn with her!), singing this at the piano at home.

This is a lovely version from a very fine – if somewhat unconventional – performance at the Theater an der Wien in Vienna two years ago. The choir is the Arnold Schönberg Chor and the orchestra the Ensemble Mattheus. The director is Jean-Christophe Spinosi and the countertenor soloist is Bejun Mehta. Describing the unusual production, one comment of YouTube observes, “The staging profoundly communicates the reality of the human condition and redemption - what “Messiah” is all about: easy to miss, I should say, when we're caught up in the usual concert versions.”

A note on orthography: In his native German, the name is written Georg-Friedrich Händel and the pronunciation is Hend-el. But from the time he came to England, his name was commonly written without the “Umlaut” [the two dots over the “a”] and the pronunciation changed accordingly. In this piece I have followed the traditional English convention.

Pictures retrieved from:

http://en.wikipedia.org/wiki/File:Georg_Friedrich_H%C3%A4ndel.jpg

http://cache.virtualtourist.com/1421340-Georgian_Dublin-Dublin.jpg

Illegal Immigrants

If you happened to be following the news carefully on Wednesday, April 6, in Europe, you might just have picked up reports about a tragedy which took place in the Mediterranean early in the morning between Libya and the small Italian island of Lampedusa.

A boat carrying perhaps as many as three hundred migrants capsized in heavy seas. Despite the efforts of three rescue ships, a plane and a helicopter from the Italian coastguard, only around fifty people could be rescued; over two hundred are feared dead. Most of those on board came apparently from Somalia and Eritrea and couldn’t swim – though given the high waves and Force 6 winds, it’s questionable how much this would have helped.

Just another ordinary day in the Western Mediterranean. The death of over two hundred people didn’t make the top headlines anywhere I checked on Wednesday evening, apart from Italy – and even there some papers preferred opening with Berlusconi’s latest sex story, La Repubblica being an honourable exception. 

The unrest sweeping across North Africa since the beginning of the year has increased the number of Tunisians, Libyans and others attempting to leave their homes for the golden fleshpots of Europe – and also the media coverage of the phenomenon – but they are only the tip of a long-existing iceberg. It is estimated that around half a million illegal immigrants enter Europe every year, a quarter of them through Spain. For the past three years, this has been more than the number assumed to have entered the United States. In the past fifteen years, at least five thousand people have died trying to cross the Mediterranean to Europe. Lampedusa, around half-way between Tunisia and Italy, is an pretty arid island about 20 square kilometres large and has a population of under 5,000. Over 22,000 fugitives of one sort or another have reached it by boat in the past three months.

* * * * *

A small thought experiment:

On the morning of April 6, 2011, a freak wave caused the ferry boat, Andrew J. Berberi to capsize and sink, halfway between Manhattan and Staten Island. Of the three hundred people on board, around two hundred and fifty are feared drowned …

News specials worldwide, CNN, Fox and Sky News reporting continually, President Obama and Mayor Bloomberg making speeches and promising thorough investigations and possible consequences, messages of condolence pouring in from leaders the world over, etc., etc.

* * * * *

Fear and suspicion of strangers is very deeply rooted within us. Like almost all other primates, we are social animals and evolved in groups. Indeed, for most of our existence, humans have lived in groups of anywhere between fifteen and fifty – over the millennia various kinds of loose, larger groups, recognising each other has having some kind of common identity also seem to have developed. Following a number of discoveries leading to the development of agriculture, local population densities could increase and our social tendencies showed themselves adaptable towards much larger units, resulting finally in nation states. But a basic factor in any kind of group identity is the division between us and them. And, I suspect, part of this tendency to distinguish – which, in pre-rational, animal terms makes evolutionary survival sense – is a visceral feeling that we are better than them.

But our evolutionary development has led us far beyond this, through the growth of our rational capabilities and the development of moral sensibility. We have surmounted many aspects of our animal inheritance. It is common that the dominant individuals in a group – alpha males and alpha females – are prepared to go to considerable lengths to ensure the continuing supremacy of their genes in the group. It can be argued, for example, that the roots of aristocracy can be found in this behavioural tendency.

“We hold these truths to be self-evident, that all men are created equal …” With this famous phrase at the latest, humanity rejected any basis for a special position for aristocracy. It is also a rejection of any argument that any group of people are inherently superior to any other. Since 1776, this basic view of humanity has become the foundation of civilised societies the world over. In its most fundamental international form, it is the basis of the Universal Declaration of Human Rights (UDHR) adopted by the UN General Assembly on December 10, 1948; “All human beings are born free and equal in dignity and rights” (Article 1).

What, then of the rights of migrants, those who wish to leave the land of their birth, their citizenship, to seek their fortune elsewhere?

The UDHR refers explicitly to the right of those politically persecuted to asylum (Article 14) and this right is generally recognised worldwide, even if many “developed” countries have hedged it with so many qualifications and administrative hurdles that it can be quite difficult to achieve in practice. But let us be generous and concede that this possibility is there for those oppressed because of their political or religious views. They are only a small fraction of the millions of migrants underway world wide anyway – a million or so of whom enter the western “developed” world [Europe, USA, Canada, Australia, etc.] illegally every year. How are they to be dealt with, on what basis can decisions be taken about who should be let in and who not, and what is to be done with those who are refused admission?

These are hard questions for which I do not have answers. What I do know, however, is that many of the grounds on which the “developed” countries base their policies – while they may have empirical justifications – have nothing to do with the principles and fundamentals of public morality we so like to give lip service to.

The basic reason why most migrants want to get into Europe or the USA is because they hope for a better life there than they can ever see themselves achieving in their countries of origin. They are economic refugees, fleeing lives of dire poverty and minimal prospects of advancement in their native lands. And a large part of the reason why their native countries are so poor and offer such dismal prospects is because these countries have historically been, and are currently exploited in all sorts of ways by the so-called developed world. Our wealth, our social and medical and educational systems, our standards of living depend, to quite an extent, on the poverty in the countries the “illegals” are coming from.

For all sorts of complex reasons, then, an imbalance is produced – a discrepancy between some countries and others. In all of this complexity, one group of people cannot be given the responsibility for the situation, the masses – the majority of them young men – who follow a deep natural urge to wish for a better life for themselves (and, in many cases, others who are dependent on them) and to do something about it.

In fact, the rich societies which try to shut out those who come to crash their borders are in many ways responsible for the situation in which they find themselves. Apart from all the issues of history, imperialism and economic power, they continually project the message to the world – the poorer world – that life as lived in their countries is better, superior than all others, that the image of the way of life they proclaim in every possible media is the only one really desirable. If you are living in the slums of Mogadishu or Mexico City, then the life you see portrayed in Desperate Housewives or advertisements for Mercedes Benz or iPhones or Rolex, or even Fifty Cent or Lady Gaga videos is going to seem very attractive. You may even be sceptical as to whether it is all true but of one thing you can be pretty sure – it has to be better than where you are now.

And so you screw up all your courage, you scrape the money (and we are usually talking of four figure dollar sums, which is a hell of a lot of money for people in such a situation) together and embark on an uncertain, dangerous journey – with no guarantee of success.

A journey which can end in a watery death in the Mediterranean in the dark hours before the dawn. It is possible that your family and those that you love will never find out what has happened to you.

I am not a starry-eyed idealist. I don’t believe we can abolish borders in the morning. What I do know, however, is that the basic reason behind the millions who try – legally and illegally – to relocate from poorer to richer countries every year is the massive discrepancy in wealth and opportunity between different regions of the world, and that a large part of the reasons for the origins and continuation of this discrepancy has to do with all sorts of unfairness and injustice in the relationships between the richer and poorer countries.

If we in the developed west are to be honest about it, the basic reason why we try to close our borders is that we see those who want to come in as a threat (even if certain parts of our economies are hypocritically dependent on the cheap unsecured labour provided by illegals). Despite the lip-service we pay to principles such as equality and human dignity, they are not an issue when it comes to immigration; the only principle applied is self-interest.

The problem is that building walls and fences isn’t going to change things – the millions trying to get into the developed world by any means, fair or foul, will continue to do so, for they have nothing to lose. The only way to effectively deal with the issue is to start tackling the roots of the problem – to help the countries from which the migrants are coming to offer their own citizens reasons not to leave.

We don’t have to, of course. We can go on living in our fortresses, secure in the knowledge that our borders are being protected by barbed wire and dogs and guards with guns, to keep out the hungry hordes who were simply misfortunate enough not to have been born citizens of our countries. But we will still have to look at ourselves in the mirror every day, in the knowledge that we limit the rights we proclaim to be universal to members of our own group.

I heard a radio interview with the mayor of Lampedusa recently. For months now, his island has been the goal of packed shiploads of people attempting to reach the EU from North Africa. The few thousand inhabitants of his island have been doing their best to help those reaching them – but they are being overwhelmed. Speaking in an admirably honest manner, he reflected that his attitude was changing (something he felt deeply uncomfortable and sad about); while he was still touched by the plight and misery of those landing on his island, he was becoming increasingly hardened to their situation. “Some days I find myself hating them,” he confessed.

* * * * *

It may come as a surprise to many hysterical US Americans who see the present situation on the Mexican border as a desperate threat, that this is not by any means a new issue. "Deportee (Plane Crash at Los Gatos)" was written by Woody Guthrie in 1948 about the situation of Mexicans trying to enter the USA, then often known as "Wetbacks," because they had waded across/swum the Rio Grande. It was a folk-singer standard in the early sixties - this is a version by Joan Baez:




Pictures retrieved from:

http://nyc.indymedia.org/images/2009/05/105248.jpg

https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwpbhzPgNpdN9zz8iPf-_RLc669BOwhzVntpSoE0p_nRbQKqduK9ix9YElAIu4XI7WsEbJGmKGNdC-VIMTP58QsNDcMn_RHN6pRRdPHrbYdMjvbMUonGslZ3xGJ9FDZ9wPdj89eCTy8xM/s400/illegal%2520immigrants.jpg