ANTHROPIATRY PART I: PSYCHE, THE MIND

What begins with this essay is a medical study of the human being. For in medicine we have pulmonologists, cardiologists, endocrinologists but we have no humanologists. Each of these essays will have the Anthropiatry Symbol, above, to signal that what follows is another in this series of concepts. The goal here is to engage health care professionals in the discovery of what it means to be a human being and to generate an emphasis on health and life in medicine to balance the current emphasis on disease and death. We begin with an exploration of what is the mind, starting with thought, and within thought, empiricism.

Anthropiatry: Psyche, or The Mind

As we begin our study of the Human Being, we examine the Mind. The Atlas of the Mind includes thought, memory and emotion. We will start with thinking or Thought, and since we are focused on the Occidental Tradition, we examine the thinking of the West.

The Three Kinds of Thinking of the West include Empiricism, Rationalism and Mysticism. We will begin with Empiricism.

Thinking Part I: Empiria

In the gleaming white hallways of Academic Medicine, the word "Empirical" has the character of the all-holy. The word is nowadays used as a kind of whip by the Academic Brahmans to slash ideas that are unworthy or dangerous, or not "empirical." That which is empirical, however, is the highest form of thought, and if you want to be properly anointed and get a key to the executive washroom, you had better be an Empiricist.

At the University of Virginia during my residency in medicine and psychiatry I observed the process of the widespread conversion to this form thinking at the expense of all others. We had been an outpost of The Enlightenment since, after all, we were intellectual heirs of Thomas Jefferson; but in the end even the Rotunda could not resist the empirical tide (1). The psychoanalysts were no longer revered and suddenly the behaviorists could no longer be bothered remember your name. Medical reasoning began to lose its value and in its place arose that which was "evidence based." It reminded me of the Old Norse Saga "Thidrandi Whom the Goddesses Slew," where the wise Thorhall sees in strange events that a New Faith (Christianity) is coming to Iceland. "I am laughing," he says, "because many a hill is opening, and every living creature, great and small, is packing his bags and making this his moving-day (2))." All of the adherents to the old way are put to the door.

When I was a fourth year resident (3), I had rotated onto the Oncology Service. Our Attending Physician was Charlie Hess, one of our most revered professors. Knowing that I was also training to be a psychiatrist, Dr. Hess felt compelled to make this observation: "No offense, Dr. Albanese, but my problem with Psychiatry is that there are no testable hypotheses." In other words, psychiatry was not sufficiently empirical.

Now Medical Schools have many Academics, but they don't have too many scholars (3). How could they? Their training teaches them to be scornful of the humanities, for they provide so little of substance! And yet to say that one is empirical makes direct reference to the philosophies of the ancient Greek Fathers, who were the first to distill its meaning. To me the evidence is that those who wield the empirical war hammer are not fully aware of its significance, what are its historical origins and even what is its proper use. Now that I have dropped the gauntlet, as it were, we will examine the origins of Empiricism and view this essential approach to knowledge in its appropriate historical context.

Empiricism, and empirical, have as their root a Greek work, empiría, meaning experience. Empirical knowledge, then, is knowledge that is acquired through experience or observation. Although Babylonian and Egyptian astronomers were great observers of natural phenomena, generally the title of Father of Empiricism is accorded to Aristotle, the most famous student of Plato. I suppose he occupies that position because of his stature as a philosopher, so monumental is his work. Also, while he may have perfected the classical empirical point of view, he is also the doorway between empiricism and Western Civilization.

Now as I describe empiricism, I will be guilty of oversimplification, and my philosopher friends will be justifiably scornful. But I am a physician by profession and not a philosopher, and in Medicine the goal is to simplify to the extent possible. We have Occam's Razor in Medicine, for example, a principle which states that the simplest answer to a problem is usually the most correct. When I'm trying to describe a medical problem to a patient or to a patient's family member, complete accuracy generally comes at the expense of the full understanding of the patient.

Aristotle's empiricism may have been a reaction to the Rationalism (we will take this one on later) of his teacher Plato. For Plato, I imagine, was like a Renaissance scholar, withdrawn into a place of study where his thoughts and theories could be analyzed and refined. Aristotle, by contrast, felt that to understand the world one had to experience it, to get out into it and record one's observations. It is no accident that Aristotle's work had a great deal of impact on how we study and understand the natural sciences.

To be an accomplished empiricist, an individual must develop the ability to be observant. This is a very difficult skill to acquire, and even the more difficult to teach. William Osler, the patron saint (so to speak) of Internal Medicine wrote: “The whole art of medicine is in observation…but to educate the eye to see, the ear to hear and the finger to feel takes time….(5)” The process of observation requires sensory attentiveness, in other words the observer must consciously direct his or her senses to phenomena and maintain a heightened level of awareness. This is not just awareness of what one is observing, but also awareness of how one's observations might be influenced by other factors. This is the great difficulty of being an empiricist: Knowing how your observations might be affected by internal and external elements.

Because empiricism involves physical proximity to what is being studied and because its adherents know the world through direct experience, empiricism has the aroma of that most unattainable thing in science: absolute truth. There are two great pitfalls in empiricism, however. The first one is physical, mechanical. We perceive the world through finite senses, each sense having a specific spectrum within which it functions. Vision, for example, is limited to those wavelengths between the infrared and the ultraviolet, and we see poorly in limited light. Similarly there are frequencies of sound waves too high and too low to be perceived by the human ear. No matter how one augments the senses by the use of various technologies, one must always be aware of the fact that observation cannot be absolute.

The second great limitation on observation is that of assumptions. If everyone in the world believes the world is flat, and they send a ship to the west and the ship never comes back, they conclude that the ship has fallen off the edge of the world. In reality the ship has gotten stranded on the North American shore. The problem with assumptions is that observers frequently don't know they have them, so erroneous conclusions derived from observations may have long and prosperous lives. An example of such an assumption comes from the field of Medicine where for many years it was believed that the spleen served no important function. When individuals sustained injury to the spleen, as is occasionally the case with blunt abdominal trauma, surgeons simply removed it. The surgeons observed that when they removed the spleens, the patients recovered better from the trauma, so splenectomy established itself as the standard of care. Later on specialists in infectious diseases observed that patients without spleens were more likely to die of certain kinds of infections (encapsulated gram-negative organisms); now surgeons make a much greater effort to preserve the spleen. The scientific term for these kinds of assumptions is bias.

One interesting aspect of empiricism is that it has two forms, one very old and one rather new. And you can use one form to prove that God exists, and another to prove that God does not exist. What a conundrum! The two forms are linked in the French language, by the verb expérimenter, which means both experience and experiment.

So the older form of empiricism is an empiricism whereby if a person observes or experiences something then it is real, or true. It could be called classical empiricism or radical empiricism, but I call it existential (6) empiricism. Let us say that a person is trying to determine whether or not God exists. This individual goes on a spiritual journey of sorts that includes, fasting, meditation and so on. One day this person has a dramatic experience of insight, inner peace, emotional and cognitive transformation. That person will now tell you that he or she has experienced God directly and that to that person, the existence of God is as certain as is the fact that they themselves are alive. By way of another example, let us say that you are hiking deep into the forests of central Idaho, and suddenly you encounter a Gigantopithecus! It grabs you, shakes, you, empties your pockets and knapsack of food items, gathers them up and lopes away. Now you know that Sasquatch exists! Experience, after all, is reality. To the scientific community, however, and to your friends for that matter, you are mad.

The second, newer (but not new) form of empiricism is what I call objectivist empiricism. In her book, Introduction to Objectivist Epistemology, Ayn Rand challenges the existential order by saying that reality is composed of absolutes, and to the extent that there are differences between people over what those absolutes are, it is because there are differences in the quality of observation. In scientific terms, the objective empiricist states an assumption called a hypothesis. Then this scientist designs experiments that are meant to test this hypothesis. The experiments are conducted, the results are carefully observed and recorded and the hypothesis is either proved or disproved. The trick here is to design experiments that, under the same circumstances, will have the same outcomes no matter where they are done, and no matter who does them (reproducibility). In addition to reproducibility, the scientist has to do his or her best to make certain that the results of the experiments do in fact answer the question that is being asked. For example, let us say that a scientist states the hypothesis that treating depression improves cancer outcomes. So she pulls together a group of 200 depressed cancer patients. One hundred will get treated with a new antidepressant, Acarcinol, and the rest will not have treatment for their depression (7). In the end it turns out that those who get the new antidepressant not only have less depression, they have improved survival with chemotherapy than those who do not. Triumph! The researcher publishes an article in a peer review journal and she is promoted to professor!

Later on other investigators try to reproduce her results. Using different antidepressants to the one she used, they find that treating depression, even when the depression is much improved, does not improve survival in the cancer patients. Later on it is discovered that the particular antidepressant she used in her trial has specific anticancer activity and it was this characteristic, not the antidepressant effect, that led to improved outcomes. So the experiment she designed does not actually answer the question whether or not treating depression improves cancer outcomes. Her experiment actually answered the question (hypothesis) whether treating depressed cancer patients with Acarcinol improves cancer outcomes.

Another pitfall for empiricists is that they have to be as neutral as they can be with respect to proving or disproving their hypotheses. We always have to entertain the possibility that an academic with a career at stake or a pharmaceutical company with a hundred million dollars at stake may have so much interest in a specific outcome that conscious or unconscious factors may enter into the experimentation and thereby influence the outcome. An associate professor may develop an idea on paper and publish it; if he later demonstrates with empirical evidence that his theory was correct he has a great deal to gain, for example full professorship. If his experiments demonstrate that he was wrong, however, it is just more data for the scrapheap and his promotion will have to wait.

Objectivist empiricists tend to be atheists, like Ayn Rand and also like Carl Sagan. In his television series Cosmos, Sagan said "I don't believe in God because I can't see him." More broadly, if you state the hypothesis that God does exist or that he does not exist, you cannot design experiments that answer that question. For the orthodox objectivist empiricist, that is as good as demonstrating the non-existence of God, for anything that exists can be proven to exist.

It was necessary for empiricism to branch into these two (objective and existential) forms because humanity has two meanings: individual human beings, for whom reality is rather subjective, and the whole of humanity, for whom reality is best viewed objectively. It incorporates the fact that the two different visions of reality, existentialism and objectivism, although opposite to one another, are paradoxically both true.


(1) Because of the historical connection to The Enlightenment (the Age of Reason), this conversion process took place at UVa, I believe, well after it took place at most universities.
(2) Eirik the Red and Other Icelandic Sagas, translated by Gwyn Jones, Oxford University Press 1961.
(3) I trained in a combined residency in Internal Medicine and Psychiatry, which lasts for five years. Despite offering one of the most useful skill sets in medicine, these residencies struggle for survival.
(4) I define a scholar as an individual who holds all knowledge as precious and worthy of acquisition. Since those in Medicine often have a dismissive attitude toward the arts and the humanities, it's hard to number them among scholars using this definition.
(5) The Quotable Osler, American College of Physicians (2007).
(6) We will say more about existentialism later in this collection of essays.
(7) To withhold treatment for depression as part of a scientific study would be considered to be unethical nowadays, thank goodness. Not too long ago it would have been considered acceptable.

Copyright 2011 Robert Albanese

Wisdom of the Fathers

Several years ago, when I was in management training (Network Executive Healthcare Leadership Institute), I attended a lecture on "Generational Dynamics." We were warned as managers that the young people today have difficulty dealing with criticism, constructive or otherwise. Current educational and parenting models, it would seem, have so emphasized reinforcing self esteem that when these children become adults they are too easily shattered by negative feedback.

Elder Porphyrios of Kapsokalyvia was dismayed at these modern ideas. Children are not edified by constant praise, he argued. He expressed concern that they would have unrealistic ideas about their importance relative to others, setting the mill of egotism in motion.

Perhaps if we were as impressed by wisdom as we are by fashionable ideas, we would not fall into similar sorts of traps with every generation. I fear we may have erected hard obstacles to our young people on their path to growth and fulfillment.

Copyright 2011 Robert Albanese

The Origin of Financial Armageddon

As our nation speeds toward economic calamity, one may well ask how we got into this predicament. I believe the answer is rather simple.

Although they differ in some respects, what unifies Liberal and Conservative politicians is their belief that mankind is fundamentally Evil and therefore must be controlled by the state. Then they tell us they love mankind! Well if they believe mankind is Evil and they love mankind, then they are themselves Evil, and well aware of it.

Ultimately the blame falls on the voters. If we would rather vote for politicians because of the sweetness of their creative unreality than for someone who would tell us the truth, we get what we deserve. Perhaps the politicians are right about us....

AMERIKA

Recently I received a catalog from Conciliar Press, a great source of Orthodox literature, icons and jewelry. There were many books about the beautiful theology of the Orthodox Church, its faithfulness to Holy Tradition, the glory of its worship. I also noticed books on contrasts with Catholicism and Protestantism and, of course how those other traditions compare unfavorably with ours. Obviously we who are Orthodox believe that our way is the most faithful to scripture and the traditions of the apostles; if we did not believe it we would not be Orthodox!

What one does not find in the catalog of Conciliar Press, however, are books on what is problematic with the Orthodox Church. I propose that it is not fully Orthodox to dwell on the errors of the other Christian confession and to ignore our own. Consider the prayer of St. Ephraim the Syrian, which we recite during Lent:

O Lord and Master of my life! Take from me the spirit of sloth, faint-heartedness, lust of power, and idle talk. But give rather the spirit of chastity, humility, patience, and love to Thy servant. Yea, O Lord and King! Grant me to see my own errors and not to judge my brother; For Thou art blessed unto ages of ages. Amen

This simple and beautiful prayer reminds us that we are more blessed if we consider our own faults and try to ignore the faults of others. In this way we escape the diabolical trap of judgmentalism. As my neighbor in South Carolina, a former Baptist minister observed to me, "Jesus never said anything about homosexuality, but he called judgmental people serpents."

Perhaps the Orthodox hierarchs, priests and lay people should spend more time in the deep consideration of what is wrong with our church. We have a number of problems that merit serious consideration:

1. The cool reception of the convert. I can only speak of this issue as it applies to the process of becoming Greek Orthodox; I do not know if this experience applies to those brought into the other Orthodox national churches.

As I was retracing the steps of my Arbëresh (1) ancestors toward the Orthodox Church, my family and I experienced the predicament of converts to Orthodoxy. This experience is vividly related by Peter Gillquist (I believe he is Chairman of Conciliar Press) in his book "Becoming Orthodox." He had hundreds of people behind him who yearned to be joined to the historical church; he had made an appointment to visit the Ecumenical Patriarch in Istanbul to discuss being received into canonical Orthodoxy but after the long journey he was told that His All Holiness was too busy to meet with him, as if Gillquist had just dropped in, unannounced!

It is a difficult matter to secure a sense of belonging in an Orthodox church. When you are a convert you are always aware of the nagging feeling that you are an intruder. Even cradle Orthodox have to contend with it. One of my patients, an elderly Greek-American originally from Cephalonia, returned from World War II and went to worship in a Greek Orthodox church in San Francisco. He was fair skinned and blue eyed, and when he entered the narthex and began venerating icons, a very saturnine (2) man with a great handlebar moustache whispered to him with a heavy acccent: "This church for Greeks!"

The largest Orthodox community in the US is the Greek. Because of recent immigrations from Eastern and Oriental Orthodox countries, most Greek churches now have significant minority groups, like Romanians, Albanians and Slavs. I believe that the church I go to, although a Greek Orthodox church, is now mostly non-Greek. Some Greeks refuse to attend such churches as ours because they feel that the emphasis on Greek culture is lacking, and because the Orthodox churches have nationality affiliations, culture often obscures faith as a reason for being a part of the community. The emphasis in some cases is so disproportionately on Greek as opposed to Orthodox, parishioners who don't even believe in God come anyway to be with other Greeks. The Romanians and others often feel they are not altogether welcome among the Greeks.

I believe that most Greeks, Romanians, Serbs and so on would be somewhat embarrassed if they could feel the sense of exclusion and isolation my family and I felt as we drew ourselves into the ancient church. While I wholeheartedly agree with our tradition's proscription against proselytism, that is not to say we cannot make people feel they will be welcome in our community.

2. The lack of communion with the Oriental Orthodox. Division is lethal to the Church. Some divisions in Greater Christianity seem pointless, and the rift between the Eastern Orthodox and the Oriental Orthodox seems to me particularly unjustifiable. The Eastern Orthodox believe that Christ has two natures: One fully human nature and one fully divine nature. The Oriental Orthodox (Copts, Ethiopians, Armenians and so on) believe that Christ has one nature that is fully human and fully divine. Is not that an example of splitting hairs? Armenia was the first nation to adopt Christianity; Ethiopia was second. Ethiopia is the only country in black Africa where Christianity was not imported and imposed by colonial powers.

Orthodox Christians are more often a religious minority in their own country than is true for Catholics and Protestants, and without diminishing the hardship Catholics and Protestants have endured, they have more experience with oppression. Solidarity will enhance the likelihood of our survival and growth. There is only one powerful Orthodox country in the world and that is of course Russia; her foreign policy includes promoting the interests of smaller Orthodox nations like Serbia. The desperate plight of the Coptic Christian community of Egypt, ignored by the West, needs a amore passionate advocate of the stature of Russia.

Certainly theologians on both sides of the Oriental Orthodox/Eastern Orthodox divide perceive other important reasons why the two families of churches cannot merge to some extent. I suspect that these theological disputes are beyond the understanding of the ordinary person. It seems to me harmful, however, that these two ancient Orthodox bodies view each other warily, each fearful of being contaminated by the other. It feels very un-Christian. The problem is very visible when for example Ethiopians attend a Greek church and they cannot take communion. Ethiopian churches in the U.S. are even rarer than Greek churches, and Greek churches are already uncommon in this country. Where are the Ethiopians to go for communion? Perhaps our hierarchs could find a way to define our differences as important but yet, in brotherly love, allow Oriental Orthodox Christians to take communion in Eastern Orthodox churches and vice versa when to attend a church of one's own origin would be extremely difficult.

3. The "irregularities" of the administrative structure of the church in America, and their implications for American culture. A recent Assembly of Canonical Orthodox Bishops of North and Central America declared its commitment to "the swift healing of every canonical anomaly that has arisen from historical circumstances and pastoral requirements." Although they are not speaking in plain language, I believe what they are referring to is the overlap of jurisdictions in the New World.

The canons of the church apparently decree that bishops' jurisdictions should not overlap. It is a simple matter to see how this overlap could cause conflict. And yet with immigration to the New World, the Greek immigrants needed a Greek bishop, the Serbs a Serbian bishop, the Arabs an Arabic (Antiochian) bishop and so on. So each Orthodox church covers the map of North American with dioceses and bishops.

It is easy to see why and how this "irregularity" occurred. Immigrants wanted to be with their own kind, and what better place is there than the church to share culture and tradition. But the strong link between nationality and church is perhaps the most important reason why many people seeking conversion to Orthodoxy are inadvertently made to feel unwelcome. Although most catechumens readily adopt the non-spiritual cultural elements of their prospective religious communities, some are bound to feel uncomfortable. "My ancestry is English," one might legitimately ask, "what is wrong with being English? Why must I become a poor imitation of a Romanian to become a full member of this church, when I have accepted all of the theological tenets of Orthodoxy?

If the jurisdictional "irregularities" are ever remediated, the result will be viewed with anxiety and dismay by our immigrant and second-generation families. For they will be thrown together with strange-smelling people who don't know how to make real baklava or lamb. Suddenly the all-important cultural elements of their communities will wither, and be replaced with...what?

Amerika, the Orthodox New World.

Cases of Autocephalous Orthodox Churches in lands where they are a minority religion are not rare. There is the Ecumenical Patriarchate, of course, which is a tiny island of Christianity in a Sea of Islam. But there are also the Patriarchates of Jerusalem, Alexandria (where Eastern Orthodox are a minority even among the minority Christians of Egypt), Antioch, Poland, Albania and that of the Czech Lands and Slovakia. Certainly a Partriarchate of the United States would represent an Orthodox Christian minority, but if all 1-4 million of us were under one canonical roof, we would stand to gain much. The greatest benefit can be illustrated by Boise, where there are three tiny Orthodox churches, Greek, Russian and Antiochian. Each church struggles to survive, and since they are so small, their places of worship do not reflect the beauty and majesty of the churches in the old homelands. If we were one church, we could construct a beautiful building--what could be more Orthodox than having a majestic house of worship? As it is our churches are rather plain by Orthodox standards. We could have more effective Sunday School and youth programs, there would be more voices for the choir, we would have more experience and talent for the Parish Council. Pooling our resources would make many things possible that we only dream of today.

It is interesting to think about what the possibilities are of a truly American Orthodox Church. The culture of America is a culture of freedom and unleashed creativity, of open minds and open possibilities, of a durable Democratic Republic. What would be the flower of the cross pollination of America and Orthodoxy? What kinds of church architecture would emerge? What kinds of domes would appear on the horizon? What kinds of iconography would appear? What kinds of chant might develop when American English can make use of its own poetry, instead of the awkward translation of it from a church's original tongue? America needs Orthodoxy, for throughout her historical development, the Church of the Apostles has been a marginal, foreign element. Orthodoxy needs America, too, because the minority churches around the world need a champion like the U.S. American Protestants and Catholics may not be too interested in the plight of people who look strange and worship in a way they find difficult to understand. And an Amerika, an Orthodox American Church, would breathe new life into Orthodoxy, which is in some ways like a bearded old man. Finally, I believe that if the Ancient Church is brought to Americans in their own culture, they will embrace it in much larger numbers than we have seen so far. Many ordinary Americans find our way very attractive, but our foreign languages and cultures are simply too great a barrier.

Certainly it would be difficult for Serbs, Romanians, Greeks and Russians to gather together under the same dome. But we have seen a precedent for this dilemma in the Catholic Church in the U.S. Some Catholic churches were established by one ethnic group and for many years they remained Italian or Polish or Irish in culture and tradition. Other churches brought these ethnic groups together to good effect, such that one church could raise money with several different food festivals during the year, and people enjoyed the diversity of their communities.

The truth is, though, that Orthodox Christians in America are changing whether or not the church chooses to change with them. New immigrants to the U.S. are streaming into Greek churches because it will take many years for their communities to be able to build a church of their own. And the young people are fully American, no matter how recently their families immigrated. How about this for irony: In my Sunday School class it was me, the Italian, who had to teach the students how to say the Lord's Prayer in Greek (only a few were fluent in Greek). Our inability to retain the young people in our churches is in my opinion a tremendous obstacle to life and growth in our greater spiritual community.

I hope I live to see a truly American Orthodox Church. I enjoy the dream of an American School of Orthodox theologians, American schools of iconography, and an American style of church architecture that rivals the Russian and the Byzantine. I do not cling too tightly to that brilliant vision, though, because in the long history of the church there is very little of importance that takes place in a person's lifetime.


(1) The Arbëresh are Albanians who fled to Italy when their homeland capitulated to the Turks. They have assimilated into Italian culture but maintain elements of their origins, for example, they speak Albanian and while most have gone under the jurisdiction of Rome, they maintain the Byzantine rite in their churches. My last name means "Albanian" in the Italian language.

(2) Very Mediterranean in appearance.

(c) Copyright 2011 Robert Albanese

Character

Character is what you get when you don't get what you want.