Dr. Thomas R. Verny

MD, DPsych, DHL, FRCPC, FAPA



SBGI CONVOCATION

Madam President, the graduating class of 2003, ladies and gentlemen,

I feel very honored and privileged to have been asked to deliver the commencement address to the first graduating class of the Santa Barbara Graduate Institute. I have known and admired this institution from its inception and its faculty and students have always been close to my heart.

Therefore, it gives me particular pleasure to congratulate those of you who receive your degrees here today. These degrees reflect to the outside world your academic accomplishments in a visible and tangible way. They say: This man or woman has acquired certain skills and knowledge, he or she deserves our trust and respect. At the same time I would like to acknowledge the contributions of your families and friends whose love and support was instrumental in bringing about the realization of your dreams.

We have been drawn to the Santa Barbara Graduate Institute, students and faculty alike, because of our yearning to make this a better world for us, for our children and for all the children of the future. We pursue higher learning because we are curious about how things work. We want to understand the true nature of things. We are seekers of truth; we search for objective, unalterable, universal truths. If I have this right then perhaps it behooves us to pause for a moment and ask ourselves: what is truth and how do we arrive at it? This is not an idle philosophical question like "How many angels can stand on the head of a pin?"

Rather, it goes to the very core of living a life of integrity.

I am sure you are all aware of the concept of IQ and how over the years the original idea of a single intelligence quotient that would reflect a person's natural mental potential has changed, so that today psychologists speak of multiple aspects of intelligence such as memory or mathematical intelligence, etc. However, one type of intelligence that, as far as I know no one has investigated and that I think is sorely neglected by our educational institutions, is what I would call Critical Intelligence, the faculty of reasoned thinking and of making sound judgments. Let me demonstrate this point with some examples from a variety of human endeavors.

My first example is from Averil Earnshaw (1981). Action Consultancy. Journal of Child Psychology, 2 (7), 18-19.

Baby X was lying in his container, watched by his special nurse; he was a wrinkled little fellow weighing just over two pounds, and he had many connections. An intravenous drip tube ran into his umbilical cord, one tube disappeared into each nostril', (one to his stomach and one to his duodenum), and he had an in-dwelling rectal lead measuring his temperature. Because he was a lively, wriggly fellow, and tended to brush at his tubes, his hands had been "gloved" and tied loosely down.

As we watched him, his mouth opened and began to "seek", I thought. His head moved from side to side a little, mouthing and gasping. He pulled with his arms against tie ties, and his mouthing turned to grimacing. His breathing was becoming faster and faster and he seemed more and more distressed, till suddenly it stopped. He exhaled all his carbon dioxide, which is the body's main chemical stimulus to respiration.

As he became gradually blue and floppy, his nurse became pale and frantic – holding a tiny oxygen mask over his face. We both thought he might not breathe again – but he did – and recovered his colour. By this time nurse was pale and sweating and we were both feeling shaken. As nurse and I shared our anxiety, and our relief, I commented on my impression that the baby got so upset when he wanted something in his mouth, and that I had seen similar episodes before.

Soon the baby began to stir again, to wriggle and then to mouth blindly, and to breathe fast again. I slipped the tip of my little finger in his mouth and he latched on tightly and began to suck strongly – now breathing quite regularly. One blue eye looked at us, then the other, and nurse cried out "he's never opened his eyes before!" After a minute or so, he closed his eyes and his gums loosened on my finger and I then removed it.

"If he asks again", I said to nurse, "you give him your finger - he's really strong". When the cycle began again, nurse did offer her finger; she was uncertain, but felt it might be the lesser of two evils - the risk of a "non-sterile" finger, as she said, or the risk of another episode of cyanosis and collapse. The baby sucked strongly, and once again opened his eyes to gaze at her as he sucked. "But they can't suck!" She told me, "The book says so."

I think there are many lessons to be learned from this example. For one, you cannot find the truth if you do not believe your own eyes. Many of us, unfortunately, have been taught from an early age not to trust our senses or our minds. How often are children told that they do not have a headache when in fact they do, or they should go to sleep because they are tired when they are not, or being called stupid for asking too many questions of a parent who did not know the answers. So from an early age we learn not to trust our own experiences and to defer to authorities; first our parents and later parental substitutes like teachers, priests, scientists or the government.

Speaking of government. I promise not to go on a political rant but this is too good an example of a lack of critical judgment to let pass. I am of course referring to weapons of mass destruction. The ubiquitous WMD's. We went to war to destroy them before they destroyed us, right? The only problem is, 100 or more UN inspectors, 350,000 allied troops and God knows how many Iraqi informers have not been able to find one solitary such weapon. Where are they? If they are not there, what happened to them? Were they ever there? One day, we may find out. In the meantime, I think we can say with certainty that some one has dropped the ball on this one. And not just one person, literally hundreds of people from the lowliest spies to expert interpreters of satellite photographs to intelligence analysts to the highest government officials. Millions of pieces of information were assembled and interpreted. We must assume that decisions were made all along this command chain and no one, or at least no one with sufficient clout, questioned them. During these deliberations, where was the critical judgment of these experts on whom the lives of thousands of people depended on?

It sort of reminds me of the Hans Christian Andersen fairy tale, The Emperor's New Clothes, about an emperor who was hoodwinked into believing that he wore beautiful clothes until a little kid cried out: "But he has nothing on at all.” Remember this, you want the straight goods while half the world wants to sell you a bill of goods. It is important for all of us who want to see things as they really are instead of how we would like them to be, to approach what we read, hear or observe without preconceptions, with attentiveness, an open mind and an open heart.

I heard the other day a quote by Mahatma Gandhi. It went like this: " Live every day as if it was the last day of your life, study, as if you lived forever.” Sounds good, really good. Until you start to think about it. "Study, as if you lived forever” meaning, I assume that one should never stop learning. I am sure we all agree with Gandhi on that. But consider the first part. If you lived every day as if it was your last, would you go to work, would you pay your taxes, would you go to the dentist, would you even brush your teeth? Would you carry on as usual? Hardly. You would not waste the little time you had left on routine tasks. Rather, you would probably spend your last day on earth with your loved ones, in your most favorite place, sipping Dom Perignon 1989 (the last good year for vintage Champaign), gorging on Beluga caviar and Maine lobster and listening to Beethoven's Fifth Symphony. Obviously, that's my fantasy and each of you would have a very different one. No matter. Next morning the chances are very good that we would all awake and, surprise, find ourselves still alive though nursing a really bad hang over and with a breath that could put a dragon to shame.

Now, I think what Gandhi meant when he said, '"Live every day as if it was the last day of your life” was that you should act honorably towards your fellow men all the time because if you don't, tomorrow may never come and you will lose the opportunity to apologize or make amends. If this is the meaning he wished to convey then he should have said so. He didn't. What he actually said does not stand up to critical analysis. Beware of catchwords, hedge words and shallow platitudes. They abound in advertising, politics, religion and the sciences.

The following is from R. D. Laing. (1983). The Voice of Experience.

I am in conversation with a professor of psychiatry.

We are discussing the arguments that go on about birth among psychiatrists and obstetricians, including such questions as: Does the baby feel it at all? Can it? If it does, does it matter? If it matters, in what ways? How can we tell? What objective evidence is there?

"Do you think the baby feels it?" I ask him.

The professor replied without hesitation, "I'm sorry. I cannot even begin to imagine the possibility of that sort of thing."

He paused to check out his remark, then, shaking his head, pursing his lips, and turning them down at the sides, he added, with some regret and some relief, in complete humility,

"There are too many core constructs in the way."


The only constructs that are in the way are due to personal blind spots, which are usually the result of upbringing or emotional involvement with the subject matter.

The following is an excerpt from an article in the New York Times, November 13, 1988:

"Natural childbirth is alive and well," said Dr. Maurice L. Druzin, director of obstetrics at New York Hospital-Cornell Medical Center, "but it has become a marriage of biology and technology."

"Although there are no reliable statistics on the use of painkillers and monitoring devices in delivery, doctors and other experts around the country agree that the definition of natural childbirth is changing to include any birth in which the mother is awake and delivers vaginally."

This truly defies logic. It is like reading George Orwell's 1984 where the Ministry of War was called the Ministry of Peace or his Animal Farm where all animals were equal except some were more equal than others. How can highly intelligent physicians stoop so low and engage in such obvious double-speak? The answer: their thought processes are ideologically driven rather than based on cold logic. It is the same kinds of thought processes that allowed doctors for the last one hundred years to yank babies out of their mothers, hold them upside down by their heels and give them a sharp slap on their bottom saying: "There is nothing like a good cry to get their respiration started.” And it is the same kind of learned blindness that made physicians believe for the longest time that babies could feel no pain.

The following is one of two letters on infant pain that appeared in the magazine Birth 1986.

"On the morning of surgery, which had been scheduled three days in advance, Jeffrey was described by the transport team as 'a very small pink male . . . very active . . . with appropriate responses and gestures.' This was not rushed, emergency surgery but rather surgery scheduled to increase the likelihood of improvement over a length of time. In spite of this, the anesthesiologist decided the operation would proceed without delay, and she paralyzed him, using no pain relief or anesthesia of any type before, during, or after surgery.

"For 1 1/2 hours he had holes cut on either side of his neck, another hole cut in his right chest, a catheter inserted in his jugular vein, and these holes stitched shut. The surgeon told us afterward hat they had trouble securing the catheter, so they repeated the procedure. Next, Jeffrey was cut open from his breastbone around to his backbone. Then his flesh was lifted aside, his ribs pried apart, his left lung retracted, and the blood vessel near his heart was tied off. Then the tissues were stitched together in layers and a final 'stab incision' made in his left side to insert a new chest tube.

Jeffrey died five weeks after surgery.

"One of the more disturbing experiences in this process was the comment made to me by the senior neonatologist on staff at Children's Hospital. At a meeting concerning Jeffrey's treatment, he said that what happened to my son didn't matter because he was a fetus. When I asked how old someone has to be to feel pain, he placed the line of demarcation at about two years."

Jeffrey was born in I985. His and the other child's treatment were not isolated incidents. Considering that since the early 1960's the neonate's reaction to pain had been shown to be similar to an adult's, it is hard to be sympathetic to doctors who caused infants pain on the grounds that reliable information on this subject was lacking.

It wasn't until I987 that the medical profession finally woke up from its self-induced slumber, thanks in large part to a groundbreaking paper written by K. J. S. Anand, head of the department of anesthesia at Harvard Medical School, and published in the prestigious New England Journal of Medicine. His conclusion: "Numerous lines of evidence suggest that even in the human fetus, pain pathways as well as cortical and subcortical centers necessary for pain perception are well developed late in gestation, and the neurochemical systems now known to be associated with pain transmission and modulation are intact and functional."

Why did it take so long to recognize the essential humanity of newborn children? Did the doctors who delivered babies not see the pain on their faces; did they not hear their cries? Of course they did. But they paid no attention to it because firstly, they learned in school that babies did not feel pain. And they did not question authority. Secondly, because of self-interest. Treating neonates as if they were subhuman made their job easier.

Which is why I ask you, nay urge you, to be skeptical, to question and test every hypothesis, every assumption and every research finding. If you have an emotional attachment to a certain position or a certain outcome, at least acknowledge it to yourself as well as to others. Know your blind spots and it will help you to recognize them in others. Learn to separate the chaff from the wheat, fact from fiction. Do not pray at the altar of science or authority; rather be led by your heart and your brain.

You are embarked now on a journey that will take you towards truth and knowledge. Along the way you will shed many a tear, suffer many a disappointment but also experience much joy and fulfillment. You are on a road less traveled but it is good road and I wish you bon voyage.

References

Anand, K. J. S. and P. R. Hickey (1987). Pain and its effects in the human neonate and fetus. New England Journal of Medicine, 317: 1321-1329.

Andersen, Hans .The Emperor's New Clothes, in The Arthur Rackham Fairy Book (1986). London. UK. Chancellor Press. p237-242.

Earnshaw, Averil. (1981). Action Consultancy. Journal of Child Psychology, 2 (7), 18-19.

Laing, R. D. (1983). The Voice of Experience. London, New York. Pelican Books. p 83.

Lawson, Jill R. and Helen Harrison, (1986). Letters. Birth, 13 (2).