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Pain medicine and addiction: A reading list

On the 10 August 2017, President Donald Trump declared a ‘national emergency’ in the United States – the cause: the country’s escalating opioid epidemic. This drug crisis has rapidly become one of the worst in American history, with data showing that in 2016 up to 65,000 people died from drug overdoses. Officials state that for citizens under 50 they are the leading cause of death, and opioid-specific overdoses make up two-thirds of all those recorded.

Despite the awareness surrounding the scale of the epidemic and the passing of the 21st Century Cures Act in December 2016, the future does not promise a clear-cut solution. Experts are now anticipating that over half a million people may die in the next ten years from opioid overdoses, and it’s believed that opioid addiction is just the beginning for many; with 80% of heroin users first misusing prescription opioids.

We have created a reading list on key Pain Medicine and Addiction titles, journal articles, and resources to build awareness of the current crisis, as well as the fundamental concepts and practices of pain medicine and addiction.

‘Opioids: An Overview’ from Chronic Pain Management for the Hospitalized Patient edited by Richard W. Rosenquist, Dmitri Souzdalnitski, and Richard D. Urman  

Up to 35% of adults suffer from chronic pain, and a substantial number of these patients are admitted to hospitals every year. A major concern of these patients is whether the pain will be adequately controlled during hospitalisation. The goal of this book is to equip clinicians to provide safe and effective management of hospitalized patients with co-existing chronic pain.

 

‘Acute pain in chronic opiate users’ from Acute Pain (Oxford Pain Management Library) edited by Lesley Bromley and Brigitta Brandner 

This compact volume serves as a concise guide to treating acute pain in its many manifestations. Providing a background of basic science, this book covers the fundamentals of pain, the pharmacology of drugs used, and summarises the current evidence base for the management of acute pain.

 

‘Adherence in Pain Medicine: Ethical Considerations’ from Facilitating Treatment Adherence in Pain Medicine edited by Martin Cheatle and Perry G. Fine  

Cheatle and Fine have produced the first book to address the obstacle patient non-adherence poses to reaching therapeutic goals in pain medicine, making it an ideal resource for pain physicians and primary care physicians who manage patients with chronic pain.

 

‘Pain and opioids’ from Addiction Medicine, Second Edition edited by John B. Saunders, Katherine M. Conigrave, Noeline C. Latt, David J. Nutt, E. Jane Marshall, Walter Ling, and Susumu Higuchi 

A practical guide for students, practitioners of medicine, and other health professions who come into contact with people with substance use disorders. Providing up-to-date practical assessment, diagnosis, treatment, and management options, this edition expands on the first edition through updated content and global coverage of addiction medicine.

 

‘The New Scarlet Letter: Addiction and Recovery’ from The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us by Lynn R. Webster, M.D.  

Internationally-recognized pain specialist Dr Lynn Webster validates the debilitating nature of pain, offers practical answers, and helps you to become a catalyst for changing the way pain is viewed in society, by drawing on his years of experience and the inspirational stories of others.

 

‘Integrative Medicine: The Treatment of Choice for Pain Management’ from Integrative Pain Management by Robert A. Bonakdar and Andrew W. Sukiennik 

Integrative Pain Management provides an overview of pain physiology, current conventional care options, an understanding of integrative medicine as it applies to pain management, the role of pain practitioners when working collaboratively, and the utilization of an expansive and patient-centred treatment model.

 

‘Pain Concepts’ from Pain: A Very Short Introduction by Rob Boddice  

In this Very Short Introduction, Rob Boddice explores the history, culture, and medical science of behind pain. Charting the shifting meanings of pain across time and place, he focuses on how the experience and treatment of pain has changed.

 

‘ Emergency Department Patient Perspectives on the Risk of Addiction to Prescription Opioids ’ by Michael Conrardy et al. from Pain Medicine  

This article aims to collate emergency department (ED) patients’ knowledge and beliefs about the addictive potential of opioids.

 

‘ Evaluation of an Integrated, Multidisciplinary Program to Address Unsafe Use of Opioids Prescribed for Pain ’ by William C. Becker et al. from Pain Medicine  

This paper describes an innovative program, the Opioid Reassessment Clinic, that addresses the assessment and management of pain and addiction (substance use disorder) in the setting that most matters – primary care.

 

Featured Image Credit: “Medications” by frolicsompl. CC0 via Pixabay.   

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Catalan independence in the Spanish Constitution and Courts

Following the recent ‘referendum’ and now declaration of independence, the status of Catalonia has become a hotly debated issue. As often happens in such cases, context is everything. It is not possible to appraise the perceived legitimacy of the respective claims without a clear picture of who says or does what in the particular legal environment (see mutatis mutandis the ruling of the Supreme Court of Canada on the secession of Québec, para. 155).

In the Spanish case, a significant part of such context has been shaped by the Constitutional Court. According to Article 1 of the 1978 Spanish Constitution, “national sovereignty belongs to the Spanish people from whom all State powers emanate”. Article 2 refers to the “indissoluble unity of the Spanish Nation, the common and indivisible homeland of all Spaniards” while it protects “the right to autonomy of the nationalities and regions of which it is composed and the solidarity among them all”. The capacity to hold referenda is regulated by Article 92 of the Constitution: they must be called by the King on the Prime Minister with regard to “political decisions of special importance” provided that it involves “all citizens”. A 1980 Law regulates in more detail the conditions for the holding of referenda in Spain. Article 2 thereof makes it clear that the decision to call for such a consultation is an exclusive competence of the State.

With respect to the status of Catalonia, the Constitutional Court rendered on 28 June 2010 what for many is the ultimate source of all the current political turmoil: the judgment on the constitutionality of the so-called ‘Estatuto de Cataluña’ (hereinafter ‘the 2006 Statute’), a piece of legislation regulating the exercise of regional powers whose adoption required consent by the legislative chambers in Madrid. An action to annul the statute was brought by ninety-nine MPs from the conservative Partido Popular against several provisions of the 2006 Statute, at a moment when the regulation of regional powers in Spain (commonly labelled ‘asymmetric federalism’) was the subject of reform by most regional governments – indeed, similar constitutional appeals were brought in parallel before the Court.

The judgment dismissed a great majority of the claims, but watered down (in some cases, annulled) certain provisions of the 2006 Statute. The provisions annulled concerned inter alia the creation of a so-called Catalan ‘Council of Justice’ (with certain powers regarding the organisation of the judiciary) and funding. Most provisions were nonetheless ‘saved’ by the Court by interpreting them in accordance with the Constitution. For instance, the statement made in Article 2.4, according to which “the powers of the autonomous community stem from the people of Catalonia”, was interpreted as an expression of the democratic principle enshrined in the Constitution. The term “national” used in Article 8 to qualify the symbols of Catalonia was considered equivalent to the term “nationality” appearing in Article 2 of the Constitution. The reference in Article 35 to a right to receive education in Catalan at schools and universities was declared constitutional inasmuch as Spanish is not excluded as a teaching language–even if Catalan becomes the “centre of gravity” of education in Catalonia. As to the preamble (which defined Catalonia as a “nation”), it was considered to have no interpretative value.

Flags by max_jam. CC0 Creative Commons via Pixabay.

Other decisions have dealt with the so-called ‘right to decide’ of the Catalan people. For instance, judgment 42/2014 dealt with a resolution of the Parliament of Catalonia whereby it adopted a “Declaration of Sovereignty and a Right to Decide of the People of Catalonia” (which called on Catalan authorities to “initiate the process to exercise the right to decide so that the citizens of Catalonia may decide their collective political future”). Interestingly, this was not the first decision of this kind made by the Court. In 2008, it had ruled on the constitutionality of a Basque law calling for a referendum on self-determination in that region (which never took place). But unlike the Basque case, here the regional resolution did not rely on the right of self-determination of the Catalan people, evoking instead a more ambiguous “right to decide”.

The Court ruled that the proclamation in the Resolution of the sovereign status of the people of Catalonia violated the principles of unity and national sovereignty enshrined in the Constitution. At the same time, it did not declare unconstitutional the recognition of a “right to decide of the Catalan people”. Indeed, such a right–which does not have express recognition in the Spanish Constitution–was considered legal when exercised within the limits of constitutional reform processes, but that excludes the possibility of holding a referendum on independence before amending the Constitution. This solution left some constitutional space for the ‘right to decide’, albeit in a manner that clearly differed from the original intention of the drafters.

In what arguably will remain its most important decision on the legal status of Catalonia, the 17 October 2017 judgment 117/2017, the Court declared unconstitutional a law passed by the regional Parliament on 6 September 2017 calling for a referendum on self-determination to be held on 1 October 2017:

“[the law] annuls as a matter of fact, in the territory of Catalonia and for all Catalan people, the binding force of the Constitution, of the Statute of Autonomy and any other rules of law that may not be compatible with its will … The Chamber [the regional Parliament], in acting in this manner, has situated itself completely outside the law, and has entered into an unacceptable de facto territory … the existence and effectiveness of any rights that the Constitution and the Statute may protect in favour of all the Catalan citizens have been put in maximum jeopardy, thereby leaving them at the mercy of a power that affirms it has no limit whatsoever.” (ground 5.d, author’s translation)

The judgment further criticised the procedural irregularities leading to the adoption of the abovementioned law. In relation to international law, the Court criticised the references made in the preamble to the right to self-determination of the Catalan people. While acknowledging that “all peoples” have a right to self-determination, it referred to UN General Assembly resolution 1514 and Declaration 50/6 in support of the contention that such a right is limited to very specific circumstances and does not encompass a right to secession. In particular, it evoked the safeguard clause that protects “the territorial integrity or political unity” of states “conducting themselves in compliance with the principle of equal rights and self-determination of peoples and thus possessed of a Government representing the whole people belonging to the territory without distinction of any kind” (author’s translation). In another passage, it ruled that the Catalan Law further violated basic constitutional principles which are “at the same time common values of the EU Member States which underpin the EU itself” (author’s translation).

From the point of view of comparative constitutional law, the Court preferred not to evoke other authorities that may have further reinforced its findings. I refer here in particular to the abovementioned Québec ruling of the Canadian Supreme Court (particularly paras. 103-104), the sentenza 118/2015 of the Italian Corte Costituzionale (para. 7.2) dealing with the prospect of a unilateral referendum in Veneto, and the less elaborate (but no less authoritative) order 2 BvR 349/16 of the German Bundesverfassungsgericht concerning Baviera. This is to be regretted in a judgment of such importance.

Featured image credit: Independence of Catalonia by lecruesois. CC0 Creative Commons via Pixabay.

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A Q&A with art historian Janet Wolff on memoir writing

Janet Wolff is a renowned art historian and writer. A combination of memoir, family history, and cultural criticism, Janet Wolff’s Austerity Baby is more than just your typical memoir; touching on themes of exile, displacement, and mortality – all of which remain relevant today. In this interview, Wolff recounts her inspiration, process, and family discoveries during her writing and research.

You have described Austerity Baby as an ‘oblique memoir.’ Why you have used this particular phrase?

First, to acknowledge that it’s not a ‘traditional’ memoir – it’s not linear, either chronologically or in a narrative sense, and it doesn’t set out to tell either the story of my life (which would really be an autobiography) or even the briefer stories of moments in my life (which is what I understand a memoir to be). It is about me, though: I am the ‘austerity baby’ (which is how my mother described me in her diary when I was born). The second, main reason is that throughout it my family’s story is told rather indirectly – through other people’s stories which parallel mine, in other people’s words (diaries, letters, novels). And to some extent the images in the book are intended to contribute to the story in their own way, which is often quite indirect.

Was there anything that you uncovered or mused in your discoveries about that sent you off to unexpected places, unsuspected destinations?

I suppose the most dramatic thing was finding out that my cousin Paulette, who lives in Massachusetts, has kept a stash of letters received by her mother Eri and written by her mother Leonie. Leonie, my grandmother’s sister was eventually deported to Auschwitz, where she die in September 1942. The letters were written in old German handwriting, so I employed a transcriber/translator to help me understand them. Eri had emigrated to New York in the mid-30s, as a young woman, and Leonie wrote to her regularly until just before her death. From the letters I learned that the Jews of southwest Germany were expelled into France in October 1940 (this with the help of my friend and colleague, Jean-Marc Dreyfus, a scholar of the Holocaust). I had never understood what Leonie was doing in France until then. From the letters we get a rather amazing day-to-day account of life in the internment camp in Gurs (where Leonie’s husband died within six weeks), and of life in Marseille, dedicated to trying to put together the necessary documents for emigration to the United States. In the end, as I already knew, this was in vain. I had the opportunity to visit Marseille a few years ago, and walk round the places Leonie would have seen and visited. Paulette and I also went to ‘our’ part of Germany together on another occasion, to our grandmothers’ home in the Palatinate, and to Offenburg, Leonie’s home after marriage.

Various unpleasant attitudes to immigration, racism, and displacement appear to have returned to Europe and America. Have you experienced any echoes whilst writing about the experiences of your father and his family?

My immediate answer is no – I didn’t make any connections at all while writing the German parts of my story. Of course the continuing refugee crisis must have resonated at some level (and the family history was certainly relevant in my deciding last year to become a volunteer mentor for Refugee Action). But I have always been very resistant to mobilising parallels between Germany in the 30s, and the National Socialist period, and other social and political events and trends – not because it’s so sacrosanct but because it’s become too facile a comparison, by-passing any detailed social (and economic) understanding of the current. And yet, recently I was at the Tate Liverpool to see the exhibition of Weimar art (August Sander and Otto Dix), and reading the abbreviated time-line of developments in Germany through the 30s I was reminded again, with a bit of a shock, that the transition from democracy to totalitarianism was incredibly fast and still rather unbelievably easy. This still doesn’t mean I am afraid that current anti-democratic trends will lead in the same direction.

The fact that the day after the Brexit vote I decided to apply for German citizenship had nothing at all to do with re-living the 30s. It was my instant response (along with many others, it turned out) to do what I could to remain a European. When I returned to England in 2006, after eighteen years in the United States, one of the primary reasons was to resume a proximity to the continent which has always felt appropriate. As it happens, I have been to Germany several times in the past few years (including involvement in an interesting exhibition in Lübeck). As the child of a refugee from Nazism, I was entitled to citizenship, awarded straightforwardly without the usual requirements of application, and my citizenship came through in little over a month. The lovely German word describing my new status, registering that the citizenship has been ‘restored’ rather than newly awarded, is ‘wiedereingebürgert’ (‘re-citizened’).

Has there been a natural stopping-point? Given the self-contained nature of the chapters, are there other places/people/incidents/pictures needing to be examined?

That’s a good question! I did know it was finished, but I’m not entirely sure I can explain why.  Yes, the chapters are self-contained, but many themes – and people – turn up again. Some obviously (my German grandmother, and her story), some more quirkily (Eleanor Rathbone, paintings by Kathleen McEnery for instance). So there is (I hope!) continuity as well as a series of separate stories. It did seem to come full circle in a concluding kind of way, I suppose. The Postscript, written very late, was provoked by the two events of Brexit and finding my long-lost German/French cousin Claude after 63 years, and felt like a good way to provide another kind of conclusion – but also (and intentionally) a rather open-ended one. And yes, I’m sure there could have been many more things to be examined. To tell you the truth, I was very tired when I finished writing the last parts – I think exhausted by the material and needing to stop! For now, anyway.

Featured image credit:  Wolff family photo, Saarland c.1906. Used with permission.

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“Too Many” Yabloesque Paradoxes

The Yablo Paradox (due to Stephen Yablo and Albert Visser) consists of an infinite sequence of sentences of the following form:

S1: For all m > 1, Sm is false.

S2: For all m > 2, Sm is false.

S3: For all m > 3, Sm is false.

: : :

Sn: For all m > n, Sm is false.

Sn+1: For all m > n+1, Sm is false.

Hence, the nth sentence in the list ‘says’ that all of the sentences below it are false. The sequence is genuinely paradoxical – there is no way to assign truth and falsity to each of the sentences in this list so that a sentence is true if and only if what it says is the case and a sentence is false if not. For some background on the Yablo paradox and variations on it, see my previous discussion here.

There are numerous variations on the Yablo Paradox. Many of these proceed by varying the quantifier used at the beginning of each of the sentences. For example, we obtain the Dual of the Yablo Paradox by considering an infinite sequence of sentences of the form:

Sn: There exists an m > n such that Sm is false.

In other words, each sentence in the Dual of the Yablo Paradox ‘says’ that at least one of the sentences below it is false. We obtain the Schlenker Unwinding (named after Philippe Schlenker) by considering an infinite sequence of sentences of the form:

Sn: For infinitely many m > n, Sm is false.

In other words, each sentence in the Schlenker Unwinding ‘says’ that infinitely many (but not necessarily all) of the sentences below it are false. And we obtain the Yablo Unwinding (named after C) by considering an infinite sequence of sentences of the form:

Sn: For co-infinitely many m > n, Sm is false.

In other words, each sentence in the Yablo Unwinding ‘says’ that all but finitely many of the sentences below it is false.

Here I want to explore another construction that results from substituting a common quantifier into the original Yablo construction. Consider what happens when we replace “for all” with “for too many”. We obtain the following sequence:

S1: For too many of the m > 1, Sm is false.

S2: For too many of the m > 2, Sm is false.

S3: For too many of the m > 3, Sm is false.

 : : :

Sn: For too many of the m > n, Sm is false.

Sn+1: For too many of the m > n+1, Sm is false.

Hence, each sentence in the list ‘says’ that too many of the sentences below it are false. The first step in analyzing this construction is to consider what, exactly, we mean by saying that too many sentences are false. In the present context – an analysis of semantic paradoxes – the following seems like a natural reading:

“Too many of the sentences are false.”

Is equivalent to:

“The number of sentences that are false is (somehow) too large to be compatible with an acceptable assignment of truth and falsity to all sentences in the list.

In short, if too many sentences are false, then that means the list would be paradoxical.

We can now analyze this list to see if there is an acceptable assignment of truth and falsity to each sentence in the list. The first step in doing so is to note that no sentence in the list can be true:

If any sentence in the list is true, then given what it says, too many of the sentences below it would be false – that is, the collection of sentences below it that will be assigned falsity is too large to allow for an acceptable assignment of truth and falsity. So if there is an acceptable assignment of truth and falsity to the sentences in the list, then no sentence is true on that assignment.

But if no sentence on the list is true, then it follows that every sentence on the list must be false. Given what each sentence says, it also must be the case that all sentences in the list being false is, nevertheless, not too many.

So far, this seems okay. We have shown that all sentences on the list are false, and it turns out that even if all of the sentences on the list are false, this isn’t too many. But now consider the bit of reasoning in the offset passage above. The reasoning amounts to a proof of the following claim:

If one or more of the sentences in the list is true, then there are too many false sentences below it.

A new, sort of meta-level puzzle now arises. Combining this claim with our overall conclusion (i.e. all of the sentences are false, but this turns out not to be too many) we arrive at the following conflicting claims:

If all of the sentences in the list are false, then there are not too many false sentences in the list.
If only some of the sentences in the list are false (and hence at least one is true), then there are too many false sentences in the list.

This seems to violate the following, I think rather obvious, principle:

Let X be a proper subset of Y (i.e. Y contains every thing contained in X, and also contains at least one thing not contained in X). Then, if there are too many things in X for some condition C to hold, then there are too many things in Y for condition C to hold.

Thus, despite the appearance of an apparently acceptable assignment of truth and falsity to each sentence in the list, the “too many” variant of the Yablo paradox seems paradoxical (or, at the very least, very puzzling) after all!

Featured image: “Infinity” by MariCarmennd9. CC0 via Pixabay. 

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Cybercrime as a local phenomenon

Nicolae Popescu was born in the small city of Alexandria, a two-hour bus ride south of Bucharest. After organising a digital scam to sell hundreds of fictitious cars on eBay, and pocketing $3 million, he was arrested in 2010 but eventually was released on a technicality. He is currently a fugitive from justice and the American reward for any information leading to his capture is $1 million.

While Popescu occupies a prominent place on the FBI’s ‘Cyber’s Most Wanted List’, he is just one of a number of high-profile cybercriminals hailing from Romania. In common with numerous other Romanians in this business, his expertise is ‘online auction fraud’. This form of activity began largely with the exploitation of eBay customers, but has now migrated to other platforms as well. It is built around the sale or rental of fictitious goods and services. This type of activity might seem unsophisticated, but it can net the fraudsters millions a year and has spawned a cottage industry. What is essential to note is the local nature of this industry: many offenders are known to each other and work together in person.

This often-overlooked local dimension of the phenomenon is not a strong feature of the academic literature or the popular press, which conventionally see cybercrime as a largely anonymous activity that exists in cyberspace. This leads to a sense that shadowy attackers could strike from anywhere at any moment: a new type of threat that challenges existing paradigms of crime and policing. In contrast, we believe the supposed anonymity of cybercrime should be counteracted by studying both the individuals behind cybercrime and the offline worlds they inhabit. It is vital to acknowledge that all cyber-attacks stem from a person who physically exists in a certain location. The economic and social dynamics of different settings are likely to variously influence who gets involved in cybercrime, what types of cybercrime they carry out, and the way they are organised.

Applying this approach to the case of Romania—a leading cybercrime hub—we explored the offline and local dimension of cybercrime in this country. Our interviews with law enforcement, security professionals, and others suggested that understanding the specifics of the Romanian context is vital to comprehending the nature of cybercrime there and how it emerged. Important factors appeared to include the technical legacy of communism; a lack of economic development; and widespread corruption/protection. These elements should be understood at both national and regional levels.

“It is vital to acknowledge that all cyber-attacks stem from a person who physically exists in a certain location.”

The Romanian case suggests that cybercrime can thrive thanks to offline social networks. In particular, this type of Romanian online fraud was centred around some key geographical hubs, such as the town of Râmnicu Vâlcea (sometimes colloquially known in the media as Hackerville, but a more accurate title would be Fraudville). In such places, cybercriminals often choose to work with those who are from the same school, neighbourhood, or have other connections. Trust seems to be enhanced in these cases and newcomers can then learn the trade. The second way in which social networks enhance cybercrime is through protection. In places where the local institutions are weak and corruption is widespread, cybercriminals make payments to corrupt officials or rely on influential acquaintances in their circle to protect them from arrest.

A number of these points do not relate only to the case of Romania, but also cybercrime in the West and many other jurisdictions. The offline/local dimension of cybercrime appears across both hi-tech and low-tech offenders as well, and mirrors broader debates on the nature of organised crime. It particularly supports arguments that organised criminal enterprises are often much more local in nature than people realise.

While the victims can be thousands of kilometres away and surely need to be vigilant, cybercrime also needs to be tackled in the places where it originates. The Romanian example potentially offers a way forward. After the country, and specific locations within it, were noticed as a major cyber fraud hub, both Romania and others have taken action. Successful relationships have been developed with foreign law enforcement agencies and companies. Manpower and resources have been allocated to the problem, including locating investigators on the ground. Training programmes have been run to increase law enforcement and prosecutorial capacity in this area. The effectiveness of these approaches would benefit from greater study and assessment, not only to evaluate how successful they have been in Romania, but also how they might be adapted successfully to other jurisdictions. The countries where the victims reside cannot win this fight alone. But the countries producing large amounts of cybercrime, also need assistance in carrying out this fight on the ground.

Featured image credit: Spyware, Cyber, Cybercrime by Macedo_Media. CC0 public domain via Pixabay.

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The importance of physics for humanists and historians

If you studied history, sociology, or English literature in your post-secondary education, it was probably in part because physics was too hard to understand or not as interesting. If you did not pay attention to quiet developments in the world of physics over the past several decades, you missed some very interesting important discoveries. Today, physics is not what our parents or even any of us who went to high school or university in the last quarter of the twentieth century learned because the physicists have been busy learning a lot of new things.

Physicists and mathematicians came up with “chaos theory,” which essentially says that among what appear to be random behavior, underlying patterns exist that can be affected by conditions, some of which may have come into existence early in the condition and that some minor change can radically alter circumstances. The notion that a butterfly flapping its wings in one part of the world leads to a major storm in another part of the world, the straw that broke the camel’s back, or the assassination of an Austrian nobleman rapidly unleashing the start of World War I are all examples of something going on that cannot be explained rationally the way that history teaches us to think of the cause-and-effect of events. Scientists study the role of chaos to identify deterministic systems to understand how to predict behavior in what are uncertain circumstances, such as in weather forecasting.

A discussion that brings up the related, but more familiar notion of randomness, as some sort of mitigating influence on events that we know as the lack of a predictable pattern of behavior. Gambling with dice leads to unpredictable results. The fact that World War I burst onto the world with such devastating consequences, or subsequent events of many sorts unfolding that we elegantly label “unintended consequences,” are manifestations of randomness. Coupled to chaos theory, scientists ask, why did one particular grain of soil all of a sudden precipitate a land slide? The two ideas led scientists to recognize that much in nature lives in a critical state of tension, and we are learning that so does human behavior and society at large. Examples include the slightly heavier bug that normally could walk on the surface of a pond that breaks through, or the “final straw” minor event that causes one Afghan tribe to attack the other over what, in a dispassionate way, might seem a trivial provocation.

Water striders using water surface tension when matting by Markus Gayda. CC BY-SA 3.0 via Wikimedia commons.

Historians, sociologists, economists, and cultural anthropologists are responsible for explaining after the fact why events happened or predicting accurately what will happen. As physicists learn more about how chaos works—they already know that it exists—will their findings inform the work of the humanists and social scientists? Will they make these non-technical physics-math-avoiding folks better at their work? Will consumers of their research get a better product in the form of deeper insight that is more definitive than, say, the half dozen alternative reasons for why World War I happened? Will we learn that the quick release of social stress in one part of society sets off many other events of a profound nature—think of them as avalanches—elsewhere, as American political commentators are beginning to think is happening as a result of Donald Trump winning his bid for the presidency?

Already historians, political scientists, and sociologists are learning that a nation’s political and social structures function on the edge of instability, a point increasingly made by science writers, such as Mark Buchanan, but instinctively understood by some historians, such as the late French scholar Fernand Braudel.

It would appear that people in all disciplines need to learn more about living in a critical state of tension to avoid being the fat bug that breaks through the water, the public official who takes an action that sets off a chain of unanticipated negative events, or the scholar who needs to up their game when analyzing the cause of past or present events. A lesson from the history of information is that when new insights and ways of analyzing circumstances become available, they seep into other disciplines, often quickly. They are appropriated to new uses and normally are seen as effective. Are we now at such another point, this time where humanists, social scientists, and even historians should understand chaos theory, the role of randomness, and start using statistical tools and Big Data analytics as part of their tool kits and worldviews?

The potential implications of this are fascinating; for instance, we should expect the unexpected and learn how to best respond to this reality. Historians will think more like gamblers by worrying about the odds of something having happened and sociologists will work more like weather forecasters. We citizens acknowledging that we have lived these past half dozen decades in a period of relative calm when compared to earlier historical eras. The collapse of civil society in many parts of the Middle East, while triggered often by unintended consequences, actually reflecting living conditions for most of human history. For the historian it all will boil down to using chaos theory as a way to reconcile notions of causality with what actually happens. We need to deal with the critical grain of sand and with the straw that so badly hurt the poor camel.

Headline image credit: dice by Peaches&Cream. CC BY 2.0 via Flickr .

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Can microbiology tell us exactly what killed the Aztecs?

The arrival of the Spanish conquistadors to Mexico in the 1620s marked the beginning of the end for the indigenous people. With an estimated population of between 15 and 30 million at this point, this dropped dramatically to only two million by 1700: the result of battles, famine, drought, and perhaps most significantly, infectious diseases. The following Q&A investigates how microbiology contributed to the ruin of the once-flourishing Mesoamerican culture.

What is the ‘cocoliztli’ and how was it introduced to the Aztec population?

Previously, historians have established that the epidemics of 1545-1548 and 1576-1580 – also known as the ‘cocoliztli’, or ‘plague’ in the native Aztec language náhuatl – were imported by the Spaniards during their arrival. The indigenous population, who had no previous immunity against the newly introduced viruses, quickly succumbed to the diseases. Alongside these epidemics, the revolution of the social order, evangelization, destruction of ancient culture, and architectonic transformation all contributed to the start of the Colonial Era in Mexico.

When was the ‘cocoliztli’ first clinically documented?

In 1576, Spanish physician and naturalist Francisco Hernández and physician Alfonso Lopez de Hinojosos described the ‘cocoliztli’. In their account, they detailed a clinical condition that was highly contagious, although different from other diseases of the time such as smallpox, measles, and typhus. Symptoms of ‘cocoliztli’ included severe weakness, strong headaches, dry mouth, dizziness, and stomach pain and haemorrhages. They included that death could occur just four or five days after the appearance of the initial symptoms. Thus, this plague was referred to as haemorrhagic fever, or blood congestion.

Indigenous victims, Florentine Codex (compiled 1540–1585). As reproduced in: Fields, Sherry (2008). Public domain via Wikimedia Commons.

How has microbiology evolved to give us a better understanding of ancient epidemics?

In recent years, state-of-the-art technologies have allowed scientists to learn much more about today’s microbial world. By extension, these same technologies could allow insight into the causal agent of epidemics which struck centuries ago. Just one example of this is a 1998 study where teeth pulp was extracted from what were believed to be the remains of victims of the Bubonic Plague. As a highly vascularized tissue, it is conceivable that blood in the pulp – contaminated with bacteria, viruses, or both – could provide insight into the various pathogens that circulated in the bodies of long-ago diseased individuals. The detection of Yersinia pestis DNA sequences from the teeth pulp in this study was the first step in discovering the microbial history of the Black Death which decimated the European population in 1347-1351.

How do these developments help us pinpoint the causal agent of the ‘cocoliztli’?

Similar to the 1998 study, investigators extracted dental pulp from individuals buried in a cemetery associated with the ‘cocoliztli’, which led to the reconstruction of two causal agent genomes. These genomes were identified as the Paratyphi C strain of the pathogen Salmonella enterica, a causal agent of enteric fever, or typhoid fever, suggesting that this bacterium could have been involved in the Aztec plague. Known to be facilitated by the faecal-oral route, this species would have thrived in the poor sanitary conditions in Colonial New Spain, with the indigenous people immunologically defenceless against the infectious diseases of the Old Continent. Another study performed on ancestral DNA from skeletons found in Trondheim, Norway found the same bacterial genome in the dental remains of an individual buried in the 13th century. This suggests that Salmonella enterica was prevalent in Europe at least 300 years before the Spanish conquest of Mexico, reinforcing the hypothesis that it could have been transported there by asymptomatic carriers.

Is it possible that there were multiple causal agents of the Aztec epidemics?

It is quite possible that other diseases could have been involved in the ‘cocoliztli’. Findings from these previous studies are not conclusive evidence that Salmonella was the major causal agent of the decimation of the Aztec population. For example, standard symptoms of Salmonella Paratyphi C do not include gastrointestinal haemorrhage, leaving room for the distinct possibility that the ‘cocoliztli’ epidemics were a result of mixed infections.

How can researchers take a holistic approach to understanding infectious diseases of the past, present, and future?

As demonstrated across these studies, and throughout history, there is much to be learnt from the diseases which impacted our ancestors. The One Health concept allows for the visualisation of infectious diseases with a multi-discipline approach, combining cultural history with microbiology and systems biology, all alongside the relationships microorganisms have with their environment. The pathogenesis of disease and the ecology of pathogen transmission are vital not only for our understanding of the historical infections of the past, but also for us to learn how to better deal with the infections of the future.

Featured image credit: Teotihuacan, Mexico Aztec pyramids by jjnanni. Public Domain via Pixabay .

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Six questions to ask before you hit record

Erin Jessee’s article “Managing Danger in Oral Historical Fieldwork” in the most recent issue of the OHR provides a litany of practical advice about mitigating risk and promoting security. The entire article is well worth a read, but for the blog we’ve asked Jessee to provide us a list of some of the most important questions for oral historians to think about in evaluating and limiting exposure to risk. Enjoy the response below, and make sure to check out the complete article, where Jessee dives more deeply into the problem and offers an important perspective on the relationship between danger and oral history fieldwork. And make sure to come back to the blog in a couple of weeks for part two of our conversation with Jessee, where we talk about best practices, spotting signs of trauma, the ethics of open access, and more!

The most important thing that oral historians can do is network to establish a community of scholars/practitioners who have experience working in the communities or areas where you plan to conduct your research and who might be more keenly aware of the potential dangers you’ll need to address. It’s particularly important to speak with people who share at least some facets of your identity in terms of gender identity, class background, ethnic heritage, religious beliefs, sexuality, and so on, to better determine how your identity—as perceived by the people you’ll be working closely with—might shape or limit your research and the kinds of questions you can ask. Similarly, in my experience it’s important to evaluate the information that is freely revealed in the course of conversations with experienced scholars/practitioners, but also to consider the silences that might be emerging. Not all scholars/practitioners are comfortable speaking openly about the problems they’ve encountered in their research—particularly if it stems from some real or perceived error on their part—and so these areas of silence can be crucial for anticipating where you might experience potential pitfalls.

To help oral historians anticipate risk, I’d suggest asking the following:

Who are the ideal people within and beyond academia to speak to about my intended research project? In drawing up your list, be sure to consider not only who might constitute ‘experts’ in terms of their overall publication record in relevant fields, but in terms of recent on-the-ground experience conducting qualitative research within and beyond academia. Additionally, consider what is the most appropriate way to approach them for advice.
How might different facets of my identity be perceived by the people I intend to work with? These can shape how people respond to you in interviews and more generally.
Where am I encountering silences? Listen closely during the background research and early conversations you conduct, and consider the extent to which any emergent silences might indicate additional areas of risk or danger that are important to evaluate further prior to starting my fieldwork.

Oral historians should also take the time to consider the various ways that they might be vulnerable within their research projects, and identify the resources available to them in their immediate surroundings aimed at helping them maintain positive mental and physical health. I’d suggest the following questions as starting points:

In what ways might this research project negatively impact my mental and physical health? Think not only about the obvious stressors related to workload and deadlines, but also ways in which your personal experiences and deeply held values might render you vulnerable to transference/countertransference, vicarious trauma, and burn-out, for example, as well as physical danger.
What resources are available to me in my community that I can draw upon to help maintain positive mental and physical health? It’s important to consider not only health services associated with the universities and organizations that you’re working with, but also options external to our places of work, such as 24-hour help lines, community support groups, and so on.
What are some everyday activities that I find enjoyable and relaxing, and that take my mind off my work/research? Focus on arranging your day/week/month to include these activities frequently enough to maximize your potential for resilience throughout the project.

As researchers, it’s important that we incorporate self-care strategies into our everyday lives throughout research projects—not just once we begin to experience poor mental or physical health.

What risks have you encountered in fieldwork, and what strategies have you developed to mitigate them? Chime into the discussion in the comments below or on Twitter, Facebook, Tumblr, or Google+.

Featured image credit: “Risk Word Letters Boggle Game” by Wokandapix. CC0 via Pixabay. 

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Shakespeare, Sinatra, and the Philosophy of Aging [excerpt]

 Aging in the world of entertainment is portrayed in a variety of ways. In some cases it’s graceful and elegant; in others it’s manic and doddering. Shakespeare has dealt with this subject numerous times with vast reinterpretations in productions through the centuries. In this excerpt from Aging Thoughtfully: Conversations about Retirement, Wrinkles, Romance, and Regret, authors Martha C. Nussbaum and Saul Levmore look at the classic example of King Lear, and how different portrayals of this elderly character can be a reflection of how people see aging and infirmity in modern times.

Productions of King Lear these days are obsessively concerned with the theme of aging. Just as the postwar period saw an emphasis on empti­ness, loss of meaning, and utter devastation (in Peter Brook’s memorable production starring Paul Scofield, but also in countless others after that), so in our time it is the age theme that has become popular, and that may even account in part for the play’s recent surge in popularity. Productions follow the preoccupations of their intended audience. Today, many or even most audience members for a Shakespeare production are personally anx­ious about aging, are currently caring for an aging relative, or both. We should mention also the legions of long- lived excellent actors who want to play the role, and are not deterred by its extreme physical demands. Laurence Olivier (76 when he played the role), Ian McKellen (68), Stacy Keach (68), Christopher Plummer (72), Sam Waterston (71), John Lithgow (69), Frank Langella (76), Derek Jacobi (72), and, most recently, Glenda Jackson (80). We are clearly a long way from Shakespeare’s own Lear, Richard Burbage, who played the role at 39, and further yet from Gielgud, at 29. (Scofield, by the way, was only 40, but it didn’t matter, because that production did not emphasize aging.)

A masterpiece yields new insights when produced with a new empha­sis, and Lear is no exception. So I do not criticize directors for choosing to emphasize the theme of aging. And the play, in which Lear asks for expres­sions of love and then divides his kingdom between the two daughters (Goneril and Regan) who fawn on him and disinherits the one (Cordelia) who really loves him, investigates themes of dispossession, loss, and even­tual madness that Shakespeare does connect clearly with Lear’s advancing age. Still, there is something amiss with one common way this emphasis is realized: some directorial choices lead us away from the insights about aging that the play actually offers. Let’s start with a representative example.

Image credit: Sherman Hawkins as King Lear by Anthony Topper. CC BY 2.0 via Flickr.

A much- lauded Chicago production of King Lear in 2014 begins like this. Actor Larry Yando, playing the king in a vaguely modern setting, as an aging tycoon in his elegant bedroom suite, wearing a high- end dress­ing gown, tries out some Frank Sinatra songs on his fancy stereo. With the petulance of a child throwing away boring toys, he rejects “That’s Life,” “My Way,” and “Witchcraft”— each time smashing a plastic remote in frustration and getting another from the attentive servants who surround him. (The repeated gratuitous destruction sounds a false note: tycoons— unlike hereditary monarchs— get where they are by not being wasteful, and he could so easily change the band without smashing the remote.) Finally he arrives at “I’ve Got the World on a String.” Satisfied, he dances around delightedly, partnering only himself, but with great agility. As Chicago Tribune critic Chris Jones notes, this is “a cheap choice because those who actually need to believe they have the world on a string, like Lear, so rarely expose themselves with so obvious a lyrical preference.” But Lear is happy, and aside from a certain manic anxiety in his whole demeanor, shows no signs of aging. Apart from the heavy- handed choice of songs, it’s a riveting performance of an unloving, captious man, aging but still very fit, wrapped up in his own power, used to having his own way with everything and everyone.

Just a few moments later, however, Lear has difficulty remembering the names of his sons- in- law— and as he searches for the words that won’t come, there’s a look of terror on his face, as the devastation of incipient dementia reveals itself. It’s a stunning moment. But is it a convincing interpretation of the play? Director Barbara Gaines informs us in the pro­gram that Lear is about all of us who either are aging ourselves, or have an aging relative— or both. In act 4, scene 7, Lear indeed describes himself as “four score and upward,” thus pinpointing the age rather precisely. Yando, however, told the Chicago Sun- Times that he is playing Lear “as my age, not 80.” Yando is currently fifty- eight. So apparently what we are seeing is extremely early-onset dementia. (This fits badly with the way Yando moves in later acts, with the shuffle of a very old man, but never mind— right now I’m just talking about the first act.) So: is Lear plausibly or revealingly staged as about early- onset dementia?

It has become almost a cliché to do what Gaines and Yando do, writing the decline and the mental frailty into the play’s very opening. In fact the device of forgetting the names was already used by Plummer, although I don’t know whether he invented it. Indeed R. A. Foakes, editor of the Arden edition of the play, finds that senior decline, inserted into the play’s very opening, is a hallmark of productions in the 1990s: Lear is likely to appear as “an increasingly pathetic senior citizen trapped in a violent and hostile environment.” The popularity of the aging theme, so emphasized, has led to a glut of productions of the play, as audiences, more than a bit narcissistic, like to focus on their own future, near or far. Los Angeles Times critic Charles McNulty, in an eloquent article, doubts the wisdom of this whole trend, which he plausibly attributes to the graying of the baby boomers. He declares that it may be time for a moratorium on attempts to stage the play at all.

So what’s wrong with Yando’s memory lapse? One obvious problem is that it is not in the text at all. It is not until he is out on the heath that Lear shows mental imbalance, and even then, it’s some sort of “madness,” but it surely doesn’t fit the all- too- familiar cliché of Alzheimer’s disease, given his verbal eloquence and his insights into the nature of human beings and their world. Indeed, a more pertinent criticism of Gaines— for of course directors can and should insert things not directly in the text if they illuminate the work— putting Lear into the box of Alzheimer’s from the start makes it pretty hard to relate the Lear of the opening to the Lear, deranged but deeply insightful, who emerges later— one reason that Yando’s performance of those later scenes has impressed audiences and critics less than his work in the opening.

In act 1— and my discussion in this essay is limited to act 1— it is Goneril and Regan, not the most trustworthy witnesses, who refer to Lear’s aging— and in a way that does not in the least suggest dementia of the Alzheimer’s sort. The former says, “You see how full of changes his age is” (1.1.190)— but she is referring to his emotionally capricious disin­heriting of Cordelia, which is hardly due to dementia, whatever we think does cause it. The latter replies: “’Tis the infirmity of his age, yet he hath ever but slenderly known himself” (294– 95), thus immediately qualifying the reference to age with allusion to a long- term problem— and getting to the heart of the matter, as we shall see. Even they, then, do not suggest that he is suffering from dementia or mental weakness: at most emotional inconstancy, and that, they suggest, has probably been caused all along by his character.

To see why this is the right place to look, consider Lear’s human rela­tionships heretofore, as act 1 reveals them. With his daughters— even Cordelia, whom he appears to favor— he is formal, cold, domineering, manipulative. He wants set speeches that exemplify subordination. What he surely does not want is any part in reciprocal affection. As for friend­ship, there’s nothing even close. He has no wife, nor does he recall the one he must at some point have had. With Kent— both before and after his fall— Lear is the commanding ruler, determined to punish disobedience, though (later) willing to accept a loyal subordinate. His only relationship of potential friendship and reciprocity is with the Fool, who (unlike most real- life court jesters) doesn’t care about royal power— and the matura­tion of that relationship, as the play goes on, tracks or even helps to cause Lear’s emergence as a human being.

Featured Image: “Shakespeare King Lear Ancient Classic Romeo” by MikesPhotos. CC0 via Pixabay. 

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Crisis in Catalonia

Spain is living through sad times. The Catalan parliament’s illegal proclamation of an independent state has sparked the most serious constitutional crisis since the failed coup in 1981. But unlike that crisis, this one has no easy solution. All the stereotypes that Spaniards are incapable of living together, epitomised by the 1936-39 Civil War, are being reinforced.

The central government in Madrid responded to the unilateral declaration, which followed the unconstitutional referendum on independence on 1 October, by imposing direct rule as of 27 October and calling a snap election in Catalonia on 21 December.

Some 2.3 million people voted in the referendum (43% of the electorate), defying police batons and rubber bullets in images that shocked the world, 90% of them in favour of independence. Human Rights Watch condemned the excessive use of force by the police.

Madrid has suspended the Catalan parliament and taken over ministries and the regional police force, while Carles Puigdemont, the deposed Catalan president, was ordered to appear before a court in Madrid on charges of rebellion, sedition, and misuse of public funds.

Catalonia, which like other Spanish regions has enjoyed autonomy since 1978, plays a key role in the Spanish economy. The region’s population of 7.5 million (16% of the total) generates around one-fifth of Spain’s GDP, one quarter of total exports, and received 18 million of the 75.3 million tourists last year. Its GDP is larger than Portugal’s.

The pro-independence parties, an unholy alliance of conservative nationalists, left wing radicals, and anti-capitalists, have 72 of the 135 seats in the Catalan parliament (47.8% of the votes cast in the 2015 election).

Polls show them narrowly gaining control of the parliament again, making the central government’s strategy of calling an election a risky one. If this happens, these same parties will claim a new mandate for independence.

Official portrait of the President of the Generalitat of Catalonia, Carles Puigdemont i Casamajó. Attributed to Generalitat de Catalunya via Wikimedia Commons.

Madrid is hoping that the unionist parties—the ruling Popular Party, the Socialists, and the centrist Ciudadanos—will galvanize the so-called “silent majority” against independence into voting on a larger scale than previously.

There is no doubt that the referendum was illegal. Something very different is whether it was legitimate. It violated Spanish law, UN resolutions on the right to self-determination, the recommendations of the Council of Europe’s Venice Commission, an agency of reference on constitutional matters and referendums, and Catalonia’s own regional charter, the Estatut.

Only Spain’s national parliament and the central government have the power to call referendums. The Constitution is based on the indissoluble unity of the Spanish nation.

In essence, the train crash between Madrid and Barcelona is a collision between Catalan self-determination and Spanish state sovereignty, between the supremacy of Spanish law and laws passed by the Catalan parliament.

How did we get here? Very simplistically, the turning point came in 2010 when Constitutional Court ruled there was no legal basis to recognise Catalonia as a nation and that the Catalan language should not take precedence over Castilian Spanish, among other things. This followed a challenge by the Popular Party, then in the opposition, to the new Catalan autonomy statute which was approved in 2006 in a referendum in the region and ratified in the Congress and Senate in Madrid.

This situation was aggravated during Spain’s 2008-2013 recession as it fed the grievance that Catalonia was paying a disproportionate amount to the Spanish coffers and not receiving enough in return.

Tensions came to a head in June 2011 when protesters over the economic crisis surrounded the Catalan parliament, forcing ministers to reach the building by helicopter. As of then, the cause of independence took off. Before then, it was unusual for more than 20% of Catalans to support independence. Support for secession reached a peak of 49% in 2013.

Not only was the referendum illegal, but it came after a series of claims made by separatists that are demonstrably false. For instance, it is not true—and European treaties reflect this and endless assertions by the European Commission—that an independent Catalonia would automatically stay in the EU and the euro zone. Nor it is true that voting is an exercise in democracy in all cases (dictatorships also organise referendums, as happened during the regime of General Franco, Spain’s dictator between 1939 and 1975). Nor are comparisons with Scotland valid. Scotland’s referendum on independence in 2014 was an agreed process and Catalonia’s unilateralist.

Companies based in Catalonia have taken fright at the crisis. More than 1,800 companies and banks, including some big names such as CaixaBank, Spain’s third largest bank, and the cava producer Codorníu have already voted with their feet and moved their legal headquarters out of Catalonia.

The crisis has put King Felipe VI in an awkward position. The tone he struck in his televised address to the nation was more that of spokesman of the central government than head of state. He had a great opportunity to speak of the enriching nature of unity and diversity, and missed it. His father, King Juan Carlos, faced down the 1981 coup, ordering the plotters to surrender.

A recent poll shows that Catalans support for a solution of Spanish constitutional reform and more self-government is around 70%. Some kind of political compromise will be required to encourage the significant proportion of the Catalan population in favour of independence to be comfortable within the Spanish state. The problem can no longer be left to the courts.

But the two sides are at the moment so entrenched that a dialogue is a non-starter; furthermore, there are divisions in the ranks of the secessionists. A lot is hanging on the upcoming election.

Featured image credit: “Barcelona” by Pexels. CC0 Public Domain via Pixabay.

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