Maintaining Hope and Sanity in Distressing Times

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This essay aims to explain what reading I recommend to best retain hope and sanity in these distressing times. Without going into too much detail about their contents, it is with a sense of obligation that I want to pass on to you my short list of the most memorable and impactful books I have ever read. In brief, these books convinced me how special human beings are and how we must not take the world for granted.

 

I was privileged to counsel countless medical trainees as a physician and scientist. They were bright, enthusiastic, and generally optimistic, with excellent prospects in life. But many also were stressed and worried about workload, finances, and relationships, to name a few. They also often were traumatized by the suffering and sadness plaguing their patients. They had grown up knowing full well that the world had pain and joy but were learning that the tragedy seemed far out of proportion. Most of my trainees’ counseling was in 1983-1997, an era of rigorous training demands. In 2003, medical trainee hours were capped at 80 hours per week in the USA, with shift lengths not exceeding 30 consecutive hours.  Even so, a study of 2,000 responding American medical students and residents (89% response rate) published in Academic Medicine in 2009 found that 12% had major depression, 9.2% had mild to moderate depression, and about 6% had suicidal ideation.

 

Well-versed in the sciences, many trainees I previously worked with were not religious. Some asked my thoughts about the tragedy of the human condition and questioned whether there was any ultimate meaning to our lives. They knew that centuries ago, Copernicus had dethroned the Earth as the presumed center of the universe, and Darwin had shown how random changes and natural selection had powerfully shaped living things. Science found that there was no predestined plan for humanity. A human was just an animal, and death was certain. In recent years, the rise of improved artificial intelligence seemed to suggest that even human-level thinking might not be so special.

 

Some trainees adopted a quietly spoken dark humor as they endured their daily trials. I believed that this was a defense mechanism. A satirical novel that became popular after 1978 was The House of God by Stephen Bergman, who used the pen name, Samuel Shem. Set in a fictionalized version of Beth Israel Hospital, a group of interns performed demanding duties for months with little sleep. Curious, I read the first few chapters but found the book too unpalatable to finish.

 

Though my religion was an extremely helpful source of comfort during my training, as a young faculty member, I realized that many trainees I was supervising would not be satisfied by offering spirituality as a potential aid. So, I found other books to guide our discussions. Now, I believe that these books will benefit nonmedical readers as well. I suggested that trainees stop reading Shem and consider instead Loren Eiseley’s beautifully written collection of essays, The Immense Journey, for example. Eiseley has a magical mastery of prose, and his almost mystical perspective on how amazing the world is as he reflects on the immense age of the Earth – deep time – helps a reader gain a new perspective on existence. I also recommended several excellent books by physician Lewis Thomas, especially The Youngest Science. Thomas recounts how as a young boy in the early 1920s, he accompanied his physician father on house calls. Few efficacious internal medicine interventions could be made, but the patients and their families highly valued attentive conversations, examinations, and prescriptions. To some extent, this was healing by the laying on of hands. Thomas recounted his own medical training and career when more useful novel medications like the sulfa drugs and penicillin became available. Medicine was being transformed from “the oldest art” to “the youngest science.” Thomas was worried about the damaging impact of human activities on the Earth’s ecosystems, and he feared that nuclear weapons could end everything. But Thomas recognized how unique humans are, and he closed the book with an optimistic note: “The good thought that I have about this is that we are, to begin with, the most improbable of all the earth’s creatures, and maybe it is not beyond hope that we are also endowed with improbable luck.”

 

Whether it was due to the books or the personal interactions – or something else entirely – every medical student I advised during my fourteen years as a faculty member successfully made it through training without serious long-term damage, as far as I could tell.

 

New challenges awaited when I left academic medicine to work in the pharmaceutical industry to attempt to invent and test new treatments. I saw few medical trainees then, but I worked closely with mature physicians and scientists, some of whom were developing burn-out or were otherwise becoming disillusioned. Through the years, I have been very impressed by Martin Gardner, a true genius who published a mathematics column regularly in Scientific American. He had edited a wide-ranging collection of scientific articles, Great Essays in Science, that inspired me in college. I then was astonished when in 1999, Gardner published a new edition of his controversial and fascinating book, The Whys of a Philosophical Scrivener, which was much praised and criticized. That book was exactly what I needed to engage fatigued, seasoned scientists and physicians who were having crises about the meaning of their lives. Gardner writes convincingly about how mysterious the world is. He dismisses the pragmatism of John Dewey, who argued that we could only know that a statement is true if it is rigorously proven; Gardner instead persuasively argues that things are true that are beyond the mind of man and that can never be proven by humans beings, which he points out is the ancient version of the truth. And there are not just a few such unprovable truths – there appears to be an uncountable number. Gardner believed that the existence of our self-aware species and the unique Earth are so mysterious that we certainly should not take these things for granted as being the usual course of nature.

 

It is notable that, if life weren’t already difficult enough, new challenges keep appearing that tend to cause even more disillusionment in thinking people. Global warming seems to be a major threat yet appears to be nearly unstoppable. New sorts of infectious diseases threaten global pandemics. Autocracies around the world are threatening democracies. And recently, rapidly advancing artificial intelligence technologies have been viewed by some experts as potential existential threats to mankind, and these technologies seem to devalue the uniqueness of humanity. How can we best maintain hope and sanity in our secular society in these distressing times?

 

I advise maintaining a broad, thoughtful perspective by reading several key books. Remarkably, my favorite essay of all time was written by Loren Eiseley in 1957, yet it deals with the question of the intellectual capacity of machines. Titled “The Bird and the Machine,” published in The Immense Journey. You can easily find it and read it in forty minutes – but when finished, be sure to re-read the first paragraph, which will make much more sense to you. Not surprisingly, Martin Gardner also wrote presciently about whether machines might someday be able truly to think as humans do. His remarkably entertaining essay, “Computers Near the Threshold,” was included in a collection of essays titled Mysteries of Life and the Universe, edited by William H. Shore in 1992. Going back even to Greek mythology, Gardner traces the long history of interest in building intelligent machines. He views computers that seem to have consciousness as mere machines that are “twiddling symbols.” Gardner mentions nonbelievers in “strong” artificial intelligence (AI), including Penrose and Searle, though he doesn’t dwell in depth on Searle’s well-known Chinese Room scenario, which has been widely discussed as an argument against strong AI in recent decades.

 

So, please consider acting this summer. The few books I’ve shared here have profoundly transformed my perspective, rippled positivity into the lives around me, and could reshape your outlook as well.

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James Magner, MD, is an endocrinologist and scientist who has worked in academic medicine and the pharmaceutical industry. The author of five books and scores of scientific articles, he was an Eagle Scout and likes chess and poker. He lives with his wife in Connecticut.

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