Howard Be Thy Name

The death of a 93 year-old man forces you to think about the small things and the big.  My wife Vic and I drove from Cincinnati to Cleveland early Saturday morning on the last day in December after her mother Betty had called us Friday night: Howard had died in his hospital bed in the living room while she watched Jeopardy, one hand in his, and waited. Howard had spent the last year in home hospice care, both of them sleeping in the living room—we’d been losing him for a long time.

At 11 on that Saturday morning Betty looked pretty good, as good as the last time we’d seen them just three weeks before.  I didn’t feel much, not as much as I expected, but we all felt unprepared. Now what? One of the things you have to think about after the death of a 93 year-old man is the empty spaces. What do you do with the vacuum?

Howard’s body was gone, donated the night before as planned to the Case University anatomy lab. The next morning a medical equipment van pulled in and a polite man in a brown uniform asked to take the hospital bed out of the living room. That was the hospice system in efficient action. It took him less than ten minutes.  Now both Howard and his recent resting place were gone, leaving a bare floor.

Betty also wanted her bed moved back upstairs, so I helped carry it up, and then cleared out the commode, the plastic floor cover, the stacks of diapers, the tub of medication bottles, the boxes of rubber gloves, and Howard’s best brown shoes.  The invalid Howard had so occupied our attentions for the past year, we’d lost touch with the man.  Now we had an empty corner in the living room. What fills this vacuum?  People would be coming to visit.  We needed more chairs.  Betty and Vic and her brother Frank talked around the dining room table and Betty took nearly every call that came in while Vic started her lists.

I putzed around out back and found a rake in the garage and was half way through filling the first bag when the rake handle snapped—a clean perpendicular break half way up the wooden handle.  If it had broken at an angle, and if Howard had been here with me, we likely would have set two screws and a splint and wrapped a tight coil of wire around the splint and kept on raking, with the satisfaction of having spared a rake from the junk heap.  But it wasn’t that kind of break.

The next morning, New Year’s Day, Frank and I drove to Home Depot and bought a rake with a fiberglass handle, more leaf bags, a chromium battery for Betty’s watch, and some adhesive for three loose linoleum panels in the kitchen floor.  By the end of the day I’d filled six bags, not just because the leaves were begging for attention, but also because during much of our early years of kid-rearing, when Howard and Betty came to help for a week a month, I spent some of my best hours in the yard raking leaves with Howard.  He taught me how to overload a wheelbarrow with leaves and faggots using a bungee cord or clothes line and haul the load to the slash pile. Later he handed down to me his red plywood wheelbarrow with removable slats that dates back to his childhood. I use it almost every weekend. That man knew how to take care of his tools so they outlived him.

In the basement buried under a heap of laundry, I found the broken rocker that had lived for so many years in the living room.  On the work bench I found the rocker’s arc that had snapped off years ago under a grandchild’s rowdy rocking.  This break had a nice angle and slipped tight into its place.  Sunday afternoon Frank and I glued the two loose joints and the rocker’s arc with gorilla glue and C-clamps.  We set the glued joints under pressure with loops of clothesline twisted tight by a chopstick. I first learned to glue a chair with clothesline and chopsticks from my father-in-law about 35 years ago.  Howard had an appetite for repairs, which is part of what led him to and kept him in social work as his profession.  This appetite, this penchant also made him a loyal friend and family man and a forgiving grandfather, patient with the things and people that don’t work as they were meant to.

Estimating funeral attendance is hard to do.  Howard and Betty’s priest Rev. Rosalind Hughes warned us to expect empty pews and a modest turnout at the Church of the Epiphany in Euclid on January 7, an occupational hazard of surviving into your 90’s.  But people came to this memorial service on short notice from Texas, Colorado, Utah, New York, Massachusetts, California.  Some drove through harsh winter weather.  The night before the service we fed at least thirty out-of-towners, and Vic’s cousin organized us into a circle to introduce ourselves and talk about why we came. After the service on Saturday, over a hundred people gathered for lunch in the church basement, photo albums covering four tables. The opportunity to speak about Howard was taken by one after another, stretching out over an hour.  They spoke with choked voices, salty cheeks, or rowdy laughter of his humility, his humor, his attention to listening, his sharing of his love of sailing and wooden boats, the powerful effect his respectful approach had on people in moments of self-doubt.  We could feel the man.  Into the vacuum we revived his life.

The night after the service we fed another 35 people and again we gathered in a circle to tell something about ourselves to this tightening web wrapping itself around the modest and meaningful life of Howard.  This was more than the usual funeral weekend. Occasionally someone alluded to the grim election two months ago or the inauguration two weeks ahead or the uncertainty we all face.  This was a gathering of die-hard liberals, carefully avoiding politicizing the remembrance of a fellow die-hard liberal.  No one said so, but I wonder if the recent election of a man who is commonly associated with bullying, billionaires, fear, and narcissism is part of what drove us to this emotional and vocal celebration of a man who was Trump’s polar opposite: compassion, thrift, contentment, and selfless service.  We needed to touch Howard, to tap the goodness of his life, to get our bearings.  Howard be thy name.

The Art of Passing

Our shifting national demographics over the past generation have foretold the end of the dominant role of the white male in US politics. We’re losing our grip, and we’re scared. Some readers of the tea leaves say that the surprise showing of rural white males at the polls on election day this year in a few key rustbelt states shows how desperate we white males are to hold on to that grip, reckless as The Donald may be.

The front page of our Sunday Cincinnati Enquirer this week gave us nine fetching portraits of the members of the Alhamoud family wrapped around the title “Finding Home.” This three-part series on the immigration process over the past year for this local family of Syrians comes to us the week after the election of a man who has repeatedly threatened to “register” all Muslims in this country and deport unspecified numbers of immigrants and build the iconic wall against immigration. This series—the warmth of these pictures and the endearing details of the ways these seven children, ages 2-13, and their two parents, Ahlam and Marie, have found some kind of home here—is clearly aimed at winning our hearts.  It won mine.

Two weeks ago our grandson Santiago Chavez Wulsin was born in Cincinnati, delivered by his Mexican-born and raised mother, an immigrant and a US citizen for the past three years, and our much loved daughter-in-law for the past seven years. On the day Santiago was born I happened to be in Texas, where I spent much of the day talking with my older brother about the mystery of our great-great-grandfather Drausin Vulsin Bacas. Why did this French-speaking man of 36 suddenly leave New Orleans in 1851 with his wife and five children, travel north to Cincinnati, change his family name to Wulsin, and settle here, never to return home?  Why at the same time did both of Drausin’s brothers and a sister leave the family home in New Orleans, all of them cut out of the will of their father Barthelme Bacas? It was time for them to get out of town.

We may never know the critical incident forcing their move, but the best working guess so far is that a new rise in the tide of racism drove them north. After generations of tolerance for people of mixed race under French rule in New Orleans, the French Revolution of 1848 resulted in New Orleans shifting to a more British influence with rising racial hostility. Though the New Orleans census of 1850 listed his father Barthelme Bacas as white, Drausin’s mother Adelaide, Drausin’s wife Josephine, and Drausin himself, along with his siblings, were all listed as mixed race. Doors once open to them began to close, including the door to their father’s estate.

We owe this guess partly to the work of Bliss Broyard. Having been raised in the privileged white life around Fairfield, Connecticut, in the 1970’s and 80’s, she spent the years after the death of her father Anatole Broyard in 1990 discovering his Creole roots in New Orleans, where he had been born, and later in Brooklyn where he was raised in a black family—a family that he had denied to his East Coast family and friends for much of his adult “white” life.

In Chapter 15 of One Drop (2007) Bliss Broyard writes about the forces in 1848 that drove her white great-great-grandfather to pass as black in order to avoid the appearance of a mixed race marriage, since his wife was clearly black. Broyard cites the Fugitive Slave Act, the Dred Scott case, and the call from the New Orleans Daily Picayune for the expulsion of all free Negroes from the city as some of the forces that fed the new intolerance of even “one drop” of black blood. Broyard notes that “more than 80 per cent of the free blacks in New Orleans were of mixed race in 1860, and they’d already been emulating white social mores for years.” By 1860 another local paper the Daily Delta observed that “scarcely a week passes but a large number of free persons [of color] leave this port for Mexico or Haiti.”

So it has only now dawned on us, my siblings and me, that though we were also raised in a privileged white world and so sure of our belonging, our great-great- grandfather Drausin Vulsin Bacas came to Cincinnati as an immigrant from a hostile culture with a funny name speaking a foreign language (French) and urgently needing to pass as white in this melting pot town nicknamed Porkopolis. For this fair-skinned music teacher and father of five, mastering the art of passing during the buildup to the Civil War was a matter of survival. All four of his sons served in the Union Army against the South, their homeland. One son later became a prominent lawyer and another the president of the Baldwin Piano Company, securing a place for their families in Cincinnati’s white society.

In our extended Wulsin family the truth about our mixed race roots was effectively buried as soon as they arrived in Cincinnati, and this intentional silence was carefully passed down across the generations. Then in the 1950’s our grandfather started to dig into his genealogy, but he abandoned his inquiries just shy of discovering that Adelaide, his grandmother, had been a Free Woman of Color and his grandfather was mixed race in the New Orleans census of 1850, but white in the Cincinnati census of 1860. Only in my generation have we come to that truth.

Drausin Wulsin and his children may have had to deny their homeland more than most immigrants, but denial is a part of the immigrant’s dilemma: how to fit in to the new culture without your roots. How do you reinvent yourself without losing your identity? Isn’t this the dilemma for our local Alhamoud family? Some truths about their homeland they might also keep to themselves.

At first glance the practice of passing as someone you’re not may seem like an act of deception, an act of questionable ethics. Bliss Broyard was initially angry at having been deceived by her father about her heritage for all of her childhood. But people usually pass in this way for love or money or survival. Martha Sandweiss tells us in Passing Strange (2009) about the brilliant white geologist Clarence King from Manhattan who passed for a black Pullman porter to secure his marriage in Brooklyn to a black woman from Georgia, hiding his true identity from her for 13 years. Like Broyard’s ancestor, he passed for love.

We descendants of immigrants benefit to this day from our ancestors who mastered the art of passing into their adopted culture. Obama has lived along this color line, and thanks in part to his example it is less dangerous today to be mixed race in this country than in the days of my great-great-grandfather. Some day the same may be true in our country for Mexicans and Syrians and other vulnerable immigrants. Some day we may face the truth that most of us are mixed race and most are descended from immigrants. That will be a better day in a better country, even for “white” boys like me.

What’s Your Tribe?

Since July 1, 1970—just one of many lucky days in my life—when I learned that the draft lottery for military service in the Vietnam war had assigned boys born on my birthday a safe 163rd out of 365, I have wondered how I would have handled the traumas of combat.  Now that I treat my age mates at the VA who were less lucky than I, I can’t forget about the question.  Would I have been among the one in six exposed to combat trauma who would later develop post-traumatic stress disorder (PTSD)?

Sebastian Junger, in his recent book Tribe: On Homecoming and Belonging (2016) raises some perplexing questions about our current epidemic of PTSD.  You don’t have to be a soldier with PTSD to find this book relevant to your struggle.  If you’ve ever felt you’re a man or woman without a tribe, this extended but short essay (136 pages) may speak to you.

Why has the rate of PTSD among US soldiers risen over the past century, even though the rates of combat exposure and combat deaths have dropped?  Why are our PTSD rates among US war veterans so much higher than the PTSD rates among war veterans in Israel, Britain, and Sri Lanka?  Why do our drone pilots in a Kansas bunker suffer the same rate of PTSD as our pilots exposed to combat in Iraq (see “Eye in the Sky,” 2015)?

The question that interests all of us is, How resilient will we be when we face our next traumatic threat?  Junger argues that one factor that protects soldiers from PTSD is “unit cohesion,” or the close-knit group within which they cope with life-threatening dangers in battle and after they come home.  In the tribal era the wounded warrior came home to the intimate circle of those who knew and cared for him.  He recovered, lived, worked, and slept in close quarters with fellow warriors and their families, all intimately related.  In the modern era, the soldier comes home often to a family and culture that knows nothing about battle culture and offers too little “unit cohesion.”

We all wonder whom we will come home to after the battle, the car crash, the rape, the earthquake, or the mugging that nearly kills us.  Will our Tribe help us heal?

Though the concept of tight social networks as protection against PTSD and other severe psychiatric illnesses is not new, Junger’s early chapters in Tribe remind us that for most of our civilized history we humans have lived under the protection of our tribe.  Only in the last two hundred years has travel, industrialization, and urbanization weakened, and in some places abolished, tribal rule.  Yet today in rural Kenya and much of the undeveloped world your tribe still dictates your language fluencies, location, marriage options, religion, healthcare practices, education, diet, and your chances for certain jobs.

It’s tempting to think we were more resilient in those tribal conditions, but how many of us would trade our modern autonomy for the protections of tribal life?   A few make that trade; we call it joining a cult.  And in countries like Kenya that are moving from third to second world status, tribalism is widely viewed as a regressive tradition to be overcome in the politics of development.  We have other options now.

Junger’s book made me ask myself what “tribes” I belong to.  Our modern substitute for the one tribe that dictates everything may be the various networks we join.  They don’t exert the influence that tribes can, but they feel like lifesavers for me, and in some sense they own a part of me: my ever-growing extended Wulsin and Wells families, my psychiatry groups within my work (two academic departments, psychosomatic medicine subspecialty meetings, work teams at the VA hospital and the family medicine psychiatry residency, my research project groups), my Antioch writers group, our St Andrews church congregation, my Terrace Park soccer team, my tennis partner group, our Clifton neighborhood.

Like most of you, I get by without one Tribe.  I may need to belong to more groups or networks than the average person, so I devote a lot of time and energy to them. They keep me going; I try to keep them going. And I’m counting on some of my networks to catch me when I fall next or take a hit.   They’re my social insurance plan.  What’s yours?

The Biology of Giving

“It is more blessed to give than to receive.”

–Paul quoting Jesus, Acts 20:35


Paul and Jesus, both generous and prophetic guys, surely were thinking ahead with these timeless words designed to comfort modern day parents who have just watched their greedy children revel in the Christmas booty with only the faintest nod of thanks to Santa. We’re all born hungry. Receiving comes naturally, but giving is an acquired taste and talent. Our societies have to train us with gold stars and heroic tales and aphorisms from our spiritual leaders to keep us on the giving track.

I learned a new word about societies this week from the entymologist E.O. Wilson: “eusociality.” Wilson is a bug man and a book writer (26 books in 55 years) now in the twilight of his academic career. I’ve been reading his 2012 book The Social Conquest of the Earth to understand better what we Homo Sapiens share with the other conquerors of the earth, the ants and the termites. It turns out that if you want to proliferate and dominate other forms of life in this world, eusociality is one feature your species cannot afford to bypass.

Here’s what the ants and termites figured out 65 million years ago, and we just figured out yesterday, or 3 million years ago: “Eusociality, the condition of multiple generations organized into groups by means of an altruistic division of labor, was one of the major innovations in the history of life. It created superorganisms, the next level of biological complexity above that of organisms. It is comparable in impact to the conquest of land by aquatic air-breathing animals. It is equivalent in importance to the invention of powered flight by insects and vertebrates.”

Eusociality is the next jump up from every-organism-for-itself. If eusociality is so essential to winning the evolutionary competition, why hasn’t every species adopt it? Apparently, it’s not an easy evolutionary jump to make. The rarity of eusociality remains a mystery. Only 15 of the 2600 taxonomic families of insects are known to contain eusocial species. And only two of the vertebrate families have made the jump: two species of subterranean naked mole rats of Africa and Homo Sapiens. I hope that fact improves your opinion of the naked mole rat of Africa.

So, if you want to be one of the rare superorganisms in this world, you better master eusociality. There are two steps. Step 1: establish altruistic cooperation to protect your nest from enemies. Step 2: organize members of multi-generational groups to divide labor in a way that sacrifices some personal interests to the interests of the group. Altruism is a key to rapid proliferation and dominion. Giving gives us power.

If that sounds too academic to guide your daily life, here’s a new study that brings that evolutionary lesson into your nest. Inagaki and colleagues wondered whether it was not only more blessed but more biologically beneficial to give than to receive. Using sophisticated psychological measures and fMRI brain scans that track the activity of specific brain circuits during tasks, they examined 36 participants in their twenties while engaged in a raffle game. The aim of the study was to examine how the experience of giving support, compared to receiving support, affected two regions of the brain known to be sensitive to stress in relationships, the ventral striatum and the septal area. In this raffle game, the participants could choose to earn tickets either for themselves (receiving support) or for someone they knew who could use the money (giving support, i.e., $300). That’s putting altruism under the fMRI scan.

The Inagaki study found that both giving and receiving support reduced distress and made the participants feel better. But only giving was associated with biologically beneficial outcomes. Specifically, giving (but not receiving) activated the ventral striatum, which is particularly sensitive to social rewards and to the degree of closeness between two people. Epidemiologic studies have shown that giving is associated with lower mortality, fewer sick days at work, and better cardiovascular resilience.

It’s just one study, but in the context of the powerful evolutionary advantages of groups that protect their nests through altruistic divisions of labor, this study lends modern weight to the Biblical blessing of giving. It scientifically affirms the value of random acts of kindness. It reminds us why sometimes those with the least give the most—we get it back in the currency that most counts: affiliations with people we care about.

And it implies what we already know from other tales in all the good books (the Bible, Koran, and Gita): when you’re feeling stressed, bereft, and short on resources, try giving what you can. Giving may work better than receiving—better for your health and better for those in your nest.

Listening Across the Gap

Listening is easy when you want hear what the other person wants to say. Listening is not so easy if you’re Jodi trying to talk with Stutz about some tough news.  Jodi has known Stutz for three wild and thrilling months, during which they discovered they’re both rebels and soulmates, with new tattoos to prove it: a chain around the right ankle, wings over each ankle bone.  This morning she went to the Health Department clinic and came back with the news that she’s pregnant and tested positive for syphilis.

She said, “Stutz, I can’t stand it.  I feel horrible, like scum.”

He said, “It’s not horrible. I’ll pay for the procedure and one shot of penicillin will take care of it.”  Stutz is 42 and has been through this kind thing before.  Jodi is 28, never been pregnant, never considered syphilis, and has been prone to catastrophes.

She said, “You don’t have a job. Your next gig isn’t for two months.  What are you saying, you’ll sell your guitar, sell your Harley?  And what if I don’t want your goddamn ‘procedure’?”

He said, “I could fix the Harley in one day, if the guys’d just let me borrow the tools. It’s just a rod jammed, I know it. One day, you watch.”

Listening is not so easy when you discover the rebel you’re in love with rebelled against a chaotic, mixed-race Creole family from the Bayou, and you rebelled against the numbness of Florida’s white suburban conformity. Listening is not so easy when he’s high on marijuana because that’s what blunts his nightmares and flashbacks, so blunted that he doesn’t realize you’re trying to negotiate a tough decision.  Listening is not so easy when you’re terrified and he’s mellow.

What makes people hard to listen to? Gaps—some we’re aware of, others we deny.  Gaps in gender, generations, language, experience, education, emotional state, illness, agendas, and expectations.  The more gaps and the wider the gaps and the less aware we are of the gaps, the harder it is to listen well.

As a psychiatrist I’m usually listening with most patients across three or four gaps at any one time.   At the VA the vets know in a blink that I’ve not served in the military, so when they’re talking about military experiences I have to listen more attentively, avoid judgment, and play back what I’ve heard. And they’re telling me about states of mind I’ve never experienced, illnesses I’ve never suffered, and cultures I’ve never lived in. It’s hard to listen effectively across so many gaps at once, but knowing the gaps and talking about them helps.

My cousin, Hathaway Barry, published this year a chronicle of the triumph of her efforts to listen across a gap, a book called Boy: A Woman Listening to Men and Boys. She has spent much of the past ten years on this project.  In her Introduction she tells us, “In my later fifties I fell in love again….He was the most open and vulnerable man I’d loved and the most elaborately defended. My heart was scrambled….I wanted to know what happens to boys growing up.  Maybe I would need to listen differently if I wanted to find out….I just wanted to listen without blame or judgment to how it is for men….to hear their honest human stories, without gloss or performance….I was just curious.”

She reminds her reader that she is not a social scientist or anthropologist or journalist, and she did not set out to write a book. “This inquiry was born out of heartache. The sorrow of not knowing how to reach one another when this is so much our common human longing.”

So she reached across the gender gap by interviewing more than 80 men and boys and weaving the transcripts of their conversations into this book. It is 362 pages, 38 chapters  organized into four sections.  The proof of her apparently acquired capacity to listen effectively to men and boys during the past decade comes through the intimate and often pain-ridden stories they share with her.  She discovered the tender vulnerabilities that lurk beneath the strutting and bluster and bravado.  “There’s a slant to the stories I’ve selected….I’ve mostly chosen to share the more vulnerable responses, those perhaps less easily spoken about publicly.”

The first line of the book is: “Everywhere I go now, I see men differently.” The triumph of this listening project delivers a lesson for us all in her Afterword: “When I took a breath and relaxed, suspended my beliefs long enough to put myself in their shoes, and let myself just listen and not know, the world lit up.  It was like falling in love again and again with life.”

What a find. In her sixties.  It’s never too late to learn to listen.  Pick your gap.  Reach across, all ears, all heart.

The Secret Lives of Secrets

[Notes for a talk to Clinton County Reads 4/12/16]


Thanks to Mary Tom Watts and to all of you in Clinton County Reads for this chance to talk with you about one of my favorite topics, secrets.  Clinton County Reads must be the only literary organization in the state that declares itself with an active verb in the present tense. Frankly, it’s a bit intimidating.  Down in Hamilton County where I come from we have nouns modified by adjectives and gerunds modified by prepositional phrases, but nothing so bold and brief as the active verb in the present tense.  Omit Needless Words.  EB White would like the name, and so do I.

Everything I Never Told You is a fine title for a book about secrets.  It hooked me.  Is there any more compelling force in this novel than the way secrets shape the lives of every one of the Lee family?  Celeste Ng manages to tell us a lot about the things these family members never tell each other.  The struggles of the Lee family show us how divisive secrets can be, so I want you to take a close look with me at how Celeste Ng shows us some of the toxic features of secrets shaping the lives of each member of the Lee family.

But first a bit about what we know and don’t know about the psychology of secrets.  How do we know that secrets can be powerful and formative?  The soaps tell us.  Shakespeare and Hollywood tell us.  It’s hard to find a good drama that does not rely on the tension surrounding a secret.  But we also know it from the playground, where most games rely on secret plans or strategies by one team or player to gain an advantage over the other.

In her 1983 book Secrets: On the Ethics of Concealment and Revelation, sociologist Sissela Bok defined secrets as “intentional concealment.”  Bok discussed the universal need for and the danger of secrets:  “We are all, in a sense, experts on secrets.”   Our societies create institutions for the management of secrets: the Catholic confession ritual, legal counsel, psychotherapy, AA groups, corporate trade secrets, war plans, political campaign strategies, and huddles before each football snap.

So if we’re all experts on secrets, or at least experienced, what do we know about the life of a secret?  What does psychology tells us about how secrets are born?  Have you ever traced a secret from its birth through its growth?  How do we protect them, change them, multiply them into several secrets, widening the circle of confidence?  And what moves us to part with them, let them fade or cease by leaking or by sudden forced disclosure?  It’s hard to trace the life of a secret, even one of your own. Why?  Because we keep our secret ways hidden.

It’s possible to practice psychiatry behind a curtain, in a crowded hallway, or at a party, but I’ve found it works better behind a closed door.  I’ve spent a lot of years helping people understand and manage their secrets.  It’s part of what I love about psychiatry—the privilege of helping people know and take care of their secrets.

About eight years ago, after a week at the Antioch Writers Workshop, I decided to try interviewing selected people about how secrets had shaped their lives in some lasting way.  From these interviews I would write creative non-fiction short stories that focus on some aspect the psychology of secrets.  I did three sets of interviews and wrote three stories, which is a start toward the ten I had planned, before I had to set the project aside for other academic work.  The project is still on hold, but I plan to finish the book some day.

Along the way I looked into what had been written about the psychology of secrets and found surprisingly little.  Psychologists are not known for being shy about prying into people’s private business, so it’s a mystery to me why so little formal research has been published on the psychology of secrets:   One book by Anita Kelly The Psychology of Secrets (1999) and a handful of original research papers.  Lots about lying, not so much about secrets.   I’m not sure why, probably a research funding fashion trend, but here’s my Cliff Notes version of what we know that is relevant to Everything I Never Told You.

Secrets often involve at least two people and require effort and resources by one person to hide information from others.  The tension between the sharing and the hiding is the heart of what drives the drama around secrets.  Emily Dickinson, hardly a paragon of transparency, taught us to “Tell all the truth, but tell it slant.”  She was the maestro of partial revelations, the recluse compelled to reveal herself, always on a slant.

We create secrets to solve problems in the short run. Like the other kind of conception, secrets are often conceived impulsively, and then they sprout legs and take off to cause trouble.  In the heat of the phone call to tell her mother about her wedding to James Lee, Marilyn chose to keep his ethnic status a secret, to delay her mother’s opposition to the marriage.  Lydia and Jack choose to keep their relationship hidden, maybe to reduce interference from Nath or her parents.   Hannah hatches her secret (p 22) about catching Lydia’s silhouette on her last night, assuming it would only make her mother upset and her brother angry.  Both secrets work in the short run.

Some secrets we create, others we inherit, often without knowing it.  After Chapter One ends with the police dragging the lake for Lydia’s body, Chapter Two opens with this line: “How had it begun? Like everything: with mothers and fathers.”  Chapter two shows us how Marilyn inherited from her mother the taboo against speaking about the disappearance of her father when she was two.  That example sets the stage for Marilyn’s own disappearance to go study medicine in hiding, and then the disappearance of desperate Lydia to go ride a boat at midnight.  Why?  We never see anyone telling anyone about any of these vanishings.  Everything I Never Told You.  Is that shame driving a culture of secrecy across three generations?  Can you hear the unspoken message that it’s usually safer to conceal the truth that troubles you than to confide or reveal it?

Secrets beget secrets, and sometimes to protect a secret, we lie.  On page 15 we learn that Nath knows that “these girls have never been Lydia’s friends.”  But Nath does not correct his parents.  Nath keeps a secret about his sister’s secret friends.  On page 16 we watch Nath’s amazement at how Lydia could lie about her secret friendships.  And then we read, “Except he can’t tell his parents that now.”  We never learn why.  What is the worst that could happen if he told them?  We never know.  But often what keeps a secret a secret is some strongly sensed assumption about the catastrophic consequences of disclosure—yet that consequence often goes unspoken and remains poorly understood.

On page 17 Nath justifies his silence with “If he says anything now…they’ll say, Why didn’t we know about this before?  He’ll have to explain that all those afternoons…” when he had covered for her she had really been with Jack.  And he’d have to admit Jack had been a part of her life for months.   So Lydia’s secret about Jack leaks to Nath and begets Nath’s secret about what he knows about her presumed quiet desperation.  Another thing I never told you.

Secrets stake out boundaries.  They define our circles of confidence.  They bind us to those inside the circle (Lydia and Jack to each other, the brotherhood of a street gang, the bonds of lovers), and they separate us from those outside (Lydia from her family).  Boundaries define character, so no wonder dramas often use secrets to develop character.  Secrets are a vehicle for spelling out the intricate tangle of ties among groups of people that we find so fascinating.  And secrets show us how people manage sensitive information.  Marilyn’s decision to just suddenly escape the family without notice to study medicine reveals an alarming lack of trust in James, her children, and in her own inner resources.  She could not find a way to pursue her goal without ditching three kids and a husband?  Then she came home and we heard nothing about it from her.  Everything I Never Told You.

Secrets are often conceived in a shifting set of circumstances and assumptions about the catastrophic consequences of revelation.  The risks and benefits of concealment may change.  A witness protection program for the mafia informant may no longer be needed after the godfather is bumped off.  To Lydia her loneliness may seem at 16 like a life sentence of misery and humiliation.  She can’t imagine 17 being different, or her desperation being relieved by love or humor or religion or time—any form amazing grace that would make her secret about her loneliness no longer necessary.

Shifting circumstances open the way for or force disclosure.  Revealing a secret is both the initial catastrophe and the eventual deliverance from the bonds of secrecy.  Secrets thrive on often untested assumptions about the dire consequences of disclosure.  If Marilyn reveals where she is studying, she will never become a doctor.  If James reveals his affair with Louisa, his family will kick him out or he’ll lose his job or his reputation…or all three!  None of these expected consequences come to pass.

Secrets that once solved problems eventually become irrelevant, bothersome, complicated, or sometimes unbearable.  Just as we crave attachments, we also crave to be known.  This longing to be known drives fugitives to turn themselves in after years on the run.  It drives deathbed confessions.  Lydia’s disappearance and death forced her family to face a series of partial revelations about her.  They came to know her in a new and painful way.  On his deathbed Anatole Broyard, the writer and New York Times book reviewer, tried to inform his children that he was not the white man he had passed for most of his adult life, but a Creole from Louisiana.  It took his daughter Bliss Broyard  six years to write in One Drop the full story of the secret she inherited from her father, who hidden it from her for over 20 years before trying to tell her as he was dying.

In Everything I Never Told You we don’t see much of the healing that comes with revealing oneself to loved ones.  In fact, this book could be titled Everything I Never Told You….and Never Will. The next edition should come with a warning to all therapists who read this that it may incite them to frustration and violence.  It’s an astute picture of the many ways that well-meaning people miscommunicate.  I don’t know what it adds up to by the end of the book, but I counted no less than 22 missed communications in the first 20 pages.  And I’m still looking among all their secrets for one honest confiding moment between two members of the Lee family.

What do you think about everything I’ve told you and Everything I Never Told You?

Church is Good for the Heart

After the Valentine’s Day service at St Andrew’s Church, Cincinnati, Father John Agbaje asked me if I would give a talk about the heart.  On 3/6/16 during the announcements part of the service, I gave the following talk to the congregation:


Father John often thanks us for coming to church.  One of his refrains in his sermons is that coming to church is good for the soul.  I want to show you, with a little help from science, that church is also good for the heart.  I’m going to read you a short vignette, ask you to think about the anatomy and physiology of the heart and the brain, and then talk about the effects of stress on the heart.  That will lead us to a few tips for minding the heart.  In less than 10 minutes.

For those of you who know me as a psychiatrist, I may appear to be an imposter talking about the heart, since my field is the mind and my organ is the brain.  Let me explain how a psychiatrist ends up preaching about the heart.  About twenty years ago I started wondering how it happens that people with depression die younger than people without depression.  This question turned into a four-year long project with a mentor of mine, George Vaillant, and the epidemiologist I sleep with, Victoria, that resulted in our publishing a review in 1999 called The Mortality of Depression.   The main finding of this review was that depression roughly doubles the rate of early death, and most people with depression die from early heart disease and other chronic illnesses, much more often than from suicide.

Since then a lot of research by others has clarified the pathways by which depression and other forms of chronic stress lead to the early development of heart disease, and how depression accelerates the rate at which existing heart disease leads to early death.  I published a book in 2007, Treating the Aching Heart: A Guide to Depression, Stress, and Heart Disease, to spread the word to non-medical readers about this research.  More recently it has become clear from sound epidemiologic studies that all the major chronic mental illnesses cut about 20 years off the expected life span in our country.  That is, if you have the good fortune to live into your 80’s, your brother or sister with bipolar disorder or schizophrenia or severe depression is more likely to die in their 60’s.  How does this happen?

A reading from the Gospel according to Lawson: Chapter 1, p 1-2:

Paula Volk, sixty-two, spends most of her time in the front bedroom of her two-bedroom house near the flood plains of the Ohio River, watching the clock, as she says.  Her father died at sixty-two from his second heart attack.  Her mother died at sixty two of a stroke.  For eight years Paula Volk’s heart has been troubling her with chest pains, shortness of breath, and exhaustion.  She’s sick enough now to need a heart transplant, but too sick to be eligible for the operation.  How did she, the daughter of a nurse and an engineer, come to this?

Her mother ate too much, drank too much, and spent too much time in bed with depression, Paula says.  Determined to defy her mother’s genes and her example, Paula skipped the booze, and worked hard as a social worker and later as the owner of a small courier business.  Aside from carrying some extra weight most of her life, Paula usually felt pretty good and considered herself pretty healthy.  She smoked a couple of packs a day for forty years and quit in the spring of 1995, when she was fifty-five and the chest pains began.  Within the year she developed congestive heart failure and (like her father) diabetes.  And then she had a coronary bypass operation.  After the operation she slid into a funk, stopped taking care of her house, kept to her bed, and ruminated about suicide day after day.

For most of the next eight years she remained depressed and disabled, untreated for anxiety or depression in spite of frequent treatments for her heart disease.


These pathways between depression and heart disease are partly genetic, but they also include some high risk health behaviors, like smoking and overeating and insomnia and slouching on the couch all day, which are common habits of the chronically depressed.  Depression also contributes to the risk for arrhythmias of the heart by reducing heart rate variability, a measure of resilience to stress.  In some people depression disrupts the whole stress response system, making them feel fragile not only in their minds but in their cardiovascular systems too.  In the six months after a heart attack, depression doubles the rate of sudden death, mostly by arrhythmias because of reduced heart rate variability.  And depression disrupts diet, exercise, and glucose regulation, accelerating the onset of diabetes, which also contributes to heart disease.  And feeding this vicious cycle, heart disease can increase the risk for depression, as it did for Paula Volk.

One way to understand how stress and depression wear and tear at the heart is to think about how the central nervous systems and the cardiovascular systems are anatomically connected.  The heart and all the blood vessels are enervated by two kinds of nerves that balance each other—the sympathetic and the parasympathetic branches of our autonomic nervous system.  Our heart rate and our blood pressure are the result of the balance of activity between these two branches, the accelerator and the brake.  One serves the fight-or-flight response and the other the conservation and relaxation response.

When we get excited, when Jerome Johnson and our Gospel Choir belt it out, our adrenalin kicks in and our sympathetic nerves light up and our heart rates rise. Later when we’re kneeling calmly during communion, some of us yawning, that other branch, the parasympathetic branch, takes over and we feel quiet and at peace. It’s a good sign when someone in the congregation yawns, a sign of that peace of mind and body.

During the rest of the week, when we’re not attending church, most of us lead lives that are overly stimulated and relentlessly activated.  Excitement and stress are easy to come by.  They seem to seek us out.  On the other hand, deep relaxation and a quiet mind and a sense of safety are harder to come by.  For many of us church offers a place to practice restoring the balance.

Think of our church service rituals and their effects on our nerves.  The sense of harmony when we sing together.  The resonant vibrations as we read the Psalms responsively.  The physical contact when we pass the peace.  The deep knee bends we call genuflecting. The lulling effects of our communion rituals.  The counting of our blessings.  The affirmations of affection from God and from each other.

Wouldn’t it be interesting to see what our average resting heart rates are at the end of the service compared to the beginning?  No wonder churchgoers tend to live longer.  One of the functions of church is to help us clarify our spiritual purposes.  No wonder people who have a clear sense of purpose in life have fewer cardiovascular disease events and live longer.  Think of church at its best as a gentle but sophisticated mind, body, and soul workout.

So I want to leave with a few key points.

First, the heart and the brain are tightly connected.  How we think and feel has a powerful effect on how resilient our hearts are.

Second, as with building our faith, building our resilience against the toxic effects of stress requires practice.  Stress management works if you practice it most days: make time to sing, dance, pray, shake hands, shake a leg, bend your knees, laugh, count your blessings, affirm your affections, reconcile and forgive.

And third, the components of our church service are good not only for our spiritual growth but also for tuning up the connection between our central nervous systems and our cardiovascular systems.  Church is good for the heart.

Our Beauty Bond

On New Year’s Day, after attending a wedding the night before in St Louis, I drove with my lovely to see the Gateway Arch.  The skyline of St Louis looks like its sister river cities until your eye finds the Arch.  Once you see it, you can’t take your eyes off the Arch.



We walked with the crowd through the chain link fences and rubble of construction, the mounds of dirt and broken concrete, to one base of the Arch.  Most of the Park was closed for six months of construction, and the Mississippi River at flood stage had piled a hundred foot wedge of driftwood flotsam upcurrent of the flatboat docked near the park.  But nobody paid much attention to the swollen river or the ugly rubble.  All eyes looked up, tracing this parabola against the pristine sky.

We were mesmerized kids and Asians and Africans and aging tourists and St Louis natives still itching to look more.  The Arch is celebrating its 50th anniversary; it looks like it was built this year.  What’s the universal magic here?

How can a tower of steel excite in all of us a sensation so moving that we call it by the same word that we apply to movie stars and daffodils, sunrises and symphonies, the Golden Gate Bridge and the gentle bend in the river?  What is it about our aesthetic brain that draws us all irresistibly to these inanimate wonders, all over the world?  Why should we be moved by the beauty of flowers?  Flowers are for the birds and the bees.

The argument that our sense of beauty evolved to favor selection of healthy mates helps us understand how we have developed a common view of beautiful people.  But physicist David Deutsch argues in The Beginning of Infinity (2011) that our shared sense of beauty is rooted in something broader than mate selection.   In a chapter titled “Why are Flowers Beautiful?” he explores the role of taste and attraction in the co-evolution of flowers and insects.  For both the insects and the flowers survival has depended on sharing a system of signaling that insured both feeding for the bees and fertilization for the flowers.  We humans find flowers beautiful too, not for their food but for their colors and symmetry and sometimes their aromas and for what they mean to us as complex signals of life and the process of procreation.  It’s a good thing that we’re fascinated by life.  The more we study it, the better we survive.

It’s not hard to imagine the survival value for our species of sharing common attractions.  In hunter-gatherer settings we are likely to hunt and gather more efficiently if members of our group are attracted to the same sights and smells and sounds and places.  And we do better if we share the same revulsions, as in teaching our toddlers not to play with their feces or eat rotten food.  And it’s easier to organize multiple groups into tribes if we’re all attracted to sunrises from the mountaintop and drumbeats and ceremonial dancing.

This shared sense of beauty may also reflect our collective imaginations at work.   If we have evolved to be attracted to mates who radiate signs of sexual health through the “eight pillars of beauty,” isn’t it possible that we’re also attracted to variants of those features in inanimate objects?  The arc of the rainbow tickles our love for symmetry and curves and motion and bright colors.  The shape of the ring on your finger and the crescent moon and an outline in a Matisse drawing capture our fascination with graceful motion, circles, and the arc of the sun.  The melodies we love evoke some magic blend of the best of the human voice and rhythms rooted in heartbeats and the gait of our footsteps and our craving for harmony.

To test this guess I tried identifying which of the eight pillars of beauty (youthfulness, symmetry, averageness, motion, body scents, complexion, hair texture, gender clarity) I could easily associate with some common inanimate icons of beauty: the egg, sunrise, pyramid, rainbow, snowdrift, rose, Beethoven’s seventh symphony, Mt Everest.  For each it was not hard to find associations with at east two or three of the eight pillars of beauty.   Guided by genes and learning, our imaginations cultivate this bond of beauty, another form of mortar for the human mosaic.

As we were leaving the Gateway Arch we ran into a couple who had been at the wedding.  In fact, that morning at breakfast they had told us they just got engaged at Christmas.  The future groom’s father, who lives just a couple of hours away, had come to town to see them and they had just visited the Arch, natives itching for another look, lovers drawn to this parabola of steel.  For them and for us, this icon captures, in addition to the mesmerizing power of its size, our love of symmetry, the parabolic motion of an object tossed upwards, simplicity (or averageness) on an enormous scale, clean lines, and the symbolic welcome that invites us in.

Our species loves to be welcomed in.  The Gateway Arch may be our largest and most beautiful icon of welcome.

The Eight Pillars of Beauty

In the early 1990’s in Vienna the biological anthropologist Karl Grammer and his colleagues noticed that symmetrical scorpion flies attract more mates than asymmetrical ones.  On the hunch that what’s true for the courting of scorpions might also be true for the courting of humans, they examined perceptions of symmetry in people and learned that symmetry was one of the features we associate with beauty.  Not just “we” in Vienna, but people all over the world.  In one of their studies, people from South Africa and Austria judged the same Japanese women to be attractive.


Though until the 1990’s there had been little research on the science of beauty—the topic was considered politically incorrect during the 1960’s and 1970’s—Grammer spent the next 15 years studying what we think of as beautiful and how beauty drives much of our behavior, from who we court to how we dress to what we buy to adorn ourselves.  After reading in a recent issue of Nature an interview with Grammer, in which he identifies “eight pillars of beauty,” I began to wonder how he and others had arrived at this list and how robust the research has been.

The best answer I’ve found is their review of their work published in 2003, titled “Darwinian Aesthetics: sexual selection and the biology of beauty.”  Over 140 references, mostly from the previous 15 years, convinced me they had plenty of good company in a wide range of disciplines who had published in sound scientific journals.  And they summarize the evidence for and against their assertions, suggesting they have done their homework on both sides of the arguments.  Here are a few notes on how they elaborate on these eight pillars of beauty.

Symmetry.  Nature has selected against asymmetries since the beginning of reproduction.  Asymmetric gametes (the organisms after the sperm and egg meet and start multiplying) don’t survive.  All plants and animals that survive show features of symmetry, and among primates obvious asymmetries usually lead to harsh exclusion by all but the most compassionate groups.  Symmetry also favors efficient movements, which for most species is essential to survival.

Youthfulness.  It is no accident that our icons of beauty tend to be in their reproductive years, between the late teens to the late forties.  Babies and children can be “cute,” but they don’t evoke the power of youthful beauty.  The elderly too can be attractive, but often in ways that retain the features of their youth.  The pitch from plastic surgeons and cosmetologists is that they can help you prolong the appearance of your youth.

Averageness.  We have learned to be wary of the extremes of human appearance as indicators of risky genes.  And the circuits in our brains for recognizing faces and bodies operate on prototypes.  Faces and bodies that don’t fit the general rules of our prototypes trigger alarm or indifference.  Try turning a picture of a face upside down and see how long it takes you to recognize it.  So we are programmed to be attracted to people who fit our concept of average humanness.

Sexual dimorphism.  Clarity of gender and readiness for reproduction have driven our sense of what makes a woman or a man attractive.  The broad male chin signals ample testosterone, but too broad a chin may signal too much aggression, a disadvantage in caring for the offspring.  The high cheekbones and smaller chins and lower facial features that signal ample estrogen differentiate the fertile woman from the undeveloped girl or boy.  The body shape of the fertile woman also signals adequate storage for estrogen in breasts and hips.  The recent effort to consider gender along a continuum instead of a binary phenomenon poses a challenge to this feature of beauty.

Body scents.  Did you know that women show a distinct preference for the body scents of “symmetric men” during the ovulatory phase of the menstrual cycle?  If you know some symmetric men who don’t smell so hot, imagine what “asymmetric” men smell like!  Sorry, we haven’t yet evolved beyond such animalistic things as pheromones.  Maybe some day soon.

Movement.  We can quickly identify a person’s gender by watching gait.  How a person moves also tells us something about age, health, and ability to compete against others.  No wonder dance plays a ritual role in most cultures.  No wonder we’re fascinated by the movements of our young and often attractive athletes.

Skin complexion and hair texture.  One of the better outward indicators of the state of a person’s immune system is the state of his skin and hair.  Blemishes and hair loss often reflect difficulty with parasites.  When choosing a mate, you’re choosing your mate’s parasites too.  Make sure he or she has good control over those buggers.


Why eight pillars of beauty, and not seven or ten?  That number seems to be a moving target that depends on the state of the research. When Grammer and colleagues published their review in 2003, they devoted some ink to the role of the voice in attractiveness, but there has been little research about the effect of voices on perceptions of beauty, so this gap in research apparently dropped it from the list.  More recent research about skin complexion and hair texture as indicators of immune function has added those two “pillars” to the list.  Science is always remodeling its house.

In the next blog, we’ll wonder aloud what this list tells us about how our highly evolved sense of beauty draws us so powerfully to the less human marvels of rainbows and songbirds and Beethoven’s seventh symphony and the mesmerizing shape of an egg.

The Science of Beauty

‘Beauty is truth, truth beauty,–that is all

Ye know on earth, and all ye need to know.’

Keats, Ode on a Grecian Urn



When I first read these lines in my high school English class on the romantic poets, I wondered what might be wrong with me that I could not find such ecstasy over the beauty in that “still unravish’d bride of quietness” on the Grecian urn.  Now I wonder what might have been wrong with young Keats, but these lines have earned him much ink and hard thought by many people smarter than me.  Is beauty really the only truth we need to know?  What I know now about beauty in people after another fifty years of wondering is that a heavy dose can make me shiver or weep.  But how and why that happens is still a mystery, artful magic that demands a handkerchief.

At the California wedding I attended in October seven bridesmaids in matching blue dresses, each with lush hair and radiant complexions, strode at a graceful pace down the aisle toward the altar, each in step with the groomsman on her elbow and with the beat of the processional tune, each adorned with a fragrant gardenia, taking her place opposite her male counterpart to form the wings that would focus our attention on the bride and groom in the center.   Such a concentration of gorgeousness demanded my handkerchief.   And at the Arkansas wedding I attended a month later the same ritual played itself out, to equally wet effect.  Weddings pull out all the stops for this kind of beauty.

But what truths do we know about beauty and how it works on us?  The October 8, 2015, issue of the weekly journal Nature devotes its Outlook Supplement to nine articles on the science of beauty, providing some truths that Keats and the rest of us can only dimly sense.  Have you ever wondered why we think of Neanderthals as ugly?  The Nature interview with Karl Grammer, an Austrian anthropologist, describes the role that beauty has played in natural selection and evolution.  Beauty favors attraction, and attraction favors contact, the kind that leads to procreation.  That is, beautiful people make more babies.  The not-so-beautiful people lose in the competition, so they’re weeded out of the gene pool.  This is true not only for Neanderthals and fashion models, but for flies, butterflies, and orangutangs.  All species engage in the ultimate beauty contest, and our sense of beauty may be rooted in those features that attract us to each other for procreation.

But for humans, isn’t “beauty in the eye of the beholder,” a fickle thing subject to fashion or decree? No, say several articles in this series.  Our sense of beauty is shared across all cultures and is wired into our human brains.  Here are the eight “pillars of beauty” that we instinctively find attractive in Biloxi, Borneo, or Beijing:

  • Symmetry
  • Youthfulness
  • Averageness
  • Sexual dimorphism (sex-hormone markers)
  • Healthy body odors
  • Graceful Motion
  • Skin complexion
  • Hair texture


Both wedding parties paraded these pillars of beauty (such a show at a funeral might seem obscene).    The evolutionists tell us that these universal pillars of beauty advertise robust health and fertility.  People (and animals) who find these traits attractive tend to have greater success breeding healthy offspring. Natural selection has chosen you and your ancestral line because of your impeccable instincts for who might breed well.

The article on “The Aesthetic Brain” describes the neuroanatomy and brain circuits that underlie our abilities to sense beauty as an indicator of health and fertility.  We attract each other through complex circuits for experiencing arousal, seeking and feeling the rewards of sex, and learning to establish the relationships that not only make the babies but raise them.  The capacity to be attractive and attracted to others overlaps with the capacity to trust and be trusted.  Beauty helps us get started, but it doesn’t do the dirty work of raising the kids.

The science of beauty has not been lost on the merchants.  Long ago they learned how to prey on our vanity and our fascination with beauty.  Now the cosmetics industry flourishes, and the newest merchant, the cosmetic surgeon, has more options than ever for catering to the wants of those who can afford to purchase symmetric faces, youthful complexions, and lush crops of hair in the right places.  You can now boost your beauty index through hormones, cosmetic surgery, joint replacement, hairstyling, exercise, and daily cosmetics.  The beauty culture has taken on a value of its own, beyond chasing fertility, because beauty is so intimately linked with pleasures of many kinds that have little to do with procreation, such as art, music, science, and entertainment.

The interview with the physicist David Deutsch raises the question of why flowers, which evolved to attract insects, are so attractive to people.  Deutsch asserts that the essentials of beauty cut across species, “and these aesthetic truths are as objective as the laws of physics or maths.”  This assertion leaves us with some tantalizing questions.  If our aesthetic sense is rooted in features that attract us to fertile members of our own species, what is it about sunsets and campfires and gardenias that fascinate us all?  How can Beethoven’s Seventh Symphony be so universally beautiful without featuring any of the “eight pillars of beauty”?  Is beauty just another word for attraction, the kind that can happen at any level, from the bride and groom down to quarks and leptons?

Maybe that’s what Keats meant.  The only truth we need to know to survive is the art of attraction.