Just over a half-century ago, in the mid-50s, at the height of our paranoia about communists and the Soviet Union, a boy sees a flying saucer land in the distance. No one else sees the event. The occupants of the mysterious spacecraft prove to be invaders from Mars. Their strategy is to capture people, one-by-one, and to perform brain surgery on them whereby an electrode controlling device is placed in the victims’ brains rendering them pawn
s of the invaders, though they retain the superficial appearance of human beings. The only clue to recognizing one of these unfortunate robots is to look for the telltale antenna at the base of the hairline in the back of the neck.
In order to understand the profound meaning of the Invaders from Mars, you have to know a little neurology.
There are really two people within each of us, a fact that reflects the two almost mirror image cerebral hemispheres, each responsible for the opposite side of the body and extra-personal space. Put simply, damage to the left hemisphere will cause paralysis and loss of sensation on the right side of the body, including loss of perception from the right side of the world.
This loss of perception is more profound than simple blindness. If reflects the fact that anything that the brain does not record is actually not there. We live, after all, in virtual reality. What our brains do not sense is, for us, not there. Do the following experiment. What is behind your head? Not what you imagine might be there or what you think you remember is there. What is actually there? Is it black, white, striped? Try to describe it. You don’t have the words, because what is there is nothing, and nothing has no color, texture or shape. Is there an antenna at the base of your hairline? You couldn’t possible know, could you?
Though the two cerebral hemispheres are roughly symmetrical, there is one striking difference. Do you know what that is? Try another mind experiment. How many of you consider yourself to be right handers? How many of you are non-right handers? How many are left handers? Note that not all people who are not right handed are left handed. For almost all of you (all of you right handers and many of you non-right handers), only the left hemisphere has the circuitry for language. Eons ago, the pressures of evolution selected those of our ancestors who could communicate with each other, an enormous advantage for social animals like ourselves.
The massive amount of computing capacity needed for language could not be duplicated in both hemispheres. The head, already too large for the body, is simply not large enough; so a compromise occurred. Language would only be represented in one hemisphere, while other important functions related to attention, would be represented in the homologous structures in the other hemisphere. Language could have gone into either hemisphere. It happens that it went left. Virtually all right-handers have left hemisphere dominance for language. Even some non-right-handers have substantial components of language in your left hemisphere. Only true left-handers are the throwbacks to our primitive ancestors. As you can now see, they are almost extinct.
When we talk to someone, we are only talking to the left hemisphere person, because that is the hemisphere with language. When I ask someone: “How are you?” they really respond “We are fine.” I, the left hemisphere person, is fine, and I hear from my mute friend, the right hemisphere, that he is also fine. When the right hemisphere is damaged, the left hemisphere person may well say, “I am fine,” even though the left side is completely paralyzed. This phenomenon is called anosognosia, meaning denial of deficit. So, when you say that there is no antenna in the back of your neck, you could be suffering from anosognosia. There is only one way for you to know what is present in the part of the world you cannot see or feel. Someone else has to tell you.
In 1971, I was asked by my classmates to speak at my medical school graduation ceremony on their behalf. They wanted me to tell the faculty about the antennae in the back of their necks. We students could see them. Though talented, dedicated, hard-working and well-meaning, many of the faculty had over the years gradually been captured by the Invaders from Mars. They had lost touch with our needs, hopes and dreams; and worst of all they didn’t and couldn’t have known it. They had anosognosia. What had happened occurred outside of their field of vision.
My message that day was based on a quotation from James A. Garfield about his college experience under the legendary educator, Mark Hopkins. He said:
“I am not willing that this discussion should close without mention of the value of a true teacher. Give me a log hut, with only a simple bench, Mark Hopkins on one end and I on the other, and you may have all the buildings, apparatus and libraries without him.”
On that day, over fifty years ago, I argued that our medical education was marked by rote learning, unnecessary repetition, lack of integration across the four years, forced menial labor and absence of mutual respect between student and teacher. I placed the blame entirely on the faculty, representatives of which sat sullen-faced behind me as I delivered a 45 minute screed, speaking on behalf of my class, which had elected me to voice their frustrations on what was customarily the celebratory occasion of graduation for the medical school, known as Honors Day, just before the university graduation.
My words were met in some quarters by anger, resentment, disappointment and disbelief. This is epitomized by a letter I received about four months later from an eminent member of the faculty. He was a fearsome figure to us; demanding, rigid, conservative and apparently humorless. His searing one page letter contained the following words:
“…you have underlined the futility of attempting the transmission of ideals to unready minds. It is my clear recollection, bolstered by an opportunity to re-read your text, that under the guise of the philosopher you exhibited malice, pettiness, and poor taste. My faith reassures me that you will one day outgrow these qualities and, whatever you course, help us in our efforts to meet the unending medical needs of people.”
Not everyone reacted in that manner. Another faculty member, who also was elected by our class to speak that day, told me that all of it needed to be said. And my mentor in neurology wrote me a long supportive hand-written letter in which he mused that that “the king was beheading the bearer of evil tidings.” He went on to say:
“Despite its inappropriateness during what was supposed to have been the happiness of Honors Day, the talk contained some telling shots.”
The following year, a poll was taken of the then second year class that documented the fact that all of the allegations were shared by the vast majority of students. They agreed that mutual respect between teacher and student was required for real education to occur and that this was largely missing in our medical school. They strongly agreed that students were being told what to learn rather than how to learn and that the pedagogical methods were poorly performed. They agreed that there was too much repetition and not enough integration across the entire curriculum and that this was due to excessive departmental hegemony rather than interdepartmental cooperation. They also found that the menial tasks students were asked to perform while on clinical rotations were grossly excessive and that the on-call periods were mostly devoid of any educational content.
In fact, I thought I was performing the most important function of a true friend. People who care nothing about you will not tell you that there is a piece of spinach between your two front teeth just as you are rising to deliver a major address. Nor would they tell you about the antenna at the nape of your neck. The greatest threat to our failing to reach our goals as a medical profession is the tendency to gradually change, falling prey to prejudices and fears, like the ones in the 1950’s about the Soviets and communists that were so perceptively satirized in William Cameron Menzie’s 1953 film, Invaders from Mars. What are the modern analogues of the Soviet Union and communists of the 1950’s? Xenophobia and blind devotion, every present throughout human history, has spawned a new wave of pseudo-religiosity, anti-intellectualism and blind faith. The News from NPR awakens me every morning at 6:00AM with a recitation of a series of disasters. It is reminiscent of the Merry Minuet written by the musical satirist, Sheldon Harnick and later popularized by the Kingston Trio:
They’re rioting in Africa, they’re starving in Spain
There’s hurricanes in Florida, and Texas needs rain
The whole world is festering with unhappy souls
The French hate the Germans, the Germans hate the Poles
Italians hate Yugoslavs, South Africans hate the Dutch
And I don’t like anybody very much!
When some of our friends and allies told us that they didn’t believe that there were weapons of mass destruction in Iraq, we denounced them as cowardly, insular, weak, naïve and short-sighted. But they were trying to be our best friends. Only they could see the antennae in the back of our neck. The problem, of course, was anosognosia. How are you to know? You are dependent on someone else telling you. When they do, don’t dismiss them as mean-spirited, ignorant or naïve. Of the most maddening responses that I get when I voice disagreement with powerful forces in my world is: “you don’t seem to get it.” My response is: “you’re wrong. I do get it. I just don’t agree with you. I’m trying to warn you that you are becoming one of them.”
I loved my medical school. It gave me the opportunity to live my dream to reduce suffering. When I told our faculty about the electrodes in the backs of their necks, I thought I was performing the most valued function of a good friend. However, what I did not, and could not, have known is that I also had fallen prey to the Invaders from Mars. I, speaking on behalf of my class, had become consumed with our victim role and I was unaware of the effect that my words would have when delivered in the context of what was to be a happy and celebratory event.
My simple advice to you is to find at least one person, who will tell you the hard truth about you. Find someone to watch for an electrode in the base of your neck. Only your dearest and most trusted friend can and will tell you that you have been captured by the Invaders from Mars. The biggest enemy of medicine is the enemy within; doctors who have been captured by the invaders from Mars. These former doctors no longer remember that medicine is about relieving suffering. They believe medicine is a business and that quality is measured by various indices that have nothing whatever to do with the relationship between the doctor and the patient. The following is a composite of words uttered by former doctors over the past several years in meeting I have attended.
Place Report From Retreat Here
Sitting in church one day in 1785, the great Scot poet Robert Burns noticed a head louse climbing up the neck and onto the hat of an elegant lady seated in front of him. He says to himself:
“Ha! Whare ye gaun, ye crowlin ferlie?
Your impudence protects you sairly, I canna say but ye strut rarely
Owre gauze and lace,
Tho’ faith! I fear ye dine but sparely
On sic a place
Ye ugly, creepin, blastit wonner,
Detested, shunn’d by saunt an’ sinner,
How daur ye set your fit upon her-
Sae fine a lady!
Gae somewhere else and seek your dinner
On some poor body.
He goes on to describe the critter impudently climbing right to the top of her stylish hat; she, of course, arrogantly never imagining that such a low-life could be standing right on the top of her head. Unlike what most of us would do, Burns turns to the woman and says:
O Jenny, dinna toss you head,
An’d set your beauties a’ abread!
You little ken what cursed speed
The blastie’s makin!
Thae winks an’ finger-ends, I dread,
Are notice takin’!
He’s done it. He has performed the most valued and rare duty of a real friend, and he and I conclude:
O wad some Power the giftie gie us
To see oursels as ithers see us!
It wad frae monie a blunder free us,
An’ foolish notion:
What airs in dress an’ gait wa lea’e us,
An’ ev’n devotion!
Once more, in American English
O would some God that gift to give us
To see ourselves as other see us!
It would from many a blunder free us,
And foolish notion:
What airs in dress and gait would leave us,
And even devotion