I have lived in four different states, and ate long sandwiches on sourdough bread in at least three of them.  In Massachusetts they called them torpedoes, in California they called them submarines, and when I lived in Kentucky I don’t think I could afford them.  In New York they called them heroes, and so it was that about two years ago when a New Yorker named Steven St. Bernard rushed to the scene of a 7-year old autistic girl falling from a third story window and caught her, he responded to the friends and neighbors who called him a hero by saying, “No.  A hero is a sandwich.  I just saw a kid, that’s it.”

Keyla McCree was dancing on the air conditioning unit of her apartment, when  the accordion-shaped fan that fits between the air conditioner and the window frame opened and she fell through.  When Steven St. Bernard, a bus driver, saw the girl, he reportedly said to himself, “Please let me catch her, please let me catch her.”  He did catch her, and although she brushed against the bushes and slightly touched the ground, she did not receive a scratch.  Mr. St. Bernard, however, tore a tendon in his left shoulder.

Such acts are often called courageous, a concept with which I have struggled much of my life.   That is because, while I spent the decade of my twenties getting through graduate school, internships, and planting the seeds of a family, I was also struggling to overcome my pathological shyness.  In challenging my deepest fears of interacting with people, it became clear that the only antidote to shyness was courage, which many have defined as the combining of fear with action directed toward whatever it is that is feared.   I pushed myself to do as many of the things as I could to face the demons directly– introduce myself to a stranger, or go to a party and actually converse with someone.   This behavioral approach worked, and it keeps on working to this day.

It is interesting to me how “heroes” such as Steven St. Bernard talk about their acts as if they were effortless, as if they felt no fear.  I submit, however, that action that takes place without fear is likely to be stupid and not courageous.  Fearless people are bold, and as they say in the flying world, there are old pilots and bold pilots, but no old bold pilots.

Perhaps I am wrong though.  People who do courageous things may experience their acts as effortless because they are practiced at acting in the face of their fears.   I do believe that courage becomes easier the more one takes calculated risks.

While I don’t know this for a fact, it is my guess that the word “hero” to describe a long sandwich is derived from a gringo’s attempt to pronounce the Greek “gyro” sandwich.  I do know that the OED informs us that the word “hero” arose in the 14^th century from the Greek “heros”, meaning “defender” or “protector.”  In that sense, I can think of no better word to describe Mr. St. Bernard’s actions that day in New York.   I have no idea if Mr. St. Bernard achieved his humility the hard way, by facing his fears repeatedly such that his actions felt fearless, but I do suspect that is how he transmogrified his view of his behavior from the status of heroism to that of a sandwich.

In a previous post, I mentioned the ABCDE checklist for handling emergencies.   My cousin commented that perhaps it is true that we learned everything we needed to know in kindergarten.    I didn’t really understand her comment at the time, because I really don’t think I learned anything in kindergarten, which is not to say the teacher didn’t try.   I think I was too scared of being around all those other kids to take anything in.

My cousin, who is a master of all trades (including medicine), noted that the ABCDE mnemonic is used in advanced trauma life support as well as flying.   I’m sure it is used all over the place, but let’s see if we can torture the aviation metaphor a bit and stretch it to good old life in general:

What does it mean to trim to the best Airspeed?  It usually means to slow down to the speed at which the airplane glides the farthest.    In a crisis, time does appear to slow down.   But, given a critical situation, it is important not to rush to judgment.  That is how we are most likely to screw up.   When all else fails, slow down.

Best field.   Where is the best place to land?  Perhaps that is another way of saying decide what you would like the outcome to be.   Crises cloud our judgment.  Panic ensues and we can only see what is in front of us.   As you slow down, take the time to decide what you would like the outcome of the crisis to look like.

Checklist.  In aviation, this means to begin the problem-solving process.  Run through the options.   What went wrong?  Can you diagnose the cause of the problem?   Back up and look at where the problem began and think it through.  What could have led to the malfunction?   What could the possible solutions be?

Declare an emergency.   Talk to people who might be in a position to help.  Talk to lawyers.  Talk to people who have been there before.  Find a good therapist.  It was Freud who is said to have invented the “talking cure,” but Catholics have had their confessionals long before that.   I am a huge fan of advisors, who nowadays call themselves consultants, psychotherapists, ministers or coaches.   Get advice, and use that advice with discernment.

Emergency checklist.   This is where you go to the manual and do the things the manufacturer tells you to do before crashing.   Perhaps you need to crack open the door so that it doesn’t get stuck, throw a coat between you and the windscreen, tighten your seat belts, and shut off the fuel flow.  You are doing whatever must be done to increase your odds of surviving the crash.   The point here is that the fat lady has yet to sing, that it ain’t never over until it’s over.  If you are going to crash, you need to fly all the way into the crash; never stop flying until you and your passengers are safely out of the airplane.

None of us are immune to the slings and arrows of outrageous fortune, but we might be able to cushion the blow, or even escape through a door that opens way past the point of no return. Humans are incredibly resilient, or at least we can be, if we remember to keep flying.

trichuris suis ova

Readers of my last blog might recall the story of the time the great satirist and math lecturer Tom Lehrer sat in my college living room in Santa Cruz, invited to our party by a housemate, and explained how it was statistically “impossible” to get wet while walking in the rain.  That is the problem with logic and statistics; it is possible to be exquisitely rational yet simply be wrong.   Mark Twain attributes the quote to Disraeli, but researchers say it originally belonged to a journalist named Leonard Courtney: There are three kinds of lies:  lies, damned lies, and statistics. 

Statistics are often used to justify the “miracle cures” that those of us who have been in the autism treatment world for a while have seen flourish, to our dismay and to the dismay of parents whose children have been harmed by them.   From the promises of colored lenses, hyperbaric oxygen chambers, clay baths, dolphin therapy, multivitamin and mineral treatments to secretin infusions, the list goes on and on.  A colleague of mine made a list 10 years ago that included over 150 of these “quack treatments,” and since then there undoubtedly have been 150 more.

It is through these jaundiced and critical eyes that I continue to read reputable journals and follow conference abstracts, and on occasion hesitatingly report some of the more interesting stuff.  Recent studies presented at the very legitimate American College of Neuropsychopharmacology annual meeting and performed at the equally legitimate Albert Einstein College of Medicine in New York revealed that children with autism had improved social behavior when bathed every day in a hot tub at 102 degrees F compared to water at 98 degrees F.   And the same researcher found that high functioning adults with autism who were treated for 12 weeks by ingesting whip worm eggs (trichuris suis ova) had less repetitive and ritualistic behaviors than when they ingested a placebo.   The whip worm eggs, in case you were worried, are safe in humans because they don’t multiply in the host, are “cleared” spontaneously and aren’t transmittable by contact.

The theory behind all of this has to do with inflammation.   There are those who believe that one possible cause of autism is a “hyperactive immune system.”  In the case of the hot baths, raising body temperatures mimics the effects of fever, which might trigger the release of anti-inflammatory signals in the body.   In the case of the worm eggs, they have been shown in the past to improve immune inflammatory illnesses by “shifting the ratio of T regulator/T helper cells and their respective cytokines,” thereby altering immune-mediated responses and diminishing inflammation.

I don’t doubt that eating worms is likely to alter one’s immune response.   I would certainly add them to my diet of frog’s legs, chocolate covered ants, salivary glands (chorizo), and sushi if I knew that it would help me in ways I desperately need to be helped.  And who could dispute the beneficial effects of taking a hot bath, or, as we do in California, a dip in the hot tub, after a long day at the office.  Does wonders for my repetitive behaviors, because it puts me right to sleep.

But explaining repetitive and ritualistic behaviors as caused by inflammation seems a bit like blaming mother:  it may not be far-fetched, but it certainly is simplistic.

There were too few patients in these studies to make the results clinically meaningful, so I imagine that it would be unlikely that you will hear much more about them. The thing is, if you or your child is suffering, anything, no matter how bizarre it sounds, will be tempting, and that is how so many of us get taken advantage of.  Our desperation will lead us to believe all sorts of things, especially the logical ones.

While the FDA and other organizations are out there to help us, we live in a caveat emptor world.  It is up to each of us, and that is how it should be.  That’s why you will not likely see me eating worms anytime soon.  Just saying.   Statistically, the probability of me getting wet while walking in the rain might be small, but I do know that the probability of me getting wet if I take a hot bath is 100%.  And if it gives me a little fever and triggers an anti-inflammatory response to boot, I think I will add it to my agenda.

Sa-wa-dee

It happened again. It happened once five times in a single day. I don’t like counting the frequency, but I can’t help it. As I was walking out of the Japanese restaurant in Ventura the young woman behind the cash register smiled at me and said it. “Have a good one!”

I know she and the increasing throngs of humanity using the phrase are well-intended, and even trying to be courteous, but it is difficult for me to refrain from replying sarcastically. Beside the first thought, which is to inquire exactly what it is that they wish me to have good, I am often tempted to respond with saying things such as, “Gee, thanks. I actually had a great one yesterday, but today doesn’t look too promising.”

Other options that have crossed my mind include “Well, sometimes having a bad one is better than not having one at all,” or, depending on who is murmuring the words: “Thanks! I’ve been having a good one so far, but you could make it even a better one!” Just in case you are reading this and you don’t know me well, you will know that you will never hear me say any of those things out loud, just thoughts that I confess have crossed my mind. In truth, my typical response is either “Thanks!” or “You too!” I always feel guilty saying the latter, because I am not sure what it is that I am wishing on the other person. She might end up having a good car accident.

I am not totally sinister; I do understand that the phrase has become popular probably because there are few good alternatives. “Goodbye” is so awfully formal; “see you later” is likely a lie, “have a good day” is stilted, “take care” is a bit too intimate. One that I hear from time to time that I used to dislike but have warmed up to is “have a blessed day.” You know that the person behind those words is probably a religious fanatic, but it’s a difficult phrase to wrap one’s tongue around, so I appreciate the effort. And frankly, as someone who believes in the power of blessing, I actually derive meaning from the sentiment. It’s certainly a whole lot more meaningful than having a good one, although you won’t hear me saying either of those phrases.

Now that I have given this more thought than it deserves, I do think that the next time someone utters the injunction to “have a good day” in my direction, I am going to smile and look them right in the eyes, and say, “I am going to try to do just that.” (I will not add, despite my devilish intention, “maybe I’ll have two!”)

My friend Kit Stolz, who writes a great blog having to do with climate change (www.achangeinthewind.com), sent me the following link, which I really love: http://io9.com/on-correlation-causation-and-the-real-cause-of-auti-1494972271

It clearly demonstrates the real cause of autism, and deals with the issue of causality versus correlation, which as those of you who have been reading my blog posts for a while will know, is one of my favorite topics. The comments on this very short piece are almost as entertaining as the piece itself.

Ever wondered how to pass the Dead Man’s Test? The Dead Man’s Test is a simple procedure developed by Ogden Lindsley back in 1965, when Sam the Sham was singing Wooly Bully and the Beatles’ incomprehensible film Help! was playing in movie theaters. The test is designed to determine if something can be categorized as behavior, which may not seem important to you, but is very important to people who seek to analyze it. Here is the test, paraphrased slightly:

If a dead man can do it, it ain’t behavior, and if a dead man can’t do it, then it is behavior.

What, you might be wondering, exactly is it that dead men CAN do?

For one thing, they are very good at being quiet for long periods of time. Dead men are also very good at keeping secrets, which may have something to do with how they get that way. But mostly, what they are very good at is NOT doing things. My father’s second wife used to say that if you want to get something done, ask a busy person to do it. But the reverse is even more true: If you really DON’T want to get something done, then ask a dead man to do it.

This turns out to be the major point of the dead man’s test. Naïve behavior analysts sometimes make the mistake of trying to study the lack of behavior. They do this by saying such things as “I want to find out how often Johnny doesn’t have tantrums,” or “How often does Jeffrey refrain from using swear words?”

Dead men are exceptionally good at not using swear words. Studying the lack of cursing, therefore, doesn’t pass the dead man’s test.

There are times in our lives when we wish to emulate dead men. For example, dead men rarely eat sweets, red meat, or fried food. In that respect, I admire dead men and would like to be just like them. They don’t hurt other’s feelings, especially after they’ve been dead for a really long time. And they rarely make big mistakes in the stock market. They don’t appear to be highly conflicted, and don’t seem to worry about small things, like whether or not they forgot to zip up their zipper. The list, obviously, goes on eternally.

The Dead Man’s Test can help us become more effective at what we do, because it stresses the difference between substance and absence. Humans have proven over the millennia to do a better job at adding to their behavioral repertoire than decreasing it. In other words, it is easier to learn new tricks than to rid ourselves of the old ones. So, for example, rather than tell yourself to stop watching TV (dead men can do that), tell yourself to read another chapter in the book you are reading. Rather than tell yourself to stop eating sweets (dead men don’t eat sweets), tell yourself to eat more vegetables. Rather than tell your business partner to stop complaining about her ex-husband (dead men don’t complain), tell her to spend more time talking about novel marketing ideas.

Now you know how to pass the test.

In teaching family therapy, I used to say that “Why” was a four-letter word, not because it starts with a double U, but because when most people are asked why they do the things they do, they feel attacked. Furthermore, when asked why someone does something, the expected response is to give reasons, and reasons are rarely helpful.

That is a popular position among certain strains of therapists, and very unpopular among others.

Psychoanalytic therapists really like reasons. It is the playground in which they spend years and rack up significant contributions to their retirement accounts. Behaviorists tend to abhor reasons, instead focusing on the how of things as opposed to the why. That’s one reason I like behaviorists, because like most guys I like to fix things, and why things are broken isn’t nearly as important as how they are broken. (The fact that you threw the toaster across the room because you were mad as hell won’t get the toaster fixed, but knowing that the spring came loose when it hit the wall will tell you how to fix it. Okay, so it won’t stop you from throwing the toaster again, but that wasn’t the problem you came to me with.) Cognitive therapists like reasons, but principally so that they can change them. I like that, because very often change is good, leading to a reduction in suffering. But of course, change isn’t always good, because sometimes we try to change the wrong things.

Reasons, to me, are a little like medication: they have their place, but hopefully, their main function is to stop using them.

Now, if you are blessed with being in any sort of intimate relationship, you have no doubt been asked the big question (or have asked it yourself): why do you love me? You know that that is an unwinnable question, that any answer you give is going to get you in deep trouble, so you undoubtedly have learned to avoid it. The truth, of course, is that there is never any good reason to love another person, because love, like faith, is beyond reason. Ultimately, honey, I love you just because I do. That’s it. End of story, as my dad would say.

Fortunately, very few people have asked me why I fly. At least most of my friends know better. If you did ask me why I choose to risk my dear life and spend ridiculous sums of money burning fossil fuel just to get above it all I would end up giving you some sort of dumb-ass lecture about mastery and competence and bore both you and me to tears. But if you asked me how I fly, you will see me light up and we both might learn something in the process.