Harriman Professor of Neurosience
UC Santa Barbara, Humanities and Fine Arts, 2016
I learned how what seems impossibly remote, years away, suddenly arrives one day.
Thank you faculty, Chancellor Yang, Dean Majewski and thank you parents, grandparents, friends, dignitaries and thanks to my family for joining us to today—Miyoung, Russell, Sabrina, John and Eena and our newest family member—little Tali. But mainly today is for you, the graduating students—Congratulations!
It might seem a bit unusual to choose a scientist as the commencement speaker for the Division of the Humanities and Fine Arts. About a minute after I impulsively accepted as the speaker, the second thought was—hey, what will I actually say. I didn’t have a lot to draw upon-- I have never given a commencement address and in one of those youthful acts of rebellion, I did not go to my own commencement. So I thought I better check out the web site: top commencement speeches of all time. As far as I can discern, the speaker gives advice—usually rather ordinary banal advice, but dressed up in a beautiful moving manner so that the advice, which is always sound, can have renewed meaning and power. Meghan Kelly advised students in her buoyant uplifting style to: “say yes to everything, no job is beneath you. JK Rowlings in a beautifully written speech offered the message, don’t be afraid of failure. Alan Alda in another quite moving speech said, love your work. Sheryl Sandberg of course said, lean in. Clearly, it’s not what you say, but how you frame it.
The classic example of making banal advice sound good is Polonius in Hamlet, the chief counselor to the king. In the play his every judgment is wrong and Hamlet calls him a "tedious old fool." But he is a "sincere" father and in a litany of farewell advice to his son Laertes he concludes:
Neither a borrower nor a lender be;
For loan oft loses both itself and friend,
And borrowing dulls the edge of husbandry.
This above all: to thine ownself be true,
And it must follow, as the night the day,
Thou canst not then be false to any man.
The words sound good, but Shakespeare puts them in the mouth of a fool. One can dress up platitudes so they sound profound, but having learned the lesson of literature, I’m reticent to give advice. After all I’ve watched my kids eyes glaze over when I give them advice. And when you’re old enough to have good advice, no one wants to listen anyway.
Perhaps a bit of personal history will help explain why I accepted as the Division commencement speaker. As an undergraduate I majored in English literature and went on to do a master’s degree in English literature. I was absorbed in a fictional multiverse—entire world’s created by the Brontes, Charles Dickens, George Eliot, Thomas Hardy, Joseph Conrad, Herman Melville, William Faulkner, James Joyce, Virginia Woolf, Samuel Beckett… to name only a few of the giants who happened to write in English. I learned how writers refract experience in microscopic detail. I learned that unlikely events –the things we say could never happen to us—happen all the time because there are so many possible unlikely events that a few of them will happen. And even as an undergrad I learned how what seems impossibly remote, years away, suddenly arrives one day. …..So I went to medical school. Now that may seem kind of random, but the world of fiction, seductive as it was, ended at the last page of the novel when you close the book and get instantaneously transported back to exactly what you had left behind. I realized that the door out of the fictional world is the opportunity to see the real world through the eyes of the literary giants.
In medical school I was restless. I joined a theatre group called “actor’s lab” where I went every evening. …Just before graduation, the culminating event at medical school is called the match. This is the day when all the students gather together, open an envelope that tells them where they will spend the next few years in residency training. It’s a big deal as the envelopes are torn open and shouts of joy come from those who get their dream residency and tears from those who are disappointed. But once in a while a student is not selected by any hospital for a residency and is called by the dean the night before the match, informed of this ultimate humiliation after four years of med school. That was me. The dean said come to my office first thing in the morning and we will look for a hospital program that has not filled all their slots. I looked through the list and spotted a small community hospital in Boston called The Faulkner. That’s the one! I didn’t know anything about the place, but remembered William Faulkner and being absorbed in Absalom, Absalom, The Sound and the Fury, and As I Lay Dying…all of them, including the titles, quite appropriate for this moment. Of course the name of the hospital had nothing to do with the famous writer.
While medical school is still not quite the real world, a residency is…patients come with trust and their lives are in your hands. I was transformed. One day a 36 year old jazz musician showed up in the emergency room with a sub-arachnoid hemorrhage. That means a blood vessel in the brain has broken. This is very serious and even if the patient is alert and able to communicate—as he was—he is still not out of danger. This guy was one of those people you instantly like; he had an easy sense of humor and saw the world as a place of joy. Because such patients are at high risk for seizures they are routinely given an anti-epileptic drug, which I administered. An exceedingly rare complication of these drugs is Stevens-Johnson syndrome. This is a terrible condition in which one’s skin peels off like that of a burn victim. My patient developed Stevens-Johnson. Unlikely events happen. Good and bad. For nearly two weeks I stayed in the hospital around the clock. The complications mounted—infections, involvement of his lungs and digestive tract and the ongoing problem of the sub-arachnoid hemorrhage. I felt I could not leave, not only because I had given the medication that caused the problem, but as each fresh consultation team showed up, how could anyone master the volumes of medical records at his bedside. They needed someone to tell the story. I told the story many times and then he died.
In medicine we learn the importance of empathy, but we also learn that too much empathy is paralyzing. I was too emotionally involved with this patient. The physician has to balance empathy with distance and objectivity.
The end of medical training meant another life decision. Medicine was exhilarating to learn, but the routine of medical practice made me hesitate. People want doctors who have seen their condition hundreds of times before and do exactly what they know works. Medicine is a noble calling, but not so tolerant of creativity. While looking at microscopic slides of brain tumors one of my fellow residents asked me, “Ken, what are you plans after the residency?” I didn’t have clue. Had not even thought about it. I said, “I don’t know. What about you?” She said she had a hospital job already lined up, knew her salary (which was a lot more than we made as residents) and her start date. Wow! How did that happen? Some people seem to know exactly what they’re doing, which makes the vast majority of us who don’t know what we're doing feel even more lost.
As crunch time neared I attended a lecture by a Harvard neurologist who used a technique to separate proteins from brain tissue into individual bands on a gel and stained them with a blue dye. It looked beautiful and full of meaning waiting to be deciphered and I said, “I want to do that”. I asked him if I could join his lab as a post-doc and he said no. Without lab experience even as a fully trained neurologist I was not qualified. But I pleaded with him until and at last he said, I could come to his lab if I get my own grant to support my salary. So inconceivably, I wrote and got my own small grant. unlikely events happen I was paid a pittance but didn’t care. I could watch those blue proteins and try to discern the story they were telling. So began a lifelong immersion in research, a career I never imagined when I graduated college. I remained in the Harvard system eventually achieving the rank of full professor. Our research contributed to the discovery of the largest family in the world with a genetic form of Alzheimer’s disease—they live in Colombia—and to more basic research on genes and proteins involved in Alzheimer’s disease. In 2004, I made another unconventional move, which baffled my colleagues. I left Harvard Medical School to come to UCSB and never looked back.
A personal story is intended to exemplify real life examples of how those bits of advice that some call wisdom might apply to you. But today is not about my story. So let me recount a few thoughts about your courageous choice of the arts and humanities as your area of emphasis for the most formative years of your life.
I’ve always been struck by the term, the “art of medicine.” An art in this sense is a skill—we say practiced in the art of some skill. But along with a skillful bedside manner, the term has begun to take on a connotation that medical artistry also includes what the artist, in the modern sense, does. The artist communicates what we cannot always see, but when written in a poem or a novel or movie or painting or even composed in a piece of music we have that ah-ha moment when the artist has shown us something that is true, something we may even anticipate, but had not seen before in quite that way, in an esthetic way that brings new insights and elicits emotion, poignancy.
Likewise, the art of medicine means telling someone what they may already know at some deep non-verbal level, something they may fear or vaguely anticipate, and communicating that something in a way that offers insight and compassion. For example, telling someone they have Alzheimer’s disease. Usually, the person suspects something is wrong. I remember seeing a professor of Shakespearean literature from a small New England college. He told me that he had no trouble reciting long passages from Shakespeare—the plays, the sonnets—but he encountered difficulty when a student asked him a question, when he had to think on his feet, had to improvise. This is quite different from losing your keys or not remembering where you parked your car at LAX. This gentleman needed an answer. The answer was Alzheimer’s disease, but no science teaches us how to tell a person they have Alzheimer’s disease—this is the art of medicine.
How is it done? First the information has to come without arrogance and with compassion. Let me tell you what a serious infraction arrogance is. Remember Odysseus, the brilliant and cunning hero, who spent ten years returning home to Ithaca from the Trojan War. Remember after the Cyclops Polyphemus eats several of his men, Odysseus shares a barrel of wine with Polyphemus and tells him that his name is "Nobody". When the Cyclops falls asleep, Odysseus ignites a wooden stake and blinds the sleeping Polyphemus who cries out in pain. The other Cyclopes ask him what the matter is. Polyphemus cries, "Nobody has blinded me!" and the other Cyclopes think he has gone mad. Meanwhile, Odysseus and his crew hide underneath sheep and escape from the island. But then when you get to Dante’s Inferno, Odysseus is now languishing in the eighth circle of hell, almost as low as you can go. Why? His arrogance put him there. In contrast to Odysseus’ cunning prudence after his escape from the cave, Odysseus unnecessarily taunts Polyphemus by telling him his name. A rather severe consequence for arrogance. I remember doing a stint on the Harvard medical admissions committee and arrogance was the one character flaw for which there was zero tolerance.
It’s not difficult to find a place for the humanities in medicine. Where the humanities are most challenged today is how to face the growing reach of basic science. Science will bring its tools to the arts; it will quantify the language of literature—for example, count word frequencies among the great writers and devise algorithms that compose musical scores indistinguishable from the great masters. Although certainly entertaining, most of us would say that reductionism of this sort is not what we intended for an arts or humanities graduate. More challenging is the view of EO Wilson who proposed Consilience or the unification of knowledge, as “the way to renew the crumbling structure of the liberal arts.” According to Wilson the burden of bringing together culture and biology rests on neuroscience. Now, this is a topic I know a little something about. He claims that neuroscience will tell us why and how we are moved by Beethoven or Beyonce. Or whether an artificial hand can ever convey the meaning of touch? Within this territory—the boundaries of neuroscience—is where one skilled in the art of the Arts and Humanities will have to play. You may play offense or defense on the approaching neuroscience tsunami, but if you’re in the game you will have to take a position.
So, I’m drifting toward delivering advice—exactly what I wanted to avoid. I’ve told you a bit about my personal story—take from it what you will. I’ve offered a view of the Arts and Humanities from the perspective of a scientist—take from it what you will. For me, as I look at our planet and the current state of affairs, I have to confess my doubts about any advice that comes from these commencement platforms. So, graduates, you’re on your own. Figure it out. I believe in you. Believe in yourselves! The world is starving for new leadership, new ideas.
Posted on: 01/07/17
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