Luis Dias
Luis Dias
Posts about Medicine written by Luis Dias
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Luis Dias
At a time when hand-washing is trending, at least among those in this world fortunate to have access to running water and soap, on account of the coronavirus, it is perhaps not surprising that even the Google Doodle chose to celebrate the pioneer of hand disinfection, Hungarian physician and scientist Ignaz Philipp Semmelwess (1818-1865).

The date chosen by Google Doodle, 20 March, marked the day in 1847 that Semmelweis was appointed Chief Resident in the maternity clinic of the Vienna General Hospital, where he deduced and demonstrated that requiring doctors to disinfect their hands vastly reduced the transmission of disease.

This pandemic has brought him out of obscurity back into the spotlight. Semmelweis is acknowledged as a pioneer of antisepsis, a concept that seems fundamentally self-evident to us but for which he faced much hostility in his lifetime.

Today Semmelweis is widely remembered as the ‘savior of mothers” and “the father of infection control. ” Semmelwiess found that the incidence of puerperal sepsis or fever (“childbed fever”, bacterial infection of the female reproductive tract following childbirth or miscarriage) could be drastically reduced simply by hand-washing and disinfection with chlorinated lime solutions in 1847 while working in the First Obstetrical Clinic of the most influential medical establishment in Europe, Vienna General Hospital. At the time, the maternal mortality in the doctors-administered wards (with doctors often turning up to deliver babies directly from dissecting cadavers without washing their hands in between) was thrice that in the midwives’ wards. Indeed, it was safer to have a ‘street birth’ than to be admitted to the maternity clinic before hand-disinfection became accepted practice.

Despite the proven efficacy of the intervention and his publication of the results, his ideas were rejected by his peers and the medical community at large, as they conflicted with the established scientific and medical opinions of the time. Semmelweis was unable to offer a scientific rationale for his findings (although he correctly attributed the cause of the disease to a “lack of cleanliness”; he called the mysterious agents “cadaveric particles” as he deduced that doctors were bringing it with them from autopsies). Many doctors were offended at the suggestion that they needed to wash their hands. In 1849, he was compelled to leave the clinic when his term expired and wasn’t renewed.

He had to petition for an inferior post of docent in the same clinic, which limited his duties mainly to teaching, with very scant clinical work. He left abruptly soon after, “unable to endure further frustrations in dealing with the Viennese medical establishment”. Some observers blame Semmelweis at least partially for the impasse, for his “brusque manner, arrogant insistence that everyone obey his rules without explanation, and failure to communicate his results.” But there seems also to have been an element of xenophobia, a Hungarian viewed with dislike by the Austrian medical fraternity.

In 1865, he was committed to a mental asylum (supposedly for a ‘nervous breakdown’) by his colleagues. He died around two weeks later, aged just 47, from a gangrenous wound on his right hand, the wound allegedly sustained after being beaten by one of the asylum guards.

His contribution was acknowledged posthumously, after Louis Pasteur’s ‘germ theory of disease’ offered the rationale for Semmelweis’ hand-disinfection suggestion, and Joseph Lister implemented the idea of operating using hygienic methods.

Today, Semmelweis has become a byword; Semmelweis reflex” is a metaphor for “reflex-like rejection of new knowledge because it contradicts entrenched norms, beliefs, or paradigms. “

A remarkable man with a life-saving contribution to posterity, but you’d hardly expect him to be the subject of a stage musical. But there are at least two, one of them released in his birth bicentenary year,2018.

“Semmelweis” is a 75-minute opera-theater work by Raymond J. Lustig (music) and Matthew Doherty (Hungarian libretto) and endorsed by the Semmelweis Foundation It poses hard-hitting questions: “what is it like to be the first to see into a terrible blind spot and perceive a truth too awful to believe? To be an “outsider”—a “foreign” doctor, Hungarian, but living and working in Vienna’s top hospital in a xenophobic era—and to fear that no-one heard you, that the answer may die with you? To hold an earth-shattering insight, and yet be haunted by all the mothers that would not be saved?”

The story of Semmelweis is still relevant, the Foundation page reminds us, because “our world seems still not to have absorbed its powerful lessons. There has never been a more urgent moment in history to reflect on the mystery of insight, the tension between truth and hubris, our cultural myopia, and the clear truth that we, as individuals and as a society, need our ‘outsiders,’ our fresh and brave ideas, literally to survive.”

It is scored for women’s vocal ensemble (8 voices minimum, 3 sopranos, 3 mezzos, 2 altos), one male soloist (baritone), and seven instrumentalists (piano/organ, percussion, and string quintet), as well as specially designed music boxes and tuned bells played onstage by all soloists and chorus.

The women’s voices represent different women haunting Semmelweis’s failing mind (patients, mothers, midwives, nurses, his wife).

In a video (available on YouTube, uploaded during this pandemic, two months ago), Lustig talks about the relevance of the work in our own time, and salutes and dedicates it to front-line health workers, among them his own wife, a nurse.

“Semmelweis –When the Truth is not Enough” is a musical by Harvard psychiatrist Dr. Joseph Aaron Shrand , “based on a true story that pits one man’s struggle for truth and justice against the cynicism and politics of the medical system.”

In the page about the musical on his website, Dr. Shrand explains that though it concentrates on the life and work of Semmelweis in the 1840s, “it is a damning comment on our own time. Semmelweis stirs issues of women’s rights, the conflict between medical care and managed care, about the ethics of medical research and discovery, the conflict between the religious right and the scientific community, about love, loyalty, betrayal, intrigue, sanity and madness. The musical delves into our relationship to God, discovery and rejection, elation and despair, and the ultimate sacrifice of one man to save the lives of thousands.”

“His discovery, so simple and so pure, was ridiculed and abandoned in his time. Now, it is so accepted that it is inconceivable it was ever questioned.” Those interested can watch Dr. Shrand talk about his musical, also released during this pandemic, and also pointing out the relevance of the Semmelweis parable today, with the same non-belief in what science is telling us today.

Then it as antisepsis, today it is global warming and humankind’s direct contribution to it through environmental destruction, and the spread of diseases like this pandemic. And similarly, people could die needlessly, just because too many of us refuse to listen and learn.

(An edited version of this article was published on 05 August 2020 in my column ‘On the Upbeat’ in the Navhind Times Goa India)

I hadn’t seen the 2011 American thriller film ‘Contagion’ (with a star-studded cast that includes Matt Damon, Gwyneth Paltrow, Kate Winslet, Jennifer Ehle, Elliott Gould, Jude Law and Laurence Fishburn among others) until now, nine years later, during this lockdown.

It seems eerily prescient of our present situation, and I was impressed at the way several scientific and medical issues were handled and explained to the general viewership.

Take R-naught (R0) or basic reproductive number; an epidemiologic metric used to describe the contagiousness of an infectious agent. The film explained it really well.

An R-naught of above one means that each case is expected to infect at least one other person on average, and the virus is likely to keep spreading. If it’s less than one, a group of infected people is less likely to spread the infection.

A disease’s R-naught value only applies when everyone in a population is completely vulnerable to the disease. This means: 1. No-one has been vaccinated; 2. No-one has had the disease before; 3. There’s no way to control the spread of the disease.

The R-naught for COVID-19 is not even conclusively known as yet, (this is how ‘novel’ the virus is), but is believed to range anywhere between 1.4 and 5.7.

To put that in perspective, the R-naught of pneumonic plague is 1.3 and history tells us just how devastating those outbreaks have been. Comparative R-naughts for other airborne droplet-transmitted diseases are: smallpox 3.5 to 6; measles at a very high 12 to 18; SARS (severe acute respiratory syndrome) 2 to 5; influenza (1918 pandemic strain) 1.4 to 2.8.

The last statistic puzzled me initially. I had read up on the 1918 ‘Spanish’ flu pandemic before writing an earlier column when this lockdown started. The estimated death toll from that virus varied between 17 to 50 million, some citing even as high as 100 million. And this was before the age of air travel and tourism.

That mystery was partly explained in another book I’m reading (the earlier one was Bryn Barnard’s ‘Outbreaks: plagues that changed history’) that focuses on disease outbreaks, and also eerily prescient, ‘Spillover: Animal Infections and the Next Human Pandemic,’ (2012) by American science, nature and travel writer and author David Quammen.

With the 1918 pandemic strain of influenza virus (as indeed with other influenza viruses, which is the rational for the seasonal flu jab), high infectivity preceded symptoms by several days. Quammen calls it “a perverse pattern: the danger, then the warning.” High infectivity among cases, asymptomatic before they experienced the most obvious, debilitating stages of illness explained the mind-numbing scale of that pandemic. “The bug travelled ahead of the sense of alarm.”

Quammen speculated in the 2012 book: “The much darker story remains to be told, probably not about this virus [he was referring then to SARS, where the progress was the reverse, i.e. symptoms tending to appear in persons before, rather than after, those persons became highly infectious] but about another. When the Next Big One comes, we can guess, it will likely conform to the same perverse pattern, high infectivity preceding notable symptoms. That will help it to move through cities and airports like an angel of death.”

Well, his prophesied Next Big One is here, barely eight years after the book. Quammen also accurately predicted it moving “through cities and airports like an angel of death.”

Was Quammen also right about the other bit, high infectivity preceding notable symptoms? The honest answer at this moment in time, with this novel virus, is we cannot say for sure. The CDC (Centers for Disease Control and Prevention) website, updated frequently, states that “preliminary evidence suggests that asymptomatic carriers may contribute to the spread of the disease.” And that, as we know, is the rationale behind our lockdown: better safe than sorry, flattening the curve, and all that jazz.

In an interview shortly after the book was released, Quammen had predicted, ”The world of nature and things we humans are doing ― disrupting ecosystems and then traveling ― those factors are going to be by far the largest measure of our risk.”

The book also underscores how much the field of medicine has expanded since my own undergraduate days in the 1980s. If memory serves correctly, our Microbiology syllabus focused mainly on bacteria, much less so on virology. When we studied about zoonoses (singular zoonosis) or zoonotic diseases, referring to infectious disease caused by a pathogen (an infectious agent, including bacteria, viruses, parasites, prions, etc) that has jumped from non-human animals (usually vertebrates) to humans, the list used to be a relatively short one. Names that I still recall from those days are brucellosis, listeriosis, toxoplasmosis, and of course rabies.

This ‘jump’ from non-human animals to humans is the ‘spillover’ that Quammen and the rest of the scientific community are referring to.

That list of zoonoses has swollen exponentially in the intervening decades, to HIV/AIDS, Ebola, SARS, Nipah virus, MERS (Middle East Respiratory Syndrome), avian flu, swine flu among a dizzying assortment of ‘bugs’ of all sorts.

We’re going to keep encountering all manner of ‘new’ or ‘novel’ zoonoses, which will continue to be a challenge to the scientific community and to governments and populations everywhere because they will be more often than not be “previously unrecognized diseases” and also more likely than not to have increased virulence in populations lacking immunity.

The challenge, as both the film ‘Contagion’ and the ‘Spillover’ book demonstrate, will be to first somehow identify the causative organism, then tracing the reservoir host through retrospectively tracing the index case(s) and their contacts, and then taking measures to contain the spread while frantically searching for a killer drug and/or vaccine. An expensive investment in time, resources, with inestimable suffering to populations due to lockdowns and loss of income (to say nothing of the unconscionable, avoidable suffering our poor migrant and daily-wage workers have been subjected to here), and to laboratory animals (this pandemic alone has probably taken a heavy toll on long-suffering Rhesus monkeys in laboratories around the world in the race to culture COVID-19 and harvest it in the search for curative drugs and vaccines).

Quammen in the same interview termed it a “race” between two factors: On the one hand, the inevitability of further zoonotic spillovers, “many of which could be extremely murderous.” On the other hand, he speaks of the scientific advances being made in public health and the advances in vigilance and response.

Or the more prudent thing would be to learn from this pandemic; learn to respect and nurture wildlife habitats, certainly to stop the wildlife trade, whether for trophy, pelts, tusks, exotic game ‘meat’, aphrodisiac or whatever. We think of this pandemic as terrible and we are living through the hardships it has brought us, to many of us more than others. But The Next Big One could well be much, much worse. It almost certainly will come, the only question is how soon and from where, unless we, all of humankind, sober up and learn a few hard lessons from This Big One.

(An edited version of this article was published on 22 April 2020 in my column ‘On the Upbeat’ in the Navhind Times Goa India)

Exactly a century ago, the world was gripped by another pandemic, the 1918 ‘Spanish flu’ pandemic.

[By Otis Historical Archives, National Museum of Health and Medicine – Emergency hospital during influenza epidemic (NCP 1603), National Museum of Health and Medicine.https://www.buckscountycouriertimes.com/news/20190923/mxfctter-museum-to-mark-historic-influenza-pandemic/1, Public Domain, https://commons.wikimedia.org/w/index.php?curid=25513204%5D

No, it had nothing to do with Spain (it was merely reported first by the press in Spain, neutral in WWI and therefore exempt from military censorship) just as COVID-19 has nothing to do with China (in your face, Trump!). It had the world in its deadly grip (50 million deaths!) for two whole years. A sobering thought; one hopes ‘our’ pandemic ebbs away a lot sooner, with markedly fewer fatalities.

How did Goa fare in that pandemic? From ‘Health and Hygiene in Colonial Goa 1510-1961’ by Fátima da Silva Gracias, one gets an idea of its impact from the fact that in Siolim (my mother’s village, incidentally) alone, “eight to ten persons died daily. The inhabitants of this territory in panic would run away at the mere sight of a dead body being carried away.” (Is there any residual oral history of those terrible times, or has the link been broken by death and migration?)

Some considerations resonate even today: the government not acting swiftly enough to implement preventive or controlling measures; “acute shortage of provisions” (due to panic buying by citizens? Or closure of the border with British India? Or both?); directives to refrain from sneezing in public or to use a handkerchief to cover the mouth; funerals held privately; free medicines to the poor at some hospitals; and “free machilas” (palanquins; I guess the ‘flying-squads’ of their time) to the “two physicians in charge of the epidemics”.

I’ve just finished reading ‘Outbreak: Plagues that Changed the World’, a really gripping book by Bryn Barnard.

It looks at six of the most extraordinary pandemic-causing diseases: bubonic plague, cholera, yellow fever, tuberculosis, smallpox and influenza.

They do have some common features. All of them (except for smallpox which has no host other than humans) co-existed with birds or animals, sometimes for centuries, and at some point crossed species, with devastating consequences. The crossing-over was either caused, or accelerated, and disseminated, by one or more of the following: poor sanitation and hygiene; overcrowding; all of these reflective of poverty (“the elephant in the room”) and compounded by it; societal upheaval caused by war, fleeing refugees, poor nutrition and famine; and ‘exploration’ (whether motivated by trade or domination) to ‘new worlds’, into forests and habitats that had hitherto been untouched by humans.

Take bubonic plague: Historically it had “been confined to populations of rats in isolated mountain regions, one in South Asia and the other in East Africa. When human activities like war and trade and disturbed these ancient reservoirs, the plague escapes its natural confines.”

Furthermore, all of them have left their mark on our world, sometimes for the better, sometimes not. The Justinian Plague (541-542 AD)

so weakened the Byzantine Empire that it never recovered. The Black Death (1347-1351)

decimated Europe’s population, irreversibly overturning its social structure. But while it raged, Jewish populations were made scapegoats, with horrific pogroms. (We have modern-day parallels, of racist attacks on ethnic Chinese abroad and people from the North-East in India over coronavirus).

The third plague pandemic (1894)

killed 13 million people and has not really been declared ended, although under control. To quote Barnard, “a global Black Death” is a “remote nightmare”, but “not impossible.” A drop in vigilance and sanitation standards and it could flare up.

Cholera outbreaks are even more directly connected to sanitation and hygiene. Indeed, it catalyzed the development on modern sanitation.

Barnard blames the British empire directly for spreading cholera, invading and connecting hitherto isolated areas.

The lethal cocktail of pathogens (hepatitis, influenza typhus, typhoid, diphtheria, measles, mumps, and smallpox carried by ’explorers’, conquistadores and ‘pioneer-settlers’ from the ‘Old’ World to the ‘New’ was “like the detonation of a biological bomb” (Barnard calls them “virgin soil” epidemics) to a native population with no prior immunity to these, among which smallpox was the most devastating.

Barnard terms it the “decisive factor” in the Spanish conquest of Mexico and Peru, the Portuguese invasion of Brazil and the colonization of the Caribbean.

Conversely, yellow fever became the white colonists’ scourge, but the African slaves brought from across the Atlantic had prior immunity. Barnard remarks how “the same people who had once concluded that Native Americans were inferior because they died from European disease now assured themselves that blacks were suited to slavery because they were immune to yellow fever. The logic of bigotry is a marvelously malleable thing.” Quite.

The disease crushed the sugar industry in Haiti hastened its independence. It scuttled plans for the Panama Canal until a cure and vaccine could be devised.

Between epidemics, the virus has found a permanent reservoir in the New World tropical forest, cycling between tree-dwelling monkeys and their mosquito parasites. But each time a tree is cut to clear more land for habitation or agriculture, the prospect of another epidemic increases.

Indeed, an article in this month’s Scientific American reinforces the message: Destroyed habitat creates the perfect conditions for Coronavirus to emerge, and COVID-19 may be just the beginning of mass pandemics. Please read it; it should scare us all into action.

Barnard discusses the variolisation versus vaccination debate in combating smallpox in Asia and Africa; it reminded me of my great-grandfather Gen. Dr. Miguel Caetano Dias (1854-1936)

in championing the cause of vaccination in Goa during his tenure as Director of Health Services (1902-1913). That period saw several outbreaks of smallpox, cholera and plague. His energetic anti-plague campaign and sanitation policies earned him the Ordem de Avis and other commendations.

His eldest son Col. Dr. Vítor Manuel Dias (1892-1949)

would do him proud in the same post, culminating in the Saneamento da Velha Goa (Sanitation of Old Goa), combating malaria and other communicable diseases, the exertion of which brought about his own premature death. In terms of outbreaks, Goa seemed to be in a quiescent phase under his watch, in the 1940s.

Barnard reminds us of the etymology of quarantine, from the Italian ‘quarantena’, for forty days, the isolation period of plague-infected ships and peoples in Venice, inspired by the forty-day period of Lent. It’s ironic that our own mass home quarantine overlaps so closely with the Lenten season.

On 24 May, World Tuberculosis Day, WHO reinforced its pledge to “ensure no one is left behind” in ending “the world’s largest infectious killer.”

Barnard ends his book with some sobering thoughts. Most wonder drugs soon encounter microbial resistance. The Red Queen (from Alice in Wonderland) hypothesis states that “organisms are constantly struggling to keep up with one another in an evolutionary race between predator and prey species.”

It is counter-productive to think of human health and disease in military terms, as a ‘war’’. In a warfare-obsessed world, we think we can ‘beat’ microbes. “Trouble is, nobody told the microbes.” They’re living beings like us, (although viruses are a special case, considered by some biologists to be “organisms at the edge of life” as they possess some but not all the key characteristics of life forms) and adapt for survival over generations. Our generation turn-over is measured in decades, theirs in hours. “In an evolutionary race, they always win.”

What will a post-COVID 19 pandemic world look like? Will it lead to a more equitable social order, at home and abroad? Epidemics have helped abolish serfdom in Europe, and slavery in the New World, but left India’s oppressive, odious caste system intact.

Will social distancing persist as an after-effect in a microbe-wary world?

Will we learn not to mess with Nature? Destroy pristine landscapes (driven by logging, mining, road building through remote places, rapid urbanization and population growth), and the species you are left with are the ones humans get the diseases from. As the Scientific American article warns “We can’t predict where the next pandemic will come from…The only certain thing is that the next one will certainly come.”

(An edited version of this article was published on 01 April 2020 in my column ‘On the Upbeat’ in the Navhind Times Goa India)

I’ve written in the past of my great admiration of Sweden and its long tradition of singing. The most familiar export that most of us grew up to is of course ABBA. One fringe benefit of our recent trip to Sistema Sweden’s Side by Side summer music camp was a visit to the wonderful, relatively new (what took them this long?) ABBA museum in Stockholm.

Closer to home, Child’s Play India Foundation has been fortunate to have two Swedish choirs make trips to Goa to do benefit concerts for us in the last few years.

Many of you will remember these concerts. The video of the most recent visitors Vocal Colors singing a beautiful a cappella polyphonic arrangement of “Tambde Rosa” has gone viral and the viewership keeps rising by the day.

I recently came upon a very interesting phenomenon via (where else?) social media. A journalist friend in Delhi tagged me in a post. Usually there aren’t enough hours in a day to sift the wheat from chaff, but the title of the song video caught my attention: “Never Google your Symptoms.”

It came as little surprise that the singer was Swedish, but the reason I had been tagged in the post was the fact that Henrik Widegren is also a doctor of medicine, a specialist physician in ear nose and throat diseases and phoniatry (the study and treatment of organs involved in speech production, mainly the mouth, larynx, vocal cords, and lungs) in Lund University Hospital, Sweden.

Back in GP-land, in my years practicing in the UK, there was a term used among doctors for patients who obsessed about the trivial deviations from what they felt was the norm, while depriving an appointment to those who really needed urgent care. The first group was called the “worried well”, and those who were actually quite ill but were too busy working and going about their daily lives to try and seek help were the “unworried unwell.”

The Worried-Well brigade would often turn up to their appointment fully armed with print-outs of whatever they had skimmed off the top of their internet trawling. It would be a heart-sink situation just watching them come through the door, as you knew they’d want nothing less than your complete acquiescence with their shopping-list of demands: a specific prescription, a specialist referral topping the list.

To be fair to them, it was their fear of the unknown and their feeling of vulnerability and helplessness that underlay their actions. But the internet is a treacherous source of information unless you know where to look.

In “Never Google your Symptoms”, all the band members are in white coats as Widegren belts out the lyrics. “Every sign is a serious condition”, he warns, elaborating further: “If you google ‘cough’ and ‘diagnosis’, you have got Tuberculosis!” “If you google ‘fever’ and ‘red’, you’ve got Ebola and soon will be dead!” And so on and so forth.

The song was such a hoot that I decided to look him up further. Widegren has many songs in Swedish about medicine and healthcare, but recently has released an album in English, titled “Medical Melodies and Surgical Songs”, with 13 songs about (as he describes it) “life and death.” In addition to “Never Google Your Symptoms”, the others have equally zany titles: “Text Message From The ER”, “It’s Always Good To Have A Stethoscope”, “The Ballad Of The Superstar Surgeon Paolo Macchiarini”, “I Want To Die”, “A Statistically Significant Love Song”, “how Do You Make a Baby”, to name just a few.

The compilation is, as Widegren puts it, “as varied as a night in the emergency room”, with something for everyone, ranging from pop and rock to disco, techno and classical.

“How Do You Make A Baby” addresses the awkward but inevitable chat that every parent will have to have with their pre-teen or teen child, about the birds and the bees.

“A Statistically Significant Love Song” explores the absurdity of using statistical rigour when it comes to falling in love.

“I love you, more than the median. I’m certain because the p value is 0.01. Our love is blessed by a t-test. I can prove to you, I love you.” It gets cornier: “Your curves don’t have a normal distribution. And your eyes are in the top 10th percentile rank.” “I look into your eyes and think of decimals of pi.” “You love me more than my control group.” If you fall for that, you’ll fall for anything.

“I Can Never See a Doctor” empathises with the children of doctors, who get treated at home even with life-threatening illness by their mums and/or dads while their peers in school or the playground are rushed to medical attention for the most minor symptoms.

“The Song of Romeo the Internist and Juliet the Surgeon” is (you guessed it) a ballad about a star-crossed fleeting hospital romance.

“It’s Always Good to have a Stethoscope” lists the varied uses of the iconic instrument beyond the call of picking up heart murmurs and listening to the “air in the lungs”: like for instance, strangling irritating patients or tying up a hyperactive child; “use it as a wrecking ball if your house is very small”; or as a lifeline to a drowning man. It gets even crazier than that.

Not every song is a medical, surgical, lyrical or musical success; some of them frankly need to be euthanized. But they’re a humorous take on a life-and-death profession; and laughter, as we know, is the best medicine.

(An edited version of this article was published on 24 November 2019 in my weekend column ‘On the Upbeat’ in the Panorama section of the Navhind Times Goa India)

“As a species, why are we willing to kill, exploit, or willfully disregard people we’ve never met?” This question leapt out of my laptop screen just as I was winding down and calling it a night.

It struck a chord. It is a question, perhaps differently phrased, that troubles me a lot, and I’m sure I’m not alone: How and why are we capable of treating others cruelly, of dehumanizing a person or a group of people?

The article, in The Economist, was titled “Does your brain care about other people? It depends”, co-written by David Eagleman, neuroscientist at Stanford University and author of several books on cognition and society; and Don Vaughn, neuroscientist at the University of California Los Angeles.

It begins with the story of Lord George Gordon (1751-1793), British nobleman and politician, who fought against the injustice meted out to sailors in the Royal Navy at the time, and against the evils of slavery on the one hand; but was also responsible for instigating several days of anti-Catholic riots (known even today infamously as the ‘Gordon riots’) in 1780. Gordon marched a 50,000-strong mob to the Houses of Parliament that went on over a whole week to destroy Roman Catholic churches and pillage Catholic homes, killing or wounding hundreds of people in what has gone down as “the most destructive domestic upheaval in the history of London.”

This, then is the conundrum: how can someone have empathy for one group or groups of people, but simultaneously harbor antipathy towards another?

The writers put it down to a “fundamental fact of human nature: our tendency to form ingroups and outgroups—that is, groups that we feel attached to and those that we don’t.” Yes, we have empathy, but it is selective. Eagleman and Vaughn cite examples such as “a hometown, a school or a religion” bonding people within an ingroup. In India, the big “bond” would also have to be caste.

The Second World War had brought into sharp focus how dangerous such divisions into ingroups and outgroups could be, with the dehumanization of Jews by the Nazis,

and American wartime propaganda portraying the Japanese as ‘subhuman’,

while Japanese propaganda depicted Americans as ‘monsters.’

The authors describe a 1954 psychological study dividing a study sample of pre-teen boys into arbitrary groups, and the antagonism and partisanship sometimes erupting into violence that resulted from this random division.

This is not an isolated study. It has been replicated at different times in different places in different age-groups. I remember reading about a similar study from about a decade later. The day after Martin Luther King Jr. was assassinated in April 1968, class-teacher Jane Elliott in a small all-white town of Riceville Iowa decided to teach her third-graders a lesson in the meaning of discrimination when she realized that they “couldn’t understand” why someone should even want to murder an icon that they had recently made “Hero of the Month”.

She divided her class by eye colour: those with blue and those with brown eyes. On the first day, one group was told they were “smarter, nicer, neater, and better” than the other group. The “better” group were given privileges such a longer recess, and being first in cafeteria lunch line. The other group had to wear a collar around their neck and their behavior and performance were criticized and ridiculed by Elliott.

The next day, the tables were turned, and the other group became the dominant group. In each case, the “superior” group became mean-spirit and took pleasure in the discrimination against the other group.

Realising that she had created “a microcosm of society in a third-grade classroom”, Elliott repeated the exercise for two consecutive years after that. Fourteen years later, Frontline’s ‘A Class Divided’ documented a reunion of the last, 1970 third-grade class, who still remembered and cherished the lessons from that experiment.

Eagleman and Vaughn relate the results of a rather bizarre experiment carried out in 2010. Scientists at the University of Zurich recruited sports fans for a brain imaging study. The fans were first allowed to meet and exchange trivia. They then underwent a brain scan during which they watched other fans receiving painful electric shocks to their hands. Watching the pain inflicted on others activated parts of the brain as if they were experiencing it themselves. “This is the neural basis of empathy,” the writers explain.

But there was a darker side to the interpretation of the data. Participants experienced higher brain activity when watching the pain experienced by those who liked the same sports team they did, and less activity when watching pain inflicted to fans of a rival team!

To remove the bias from the sports fans recognizing each other, Eagleman and Vaughn designed another study: “Participants lay in an MRI scanner and looked at six hands on a video screen. The computer selected one hand at random, and then a hypodermic needle entered the picture and stabbed into the flesh of that hand. In a control condition, a long cotton swab touched the person’s hand—visually similar to the needle, but this time with no pain.” By contrasting the brain’s reaction to the needle and the cotton swab, the researchers felt they could measure the brain networks that became active when witnessing another’s pain.

Then came the twist: “Each hand became marked with a simple label: Christian, Muslim, Jewish, Hindu, Scientologist or atheist.” The question they wished to answer was: would a participant experience more pain if h/she belonged to the ‘label’ hand being stabbed? Would a Christian feel more pain on watching pain inflicted to a ‘Christian’ hand?

That was indeed their conclusion. “Watching an ingroup hand get stabbed evoked more empathic brain activity; an outgroup hand triggered less”, despite all the protestations of neutrality by some participants.

The authors ask us to reflect: “Take a moment to think about your own level of empathy toward others. Imagine that you see a 60-year-old man twist his ankle and fall to the ground. Do you feel an empathic sting? Now imagine he’s at a rally for a politician that you loathe. Is your empathy any different? And if so, does that challenge your view of yourself as an empathic person? If you had unequal responses in the two situations, you’re not alone: people generally assess their own empathy by thinking about those in their ingroup.”

I thought the same thing when pictures of the horrific blaze of the Tezgam passenger train travelling between Karachi and Rawalpindi, killing at least 75, appeared on social media.

The ‘ha-ha’ emoticon reaction from tens of thousands of people (while many more reacted with concern, to be sure) was mind-numbing. How could anyone trivialize a tragedy like this, wherever it may have occurred, and regardless of who the unfortunate victims were?

Eagleman and Vaughn suggest that rather than feeling doomed to succumb to our ingrained biases, we can fight them through several strategies such as Understanding our own biases; Building a better model of others; and Learning to resist the tactics of dehumanization.

(An edited version of this article was published on 17 November 2019 in my weekend column ‘On the Upbeat’ in the Panorama section of the Navhind Times Goa India)

Think back to the last time you were at a wedding, a party, or a festival. Can you imagine any of these, but without music?

Music is literally everywhere we go, even without our realising it. And it affects us, strikes a chord, as it were, in ways that other modalities cannot.

Music has been described as one of the longest-standing self-prescribed therapies in history. We have been using music to effect emotional, psychological or even physical change within us from the dawn of time. Mothers have sung babies to sleep with lullabies, religions use hymns to awaken feelings of devotion and community, national anthems stir up patriotic fervour, and football anthems unite fans. Sad songs can help heal heartbreak, while upbeat peppy music can motivate us to exercise or run or dance just a little bit longer. Often, the best tribute to a loved one at their memorial service is to sing or play their favourite song. Music has been an almost intuitive crutch or coping mechanism, in the ups and downs of our lives.

The definition of music therapy, however, is a little more specific: the use of music to improve health or functional outcomes. Again, this is a concept well-known through history, going back to antiquity. It’s no coincidence that Apollo was the Greek god of both, Music and Medicine.

Aulus Cornelius Celsus recommended the sound of cymbals and running water for the treatment of some mental illnesses. Similarly, Hippocrates found that playing music alleviated the symptoms of patients with mental disorders. In many indigenous cultures ranging from Asia to Africa, the Americas and Australia, medicine men (and women) often employed (and in some instances still do) chants and dances as a modality of healing.

Music therapy formally came to the attention of the medical world, in the West (particularly in the UK and US), in the aftermath of the two World Wars, when soldiers returned from the battlefronts with what was then, for want of a better term, described as “shell- shock”, but what we today call post-traumatic stress disorder. Musicians would travel to hospitals and play music for soldiers suffering from war-related emotional and physical trauma. The systematic clinical study of “music presented according to a specific plan in independently influencing recovery among service members with mental and emotional disorders” began subsequently.

In effect, musicians were using music to achieve “non-musical” goals. A friend of mine, brilliant violinist Robert Vijay Gupta (incidentally the youngest ever to enter the ranks of the Los Angeles Philharmonic Orchestra) describes this well in one of his TED talks: In 2011, US Congresswoman and gun-control advocate Gabrielle Giffords survived an assassination attempt, but one of the bullets entered her left hemisphere and damaged her Broca’s area, the speech centre of her brain. In one of her recovery sessions (accessible on YouTube), while working with her therapist, she struggles to produce the most basic words, and bursts into sobs in sheer frustration. The therapist then tries a new tack, and they attempt to sing together. Through her tears, Giffords begins to sing along, and is able to clearly enunciate the words of the song, in one descending scale: “Let it shine, let it shine, let it shine.” As Gupta puts it, is a very “powerful and poignant reminder of how the beauty of music has the ability to speak where words fail; in this case, literally, speak.”

One of the pre-eminent neuroscientists studying Music and the Brain at Harvard, Dr. Gottfried Schlaug, is a proponent of Melodic Intonation Therapy, which is now quite popular in music therapy. Schlaug found that stroke victims who were aphasic, and unable to form three- or four-word sentences, could still sing the lyrics of a song. After hours of intensive singing lessons, Schlaug found that the music was able to literally ‘rewire’ the brains of his patients and create a homologous speech centre in the right hemisphere to compensate for the left hemisphere’s damage.

The “non-musical goals” in music therapy are created depending on the patient, and on what their needs are. They could variously be: having the patient feel better; alleviating symptoms; or helping them progress in their treatment.

The experience of music is an extremely complex phenomenon. It is the only life experience that gets processed on both sides of our brain. Music has all of these elements in play, occurring simultaneously: melody, rhythm, words (lyrics), harmony, timbre, tempo, dynamics, and form. And consider how you as a human being experience all this: you have memory, emotion, participation type (so active or passive) and familiarity. If you now consider all the areas of our brain that are processing all this information in real-time, it involves most if not all of both hemispheres.

This has been demonstrated by researchers using fMRI imaging, to show multiple areas of the brain ‘lighting up’, all at once. These include the areas responsible for auditory processing, motor control, emotion, memory. And within these larger areas are even smaller areas that are more finely tuned to respond to this stimulus.

Take just one element, for example: rhythm or pulse. Simply, the “beat” draws your brain into this idea called “entrainment.” So your brain hears the beat, processes it, and responds to it by “matching”. This aspect of music therapy has been used to good effect in the recovery of stroke victims or those with Parkinson’s disease, by giving them a steady beat by which they can pace their stride lengths. If they are given a beat, their brain will entrain to it (a phenomenon known as rhythmic auditory stimulation) and their feet will keep pace.

Music therapy has likewise been found to be effective in Alzheimer’s disease. When brain damage occurs on one side of the brain, (and since music stimulates both sides of the brain), music therapy can encourage the homologous area in the opposite hemisphere to compensate for that loss. Through the use of music, our brains are able to access long-term memory by these different neural pathways.

A music therapist is not just a competent musician, but also a flexible one, who should know how to engage and interact with patients across a multitude of diseases, disorders and conditions. These range from autism to others with special needs, rehabilitation of stroke victims, Alzheimer’s and other forms of dementia, Parkinson’s disease, syndrome and other movement disorders, post-traumatic stress disorder, cardiovascular disease, psychiatric illness, in cancer centres, palliative care and those suffering from chronic pain, alcohol and drug rehabilitation programmes, correctional facilities, and even in neonatal intensive care units, especially for prematurely-born infants. The list keeps growing. Due to its versatility, music therapy is finding use in more and more areas of healthcare.

The standards of practice are, however, just as rigorous as any other therapy in healthcare. The tendency by some to label themselves as music therapists without undergoing the necessary training is quite unfortunate and discredits the profession. As explained, music evokes emotional and psychological, even physical reactions in us, and knowing what sort of music to use (or avoid), for whom, when, and for how long, is a learned science. Music must be chosen purposefully, and with understanding supported by evidence-based research.

(An edited version of this article was published on 14 July 2019 in my weekend column ‘On the Upbeat’ in the Panorama section of the Navhind Times Goa India)

The Serendipity Arts Festival has become a regular fixture on our cultural calendar. For emotional reasons, my own years and those of so many generations in the family in those corridors and what were once hospital wards, operation theatres, centres of learning and healing for certainly a century and a half, I find myself drawn to the “old GMC” Panjim, as the heritage building is today called in SMS-speak.

And this year, the “old GMC” Ribandar was also part of the festival as a last-minute resort, apparently).

This year being the 175th anniversary of the declaration of Panjim (of which Ribandar was and is considered a part, for historic reasons), celebrated so beautifully in the “old PWD” by the festival, you’d have thought it the perfect opportunity for its planners to showcase the city’s medical past and legacy at both these hallowed venues. Indeed, the Escola Médica de Goa, established in 1842, is barely a year older. Sadly, they let it slip through their fingers.

A portion of the former surgery ward literally had a heap of trash piled in a corner, and passed off as art, with some slick yet unconvincing captioning. Another room, once a private room that I myself was admitted in for a minor operation in the 1980s, had a video loop of a sleepy old man nodding off in a chair.

Going up the imposing marble staircase, again in a former surgery ward, were a bank of flat television screens, each displaying the back of a man or woman staring out at the ocean as waves came relentlessly crashing in. There were yet more explanatory paragraphs for one to ‘get the message.’ But what caught my attention, for old time’s sake, was not part of the exhibit but nevertheless seemed to make a powerful statement.

It was the profile (left) of a man, bearded and moustached in the way that only someone from the 1800s could be, looking ruefully towards the heart of what had been his stamping-ground. It was cast in bronze, but you wouldn’t know it from the way it had been looked after. A lick of paint had been slap-dashed on the walls and spilled onto the edges of the memorial. But what was more shocking and hurtful, were the flecks, nay intentional dabs of paint on the distinguished gentleman’s ear, nasal orifices and picking out ‘teeth’ or ‘fangs’ along the line of his mouth, to give a him ghoulish appearance. Someone’s idea of a practical joke? Common decency won’t let me compound the indignity by sharing the picture. But I have pictures of the outrage. I hope the powers-that-be have corrected this by now.

To be fair, this painter’s devil prank may not be the fault of the Serendipity festival organisers, but the carelessness of the administration that oversees the building maintenance, but don’t realise the full import of their responsibility. The amnesia had already begun even when I studied and worked there: few knew (or cared) who the plaque was honouring.

Who was this man? The plaque reads below: “AO DR F. A. WOLFANGO DA SILVA, HOMENAGEM DOS SEUS ADMIRADORES”. “To Dr. F. A. Wolfango da Silva, in homage from his admirers.”

My father sang the praises of the great men and women of yesteryear (and we as children would only half-listen, sadly) but in that litany of fame was this man. After my dad’s death, I have to look elsewhere for information. So I quote largely from data gleaned from Aleixo Manuel da Costa’s ‘Dicionário de Literatura Goesa’.

Francisco António Wolfango da Silva, doctor, pharmacologist and former Director of Health Services, was born in Nova Goa (18 July 1864) and died in the same city, (12 December 1947), son of distinguished doctor Bernardo Wolfango da Silva and Leopoldina Deodata Barreto. He graduated in medicine and pharmacology at Escola Médica Goa, where he defended theses respectively, “Considerations on a case of cardiomyopathy”(1887) and “The New Pharmaceutical Code” (1888). He repeated his medical studies at Escola Médica-Cirúrgica de Lisboa, with a thesis on “Cardiac medications” (1890).

In 1891, he was nominated faculty of the Health Department in Angola and also sent to Cabo Verde to combat a smallpox epidemic, then transferred in 1892 to India. He rose rapidly: capitão- médico (1902); major- médico (1906); tenente-coronel (1909); and coronel- médico (1914).

He was knighted to the order of Aviz, with a silver medallion from the Queen, D. Amélia in 1895. During several governor regimes he was Member of the Governing Council, in which he impressed with his knowledge, intelligence, dedication and zeal which defined his career.

If I’ve translated correctly, he performed the first laparotomy operations for strangulated hernia in Goa. He was responsible for solving many of Panjim’s sanitation issues during his tenure in the Health Services, described by a contemporary “one of the greatest stars in the brilliant constellation of the greatest thinkers who sparkled so much light among us with the clarity of his knowledge.”

Panjim will remember him gratefully (although they may not know it) for his decision in 1931 to have the walls of the entrance of the Instituto Vasco da Gama (today Institute Menezes Braganza) decorated with the glorious azulejo panels by the artist Jorge Colaço (1935), five episodes from the epic poem Os Lusíadas by Luís de Camões.

He was an eloquent orator and writer in all the journals and periodicals of the day.

In that old surgery ward with a 21st-century technologically-savvy ‘smart’ art installation, a 20th-century bronze plaque (installed in his lifetime, in 1931) celebrating a man whose prime had been in the century before, although defaced, nevertheless still had the quiet dignity he must have exuded in his lifetime.

Thanks to public-spirited individuals like Vasco Pinho, we have a repository of information of a Pangim that once was, but no longer exists.

In his recent book ‘Meu Pangim Inesquecível’ (My Unforgettable Panjim), he cites an episode I had long forgotten: in the iconoclasm that followed Goa’s Liberation, a frenzied mob tried to smash the bust of my great-grandfather Lt. Col. Gen. Dr. Miguel Caetano Dias (1854-1936, incidentally a friend of Wolfango da Silva, and whose bust once also graced the old Panjim GMC), thinking he was Portuguese.

Fortunately the local population prevented this. More recently, a long-standing Panjim MLA publicly confessed he also thought it was the bust of someone Portuguese, not native Goan.

Our city fathers have no link with the past, and are custodians of a heritage they have no knowledge of, or interest in, any more. If someday, sledgehammer-wielding ‘todd-fodd’ mobs come a-calling, will there be any public memory, consciousness or conscience that will dissuade them from smashing this or that? Today is the feast of the Epiphany. May we all have an epiphany about our history, heritage, and our duty to uphold and protect it.

(An edited version of this article was published on 6 January 2019 in my weekend column ‘On the Upbeat’ in the Panorama section of the Navhind Times Goa India)

“They’re all like that!” Are we all guilty of, at some point in our lives, having made such a sweeping generalization?

It could be something somewhat playful and seemingly harmless, like the endless memes on social media about gender differences. “Men are like this, women are like that.”

It gets much more sinister when opinions get entrenched about differences based upon anything, be it gender, sexual orientation, race, caste, or the “outsider”.

When this morphs into hatred, it can actually transform our brain as well. This was the subject of a recent article (31 October 2018) in the New York Times titled “The Neuroscience of Hate Speech” by a psychiatrist, Dr. Richard A. Friedman.

Dr. Friedman was reacting to the mass shooting at the Tree of Life synagogue in Pittsburgh on 27 October 2018 by 46-year old Robert Bowers who told police he “wanted all Jews to die”, and that “they [Jews] were committing genocide” to “his” people.

While neighbours and acquaintances described him as “normal” (one neighbor even said “The most terrifying thing is just how normal he seemed”), his trail on social media reveals a totally different picture. Here, he had hurled all sorts of abuses at the Jewish people, ranging from “children of Satan”, “an infestation”, to “filthy” and “evil.”

Does this sound familiar? Any of us who spends even a little time on Facebook or Twitter or other social media sites here in India will find such vitriol directed variously at women, Dalits, people from minority faiths, the differently-abled, or those holding sexual orientations different from theirs, or anyone deemed “anti-national”, that very amorphous group.

It is mind-boggling how, under cover of cyber-anonymity, often using fake profiles, but sometimes not even this fig-leaf, the most hate-filled venom can be spewed with seeming impunity. And while the establishment can swing into action at the most innocuous posts devoid of any hatred but deemed “seditious”, the hatred of others is allowed to thrive and fester.

As Dr. Friedman says in his NYT article: “Of course, it’s difficult to prove that incendiary speech is a direct cause of violent acts. But humans are social creatures — including and perhaps especially the unhinged and misfits among us — who are easily influenced by the rage that is everywhere these days.”

It’s already happened, much further than anyone could have imagined. Nigeria has used current President of the US, Donald Trump’s threat (to open fire on the migrant caravan approaching the US southern border) to justify its own fatal shooting of rock-throwing protestors.

Three 2017 Polish studies by Soral, Bilewicz and Winiewski explored “the effects of exposure to hate speech on outgroup prejudice.” Their conclusion? “Frequent and repetitive exposure to hate speech leads to desensitization to this form of verbal violence and subsequently to lower evaluations of the victims and greater distancing, thus increasing outgroup prejudice.”

Part of the problem is the “normalization” of what is usually socially condemned behavior. A relevant example is the attitude towards lynchings or mass murder through ‘rioting’ here. It is disturbing to note how many, even within our own circle of acquaintances, otherwise “normal” people in every other respect, just brush this off: “These things happen from time to time. What can one do?”

Dr. Friedman in his NYT article also touches upon the effect of hate-mongering politicians (and we have our own home-grown counterparts here in India) on their supporters and those who are roused to a frenzy by their hate speech. He was responding to the attempted bombing of critics of Trump by “an ardent supporter.”

He cites another study published in the Proceedings of the National Academy of Sciences which demonstrated that threatening language can directly activate the amygdala (the almond-shaped set of neurons located deep in the brain and shown to play a key role in the processing of emotions), making it hard for people to “dial down their emotions and think before they act.”

When Dr. Friedman asks whether Bowers and those implicated in the bombing attacks against critics of Trump were roused by the latter’s inflammatory, paranoid hate speech, it is worth looking at parallels closer to home.

In a paper titled “Us versus Them: Social Identity Shapes Neural Responses to Intergroup Competition and Harm”, Cikara, Bottvinick and Fiske discuss how distrust of an “out-group” is linked to anger and impulses toward violence. Not surprisingly, this is especially true when a society faces economic hardship and people view “outsiders” as competitors for their jobs. Again, this strikes a chord with us in India, where violence breaks out in one state targeting people from another state who are viewed as the “other” for precisely such reasons, and politicians take advantage of such feelings of vulnerability for electoral gain. This also explains the exaggerated paranoia towards Rohingya Muslims, stoked by almost rabid, hysterical television anchors of some irresponsible TV channels.

Cikara, psychologist and co-author of the above paper, said as much to Dr. Friedman: “When a group is put on the defensive and made to feel threatened, they begin to believe that anything, including violence, is justified.”

Trump, in dehumanizing immigrants (“These aren’t people; these are animals”) could have taken lessons from Adolf Hitler himself, who called Jews, Gypsies, homosexuals, and vast swathes of people from Eastern Europe “untermensch” (“sub-human”). The Hutu regime used similar language in the run-up to the 1994 Rwandan genocide against the Tutsi minority.

Thinking of a group of people as sub-human leads to little or no empathy for those people. Both these psychological conditions are conducive to violence. A call to violence by a rabble-rouser in such a tinderbox situation can result in mass violence on an industrial scale, as history has shown us. And when such violence is sanctioned by a higher power, it is easy to “rationalize” is as “merely obeying orders.”

Another co-author, psychologist Susan Fiske, in an article in the Greater Good Magazine, “Science-based Insights for a Meaningful Life”, writes: “Both science and history suggest that people will nurture and act on their prejudices in the worst ways when these people are put under stress, pressured by peers, or receive approval from authority figures to do so.” But although prejudice is hard-wired into our brains, “the good news is that we can still learn to override our prejudices and embrace difference.”

MRI brain imaging by British neuroscientists has shown that hatred activates the regions of the brain associated with aggression and the motor regions that would translate this aggression into action. “The hater may want to exercise judgment in calculating moves to harm, injure or otherwise extract revenge.” The cold-blooded logic and planning in these “calculated moves” surprised even the researchers.

The findings (“The Neural Correlates of Hate”) are so specific and unmistakable that they might even have possible legal implications, for example in places where hate crimes face tougher sentences.

Hatred is more than just a runaway emotion; it is a pathological condition that can transform our brains, harm others immeasurably, and consume us as well, as inexorably as a cancer.

(An edited version of this article was published on 11 November 2018 in my weekend column ‘On the Upbeat’ in the Panorama section of the Navhind Times Goa India)

I had heard of and read about Robert Vijay Gupta perhaps about two decades ago. His is a remarkable story on so many levels.

Gupta was born in 1987 in Walden, New York State, to first-generation emigrés from India. In a recent interview with Dateline NBC, he described his parents’ struggle in their adopted country. His father Vivek worked in kitchens all over New York, as a baggage handler in JFK airport, eventually becoming a travel agent while his mother Chandana worked as a bank teller.

He began playing at age four. “I don’t remember a time without playing. Music has always been a part of my life”, he said in that interview.

Gupta described the initial years as “painful”. “The motivation wasn’t mine.” He acknowledges that his parents lived vicariously through their children, fulfilling their own dreams through them.

When Gupta’s parents took him aged four to a music teacher, he was offered a choice of either piano or violin. The size of the piano was too daunting, so he chose the violin instead.

His trajectory since then was nothing short of meteoric: a successful audition aged just six at the prestigious Juilliard School of Music’s pre-college program; a solo debut with the Israel Philharmonic Orchestra under the baton of Zubin Mehta at eleven.

However, despite these incredible achievements, the family still felt that a medical career would ensure a more secure future. A tug-of-war began between music and medicine; while Gupta di have both the aptitude and interest in medicine, music was far more important, “like oxygen”.

At 16, Gupta accepted a research assistant position at Hunter College where he studied spinal cord repair. He graduated with a pre-med biology degree at 17 at Marist College. Gupta then accepted a research position at Harvard University, where he studied Parkinson’s disease and the effects of pollution on the brain.

Around this time, Gupta met with Dr. Gottfried Schlaug, one of the pre-eminent neuroscientists studying music and the brain at Harvard.

Schlaug is one of the proponents of what is called the ‘melodic intonation therapy’, which has become very popular in music therapy today. Schlaug found that his stroke victims who were aphasic, and couldn’t form three- or four-word sentences could still sing the lyrics to a song.

After intensive hours of singing lessons, the music was able to “literally re-wire” the brains of his patients and create a homologous speech centre in the right hemisphere to compensate for the damage inflicted by the stroke on the left hemisphere of the brain.

In a 2012 TED talk, Gupta describes what he learned regarding some leading research on music and the brain when he visited Schlaug’s lab: how musicians had fundamentally different brain structure than non-musicians; how just listening to music could just “light up” the brain, “from our pre-frontal cortex all the way back to our cerebellum”; how music was becoming a neuropsychiatric modality, to help children with autism, to help people struggling with stress, anxiety and depression; how advanced Parkinsonian patients would find that their tremor and their gait would steady when they listened to music; and how late-stage Alzheimer’s patients whose dementia was so far progressed that they could no longer recognize their family, could still pick out a tune by Chopin at the piano that they had learned when they were children.

But Gupta had come to meet Schlaug for a much more personal reason: “I was at a crossroads in my life”, he said at the TED talk, “trying to choose between music and medicine.” He had “fallen in love with neuroscience; he wanted to be a surgeon; to be a doctor who would go far afield doing humanitarian life-saving medical work, a “Red Cross doctor, doctor without borders.”

But on the other hand he had been playing the violin his entire life. “Music for me was more than a passion. It was obsession.”

Gottfried Schlaug was perfectly placed to empathise with Gupta and offer advice based upon his own life. Schlaug had studied as an organist at the Vienna Conservatory, but had given up his love for music to pursue a career in medicine.

That afternoon of their meeting, Guptaasked Schlaug, “How was it for you, making that decision?’

Schlaug responded that there were still times when he wished he could go back and play the organ the way he used to. He told Gupta that for him, “medical school could wait, but the violin simply would not.”

Gupta must have decided to take Schlaug’s advice seriously. In the TED talk, he elaborated, “After two more years of studying music, I decided to shoot for the impossible before taking the MCAT and applying to medical school like a good Indian son to become the next Dr Gupta,” to much laughter in the audience.

He auditioned for a position as violinist in the Los Angeles Philharmonic Orchestra. His parents were, perhaps justifiably, skeptical of his chances of securing a place in this, one of the world’s top orchestra. It was his first-ever orchestral audition.

But, “after three days of playing behind a screen in a trial week”, he was offered the position, edging out the competition, some of who had decades of experience more than him. He still remains th youngest-ever to enter the hallowed ranks of the LA Phil, and if I am not mistaken, must be the only South Asian-origin person ever to do so.

A year later, Gupta met another musician, one who had also studied at Juilliard; Nathaniel Ayers (whose life-story inspired the book and the movie “The Soloist” featuring Jamie Foxx and Robert Downey Jr.) was a double-bassist at Juilliard, but had suffered a series of psychotic episodes in his early twenties, and eventually ended up homeless thirty years later on Skid Row in downtown Los Angeles.

Gupta became his friend and violin teacher. “Playing for Nathaniel, the music took on a deeper meaning, because now it was about communication, of a message that went deeper than words, that registered at a fundamentally primal level in Nathaniel’s psyche, yet came as a true musical offering from me.”

Gupta’s experience with Nathaniel opened his eyes to how many tens of thousands more like him were homeless or neglected due to mental issues. “In the end, it was Nathaniel who showed me that if I was truly passionate about change, if I wanted to make a difference, I already had the perfect instrument to do it”, said Gupta in his TED talk, gesturing to his violin. “Music was the bridge that connected my world and his.”

Gupta quotes the German Romantic composer Robert Schumann (who himself suffered from schizophrenia and died tragically in an asylum): “To send light into the darkness of men’s hearts, such is the duty of an artist.”

Nathaniel Ayers inspired Gupta to launch Street Symphony (www.streetsymphony.org), “bringing the light of music into the very darkest places,” performing for the homeless and mentally ill; for combat veterans with PTSD, anf for the incarcerated and those labeled “criminally insane.”

Gupta has found that, “away from the stage, footlights, out of the tuxedo tails”, musicians “become the conduit for delivering the tremendous therapeutic benefits of music on the brain to an audience that would never have access” to it.

He ended his TED talk with a quote by the Romantic English poet John Keats (who had also given up a career in medicine to pursue poetry): “Beauty is truth, and truth beauty. That is all ye know on Earth, and all ye need to know.”

At Child’s Play India Foundation (www.childsplayindia.org), we too can attest to the healing power of music in our children’s lives, many of whom have undergone traumatic upheavals no child should ever have to suffer.

I am most grateful to Gavin and Joanne Pearce Martin, who not only hosted my visit to Los Angeles in 2012 and let me sit in on rehearsals of the Los Angeles Philharmonic, but when I expressed an interest in meeting with Robert Gupta, invited him over so we could discuss ideas at length.

(An edited version of this article was published on 23 September 2018 in my weekend column ‘On the Upbeat’ in the Panorama section of the Navhind Times Goa India)