Sunday, June 12, 2016



I let him brush against me,
let his face muss my hair.
I turn to the half-glimmer

of dawn in his eyes —
hold his hand and whisper,
“No, no, it’s impossible.”

I wake up and wonder,
is it all behind me,
that alphabet of glances,

silences — is it all behind us,
that fire and shiver,
lost to us like lilacs,

like the scent of rain —
gone from us forever
because we’re not young —

No, it’s the sacred
shyness of the soul — the heart’s
double truth, an eternal flame.

The flame says nothing is wasted,
not even youth on the young.
How high that highest lantern

shines above our fear of the dark.
He said nothing and I said no,
but in silence everything was said.

~ Oriana © 2016

Upon awakening, I was also keenly aware that the man in the dream was only a “mere suggestion” of a man. It wasn’t anyone I knew — in fact that was the whole point. He was a generic figure standing for the situation when two people meet and within a short time know that under different circumstances they’d likely become lovers.

But do we really know it? A poem like this needs to be kept short, so I didn’t go into “the heart’s double truth.” Infatuation is intoxicating — nature’s trap to get the woman pregnant. But thanks to our complex brain with its competing pathways, there is also usually a shyness about these matters . . .  and there is hardly anymore more erotic than those initial silences between potential lovers.

I’ll say no more.


After an interminable wait (“We thought you became a missing person in that office!” the formidable stem-cell coordinator joked — not funny), the X-rays were up-loaded on the computer — another delay, because the temp technician didn’t know how to do it. Then I heard the PA’s voice (PA stands for “physician assistant” — they do some pretty sophisticated stuff these days) — I heard his loud, powerful voice from the adjacent room (I was in the tiny sausage-like treatment room).  And the voice exclaimed:

“But that’s an incredible improvement!”

And the PA, Patrick, rushed in to talk with me. “I’d love to see the X-rays,” I said. “Just a moment, let me take a picture.” Patrick rushed out. Soon he was back, his I-phone in his outstretched hand. “See, this is your previous X-ray: it’s bone on bone. Now look here: see all the space?”

~ “Does that mean that new cartilage is growing?”

~ “It’s growing.”

In a nutshell: cartilage is very difficult (many sources say “impossible”) to regenerate. Medical advice websites will tell you it simply doesn’t happen (so stop wasting your money on unproven pills and procedures, you fool). And the MRI made it clear that my left knee is extremely damaged. “Severe degeneration.” A damaged ligament, possibly torn. Bones near the knee becoming cystic rubble. The blackness of inflammation surrounding everything. A war zone. Think Syria.

~ “Yes, it’s the new cartilage that’s created the space.”

Patrick gently patted the area right above my knee on the left side. “No swelling,” he said. “Last time you were swollen.” I was amazed that he’d remember. I was still too taken aback by it all to tell him, in regard to swelling, that there were the good days and the bad days — the main factor seemed to be the amount of walking or trying out some recommended exercise (now I know better; more about this later).

And the stem cells aren’t yet done with their good work, Patrick said. I’ll probably have another treatment in December — at half price! Patrick got a big, big hug after that announcement.

But here is the bad news: there’s been very little functional improvement. So we discussed some options for that. Actually there is an adjuvant treatment that helps the stem cells: “Hyaluronic acid helps the stem cells,” Patrick said. He meant injections — hyaluronic acid is not absorbed orally.

As I’ve indicated, the mainstream medical view is that cartilage cannot heal. Stem cells treatment is still very new and untested — most MDs would warn against it. No insurance covers the cost. I knew from the start that I may be wasting my money, depleting my savings chasing a false hope. I took that risk. I just “had to do it.”


There are also new ways to fight inflammation. I told Patrick that my experience has taught me that the key is fighting inflammation. One cause of inflammation is too much exercise, of the wrong sort (and almost all typical exercise is the wrong sort). A damaged joint, already inflamed, can get horribly inflamed after wrong, stressful exercise. In fact, in extreme cases, only the passive motion machine may do good rather than harm.

I realize that exercise is precisely what every website recommends for arthritis. It’s like the pressure to eat “whole grains” and stick to low-fat, high-carbohydrate diet — except that Atkins was a powerful voice who showed otherwise — and all nutritionists condemned him. Some of them are still vocal, though study after study has validated Atkins.

Now, we all know the benefits of exercise for healthy people with undamaged joints, but when it comes to severe damage, painful inflammation can follow (my joint damage began with a torn meniscus when I shattered my knee in a fall down a slippery staircase; I seemed to recover from that, but months later too much walking on hard pavement led to chronic pain, which led to seek medical attention; this led to a disastrous meniscus removal surgery that predictably led to terrible arthritis, as it always does — it wasn’t known back then; the meniscus, a crucial part of the knee’s shock-absorption system, was regarded as a useless clump of tissue, its function unknown, so surgeons removed it with the same gusto with which they used to remove tonsils).

Even too much walking — and “too much” isn’t much by normal standards — can lead to awful pain. Walking, especially on hard surface, is an impact exercise — not as much as running, but it’s still impact. So much for the countless websites saying that nothing is so good for arthritis as walking! Worse, even “gentle stretching” is not at all gentle — there comes a point when any active movement comes with a risk of pain. 

When I reflect on my worst episodes of pain over the years, I now see it with terrible clarity: with only one exception they were all caused by overexercise. 

It took me decades to realize this. Talk about being a slow learner!

Riding a bike, trying to learn to play tennis, a tai-chi class, a yoga class, climbing a steep hill, trying to keep up with the rest of the group — one by one I discovered what I mustn’t do. I discovered it the hard way. As if my awful migraines weren’t enough . . . “Perhaps my life really is a punishment for something terrible I must have done in my past life,” I even said to a couple of friends in what now seems a fit of metaphysical insanity.

Just as “health food” can be the very worst diet for a particular individual, so “healthy exercise” can be the worst thing for a person with an injured joint.


I don’t know enough to comment on a special “light workout” recommended by a certain book — say 60 steps once every hour, and “micro-pushes” against a ball — but even with such minimal workout I would suggest proceeding with caution. If the pain worsens — and it may take a few days to find out — immediately stop any new activity. Stretching, trying to strengthen the quads — all risky, all may aggravate the pain. And pain indicates inflammation and more cartilage loss.

At the same time, we know that lack of motion is bad. I’d like to learn more about the passive continuous motion machines that are being introduced not only after knee replacement, but also after cartilage injuries — I think the light is beginning to dawn that cartilage CAN regenerate — but it takes time and just the right treatment. Passive motion machines show great promise.

The usual treatment is anti-inflammatories. The downside — and this will sound like a cruel joke — is an actual acceleration of joint damage. That, and if the doses are high and taken for a long time, a high risk of kidney failure, and an increased risk of a heart attack and stroke.

But a short-term use of high-dose NSAIDs can make a terrific difference — for a while.

The new anti-inflammatory developments, Patrick said, include microdoses of NSAIDs and the injections of ibuprofen directly into the knee.


I told him I just discovered something much simpler: using a compression bandage to wrap the knee. I couldn’t tolerate various knee sleeves and braces, especially the dreadfully expensive ones meant to compensate for the misalignment of the knee that develops after meniscus removal. But the day before my X-ray appointment I happened to see an elderly man at the library, adjusting the elastic bandage around his knee. At home one of the first posts I read was by a man who’d just happened to discover that wrapping his knee brought great relief from pain. In a dresser drawer I found a generous length of elastic bandage — left from my first stem-cell treatment, I later realized.

On went the bandage, snap went the velcro-like sticky part that holds it, and — instant relief.

I’d been relying on a pain lotion, and having to constantly reapply it was quite disruptive. The bandage turned out to be more effective.


During the consultation, the word “surgery” was never mentioned.

Oh, by the way, my left shoulder also got some stem cells for bursitis and a possible tear. X-rays showed no bursitis or any other abnormality. I expected as much: the recovery was very quick.


Actually, there IS a bit of functional improvement, but definitely not the sort that many people desire: being able to take do pretty much everything, even certain sports (running is out, but one retired nurse claims that after her knee replacement and lots of physical therapy she can sit in the lotus position). For me, more improvement is likely to come later, but given the absence of meniscus, I'll never have full function. Thanks to the original ignoramus surgeons who crippled not just me, but many UCLA football players, the trauma of the surgery was too much to contemplate, and the possible complications later. Infections and resulting amputations are rare, but they do happen to some patients.

For someone still at a relatively early to intermediate stage of joint deterioration, I wouldn't hesitate to recommend stem cells. At my advanced stage, it’s up to the person, after considering the many factors involved: age, state of fitness, presence or absence of cardiovascular disease, ability to tolerate some disability, and so on.

The interesting thing is that I was told back in 1992 that I needed TKR or I wouldn't be able to walk within two years. The orthopedic surgeon showed me the devastating X-rays. But because I remembered the horror of my first knee surgery, when my meniscus was removed, I decided to research alternative treatments. Glucosamine was just gaining publicity then, but the recommended doses were pathetically insufficient. Being a wild spirit, I started taking more and more of it; two years passed, then three, then four etc and I was walking better than before. And not just walking — I was hiking in the mountains. Thank goodness I didn't have knee replacement back in the early nineties, when the artificial joints were of terrible quality and the procedure extremely invasive. Now I still haven't 100% ruled out TKR, but I'm very happy that a biological solution exists.


The big promise of stem cells: heart disease, brain diseases, and autoimmune diseases. The future is not yet, but you can read online about the first steps being made.

One last detail: as I was driving home, my brain started playing Rachmaninoff’s Second Piano Concerto, the grand, sweeping orchestral part. It was involuntary — it’s just the sort of thing my brain does now and then instead of commenting in words. I love it when it happens.


You can read about my stem cell treatment (the step-by-step procedure) here:

OUR INNER MONOLOGUE (Julian Jaynes: When the gods stopped speaking — how his theory fares today)

“In the beginning of the book, Jaynes asks, “This consciousness that is myself of selves, that is everything, and yet nothing at all—what is it? And where did it come from? And why?” Jaynes answers by unfurling a version of history in which humans were not fully conscious until about 3,000 years ago, instead relying on a two-part, or bicameral, mind, with one half speaking to the other in the voice of the gods with guidance whenever a difficult situation presented itself. The bicameral mind eventually collapsed as human societies became more complex, and our forebears awoke with modern self-awareness, complete with an internal narrative, which Jaynes believes has its roots in language.

The kind of search that Jaynes was on—a quest to describe and account for an inner voice, an inner world we seem to inhabit—continues to resonate. The study of consciousness is on the rise in neuroscience labs around the world, but the science isn’t yet close to capturing subjective experience. That’s something Jaynes did beautifully, opening a door on what it feels like to be alive, and be aware of it.

He writes that the characters in The Iliad do not look inward, and they take no independent initiative. They only do what is suggested by the gods. When something needs to happen, a god appears and speaks. Without these voices, the heroes would stand frozen on the beaches of Troy, like puppets.

The combination of instinct and voices—that is, the bicameral mind—would have allowed humans to manage for quite some time, as long as their societies were rigidly hierarchical, Jaynes writes. But about 3,000 years ago, stress from overpopulation, natural disasters, and wars overwhelmed the voices’ rather limited capabilities. At that point, in the breakdown of the bicameral mind, bits and pieces of the conscious mind would have come to awareness, as the voices mostly died away. That led to a more flexible, though more existentially daunting, way of coping with the decisions of everyday life—one better suited to the chaos that ensued when the gods went silent. By The Odyssey, the characters are capable of something like interior thought, he says. The modern mind, with its internal narrative and longing for direction from a higher power, appears.

He cites a carving of an Assyrian king kneeling before a god’s empty throne, circa 1230 B.C. Frequent, successive migrations around the same time in what is now Greece, he takes to be a tumult caused by the breakdown. And Jaynes reflects on how this transition might be reverberating today. “We, at the end of the second millennium A.D., are still in a sense deep in this transition to a new mentality. And all about us lie the remnants of our recent bicameral past,” he writes, in awe of the reach of this idea, and seized with the pathos of the situation. “Our kings, presidents, judges, and officers begin their tenures with oaths to the now-silent deities, taken upon the writings of those who have last heard them.”

It’s easy to find cracks in the logic: Just for starters, there are moments in The Iliad when the characters introspect, though Jaynes decides they are later additions or mistranslations. But those cracks don’t necessarily diminish the book’s power. Particularly, [Dennett] thinks Jaynes’ insistence on a difference between what goes on in the minds of animals and the minds of humans, and the idea that the difference has its origins in language, is deeply compelling.

“There is such a difference between the consciousness of a chimpanzee and human consciousness that it requires a special explanation, an explanation that heavily invokes the human distinction of natural language,” though that’s far from all of it, he notes. “It’s an eccentric position,” he admits wryly. “I have not managed to sway the mainstream over to this.”

It’s a credit to Jaynes’ wild ideas that, every now and then, they are mentioned by neuroscientists who study consciousness. In his 2010 book, Self Comes to Mind, Antonio Damasio, a professor of neuroscience, and the director of the Brain and Creativity Institute at the University of Southern California, sympathizes with Jaynes’ idea that something happened in the human mind in the relatively recent past. “As knowledge accumulated about humans and about the universe, continued reflection could well have altered the structure of the autobiographical self and led to a closer stitching together of relatively disparate aspects of mind processing; coordination of brain activity, driven first by value and then by reason, was working to our advantage,” he writes.

In 2009 [Kujisten] highlighted brain-imaging studies suggesting that auditory hallucinations begin with activity in the right side of the brain, followed by activation on the left, which sounds similar to Jaynes’ mechanism for the bicameral mind. He hopes that as time goes on, people will revisit some of Jaynes’ ideas in light of new science.

Ultimately, the broader questions that Jaynes’ book raised are the same ones that continue to vex neuroscientists and lay people. When and why did we start having this internal narrative? How much of our day-to-day experience occurs unconsciously? What is the line between a conscious and unconscious process? These questions are still open. Perhaps Jaynes’ strange hypotheses will never play a role in answering them. But many people—readers, scientists, and philosophers alike—are grateful he tried.


I continue to be fascinated by the “inner chatter” as well as by the question that first arose with religion lessons: why did multiple people hear god speak in the biblical times, but now there is only silence? Jaynes may be onto something — and he came up with his “bicameral” theory well before neuroimaging and all we’ve learned about hallucinations and dreams.

Emile Cioran said, “The Greeks awakened to philosophy the moment their gods were no longer adequate; ideas begin where Olympus leaves off. To think is to stop venerating.” But when and why did the gods become inadequate? Here Jaynes's theory may be relevant.

To me the lingering death of religion, along with the shift toward naturalistic explanations and humanism as opposed to the worship of an imaginary Superman in the Sky, is the greatest story and adventure of humanity, the most dramatic development in the cultural evolution. First, granted, came the development of language, and nothing compares to the quantum leap of that -- but that was so long ago . . .  The development of modern consciousness is relatively recent.

“Cultural” doesn’t mean that the biology of brain function is not involved. On the contrary, we know that speech rewires the brain. Perceiving our inner voice as simply our thoughts rather than a god speaking to us (also, think of a schizophrenic hearing voices) — what a breakthrough! Amazingly, there are those — certain Jungians in particular — who prefer the archaic — or maybe “schizophrenic” is a more accurate term — idea that our thoughts are being broadcast to us from the astral realm, and the brain is
only a radio.

Detail of "Dormition of the Virgin" at Cloisters, New York. Photo: Leonard Kress

“The real cause of depression, and all the rest of psychiatric symptoms, follows from the way one’s unique consciousness is formed in the brain all through development from embryonic life to age twenty. Our developmental experience is mapped in the limbic system and the cortex as incredibly complex circuits of neuronal maps that reflect the impacts of love, respect, deprivation, and abuse as digested by one’s unique temperament. These brain maps generate human consciousness — which is organized in as a drama in the theater of the brain with a cast of personas, feeling relationships between them, scenarios, plots, set designs and landscapes. The internal play is the consummate creation of the human genome. Once established, beginning at age three, the representational play operates via top down cortical processing, and is the invisible prism through which we live our lives.

Serotonin and the other neurotransmitters operate in the synapses of our limbic cortical brain maps connecting the trillions of neurons that create the mappings that form our plays. Serotonin has no life of its own. It is merely a brain mechanism that serves the neuronal organization of consciousness, the play itself. The way the limbic-cortical brain maps our experience reflects the actuality of our experience. IF OUR CHARACTER PLAY IS TOO DAMAGED BY DEPRIVATION AND ABUSE, IT GENERATES AN INVISIBLE SADOMASOCHISTIC PLAY THAT IS FILLED WITH ATTACK AND HUMILIATION, endless war. Consequently the activated internal play is one of continuous internal fighting between personas. As such it feeds on the serotonin supply on an ongoing basis. It is inevitable that the supply will be overtaxed. This is not the result of a serotonin problem. It is built in from a damaged characterological play. It is not a question of ‘if’, but only ‘when’ serotonin will be overused and depression will appear.”


I feel uneasy about anyone who states, “The REAL cause of X is Y.” But the two paragraphs I chose do speak to my own experience. I used to have an acute sense of an “anti-self” within. The anti-self wanted me to fail just to prove that I was a total failure — especially in poetry (alas, I did pay for becoming a poet with a life-long sense of failure) and in love, but also in professional life — in everything that mattered.

I realize that the play of sub-personalities a simplified conceptualization — but the anti-self that felt real and kept producing images of my dead body or my body falling in an act of suicide. So “depression as an internal theater” makes some sense to me, as does the sadomasochistic tone of it, “attack and humiliation.”

As a result of insight, or perception shift, my own “anti-self” appears to have vanished, while the “wise one” keeps pointing out that having “failed” (in quotation marks because success is a matter of definition) at this or that doesn’t mean that I don’t have a lot to give. “You can fail at everything you do, and still be a success as a person.” But it was interesting to read this, and to find myself nodding my head.

The rest of the article is controversial, I know. I step away from the drug issue. I simply don’t know. “I did it my way.”

But I have also experienced a mood elevating effect from anti-inflammatories, so the issue of inflammation and depression is also of great interest to me. And the fact that anti-inflammatories produce mood elevation shows that physiological factors do have an impact and must be taken into consideration — without denying that the sadomasochistic automatic thinking is critical in deepening and perpetuating depression.

With billions of people intersecting, interacting globally, continuously, we can figure that billion of things bounce off each other globally, continuously. Good things, bad things, unpredictable things, kind and terrible things, strange and unexplainable things.

 But the Law of Large Numbers degrades to nonsense when we try connecting dots for personal meaning and comfort. We want the dots to spell a message that we, among all people on earth, are special to God. That's when Jesus shows up on toast. That's when a hurricane kills dozens in New Orleans — because — as Pat Robertson put it — God hates gays.

People connect dots for personal reasons. A family survives a tornado in Kansas that blows their neighbors off the map, and they declare on national TV that God answered their prayers. Too bad about the neighbors.

Since time began we have been story telling, pattern seeking, meaning making animals. But religious dots, like history, are connected only by survivors.

Chris Kammal, a Florida paramedic:

 “I work as a medic fireman. I see death and mayhem routinely. I have run thousands of calls over the last 23 years and so many of them were people in extreme crisis, or already dead when we got there.

I was asked the other day if I've ever seen miracles or things that can't be explained. My response was that I see many things beyond explanation but never anything miraculous. The miraculous implies that forces outside this world intervened, defying the basic principles of nature. But theres no evidence that the laws of physics have ever been suspended to save someone who was standing in the way.

A tree falling on a child doesn't reverse course because a mom cries out to God. There's no evidence that the universe has ever been manipulated by outside forces — in spite of ancient mythology or miraculous bible stories.

I've seen cars recognizable only by their tires, yet everyone came out alive with light injuries. I've seen cars with only moderate damage, with everyone dead.

I've seen a college freshman waiting at school for his mom to pick him up, but before she got there another driver had a heart attack, jumped the curb and killed the kid. Random is the rule.

The universe does not care who you are, where you come from, how religious you are, or how much money you have. We are all potential victims. Of course, good information and alert thinking help avoid problems before they happen. But you can't always avoid a drunk barreling the wrong way in your lane, or a tsunami that washes 430,000 innocent people to their deaths.

When you are at wits end, or your life is on the line, or you're down in the foxhole of war, you might or might not pray. It helps people transcend the circumstances they're trapped in. When people pray, it can ease the stress in their minds. They need hope, even if it's fantastical. Personally, I think it's no different than doing a line of coke, or smoking a joint.

It's my belief that if more of the world embraced the truth of randomness, we would spend less time being afraid of imaginary, omnipotent gods in the sky, and spend more time helping our fellow human beings.”


“A tree falling on a child doesn’t reverse course because a mom cries out to God” — I don’t think there is a single adult in the world who believes otherwise. Gravity rules, not god — the laws of nature in general. The best discussion of this that I’ve come across happens to be a chapter on “Signs and Wonders” in Jesse Bering’s “The Belief Instinct” — one of the most important books I’ve ever read. Its intellectual clarity is breath-taking. 

We are wired for seeking patterns. For instance, we tend to see faces even in inanimate objects: trees, cars. Our pattern-seeking cognitive bias, the practically irresistible tendency to connect the dots, can easily lead us astray. 

Speaking of cognitive errors, my father often pointed out that the basic error was the assumption of divine omnipotence. Once we remove that, more interesting concepts of something like a deity can be developed (though I'm not sure we need to cling to “deity”; when Rabbi Kushner speaks about the “power of ideals” it’s a lot more clear to keep calling it the “power of ideals” rather than hanging the god baggage on it). The healing power of empathy and of our own unconscious are of special interest to me, how certain neural pathways are capable of taking over and the brain can rewire itself in an instant. 

Paul Klee, The Forgetful Angel, 1939

ending on beauty:

The truth is, we are nearer to heaven
Each time we lie down.
Take a look at the cat
Rolled over with its feet in the air.

~ Charles Simic, from “Midsummer”


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