It may be less than flattering to compare oneself with a government, much less a building or bridge.  Americans do not readily accept support, and view the need for support as a sign of weakness.  Americans are great at providing support, especially physical support; perceiving the lending of support as virtuous and powerful.  Americans are much happier giving support than receiving the same.  Perhaps it is the vestiges of the pioneer spirit.  Perhaps it is a fear of appearing needy and weak.  It can’t be denied that the receiving of support automatically assumes a one down position.  How one chooses to perceive this one down position is the critical factor in the equation.

No matter the degree of intelligence and self-sufficiency, all people require support at some time in their lives.  Some people may never require further physical support after childhood, but they will require emotional support to thrive.  We are social animals, and the fact that ninety percent of us live in cities is sufficient proof of this allegation.  A particular subset of people called schizoid do not appear to need contact with other people; at least not much.  For the rest of us, depression ensues when there is a lack of emotional support in our social environment.  The experience of grief is largely the result of a sudden break in social support.  The recent surge in mass shootings almost always comes from those who, for one reason or another, lack emotional support.

The schizoid person, mentioned above, does not perceive a problem with little emotional support.  This is their preference, and they may be quite successful in other areas of their life.  Such people are rather rare, accounting for far less than one percent of the population.  People that experience grief over a sudden loss are typically bathed in attention from other people, as this is the standard response of most cultures.  A progressive loss of support from illness or job loss does not curry the sympathy engendered by the death of an intimate attachment.  It may be difficult for this subset of people to develop supportive relationships, at least until they feel better or obtain a new job.  Those who take up a gun are exacting revenge upon a society that they perceive as purposefully withholding support.  They experience the lack of emotional support as a personal affront.

Perhaps the alienation many Americans experience is really a loss of emotional support.  We Americans are loath to ask for physical or emotional support, such that the subsequent alienation may be more prevalent in this country than others.  Furthermore, the recent economic downtown has disrupted work relationships and created greater familial stress over finances.    It is a general rule that increased stress engenders decreased emotional availability.  It is difficult to think of others when preoccupied with ourselves.  Many are injured and yet they do not ask for help.  Perhaps it is time for the pioneer philosophy to end.  It would be great to retain its spirit of optimism and enterprise, but this philosophy appears to come at the cost of our emotional well-being.  Increasingly, it is placing our physical well-being at risk from an alienated few.  If only Adam Lanza had decided to pick up the telephone, before deciding to pick up the gun.

The difficulty in observing and measuring emotional support may account for its discounted importance.  If you help a neighbor erect a barn, that barn will stand as a monument to your physical support for many years.  If you assist an aged relative with their finances, their continued independence is a monument to your provision of cognitive support.  If you spend hours wiping away the tears of a recently widowed neighbor, rendering them emotional support, how will you know if it was helpful?  Perhaps it did not help them work through the grieving process, whatsoever.  Perhaps the emotional support merely encouraged them to wallow in self-pity.

This is a similar issue as those who suffer with chronic pain.  Unless others are able to physically visualize the damaged body part, they will tend to progressively discount the suffering of the afflicted over time.  Even if someone spends a thousand percent more time lending emotional over physical support, most people will only be aware of and reward the results seen with their own eyes.  This is to be expected and has good face validity.  There is a greater level of confidence if something is seen rather than inferred or communicated symbolically.  It is as if the world states,”It’s nice you held their hand, but what did you really do for them?”

Perhaps it is less the global worth of each support subtype, than what type of support would be most helpful at a given moment in time.  After a bout of incontinence, it is better to clean the person’s undergarments than hold their hand.  It may be helpful to hold their hand after the garments are cleaned, but the primary need for physical support is quite clear.  On the other hand, if a relative is already placed in a nursing facility, the act of giving physical support may be discouraged by the facility.  The relative worth of a nursing center is realized in its ability to provide physical support.  Most nursing centers encourage significant others to provide cognitive and emotional support.  The provision of cognitive support is typically managed by a relative acting as a power of attorney.  This type of support is cannot be provided by an institution, since it would be a conflict of interest.  The role of social work is to offer both cognitive and emotional support, but all to often, nursing facilities lack a sufficient number of social workers to offer emotional support.  Their hands are full with admission and discharge paper work, which is of critical importance, but limits the time they may employ in what is regarded as support of a secondary nature.

Modern nursing facilities often look to activities therapy staff to provide emotional support, or at least distraction from emotional issues.  This is not the task most of these staff were trained to perform, and it may distract them from the primary mission of providing cognitive stimulation.  It is as if emotional support were a bastard child that is placed with increasingly distant relatives.  Because of these complications, the role of emotional support tends to fall squarely on the shoulders of friends and family.  The most common mistake of the family is to offer physical support in lieu of emotional.  Many family members are critical of the physical support received by their loved one, and often jump in to change or clean the resident of a nursing facility.  This is commonly the result of a guilty conscious.  The caretaker is unable to provide effective care for their loved one in their own home.  In this situation, the relation is providing physical support in an effort to achieve personal emotional support for their own guilt.  Offering physical support to an institutionalized person is rarely appreciated by the person, and is actively discouraged by the nursing center.  It is not the type of support needed from friends and family of an institutionalized person.

The act of providing emotional support is largely measured in the negative.  For example, the resident is not depressed or the resident is not acting-out aggressively.  If the resident is compliant and seemingly happy, it is presumed they are receiving adequate emotional support.  Conversely, if an institutionalized person is depressed or hostile, a lack of familial support is often assumed by the staff.  Emotional support is typically measured by the absence of emotional problems.  This is an inaccurate and sometimes dangerous inference.  All too often smiling friendly people fall to tears after a five minutes of unstructured conversation.  A person’s facial expression and behavior are important clues into their emotional life, but are not by any means a road map.

Unlike physical and cognitive support, do not expect others to acknowledge or appreciate the provision of emotional support.  It typically lacks the emergent and observable nature of physical and cognitive support.  The importance of emotional support assumes a back seat to physical and cognitive support when a person lives in the community.  It moves to the front seat when they reside in an institution.  The individual needs of a person will define the subtype and possible worth of a supportive intervention.   The nature and magnitude of their needs are highly dependent on the environment.  Regardless of the particular environment, though, it is rarely wrong to offer emotional support.  Managing the finances of a independent clear thinking person is usually wrong.  Changing your mother’s bandage in the hospital is always wrong, and may result in the prohibition of further visits.  Offering sympathy is rarely rewarded, and it may not be critically necessary, but it is almost always correct.  How can something be considered of little worth if it always has some value?

This article is perhaps most notable for its contradictions than it is for presenting new ideas.  It is very seductive to believe there is an exact area of the brain that serves as a storage sight of each memory.  It corresponds to the way we store objects in our everyday life.  Nothing is easier or more attractive than to relate complicated processes to our everyday experience.  Contrary to this end, the authors (to their credit) admit that brain cells that fired to a picture of Jennifer Aniston also fired to a picture of another blond actress.  This tends to disprove their contention of discrete cellular representations of each memory.  Another objection advanced by the authors is that there is not enough brain cells to encode every new experience in the human brain.  Essentially, our brain would fill with memories until the bucket could hold no more.  The authors believe the solution to this contradiction is that a “typical person remembers no more than 10,000 concepts.”  Their notion of “concept” is problematic, even beyond their vague definition as to what defines a “concept.”  The notion that all information regarding objects and their relations should hover around 10,000 bits is difficult to accept.

The authors advance another contradiction as proof of their theory.  They cite the famous case of a man whose hippocampus was surgically destroyed.  The hippocampus is a medial temporal lobe structure where the authors believe all our memories are stored.  This unfortunate man could not encode new memories at all, but he enjoyed complete retention of all his old memories-until the time of the surgery.  This strongly contradicts the authors contention of exact cellular storage of each memory.  Given that the hippocampus was destroyed by a surgeon, this man should lose all his old memories as well.  He would literally become a tabula rasa; incapable of even drawing anything new upon the slate.

Even without a detailed knowledge of neuroscience, a critical reading of this article would alert the reader to fundamental problems.  In psychology it is called “internal consistency.”  This refers to a story having a logical progression that avoids contradictions.  The authors brought up the contradictions in order to dispel these arguments; long advanced by psychologists.  They tended to reframe the contradictions in an effort to prove their theory; rather breath new life into an old theory.  This is a perfectly normal error that bedevils all human thought.  Once humans formulate a goal, we will tend to gloss over the contradictions to obtain that goal.  It may be termed “messaging the data” to ensure that data proves the desired outcome.  Science is the bulwark protecting us from ourselves.  Always maintain a critical eye.  These authors have a bit of wool over theirs!

1)  Nothing is as dangerous as a poor doctor: not even a poor employer or a poor landlord.

2)  Of all the anti-social vested interests the worst is the vested interest in ill-health. Mr. Shaw was very much against the profit motive in medicine, and conceptualized it as the greatest impediment to achieving truly scientific medicine.  In an early phase of this treatise, he goes on to write…private medical practice is governed not by science, but by supply and demand; and however scientific a treatment may be, it cannot hold its place in the market if there is no demand for it; nor can the grossest quackery be kept off the market if there is a demand for it.

3)  Remember that an illness is a misdemeanor; and treat the doctor as an accessory unless he notifies every case to the Public Health Authority. Mr. Shaw was for greater transparency in medicine.  He believed that much of the confidentiality advanced by organized medicine assisted the doctor’s practice more than the patient’s health.

4)  Treat every death as a possible and under our present system a probable murder, by making it the subject of a reasonably conducted inquest; and execute the doctor, if necessary, as a doctor, by striking him off the register. This may be considered an extreme form of increasing accountability.

5)  Make up your mind how many doctors the community needs to keep it well.  Do not register more or less than this number; and let registration constitute the doctor a civil servant with a dignified living wage paid out of public funds. This harks back to Mr. Shaw’s belief that the greater the number of physicians practicing in a given area, the greater the pressure on the doctor to secure an income by any means available.

6)  Municipalize Harley Street. This is a famous street where very expensive medical specialists practice.

7)  Treat the private operator (doctor in private practice) exactly as you would treat a private executioner. A bit harsh.

 Treat persons who profess to be able to cure disease as you treat fortune tellers. Mr. Shaw perceived that most medical treatments are advanced because of habit, rather than usefulness.  It was the duty of the doctor to be above treatment based soley upon habit and tradition.  He wrote a bit earlier in this work…A respectable man will lie daily, in speech and in print, about the articles he is selling, because it is customary to do so.  He will flog his boy for telling a lie, because it is customary to do so…He will give the same boy a present on his birthday, and buy him a spade and bucket at the seaside, because it is customary to do so, being all the time neither particularly mendacious, nor particularly cruel, nor particularly generous, but simply incapable of ethical judgment or independent action.

9)  Keep the public carefully informed, by special statistics and announcements of individual cases, of all illnesses of doctors or in their families.

10) Make it compulsory for a doctor using a brass plate to have inscribed on it, in addition to the letters indicating his qualifications, the words “Remember that I too am mortal.” Mr. Shaw believed that much of the doctor’s difficulties in providing scientific treatment were the superstitions of the public.  He understood that frustrating the demands of the patient will quickly bankrupt the doctor.  Despite this understanding, he did not excuse the profession for gratifying the public need for a medical messiah.

11)  In legislation and social organization, proceed on the principle that invalids, meaning persons who cannot keep themselves alive by their own activities, cannot, beyond reason, expect to be kept alive by the activity of others. Mr. Shaw is alluding to the fact that society cannot afford to provide total care for all the needy, and that rationing care should be based upon the usefulness of the person.  A very dark proposition indeed.

12)  Do not try to live forever.  You will not succeed.

13)  Use your health, even to the point of wearing it out.  That is what it is for.  Spend all you have before you die; and do not outlive yourself. This may not be as roughly untrue as it sounds.  The evidence is piling up that antioxidants may actually reduce lifespan, since intermittent stress on the organism appears to increase length of life.  For example, exercise increases free radicals and stresses the organism, but it is indispensable to a healthy lifestyle.

14)  Take the utmost care to get well born and well brought up…Be particularly careful to have all this done at the expense of the nation, as otherwise it will not be done at all, the chances being about forty to one against your being able to pay for it directly yourself, even if you know how to set about it.

As a comedic writer, Mr. Shaw pushes concepts to absurdity in order to find humor in the mundane, such that a number of his statement shouldn’t be taken literally.  The core of his argument appears to be threefold.  First, that medicine was too reliant on ritual and tradition; all too often at the expense of the patient’s health.  Second, that organized medicine was too reliant on pushing more drugs and procedures, at the expense of the patient’s health and finances.  Third, that organized medicine was too isolated and insular, at the expense of the patient’s possible comprehension of their condition.  Regarding the present state of affairs, the gentle reader will have to judge for themselves whether the “was” in the last three sentences should be replaced with an “is.”  All in all, it is fortunate that the study of psychology was strictly an academic discipline at the time of Mr. Shaw’s excoriation of medicine.    It is likely that the Psychologist’s Dilemma would be equally unflattering.