Saturday, April 28, 2007

Changing Attitudes about Addiction

In the 1960s, Dr. Marie Nyswander, a trained Freudian psychoanalyst, and Dr. Vincent Dole, a metabolic disease specialist who was chair of the NYC Health Research Council's Committee on Narcotics (not a job he particularly wanted) established the first methadone maintenance clinics in NY for heroin addicts. In the late fifties, Nyswander had begun working with jazz musicians addicted to heroin. The prevailing Freudian theory of heroin addiction at that time hypothesized that these male artists were actually homosexuals who used heroin to over-activate the superego and suppress the id. The overall understanding of drug addiction in the 60s was that there was an "addictive personality" type that took drugs to escape reality in order to conceal inadequacies. Frustrated by her experience with her patients' propensity to relapse, Nyswander accepted a position at the Rockefeller Center offered by Dole and the two began a collaboration to discover both the nature of addiction and possible treatments. In 1965, they were the first to establish methadone treatment clinics. In 1967, Dole and Nyswander published a groundbreaking theory that heroin addicts had undergone permanent metabolic changes, and that abstinence was an unrealistic expectation - maintenance in the form of methadone replacement was the goal. It brought into prominence the existing but previously unpopular theory that drug addiction was a physical disease and not a moral failing, as Drs. Nyswander and Dole saw no correlation between sociopathic tendencies and addiction once addicts were being treated. They were one of the first to refer to the disease of addiction as "persistent neurochemical disturbance," though the theory can be dated (without scientific support) to the 20s. In personal gossip, in 1965 Nyswander abruptly ditched her writer husband and married Dole.

More info about methadone: it is a long-lasting mu opioid receptor agonist. It reduces craving and withdrawal symptoms, but does not produce euphoria unless doses are very high. If heroin is administered while methadone is on board, it prevents the euphoria associated with heroin. Its use as a replacement therapy is controversial and affected by general attitudes and perceptions about drug addiction. The late 70s especially saw strong demand to not open more methadone clinics, as punitive measures against drug addicts again became popular. Its controlled substance status prevents it from being administered by a personal physician, and it can only be given at one of these special clinics (it also is rarely allowed to be self-administered at home). I believe the Drug Enforcement Agency, and not a health care organization, is still the group that operates methadone clinics.

More about heroin: Heroin is converted into morphine in the brain, and acts at μ-opioid receptors on GABA inhibitory interneurons in the ventral tegmental area. This activation may close N-type calcium channels, possibly through G-protein interactions or inhibition of adenylyl cyclase. These interneurons are therefore inhibited. The resulting disinhibition at the post-synaptic cell leads to increased firing of dopaminergic cells that are usually inhibited by these interneurons.

The first epidemic of opiate addiction in the U.S. occurred after the Civil War - it is estimated that up to 400,000 soldiers were addicted to morphine (the infamous "skin-poppers," - morphine administered subcutaneously). The next time opiate addiction was widely publicized in this country was after the Vietnam War; where it's estimated that up to 50% of American soldiers used heroin regularly while in Vietnam, and 20% returned to the U.S. addicted. This was also around the time when cocaine was touted as "the perfect drug" by a weekly news magazine, a "non-addictive party drug," because of the lack of physical withdrawal symptoms from repeated cocaine use - it was believed then that addicts took drugs to alleviate withdrawal symptoms. Thirty years later, the anhedonia hypothesis has largely been discredited.

Thursday, April 26, 2007

Family Music

When I was a child, I told my family I was going to marry Smokey Robinson one day. I could recognize Smokey's beautiful tenor, the child-like innocence and sadness in his lyrical phrasing, the second I heard it. Hearing Smokey sing, “One day, I’ll hold you near, whisper I still love you, but ‘til that day is here, oh, I’m crying…” sent me into girlish ecstasy. And he was so darn cute. I could do a wonderful Diana Ross impression, tilting my head, brushing my hair away from my face, and lifting up my hands to sing "Ain't no Mountain High Enough," but only if it would have seduced Smokey. The first cds I ever owned (given to me by my parents) were Smokey Robinson cds. I'm fairly confident they weren't really trying to make me so obsessed with Smokey that I WOULD pursue nothing in life other than being Mrs. Robinson, but I do think they took joy in the fact that I was so seduced by that music, that voice.

I've written previously that my father grew up as a sharecropper, from a paternal line of sharecroppers. He graduated from high school (neither of his parents had), went to college, majored in physics, and got a job working as an engineer with an oil company. He worked there for nearly 30 years, retired, and now works there as a consultant. Upward mobility.

But other than neighborhoods, houses, and cars, my father has never embraced any of the other aspects of upper middle class American society, or what it means in such society to be "cultured." He doesn't care about plastic art or opera, Mozart or Magritte. He has no idea why I own so many books about ballet or history. The first time classical music crossed the threshold in our home was when my sister and I became fanatical about it, exposed to it through piano lessons.

But my father does love music. And how he loves it - with a stereo system that certainly rattles the windows of the house next door, blasting Ray Charles, offering up a, "Sing it, boy!" to an impassioned plea of a male soul singer to his lost lover. I could probably label each year of my childhood by the songs that my father was playing over and over again.

When I was very young, I particularly remember B.B. King and Bobby "Blue" Bland. My father would be driving the car on the way to Opelousas, eyes on the road, but tilting his head back and forth and slapping his knee, singing a half step behind B.B. King to "The Thrill is Gone." When "Caledonia" came on, he'd look at my mom, and sing,"what makes your big head so hard?!" I also knew, even then, that this music meant something special to him. As a kid, his family hadn't owned a record player, except for the brief time his family had one on "loan," lent to them by his older sister's suitor. When the romantic relationship ended, the young man took his record player with him, and my father and his siblings were once again left in musical silence. I think my father's been making up for the lack ever since he could afford to.

Once we arrived in Opelousas, what can only be described as the great zydeco tape exchange would occur. My paternal grandmother (MaMa) would usually have the radio on and tuned to a Saturday morning zydeco program, on a radio station that probably played other types of music during the rest of the week. MaMa or my father's brother would start the exchange: "This is a really good tape..." and so it would go - making copies of tapes, putting them on to listen to a particular song and laugh out loud, my father occasionally looking at me and repeating what had just been said in French by Clifton Chenier (pictured above) or Queen Ida or Buckwheat Zydeco to me. I don't understand Cajun or Creole French, or even formal French, but this didn't stop my father's delight in repeating the French lyrics of zydeco songs to us. It also made him reflective, and he'd tell us about his pig named Susie, who'd given birth to six pigs on his sixth birthday, or how picking okra was so much worse than picking up cotton (okra cuts open your hands, neck, and back), or give us instruction in how to make a stubborn mule move.

There are songs I remember from my first five years of life, songs that I sang and danced to, that have no place in a particular memory: James Brown's "Night Train," and "I Got the Feelin,'" Rufus and Chaka Khan in "Tell Me Somethin' Good." And later, when I was about 11 and my father got a brand new stereo system with speakers that could rattle the glasses in the kitchen cabinet: Otis Redding's "I've Been Loving You Too Long," Wilson Pickett, Marvin Gaye, and Sam Cooke. I don't think my father has ever bought music by a white artist for his own consumption. Whether it's because he doesn't like it or doesn't relate to it, I'm not sure. But there is something about that zydeco, the blues, the R&B and soul singers, that he does relate to. And as even I can recognize, there's something about the music of black artists that's utterly absent in the music of white artists, and if you've grown up with the former, you long for that special something.

I referenced bell hooks' essay on Madonna in a comment, and this valuable quote: "White folks who do not see black pain never really understand the complexity of black pleasure." I include that here, because listening to these songs often put my father in a reflective mood, not only about the poverty of his childhood, but about being black in south Louisiana. He'd recall, sadly, being in (segregated) schools and getting 'new' textbooks, only to look inside the cover and see that they'd already been used, with the names of the white kids who had used the books in the years before written there, just as an extra reminder (as if it were needed) of black inferiority, since one had to sit out on the curb to eat, not being allowed to sit in most restaurants, and using the back door. Or of having no place to stay in New Orleans in the late 60s, being refused to have a car sold to him in the late 70s, or of being told in the late 80s that black people weren't allowed to live in certain neighborhoods of the community where we moved.

The pain in his voice, the resignation, was so similar to that of a former roommate. She was from Zimbabwe; her parents came to America because, in her father's words, "It's better to be treated like a dog in someone else's back yard than in your own." Elegant would be the one word I would use to describe her, and she had been a molecular biology graduate student, looking for a place to live in College Station, TX in 1999. Over the phone, she'd talk to potential roommates and landlords and they would be enthusiastic about meeting her. But when they'd see her, the expression would change, the voice would become curt, and they'd say, "sorry, someone else wants the room/apartment." This happened six times, until she learned to say, "Hi, my name is Sharon, and I am African-American..." in her phone introductions, which at least reduced her travel time to visit places to live.

In our own home, my father would sometimes get down on his knees, to show us the way James Brown performed his song "Please, Please, Please" -“Please, please, please, please…please, please…Baby, take my hand. I wanna be your lover man. Oh yeah, good God Almighty, honey please…” I learned what it meant for a man to love a woman from those soul songs. In the vocal range of male R&B singers there has to be the falsetto, the duplication of female vulnerability, the adoration of the beloved. In some fundamental way, in the stylings of black vocalists and the simple lyrics of their songs, all that mattered was having a woman - she could mitigate the rest of the pain caused by the reality of life for a black man. Maybe that's why the pleas of Redding, Brown, Cooke, Charles, and other R&B and soul singers are so much more moving than in any other style of music I've heard. They're back down to basics - nothing in life to look forward to or hold on to but love. The most simple joys of life are all you've got.

My mother's musical interests centered around easy listening, like Johnny Mathis, Nat King Cole, and Julio Iglesias. I don’t know how many times I’ve heard “99 Miles from L.A.” in my life, or how many alternate lyrics my sister and I came up with for Dionne Warwick's "Do You Know the Way to San Jose." My mother got excited over receiving an Anne Murray album. I thought these were appropriate musical selections for a woman who had nearly been a nun, who attends daily Mass, who spends several hours using the Montessori method to teach underprivileged 3 and 4 year olds their letters, numbers, shapes, and colors, and who would then prepare meals or pick up dinner for the homebound, spending extra time at their homes to talk to them, wash their dishes and clothes, and clean their house if necessary.

But these musical preferences weren’t always the case with my mother: get her to talk about herself (a nearly impossible task), and she’ll admit to loving the Commodores, the Beatles - the Temptations’ “Just My Imagination” is her favorite song. So every now and then, when my mother wasn't cleaning up, cooking, or sitting at the kitchen table learning the names that went along with the faces of the kids she taught (and oh, what names), my father could induce her to dance with him for part of a song. He'd call her name, ask her to dance, she'd say she was too busy, but okay, and they'd dance to a song like Marvin Gaye and Tammi Terrell's "Your Precious Love." My mother would giggle, my father would tease my sister and me with a "don't look!" and we'd listen: "heaven must have sent you from above/oh, heaven must have sent your precious love." (And my parents have been married for nearly 34 years now, so it must work.)

But for female ecstasy when listening to soul singing, oh, that came from my cousin and her devout love/lust for Al Green. My cousin would occasionally babysit us, and she'd put my parents' copy of Al Green's "I'm Still in Love with You" LP on the record player, and moan and sing. She'd fling her head back and sing, "Lay your head...on my pillow...make believe you looove last tiiiime...for the good times." And then salivate over the pictures of Al Green on the album cover. I learned from her that the mere sound of a man's lyrical voice could make a woman leave reason behind.

As I wrote at the beginning of this way too long trip down memory lane, my own favorite was Smokey Robinson. However, my favorite song came from another soul great, the one who objectively, I have to say had the most beautiful, lyrical voice. There's no one like Sam Cooke ("A Change is Gonna Come" has probably sent chills down the spine of anyone who's ever heard it), and no song I love more than "Bring it on Home to Me." With Lou Rawls singing backup vocals, this song is as perfect as can be in conveying the desire for a lost lover, the desire to be the steady force in her life, and her haven. And it's so utterly, heartbreakingly simple, starting off with just a piano and bass.

If you ever change your mind
About leavin', leavin' me behind,
Oh, bring it to me, bring your sweet lovin'
Bring it on home to me.

I know I laughed when you left
But now I know, I only hurt myself
Bring it to me, bring your sweet lovin'
Bring it on home to me.

I'll give you jewelry and money too
That ain't all, that ain't all I'd do for you, (Oh, I'm gonna give you)
Bring it to me, bring your sweet lovin',
Bring it on home to me, yeah, yeah, yeah.

You know I'll always, be your slave
Til I'm buried, buried in my grave,
Oh honey, bring it to me, bring your sweet lovin'
Bring it on home to me, yeah.

Of course, alot of the great R&B and soul singers of days past started off singing in gospel choirs, several were sons/daughters of pastors, and at least two notable ones, Little Richard and Al Green, actually became pastors after huge secular success. And in their music, I think, you can hear the lack of difference between loving in this life and worshipping the Lord. When it works, this is music that demands that every fiber of your being be turned over to love, to the moment, to the music, to the Almighty. It testifies, it praises, it pleads. And I'm thankful for every moment my father unintentionally blasted it in my eardrums, and for seeing him with his eyes closed, sway back and forth to it, with the most peaceful of smiles on his face feeling that music and the joy.

P.S. Here is a review of Al Green's album mentioned above, from 1972:

This is what they are: "I'm Still in Love with You" opens the album with one of Green's more extraordinary vocals. The line, "I'm ... wrapped up in your love," delivered twice, is sung high, almost disappearing at the end of his range, and yet enveloping—the perfect vocal equivalent of being hugged tightly in someone's arms. He stretches the word "heaven" and it shimmers or he dips his voice down low at the end of a line as if to insinuate it into every possible corner of the song. As with most Al Green songs (this one written in collaboration with drummer Al Jackson and producer Willie Mitchell), the lyrics are simple, almost unremarkable and in this case touchingly inarticulate: "Spending my days/thinkin' 'bout you girl./Being here with you/being near with you/Can't explain myself." Throughout, Willie Mitchell's production work is as consistently strong as Green's vocals. It's never trite, never obtrusive—none of those wedges of unrelieved production (something quite different from music) you find driven into so many other albums—and always several steps ahead of being just right. Mitchell provides a texture in his production that is the perfect complement to Green's singing while establishing its own richness but avoids calling attention to itself with those hey-hey-aren't-I-hot touches so many big-time producers love to indulge themselves with.

"Love and Happiness" is about my favorite new cut here (the other previously released cut, aside from the title song, is "Look What You Done for Me," released early last spring)—after a powerful, take-your-time introduction, a very upbeat, horn-punctuated five minutes. The lyrics aren't much, but they have a loose, elliptic quality that allows the song to drift off into all kinds of improvisatory-style things at the end. The following two cuts are lovely, almost too pretty but with a saving edge of emotion. Again, the lyrics are not exceptional but, oh god, who cares with these glowing arrangements and Al Green caressing, stroking, loving the words until they're about to burst. On "What a Wonderful Thing Love Is," he says "I been cryin'" with a feeling that equals Smokey Robinson's "I'm cryin'" in "Ooo Baby Baby." Is there anything finer? "Simply Beautiful" is more vocal exposition, very loose, slightly indulgent but so tenderly sexy it gives you shivers.

Rolling Stone review, Vince Aletti, 1972.

Monday, April 23, 2007

Plan for Alexandria, Wind up in Constantinople?

Deus Vult! Jonathan Phillips’ The Fourth Crusade and the Sack of Constantinople (2004) (I’ve previously reviewed Madden’s Enrico Dandolo and the Rise of Venice and a book Phillips edited about the First Crusade.)

Here is a (very) brief chronology of the Fourth Crusade, with parts for the major players:

June 1198
Pope Innocent III: Go to the Holy Land, avenge the injury to Christ!

Crusaders: Mea culpa, we have sinned! We will repent by recapturing the Holy Land! We will pay our own way there!

April 1201
Crusade leaders: We need a way to get 33,500 men there.
Venetians: We will suspend all other operations for a year to help you get there; we’ll only charge per man and horse for all the men.
Crusade leaders: Yeah! (sotto voce) Don’t tell anyone we are really going to first sack Alexandria and use Egypt as a launching point for recapturing the Holy Land.
Venetians: Yeah! (sotto voce) The riches of Alexandria will also help pay our expenses and give us access to that market!
Pope Innocent III: Get moving!

Summer 1202
Venetians: Where is everyone?
Crusade leaders: Oh no! We are idiots! Some of the crusaders found passage to the Holy Land another way! We only have 12,000 men with us!
Crusade leaders: (sotto voce) Don’t forget, we are going to Alexandria.

utumn 1202 – the Sack of Zara
Venetians: Why not help us recover our debts now – let’s sack the Christian city of Zara!
Crusaders: Yeah! They have been fighting you guys for years anyway!
Innocent III: You’re all excommunicated!

December 1202
Young Prince Alexius: Help me depose the usurper Alexius III and recover the Byzantine throne for myself and my father! I will pay LOTS! And give you even more men and ships to conquer Alexandria.
Venetians: We can get our money back?!
Crusaders: Yeah, let’s go to Constantinople!
Pope Innocent III: You’re all excommunicated!

June 1203
Crusaders: Yeah, we’re outside of Constantinople!
Venetians: Parade Alexius around so that the people will welcome him and we can get our money and get out of here!
Young Prince Alexius: OOPS! (sotto voce) I might have left a few things out…I don’t know…the situation is more delicate than that….
Byzantines: Who is this fool Alexius? We will not negotiate!

July 1203 – SIEGE! FIGHT!
The Byzantines roll over, Alexius and his increasingly insane father Isaac II share power, Alexius III flees.

August 1203
Venetians: Where is our money?
Now Emperor Alexius: Ah, oh, hmm, um…
Isaac II: We owe you nothing!


Fall 1203
Crusaders: Let’s leave!
Emperor Alexius (Alexius IV): If you leave, I can’t keep the throne and I won’t be able to repay you! But here, let me burn down some religious art and relics to pay you!
Venetians: Money, money, money!
Pope Innocent III: You’re all excommunicated!
The Byzantine throne changes hands a few more times, all the emperors (6 in about a year) refuse to negotiate with the Crusaders and get them away from the city.

Winter 1204
Byzantines: We’re going to kill you!
Crusaders: Huh?!

Lent 1204
Byzantines: Prepare for war!
Crusaders: Umm, okay!

April 1204 – SIEGE, take two
Crusaders: GRRR!
Byzantines: AAAH!!! Run for your lives!

13 April 1204
Byzantines: We surrender!
Crusaders: We’re going to take EVERYTHING!
Byzantines: AAAH!!! Run for your lives!

Venetians: We have our money!
Crusaders: We have money too!
Both in unison: Divide the spoils of the city!

Innocent III: You’re all excommunicated! How many times do I have to declare it? 'How, indeed, will the church of the Greeks, no matter how severely she is beset with afflictions and persecutions, return into ecclesiastical union and to a devotion for the Apostolic See, when she has seen in the Latins only an example of perdition and the works of darkness, so that she now, and with reason, detests the Latins more than dogs? As for those who were supposed to be seeking the ends of Jesus Christ, not their own ends, who made their swords, which they were supposed to use against the pagans, drip with Christian blood,­ they have spared neither religion, nor age, nor sex.' Oh, wait (November 7, 1204), the capture of Constantinople is a ‘magnificent miracle…done by the Lord and is wondrous in His eyes.’

In Phillips' analysis, the fundamental error of the Fourth Crusade, the one that placed the whole expedition on the railings towards a train wreck, was the failure to ensure that all Crusaders would take the Venetian vessels to the Holy Land, as had been contracted by the Crusade leaders. For thirteen months Venice suspended all other commercial activity to prepare a fleet for the Crusade: enough room for 4,500 knights, 9,000 squires, and 20,000 foot soldiers. Also included was room for 4500 horses and the 30,000 Venetians (half the population of the city) who would be required to sail this fleet of 200 to 250 ships. When less than half the proposed number of Crusaders showed up in Venice, the leaders were left holding a contract that owed a tremendous amount of money to the Venetians to avoid the economic collapse of that state. Almost everything that played out over the next two years were maneuvers to allow the Crusade leaders to recover the money that was owed to the Venetians.

Once we reach Constantinople, there are a few very important lessons: 1) Do not antagonize a standing army outside one’s city, particularly an army composed of battle-experienced soldiers who have been away from home and family and living on rations for over three years. Do not rattle this cage. 2) Byzantine politics have never looked so byzantine. When an army is outside the gates and all they really want is money and then to get out of there, never-ending political upheaval, refusing them money, and attacking them is NOT a good idea, especially if on the way to your city they already sacked one of their own. 3) Was there not a single skilled military leader for the Byzantines in all of Constantinople?! Talk about a military in disarray…

Phillips' book follows the work of Queller and Madden to re-examine the Fourth Crusade, and revise the rather hostile to the West interpretations of Runciman and JJ Norwich. About 30 years ago, Queller published works that focused attention on the devout piety of Western crusaders, and as is clear from contemporary accounts (Robert of Clari, Geoffrey of Villehardouin), Westerners really were profoundly moved by requests to reconquer the Holy Land for the sake of Christ. They were also battle-experienced: military skills were a regular part of life. Both Queller and Madden have carefully searched for support for the commonly held view that the Venetians wanted to divert the Crusade to Constantinople in order to eliminate a shipping rival, and have found the evidence sorely lacking. Madden's works on Venetian history carefully demonstrate the degree to which stability was prized by the Venetians, and how they would have had no interest in diverting resources to maintain control or govern additional lands, as their own actions after the establishment of the Latin Empire indicate. It was mere chance that the future Emperor Alexius IV, also a brother-in-law to one of the Crusade leaders, would show up asking for assistance in recapturing the Byzantine throne of his deposed father, Isaac II.

But these facts do not address the most striking element of the sack of Constantinople: not the fact that it happened, but the sheer violence of it. The Crusaders, in fact, had made a vow not to engage in killing of women or children, or pillage of sacred sites, and they were also supposed to turn in all of their spoils to be divided according to previously agreed upon percentages. Neither Phillips, Queller, or Madden have proferred explanations of why the sack of the city played out the way it did. We are only left to surmise that perhaps the average knight in Crusade, having committed himself to the conquest of the Holy Land, and then forced to languish on a sandy island outside of Venice for nearly 9 months, suffered through disease outbreaks and plague conditions on the Adriatic coast, diverted to conquer another Christian city and been excommunicated for it, only to end up outside of Constantinople for nearly a year and at times be terrorized by a hostile populace was perhaps not, in modern day terms, in the healthiest frame of mind.

Now to the book: Phillips writes in an engaging style that is meant to entertain the casual reader. He intersperses his thoughts with letters and documents from the time period and successfully creates an “if you were there” feel. This book is not as detailed or exhaustive as Queller & Madden’s definitive The Fourth Crusade: The Conquest of Constantinople (2nd ed 1997), which revised the entire view of the Fourth Crusade by analyzing the goals of the Venetians and finding the evidence to support a planned attack on Alexandria, not Constantinople, on the way to the Holy Land. But it is a fun read.