Oliver Sacks Everything in Its Place book extract | Saturday Review | The Times

In this unpublished essay, the late neurologist and writer discusses his insights and where he felt hope.

Having worked as a neurologist in old-age homes and chronic hospitals for almost 50 years, I have seen thousands of older patients with Alzheimer’s disease or other dementias. One sees a kaleidoscopic array of symptoms and dysfunctions, never exactly the same in any two people. The neurological dysfunctions interact with all that is unique in an individual — their pre-existing strengths and weaknesses, their intellectual powers, their skills, their life experience, their character, their habitual styles, as well as their particular life situations.

Alzheimer’s disease may first present as a full-blown syndrome, but more often it starts as isolated symptoms so focal that one may initially suspect a small stroke or tumour; it is only later that the generalised nature of the disease becomes evident (hence the frequent failure to diagnose Alz- heimer’s at the start). The early symptoms, whether they appear singly or in clusters, are usually subtle. There may be momentary illusions or misperceptions; or difficulties getting jokes or following arguments. But in general it is the most recently evolved functions that are the first to be affected.

In these very early stages, the dysfunctions tend to be momentary. But soon there are grosser disturbances of cognition, memory, behaviour, judgment, and disorientation in space and time, all finally coalescing as profound dementia. As the disease advances it may bring distressing personality changes and even violent behaviour in some people. Finally, every possible cortical disorder may be seen in this devastating disease, even though the paths by which the disease advances are so different in each patient.

Sooner or later patients lose the power to articulate their condition, to communicate in any way, except in so far as tone of voice, touch, or music can briefly reach them. Finally, even this is lost and there is indeed total loss of consciousness, of cortical function, of self-psychic death.

Caring for someone else, especially if that someone is already quite demented and is inexorably going downhill, can involve back-breaking physical exertion as well as a constant, almost telepathic sensitivity to what is going on in a mind now less and less able to communicate its thoughts, less and less able to have clear thoughts. People with dementia may get terrifyingly confused and disoriented. Such a burden can make the caretaker ill with stress. As a physician, I see this all too often.

And yet there are many ways the beleaguered patient may adapt and react, or even help themselves. One of my patients, very early in the course of her disease, suddenly found that she could no longer tell the time when she looked at her watch. She saw the position of the watch hands clearly, but she could not interpret them; for a split second, they made no sense, and then, equally suddenly, they did. The unintelligible periods lengthened to seconds, then minutes, and soon the watch hands were unintelligible all the time.

She was acutely and mortifyingly conscious of this deterioration; it gave her a sharp sense of horror, of the Alzheimer’s process behind it. But she herself was the one to make a crucial therapeutic suggestion: Why don’t I wear a digital watch, she asked, and have digital clocks everywhere? She acted on this, and although her agnosia and other problems continued to increase, she remained able to tell the time and organise her day for another three months.

Another of my patients, who was fond of cooking and whose overall cognitive powers were still very good, found that she could no longer compare the volume of liquids in different containers; an ounce of milk did not look the same if it was poured from a glass into a pan, and ludicrous errors started to occur. The patient herself, a former psychologist, ruefully recognized this as a Piagetian error, a loss of the sense of volumetric constancy that is acquired in early childhood. However, by using graduated vessels and measuring cups instead of trying to guess as she used to, she was able to compensate for the problem and to continue safely in the kitchen.

Such patients may perform badly on formal mental testing and yet be able to describe with clarity, vividness, correctness and humour precisely how one bakes an artichoke or a cake; they may be able to sing a song, tell a story, act a part, play a violin, or paint a painting with remarkably little impairment. It is as if they have lost certain modes of thought while retaining other modes perfectly.

It is sometimes said that people with Alzheimer’s do not realise that they are impaired, that insight is lost from the start. Although this may sometimes be so, it is more common, in my experience, for patients to realize their condition at first. Thomas DeBaggio, a writer and horticulturalist, was even able to publish two insightful memoirs about his own early-onset Alzheimer’s before the disease killed him at the age of 69. Most patients are frightened or mortified by the knowledge of what is befalling them.

Some continue to be severely terrified as they lose their intellectual competences and bearings and find themselves in a world increasingly fragmented and chaotic. But the majority, I think, become calmer with time as they perhaps start to lose the sense of what they have lost and find themselves shifted into a simpler, unreflective world. Such patients might seem to have regressed intellectually, so that they are once again like children. Kurt Goldstein, a neurologist and psychiatrist, would say of such patients that they were now in a lower, more concrete form of consciousness or being.

For John Hughlings Jackson, the great English neurologist, there were never just deficits with neurological damage, but “positive” symptoms, as he called them, “releases” or exaggerations of normally constrained neural functions. He spoke of “dissolution”, which was, for him, characterised by regression or reversion to more archaic levels of neural function — the reverse of evolution.

Although Jackson’s notion of dissolution in the nervous system as evolution in reverse can no longer be maintained in so simplistic a fashion, one does see some remarkable behavioural regressions or releases in a disease like Alzheimer’s. I have often seen patients with advanced dementia who show picking, hunting and brushing — a whole range of primitive grooming behaviours that are not seen in normal human development, but are suggestive, perhaps, of a reversion to a primate level. In the final stages of dementia, where no organised behaviours of any sort remain, one may see reflexes that are normally only seen in infancy, including grasping reflexes, snout and sucking reflexes.

Such dissolution was very clear, Jackson thought, in the processes of dreaming, delirium and insanity, and his long 1894 paper The Factors of Insanities is full of fascinating observations and insights in this regard.

One may see remarkable (and sometimes very poignant) behavioural regressions at a more human level too. I had one patient — a very demented woman of 100, who was incoherent, distracted and agitated much of the time — who, if given a doll, would immediately become focused, sharply attentive and take the doll to her breast as if to nurse it, rocking it in her arms, cuddling it, crooning to it. As long as she was occupied by this mothering behaviour, she was perfectly calm; but the moment she stopped, she became agitated and incoherent again.

The sense that everything is lost with a diagnosis of Alzheimer’s is all too common among neurologists, as well as among patients and their families. This may give rise to a premature sense of impotence and doom, whereas in fact all sorts of neurological functions seem remarkably able to persist relatively intact.

In the early part of the 20th century, neurologists started to pay more attention not just to the primary symptoms of neurological disease, but also to the compensations and adaptations to these. Goldstein, studying brain-damaged soldiers during the First World War, was moved from his original, deficit-based point of view to a more holistic one. There were never, he believed, just deficits; there were always reorganisations, and these he saw as strategies (albeit unconscious) by which the brain-damaged organism sought to survive.

People with Alzheimer’s disease may remain intensely human, very much themselves, and capable of normal emotion and relationships until quite late in their illness. (This preservation of self may, paradoxically, be a source of torment for the patient or their families, who see them so painfully eroded in other ways.)

The relative preservation of the personal allows a great range of supportive and therapeutic activities that have in common that they address or evoke the personal. Religious services, theatre, music and art, gardening, cooking, or other hobbies can anchor patients despite their disintegrations and temporarily restore a focus, an island of identity. Familiar melodies, poems, or stories may still be recognised and responded to despite advanced disease.

As Henry James was dying, with pneumonia and a high fever, he became delirious — and it is said, as I wrote in Hallucinations, that though the master was raving, his style was “pure James” and, indeed, “late James”. The neural embodiment of self, it seems, is extremely robust. Every perception, every action, every thought, every utterance seems to bear the mark of the individual’s experience, of his value system, of all that is peculiar to him. If individual experience and experiential selection so determine the developing brain, we should not perhaps be surprised that individuality, self, is preserved for so long even in the face of diffuse neuronal damage.

Aging, of course, does not necessarily entail neurological illness. Working in old-age homes, where people are admitted with a variety of problems (heart ailments, arthritis, blindness, or sometimes just loneliness and a desire to live in a community), I see numbers of old people who are, so far as I can judge, intellectually and neurologically wholly intact. Indeed, several of my patients are bright and intellectually active centenarians who have retained all their zest for life.

One woman, admitted at the age of 109 with diminishing vision, discharged herself once her cataracts had been taken care of and returned home to an independent life. (“Why should I stay here with all these old people?” she asked.) Even in a chronic hospital, there is a sizable proportion of people who can live out a century or more without significant intellectual decline, and this proportion must be considerably greater in the population at large.

So it is not just the absence of disease or preservation of function that we should be concerned with, but the potential for a continuing development throughout life. Cerebral function is not like cardiac or renal function, which proceeds autonomously, almost mechanically, in a fairly uniform way throughout life. The brain/mind, in contrast, is anything but automatic, for it is always seeking to categorise and recategorise the world, to give meaning to its own experience.

It is the nature of living a real life that experience is not uniform, but ever changing and ever challenging and requiring more and more comprehensive integration. It is not enough for the brain/mind simply to tick over (like the heart); it must adventure and advance throughout life. The very concept of health or wellness requires a special definition in relation to the brain.

A distinction must be made in the aging patient between longevity and vitality. A constitutional sturdiness and good luck may make for a long and healthy life. I think here of five siblings I know, all in their nineties or early hundreds, all looking far younger than their age, and all having the physiques, the sexual drives, the behaviours of much younger people. And yet, human beings may be physically and neurologically healthy, but psychically burned out at a relatively early age.

If the brain is to stay healthy, it must remain active, wondering, playing, exploring and experimenting right to the end. Such activities or dispositions may not show up on tests, but they are of the essence in defining the health of the brain and in allowing its development throughout life. This accords well with what Erik and Joan Erikson devoted a lifetime to studying: universal, age-related stages that seem to appear in all cultures. As the Eriksons advanced through their nineties, they added a further stage to the eight stages they originally described: the stage appropriate to old age — wisdom or integrity.

The achievement of this stage involves the synthesis of a long lifetime’s experience, coupled with the lengthening and enlargement of the individual’s perspectives and a sort of detachment or calm. Such a process is entirely individual. It cannot be prescribed or taught; nor is it directly dependent on education or intelligence or specific talents. “We cannot be taught wisdom,” as Proust remarks, “we have to discover it for ourselves by a journey which no one can undertake for us, an effort which no one can spare us.”

Are such stages purely existential or cultural — the behaviours, the perspectives appropriate to various ages and stages — or do they also have some specific neural basis? We know that learning is possible throughout life, even in the presence of cerebral aging or disease, and we can be sure that other processes, at a much deeper level, are continuing, too — a culmination of the ever wider and deeper generalisations and integrations that have been occurring in the brain/mind throughout life.

In the 19th century, when a powerful mind could still take all of nature for its subject, the great naturalist Alexander von Humboldt, after a lifetime of travel and scientific research, embarked in his mid-seventies on a grand synthetic view of the universe, bringing together everything he had seen and thought into a final work, Cosmos. He was well into its fifth volume when he died at 89.

If we are lucky enough to reach a healthy old age, this sense of wonder can keep us passionate and productive to the end of our lives.

Everything in Its Place: First Loves and Last Tales by Oliver Sacks, is published by Picador on May 2.

link to the original : What Oliver Sacks’s patients taught him about dementia — Everything in Its Place book extract | Saturday Review | The Times


Oliver Black obituary | The Times

Oliver Black with Maud, who changed radio channels with her backside

For the past 13 years an eclectic group of writers, academics, philosophers, diplomats, lawyers and others have gathered on a Sunday afternoon every other month at a gorgeous Georgian house in Spitalfields, east London, the home of Oliver Black and his wife, Jenny. After tea and cake there is a 20-minute talk followed by a discussion. Such is the popularity of this salon, with guests sitting on chairs, window ledges, floors and stairs, that on one recent occasion the drawing-room floor began to sag and numbers have had to be limited.

Black was a paradoxical man: serious yet humorous, misanthropic yet sociable. He collected friends with the same enthusiasm a young boy might collect stamps. He loved conversation and dinner parties. Acquaintances would be gathered to read through a play or to listen to a recording of an opera, with Black providing copies of the score.

Despite effortlessly blending his academic studies in philosophy with his “day job” as a lawyer, Black was sometimes introduced to people as “London’s leading hypochondriac”, although he insisted that “valetudinar–ian” was more accurate. “A valetudinarian can always find something on which to hook his anxiety: a tender gland in the neck (sign of mumps), a mild rash (shingles), a dry throat (Ebola), a lack of energy (almost anything),” observed the man who was on first-name terms with his GP, Vera.

This and other subjects were discussed with dry, deadpan humour in his book Shrunk and Other Stories (2016), its title coming from the way in which his bank account was diminished by visits to shrinks. In these autobiographical meanderings, with chapter headings such as DIE-DIY, Road Hogs of the World, and Spotty and Horny, Black describes the pitfalls of arranging DIY funerals for relatives, the delights of driving a black cab as a private car, and how he refused to live in East Anglia for fear that the fallout from a dirty bomb in London would be carried on the prevailing wind.

One of Black’s university friends was Anthony Gottlieb, who became executive editor at The Economist, and it was through him that Black met Jenny Geddes, who was editorial manager of the paper’s website. They married in 2004 and settled in east London, where Jenny, who survives him, is now an interior decorator. One friend described how the couple had a “grinning delight” in each other, revelling in the absurd and enjoying each other’s sense of playfulness. Children adored him, although the affection was rarely reciprocated.

His nickname for Jenny was Fluffy, while she would call him “Baby Jesus”, a name that came about during the “passionate stage” of their courtship, as he explained: “It was that moment when, seed and passion spent, you used to light a cigarette, but, as neither Fluffy nor I smoked, she wrapped the duvet around my head and shoulders like a shawl. ‘Baby Jesus!’ she cried.”

On one occasion they contemplated acquiring a bird as a pet, which brought back memories for Black of travelling with a former girlfriend to a farmhouse near Bologna to visit a gay couple who kept hens and “a strutting, polychromatic cock”. He was making clucking noises at it when one of their hosts walked up in a pair of tight white jeans. “ ‘I’m admiring your cock,’ I heard myself say, and he gave me a sly smile,” Black wrote, adding: “You can understand why Americans prefer to say ‘rooster’.”

Oliver Misha Black was born in London in 1957, the son of Misha Black, an eminent Azerbaijani-Jewish designer who helped to create the distinctive road signs on the streets of Westminster, and his second wife, Joan (née Fairbrother), a former Wren who worked for Unesco. From his father’s first marriage he had a half-brother, Jake, who became an anthropologist and died in a skiing accident some years ago, and a half-sister, Julia, a textile designer, who survives him. An uncle was Max Black, a leading postwar figure in analytic philosophy.

Young Oliver was about 15 when he accompanied his parents to Buckingham Palace, where his father was being knighted by the Queen. He was wearing a maroon denim suit with flared trousers, with disastrous consequences. “As I got into the limo, the crotch split from end to end, and I spent the morning with my thighs pressed together.”

He recalled his mother acquiring a car, although once she got out to ask directions and forgot to apply the handbrake. As the car rolled backwards she shouted, “The brake, the brake,” to Black’s father, “whose head wobbled in panic as he gawped at the dash board”. Leaning forward from the back seat, Oliver pulled on the brake, later musing: “It is worrying to think that my father designed planes and locomotives.”

He was educated at Bryanston School, Dorset, where he was third trombonist in the school band, and read philosophy at Queens’ College, Cambridge, taking the parts of both Rosencrantz and Guildenstern in a production of Hamlet because the student playing Guildenstern was “useless”. He continued to act, taking part in “playlets” by Gottlieb.

It was at Cambridge that he had his first encounter with psychotherapy, although he was mortified when a letter referring him to a new analyst was opened by his mother, who had mistaken the brown envelope for a bill. It read: “Dear Oliver, you are right to continue treatment, especially for your sex problem.”

His first brush with the law came when driving a friend home after an evening’s hard drinking. “As we hit 65 on Ladbroke Grove, a blue flashing light appeared in the mirror,” he recalled. “Getting out of the car, I lost my balance and rolled on to the road. ‘You don’t care if you lose your licence or not, do you, chummy?’ the policeman said to me with standard irony, his face hardening when I prattishly replied, ‘Not really, I’m at Cambridge most of the time and have little use for a car.’ ” He got a £200 fine and a ban.

For two years he worked at Bernard Quaritch, the antiquarian book store in Mayfair, developing a new department specialising in philosophy and the human mind, before spending 1981 as a fellow at the University of California, Berkeley. Back in Britain he taught philosophy at Cambridge.

By 1987 Black had a doctorate in philosophy from University College London, but jobs for philosophers were few and far apart. It was a problem he encapsulated in Diary of a Misplaced Philosopher (1989), a humorous, first-person account written using the pseudonym Joseph North that describes his fellow lodgers in a shabby boarding house and his family, friends and lovers, and his triumphs and humiliations.

Instead, Black sat his law exams and in 1989 joined Linklaters, the multinational law firm, where he eventually rose to be head of the UK procurement law practice and counsel in the competition and regulation group. The issues on which he advised included Network Rail’s acquisition of Railtrack, the restructuring of Anglian Water, and NatWest’s defence against takeover bids.

He kept in touch with academic life, writing several papers on competition law, and in 2000 was appointed visiting research fellow in philosophy and law at King’s College London, later becoming visiting professor. By then he had arranged with Linklaters to work a four-day week spread over five days, studying philosophy at home until 11am before walking into the City.

In 2005 Black brought together the two halves of his life, philosophy and antitrust law, in Conceptual Foundations of Antitrust, followed in 2012 by Agreements: A Philosophical and Legal Study. His novel The Commune (2014), a bittersweet comedy about a group of old people who decide to live together, was well received, and work is expected to start this summer on a film adaptation, while Other Revelations, a sequel to Shrunk, is due to be published next year.

Black had no interest in religion, but he adored trains, especially steam-hauled services. He recalled that the best birthday present he received from Fluffy was “a ride in a driver’s cab” on the Underground, although he perhaps spoilt the effect by comparing it with the images as he watched a colonoscopy camera explore his bowels, describing the latter view as “like that from the cab of the Northern Line train, only the sides of the tunnel were pink and squashy, and there were no stations”.

In recent years Black’s feline companion was Maud, an eight-year-old tabby rescue cat. She regularly accompanied him to his beloved 18th-century cottage in Dorset, where he would write. Maud had a habit of sitting on the radio, using her backside to change channels. “We therefore covered the buttons with a large cookery book, and Maud now sits on the face of Delia,” he observed with possibly too much pleasure.

Oliver Black, corporate lawyer, philosopher and author, was born on January 8, 1957. He took his own life on March 27, 2019, aged 62

via Oliver Black obituary | Register | The Times

A Mysterious Infection, Spanning the Globe in a Climate of Secrecy

The New York Times · by Matt Richtel · April 6, 2019

i love the alarmist tone of this article and i love that ‘nature’ is ‘fighting back’ against the humans and yeah we’re all gonna die sooner or later and with any luck ‘we’ will completely die out because ‘we’ are fuckwits.

see also this : Spread of the killer superfungi

Bacteria are rebelling. They’re turning the tide against antibiotics by outsmarting our wonder drugs.

Last May, an elderly man was admitted to the Brooklyn branch of Mount Sinai Hospital for abdominal surgery. A blood test revealed that he was infected with a newly discovered germ as deadly as it was mysterious. Doctors swiftly isolated him in the intensive care unit.

The germ, a fungus called Candida auris, preys on people with weakened immune systems, and it is quietly spreading across the globe. Over the last five years, it has hit a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and taken root in India, Pakistan and South Africa.

Recently C. auris reached New York, New Jersey and Illinois, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.”

The man at Mount Sinai died after 90 days in the hospital, but C. auris did not. Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it.

“Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” said Dr. Scott Lorin, the hospital’s president. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”

C. auris is so tenacious, in part, because it is impervious to major antifungal medications, making it a new example of one of the world’s most intractable health threats: the rise of drug-resistant infections.

Dr. Shawn Lockhart, a fungal disease expert at the Centers for Disease Control and Prevention, holding a microscope slide with inactive Candida auris collected from an American patient.CreditMelissa Golden for The New York Times

For decades, public health experts have warned that the overuse of antibiotics was reducing the effectiveness of drugs that have lengthened life spans by curing bacterial infections once commonly fatal. But lately, there has been an explosion of resistant fungi as well, adding a new and frightening dimension to a phenomenon that is undermining a pillar of modern medicine.

“It’s an enormous problem,” said Matthew Fisher, a professor of fungal epidemiology at Imperial College London, who was a co-author of a recent scientific review on the rise of resistant fungi. “We depend on being able to treat those patients with antifungals.”

Simply put, fungi, just like bacteria, are evolving defenses to survive modern medicines.

Yet even as world health leaders have pleaded for more restraint in prescribing antimicrobial drugs to combat bacteria and fungi — convening the United Nations General Assembly in 2016 to manage an emerging crisis — gluttonous overuse of them in hospitals, clinics and farming has continued.

Resistant germs are often called “superbugs,” but this is simplistic because they don’t typically kill everyone. Instead, they are most lethal to people with immature or compromised immune systems, including newborns and the elderly, smokers, diabetics and people with autoimmune disorders who take steroids that suppress the body’s defenses.

Scientists say that unless more effective new medicines are developed and unnecessary use of antimicrobial drugs is sharply curbed, risk will spread to healthier populations. A study the British government funded projects that if policies are not put in place to slow the rise of drug resistance, 10 million people could die worldwide of all such infections in 2050, eclipsing the eight million expected to die that year from cancer.

Dr. Johanna Rhodes, an infectious disease expert at Imperial College London. “We are driving this with the use of antifungicides on crops,” she said of drug-resistant germs.CreditTom Jamieson for The New York Times

In the United States, two million people contract resistant infections annually, and 23,000 die from them, according to the official C.D.C. estimate. That number was based on 2010 figures; more recent estimates from researchers at Washington University School of Medicine put the death toll at 162,000. Worldwide fatalities from resistant infections are estimated at 700,000.

Antibiotics and antifungals are both essential to combat infections in people, but antibiotics are also used widely to prevent disease in farm animals, and antifungals are also applied to prevent agricultural plants from rotting. Some scientists cite evidence that rampant use of fungicides on crops is contributing to the surge in drug-resistant fungi infecting humans.What You Need to Know About Candida AurisC. auris is a mysterious and dangerous fungal infection that is among a growing number of germs that have evolved defenses against common medicines. Here are some basic facts about it.April 6, 2019

Yet as the problem grows, it is little understood by the public — in part because the very existence of resistant infections is often cloaked in secrecy.

With bacteria and fungi alike, hospitals and local governments are reluctant to disclose outbreaks for fear of being seen as infection hubs. Even the C.D.C., under its agreement with states, is not allowed to make public the location or name of hospitals involved in outbreaks. State governments have in many cases declined to publicly share information beyond acknowledging that they have had cases.

All the while, the germs are easily spread — carried on hands and equipment inside hospitals; ferried on meat and manure-fertilized vegetables from farms; transported across borders by travelers and on exports and imports; and transferred by patients from nursing home to hospital and back.

C. auris, which infected the man at Mount Sinai, is one of dozens of dangerous bacteria and fungi that have developed resistance. Yet, like most of them, it is a threat that is virtually unknown to the public.

A projection of the C. auris fungus on a microscope slide.CreditMelissa Golden for The New York Times

Other prominent strains of the fungus Candida — one of the most common causes of bloodstream infections in hospitals — have not developed significant resistance to drugs, but more than 90 percent of C. auris infections are resistant to at least one drug, and 30 percent are resistant to two or more drugs, the C.D.C. said.

Dr. Lynn Sosa, Connecticut’s deputy state epidemiologist, said she now saw C. auris as “the top” threat among resistant infections. “It’s pretty much unbeatable and difficult to identity,” she said.

Nearly half of patients who contract C. auris die within 90 days, according to the C.D.C. Yet the world’s experts have not nailed down where it came from in the first place.

“It is a creature from the black lagoon,” said Dr. Tom Chiller, who heads the fungal branch at the C.D.C., which is spearheading a global detective effort to find treatments and stop the spread. “It bubbled up and now it is everywhere.”

‘No need’ to tell the public

In late 2015, Dr. Johanna Rhodes, an infectious disease expert at Imperial College London, got a panicked call from the Royal Brompton Hospital, a British medical center outside London. C. auris had taken root there months earlier, and the hospital couldn’t clear it.

“‘We have no idea where it’s coming from. We’ve never heard of it. It’s just spread like wildfire,’” Dr. Rhodes said she was told. She agreed to help the hospital identify the fungus’s genetic profile and clean it from rooms.

Under her direction, hospital workers used a special device to spray aerosolized hydrogen peroxide around a room used for a patient with C. auris, the theory being that the vapor would scour each nook and cranny. They left the device going for a week. Then they put a “settle plate” in the middle of the room with a gel at the bottom that would serve as a place for any surviving microbes to grow, Dr. Rhodes said.

Only one organism grew back. C. auris.

It was spreading, but word of it was not. The hospital, a specialty lung and heart center that draws wealthy patients from the Middle East and around Europe, alerted the British government and told infected patients, but made no public announcement.

“There was no need to put out a news release during the outbreak,” said Oliver Wilkinson, a spokesman for the hospital.

This hushed panic is playing out in hospitals around the world. Individual institutions and national, state and local governments have been reluctant to publicize outbreaks of resistant infections, arguing there is no point in scaring patients — or prospective ones.

“Somehow, it made a jump almost seemingly simultaneously, and seemed to spread and it is drug resistant, which is really mind-boggling,” said Dr. Snigdha Vallabhaneni, a fungal expert and epidemiologist at the C.D.C.CreditMelissa Golden for The New York Times

Dr. Silke Schelenz, Royal Brompton’s infectious disease specialist, found the lack of urgency from the government and hospital in the early stages of the outbreak “very, very frustrating.”

“They obviously didn’t want to lose reputation,” Dr. Schelenz said. “It hadn’t impacted our surgical outcomes.”

By the end of June 2016, a scientific paper reported “an ongoing outbreak of 50 C. auris cases” at Royal Brompton, and the hospital took an extraordinary step: It shut down its I.C.U. for 11 days, moving intensive care patients to another floor, again with no announcement.

Days later the hospital finally acknowledged to a newspaper that it had a problem. A headline in The Daily Telegraph warned, “Intensive Care Unit Closed After Deadly New Superbug Emerges in the U.K.” (Later research said there were eventually 72 total cases, though some patients were only carriers and were not infected by the fungus.)

Yet the issue remained little known internationally, while an even bigger outbreak had begun in Valencia, Spain, at the 992-bed Hospital Universitari i Politècnic La Fe. There, unbeknown to the public or unaffected patients, 372 people were colonized — meaning they had the germ on their body but were not sick with it — and 85 developed bloodstream infections. A paper in the journal Mycoses reported that 41 percent of the infected patients died within 30 days.

A statement from the hospital said it was not necessarily C. auris that killed them. “It is very difficult to discern whether patients die from the pathogen or with it, since they are patients with many underlying diseases and in very serious general condition,” the statement said.

As with Royal Brompton, the hospital in Spain did not make any public announcement. It still has not.

One author of the article in Mycoses, a doctor at the hospital, said in an email that the hospital did not want him to speak to journalists because it “is concerned about the public image of the hospital.”

The secrecy infuriates patient advocates, who say people have a right to know if there is an outbreak so they can decide whether to go to a hospital, particularly when dealing with a nonurgent matter, like elective surgery.

Outside the Royal Brompton Hospital near London. By June 2016, the hospital had seen at least 50 “proven or possible” cases of C. auris, and decided to shut down its intensive care unit for 11 days to address the contamination.CreditTom Jamieson for The New York Times

“Why the heck are we reading about an outbreak almost a year and a half later — and not have it front-page news the day after it happens?” said Dr. Kevin Kavanagh, a physician in Kentucky and board chairman of Health Watch USA, a nonprofit patient advocacy group. “You wouldn’t tolerate this at a restaurant with a food poisoning outbreak.”

Health officials say that disclosing outbreaks frightens patients about a situation they can do nothing about, particularly when the risks are unclear.

“It’s hard enough with these organisms for health care providers to wrap their heads around it,” said Dr. Anna Yaffee, a former C.D.C. outbreak investigator who dealt with resistant infection outbreaks in Kentucky in which the hospitals were not publicly disclosed. “It’s really impossible to message to the public.”

Officials in London did alert the C.D.C. to the Royal Brompton outbreak while it was occurring. And the C.D.C. realized it needed to get the word to American hospitals. On June 24, 2016, the C.D.C. blasted a nationwide warning to hospitals and medical groups and set up an email address, candidaauris@cdc.gov, to field queries. Dr. Snigdha Vallabhaneni, a key member of the fungal team, expected to get a trickle — “maybe a message every month.”

Instead, within weeks, her inbox exploded.

Coming to America

In the United States, 587 cases of people having contracted C. auris have been reported, concentrated with 309 in New York, 104 in New Jersey and 144 in Illinois, according to the C.D.C.

The symptoms — fever, aches and fatigue — are seemingly ordinary, but when a person gets infected, particularly someone already unhealthy, such commonplace symptoms can be fatal.

The earliest known case in the United States involved a woman who arrived at a New York hospital on May 6, 2013, seeking care for respiratory failure. She was 61 and from the United Arab Emirates, and she died a week later, after testing positive for the fungus. At the time, the hospital hadn’t thought much of it, but three years later, it sent the case to the C.D.C. after reading the agency’s June 2016 advisory.

This woman probably was not America’s first C. auris patient. She carried a strain different from the South Asian one most common here. It killed a 56-year-old American woman who had traveled to India in March 2017 for elective abdominal surgery, contracted C. auris and was airlifted back to a hospital in Connecticut that officials will not identify. She was later transferred to a Texas hospital, where she died.

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The germ has spread into long-term care facilities. In Chicago, 50 percent of the residents at some nursing homes have tested positive for it, the C.D.C. has reported. The fungus can grow on intravenous lines and ventilators.

Workers who care for patients infected with C. auris worry for their own safety. Dr. Matthew McCarthy, who has treated several C. auris patients at Weill Cornell Medical Center in New York, described experiencing an unusual fear when treating a 30-year-old man.

“I found myself not wanting to touch the guy,” he said. “I didn’t want to take it from the guy and bring it to someone else.” He did his job and thoroughly examined the patient, but said, “There was an overwhelming feeling of being terrified of accidentally picking it up on a sock or tie or gown.”

Dr. Tom Chiller, head of the fungal branch at the C.D.C. “It is a creature from the black lagoon,” he said of C. auris.CreditMelissa Golden for The New York Times

The role of pesticides?

As the C.D.C. works to limit the spread of drug-resistant C. auris, its investigators have been trying to answer the vexing question: Where in the world did it come from?

The first time doctors encountered C. auris was in the ear of a woman in Japan in 2009 (auris is Latin for ear). It seemed innocuous at the time, a cousin of common, easily treated fungal infections.

Three years later, it appeared in an unusual test result in the lab of Dr. Jacques Meis, a microbiologist in Nijmegen, the Netherlands, who was analyzing a bloodstream infection in 18 patients from four hospitals in India. Soon, new clusters of C. auris seemed to emerge with each passing month in different parts of the world.

The C.D.C. investigators theorized that C. auris started in Asia and spread across the globe. But when the agency compared the entire genome of auris samples from India and Pakistan, Venezuela, South Africa and Japan, it found that its origin was not a single place, and there was not a single auris strain.

The C.D.C. in miniature. In the United States, two million people contract resistant infections each year, and 23,000 die from them, according to the official C.D.C. estimate.CreditMelissa Golden for The New York Times

The genome sequencing showed that there were four distinctive versions of the fungus, with differences so profound that they suggested that these strains had diverged thousands of years ago and emerged as resistant pathogens from harmless environmental strains in four different places at the same time.

“Somehow, it made a jump almost seemingly simultaneously, and seemed to spread and it is drug resistant, which is really mind-boggling,” Dr. Vallabhaneni said.

There are different theories as to what happened with C. auris. Dr. Meis, the Dutch researcher, said he believed that drug-resistant fungi were developing thanks to heavy use of fungicides on crops.

Dr. Meis became intrigued by resistant fungi when he heard about the case of a 63-year-old patient in the Netherlands who died in 2005 from a fungus called Aspergillus. It proved resistant to a front-line antifungal treatment called itraconazole. That drug is a virtual copy of the azole pesticides that are used to dust crops the world over and account for more than one-third of all fungicide sales.

A 2013 paper in Plos Pathogens said that it appeared to be no coincidence that drug-resistant Aspergillus was showing up in the environment where the azole fungicides were used. The fungus appeared in 12 percent of Dutch soil samples, for example, but also in “flower beds, compost, leaves, plant seeds, soil samples of tea gardens, paddy fields, hospital surroundings, and aerial samples of hospitals.”

Dr. Meis visited the C.D.C. last summer to share research and theorize that the same thing is happening with C. auris, which is also found in the soil: Azoles have created an environment so hostile that the fungi are evolving, with resistant strains surviving.

This is similar to concerns that resistant bacteria are growing because of excessive use of antibiotics in livestock for health and growth promotion. As with antibiotics in farm animals, azoles are used widely on crops.

“On everything — potatoes, beans, wheat, anything you can think of, tomatoes, onions,” said Dr. Rhodes, the infectious disease specialist who worked on the London outbreak. “We are driving this with the use of antifungicides on crops.”

Dr. Chiller theorizes that C. auris may have benefited from the heavy use of fungicides. His idea is that C. auris actually has existed for thousands of years, hidden in the world’s crevices, a not particularly aggressive bug. But as azoles began destroying more prevalent fungi, an opportunity arrived for C. auris to enter the breach, a germ that had the ability to readily resist fungicides now suitable for a world in which fungi less able to resist are under attack.

The mystery of C. auris’s emergence remains unsolved, and its origin seems, for the moment, to be less important than stopping its spread.

An empty hospital bed at Mount Sinai.CreditHilary Swift for The New York Times

Resistance and denial

For now, the uncertainty around C. auris has led to a climate of fear, and sometimes denial.

Last spring, Jasmine Cutler, 29, went to visit her 72-year-old father at a hospital in New York City, where he had been admitted because of complications from a surgery the previous month.

When she arrived at his room, she discovered that he had been sitting for at least an hour in a recliner, in his own feces, because no one had come when he had called for help to use the bathroom. Ms. Cutler said it became clear to her that the staff was afraid to touch him because a test had shown that he was carrying C. auris.

“I saw doctors and nurses looking in the window of his room,” she said. “My father’s not a guinea pig. You’re not going to treat him like a freak at a show.”

He was eventually discharged and told he no longer carried the fungus. But he declined to be named, saying he feared being associated with the frightening infection.

Matt Richtel is a best-selling author and Pulitzer Prize-winning reporter based in San Francisco. He joined The Times staff in 2000, and his work has focused on science, technology, business and narrative-driven storytelling around these issues.


Andrew Jacobs is a reporter with the Health and Science Desk, based in New York. He previously reported from Beijing and Brazil and had stints as a Metro reporter, Styles writer and National correspondent, covering the American South. @AndrewJacobsNYTThe New York Times · by Matt Richtel · April 6, 2019

Spread of the killer superfungi

The Times 7-4-19

Drug-resistant fungi are appearing in gardens and compost heaps

Farmers are being blamed for creating a wave of drug-resistant fungi that can infect people’s lungs or blood — and which are appearing in many gardens and compost heaps.

Several forms of the “superfungi” have emerged, often infecting people with weak immune systems. They are also becoming common in hospitals, causing post-operative blood infections.

The rise of the superfungi is strongly linked to farming, where widespread use of antifungal sprays on crops has made ordinary yeasts and moulds evolve resistance to such chemicals.

Farmers use similar compounds to those used in treating humans — so fungi that evolve resistance in the wild cannot be treated when they attack people.

Aspergillus, a mould that rots compost and vegetation, is emerging as a leading killer. It has evolved drug-resistant strains and is linked with up to 400,000 UK asthma cases a year and 3,600 lung infections. The most dangerous form is “invasive aspergillosis” where the fungus enters the blood, with 4,000 cases a year, according to Professor David Denning, head of the National Aspergillosis Centre in Manchester.

“Four or five years ago only 1%-1.5% of strains tested were drug resistant. Now it has reached 13% in London and 6% in south Wales. It seems very likely that resistance is increasing, and we think farmers spraying crops with fungicide is the cause,” he said.

The drug-resistant strains can be found in most gardens. Mother-of-two Karen Hook, 50, a horticulturist from Bishop’s Stortford, Hertfordshire, discovered the fungus growing in her lungs when she started coughing up green lumps of fungus.

“I started feeling really tired and coughing. I also had bad breath. The mould was growing in my lung.” The fungus had to be removed in an operation which also destroyed part of her lung.

Such cases raise fears that the rise in local authority compost heaps, linked to food recycling, could expose residents to surges in fungal spores. Some UK studies carried out downwind of such sites show spore levels 60 times above normal.

When Sandra Hicks was diagnosed with aspergillosis in 2008, doctors prescribed drugs, but her infection has proven resistant.

The pharmacist, 51, from Verwood, Dorset, said the infection would eventually kill her. “It’s destroying my lungs. I used to walk my dog for miles, but now walking up a slight incline is a problem … it’s very scary to be told the treatment isn’t working.”

The Times

Philosopher of the Heart: The Restless Life of Soren Kierkegaard by Clare Carlisle review | Saturday Review | The Times

Replete with pop culture references and quips about his preposterous quiff, a more comprehensively flawed misapprehension (and, one suspects, wilful misrepresentation in the service of what passes for journalism in The Times these days) of Kierkegaard’s ideas in 1000 words is difficult to imagine.

The Times · by James Marriott

Kierkegaard had the habit of bursting into tears whenever he spent time with his girlfriend Regine Olsen

Like most great philosophers, Soren Kierkegaard was something of a pain in the arse. Brooding, over-privileged and Danish, he sported a preposterous quiff that stood nearly six inches tall. Even Clare Carlisle’s sympathetic new biography can’t make him seem particularly likeable. Kierkegaard emerges as the sort of self-absorbed eternal student familiar from philosophy departments across the world. This, of course, is crucial to his appeal.

Kierkegaard, born in Copenhagen in 1813, was no feckless waster, however. He had a furious work ethic. In his short life (he died aged 42) he published 22 books — and in 1843, he even managed to publish three on one day. Among his works are some of the masterpieces of western philosophy: Either/OrFear and Trembling and The Sickness Unto Death. Kierkegaard’s view of the human condition as a mire of anxiety and regret earned him his reputation as the “father of existentialism”.

Outside philosophy, Kierkegaard’s biggest hobby was making mountains out of molehills. The biggest drama of his life was his failed engagement to a young woman called Regine Olsen. He proposed in 1840, dumped her in 1841 and then spent the rest of his life over-analysing their brief relationship, cycling through resentment, indignation and pity. It sounds as though Olsen had a lucky escape: Kierkegaard comes across as a terrible boyfriend. When he met Olsen he’d been at university for almost ten years, which should have set alarm bells ringing straight away, and when they spent time together he tended to burst into tears, “beside himself with sorrow and self-accusation”. He believed (correctly) that he would make a terrible husband and, although Olsen “fought like a lioness”, he broke things off.

This was the early 19th century, a time when young educated people were prone to overwrought displays of Romantic passion. Olsen gave as good as she got and wrote Kierkegaard some smashing letters calling him “my seducer, my deceiver, my enemy, my murderer . . . the tomb of my joy, the abyss of my unhappiness”. Chastened, the young philosopher fled Copenhagen for Berlin to begin work on his first magnum opus, Either/Or.

The angst of his failed relationship with Regine fuelled his philosophy and echoes everywhere in his work, informing his views on marriage, God, love and authenticity. Although he undeniably produced some great philosophy, he remained an annoying person. For instance, when Kierkegaard finally slunk back from Berlin with a finished manuscript of Either/Or, he entrusted it to his friend Jens Finsteen Gjodvad to proof-read. He then got into the habit of dropping in on Gjodvad when he was trying to do his day job at a newspaper office and subjecting him to long, distracting (and one-sided) “chats”. The paper’s editor was driven to distraction by this “impractical and very self-absorbed man sitting in the office, ceaselessly lecturing and talking without the least awareness of the inconvenience he is causing”.

Anyone familiar with Kierkegaard would agree that he was precisely the sort of person who could have benefited from the structure of a job. No time for melancholy introspection and bothering your friends when you’ve got quarterly reports to file! Unfortunately for Kierkegaard (but fortunately for philosophy), he didn’t need to work because of his family’s vast wealth.

His father, Michael Pedersen Kierkegaard, was a formidable figure who started out herding sheep on the Jutland heath, but made his fortune in Big Wool and became one of the richest men in Copenhagen. The sensitive, large-eyed young Kierkegaard (a “spoiled and naughty” mummy’s boy according to family friends) thought that his father was a tyrant who made his childhood “torture”. Kierkegaard senior retired early to study philosophy. His son inherited his father’s intellectual earnestness as well as his wealth.

Kierkegaard’s life was consumed by work, scribbling away in a blacked-out room to protect him from sunlight, which he found overpowering. He acquired fame in his lifetime, idolised by admirers, but also satirised in newspapers and plays as a gloomy, diminutive hunchback. He died in 1842 of an excruciating spine condition. Even he may have been surprised by his pop-cultural afterlife. Thanks, perhaps, to the melancholy, the long Nordic name and that quiff, Kierkegaard has morphed into many people’s idea of a sort of archetypal philosopher.

More than 1.3 million people have watched Alain de Botton’s YouTube video about him, and a popular Twitter account, Kim Kierkegaardashian, mashes up his philosophy with the tweets of Kim Kardashian with amusing results: “Dress for the void you wish to escape from”; “Summer’s easiest hair trend is beach waves. It says: the seas of life are rough and I am drowning”; “Eight incredible new lipstick shades and one incurable melancholy”.

Naturally, it is Kierkegaard the nihilist who has caught on. “As I grew up,” he once wrote, “I opened my eyes and saw the real world and began to laugh and haven’t stopped since.” He saw life as inevitably unsatisfying: “Marry, and you will regret it; don’t marry, you will also regret it; marry or don’t marry, you will regret it either way . . . hang yourself or don’t hang yourself, you’ll regret it either way; whether you hang yourself or do not hang yourself, you will regret both. This, gentlemen, is the essence of all philosophy.” He also wrote about anxiety as the inevitable state of human life, a product of the almost infinite choices that are presented to us and which we can never hope to make informed decisions about.

Kierkegaard’s questions about existence were more interesting than his solutions, which, boringly, were very Christian. The Christian Kierkegaard is fully in evidence in Carlisle’s book. Although it is usually readable and entertaining, many will find themselves becalmed in the sections that deal with the meaning of Christianity and the theological failings of various Danish bishops. I’m no Kierkegaard scholar and Carlisle, reader in philosophy and theology at King’s College London, very much is. I’m sure the picture of Kierkegaard she presents here is the accurate one. But amid all the theologising, I missed the crazily quiffed nihilist I once knew.

Philosopher of the Heart: The Restless Life of Soren Kierkegaard by Clare Carlisle, Allen Lane, 368pp; £25



De volgorde. Op een stukje papier schrijf ik met een Ikea-potloodje een kort verhaal. Langzaam, ik doe al m’n hele leven alles langzaam. Daarna schrijf ik het over op de computer, behalve een enkele d/t verander ik niets. Tenslotte stuur ik het weg – het apparaat maakt het geluid van een vliegende vogel. Nieuw bedrijf. Een zeer grote bestelauto stopt op het pad. Ik zou graag alles begrijpen, ik loop naar buiten, maar vraag natuurlijk weer niets aan de vrolijke chauffeuse. Ze noemt m’n naam en vraagt of ik het ben. Ik knik, ik ben het altijd. Ik zou wel eens Philip Glass willen zijn, maar dat gebeurt nooit. Ze overhandigt me het pakket en wenst me een goede middag. Het regent, ik ga snel naar binnen. Het is een boek, Ode aan de brief, kroniek van een verdwijnend fenomeen – schrijver: Simon Garfield. Er is een brief bij, door Richard met een vulpen geschreven, twee kantjes. Hij is meer dan dertig jaar jonger dan ik, zulke dingen komen voor. Hij vraagt zich af of het erg is dat de geschreven brief verdwijnt. Hij vraagt of ik nog wel eens verlang naar het kleitablet, een vraag die me verrast en op m’n nummer zet. Hij kan goed schrijven, hij spreekt z’n talen, zijn kinderen kunnen goed leren, zijn vrouw werkt in het onderwijs, hij voetbalt en surft op zeeën aan de kusten van Brazilië, Australië, Italië. Hij correspondeert met iedereen via internet, behalve met mij. Vanuit Brazilië, Australië, Italië en Leiden ontvang ik zijn post met zegels en stempels. Hij schrijft me met een vulpen omdat hij weet dat ik de verdwijning van de klassieke brief betreur. Hij probeert me met uitstel te troosten.

Job Koelewijn | De Volkskrant


Sinds de dood een nacht van hem gescheiden was is Job Koelewijn nooit meer dezelfde geweest 

Wat is de zin van ons leven?
‘Zolang je die vraag stelt, heb je de zin niet begrepen. Voor mij is het: de vervoering van in leven zijn, zonder enige aanleiding. Dus zonder dat je iets bijzonders doet of je verliefd voelt. Als je bent aangeraakt door die vervoering, de energie die dat meebrengt, dan wordt ook afwassen leuk. Of een rood stoplicht – te gek!’

VK 17 maart 2019

Job Koelewijn Beeld Jitske Schols

Op een zondagavond in januari 1983 wordt de familie van de dan 20-jarige Job Koelewijn gevraagd naar de intensive care van het Academisch Ziekenhuis Utrecht te komen. Vader Koelewijn, een aannemer uit Spakenburg, zijn gelovige moeder en vier broers en zussen krijgen van de artsen te horen dat ze vrezen dat Job de volgende ochtend niet haalt, nadat hij bij een auto-ongeluk zijn nek heeft gebroken. ‘Tegen de verwachtingen in overleefde ik. Alleen was mijn prognose superslecht, ik zou mijn hele leven in een rolstoel moeten zitten.’

Ook die verwachting komt niet uit – hij leert eerst weer ademen en daarna lopen, zij het voor altijd mank. Zijn ontmoeting met de dood laat vooral geestelijk sporen na. Koelewijn, tot dan toe ‘een jongen die niet wilde deugen’, besluit kunstenaar te worden en meldt zich aan bij de Gerrit Rietveld Academie. Voor zijn eindexamenwerk grijpt hij terug op zijn Spakenburgse wortels: hij vraagt zijn moeder en drie tantes in klederdracht naar ‘de Rietveld’ te komen om het gebouw schoon te maken. De beelden ervan creëren een sensatie in de internationale kunstwereld – in een klap geldt Koelewijn als een van de grootste Nederlandse talenten. Uit het buitenland komen verzoeken het kunststukje elders te herhalen. ‘Eerst sprong ik een gat in de lucht. Toen realiseerde ik me: dat zijn hun ideeën.’ Dus weigert hij. Koelewijn wil zijn eigen spoor volgen. Dat brengt hem naar New York, na toekenning van een prestigieuze kunstbeurs voor een van zijn bekendste werken, The World is My Oyster. De Amerikaanse geldschieters zijn onder de indruk van zijn ogenschijnlijk simpele ingreep in de werkelijkheid: in een galeriemuur in de Jordaan maakt hij een opening ter grootte van een voetbaldoel, waardoor de weelderige tuin erachter zichtbaar wordt. Dat levert een ontregelende kijkervaring op.

Koelewijn maakt installaties, foto’s, video’s en beeldhouwwerken. Nimmer wil hij zichzelf herhalen, zijn mantra is dat hij ‘ongeconditioneerd’ wil zijn. Tegelijkertijd is de vader van twee tienerzonen een toonbeeld van discipline. Al dertien jaar spreekt hij iedere ochtend 45 minuten een cassettebandje in door uit een boek te lezen – van de bandjes heeft hij al diverse, unieke ‘boekenkasten’ gebouwd. Over existentiële vraagstukken leest hij het liefst. Kant en Spinoza behoren tot zijn favorieten, maar de 57-jarige Koelewijn is ook liefhebber van taoïstische en boeddhistische werken. ‘Aan grote denkers kan ik mijn geest slijpen. Een mens moet zijn eigen stompzinnigheid niet als norm nemen.’

Wat is de zin van ons leven?

‘Zolang je die vraag stelt, heb je de zin niet begrepen. Voor mij is het: de vervoering van in leven zijn, zonder enige aanleiding. Dus zonder dat je iets bijzonders doet of je verliefd voelt. Als je bent aangeraakt door die vervoering, de energie die dat meebrengt, dan wordt ook afwassen leuk. Of een rood stoplicht – te gek! De grote, westerse denkers zullen je niet snel op dat spoor zetten.’

Bent u daar door uw auto-ongeluk op gekomen?

‘Achteraf is dat het beste wat me ooit is overkomen. Ik lag op de intensive care en moest alles opnieuw leren. Alles, zelfs ademen. Mijn zintuigen zijn daardoor aangescherpt. Met die gebroken nek lag ik bewegingloos en plat, dus als er iemand binnenkwam, hoorde ik eerst alleen de stem. Janneke, Janet, Sonja, de verpleegsters die me hielpen, ik kan hun stemmen nog oproepen. Daarbij kwamen de hallucinaties door de morfine. Veel beleefde ik opnieuw, maar dan superscherp.

‘Toen ik terugkwam in de werkelijkheid, voelde ik een enorme energie. En mijn angst was geknapt. Daardoor durfde ik naar de kunstacademie. James Joyce heeft het over momenten van epiphany, openbaring; boeddhisten noemen het satori, een moment van verlichting. Een boeddhist zei me eens: ‘Als dat het echt is geweest, wil je er steeds naar terug.’ Dat klopt, ik zie het als het doel van mijn kunstenaarschap.’

Waar wilt u precies naar terug?

‘Ik vind het moeilijk woorden ervoor te vinden, misschien is dat ook wel de bedoeling. Voor mij is het genoeg dat ik weet dat het een soort schat is. Ik hoef er alleen maar naar te luisteren. Het heeft in ieder geval niets te maken met het intellect – het is een soort energie, een gevoel. Als ik thuis ben en drie dagen niet werk, wordt mijn leven gewoon. Maar kom ik hier in mijn studio dan voel ik na tien minuten die energie opborrelen en ben ik terug bij dat gevoel. Ik voel me dan onbreekbaar. Ik zie de werkelijkheid dan in zijn essentie. Die draait voor mij om polariteit.

‘Zonder begrip daarvan kan eigenlijk niets worden begrepen. Je ervaart de dag en de nacht, warm bestaat bij de gratie van koud, et cetera. Dat zijn geen tegenstellingen, zoals we in het Westen denken, maar polariteiten: ze bestaan niet los van elkaar, maar juist dankzij elkaar. In het westerse denken draait het om causaliteit: ik geef jou een tik, jij geeft een tik terug. Maar Jezus keerde de andere wang toe, hij is de polariteitsdenker bij uitstek. We slaan hem aan het kruis en hij zegt: ‘Hé makkers, ik heb echt medelijden met jullie!’

Is uw andere ervaring van de werkelijkheid wat u aan anderen wilt overbrengen?

‘Natuurlijk gun ik iedereen die ervaring, maar ik ben geen onderwijzer. Mensen zien mijn werk en krijgen daardoor energie. Dat vind ik fantastisch. Maar als ik zou zeggen: ‘Ik heb het zo gemaakt en je moet het zo ervaren’, dat werkt niet. Dan wordt het onvrij, een dogma. Zelf voel ik me ook niet goed bij dogma’s. Ik ben een paar keer naar een boeddhistisch klooster geweest, maar ik word daar kriegelig. Dan wordt het religie en komt het van buiten, niet van binnen. Ik wil niet op de berg zitten en me dan mediterend goed voelen. Ik wil die innerlijke rust wanneer ik in de Albert Heijn sta, wanneer het tegenzit, dat is veel uitdagender.

‘Ik wil geen docent zijn, maar mensen kunnen zelf wat doen. Lees een boeddhistisch boek waarin staat: ‘Loop drie keer in de week naar het strand. De ene keer zullen de golven hoog zijn, de andere keer laag. Vertel me eens: welke golf is natter?’ Als je echt begrijpt dat elke golf even nat is, dat is verlichting. Dat betekent niet dat je geen pijn meer zult voelen, maar dat stofzuigen ook te gek is. Elke golf is even nat.’

Kunt u dat verder uitleggen?

‘Ik heb hier stagiaires die op zaterdagavond een feest hebben, daar kijken ze dagen naar uit. Op die avond lijkt de golf heel hoog en supernat. Wat ze nog niet begrijpen is dat over straat lopen even nat is. Als op een dag alles soepel verloopt – je computer aan, je mail komt binnen, de boodschappen zijn er – is dat toch ook geweldig? Je kunt wel veel energie spenderen in van de ene naar de andere golf zwemmen, maar als iedere golf toch even nat is, wat zou je dan? In het Westen denken we: ‘Het gras is elders groener.’ Volgende week op vakantie, dat wordt te gek. Maar wat doe je nu? Daar gaat het over. De projectie naar het verleden en de toekomst heb ik losgelaten.’

U leest dagelijks existentiële boeken – geeft dat uw leven ook zin?

‘Absoluut. Welke eigenschap van ons is nu mooier dan het denken? Er is een hiërarchie in ons lichaam, het hoofd vormt niet voor niets de top. Denken is ons meest verfijnde mechanisme en het is prachtig dit elke dag te trainen. Ik laaf me aan die kennis. Die wil ik integreren in mijn leven en doorgeven.

‘Neem Spinoza, voor mij een ongelooflijke held. Als de regels voor menselijk gedrag in zijn Ethica zouden worden gevolgd, hadden we een betere wereld. Hij kwam in de armoe terecht, maar toen hem de kans werd geboden eruit te komen, deed hij dat niet. Omdat hij zijn opvattingen over God weigerde aan te passen, hij ging niet mee met die eis van het Pruisische hof. Ik ben totaal niet te vergelijken met Spinoza, maar dat rechtlijnige herken ik. Ik ben ook niet voor het grote geld gegaan. Om dat te durven heb je zo’n held nodig. Ik zie zijn Ethica uit 1678 als het allereerste zelfhulpboek. Hij roept ook op je bewust te zijn van je geconditioneerd zijn. Daarmee heeft hij me ook geholpen. Pas als je die bewust bent, kun je die conditionering ook doorbreken.

‘Dat dagelijkse lezen heeft ook weer te maken met mijn ongeluk. Ooit was ik verlamd, en kijk nu: elke ochtend kan ik die knop van de cassetterecorder indrukken. Het is een dagelijkse handeling die ik aan het transcenderen ben. Dat zit in al mijn werk, is dat niet prachtig?’


‘Tussen iemand en niemand van Joseph Brodsky. Een essaybundel die een vaste plaats in mijn geest heeft veroverd. De Russische dichter Joseph Brodsky (1940-1996) was een meer dan fatsoenlijk man. Dit hele boek is doordrenkt van liefde voor de poëzie en de literatuur. En daardoor staat het vol met inzichten in de menselijke psyche. Dat geeft de teksten een enorme rijkdom, waardoor je ze keer op keer kunt blijven lezen.’

Dus eigenlijk drukt u steeds de blijdschap uit dat u leeft?

‘Ja, zo is het.’

Hoe kijkt u aan tegen de dood?

‘Zolang je de dood nog wegdrukt, omarm je het leven niet. Ik zeg: omarm de dood. Die ervaring met de dood op mijn 21ste heeft me wijs gemaakt over het leven. Ik heb hem in de ogen gezien. De beperking van het leven die de dood is, scherpt ons. Stel dat je mannen de beperking oplegt: je mag maar met drie vrouwen een relatie hebben. Of een kunstenaar: je mag maar honderd kunstwerken in je leven maken. Reken maar dat hij dan de diepte in wordt gedwongen. Zo werkt het ook met de dood. Stel dat we allemaal zouden weten dat het op onze 70ste verjaardag is afgelopen, hoe zou ons leven er dan uitzien?

‘Maar we leven hier in het Westen alsof we oneindig meegaan en doen alsof de dood er niet is. Simone de Beauvoir laat in Niemand is onsterfelijk haar hoofdpersoon Fosca een levenselixer drinken dat hem onsterfelijk maakt. Het maakt hem tot een tragische figuur.

‘De taoïst lacht om de dood, hij doorbreekt de conventie dat je er bang voor moet zijn. Zover ben ik nog niet. Als ik nu te horen krijg dat ik nog maar een paar weken te leven heb, zou ik dat verschrikkelijk vinden.

‘Het gaat erom je angst tegemoet te treden, of dat nu vliegangst is of doodsangst. Als je angst of verdriet hebt, moet je niet je vrienden opbellen. Nee, dan moet je een mooi pak aantrekken, de verwarming hoger, de deur openzetten en zeggen: ‘Angst, kom maar op! Laat je gezicht maar zien, ik ga jou eerst zelf te lijf.’ Je moet die confrontatie aangaan, een ander kan het niet voor je oplossen. Die kan hooguit tijdelijk angst wegnemen. Uiteindelijk blijf je zelf verantwoordelijk.’