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January 2016 Archives

by Dr. Merryl Kafka, Ed.D.

What better way to support and enhance science, technology, engineering, arts and mathematics (STEAM) than to dive into the rich and beautiful history of Art Deco!

Art Deco, a decorative style characterized by rich colors, bold geometric shapes, and lavish decorative details, flourished internationally during the 1920's and 30's, although early origins may have had its roots in the ancient Egyptian tombs of King Tut.  The dominant movement, however, originated in France just before WW1, and the term Deco can apply to just about anything - - - jewelry, cars, cookware, planes, trains, clocks, jukeboxes, furniture, radios, clothing, and buildings.  The unique style was punctuated by the age of rapid industrialization, hence the strong sense of the machine age and technology in many of its themes.

Emblematic of its commitment to education, the Art Deco Society of NY developed curriculum and lesson plans, called "Documenting Deco" on its website

(ArtDeco.org, "learn" tab) that will escort both teachers and students into the rich art deco history and provide visually exciting images of videos and photographs, along with an interactive map and art deco building registry in NYC.  Navigating through this instructional program will help students define and identify buildings, explore neighborhoods to include new entries for the registery, learn the vocabulary of art deco lingo, and view presentations for a comprehensive education, including the policy and importance of the Landmarks Preservation Law.

Documenting Deco will encourage students to apply, analyze, and evaluate the information presented, while learning about and appreciating our rich architectural heritage.  This Art Deco curriculum infuses the arts and the STEM sciences, as well as career awareness, in introducing students to the world of deco design.  Art Deco can provide many curriculum extensions including international understanding of other cultures; industrial and decorative arts, math and model making, and walking tours to explore the architectural resources of New York City.  Every borough has art deco treasures and the program encourages students to take pride and to value their own neighborhoods.

The Art Deco Society of NY, a not-for-profit organization, is dedicated to education and preserving and protecting New York's art deco masterpieces.  Activities include school outreach, lectures, walking tours, film series, book events, day trips, and social events, such as the Prohibition Era Cocktail Party, and advocacy for landmark status.

Please visit the website for upcoming events, membership information, and to learn more about classroom programs: ArtDeco.org

Roberta Nusim, President, and Meghan Weatherby, Director of Operations. 212 679-DECO

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Review of 'Rights Come to Mind'

Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness
By Joseph J. Fins, M.D., M.A.C.P.
Cambridge University Press, 2015  (391 pages)
Review by Jacob M. Appel MD JD

Game-changing scholarship in the sciences arrives in roughly two varieties. Some scholars engage in paradigm-shifting research and target their results toward opinion leaders within their fields. Another set of authors, although often gifted investigators themselves, makes its greatest impact synthesizing the works of contemporaries to distill a complex domain for lay audiences--think Steven Jay Gould or Carl Sagan or Steven Pinker. Dr. Joseph Fins, an internationally renowned authority in neuro-ethics, has achieved both of these feats simultaneously in Rights of the Mind, a seminal and authoritative work that explores the science, ethics and politics surrounding disorders of consciousness.

Jacket.gifRights Come to Mind weaves together three distinct narratives. The first, familiar to students of medical ethics, but likely not so to many clinicians or laypeople, is the dynamic evolution of neurology's understanding of brain trauma and consciousness disorders over the past fifty years. Starting with the shift from cardiopulmonary death to "whole brain death" in the 1960s, Fins introduces readers to the major diagnostic developments in the field: the first description of the persistent vegetative state (PVS) by Bryan Jennet and Fred Plum in 1972 and, thirty years later, the recognition of the minimally conscious state (MCS). The key distinction between the two conditions, which stands at the core of Fins' argument, is that PVS patients display "wakeful unresponsiveness" and remain unconscious while MCS patients display "definite albeit intermittent evidence of consciousness." Eventually, PVS patients can pass into a permanent vegetative state from which recovery is not possible, while MCS patients retain the potential for recovery at any point in time. Fins laces this history with snapshots of the classic cases in neurological ethics: the efforts of the families of Karen Ann Quinlan in New Jersey and Nancy Cruzan in Missouri to withdraw life-support, the intense public controversy surrounding Terri Schiavo, and, more recently, the seemingly miraculous recovery of Terry Wallis after nineteen years in a minimally conscious state.

The second narrative is the heart-rending story of Maggie Worthen, a Smith College senior disabled by a fluke brainstem stroke, and her devote mother, Nancy, who questions Maggie's diagnosis of PVS. Nancy brings her daughter to Dr. Fins' research facility at Cornell, where a thorough evaluation confirms that Maggie is, at times, conscious. Eventually, Maggie is equipped with a prosthetic device called My Tobii that allows her to communicate through moving her eye. (Worthen died in 2015, at the age of thirty-one, after the volume had gone to press.) Fins supplements Maggie's saga with those of dozens of other patients and families who have suffered with brain injuries of various sorts. Through these stories, he explores the challenges faced by both patients and families--from the financial and emotional burdens of care to an indifferent and often byzantine medical system. If there are villains in Fins' tale, they are insurance company bureaucrats and an intransigent government that provides treatment only on the basis of so-called "medical necessity" and rapid improvement, which seem out of place for illnesses that require patience for long-term recovery.

Finally, Fins offers an impassioned plea for the rights of those suffering in MCS, invoking the legacy of the Civil Rights Movement. Here lies the casus belli of his work: a belief that MCS patients are being lumped together with PVS patients and denied their rights to participation in the community of humankind. His own work with deep brain stimulation, for instance, suggests that at least some MCS patients may be able to make significant recoveries. Cheaper, less invasive remedies may help others--such as the medications zolpidem and amantadine. But none of this is possible without proper diagnoses, which Fins fears are currently lacking.

Fins, who is the E. William Davis, Jr. M.D. Professor of Medical Ethics and Chief of the Division of Medical Ethics at Weill Cornell Medical College, has acquired a list of honors and awards as long as any in academic medicine. He also has a compelling gift for analogy, an ability to render lucid the thorniest issues in healthcare ethics--drawing comparisons to calculus and physics, but also the moon landing and the Lewis & Clark Expedition. We learn of the error potential in neuroimaging through an allusion to Matisse's The Conversation; he used the image of the diver in the Greek ruins at Paestum to explain the "eternal present" of some patients who emerge from MCS. These erudite, humanistic touches help made the volume a highly-compelling read.

Fins raises as many questions as he answers. What is to be done, for instance, with patients who show consciousness on neuroimaging but display no long term recovery? Some might see these scans as a sign of hope; others--including myself--find these results deeply unsettling, raising the prospect of fully aware beings trapped and suffering with no recourse. Not everyone will agree with all of Fins' answers. Yet what matters more is that he is asking the right questions, potentially launching a recalibration of attitudes toward MCS patients both among clinicians and the public at large. Rights Come to Mind is a multifaceted tour de force not to be missed.


Transcending Educational Labels


StephenSpahnDwight.jpgBy Stephen Spahn, Chancellor of Dwight School

Today, education requires a broad vision of what it means to be a "well-educated person." We must move beyond labels and soundbites and transcend terminology such as progressive, inquiry based, competency based, transdisciplinary, real-world, liberal arts, and career education.

The International Baccalaureate embraces all of these pedagogical shibboleths. It was created to transcend barriers, boundaries, and labels. The IB vision is to prepare students to thrive and prosper anywhere in the world and to participate in solving local, national, and global challenges in innovative ways.

It is our obligation to provide students with vigorous academic preparation paired with character development, communication, critical thinking, civic engagement, and leadership skills ― and opportunities to apply them within and outside of the classroom. This requires going on an open-minded and open-hearted journey that begins with the individual talents and passions that a student brings to each class. If one label or soundbite is to be applied, it would be "to ignite and nurture the spark of genius in every child."

Chancellor Stephen Spahn is the longest-serving head of school in New York City. Dwight School is a founding International Baccalaureate Prek-12 school in the United States and the first to offer the comprehensive IB curriculum in the Americas.

Gutted River



By Patricia Grodd

An arroya once passed behind my bedroom window

I awakened to its rushing Hummmmm.

It ran and sang. It is true, I tell my little brother who has never heard its nightly lullaby.

I now wake up tired because it is so early, the night is still upon us.

The work on our fields must be done by noon, the hottest part of the day.

This struggle to grow food at seven thousand feet, with little water;

So arid that only the chilies have met the challenge of surviving in this harshness.

Time is not linear, in any sense, on a farm.

You need to know the tricks of proper irrigation, how to feel the heart of the water.

To coax it where you want it to go.

How to use the earth like a sponge.

There are few that realize that this is an art form.

Blessings are chanted in the lower farmlands of Aqua Fria at the beginning

Of every season over the acequias,

Honoring the sacredness of water and the land.

Still, secularization affronts the sensibilities of those who rejoice in the seasonal

Cycles and hold great celebrations that honor the spirit of a place.

Perhaps, my grandfather says,

That communal force has a connection to our empty watersheds.

It will enlighten us so that we may re-incarnate the winding blue of memory.

People to land.

We remember the river dreams of P'oe tsawa, the rivers protector and archivist.

Her people, the Tewa, pray at the mountain top of sangre de cristo for the return of

The consecrated waters

They sing canciones encantados to please it.

In their throats a parched silence hangs all the while blistering their songs.

The sounds of the wind and sand travels into them.

Thinking like a watershed is possibly the clearest way to understand homeland.

My mother and father tell me stories of the great river:

How they fished in it and how they skated in it in winter.

How there were great duck ponds and large cottonwoods on its banks

Now amongst the beer cans, cigarette butts, vertebrae, fossils, and fish bones,

People still try to honor the river with sculptural stone pilings and rare feathers

In the dry canyons.

Time imprints itself with fading footsteps tracking across the red clay of the basins' floor.

It reminds me of some sort of ghost-like memorial, such a strange landscape.

I watch as a snake jellies up a large sun-baked rock to shed its skin.

He lies there, iridescent, exhausted by his labor, for days.

There is a silent vocabulary of devotion, belief, and mourning.

The language of motion, vision. What is possible and what is not.

There is no avocado, no grapes. We are treading water now.

Nothing is sacred.

STEAM, STEM, tinker space, maker space - these are all buzz words in the world of innovative education. At Gaynor, we've taken elements from all of these concepts and incorporated them into our new Science, Math, Art, Research, and Technology (SMART) Lab.

The SMART Lab wasn't always intended to be so. Originally, the space was slated as a Research and Writing Center - a library of the future. But it soon became clear that in order for students to succeed in the 21st century, we needed to design a trans-disciplinary space where they can be engaged in exploration, problem-solving, and project-based learning. The SMART Lab allows teachers to take curriculum from a 2D level to a 3D level, inspiring students along the way. "We see the lab as an area of opportunity for students to expand their horizons and open their minds to new opportunities," explained Mr. LeWinter, Director of Technology. "The end results may look different - from robotics and design, to video editing or 3D printing - but the goal is the same: creative exploration."

Much thought and research was put into what we now proudly call our SMART Lab. Administrators, teachers, and specialists participated in bi-weekly brainstorming sessions, as well as site visits to schools and colleges with successful design and tinker labs to examine the spaces and curricula. Determining the layout of the room to ensure creative work flow (e.g., collaborative project space and individual space) and the specific materials that would flexibly work well within the space, and more importantly, pique students' creativity, required thoughtful time and planning. Materials like cardboard, foam, Legos, zip ties, popsicle sticks, bamboo poles, repurposed plastics, modeling clay, circuitry components, and twine fill the shelves, which are surrounded by tables that fold down to make additional floor space for student work, as needed.

But most importantly, there was deep discussion on the ideal philosophy of the space. The emphasis is on being bold enough to try, not whether or not students have accurate hypotheses. A critical aspect of the SMART Lab is its ability to be a safe haven for our students where they are encouraged to problem- solve, fail, learn from their mistakes, try again, and succeed. This idea requires close collaboration with teachers to ensure the space is being used for the right types of activities and projects, incorporating Science, Math, Art, Research, and Technology.

This summer, teachers, specialists, and administrators participated in vital professional development to ensure optimal use of the SMART Lab. They took part in the "SMART Lab Challenge" where each team was tasked with developing something in a short amount of time, forcing them to experience first-hand how creative problem-solving works within the confines of the lab. This experience better informed their lesson plans and allowed them to see what type of resource the lab could become. "It's all about connecting the use of the materials to enhance what you're teaching," explained Ms. Schostak, Writing and Social Studies Coordinator, who has helped teachers this fall facilitate low- and high-tech projects in the lab.

Ms. Paterson/Ms. Janczyk's Orange Cluster students' inaugural SMART Lab visit centered on a low-tech assignment - they had to "save Fred." Fred, a gummy worm, was positioned on top of a life raft (AKA a cup) and had to be dressed in a life jacket (AKA wire), which was stuck under the life raft, to become safe. The students were armed with two paper clips and were not allowed to use any technology in the room. Mr. Koble, Lower School Technology Teacher, designed the experiment to help foster creative problem-solving. "I was looking to gage how students worked together to deconstruct a problem. It helped me understand how to get them to the next level of creative problem-solving." Ms. Paterson added, "It was important for students to understand that technology isn't just about iPads and key boards. The goal is to work on problem-solving first, then weave in technology."

Middle School Technology Teacher, Mr. Russ, encourages his students to use every aspect of the SMART Lab. "It's typical for students to circulate the room, grab and go, build, experiment, break, damage, get dirty, and have fun exploring and solving problems," he expounded. Blue Cluster students taking his Sustainability through Technology elective have been exploring different technologies that can be used for environmental causes such as energy, gardening, and recycling. They used their time in the lab to build three different types of gardens using recycled materials, repurposed materials, and a hydroponic system to compare/contrast the best system to grow plants in an indoor environment.

Providing an opportunity and innovative space for students to tinker, explore, and problem-solve is essential to their growth. Gaynor's new SMART Lab affords our students the ability to do just that and we believe the benefits will be seen for years to come.


by Allen Frances To take or not to take psychiatric medicine? That is the question. Far too many people answer yes and take meds they don't really need for problems that would get better just with the passage of time and/or brief counseling. More than 20% of Americans are on at least one psychotropic drug (sometimes several), too often not for real mental disorders, but for transient emotional distress or for the demoralization that comes from difficult life circumstances. Meds that are very helpful for clear cut psychiatric disorders usually do more harm than good when used for the everyday difficulties that life throws at us. When prescribed loosely, meds provide little benefit, risk harmful side effects, distract attention from solving the real life problems, and reduce people's trust in their own resilience and the help they can receive from family and other social supports. Even for those who really need them, psych meds are not always prescribed well. Doses are often too high or too low. And doctors tend to add new drugs when old ones aren't working, without withdrawing the old ones. This irrational polypharmacy adds to the risks of drug- drug interactions and increases the burden of side effects. Lots of patients who do need to be on medication do better when on lower doses and fewer different types of pills. But there is another side of the equation. Far too many people who need drugs don't take them - either because treatment is unavailable or because they don't realize or accept the fact that they need it. So we are trapped in the cruel, dumb, and sometimes tragic paradox that the wrong people often take meds, while the right ones don't. This terrible situation has many causes that have been discussed already in previous blogs. Our focus here will be on what has been a futile and harmful struggle between two different 'one glove fits all' mentalities. On one side are medication fanatics- some of whom are psychiatrists but also many primary doctors who prescribe 80% of psych meds. On the opposing side are die-hard anti-medication crusaders who try to persuade everyone, including those who really need meds, that they are globally unhelpful and globally harmful. The best person I know to bridge this worrisome gap is Virgil Stucker. He is Founding Chairman of the Foundation for Mental Health Excellence and Founding Executive Director of the CooperRiis Healing Community. Virgil has spent most of his adult life living at close quarters with patients in therapeutic communities. He knows how important meds are in improving the lives of people who need them. But he also has close contact with user groups and understands the concerns of those who have been harmed by psych meds. If anyone can find a proper balance in this far too acrimonious debate, Virgil can: " I was recently in Iowa on an emergency trip, thinking I was going there possibly to bury my 97 year old father. He was declining rapidly, experiencing profound hallucinations, severe confusion, and disorientation. It began with a fall that led a doctor to prescribe Tramadol. I reviewed this drug's side-effects and discovered it can produce hallucinations and confusion. When I presented this information to his prescribing doctor, the Tramadol was discontinued immediately and my father was back to himself within a day. The medication, which I also initially endorsed for his pain, could have led to his death, something that happens far too often in our country. This weekend we are celebrating my parents' 70th wedding anniversary; I am glad and joyful that they can both be there! During most of these past 40 years, I have lived in therapeutic communities, in close day-to-day contact with people who have severe mental illness. I have seen psychiatric medication save lives and I have seen it harm lives. Often I have helped orchestrate life-saving medication for people suffering from the dangerous hallucinations of psychosis. But other times, I have helped to create supportive conditions within which our psychiatrists could help people do much better by coming off what had been excessive cocktails of over prescribed medication. I have so many memories both of people harmed by meds and of people saved by them. Cynthia was a rising executive in a stressful situation when she was misdiagnosed with thought disorder and overmedicated with more than one antipsychotic. She improved when gradually weaned off meds and is back at work. Jane had 50 prior hospitalizations for schizophrenia, most precipitated by her erratic excessive or inadequate use of medication. She came in a fog on a boatload of medications. Now hospital-free and independent, she has learned to stay faithfully on a low dosage of Clozaril that controls her symptoms without causing problematic side effects. Jane now has a full life, is an artist, works in a retail store, and has her own condo. Her recovery would not have been possible were she on too much or too little medication. The path can be very hard at times. Aaron came to us riding the waves of psychosis, often erratically stopping his medications. His psychosis is persistent and it is clear that he needs an antipsychotic, but he persistently refused to take one. We continued holding on to him, caring for him, even though twice in the last five months, he had to be involuntarily hospitalized. We kept welcoming him back and, finally, finally, he has seen the necessity of selectively using a moderate level of medication. I think he will go the distance and has begun a new and perhaps his best year in a long, long time. This coming Tuesday, we are getting another young man back. He initially came to us from a very poorly run hospital, where his medications were ineptly handled. He was so psychotic that we could not safely include him into our community. With his agreement we arranged for transport to a better hospital that treats its patients more respectfully and collaboratively. I visited him a few days ago in the hospital and found him to be present, centered, more understanding of his medications and ready for recovery. Wonderful! Just two nights ago, I visited a potential applicant in her parents' home in NYC. Floridly psychotic, she was clearly unable to care for herself and her parents were also exhausted. With the careful help of a special mental health attorney in NYC we got her into a trusted hospital. Through the cloud of her delusions and hallucinations I could see a young woman with a spark of hope, hope that she might reclaim her life. She's at the beginning of the journey. I hope that she, too, can benefit from the selective use of medications, therapy, and social support. It's not black-and-white...We need to find a common sense middle ground between opposing wholesale beliefs that psychiatric medicine is all good or all bad. We need to focus instead on the benefits of more selective, moderate and minimal use of medications. How do we achieve this selective use model? Our current medical culture has set a high value on "evidence-based medicine," that is, on treatments that have been shown to produce overall improvement in large groups of subjects in research studies. Unfortunately, research studies cannot capture the individual differences among people that are critical in mental health recovery. Whether or not medications are supportive for a particular individual's recovery is best decided by shared collaboration in an ongoing and trusting relationship between a person seeking recovery and well-trained clinicians, with openness on both sides to the observations of loving friends and family and a careful consideration of what has worked and what has not in the past. There is no one size fits all. And it often takes time and patience to discover what will work best for any given person." Thanks so much, Virgil, for sharing your wisdom and rich experiences. Proper treatment must always be selective and customized to each individuals particular needs. It is equally important to fight both the overuse and the underuse of meds. Indeed, no one size fits all and meds that are essential for the few are harmful when overused for the many. People who have short-term, stress induced psychiatric problems, even if they are severe, often do well with short-term medication, and sometimes with no medication ar all if intense support is available. Too much medication for too long will likely do them more harm than good. People with long term, severe psychiatric problems usually require long term medication, along with social support, decent housing, vocational rehabilitation, and psychotherapy. Too little or too much medication and the lack of psychosocial support will risk deterioration, prison, and homelessness. The biggest puzzle is what's best for those who once had persistent, severe problems that have responded well to medication over a substantial period of time, but who would now like to come off the medication. There are risks on both sides. Staying on meds can cause serious complications, particularly if the person gains substantial weight on them. But going off meds can be a path back to illness and all of its dire consequences. I have seen hundreds of patients deteriorate badly after stopping meds. And sometimes meds that previously worked wonderfully well in maintaining recovery fail miserably in treating the relapse caused by their trrmination. I used to be more enthusiastic about the possibility of psychosocial treatment replacing meds, or markedly reducing the doses need, even in the most severely ill. In the mid 1980's, I helped plan and conduct a large study that compared three medication strategies in the continuation phase of treatment for people who had recovered from a psychotic episode : 1) usual dose; 2) one fifth dose, and; 3) placebo. All groups also received intense family support in the community. Some people did fine with less or no meds. But the catastrophes remain unforgettable. There will never be one right decision on psychiatric medicine that applies to everyone. In the US, there has been far too much acrimony and far too little cooperation among providers, families, and disaffected users- as if there were one right answer. This results in bad treatment and ineffective advocacy for the mentally ill. Mental health care in Europe is in much better shape because no such opposition hinders cooperative efforts in clinical decision making or political advocacy. Let's hope Virgil has shown us the middle way.

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