Last month I wrote to you about Miles Levin (Schlagbyte, July 16, 2007), an 18-year-old young man living with an unremitting malignancy. Since I was introduced to Miles, I have followed his precocious wisdom on his care pages postings. Over the last month when no therapy was effective, he still managed, in spite of pain, to connect with his growing number of readers. He brought us into his life and connected us to him and to each other; he taught us the difference between healing and curing. He told us what it was like to live life every day. He showed how to make new connections, and in so doing made his death a healing ceremony.

A month before his death, he went away to a camp exclusively for boys with cancer. He said totally contrary to what you might expect at the camp, it had nonstop energy with vitality bursting from its victims. Miles said the best part of being there was “Everybody here gets it, and that’s not something you can experience with your regular friends.”

On his return from the camp, he wrote without a working treatment plan, “My time left is probably two to five weeks….I’m trying to relax, I know I’ve fought my very best and now it’s up to greater powers, whether they be divine or forces of nature. I find myself altering between feelings of gratitude for all that my life has been, and wishing to trade it all for a normal, obscure teenage existence.”

On August 3rd, nearing the end, Miles said “I know I’ll never be happy with this update because there’s no way to say thank you it’s so huge but not to try to say it would be worse. It’s a stupid system, but the only way to fully understand what you have is by losing it therefore luckily for me that’s something I will never know…. I am blessed to be enveloped in the love that I will never lose.”

On August 7th, he wrote “This isn’t going to be much of the crowd pleaser. I’m getting worse pretty quickly. I wish I could offer better news, I really do, and all I can say is thank you. Thank you for your ongoing support of me and my family through this most difficult time.”

On Aug. 9th, his mother wrote “Have received word that the spaceship is on its way. Miles is packed and ready to go……He told me this morning that this process requires lots of patience…The house is quiet….I pray he drifts away in peace, he deserves that.”

Farewell Miles. A while ago you said, “It’s not dying I’m afraid of; it’s dying without having had an impact.” No worry, thanks to you and your loving family, you brought a whole community together, reminded us to live in the present and to make every day so beautiful that it will be worth remembering. You have shown us the difference between healing and curing; you can heal and be healed even if you are not cured. You have made your dying a healing ceremony for us who remain.

In last month’s issue of the distinguished British medical journal Lancet (July 23, 2007), researchers reported that smoking marijuana increases the risk of psychosis later in life. The scientists tracked the records of tens of thousands of people to examine the effect of marijuana on their mental health. They found that people who used marijuana had a roughly 40% higher chance of becoming a psychotic; smoking every day or weekly increased the users risk for psychosis from 50% to 200%.

The researchers concluded that marijuana is not as harmless as many people think. At the same time, however, they admitted they could not prove that it was the marijuana that increased the risk of psychosis. All it means is that people who become psychotic later in life have smoked marijuana (who knows what other drugs they’ve done — and undoubtedly also drank milk as children). That hardly proves causality. Here’s another example: this month’s Annals of Plastic Surgery reported that women who receive breast implants are 3 times more likely to commit suicide — this does not mean breast augmentation causes women to kill themselves.

My personal and professional opinion is that it’s not the pot and it’s not the procedures, it’s the people. I am a scientist and like to subject my hypotheses to serious scientific inquiry, but serious research on marijuana is not possible in the United States. The federal government has a monopoly on research-grade marijuana and the authority to stifle independent research.

Professor Lyle Craker, Ph.D., director of the Medicinal Plant Program at the University of Massachusetts has been trying for six years to obtain a DEA Schedule 1 license to manufacture marijuana exclusively for privately funded, federally-approved research. The DEA first claimed his application was lost; thereafter, they didn’t respond for another two and a half years, so Craker sued the DEA for unreasonable delay. In February 2007, a DEA Administrative Law Judge, Mary Ellen Bittner, issued a decisive opinion recommending that Dr. Craker’s application be approved. But Judge Bittner’s decision is nonbinding, which means that Federal authorities can choose to ignore it. Practitioners and growers in states where marijuana reform legislation allows for its medical use are still prosecuted, because in 2005, the United States Supreme Court ruled that the federal government can enforce federal marijuana laws anywhere they want to.

Patients, doctors, and scientists have systematically been obstructed in their ability to perform and participate in privately funded FDA approved research. We need more credible research instead of fright tactics, because it is keeping us from helping patients for whom it can be profoundly beneficial.

Walking in to see a dying patient on the advanced dementia unit is a four-legged Hospice worker called Oscar. Oscar is a gray and white cat who was adopted as a kitten by staff members and raised on this locked unit. Oscar has an uncanny ability to predict when residents are about to die; thus far he has presided over the deaths of more than 25 residents on the unit. His mere presence at the bedside is viewed by physicians and nursing home staff as an almost absolute indicator of impending death, allowing staff members to adequately notify families.

This story appeared in the prestigious New England Journal of Medicine (July 26, 2007) where Dr. David Dosa, a geriatrician and professor at Brown University, described Oscar’s unique skill of divination. He said Oscar is not a particularly friendly cat, but he was there to be with people when they took their last breath. Sometimes Oscar arrived as early as four hours before, but he was universally there at least two hours before they died. The only death he missed was because a patient’s family asked for him to be removed, and when the staff did so, Oscar made such a ruckus outside that he had to be locked in.

What draws Oscar so strongly to those nearing death? Veterinarians and animal behaviorist say animals are sensitive to picking up chemical changes and detecting other subtle cues; for example, dogs can be trained to predict an epileptic seizure before patients sense it themselves. Laurie Cabot, the official witch of Salem, Massachusetts, said cats are a witch’s constant companion because they have psychic abilities.

I’m interested in what Oscar is getting out of this behavior, but it’s clear that patients, families and the staff are getting a lot. Oscar is the ceremonial director orchestrating this life-closing ritual. Everybody looks at Oscar’s presence at the death bed as the signal to prepare themselves for the end. This soft, furry, purring, feline brings people together in loving community. On the wall of this unit is an engraved commendation from a local hospice agency . . . .“For his compassionate Hospice care, this plaque is awarded to Oscar the Cat.”

What a glorious ceremonial departure . . . to breathe ones last breath enveloped by soft, warm purring pussy.

As a community psychiatrist, I believe that mental health is not solely determined by intrapsychic mechanisms. In addition to infantile traumas, our sense of well-being in the world is determined by outside influences like poverty, racism, and powerlessness, as well as positive influences like teachers and mentors.

Rather than just identifying patients’ internal conflicts and prescribing medications, community psychiatrists focus on getting families, schools, churches, and service agencies to come together to support their most vulnerable members. Building a collaborative model where talents are pooled helps to identify, intervene and help people before they become desperately symptomatic. This is a preventative model rather than an interventional approach.

For 14 years, I was the only psychiatrist for my area of the Indian Health Service. Since we had so few resources, it was critical to mobilize and help tribes identify their strengths. I worked with teachers to help them identify and intervene early with children, brought traditional healers into hospitals, and trained community health representatives, doctors and nurses. But I had never worked with non-Indian communities in this way until recently. My friend, the CEO of a hospital in a small city in Minnesota, asked me to help him design a community healing ceremony. As a 10th anniversary gift of its presence in the community, he wanted to sponsor an event that would promote the idea that living together in community promotes health.

It didn’t take much to persuade me to go to Red Wing Minnesota, for what he called my “Discovery Tour.” He wanted me to meet and talk to people, walk the streets, meet with its support structure, and then make some recommendations.

Red Wing is a lush, verdant, Mississippi River Valley town of 16,000 that has eagles nesting on its riverbanks. Driving into town is like entering a Dutch master’s painting. Ninety-five percent of its inhabitants are descended from Scandinavian and German Protestants who arrived in the mid-1800s. Upon arrival of the new settlers, Chief Red Wing of the Mdewakanton Dakota (Sioux) welcomed them. This Dakota community is still here (quite affluent now because of its profitable casino) and represents 3% of the population. The other 2% are by and large Hispanic (mostly Mexican) and African-American, and they are a growing presence in the schools and social service agency utilization.

Red Wing is community that shares a common ethic of mutual support. They build art centers, concert halls, support their local baseball team, fill the new hockey arena, hang fresh flowers from downtown lampposts, and are environmentally conscious. My discovery tour included time with the mayor, civic leaders, philanthropists, artists, fishermen, waitresses and bartenders. I spoke with children, teenagers, retirees, and visited the Anderson Center which is the largest artist community in Minnesota.

On my last night, I met with the Hospital Board for dinner. We dined outside on a bluff overlooking the Mississippi River as the sun set. I told them what I’d seen and that Red Wing was already a living example of a collaborative model of health; they all understood the importance of mobilizing their strengths, and moving proactively into the future while staying connected to the principles that have sustained the city’s remarkably healthy soul.

The sun was setting when our hostess spoke; she said she had lived in her home for nine years and, for the first time, had found an eagle feather on her lawn that morning. She wanted to give it to me . . . it sent shivers down my spine. I took the feather and talked about its traditional significance, its serendipitous arrival at this moment in time, and how the healing ceremony we were contemplating had already begun with this blessing.

Then I walked alone to the embers of the charcoal cooking fire and waved the curling smoke skyward carrying my words to touch the ear of the Great Spirit. I gave this blessing, “Thank you for all the gifts that have sustained us in community, bless this community as it moves into the future. In the language of the Mdewakanton Dakota, I say this for all my relations, Mi Takuye Oyacin.”