Vertigo: An EP’s Diagnosis of a National Epidemic

It seems like the whole country has a bad case of vertigo.  Oh, not acute labyrinthitis.  But it does seem to have a lot of similarities.  Just like being on a tossing sailboat, it’s hard to tell what’s in motion and what’s not.  And it’s making everyone sick as hell.  Vomiting up everything they have consumed all over everyone.

I was the ship’s doctor once on a cruise ship to Alaska when we encounter 65 mile an hour winds and twenty-foot seas.  Despite everything the captain could do, the ship was pitching and rolling so badly that everyone was confined to quarters and all the water from the swimming pools splashed out.  The deck chairs, instead of being packed with sunning passengers, had become projectiles flying across the deck threatening anyone in their paths.

We didn’t bother trying to see and examine the patients that complained of nausea.  We were all sick.  We just handed out bags full of Dramamine.  And despite this, there were patients that were vomiting so badly that we would tie them into the beds in our small infirmary and hook them up to IVs and just hope we didn’t run out of fluids.

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Before we ran out of meds and fluids, we put out a ship wide announcement to all passengers to try to get to a spot that they could see the horizon.  Concentrating on a fixed point was enough to convince the brains of most people that it was not the world that was moving but them.

Over the years, when I would see a patient with benign positional vertigo, I tried to reassure them by explaining the basics of the vestibular system.  It was probably more than they wanted to hear at the moment.  But I found that it took their anxiety down a notch.  I would make rough drawings of the semi-circular canals and explain how, in normal circumstances, the tiny nerve hairs in those canals would send signals to the brain when there was motion in the fluid filling the canals.

These signals, when transmitted to the brain, would reflexively come back to the muscles coordinating eye movement and allow them to adjust eye motion in such a delicately precise manner that the eyes could maintain a focus on a fixed object despite being in motion.  I doubt they appreciated the majesty of such an intricate system.  But I never ceased being amazed by it.

However, I would go on to explain, when something effected the transmission of this signal, such as the constant overwhelming stimulation of the motion of the sea, or toxins like alcohol, or even viral infection, these sensors could over react and send a barrage of signals to the brain and convince it that the world was in violent and constant upheaval.

But the vertigo that the nation is now experiencing is not due to rolling seas that distort the sense of stability.  It is, however, similar in the sense that the sensors that tell us about the real world are either over stimulated, under the influence of toxins, or suffering from an infection.  Moreover, while concentration on a fixed point could ameliorate the symptoms by convincing the brain that world is stable and it is just our perception of it that is distorted, it seems that we don’t trust that the fixed point is real.

Put in plain language, the nation is sick from all the barrage of social noise that distorts what they have always understood to be up and down, right and left.  And analogizing to vertigo is just a way for us to think about it.  It is an emergency.  At least the country perceives it that way.  So, how do we work the problem?

The first way is to dampen the over stimulation, especially from the internet, to which we all have grown so accustomed.  For example, my wife was complaining of poor sleep and a growing fearfulness about life.  I told her that virtually any time during the night that I woke up she was on her phone scrolling the internet.  And since it was blue toothed into her hearing aids, it could be as loud as she wanted without disturbing me.

Somebody was calling someone Hitler.  Someone was calling someone evil.  It appears that the US is descending into chaos and violence.  Some of the information on the internet is true, of course.  But the loudest, most profane, most violent, most sexually provocative voices get the most attention.  And when the algorithms catch you looking at something for more than a second, it sends you more of the same.  And soon you find yourself depressed, sad, angry, or just sick of it all.

It is well known that the isolation of the covid pandemic sent many people into alcoholism.  But I would submit, partially from personal experience, that the isolation of an internet overdose can cause people to retreat into the haze of depressants, like alcohol.  But it may also make people more sensitive to the side effects of antidepressants.

It simply amazes me that a drug with a black box warning that it could result in suicidal (and by inference homicidal) ideation is being prescribed for the thinnest of indications to patients for years.  And now we are adding sex hormones and hormone blockers to the equation.  As a humorous side note, I’m over a foot taller and hundred pounds heavier than my wife.  But when she is PMSing I give her a wide berth.  If someone shot her full of testosterone I’d need to move to another state for several weeks out of each month.

My heart goes out to all the kids who are going through puberty now.  It’s depressing as hell to be skinny, pimple faced, terrible at sports, and a total reject to girls like I was.  I considered suicide once.  If someone had gotten a hold of me at that time and offered me drugs, a rejectionist lifestyle, or a different mythically beautiful body with an accepting community I might have gone for it.

And the infection that society is fighting is the virus of those seeking power to take over our lives, money, and personal freedom.  Interestingly it is often disguised as freedom…from personal responsibility.  All the problems, and the solutions, are the responsibility of someone else.  It’s those liberal progressives, those MAGA Republican, those black suited ANTIFA/BLM rioters, those white supremacists.  Of course, others must be held accountable for their actions.  But how I react to them is up to me.

Simple things like decreasing the craziness of the internet, taking a hard look at the chemicals we put in our bodies (and our children), and pushing back on pushy people and groups that want to tell us how to think are great places to start.  But one old tried and true method is the gold standard.  Looking at the horizon.

Now we know that earth is round, and the horizon is not flat.  Heck, it’s not even staying still but moving at thousands of miles per hour.  But relative to us, it’s stable and fixed.  Stare at it long enough and you’ll become convinced that the universe isn’t in chaotic motion…you are.  And you will settle your mind, at least to some degree, and be able to function on a moving deck.

So, what is that horizon in our lives?  What is the fixed object?  It is objective truth.  It is the foundation of our entire education.  As philosophically attractive it is for everyone to have their own truth, math and science don’t work that way.  Two plus two always equals four.  Always.  Objective truth is how we managed to put men on the moon and transplant hearts.  We asked the public to trust us, to trust the science.  But we let power, money, and politics infect science.  So now the public believes that science is subjective.

I remember sitting in class medical school in 1976, listening to a noted and trusted neonatologist tell about the case of the Reimer twins born in Winnipeg, Canada.  During a botched circumcision one of the twin’s penis was destroyed by electrocautery.  The family was referred to a psychologist named John Money, at John Hopkins, who recommended castration and hormone therapy for the injured boy.  He was raised as a girl alongside his twin brother.  Dr Money became world famous and wealthy.  He claimed to have finally and definitively put the “nature vs nurture” debate to rest.  He claimed that here were two genetically identical children who were now supposedly living happy lives with opposite genders.

But when the boys entered puberty, despite the hormone therapy, they claimed something wasn’t right.  At age 14 both of the boys were told the truth.  The one undergoing the therapy stated that “I felt badly for my mother, but I was in shock.  My first reaction was anger that we had told a lie all of these years… my next reaction was a sigh of relief.  Now everything was starting to make sense.”

Money, power, prestige and politics still infect our profession.  The nation looks to us for answers to the sickness that is infecting everyone.  The first step in healing is to find the fixed point.

Commit ourselves to finding and telling the truth. How many times has a critical patient asked me, “Just tell me the truth, doc.”  That’s what I want to do.